Understanding help‐seeking in rural counties: A serial mediation analysis

• Published in: Journal of clinical psychology Vol. 78; no. 5; pp. 857 - 876
• Main Authors: Keller, Emily M., Owens, Gina P.
• Format: Journal Article
• Language: English
• Published: United States Wiley Periodicals Inc 01-05-2022
• Subjects: attitudes toward mental healthcare; culture; Help seeking behavior; Humans; Mediation Analysis; Mental Disorders - psychology; Mental Disorders - therapy; Mental health; Mental Health Services; Patient Acceptance of Health Care - psychology; rural; Rural areas; self‐reliance; Social Stigma; Stigma; United States > US; stigma; self-reliance; attitudes toward mental healthcare; culture; rural
• ISSN: 0021-9762; 1097-4679
• DOI: 10.1002/jclp.23260

Objective
Rural areas in the Southern United States are characterized by certain cultural values that may delay or prevent mental health service utilization. The present study examined a four‐stage chain of serial mediation where higher levels of general self‐reliance would be related to greater levels of public stigma, which would in turn be related to higher levels of self‐stigma, followed by greater self‐reliance about managing mental health problems, and finally, more negative attitudes toward seeking help from psychologists.
Method
Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs online.
Results
Mediation analyses supported a direct association between general self‐reliance and attitudes toward help‐seeking that was explained in serial by higher levels of public stigma, self‐stigma, and mental health self‐reliance.
Conclusions
Clinical implications for rural practitioners are suggested including instilling policy changes, increasing provider visibility, and addressing barriers in therapy.