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Mental Health Care and Sociocultural Context: Understanding Intersections of Stigma Socialization and Mental Health Care Service Use in Rural Areas

Gretchen Bergquist, University of Nebraska - Lincoln


43 million adults in the United States have a mental health condition, yet the majority of these individuals (over 50%) will not receive treatment (Mental Health America, 2018). This problem is particularly complex in rural areas where shortages of mental health care providers (Handley et al., 2014) and a unique sociocultural environment (Ulrich-Schad & Duncan, 2018) exacerbate the structural and attitudinal barriers to treatment seeking. Extant rural-nonrural classification limit our understanding of how this treatment seeking process unfolds in rural areas because these classifications do not account for rural sociocultural environments. This dissertation investigates links between mental health stigma, mental health care service use, and rural sociocultural context in two subsequent studies. In Study One, I explore the ways in which stigmatized attitudes toward mental health are socialized within the family and community and how these constructs relate to the perceived importance of treatment and support across rural-nonrural groups. In Study Two, I use an ecological health communication perspective (Moran et al., 2016) to conceptualize macro-level sociocultural norms as attributes of rural identity and investigate how these attributes influence mental health stigma and treatment seeking intentions in rural areas. Findings from Study One reveal that family and community stigma play an important role in shaping the extent to which individuals internalize the negative stereotypes associated with mental health treatment (self-stigma; Vogel et al., 2006) and the extent to which individuals perceive formal treatment and informal support providers as important resources. Results also suggest that these associations do not vary across rural-nonrural groups when assessing rurality using rural-nonrural typologies (Rural-urban Continuum Codes; RUCC; USDA, 2013). Study Two results reveal that attributes of rural identity (PSOC, self-reliance, self-efficacy, stoicism, control) moderate direct and indirect paths between stigma socialization variables (perceived family and perceived community stigma), mental health stigma (self-stigma, perceived public stigma), and treatment (mental health practitioner, general practitioner) and support (semiformal, informal, self-help) intention. Findings from Study Two suggest that attributes of attributes of rural identity function as rural sociocultural values as well as mechanisms that reinforce those values.

Subject Area

Mental health|Social psychology|Communication

Recommended Citation

Bergquist, Gretchen, "Mental Health Care and Sociocultural Context: Understanding Intersections of Stigma Socialization and Mental Health Care Service Use in Rural Areas" (2018). ETD collection for University of Nebraska - Lincoln. AAI10930952.