Influence of Stigma on Attitudes Towards Help-Seeking for Major Depression in Rural Central Texas

Objective: Stigma about depression may be perceived stigma or personal stigma (negative attitudes about oneself as a result of internalization of stigmatizing ideas held by society). Both types may inhibit help-seeking. Few researchers have reported on these constructs in rural samples despite higher prevalence and completion rates of suicide among rural residents. The current study investigated the relationship between attitude towards professional mental health help-seeking and personal and perceived stigmas towards depression among rural central Texas residents. Methods: This analytical, cross-sectional study used the Stigma and Attitudes towards Depression Questionnaire (SAD-Q) to determine a) contact with help-seeking, b) personal stigma and perceived stigma, c) attitudes toward seeking help from a mental health professional, and d) depression status of 273 residents of the towns and surrounding areas of Eastland, Dublin, and Gatesville, Texas. Through factor analysis, factors were identified that attribute to personal stigma and perceived stigma. After adjusting socio-demographic variables, multiple linear regression was fitted on help-seeking attitude to understand the relationship of history of seeking help from a mental health professional for depression, current depression status, and personal stigma and perceived stigma factors. Results: Personal stigma and perceived stigma factors were distinguished with Cronbach alpha coefficients of 0.90 and 0.94, respectively. Female gender and having a history of help-seeking for depression were found to be significantly related to an attitude favorable towards help-seeking for depression. Participants with possible depression status were found to have significantly more personal help-seeking contact than participants who screened negative for depression. Depression status was not significantly related to either perceived stigma or personal stigma. Contrary to the authors’ expectations and the findings of previous studies, personal and perceived stigmas were not significantly related to help-seeking attitudes in these samples. Conclusion: Some of these results are reassuring: many rural Texas residents who have symptoms of major depression are seeking help from mental health professionals and b) many rural Texas residents who have sought mental health help in the past seem to maintain a positive attitude towards help-seeking. However, the question remains: for those who are depressed but do not seek help, why not? These results suggest that factors other than stigmas influence help-seeking attitudes. Exploring these factors would help inform interventions to address social barriers to help-seeking. Further work could assess the following factors’ influences on attitudes towards help-seeking: perceptions of a) effectiveness of mental health services and b) barriers to obtaining them.