Understanding Help-Seeking in Rural Counties: A Serial Mediation Model of Self-Reliance, Stigma, and Attitudes toward Psychologists

Rural areas in the Southern United States are characterized by certain cultural values, including self-reliance. Prior research has shown that cultural values can affect stigmatizing beliefs about mental health needs and service utilization. The present study examined a four-stage chain of serial mediation where higher levels of general self-reliance would be related to increased levels of public stigma, which would, in turn, be related to greater levels of self-stigma, followed by higher self-reliance about managing mental health problems, and finally, more negative attitudes toward seeking out help from psychologists. Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs through an online survey. Mediation analyses supported a direct association between general self-reliance and attitudes toward seeking help from a mental health professional that was explained in serial by higher levels of public stigma, self-stigma, and mental health self-reliance. Clinical implications for rural practitioners are suggested, including increasing provider visibility in the community and addressing self-reliance over the course of therapy. Future research might consider including variables related to acceptability and availability of mental healthcare services in order to determine how these constraints impact mental healthcare attitudes in rural localities.