Help-seeking by rural residents for mental health problems: The importance of agrarian values

Objective: To examine the role of stoicism, self-efficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems. Method: A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-efficacy, stoicism, attitudes towards and experience of seeking help for psychological problems. Results: Overall, 7.6% (n = 129) of respondents had sought help from a general practitioner and/or mental health professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime help-seeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-efficacy. Conclusions: Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking. © 2006 The Authors; Journal compilation © 2006 The Royal Australian and New Zealand College of Psychiatrists.C

Service utilisation by rural residents with mental health problems

Objective: To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use. Method: This was a cross-sectional, community-based study. Subjects were recruited from three locales in rural north-west Victoria: a large regional centre, towns of 5,000-20,000 population and towns of <5,000 population. Three hundred and ninety-one individuals (54% females) participated. A logistic regression analysis was used to investigate which factors (i.e. need, sociodemographic and town size) predicted lifetime help-seeking for emotional or mental problems from formal health providers in the study sample. Results: Factors that predicted having ever sought help from a formal health provider for emotional or mental health problems were: a lifetime and/or current psychiatric disorder, being female, being separated, divorced or widowed, and living in medium sized towns (population 5,000-20,000). Conclusions: While traditionally known predictors of help-seeking, i.e need and gender, were associated with help seeking in this study, help seeking for mental health problems was also more common amongst individuals living in medium sized rural towns than those living in a large regional city. Possible explanations include availability, accessibility and organisation of services, and individual and/or community attitudes towards help seeking

Understanding suicide in Australian farmers

Objective: Male farmers in Australia have an elevated risk of suicide. The aims of this study were to investigate the rate of mental health problems amongst farmers compared with non-farmer rural residents and to investigate what additional factors might contribute to an increased risk of suicide amongst farmers. Method: This study used a combination of quantitative and qualitative approaches. First, using self-report questionnaire data, we compared rates of mental health problems (a common correlate of suicide) and a number of personality measures between farmers (n=371) and non-farming rural residents (n=380). In addition, semi-structured interviews with farmers (n=32) were used to gain a richer understanding of how the context of farming and mental health interact. Results: Five key findings emerged from the study. First, in the quantitative study, we found no support for the proposition that farmers experience higher rates of mental health problems than do non-farmer rural residents, but we identified potentially important personality differences between farmers and non-farmers, with levels of conscientiousness being significantly higher amongst farmers and levels of neuroticism being significantly lower. A strong association between maleness and farming was also found. In the qualitative study, participants indicated that farming is an environment in which individuals experienced a range of stressors but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to seeking help for those who may have mental health problems, particularly male farmers. Conclusion: The elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes that limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers

Personality for free: psychometric properties of a public domain Australian measure of the five-factor model

Fifty items from Goldberg's International Personality Item Pool were compiled to form a public-domain measure of personality, the Australian Personality Inventory (API). Data from a random community sample (N=7615) and a university-based sample (N =271) were used to explore psychometric properties of this 50-item measure of the five-factor model of personality (FFM). In both samples, internal reliabilities were adequate. In the university-based sample an appropriate pattern of convergent and divergent relationship was found between scale scores and domain scores from the NEO Five-Factor Inventory. After adjusting for an apparent response set (mean response across items), exploratory factor analyses clearly retrieved the FFM in both samples. It is provisionally concluded that raw scale scores from the API provide reliable estimates of the FFM, but adjustment for mean response across the 50 items might clarify the five-factor structure, especially in less educated samples

High prevalence disorders in urban and rural communities

High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health? A literature review (Medline and PsychLIT) was carried out using the words ‘rural, urban, mental/psychiatric, illness/disorders and prevalence’, as well as a review of relevant papers and publications known to the authors. Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a ‘one size fits all’ definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting

Depression in people living with HIV/AIDS attending primary care and outpatient clinics

Objective: Our aim was to gain an estimate of the rate of depressive disorder in patients with HIV/AIDS attending general practice and to investigate factors associated with depression. A further objective was to determine the ability of non-mental health medical practitioners to detect depressive symptoms in their patients with HIV/AIDS. Method: Participants comprised 322 persons living with HIV/AIDS ((PLWHA); 13 females, 309 males; mean age 41.4, SD = 8.9) who were recruited from four general practice clinics specializing in HIV medicine and from an infectious diseases clinic. Medical, psychiatric and sociodemographic data were obtained. In addition, participants completed the Inventory to Diagnose Depression (IDD), a self-report measure to detect depression. Results: Twenty-two per cent of the sample met criteria for a current Major Depressive Episode (DSM-IV defined) on the IDD. Overall, there was moderate agreement between treating doctors&#8217; diagnosis of depression and patients&#8217; self-report of depressive symptoms. A multivariate model indicated that being in a current relationship was associated with lowered odds of depression (OR = 0.43; CI = 0.23&#8211;0.81). The factors strongly associated with increased odds of depression were a past history of illicit drug use (OR = 2.98; CI = 1.60&#8211;5.54) and a diagnosis of &#8216;stress&#8217; by treating doctors (OR = 5.65; CI = 2.50&#8211;12.77). HIV-related medical variables such as immune function, use of antiretroviral medication and duration of HIV infection were not associated with depression. Conclusions: There was a high rate of self-reported depression in this group of PLWHA which was also recognized by treating clinicians. Being in a relationship appeared to afford protection against depression while having a history of illicit drug use and current &#8216;stress&#8217; were highly associated with depression. Interestingly, HIV-related medical variables including laboratory markers of HIV disease, duration of illness and antiretroviral medication regimen were not related to depression

Rurality and mental health: the role of accessibility

Objective: The absence of an agreed definition of 'rural' limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. Method: A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. Results: Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. Conclusions: By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted

The five factor model and accessibility/remoteness: novel evidence for person-environment interaction

The Accessibility/Remoteness Index of Australia (ARIA) is a validated index of the availability of services and opportunities for social interaction afforded by every location in Australia. ARIA therefore measures a feature of the social environment, and provides a unique foundation for investigating the relationship between persons and environments. The present study used ARIA alongside a measure of the Five-Factor Model of personality to test predictions about person–environment interactions deduced from the seminal work of Emmons and colleagues. Survey responses were received from N = 7615 adults residing across a range of non-metropolitan locales ranging from very accessible (ARIA = 0.0) to very remote (ARIA = 11.1). Respondents were categorised into High, Moderate and Low Accessibility based on the ARIA value of their location of residence. Consistent with the choice of situations model, average levels of the traits openness to experience (O) and extraversion (E) tended to be higher amongst respondents living in High Accessibility locations. As predicted under the affect congruence model, analyses of extreme subgroups found that for both O and E, those respondents high on the trait who resided in more accessible locales reported higher Positive Affect than similar respondents who resided in less accessible locales. Avenues for future research are discussed in light of the findings and the present study’s limitations