Mental health problems in rural contexts: What are the barriers to seeking help from professional providers?

The aim of this review was to determine which sociodemographic, illness-related and psychological/attitudinal factors impact on a person's decision to seek help and the factors associated with attitudes to help-seeking in rural contexts. A computer search of the literature for 1990 – 2006 using the terms “help-seeking” and “mental” found 350 studies. Examination of the abstracts by one of the authors (AK) identified 20 relevant studies, which we review under two major headings: those papers dealing with help-seeking studies not specific to (but which may have included) rural settings; and a second group of studies conducted specifically in rural locations or that directly compared rural with urban locations. A number of factors were found consistently to be predictive of both mental health utilisation and attitudes toward formal help-seeking. They included sociodemographic factors such as gender, age, and marital status; illness-related factors such as having a mental disorder, comorbidity, and psychological distress; and, to a much lesser extent, psychological/attitudinal factors, including stigma, stoicism, and self-efficacy. Psychological/attitudinal factors have been poorly investigated compared to sociodemographic and illness-related variables and are worthy of further investigation. Their impact and value may vary according to location. Proposed herein is the development of a comprehensive framework that has emerged from the health and place literature as one way of understanding barriers to accessing mental health care.