Stigma has been widely cited as the most significant barrier to individuals seeking mental health services (e.g., President's New Freedom Commission on Mental Health, Report of Surgeon General on Mental Health) and it is often identified as a particularly salient concern for those living in rural areas (e.g., Bray, Enright, &Easling, 2004;deGruy, 1997;Jameson &Blank, 2007). Despite these statements, little empirical work has been conducted, particularly with regard to children. The purpose of the proposed project is to examine rural parents'perceived stigma regarding seeking mental health services for their children using the R21 Exploratory/ Developmental Grant mechanism (PA-10-069). This project addresses the NIMH Strategic Plan to strengthen the public health impact of NIMH-supported research by identifying barriers to the implementation of current knowledge (Objective 4).
Specific aims are: 1) to examine rural parents'perceived stigma around seeking mental health services for their child;2) to validate a new measure assessing parents'perceived stigma about seeking mental health services for their child;and 3) to explore the relations between parents'perceived stigma of mental health service seeking and their willingness to seek both traditional and innovative (e.g., integrated care, telehealth, etc.) mental health services. These relations will be tested in the context of a theoretical model that considers: 1) established factors affecting perceived stigma and service- seeking (e.g. caregiver strain, other barriers to rural care access) and 2) developmental, experiential, and demographic factors (e.g., past experiences with mental health services, age, gender, religiosity). Participants will be the parents of 350 children who have borderline or higher parent ratings on a measure of psychosocial concerns. Parents will complete a newly- developed measure regarding their perceived stigma of seeking mental health services for their child as well as a variety of other measures included to validate the primary measure and explore a theoretical model in which perceived stigma impacts willingness to seek traditional versus innovative services. The results of this study will inform the field about the role of stigma in service seeking for rural Appalachian parents. The study will serve as a platform for future research examining and comparing other contexts (i.e., urban and other rural settings) as well as experimentally examining the impact of innovative services on perceived stigma and service use.

Public Health Relevance

The proposed study will examine parents'perceived stigma around seeking mental health services for their children including both traditional and innovative service mechanisms (e.g., integrated care, telehealth, etc.). Results will inform the field about the attitudes of parents in rural Appalachia and provide information about the role of stigma in the context of other, well- established factors influencing help-seeking. These findings will serve as a platform for developing service delivery mechanisms that decrease stigma as a barrier to treatment (i.e., translating evidence-based treatment), particularly in rural communities.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Community Influences on Health Behavior (CIHB)
Program Officer
Pringle, Beverly
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East Tennessee State University
Schools of Arts and Sciences
Johnson City
United States
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Polaha, Jodi; Williams, Stacey L; Heflinger, Craig Anne et al. (2015) The Perceived Stigma of Mental Health Services Among Rural Parents of Children With Psychosocial Concerns. J Pediatr Psychol 40:1095-104
Williams, Stacey L; Polaha, Jodi (2014) Rural parents' perceived stigma of seeking mental health services for their children: development and evaluation of a new instrument. Psychol Assess 26:763-73