Abstract
Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n = 163) with qualitative interviews (subsample n = 21). Most of the mothers expressed confidence in mental health care providers’ to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents’ mental health problems, and building community resources to enable all youth to participate in community life.
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Achenbach, T. (1991). Manual for the child behavior checklist/4–18 and 1991 profile. Burlington, VT: University of Vermont Research Center for Children, Youth, and Families.
Aday, L. A., & Andersen, R. A. (1974). A framework for the study of access to medical care. Health Services Research, 9, 208–220.
Aday, L. A., & Awe, W. C. (1997). Health services utilization models. In handbook of health behavior research I: personal and social determinants. Gochman, D.S. New York, NY: Plenum Press.
Allen, A. J., Davey, M. P., & Davey, A. (2010). Being examples to the flock: The role of church leaders and African American families seeking mental health care services. Contemporary Family Therapy, 32, 117–134.
Anderson, R. L. (2003). Use of community-based services by rural adolescents with mental health and substance use disorders. Psychiatric Services, 54, 1339–1341.
Angold, A., Erklani, A., Farmer, E. M. Z., Fairbank, J. A., Burns, B. J., Keeler, G., et al. (2002). Psychiatric disorder, impairment, and service use in rural African American and White youth. Archives of General Psychiatry, 59, 893–901.
Anonymous. (2005). Rural nurses not equipped for mental health. Australian Nursing Journal, 13, 7.
Badger, L., Robinson, H., & Farley, T. (1999). Management of mental disorders in rural primary care: A proposal for integrated psychosocial services. Journal of Family Practice, 48, 813–818.
Beale, C. L., & Gibbs, R. M. (2006). Severity and concentration of persistent high poverty in nonmetro areas. Amber Waves, 4, 10–11.
Belue, R., Taylor-Richardson, K. D., Lin, J., Rivera, A. T., & Grandison, D. (2006). African Americans and participation in clinical trials: Differences in beliefs and attitudes by gender. Contemporary Clinical Trials, 27, 498–505.
Benson, P. L., Donahue, M. J., & Erickson, J. A. (1989). Adolescence and religion: A review of the literature from 1970 to 1986. Research in the Social Scientific Study of Religion, 1, 153–181.
Bird, D. C., Lambert, D., Hartley, D., Beeson, P. G., & Coburn, A. F. (1998). Rural models for integrating primary care and mental health services. Administration and Policy In Mental Health, 25, 287–308.
Boatright, S. R. (2003). The Georgia county guide: 2004. Athens, GA: Center for Agribusiness and Economic Development.
Brannan, A. M., & Heflinger, C. A. (2006). Caregiver, child, family, and service system contributors to caregiver strain in two child mental health service systems. Journal of Behavioral Health Services and Research, 33(4), 408–422.
Brody, G. H., Stoneman, Z., Flor, D., McCrary, C., Hastings, L., & Conyer, O. (1994). Financial resources, parent psychological functioning, parent co-caregiving, and early adolescent competence in rural two-parent African-American families. Child Development, 65, 590–605.
Brody, G. H., Kim, S., Murry, V. M., & Brown, A. C. (2003). Longitudinal direct and indirect pathways linking older sibling competence to the development of younger sibling competence. Developmental Psychology, 39, 618–628.
Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.
Brown, D. R., & Keith, V. M. (2003). In and out of our right minds: The mental health of African American women. New York: Columbia Press.
Busch, S. B., & Barry, C. L. (2007). Mental health disorders in childhood: Assessing the burden on families. Health Affairs, 26, 1088–1095.
Carey, J. W. (1996). Intercoder agreement in analysis of responses to open-ended interview questions: Examples from tuberculosis research. Cultural Anthropology Methods, 8(3), 1–5.
Cauce, A. M., Domenech-Rodriguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebrik, D., et al. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
Centers for Disease Control and Prevention. (2005). Mental health in the United States: Health care and well being of children with chronic emotional, behavioral, or developmental problems—United States, 2001. Morbidity and Morality Weekly Report.
Chandra, A., & Minkovitz, C. S. (2007). Factors that influence mental health stigma among 8th grade adolescents. Journal of Youth and Adolescence, 36, 763–774.
Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a stressor for African Americans. A biopsychosocial model. American Psychologist, 54, 805–816.
Coard, S. I., Wallace, S. A., Stevenson, H. C., & Brotman, L. M. (2004). Towards culturally relevant preventive interventions: The consideration of racial socialization in parent training with African American families. Journal of Child and Family Studies, 13, 277–293.
Coburn, A. F., Kilbreth, E. H., Long, S. H., & Marquis, H. S. (1998). Urban-rural differences in employer-based health insurance coverage of workers. Medical Care Research and Review, 55, 484–496.
Cole, D. A., & Carpentieri, S. (1990). Social status and the comorbidity of child depression and conduct disorder. Journal of Consulting and Clinical Psychology, 58, 748–757.
Costello, E. J., Gordon, P., Keeler, M. S., & Angold, A. (2001). Poverty, race/ethnicity, and psychiatric disorder: A study of rural children. American Journal of Public Health, 91, 1494–1498.
Costello, E. J., Egger, H., & Angold, A. (2005). 10 year research update review: The epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Adolescent Psychiatry, 44, 972–986.
Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods approaches. Thousand Oaks, CA: Sage.
Cuffe, S. P., Waller, J. L., Cuccaro, M. L., Pumariega, A. J., & Garrison, C. Z. (1995). Race and gender differences in the treatment of psychiatric disorders in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1536–1543.
Duncan, G., Brooks-Gunn, J., & Aber, J. L. (Eds.). (1997). Neighborhood poverty: Context and consequences for children (Vol. I and II). New York: Russell Sage.
Duncan, G. J., Ziol-Guest, K. M., & Kalil, A. (2010). Early-childhood poverty and adult attainment, behavior and health. Child Development, 81, 306–325.
Dutra, L., Campbell, L., & Westen, D. (2004). Quantifying clinical judgment in the assessment of adolescent psychopathology: Reliability, validity, and factor structure of the child behavior checklist for clinician report. Journal of Clinical Psychology, 60, 65–85.
Eccles, J. S., Barber, B. L., Stone, M., & Hunt, J. (2003). Extracurricular activities and adolescent development. Journal of Social Issues, 59, 865–889.
Elster, A., Jarosik, J., VanGeest, J., & Fleming, M. (2003). Racial and ethnic disparities in mental health care for adolescents: A systematic review of the literature. Archives of Pediatric and Adolescent Medicine, 157, 867–874.
Evans, D. N. (2008). Peter Burke, disability and impairment: Working with children and families. Journal of Youth and Adolescence, 37, 1025–1027.
Farmer, T. W., Irvin, M. J., Thompson, J. H., Hutchins, B. C., & Leung, M. (2006). School adjustment and the academic success of rural African American early adolescents in the deep south. Journal of Research in Rural Education, 21, 1–14.
Fehar, A., & Tyler, J. D. (1987). Public awareness of mental health services in rural communities. Journal of Rural Community Psychology, 8, 36–40.
Fortney, J., Rost, K., Zhang, M., & Warren, J. (1999). The impact of geographic accessibility on the intensity and quality of depression treatment. Medical Care, 37, 884–893.
Fox, J. C., Merwin, E., & Blank, M. (1995). Characterizing the de facto mental health service system in the rural south: A review of essential data for health care reform. Health Care for the Poor and Underserved, 6, 434–468.
Fox, J. C., Blank, M., Rovnyak, V. G., & Barnett, R. Y. (2001). Barriers to help seeking for mental disorders in a rural impoverished population. Community Mental Health Journal, 37, 421–436.
Glasmeier, A. (2005). An atlas of poverty in America: One nation, pulling apart, 1960–2003. New York: Routledge.
Grimes, K. (2004). Systems of care in North America. In H. Remschmidt, M. Belfer, & I. Goodyer (Eds.), Facilitating pathways: Care, treatment and prevention in child and adolescent mental health (pp. 35–41). Berlin: Springer.
Grossman, J., Laken, M., Stevens, J., & Hughes-Joyner, F. (2007). Use of psychiatric nurse practitioner students to provide services in rural school-based health clinics. Journal of Child and Adolescent Psychiatric Nursing, 20(4), 234–242.
Hardaway, C. R., & McLoyd, V. C. (2009). Escaping poverty and securing middle class status: How race and socioeconomic status shape mobility prospects for African Americans during the transition to adulthood. Journal of Youth and Adolescence, 38, 242–256.
Hartley, D. (1997). Rural primary care practitioners are a major source of mental health services. Rural Clinician Quarterly, NRHA, 7(4), 1–2.
Hartley, D., Korsen, N., Bird, D., & Agger, M. (1998). Management of patients with depression by rural primacy care practitioners. Archives of Family Medicine, 7, 139–145.
Heflinger, C. A., & Christens, B. (2006). Rural behavioral health services for children and adolescents: An ecological and community psychology analysis. Journal of Community Psychology, 34, 379–400.
Heflinger, C. A., & Hinshaw, S. (2010). Stigma in children’s mental health services research: Understanding professional and institutional stigmatization of children with mental health problems and their families. Administration and Policy in Mental Health and Mental Health Services Research, 37, 61–70.
Heflinger, C. A., & Saunders, R. C. (2005). Physical and behavioral health of medicaid children in two southern states. Southern Medical Journal, 98, 429–435.
Hines-Martin, V., Malone, M., Kim, S., & Brown-Piper, A. (2003). Barriers to mental health care access in an African-American population. Issues in Mental Health Nursing, 24, 237–256.
Institute of Medicine (IOM). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: Author.
Irvin, M. J., Farmer, T. W., Leung, M., Thompson, J. H., & Hutchins, B. C. (2010). School, community, and church activities: Relationship to academic achievement of low-income African American early adolescents in the rural deep south. Journal of Research in Rural Education, 25, 1–21.
Jargowsky, P. A., & Yang, R. (2006). The ‘underclass’ revisited: A social problem in decline. Journal of Urban Affairs, 28, 55–70.
Jensen, L., McLaughlin, D. K., & Slack, T. (2003). Rural poverty: The persisting challenge. In D. L. Brown & L. E. Swanson (Eds.), Challenges for rural America in the twenty-first century. University Park PA: The Pennsylvania State University Press.
Johnson, R. W. J. (2008). Overcoming the obstacles of health. New York: Robert Wood Johnson Foundation.
Jones, D. L., Heflinger, C. A., & Saunders, R. C. (2007). The ecology of adolescent substance abuse service utilization. American Journal of Community Psychology, 40, 345–358.
Kaiser Commission on Medicaid and the Uninsured. (2003). The uninsured in rural America. Washington, DC: Author.
Kaiser Commission on Medicaid and the Uninsured. (2009). State fiscal conditions and medicaid. Washington, DC: Author.
Kelleher, K. J., Taylor, J. L., & Rickert, V. I. (1992). Mental health services for rural children and adolescents. Clinical Psychological Review, 12, 841–852.
Lichter, D. T., & Johnson, K. M. (2007). The changing spatial concentration of America’s rural poor populations. Rural Sociology, 72, 331–338.
Lichter, D. T., Parisi, D., Taquino, M. C., & Beaulieu, B. (2008). Race and the micro-scale spatial concentration of poverty. Journal of Economic Geography, 1, 51–67.
Markstrom, C. A. (1999). Religious involvement and adolescent psychosocial development. Journal of Adolescence, 22, 205–221.
Masi, R., & Cooper, J. L. (2006). Children’s mental health: Facts for policymakers. New York: National Center for Children in Poverty, Mailman School of Public Health, Columbia University.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage.
Milstein, G., Manierre, A., Susman, V., & Bruce, M. (2008). Implementation of a program to improve the continuity of mental health care through clergy outreach and professional engagement. Professional Psychology: Research and Practice, 39, 218.
Mukolo, A., & Heflinger, C.A. (in press). Rurality and African American perspectives on children’s mental health services. Journal of Emotional and Behavioral Disorders.
Mukolo, A., Heflinger, C. A., & Wallston, K. (2010). The stigma of childhood mental disorders: A conceptual framework. Journal of the American Academy of Child and Adolescent Psychiatry, 49(2), 92–103.
Murry, V. M., Berkel, C., Brody, G. H., Gibbons, F. X., & Gerrard, M. (2007). The strong African American families program: Longitudinal pathways to sexual risk reduction. Journal of Adolescent Health, 41, 317–418.
Murry, V. M., Harrell, A. W., Brody, G. H., Chen, Y.-F., Simons, R. L., Black, A. R., et al. (2008). Long-term effects of stressors on relationship well-being and parenting among rural African American women. Journal of Family Relations, 57, 116–125.
Murry, V. M., Berkel, C., & Copeland, N. (in press). Ecological and sociocultural determinants of risk and health-promoting behaviors among African American youths. In N. Hill, T. Mann, & H. E. Fitzgerald (Eds.), African American children’s mental health: Development and context, volume 1. New York: ABC-CLIO Preager Press.
National Institute of Mental Health. (2000). Research on mental disorders in rural and frontier population (PA-00–082). Rockville, MD: Author.
Pescosolido, B. A., Martin, J. K., Lang, A., & Olafsdottir, S. (2008). Rethinking theoretical approaches to stigma: A framework integrating normative influences on stigma (FINIS). Social Science and Medicine, 67(3), 431–440.
Poole, D. (1997). The SAFE project: Community-driven partnerships in health, mental health, and education to prevent early school failure. Health and Social Work, 22(4), 282–289.
Prilleltensky, I. (2010). Child wellness and social inclusion: Values for action. American Journal of Community Psychology, 46, 238–249.
Proctor, B. D., & Dalaker, J. (2003). Poverty in the United States: 2002. Washington, DC: U.S. Bureau of the Census.
Puskar, K. R., Serika, S. M., Lamb, J., Tusaie-Mumford, K., & McGuinness, T. (1999). Optimism and its relationship to depression, coping, anger, and life events in rural adolescents. Issues in Mental Health Nursing, 20, 115–130.
Resnicow, K., Braithwaite, R. L., & Kuo, J. A. (1997). Interpersonal interventions for minority adolescents. In D. K. Wilson, J. R. Rodrigue, & W. C. Taylor (Eds.), Health-promoting and health-compromising behaviors among minority adolescents (pp. 201–228). Washington DC: American Psychological Association.
Ringel, J. S., & Sturm, R. (2001). National estimates of mental health utilization and expenditures for children in 1998. Journal of Behavioral Health Services and Research, 28, 319–333.
Rost, K., Humphrey, J., & Kelleher, K. (1994). Physician management preferences and barriers to care for rural patients with depression. Archives of Family Medicine, 3, 409–414.
Rost, K., Zhang, M., Fortney, J., Smith, J., & Smith, G. R., Jr. (1998). Rural-urban differences in depression treatment and suicidality. Medical Care, 36, 1098–1107.
Rost, K., Fortney, J., Fischer, E., & Smith, J. (2002). Use, quality, and outcomes of care for mental health: The rural perspective. Medical Care Research and Review, 59, 231–265.
Rourke, J., Steele, M., Fisman, S., & Grindrod, A. (2003). Assessing the need for and interest in a scholarship program in children’s mental health care for rural family physicians. Canadian Journal of Rural Medicine, 8, 163–170.
Schensul, S. L., Schensul, J. J., & LeCompte, M. D. (1999). Essential ethnographic methods: Observations, interviews, and questionnaires. Walnut Creek, CA: Altamira Press.
Sheldon-Keller, A. E. R., Koch, J. R., Watts, A. C., & Leaf, P. J. (1996). The provision of services for rural youth with serious emotional and behavioral problems: Virginia’s comprehensive services act. Community Mental Health Journal, 32, 481–495.
Stagman, S., & Cooper, J. L. (2010). Children’s mental health: What every policymaker should know. Columbia University, NY: National Center for Children in Poverty.
Starr, S., Campbell, L. R., & Herrick, C. A. (2002). Factors affecting use of the mental health system by rural children. Issues in Mental Health Nursing, 23, 291–304.
Steen, S., & Noguera, A. (2010). A broader, bolder approach to school reform: Expanded partnership roles for school counselors. Professional School Counseling, 4(1), 42–52.
Strauss, A. L., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage.
Substance Abuse and Mental Health Services Administration (SAMHSA) (2006). Helping children and youth with serious mental health needs: Systems of care (DHHS Publication No. SMA-06-4125). Rockville, MD: Author.
Takeuchi, D. T., Leaf, P. J., & Kuo, H. S. (1988). Ethnic differences in the perception of barriers to help-seeking. Social Psychiatry and Psychiatric Epidemiology, 23, 273–280.
Thomas, Y. F., & Compton, W. F. (2007). Rural populations are not protected from drug use and abuse. Journal of Rural Health, 23, 1–3.
U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. Washington, DC: U.S. Government Printing Office. Available at: http://www.surgeongeneral.gov/library/mentalhealth/cre/.
Wallace, J. M. J. (1999). The social ecology of addiction: Race, risk, and resilience. Pediatrics, 103, 1122–1127.
Weil, A. (2003). There is something about medicaid. Health Affairs, 22(1), 13–30.
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Murry, V.M., Heflinger, C.A., Suiter, S.V. et al. Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents. J Youth Adolescence 40, 1118–1131 (2011). https://doi.org/10.1007/s10964-010-9627-1
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DOI: https://doi.org/10.1007/s10964-010-9627-1