American Journal of Community Psychology

, Volume 25, Issue 4, pp 449–470 | Cite as

Psychological Distress and Help Seeking in Rural America

  • Danny R. Hoyt
  • Rand D. Conger
  • Jill Gaffney Valde
  • Karen Weihs


The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.

psychological distress seeking mental health care 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Armstrong, P. S., & Schulman, M. (1990). Financial strain and depression among farm operators: the role of perceived economic hardship and personal control. Rural Sociology 55, 475–493.Google Scholar
  2. Beeson, P., & Johnson, D. (1987). A panel study of change (1981–1986) in rural mental health status: Effects of the rural crisis. Paper presented at the National Institute of Mental Health Conference on Mental Health Statistics, Denver, CO.Google Scholar
  3. Belyea, M., & Lobao, L. (1990). Psychosocial consequences of agricultural transformation: The farm crisis and depression. Rural Sociology, 55, 58–75.Google Scholar
  4. Berry, B., & Davis, A. (1978). Community mental health ideology: A problematic model for rural areas. Orthopsychiatry, 48, 673–679.Google Scholar
  5. Bloomquist, L., Gringeri, C., Tomaskovic-Devey, D., & Truelove, C. (1993). Work structures and rural poverty. In Rural Sociology Society Task Force on Persistent Rural Poverty (Eds.), Persistent poverty in rural America (pp. 68–105) Boulder, CO: Westview.Google Scholar
  6. Bokemeier, J., & Tickamyer, A. (1985). Labor force experiences of nonmetropolitan women. Rural Sociology, 30, 51–73.Google Scholar
  7. Brown, D., & Hirschl, T. (1995). Household poverty in rural and metropolitan-core areas of the United States. Rural Sociology, 60, 44–66.Google Scholar
  8. Buckwalter, K. C., Smith, M., Zevenbergen, P., & Russell, D. (1991). Mental health services of rural elderly outreach programs. Gerontologist, 32, 408–412.Google Scholar
  9. Bultena, G., Lasley, P., & Galler, J. (1985). The farm crisis: Patterns and impacts of financial distress among lowa farm families. Rural Sociology, 51, 436–448.Google Scholar
  10. Catalano, R., & Dooley, D. (1977). Economic predictors of depressed mood and stressful life events in a metropolitan community. Journal of Health and Social Behavior, 18, 292–307.Google Scholar
  11. Catalano, R., & Dooley, D. (1981). The behavioral costs of economic instability. Policy Studies Journal, 10, 338–349.Google Scholar
  12. Catalano, R. A., & Dooley, D. (1983). Health effects of economic instability: a test of economic stress hypothesis. Journal of Health and Social Behavior, 24, 46–60.Google Scholar
  13. Conger, R. D., & Elder, G. H., Jr. (1994). Families in troubled times: Adapting to change in rural America. New York: Aldine de Gruyter.Google Scholar
  14. Coward, R. T., K. L. DeWeaver, K., Schmidt, F., and Jackson, R. (1983). Distinctive features of rural environments: A frame of reference for mental health practice. International Journal of Mental Health, 12, 3–24.Google Scholar
  15. Davidson, O. G. (1989). Broken heartland: The rise of America's rural ghetto. New York: Free Press.Google Scholar
  16. Dean, A., & Ensel, W. (1982). Modeling social support, life events, competence and depression in the context of age and sex. Journal of Community Psychology, 10, 92–107.Google Scholar
  17. Dohrenwend, B. P., & Dohrenwend, B. S. (1974). Social and cultural influences on psychopathology. Annual Review of Psychology, 25, 417–452.Google Scholar
  18. Dooley, D., & Catalano, R. (1984). The epidemiology of economic stress. American Journal of Community Psychology, 12, 387–409.Google Scholar
  19. Duncan, C. (1992). Rural poverty in America. New York: Auburn House.Google Scholar
  20. Farmer, F., Ilvento, T., & Luloff, A. (1989). Rural community poverty: A LISREL measurement model. Rural Sociology, 54, 491–508.Google Scholar
  21. Flaskerud, J., & Kviz, F. (1982). Resources rural consumers indicate they would use for mental health problems. Community Mental Health Journal, 18, 107–116.Google Scholar
  22. Flax, J., Wagenfeld, M., Ivens, R., & Weiss, R. (1979). Mental health in rural America: An overview and annotated bibliography. Rockville, MD: National Institute of Mental Health.Google Scholar
  23. Heffernan, W. D., & Heffernan, J. B. (1986). The impact of the farm crisis on families and communities. Rural Sociologist, 6, 160–170.Google Scholar
  24. Hendricks, J., & Turner H. (1988). Social dimensions of mental illness among rural elderly populations. Internal Journal of Aging and Human Development, 26, 169–190.Google Scholar
  25. Hoyt, D. R., O'Donnell, D., & Mack, K. Y. (1995). Psychological distress and size of place: The epidemiology of rural economic stress. Rural Sociology, 60, 707–720.Google Scholar
  26. Husaini, B, Neff, J., Harrington, J., Hughes, M., & Stone, R. (1980). Depression in rural communities: Validating the CES-D Scale. Journal of Community Psychology, 8, 20–27.Google Scholar
  27. Jeffrey, M., & Reeve, R. (1978). Community mental health services in rural areas: some practical issues. Community Mental Health Journal, 14, 54–62.Google Scholar
  28. Johnson, K. M., & Beale, C. L. (1992). Natural population decrease in the United States. Rural Development Perspectives, 8, 8–15.Google Scholar
  29. Johnson, D., & Ortega, S. (1994). A longitudinal analysis of the mental health impacts of the farm crisis. Paper presented at the Fifth International Social Stress Conference. Honolulu, May 25–28.Google Scholar
  30. Kessler, R., Turner, J., & House, J. (1988). Effects of unemployment on health in a community survey: main, modifying and mediating effects. Journal of Social Issues, 44, 69–85.Google Scholar
  31. Kessler, R., Price, R., & Wortman, C. (1985). Social factors in psychopathology: Stress, social support and coping processes. Annual Review of Psychology, 36, 531–572.Google Scholar
  32. Lahr, M. (1993). Nonmetro poverty rate inches back up. Rural Conditions and Trends, 4, 48–49.Google Scholar
  33. Lamphere, L. (1992). Structuring diversity: Ethnographic perspectives on the new immigration. Chicago: University of Chicago Press.Google Scholar
  34. Lasley, P. (1994). Rural economic and social trends. In R. Conger & G. Elder (Eds.), Families in troubled times: Adapting to change In Rural America (pp. 57–78). New York: Aldine de Gruyter.Google Scholar
  35. Lichter, D. (1993). Migration, population redistribution, an the new spatial inequality. In D. Brown, D. Field, and J. Zuiches (Eds.). The demography of rural life (pp. 19–46). University Park, PA: Northeast Regional Center for Rural Development.Google Scholar
  36. Lichter, D., Johnston, G., & McLaughlin, D. (1994). Changing linkages between work and poverty in rural America. Rural Sociology, 59, 395–415.Google Scholar
  37. Lichter, D., & McLaughlin, D. (1995). Changing economic opportunities, family structure, and poverty in rural America. Rural Sociology, 60, 688–706.Google Scholar
  38. Lorenz, F., Conger, R., Montague, R., and Wickrama, K. A. S. (1993). Economic conditions, spouse support, and psychological distress of rural husbands and wives. Rural Sociology, 58, 247–268.Google Scholar
  39. Lorenz, F., Saltiel, J., & Hoyt, D. (1995). Question order and fair play: Evidence of even-handedness in rural surveys. Rural Sociology, 60, 641–653.Google Scholar
  40. Mirowsky, J., & Ross, C. (1989). Social causes of psychological distress. New York: Aldine de Gruyter.Google Scholar
  41. Naples, N. (1994). Contradictions in agrarian ideology: Restructuring gender, race-ethnicity and class Rural Sociology, 59, 110–135.Google Scholar
  42. Nease, D. E. (1993, September). Mental health issues in rural settings. Kansas Medicine, pp. 246–248.Google Scholar
  43. Newman, J. (1989). Aging and depression. Psychology and Aging, 4, 150–165.Google Scholar
  44. O'Brien, D. J., Hassinger, E. W., & Dershem, L. (1994). Community attachment and depression among residents in two rural midwestern communities. Rural Sociology, 59, 255–265.Google Scholar
  45. O'Hare, W. P. (1988). The rise of poverty in rural American: Population trends and public policy. Washington, DC: Population Reference Bureau.Google Scholar
  46. Ortega, S. T., Johnson, D. R., Beeson, P., & Craft, B. J. (1994). The farm crisis and mental health: A longitudinal study ofthe 1980s. Rural Sociology, 59, 598–619.Google Scholar
  47. Patton, H. (1989). Setting the rural health services research agenda: The congressional perspective. Health Services Research 23, 1005–1013.Google Scholar
  48. Pearlin, L., Lieberman, M., Menaghan, E., & Mullin, J. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356.Google Scholar
  49. Robins, L. N., & Regier, D. A. (1991). Psvchiatric disorders in America: The epidemiologic catchment area study. New York: Free Press.Google Scholar
  50. Ross, C. E., & Huber, J. (1985). Hardship and depression. Journal of Health and Social Behavior, 26, 312–327.Google Scholar
  51. Rost, K., Smith, R., & Taylor, J. (1993). Rural-urban differences in stigma and the use of care for depressive disorders. Journal of Rural Health, 9, 57–62.Google Scholar
  52. Sachs, C. (1983). The Invisible Farmers: Women in Agricultural Production. Totowa, NJ: Rowman and Allanheld.Google Scholar
  53. Tickamyer, A., & Duncan, C. (1990). Poverty and opportunity structure in rural America. Annual Review of Sociology, 16, 67–86.Google Scholar
  54. Wagenfeld, M., Murray, J., Mohatt, D., & DeBryn, J. (1994). Mental health and rural America: 1980–1993. An overview and annotated bibliography. Washington, DC: Public Health Service.Google Scholar
  55. Wagenfeld, M., & Wagenfeld, J. (1981). Values, culture, and the delivery of mental health services in rural areas. In M. Wagenfeld (Ed.), Perspectives on rural mental health. San Francisco: Jossey-Bass.Google Scholar
  56. Wilkinson, K. (1981). The community in rural America. New York: Greenwood.Google Scholar
  57. Wright, S., & Rosenblatt, P. (1987). Isolation and farm loss: Why neighbors may not be supportive. Family Relations, 36, 391–395.Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Danny R. Hoyt
    • 1
  • Rand D. Conger
    • 2
  • Jill Gaffney Valde
    • 2
  • Karen Weihs
    • 3
  1. 1.Department of SociologyIowa State UniversityAmes
  2. 2.Iowa State UniversityUSA
  3. 3.George Washington UniversityUSA

Personalised recommendations