Rural Residents' Depressive Symptoms and Help-Seeking Preferences: Opportunities for Intervention Development in Non-Mental Health Settings

Background/Purpose: A shortage of mental health providers in rural areas has persisted for decades. As a result, rural residents have limited access to evidence-based treatment. This unacceptable access disparity reflects an understudied social justice issue. To close this gap, opportunities for delivering evidence-based treatment in non-mental health settings must be considered. In general, Americans prefer seeking help for mental disorders from clergy and rural residents have indicated a willingness to seek mental health services if available through churches; therefore, it seems that adapting evidence-based treatment for delivery in the church setting may offer a logical, promising way to increase rural residents’ access to effective, acceptable care. This study examines rural residents’ depressive symptoms, help seeking preferences, and perceptions of a church-based group depression treatment. This work informs the feasibility and acceptability of adapting and implementing group cognitive behavioral therapy for depression for delivery in church settings within a rural Midwestern community.

Methods: As part of community-based participatory research aimed at increasing access to effective, acceptable mental health treatment, researchers and clergy collaborated to administer a cross-sectional mail survey to members of two churches in a rural Midwestern community.  One-hundred congregants received surveys assessing demographic characteristics, depressive symptoms, help seeking preferences, and perceptions of church-based depression treatment; 63 congregants responded. Depressive symptoms were assessed via the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistical analyses were performed.

Results: Demographics: Respondents were, on average, 61 years old (SD=16.4). Two-thirds were (N=42) women and 73% (N=46) were married. About 80% (N=51) of respondents identified as white.

Depressive Symptoms: PHQ-9 scores suggest 12.9% (N=8) of respondents screened positive for Major Depressive Disorder (MDD), whereas another 24.4% (N=15) experienced mild to moderate depressive symptoms.

Help-Seeking Preferences. When asked who they would go to for help if feeling down or blue, respondents most frequently endorsed clergy (59%), family (59%), and friends (59%). Almost 50% indicated they would seek help from primary care providers; though only 22% reported that they would go to mental health professionals. Respondents were also asked who they would recommend to a friend feeling down or blue. Three-quarters of respondents (76%) indicated they would recommend clergy and 60% reported they would recommend a primary care provider. Interestingly, 54% of respondents suggested they would recommend a mental health professional. Forty-eight percent of respondents indicated they would recommend either a friend or family member to a friend feeling down.

Perceptions of Church-Based Group Depression Treatment: Sixty percent (N=37) of respondents indicated church-based group depression treatment would benefit persons who were feeling down. Two-thirds of respondents (67%; N=41) indicated, if feeling down or blue, they would consider attending an evidence-based group depression treatment offered at church, whereas 80% (N=50) indicated they would encourage a friend with emotional problems to attend this type of group treatment.

Conclusions and Implications: Results suggest delivering evidence-based depression treatment within church settings may provide a viable option for increasing access to care in this rural community. Given all respondents were church members, research replicating this study within the larger rural community is needed.