Depressive Symptoms, Material Hardship, and Barriers to Mental Health Treatment Among Rural Residents Seeking Food Bank Services

Background: Rural Americans are significantly less likely to receive evidence-based mental health treatment compared to urban Americans. This treatment access disparity reflects an understudied social justice issue. To address this gap, we must increase our understanding of rural residents’ mental health needs and perceived barriers to care. As 85% of persistently poor counties are rural, the relationship between material hardship and rural residents’ mental health requires further attention. This study examines depressive symptoms, material hardship, and perceived barriers to mental health care among rural residents seeking food bank services within a rural Midwestern community. This work informs potential strategies for addressing rural residents’ mental health needs and overcoming barriers to care in order to increase access to evidence-based treatment.

Methods: As part of community-based participatory research, researchers and community partners administered a cross-sectional survey at a food bank in July 2018. Fifty-seven of 73 (78.1%) individuals seeking food bank services completed the survey. Depression was assessed via the Patient Health Questionnaire-2 (PHQ-2). Material hardship was measured via five items assessing respondents' ability to meet their basic needs within the last 12 months. Twelve items measured respondents’ perceived barriers to mental health treatment. Seven items assessed structural barriers (e.g., cost; transportation). Five items assessed attitudinal barriers (e.g., I want to handle these problems on my own; I am worried about others judging me if I get help).

Results: Demographics: Respondents were, on average, 45.1 years old (SD=16.8). Over 60% of respondents identified as women (n=36; 63.2%); almost half reported being married (n=26; 45.6%). 28% of respondents reported having less than a high school education (n=16). Approximately 95% of respondents identified as White (n=54).

Depressive Symptoms: Forty nine percent (49%) of respondents screened positive for depression.

Material Hardship: Respondents screening positive for depression reported significantly greater material hardship (M=2.22; SD=1.74), on average, than non-depressed respondents (M=1.21; SD=1.00; t(55)=-2.63; p=.01).

Perceived Barriers to Care: Among the full sample, three of the four most commonly endorsed barriers were structural, including cost (n=27; 47.4%), lack of transportation (n=18; 31.6%), and no/inadequate insurance coverage (n=15; 26.3%), whereas one, wanting to handle these problems on my own (N=15; 26.3%), was attitudinal. Respondents screening positive for depression were significantly more likely than non-depressed respondents to endorse three of the five attitudinal barriers: wanting to handle these problems on my own (χ²(55)=4.42; p=.03), thinking I will get better on my own (χ²(55)=6.53; p=.01), and thinking treatment will not work for me (χ²(55)=4.10; p=.04).

Conclusions: Depression is a substantial mental health need among this sample of rural residents receiving food bank services. Findings support growing literature demonstrating the relationship between depression and material hardship, suggesting the need to develop systems of care within rural communities that promote adequate screening, intervention, and referrals related to mental health and economic needs. Delivering evidence-based mental health treatment in community settings where rural residents naturalistically go for help, and utilizing technological innovations, could mitigate structural barriers to care. However, results suggest the need to further address attitudinal barriers through public education and outreach.