Depression literacy: rates and relation to perceived need and mental health service utilization in a rural American sample.

INTRODUCTION: Mental health literacy assists patients to recognize, manage and prevent emotional disorders such as depression. Depression literacy is a specific type that varies among populations; however, there is a paucity of research on the depression literacy of rural Americans. The purposes of this study were to evaluate the depression literacy of a rural American sample, and to examine the relationship of depression literacy with perceived need for and utilization of different types of services for those with emotional problems.
METHODS: Participants were recruited outside grocery stores in rural towns by consenting to be contacted and providing contact information. They were contacted via telephone to complete a survey of 15 min duration. Depression literacy was measured by assessing participants' ability to correctly label a vignette that depicted depressive symptoms. Demographic data, psychiatric symptoms, perceived need for seeking services (primary care, counselor and religious leader), and lifetime utilization of services (medical, specialty mental health and religious leader) for emotional problems were also assessed in the survey.
RESULTS: High depression literacy (i.e., able to correctly label the vignette) was found in 53% of the sample. Men had lower depression literacy than women (35% vs 68%) and this effect remained after controlling for demographic and symptom variables. Multivariable regression analyses revealed that, after including demographic and symptoms variables in the regression equation, depression literacy did not significantly predict perceived need for a doctor, counselor, or religious leader, but depression literacy did significantly predicted utilization of a religious leader (but not a doctor or counselor).
CONCLUSIONS: The rate of depression literacy in this sample was lower than the rates in other samples, especially among men. The disparity in depression literacy among men in this sample is consistent with the literature. Differences in utilization of a religious leader among those with high depression literacy may be due to differing cultural understandings of depression. Further research is needed to better understand this, and to examine larger and more urban samples. Future directions in rural depression literacy may focus on the knowledge, attitudes, and beliefs that rural men have about depression and how this affects help-seeking; and how to design interventions to improve depression literacy in this population.