The Role of Rural and Urban Geography and Gender in Community Stigma Around Mental Illness.

Empirical evidence describes the negative outcomes people with mental health disorders experience due to societal stigma. The aim of this study was to examine the role of gender and rural-urban living in perceptions about mental illness. Participants completed the Day's Mental Illness Stigma Scale, a nationally validated instrument for measuring stigma. Directors of Chambers of Commerce in North Dakota distributed the electronic survey to their members. Additionally, distribution occurred through use of social media and other snowball sampling approaches. Analysis of data gathered from 749 participants occurred through examination of the difference in perceptions based on geography and gender. The zip codes of residence were sorted to distinguish between rural and urban participants. Application of weighting measures ensured closer alignment with the general population characteristics. Findings indicate that for the majority of the seven stigma measures the Day's Mental Illness Stigma Scale examines, the coefficient of rural-gender interactions was positive and highly significant with higher levels of stigma in rural areas. Females exhibited lower stigma perceptions than males. However, women living in rural areas held higher degrees of stigma compared to urban residing females. Implications of the study include the need to advance mental health literacy campaigns for males and people residing in rural communities. Additional empirical studies that examine the role of geography and gender in understanding stigma toward people with mental health disorders will result in improved treatment outcomes due to increased and focused educational efforts.