Keywords
behavioral health
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How to Cite
Abstract
Objective: To synthesize sociocultural barriers to mental health help-seeking among rural U.S. populations, with focused attention to vulnerable groups (LGBTQ+/sexual & gender minorities, racial/ethnic minorities, women/perinatal, veterans, and youth), and to integrate findings within ecosocial, social stress, and minority stress frameworks.
Methods: A systematic PubMed review (2000–2025) was conducted using predefined inclusion criteria for qualitative or mixed-methods studies with a substantial qualitative component. Eligible studies involved U.S. rural or non-metropolitan participants or providers and examined sociocultural barriers to mental health care. Studies focusing solely on structural barriers were excluded. Of 221 records screened, 26 met criteria. Barrier themes were coded and summarized by frequency.
Results: The most common barriers were public stigma (75 percent of studies), mistrust of providers (63 percent), self-stigma (50 percent), and confidentiality concerns tied to small-town visibility (42 percent). Additional themes included low perceived need, rural identity and insularity, cultural and religious beliefs, language and mental health literacy gaps, low provider affirmingness, and population-specific norms such as military culture and stoicism. Three barrier mechanisms were identified: visibility leading to stigma and nondisclosure, competence gaps leading to mistrust and disengagement, and structural frictions producing pre-encounter attrition. Across groups, participants emphasized that identity-affirming competence and safety mattered more than generic welcoming gestures.
Conclusions: Rural underutilization of mental health services reflects the layering of ecosocial constraints (scarcity, distance, cost), social stress processes (stigma, role norms, low perceived need), and minority stress (non-affirming care, disclosure fears). Interventions should combine competence guarantees with reliable first-contact access and privacy-protective delivery models. Limitations include use of a single database, heterogeneous rural definitions, and reliance on predominantly qualitative designs.
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