title: Cognitive appraisals of specialty mental health services and their relation to mental health service utilization in the rural population.
abstract: OBJECTIVE
  Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of help-seeking for depression symptoms are related to the utilization of specialty mental health services in a rural sample.
  
  
  METHODS
  Demographic and environmental characteristics, cultural barriers, cognitive appraisals, and depression symptoms were assessed in one model predicting specialty mental health service utilization (MHSU) in a rural sample. Three hypotheses were proposed: (1) a higher number of environmental barriers (eg, lack of insurance or transportation) would predict lower specialty mental health service utilization; (2) an increase in cultural barriers (stigma, stoicism, and lack of anonymity) would predict lower specialty mental health utilization; and (3) higher cognitive appraisals of mental health services would predict specialty mental health care utilization beyond the predictive capacities of psychiatric symptoms, demographic variables, environmental barriers, and cultural barriers.
  
  
  RESULTS
  Current depression symptoms significantly predicted lifetime specialty mental health service utilization. Hypotheses 1 and 2 were not supported: more environmental barriers predicted higher levels of specialty MHSU while cultural barriers did not predict specialty mental health service utilization. Hypothesis 3 was supported: cognitive appraisals significantly predicted specialty mental health service utilization.
  
  
  CONCLUSIONS
  It will be important to target perceptions and attitudes about mental health services to reduce disparities in specialty MHSU for the rural population.
authors.affiliation: Department of Psychology, University of Arkansas, Fayetteville, Arkansas, USA. tdeen@uams.edu
authors.forename: Tisha L
authors.initials: TL
authors.lastname: Deen
authors.forename: Ana J
authors.initials: AJ
authors.lastname: Bridges
authors.forename: Tara C
authors.initials: TC
authors.lastname: McGahan
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Andrews
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012424:Rural Population