title: Depression in rural adolescents: relationships with gender and availability of mental health services.
abstract: BACKGROUND
  There is growing evidence in the literature which indicates that the prevalence of depression is similar in both non-metropolitan and metropolitan areas. However, it is generally perceived that factors associated with compromised mental health in rural residents include deprivation and lack of access to healthcare services. This study examines the relationship between depression and possible determinants of mental health among rural adolescents. The determinants identified were degree of remoteness, gender, socioeconomic status and the perception of rural community characteristics. Rural community characteristics examined were long waiting lists and lack of mental health professionals.
  
  
  METHODS
  Respondents were 531 South Australian adolescents (55.7% female) aged 13 to 18 years, living outside the Adelaide (state capital) metropolitan area. Respondents completed a questionnaire including: demographic questions; the Kutcher Adolescent Depression Scale (KADS); and questions regarding individual perceptions of community characteristics. The data were obtained by self-report, degree of remoteness was measured using the Accessibility and Remoteness Index of Australia Plus, and socio-economic status was determined from the Australian Bureau of Statistics (ABS) Socio-Economic Index of Relative Socio-Economic Advantage and Disadvantage (SEIFA).
  
  
  RESULTS
  The rate of depression obtained from this sample of rural adolescents is concerning; 18% screened positive for depression on the KADS, 41% reported low mood much of the time or more often, and 20% experienced occasional or more frequent self-harm or suicidal thoughts, plans or actions. Depression was related to gender, with more females (23%) screening positive for depression than males (11.8%). Prevalence of depression was unrelated to degree of remoteness or the socioeconomic status of the participants. This finding is not consistent with other research that identifies socioeconomic status as a psychosocial determinant of mental health. It is noteworthy that the perception of long waiting lists and a lack of mental health professionals were related to depression but that this relationship was only significant for females. This may be because those who experience symptoms of depression are more likely to be aware of service availability due to help-seeking behaviour. That this finding is significant for females is consistent with research that identifies females as being better able to identify symptoms of depression and more willing to seek help.
  
  
  CONCLUSIONS
  Efforts to enhance the mental health of rural Australian adolescents should focus on improving the availability of mental health services, improving mental health literacy and promoting help-seeking behaviour for mental health difficulties. Consideration should be given to the gender differences identified when developing future mental health initiatives.
authors.affiliation: Psychological Services, Families SA Country Directorate, Adelaide, South Australia, Australia.  georgina.black@dfc.sa.gov.au.
authors.forename: Georgina
authors.initials: G
authors.lastname: Black
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Roberts
authors.forename: Tan
authors.initials: T
authors.lastname: Li-Leng
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D016009:Chi-Square Distribution; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011610:Psychosocial Deprivation; D012424:Rural Population / Q000706:statistics & numerical data*; D012574:Schools / Q000706:statistics & numerical data; D012649:Self Concept; D017678:Sex Distribution; D012934:Social Isolation / Q000523:psychology; D012959:Socioeconomic Factors; D013021:South Australia / Q000453:epidemiology; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*; D014850:Waiting Lists