title: Self-reported contacts for mental health problems by rural residents: predicted service needs, facilitators and barriers.
abstract: BACKGROUND
  Rural and remote Australians face a range of barriers to mental health care, potentially limiting the extent to which current services and support networks may provide assistance. This paper examines self-reported mental health problems and contacts during the last 12 months, and explores cross-sectional associations between potential facilitators/barriers and professional and non-professional help-seeking, while taking into account expected associations with socio-demographic and health-related factors.
  
  
  METHODS
  During the 3-year follow-up of the Australian Rural Mental Health Study (ARMHS) a self-report survey was completed by adult rural residents (N = 1,231; 61% female; 77% married; 22% remote location; mean age = 59 years), which examined socio-demographic characteristics, current health status factors, predicted service needs, self-reported professional and non-professional contacts for mental health problems in the last 12 months, other aspects of help-seeking, and perceived barriers.
  
  
  RESULTS
  Professional contacts for mental health problems were reported by 18% of the sample (including 14% reporting General Practitioner contacts), while non-professional contacts were reported by 16% (including 14% reporting discussions with family/friends). Perceived barriers to health care fell under the domains of structural (e.g., costs, distance), attitudinal (e.g., stigma concerns, confidentiality), and time commitments. Participants with 12-month mental health problems who reported their needs as met had the highest levels of service use. Hierarchical logistic regressions revealed a dose-response relationship between the level of predicted need and the likelihood of reporting professional and non-professional contacts, together with associations with socio-demographic characteristics (e.g., gender, relationships, and financial circumstances), suicidal ideation, and attitudinal factors, but not geographical remoteness.
  
  
  CONCLUSIONS
  Rates of self-reported mental health problems were consistent with baseline findings, including higher rural contact rates with General Practitioners. Structural barriers displayed mixed associations with help-seeking, while attitudinal barriers were consistently associated with lower service contacts. Developing appropriate interventions that address perceptions of mental illness and attitudes towards help-seeking is likely to be vital in optimising treatment access and mental health outcomes in rural areas.
authors.forename: Tonelle E
authors.initials: TE
authors.lastname: Handley
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Kay-Lambkin
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Inder
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Lewin
authors.forename: John R
authors.initials: JR
authors.lastname: Attia
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fuller
authors.forename: David
authors.initials: D
authors.lastname: Perkins
authors.forename: Clare
authors.initials: C
authors.lastname: Coleman
authors.forename: Natasha
authors.initials: N
authors.lastname: Weaver
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kelly
mesh_terms: D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data; D057566:Self Report