RESEARCH WEEKLY: Perceptions of Stigma in Urban and Nonurban Environments
By Sophie Ali
The gentrification of urban areas in the United States has pushed individuals with serious mental illness toward suburban and rural areas with affordable housing but limited mental health services. Though benefits, such as proximity to nature and social cohesion, exist in these nonurban areas, heightened levels of mental illness stigma may have detrimental effects on those living with serious mental illness. Research published this year in the American Journal of Orthopsychiatry by researchers from Portland State University and Temple University explores the relationship between perceived stigma and urbanicity, suggesting that perceived stigma was associated with psychological distress in both urban and nonurban settings.
The impact of perceived stigma
The perception of increased mental health stigma, referred to as perceived stigma, by individuals is linked to several negative outcomes. Psychological distress and sense of community are two such outcomes which may impede the well-being of people with serious mental illness. Previous research has demonstrated that perceived stigma is especially prevalent in nonurban areas. Moreover, perceived stigma is a barrier to seeking mental health services in these areas, and this lack of treatment only exacerbates psychological distress. Researchers at Portland State University and Temple University further explored the relationship between urbanicity and perceived stigma to determine if living in a nonurban setting led to increased stigma and negative outcomes for people with serious mental illness.
Study details and results
In the study, 300 adults with serious mental illness receiving outpatient community mental health services were surveyed across 15 different states. The locations of the community mental health services were selected to represent a range of urbanicity. Urbanicity was evaluated using the Department of Agriculture’s measure of Rural-Urban Continuum Codes (RUCC). The RUCC adapted for this study designates a score of 1-2 as urban and 3-9 as non-urban. These rankings are based on the proximity to metropolitan areas and population size.
While the researchers found that a higher perceived stigma was related to higher psychological distress and lowered sense of community, they were unable to determine if it was the perceived stigma that caused these negative outcomes when comparing urban versus nonurban settings. When looking at general correlations between well-being outcomes, higher psychological distress was associated with lower sense of community. In addition, the preliminary analysis showed gender to be significantly associated with study outcome variables - women reported higher levels of psychological distress and lower levels of sense of community than men.
Implications
In summary, associations between perceived stigma and poor outcomes occur at both levels of urbanicity. This finding is contrary to the hypothesis that the relationship between perceived stigma and psychological distress is moderated by urbanicity. Nevertheless, associations between urbanicity, psychological distress and sense of community persist. This emphasizes the importance of addressing serious mental illness stigma in all environments.
The research indicates that stigma may lead to negative outcomes such as low sense of community and high psychological distress for individuals with serious mental illness. Furthermore, the increasing numbers of individuals with serious mental illness living in nonurban areas emphasizes the need for interventional support against the negative outcomes of stigma in these regions. Future research should take factors such as conservative attitudes and accessibility of transportation and social services into account when examining the impact of urbanicity on perceived stigma.
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