Community Health Commons^™

Barriers And Bridges: Exploring Factors That Shape Mental Health Service Utilization In Rural America, Margaret Wiwuga

Educational Specialist, 2020-current

Despite disproportionately higher suicide mortality rates and comparable prevalence of mental illness across urban and rural communities in the United States, rural populations across the nation experience significantly lower access to and utilization of mental health services, naturally leading to worse comprehensive outcomes. This literature review examines multifaceted factors shaping mental health service use in rural America, taking note of both barrier and enabling factors that impede or enable these unique populations’ willingness and ability to access and use mental health services. Ten articles published prior to September 9, 2025, were selected from the James Madison University Libraries’ Psychology and …

Chit-Chat With Hats: Addressing Mental Health Decline Through Art Therapy And Community Engagement, Zoe G. Mendez-Sosa

Capstone Projects and Master's Theses

This capstone addresses the prominent social issue of mental health decline in Central Pacific California driven by lack of support systems for individuals. In partnership with Health Advocacy Team Support (HATS), “Chit-Chat with HATS was developed as a peer to peer group with art therapy techniques to promote emotional resilience and community connection. The primary objective of the program was to provide individuals struggling with mental health with tools to help them manage their feelings and thoughts.

The program was structured with check-ins, mindfulness techniques, and opportunities of creative expression through art therapy techniques to help participants with processing complex …

Prevalence And Determinant Factors Of Depression Among Pregnant Women In Poned Health Center In Tangerang City Area, Dian Geumala Hayati, Sudijanto Kamso, Popy Yuniar, Yuli Puspita Devi

Jurnal Epidemiologi Kesehatan Indonesia

According to World Health Organization (WHO), approximately 10% of pregnant women experience mental disorders, with depression being particularly prevalent. In developing countries, this rate is was even higher, reaching 19.8% after childbirth and 15.6% during pregnancy. Various studies conducted in Indonesia show that the prevalence of depression among pregnant women ranges widely, from 21.4% to 26.2%.This study aimed to determine the prevalence and risk factors associated with depression during pregnancy in pregnant women at the PONED Community Health Center in Tangerang City Area. A facility-based cross-sectional study was conducted with 105 pregnant women attending antenatal check-ups at the 17 PONED …

Accessing Campus Mental Health Services In A Nigerian Southwestern University: Barriers To Academic Success, Caroline Dada

Electronic Theses and Dissertations

Mental health disorders are a significant health concern among higher education institutions in sub-Saharan Africa, including Nigeria. A substantial treatment gap exists in the Nigerian healthcare system, and this gap is further worsened by cultural and religious barriers, which reinforce stigma that discourages students from seeking professional help. This qualitative narrative inquiry explored the barriers students encountered when accessing mental health services at a university in Southwestern Nigeria, to increase service access. Qualitative semistructured interviews were conducted with seven professional mental health providers at a university counseling center between March and April 2025. Inductive thematic analysis was used to identify …

Experiences With Social Media Social Comparison In Women Ages 18-28: A Qualitative Study, Olivia Oakley Dr.

Dissertations

This qualitative study aimed to understand young women’s experience using social media and their reported mental health connections, such as self-esteem and comparison. As inferred in recent research, a wide range of social media content is being produced and consumed, from promoting the “thin ideal” to newer campaigns advocating for body positivity (Cohen et al., 2019, Grabe et al., 2008; Groesz et al., 2002). In a time where there is so much online content to consume, it is important to continue to evaluate the lived experiences of those using social media. This phenomenological qualitative research captured the lived experiences of …

Academic Burnout And Its Association With Sleep Quality, Physical Activity, And Social Media Addiction Among University Students In Perak, Malaysia: A Cross-Sectional Study, Kai Eng Joanne Lim, Khang Jin Cheah, Farzana Athirah Abdul Latif, Fatin Izzaty Mohd Shahrin

Makara Journal of Health Research

Background: Academic burnout among Malaysian undergraduates is a rising concern, driven by academic pressure and compounded by lifestyle and behavioural factors. This study aimed to examine the associations between academic burnout, sleep quality, physical activity, and social media addiction.

Methods: A cross-sectional study involving 382 undergraduate students was conducted using an online survey to collect the data. The chi-square test was used to assess bivariate associations, and multivariable logistic regression was employed to identify independent predictors of academic burnout.

Results: The majority of respondents were aged 21 to 23 years (59.7%) and female (60.7%). Overall, 56.0% of …

Addressing Psychosocial Barriers To Participation In People Experiencing Homelessness: An Occupational Therapy Workshop, Preston Bender, Steven M. Gerardi, Lacey Spark

Summer 2025 OTD Capstone Symposium

Despite the occupational therapy (OT) profession's emphasis on holistic, person-centered care, many OT practitioners and students report feeling a lack of self-efficacy and preparedness to navigate the complex psychological, social, and systemic barriers that hinder occupational participation in people experiencing homelessness (PEH). This capstone project aimed to address the perceived unpreparedness among clinicians through the creation of an 8-hour interactive educational workshop aligned with Experiential Learning Theory. The content is grounded in the Model of Human Occupation (MOHO) and informed by the Bridging the Transition from Homelessness: A Social Justice Framework (BTTF), trauma-informed care (TIC), harm reduction, and diversity, equity, …

Mental Health And Substance Use Interventions Within Muslim Community Spaces: A Community Based-Participatory Research Proposal, Halah Mansour Alayleh

Master's Projects and Capstones

Background. Muslim Americans face significant mental health and substance use challenges compounded by Islamophobic discrimination, cultural stigma, and barriers to accessing culturally competent services. They also significantly underuse professional mental health services. Purpose. This study aims to collaborate with Muslim communities within the San Francisco Bay Area to develop a replicable intervention framework for addressing mental health and substance use stigma within mosques and other Muslim community spaces. Methods. The proposal uses a community-based participatory research (CBPR) methodology while integrating the theory of planned behavior (TPB) and stigma theory in the framework. This proposal outlines the four phases of intervention …

Finding Freedom In Appalachia: Evaluating A Mental Health Intervention In West Virginia, Elizabeth A. Claydon, Karen Haring, Jessica Haring, Kelsey Riggi, Beth Currence

Journal of Appalachian Health

Introduction: Rural areas have limited capacity to provide comprehensive mental health treatment and resources. This creates the need for interventions to ensure individuals with mental health concerns have access to resources to improve their mental health.

Purpose: The purpose of this mixed-methods evaluation was to assess the effectiveness and impact of Libera, a mental health program tailored for girls and women within the Appalachian region.

Methods: Quantitative surveys, including validated measures for depression, anxiety, and eating disorder symptoms, and life satisfaction, were collected pre- and post-Libera intervention for participants. Simultaneously, annual surveys were sent to Listeners in addition to qualitative …

Assessing The Impact Of The Covid-19 Pandemic On Mental Health In Patients Presenting To A Student-Run Free Clinic, Sabah Iqbal, Kirsten Carlberg, Emily Reilly, Jessica Ivanov, Victoria Youssef, Lily Roessler, Maikel Monsour, Nils Brolis

Rowan-Virtua Research Day

Background

Mental health is an important part of patient care, therefore it is imperative to understand how it’s recognized and treated. Socioeconomic status and the COVID19 pandemic contribute to disproportionate incidences of mental illness^{1, 2, 10, 11, 12}. This study uses data from a student-run clinic, the Rowan-Virtua Community Health Center (RVCHC), to examine disparities in mental health needs and screenings among the local population.

Hypothesis

It was hypothesized that underserved populations are at a disadvantage when it comes to both mental health screenings and treatment due to restricted access to healthcare and other unmet needs. Additionally, the …

Comparison Of Cognitive Functions, Sleep Quality, Emotional State, Balance And Physical Activity Levels Of University Students According To Academic Success, Sevim Oksuz, Ozde Depreli, Aytül Ozdil, Gozde Iyigun, Ender Angın, Betül Fatma Bilgin, Ayşen Karaman

Internet Journal of Allied Health Sciences and Practice

Purpose: This study was planned to compare the level of attention, dual-task abilities, sleep quality, emotional state (anxiety, depression, stress), dynamic balance, and physical activity level in low and high-academic success university students. Method: A total of 134 international undergraduate students between the age of 18 and 25 (low academic success group n=67, high academic success group n=67) were recruited for this study. The Trail Making Test (TMT) – A and B was used for attention assessment, the TMT While Walking – A and B was utilized for dual-task performance, the Pittsburgh Sleep Quality Index (PSQI) was utilized to assess …

Social Health Among Adolescents In The Global School-Based Student Health Survey (Gshs), Luke Pontoriero, Sarah Simon, Lauren Anderson

Seaver College Research And Scholarly Achievement Symposium

Background: Social health is a function of the quantity and quality of relationships, including with family members and peers. Adolescents who report being lonely or having no close friends have a low quantity of relationships, and those who feel that their peers are unkind and their parents are not understanding have low quality relationships. We examined whether poor social health is associated with violent behavior.

Methods: We analyzed data from the Global School-based Student Health Survey (GSHS), which employs a standardized two-stage cluster sampling method and a validated questionnaire to explore health and risk behaviors among nationally representative samples of …

A Wellness And Social Engagement Program For Post-Lower Limb Amputees, Graciela Gonzalez, Cassandra Nelson

Spring 2025 OTD Capstone Symposium

A wellness and social engagement program was developed and implemented to provide education relating to the mental health impacts, decrease in health management, and lack of social participation after a lower-limb amputation amongst adults, 18 years or older. The program provided a manual with educational information, external resources, and visual aids to enhance independence in activities of daily living (ADLs).

Impacts On College-Aged Asian American Mental Health, Zahra Soherwardy

Senior Theses

This study explores the relationship between different forms of racial harassment and mental health issues in Asian American college students. Asian American mental health is a growing concern in the field of public health. Asian Americans have the lowest treatment rates and some of the highest stigma levels of any demographic. They are also impacted by the model minority myth and discrimination, further alienating them from getting help. The topics of subtle racism, blatant racism, and current racial discrimination were compared to depressive symptoms, anxiety, self-esteem, and four domains of aggression using survey data. Subtle racism was found to be …

A Qualitative Approach To Identifying Obstacles To Mental Healthcare In The Rio Grande Valley From The Perspective Of Mental Healthcare Professionals., Shania M. Linder, Cristian Botello, Raquel Villarreal, Nelda Rodriguez, Mario Gil, Dayana Zamora

Research Symposium

Background: There are many factors that prevent members of the Hispanic/Latino community from accessing mental health resources. This is important to investigate because there is a lack of knowledge on why residents of the Rio Grande Valley, an underserved region of South Texas, are unable to access and/or utilize mental health resources.

Methods: A focus group session was held at a mental health counseling clinic in Cameron County, Texas on February 1, 2024. The participants consisted of mental health professionals, such as two mental health clinicians, a clinical counselor, two school counselors, a licensed professional counselor supervisor, and a …

Exploring Mental Health In Veterinary Students: Common Stressors And Effective Coping Strategies: A Narrative Review, Rahib K. Islam, Emily K. Cobb, Hannah K. Mccowan, Kylie Watson, Kaustuv Bhattacharya, Anjali Chandra, Warda Mohiuddin, Karen Gruszynski, Amanda H. Wilkerson, John J. Dascanio, Robert E. Davis, Vinayak K. Nahar

School of Medicine Faculty Publications

INTRODUCTION: Veterinary students face significant challenges impacting their mental health and wellbeing. The rigorous academic curriculum, high expectations, and demanding clinical training create an environment of intense pressure and constant stress. This review explores the demographic and psychosocial variables influencing mental health outcomes, highlighting common stressors and coping strategies. METHODS: A systematic literature search was conducted using PubMed, CAB Abstracts, and Google Scholar. Studies published up to 2021 involving veterinary students were included. Twenty-one peer-reviewed studies met the inclusion criteria. Demographic data, stressors, mental health measures, and coping strategies were extracted and analyzed. Studies focused on various mental health aspects, …

Investigating Mental Health Disparities In Rural Sexual And Gender Minority Adults: Protocol For The Rural Exploration And Approaches To Lgbtq + Mental Health (Realm) Prospective Cohort Study, Shoshanna L. Fine, Kalai Willis, Iaah L. Lucas, Kirsten F. Siebach, Jennifer L. Glick, Mariah Valentine-Graves, Savannah Winter, Michael Smith, Thomas Waltz, Gina Bailey Herring, Marissa Hannah, Holly C. Wilcox, Travis Sanchez, Stefan D. Baral, Sarah M. Murray

School of Public Health Faculty Publications

BACKGROUND: Sexual and gender minority (SGM) persons experience substantial mental health disparities throughout the life course, including increased vulnerability to depression and suicide. Few existing studies, however, have explored how pervasive experiences of SGM-related stigma, discrimination, and trauma (i.e., minority stress) contribute to adverse mental health outcomes among diverse sub-populations of SGM adults living in rural areas of the United States. This paper describes the protocol for a prospective cohort study, "Rural Exploration and Approaches for LGBTQ + Mental Health (REALM)," that will explore minority stress in relation to mental health conditions and suicidal behaviors among rural SGM adults. METHODS: …

Los Inmigrantes Indocumentados Y Su Pelea Para La Salud Medica En Los Estados Unidos, Alejandro Del Rello

World Languages and Cultures Senior Capstones

This essay explores the critical issue of healthcare access for undocumented immigrants in the United States. Despite contributing significantly to the economy through labor and taxes, undocumented immigrants face systemic barriers to medical care, including lack of insurance, fear of deportation, and economic troubles. These barriers result in untreated illnesses, mental health struggles, and increased use of emergency services, which generate higher long-term costs. The paper argues for inclusive healthcare policies, such as Medicaid expansion and protections for patient privacy, to improve public health, reduce disparities, and enhance economic stability. Drawing from U.S. and international examples, the essay demonstrates that …

Nh State Parks Outdoor Recreation And Wellbeing, Muriel C. Bennett

Honors Theses and Capstones

This evaluation strives to analyze NH residents’ usage of outdoor spaces (adults 18+) and NH State Park lands. The general purpose of this evaluation is to gain evidence and develop an understanding of participant use of outdoor spaces and whether participant’s mental well-being is a driving factor in outdoor recreation. As children and adults are spending increasingly more time indoors and on phones and computers, it is necessary for further research and advocacy efforts to be developed on the importance of time outdoors. It has be found that “urban lifestyles impose increasing demands on our cognitive resources” (Ohily, 2010) which …

The Chemical Straightjacket: Institutional Over-Use Of Psychotropic Drugs On Children In Lieu Of Therapeutic Community Mental Health Services, Marisa Leib-Neri

Indiana Journal of Law and Social Equality

This Article argues that the abysmal state of children’s mental health in America is in part due to an overreliance on and over prescription of psychotropic drugs inside psychiatric residential institutions in lieu of community based mental health services. This overreliance on residential institutions and psychotropic drugs has allowed a new form of chemical restraint to flourish—the chemical straitjacket. This Article uses the medication lists of twelve children in seven different North Carolina psychiatric residential treatment facilities to demonstrate how the chemical straitjacket operates: the prescription of drugs not approved for pediatric populations, counter to evidence-based practices for particular diagnoses, …

Examining The Association Between Perceived Stigma And Mental Health Help-Seeking Behavior Among Racial/Ethnic Minority Students In Health Professions Education, Camila A. Agurto

Honors Undergraduate Theses

Racial and ethnic minority (REM) students in health professions programs in the U.S. have considerable mental health issues. Still, they are less likely to access mental health services when compared to their White peers. The stigma they face, such as —public stigma, self-stigma, or intersectional stigma, may serve as a barrier to help-seeking. Although there is increasing recognition of the barriers to mental health care experienced by these students, there is no systematic understanding of how perceived stigma associated with mental health issues affects mental health help-seeking by REM students enrolled in health professions education. This systematic literature review aims …

Assessing The Relationship Between Perceived Psychological And Physical Pain In Adults With Orthopedic Pain, Daniel C. Karimi Dehkordi

Honors Undergraduate Theses

Suicide remains a public health concern in the U.S., particularly among individuals experiencing chronic pain and psychological distress. This cross-sectional study investigated the relationship between perceived physical and psychological pain in 41 adults with chronic orthopedic conditions. The relationship between other risk and protective factors and perceived levels of pain distress was also examined. Results showed a significant positive correlation between psychological distress and physical pain (r(39) = 0.388, p < .05) and psychological distress and depressive/anxiety symptoms (r (39) = 0.477, p < .01). Psychological distress was moderately associated with feelings of hopelessness (r (39) = 0.403, p < .01), however, the relationship between physical pain and hopelessness was weak and nonsignificant (r (39) = -0.06, p = .71). Contrary to expectations, emotional support did not buffer the effects of psychological distress (r (39) = 0.07, p = 0.66). Mediational analysis confirmed that emotional support did not influence the relationship between physical pain and psychological distress (Beta (β) = -0.969, p = 0.572; Sobel Z = 0.5598, p = 0.575). Age was not correlated with psychological distress (r (39) = -0.24, p = 0.13) or mental health symptoms (r (39) = -0.05, p = .77). While there was no significant difference across sex, males reported higher mental health symptomatology and psychological distress scores than female counterparts. These findings underscore the direct impact of physical pain on psychological distress and challenge assumptions about the protective role of social support. The study highlights the need for integrated, multidisciplinary interventions targeting both physical and psychological pain to mitigate suicide risk among individuals with chronic orthopedic conditions. Future research should iii explore alternative support mechanisms and resilience-building strategies to address the complex interplay of pain, distress, and suicidality.

Improving Health Equity: Integrating Mental Health Services Into Mobile Health Clinics For Unhoused And Low-Income Populations In The United States, Tiffany Lynn Wong

Master's Projects and Capstones

Mental health disparities among homeless and low-income populations in the United States highlight significant challenges in access and quality of care. This literature review explores the integration of mental health services into Mobile Health Clinics (MHCs) as a promising recommendation to address these disparities. I used various search engines, extracting 10 articles published from 2013 to 2023 focused on the U.S. MHCs show its effectiveness in improving healthcare access and quality of care, covering different services like mammography, reproductive health, COVID-19 testing, and diabetes care. Building on these successful models, this paper proposes extending MHCs to include mental health screenings, …

Bridging The Gap: Fostering Open Dialogue On Resource Access And Service Needs, Cameron Castillo

Capstone Projects and Master's Theses

This project investigates whether there are additional resources desired by clients or are needed to better support said clients in their recovery at the Interim, Inc. organization. This agency is a nonprofit organization whose sole purpose is to build community connections through providing services to individuals facing mental health and substance use challenges. While there is a wide range of programs available, there may still be clients with unmet needs. The purpose of this project was to identify any service gaps by conducting separate surveys of clients and staff members. Through the use of open-ended questions, the expectation of receiving …

Healthy Community Healthy Mind: An Evidence-Based Culturally Sensitive Aboriginal Child And Adolescent Mental Health Program, Shane Murphy, Kirra Roberts

Journal of the Australian Indigenous HealthInfoNet

This brief report describes an area of promising practice and a model of care that encapsulates the intersection of non-Indigenous methods and Aboriginal and Torres Strait Islander ways of knowing, being, and doing. The Ballarat and District Aboriginal Cooperative (BADAC) Aboriginal Child and Adolescent Mental Health Program provides evidence-based mental health practice integrating the cultural knowledge and lived experience of Aboriginal staff, clients, and families. The program focus is on building trust with community and clients. This paper presents the outcomes from the first year of the program. Data from referral and assessment processes and outcomes for the young people …

Disparities And Protective Factors In Pandemic-Related Mental Health Outcomes: A Louisiana-Based Study, Ariane L. Rung, Evrim Oral, Tyler Prusisz, Edward S. Peters

School of Public Health Faculty Publications

Introduction: The COVID-19 pandemic has had a wide-ranging impact on mental health. Diverse populations experienced the pandemic differently, highlighting pre-existing inequalities and creating new challenges in recovery. Understanding the effects across diverse populations and identifying protective factors is crucial for guiding future pandemic preparedness. The objectives of this study were to (1) describe the specific COVID-19-related impacts associated with general well-being, (2) identify protective factors associated with better mental health outcomes, and (3) assess racial disparities in pandemic impact and protective factors. Methods: A cross-sectional survey of Louisiana residents was conducted in summer 2020, yielding a sample of 986 Black …

Depression Screening And Education For Immigrants To Increase Access To Care, Viktoriya Ivantsova

Dissertations

Abstract

Problem: Immigrants are at risk for developing mental health disorders due to multiple factors including social, cultural, or economic factors. This can result in a lower quality of life and an increased chance of further disabilities. Although immigrants are at increased risk for the development of mental health disorders, studies show that utilization of available services and resources are low. Additionally, organizations that provide services to immigrants may not be implementing screening and psychoeducation.

Methods: This quality improvement (QI) project followed a descriptive, observational design along with an educational intervention. Using convenience sampling for recruitment, Russian and/or Ukrainian adults …

A National Perspective Of Mental Health Awareness Among Agricultural Workers, Anna Gilliam, Ethan Gilliam

Outcomes and Impact Quarterly

The knowledge and perceptions of mental health resources for agricultural workers were explored at the 2024 American Farm Bureau Federation (AFBF) National Conference. Data were gathered via a voluntary survey conducted at the event. With 137 completed surveys, the study revealed that the participants desired more information regarding agricultural mental health resources and revealed their preferences for receiving this information. These findings will lead USU Extension to create impactful educational resources to better address mental health awareness and education needs in agricultural workers.

Online Mental Health Help Seeking Behaviors Among College Students, Rachel Johnson, Monica Nandan, Brian Culp, Dominic Thomas

Faculty Articles

Even before the pandemic, utilization of online mental health resources continues to grow among young adults. There is limited research on online help seeking behaviors, let alone specific research on college students’ online mental health help seeking behaviors. This study aims to identify which terminology college students utilize on online search engines to seek assistance related to mental health. A cross-sectional survey design was used during the 2019-2020 academic year. The respondents consisted of 259 college students at one of the 50 largest public institutions of higher education in the Southeastern United States. Overall, the sample data suggests that college …

Evaluating The Caring Cards Program And Its Effect On Mental Health Indicators Among A Self-Defined Agricultural Group In Rural Kentucky, Katrina Clontz

Theses and Dissertations--Community & Leadership Development

Suicide is currently the 11^th leading cause of death in the Unites States (American Foundation for Suicide Prevention, 2024), and is especially high among the farming and agricultural population (Kennedy et al., 2021; Klingelschmidt et al., 2022; Monteith et al., 2020). Additionally, mental health access and outcomes are worse among this population, partially due to the inaccessibility of care in rural areas (Taylor, 2019). Communication among caring individuals is thought to be an effective suicide prevention strategy (Long, 2023; Ross & Bassilos, 2019). The Caring Cards program was developed as a way to facilitate mental health communications among a …