Racism shapes African-American women’s views on depression care

PORTLAND, Ore. — African-American women’s beliefs about depression and depression care are consistently and systematically influenced by racism, according to a new study conducted at Oregon Health & Science University. The results are published online in the American Journal of Public Health.

To be eligible for the study, participants had to be 18 or older, consider themselves African-American, have a score of 15 or higher on Patient Health Questionnaire Depression scale and have experienced intimate partner violence at some time in their lives. Thirty women participated in four private focus groups facilitated by African-American female community members of the research team.

Study participants were asked about their experiences and beliefs surrounding the relationship between violence and health in general, mental health, depression, and depression treatments. They also were asked to discuss their recommendations for improving depression care. The researchers found one issue dominated discussions about depression care — the participants’ deep mistrust of what they perceived to be a “White” health care system.

“These women were extremely wary of most depression treatments and providers they associated with ‘White’ systems of care. Although they acknowledged that violence, depression and substance abuse adversely affected their health, discussions about health care revolved around their perceptions of racism,” said Christina Nicolaidis, M.D., M.P.H., principal investigator and an associate professor of medicine (general internal medicine and geriatrics), and public health and preventive medicine in the OHSU School of Medicine. “Based on our findings, we recommend health and mental health providers endeavor to better understand and acknowledge how racism informs the experiences and perceptions of their patients.”

The expectation of being a “strong Black woman” also was a significant barrier to recognizing depression and seeking care. Co-investigator S. Renee Mitchell has used this finding to launch a campaign asking: “Strong Black woman — what are you burying, your feelings or the myth?” The research team also has organized several community depression and violence awareness events titled “Redefining the Blues.” An additional event is planned for the fall.

Study participants expressed a desire for community-based depression programs that addressed violence and drug use and are staffed by African-Americans with “real-life experiences.” In response to this request, the research team used their study data to create a community-based, culturally tailored depression-care program, which they currently are pilot-testing at Bradley-Angle House’s Healing Roots Center, a drop-in center for survivors of domestic and sexual violence.

The researchers make clear that their results aren’t reflective of all African-American depressed women, especially those who live in places with larger African-American populations, those with higher incomes and those who have not experienced intimate partner violence.

“Future study is needed to test the generalizability of our findings, as well as the effectiveness of culturally specific interventions in reducing depressions severity and improving depression care among African-American women,” the researchers concluded.

The research team comprised Nicolaidis; Vanessa Timmons, Oregon Coalition Against Domestic and Sexual Violence, Portland; Mary Jo Thomas, Multnomah County Department of Mental Health and Addiction, Portland; A. Star Waters and S. Renee Mitchell, Interconnections Project community partners at large, Portland; Stephanie Wahab, School of Social Work, Portland State University; and Angie Mejia, OHSU Department of Medicine.

The study was funded by the National Institute of Mental Health, a branch of the National Institutes of Health, and the Northwest Health Foundation Kaiser Permanente Community Fund.