Depression and African American Women - Research Paper Example

? Depression and African American Women Core 3990 Proposal Stefania Strowder Dr. Jyothi Gupta, Depression and African American Women Introduction “Depression is an illness that involves the mind, body, and spirit and is different from a passing ‘blue mood’. It is not a sign, however, of personal weakness or a condition that can be willed or wished away.” (Collins, 2006, p. 147). It is normal for a person to feel low and sad. However, when such feelings do not go away and start interfering with the affected person’s life, work and functioning, it is said that he is suffering from depression. Very often depression is ignored; however, it is a serious illness that needs cure and the affected person is required to seek help as soon as he can. If left untreated, depression can not only adversely affect the patient’s life but also that of those around him. Sometimes depression can become so severe that the patient may end up committing suicide. In fact, it is the top reason for suicide in the United States (National Alliance on Mental Illness, 2009). Although depression affects both men and women, it is more common among the latter. All women with depression do not show the same signs and symptoms. Besides that, the severity and frequency also varies. A woman can also develop other health problems if her depression is not cured. It is not unusual for a woman to be sick while depressed. She may have eating disorders, obsessive-compulsive disorder, phobias, and more seriously, heart problems, cancer and diabetes. Therefore, it is extremely important for a depressed person to approach a counselor or obtain health care at the earliest. She will need to be first diagnosed properly following which appropriate medication and treatment will be applied to her. Depression can be ignored to a certain limit only. After the limit has been crossed the person’s productivity and dreams start getting affected. The most common treatments include medication and psychotherapy, and it is very important for the affected person to seek treatment immediately for in the long run depression can definitely destroy her. Thesis Today the world has advanced phenomenally and the once discriminated African American women are now reaching out to new heights and milestones. They have managed to gain this status through continuous hard word and education. Now even African American women have successful careers and respect in society. However, one thing they are still behind in is healthcare, both physical and mental. This is obvious from the reports that suggest that African American women have an almost 50% higher depression rate than Caucasians. An important reason behind such a trend is the stigma attached to seeking help in such cases. The psychological factors are what hold the Blacks back from going to a counselor. Now, black women and depression do not really go together; at least not in the society. Black women are not supposed to have depression – they are supposed to be the strong females who take care of their family without complains and who never need any help. However, what happens in reality could not be further from this attitude, as Black women also suffer greatly from depression yet they are unable to admit to it due to what is expected of them and the societal stigma attached with mental illness such as depression. For my thesis I want to explore depressive disorders in African American women and their access to mental healthcare. African American women are most likely the primary caregivers in the family as well as for extended family members. The African American women’s emotional wellbeing not only affects their health – both physical and emotional; but also the emotional wellness of their children. There is limited research on the rates of depression in women of color, let alone African American women and access to therapeutic interventions. Practitioner bias and misinterpretation of symptomology has hurt African American women’s access to appropriate care. However, there has been enough research conducted to relate that colored people have less access to mental health care as compared to the Whites. Besides, they are also reluctant to get counseling and, when they do get health care, they receive poor quality treatment. This is in spite of the findings that colored people get more depressed than non-Hispanic Whites, and the degree of depression they experience is also more severe, leading to worse consequences as compared to what White people get. Rates According to the National Institutes of Mental Health, women are much more likely to be diagnosed with depressive disorders than men, even though depression is seen in both women and men (National Institute of Mental Health). Current research has no clear conclusion as to why there is such a difference, but there are clear associations between mental wellness and general health. Depression has been recognized as a leading cause of disease and, according to WHO (World Health Organization), by 2020 depression will be second only to heart disease (Lazear, Pires, Isaacs, Chaulk, & Huang, 2008) (O'Malley, Forrest, & Miranda, 2003). Going deeper into statistics, it is found that even among women there is a disparity in terms of depression; the African American women suffer from depression more than the White women, and it is no surprise since women are discriminated and Blacks are discriminated; when the two are the same person, that is Black and a woman, she would definitely be getting double the discrimination. Keeping this information in mind, medical practitioners incorporate mental health screenings in their general practice; however, they tend not to screen for mood disorders in African American women as common practice. African American women are less likely to be screened for depression by healthcare professionals due to practitioner bias. There are racist doctors with various attitudes and belonging to different cultures who have no sympathy whatsoever towards the Blacks and they do not diagnose them properly, or give them the treatment they require. And when these women go without treatment their illness keeps building up and the consequences worsen, destroying the person. Women belonging to the low-income class and those of color experience twice the maternal depression that a white woman does (25% vs. 12%). Middle class African American women may suffer from major depression owing to a number of reasons. These women get continuous exposure to negative social factors, such as racial discrimination and oppression related to gender, and according to a number of studies, income, age, marital status and education level have a direct effect upon depression in Black women (Collins, 2006). To be precise, it has been found that the yearly household income and education level of the Black women is inversely proportional to levels of depression among younger Black women. Also, depression was found to be higher in unmarried rather than married women. Social support that they received also determined the level of depression that they felt; the stressed women and those having minimal to no social support obviously experienced higher levels of depression. Besides the prevalence, even the consequences of depression are worse for low-income and colored women (Jones & Shorter-Gooden, 2003). While about 20% of the depressed Americans seek help for their illness, only about 7% of the black women do that (Beauboeuf-lafontant, 2008). Again, as mentioned earlier, the reason is mainly because the Blacks do not think their women need help and that depression is alien to them. (Shim, Compton, Rust, Druss, & Kaslow, 2009) relate the rates of depression among the colored people. According to their sources, it has been deduced from recent studies that, as compared to non-Hispanics, chronicity and disability related to psychiatric disorders are more prevalent among the minorities. It was found that African Americans and those of the Caribbean race had a higher chance (57% and 56%) of major depressive disorder in comparison with the white people (39%). The same report also deduced that the severity of the depression was more in African Americans and Caribbean people as compared to in non-Hispanics. And it was in spite of such differences that the more affected groups received and could access lesser health care and that too of lower quality, than what the White people got. It has also been reported that it is the overworked and underpaid African American women who get more depressed, and this depression increases during holidays (Austin, 2002). However, they are not really aware of their conditions. Besides, they consider depression to be a “crazy person’s” disorder. Few reasons why Black women are more often depressed is that they live around economic insecurity, they have the responsibilities of taking care of their families, they have to go through neighborhood violence and they do not get any kind of social support. During holiday seasons the already stressed women become further depressed due to lack of finances, the fact that they cannot be independent, and that they are separated from their family. Poverty is a major reason too (de Groot, Auslander, Williams, Sherraden, & Haire-Joshu, 2003). Also, black women are expected to neglect themselves and take care of others. Such an attitude makes them more prone to depression. They have to do what is expected of them. Misdiagnosis “If you’re trying to identity depression in Black women, one of the first things to look for is a woman who is working very hard and seems disconnected from her own needs. She may be busy around the clock, constantly on the go, unable to relax, and often compromising her sleep for household, child-care, and job tasks that she feels impelled to take care of. Not taking the time to tend to herself makes her more vulnerable to depression. Or her busyness may be a way to keep her mind off the feelings of sadness that have already arisen” (Jones & Shorter-Gooden, 2003, pp. 125-126). For many African American women, depressive disorders are unrecognized and go untreated for several years. African American women experience higher rates of comorbid health issues such as hypertension, obesity and heart disease, many of which have links to depression and depressive disorders. Many of these life threatening disorders can be lessened if not preempted if the diagnosis and treatment of depression was caught early. If you are depressed you are less likely to make the lifestyle changes needed to prevent life threatening conditions such as cardiovascular disease (Mastrogiannis, Giamouzis, & Dardiotis, 2012). Mental health problems are also difficult to diagnose and treat in African American women. One reason for this is that they do not trust their healthcare providers. This was an important and significant barrier. Only those women who have been getting treated since a long time and can trust their provider continue with the treatment. They want to see how the provider talks to them and treats them before starting to trust them and pursue the sessions. Also, it is difficult for them to trust their providers especially if they are White. In many cases the White doctors do not treat the Black patients properly, not giving them the respect and care that they would normally give to a White patient. This is also a major deterrent for the Blacks not being able to build a rapport with their doctors and thus opting for no treatment, since what they are getting is adversely affecting them rather than being of help. Secondly, they do not accept that they are depressed. They are forever in denial regarding their illness. They feel that they are strong enough to deal with the problems themselves. In their opinion it is just pain and stress and they can get over it. They have strong faith in God and believe Him to be enough. One woman, however, confessed that she saw a therapist when her pastor told her it was acceptable and normal for her to (Waite & Killian, 2008). Besides, women are also concerned about their family and they have to take care of them; it does not suit them to go for sessions while being in such a position. Majority of the people are unaware of the etiology of the illness. Many do not even know there is something called depression and when they get such a feeling they simply feel that it is just in their head and they can shake it off. When they do seek help they reveal to the doctor as little as possible. They do not take their problems seriously and consider them to be just a phase in life rather than taking them to be an actual mental health problem. The Black society considers such problems to be a personal weakness rather than a health issue. They do not think that it requires medication or treatment; instead, they think that they will get over it (Waite & Killian, 2008). Therefore, this greatly interferes with the diagnoses and eventually the treatment of their problem. Finances is another reason – they do not have enough capital to pursue their professional therapy sessions. The places where they feel more comfortable and where they feel the treatment and attitude is better always cost more and thus they end up not getting any treatment. The Black women prefer to get support rather than go to professional mental health services – this is one of the reasons for there not being enough clinical research in this respect (Kennedy, 2009). They rely on their community, family and religious community when they are going through distress. Along with Black women seeking healthcare lesser than the Whites, another factor that affects their outcome is that when they actually do seek counseling they do so at a very late stage of their illness. However, they may also have another reason for not going for help which is that the service they get is not worth it. In African American community very many times the health professionals under-diagnose disorders such as depression and over-diagnose other illnesses like schizophrenia. Such misdiagnoses are obviously not helpful to the patients and it makes no sense to seek treatment when it is not even going to be given. Black people also do not trust the Whites. And therefore, they do not trust the White system either. They have gone through all kinds of racist discrimination at their hands which makes them hide things from the White people. They do not consider them to be as honest as their own kind – the Blacks. Therefore, they also consider the health care system to be racially biased, especially in places where there is a very small population of Blacks. And such a perspective is strengthened when they themselves actually have bad experiences with them, especially health care, where everyone should be treated equally since a life should be considered valuable no matter whose it is. The African Americans believe that they are considered more like a pig in front of White people and their life is worthless; and they must have good reason to think that way. Therefore, there is absolutely no reason for them to trust or visit a health care system where they are not even given the due respect, quality treatment and not treated as a White would be. “Racial disparities in health are shaped by the multiple mechanisms through which racism shapes life chances and access to material resources that are necessary to maintain health” (Schulz, Gravlee, Williams, & Israel, 2006, p. 1269). Access to care/care seeking behavior According to (Nicolaidis, et al., 2010), plenty of evidence exists that would support the common view of the vast differences in depression care. Guideline-appropriate depression care is more openly and widely available to Whites than the African Americans although it is the latter who are more vulnerable to the illness (Schreiber, Stern, & Wilson, 2000). Even the experiences of depression in Blacks and Whites are different. The African American women in the United States are more prone to additional jeopardies due to minority status, socioeconomic status, and multiple roles. Nicolaidis, et al. (2010) have referred to a couple of other studies in their research and pointed out how real-world physicians appear to be more efficient in dealing depression in White patients and look over it in African-Americans. Shim, et al. (2009) have also reported this finding. They mention in their journal article about the three major issues that colored people face when it comes to health care. First of all, they do not have as much access to health care as do the White people; secondly, the Whites are preferably given treatment and the African Americans are not; lastly, even if the colored people are lucky enough to get any health care, the treatment they do get is not up to the mark, and definitely nowhere near to what the White people get. Access to all types of healthcare has eluded many people of color, from missed diagnosis of signs and symptoms of depression and depressive disorders to blanket race based medical models of mental health. The African American woman’s views on depression and depressive disorders are seen as a “white person’s” disease, the image of the strong Black woman are both barriers to recognizing depression and seeking care (Nicolaidis, et al., 2010). If they are to show that they are strong enough, the Black women have to make sure to hide their discrepant feelings. They cannot show when they are angry, afraid, uncertain and needy; they have to keep all these emotions away and remain the strong Black woman (Beauboeuf-lafontant, 2008). They want to manage their depression themselves and live with grace. And such responses are culturally driven that Black women are stronger than Whites. Even when a Black woman would talk about her problems to her family or friends, they would simply shame her or shut her up by saying that they are strong and she needs to get it together. Besides, they are expected to keep their and their family’s problems to themselves rather than going around telling them to others. Therefore, the stigma attached to depression and admitting to be having the illness is so great that they prefer to simply keep it to themselves and suffer privately. Thus, they simply accept depression as part of their living. Although the devastating consequences of depression to a mother and her children are very well recognized, low-income colored women are still ignored and untreated for the disease. African Americans are very much less likely to seek treatment and care as compared to the Whites, and neither do they consider counseling to be appropriate. When they do actually turn to counseling, they prefer that their provider is a female, and in some cases it is someone of their own race. In fact, the latter appeared to be more important than the gender. They also preferred experience over a degree. That is, they preferred to go to counselors who were personally experienced with violence, drugs, and depression rather than someone just certified in a program. According to data less than one in five such women seek help for depression. Another report suggests that just about 16% of African Americans having a mental illness go for any type of treatment to cure it (Waite & Killian, 2008). From a research it was determined that the major barrier to the women seeking help was that they found it difficult to talk about it and they feared they would be called mad. The stigma and cultural attitudes that are associated with such issues was what prevented them from seeking help. They did not want shame. Because of such a societal belief the African American women preferred to not believe that they are susceptible to depression. It becomes difficult for them to accept such a diagnosis and such an issue was rarely, if ever, talked about in their families (Waite & Killian, 2008). Such issues are always kept a secret, even if they run in the family. Such attitude does not help; in fact the sufferer gets further pushed off the edge. Stigmatizing perceptions about mental illness are often major impediments to accessing mental health services for all populations, particularly for minority populations (Shim, Compton, Rust, Druss, & Kaslow, 2009, p. 1337). In the study by (Waite & Killian, 2008) the participants confessed that depression could be serious and even cause suicide. They believed depression could destroy you. Initially the person may be able to shake it off but it would keep growing, and a point will come when it starts affecting them so badly that urgent treatment may be required before something unfortunate happens. It can affect the person both mentally and physically. Other women believed that lack of health insurance was one of the reasons for not being able to seek help. Still others reported that the behavior of the providers is also what determines how openly and securely a woman talks to them about her issues, and only if they respect the patient and support them that they are able to bring out any difference in them. Some women confessed that they would go only to a professional whom they can trust; some go to their pastor; while still others just limit themselves to a family member, like sister, or a close friend (Waite & Killian, 2008). Those suffering women who do actually seek help are not given the due quality care. On the other hand, they are given over to primary care physicians who use non-evidence-based practice models or pharmacology. What normally happens is that this treatment is also disrupted very early in the stage. Besides, because maternal depression is not very well recognized and treated, it is not counted among the factors of healthy development trajectory of kids. Also, the women had a negative attitude toward antidepressants. They had the view that they might get addicted to it, or they would dope up. Besides, they did not want to rely on some drug to cope up; they wanted to do that on their own. They were also not very informed regarding antidepressants, another reason for rejecting the drugs, and they also mistrusted the prescribers and feared that the side effects would be too adverse for them. One such experience of an African American woman was that her doctor did not ask her any questions or talk to her; he simply gave her some medicines and this attitude put her off since she could not fathom how he could know what she should be treated for without bothering to even talk to her (Waite & Killian, 2008). She ended up throwing away the prescription. References Austin, L. (2002, December 12). Depression in black women peaks during the holidays. Sentinel. Beauboeuf-lafontant, T. (2008). Listening Past the Lies that Make Us Sick: A Voice-Centered Analysis of Strength and Depression among Black Women. Qualitative Sociology, 31(4), 391-406. Collins, C. F. (Ed.). (2006). African American Women's Health And Social Issues (2 ed.). Greenwood Publishing Group. de Groot, M., Auslander, W., Williams, J., Sherraden, M., & Haire-Joshu, D. (2003). Depression and poverty among African American women at risk for type 2 diabetes. Ann Behav Med, 25(3), 172-81. Jones, C., & Shorter-Gooden, K. (2003). Shifting: the double lives of Black women in America. New York: Harper Collins. Kennedy, B. R. (2009). Depression and African American Women. iUniverse. Lazear, K. J., Pires, S. A., Isaacs, M. R., Chaulk, P., & Huang, L. (2008). Depression among Low-Income Women of Color: Qualitative Findings from Cross-Cultural Focus Groups. J Immigrant Minority Health, 10, 127–133. Mastrogiannis, D., Giamouzis, G., & Dardiotis, E. (2012). Depression in Patients with Cardiovascular Disease. Cardiology Research and Practice. National Alliance on Mental Illness. (2009, October). African American Women and Depression Fact Sheet. Retrieved April 2013, 28, from National Alliance on Mental Illness: http://www.nami.org/Template.cfm?Section=Women_and_Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=88884 National Institute of Mental Health. (n.d.). Women and Depression. Retrieved April 26, 2013, from National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/women_depression_09_17_09_ln_04_final.pdf Nicolaidis, C., Timmons, V., Thomas, M., Wahab, S., Waters, A. S., Mejia, A., et al. (2010). You don't go tell White people nothing": African American women's perspectives on the influence of violence and race on depression and depression care. Am J Public Health, 100(8), 1470-6. O'Malley, A., Forrest, C. B., & Miranda, J. (2003). Primary care attributes and care for depression among low-income african american women. American Journal of Public Health, 93(8), 1328-34. Schreiber, R., Stern, P. N., & Wilson, C. (2000). Being strong: How Black West-Indian Canadian women manage depression and its stigma. Journal of Nursing Scholarship, 32(1), 39-45. Schulz, A. J., Gravlee, C. C., Williams, D. R., & Israel, B. A. (2006, July). Discrimination, Symptoms of Depression, and Self-Rated Health Among African American Women in Detroit: Results From a Longitudinal Analysis. American Journal of Public Health, 96(7), 1265-70. Shim, R. S., Compton, M. T., Rust, G., Druss, B. G., & Kaslow, N. J. (2009, October 1336-1341). Race ethnicity as a predictor of attitudes toward mental heatlh treatment seeking. Psychiatric Services, 60(10). Waite, R., & Killian, P. (2008). Health Beliefs About Depression Among African American Women. Perspectives in Psychiatric Care, 44(3), 185-95. Read More