A couple of weeks ago, I received an email from a colleague
encouraging me to read a paper she had published on the need for culturally
competent treatment of depression in African American women. As I read it, I recognized the African American
women in my clinical practice for whom I have had the privilege of providing
care for more than 20 years. I have
always admired their strength in the face of adversity and discrimination,
their role as the central figure in their families, their spirituality – and I
have developed a deep respect and fondness for them as they have shared their
joys and struggles. But it also made me question
whether I have provided adequate, culturally sensitive mental and emotional
support.
What I learned is that clinical depression among African
American women is 50% greater than among Caucasians. These women experience significantly more racism,
sexism and poverty compared to their white counterparts, and have fewer support
systems. Many have less education,
higher unemployment, work low-status, low-paying jobs, and live in sub-standard
housing in high crime communities. Subject
to high levels of stress, they suffer poorer mental and physical health and low
self-esteem. And yet, they appear to be towers
of strength. Why is this so?
Historically,
African American women have suppressed emotion, masked difficulties, and
maintained a code of silence. This Strong
Black Woman identity and superwoman mentality of needing to be self-reliant,
invulnerable, selfless, resilient, and psychologically, physically and emotional
strong has been passed down generation to generation and dates back to their
coping mechanisms in dealing with slavery and oppression. Unfortunately, this may also prevent them from
reaching out for needed support. Instead,
their coping mechanisms may include overeating, smoking, and alcohol and drug
abuse.
Culturally in the African American community, there is a
stigma associated with seeking mental and emotional health. Treatment is considered a sign of weakness. In addition, African American women often
present to healthcare providers well-groomed and deny feeling depressed because
they don’t want to be seen as not spiritually strong or lacking self-control. Their depression often manifests as somatic
complaints of GI distress, chronic pain, palpitations, dizziness, fatigue or
sleep disturbances which are more socially acceptable than sadness, depression
or difficulty concentrating. They enter
treatment at a later, more advanced stage and are often misdiagnosed and
undertreated. They not only have poorer
access to care, but also are less likely to be prescribed and/or fill
prescriptions for antidepressants or receive non-pharmacologic treatment. Faced with seeking care from a healthcare
professional who is most often European American and who lacks familiarity with
the language and behavioral mannerisms of African American culture, it is not
surprising that support is preferentially sought through social networks and
from African American community or religious leaders.
So, what can be done to address these disparities and provide
more effective, culturally sensitive care for African American women? My colleague suggests a holistic approach that
takes into consideration biopsychosocial-spiritual components including
environmental, socioeconomic, health and cultural factors. As healthcare providers, if we are cognizant of
and sensitive to the Strong Black Woman Archetype and the importance of
spirituality and the faith-based community, we will be better at gaining the
trust of our patients and addressing their mental health needs.
Judith Wolf, MD Associate Director, WHEP
Bernice Roberts Kennedy, PhD, PMN-CNS, BC and Chalice
Jenkins, PhD, LPC, NCC
African
American Women and Depression: Promoting the Need for Culturally Competent
TreatmentBRK Global Healthcare Journal, 2018, 978-1-5323-4858-7
