“We Pride Ourselves on Being Strong…and Able to Bear a lot”: Examining the Socio-Cultural and Historical Context of Black Americans’ Experiences with Depression and Help-Seeking
Research consistently shows that Black Americans’ symptoms of depression are more severe and persistent than their white counterparts yet they seek out and/or use services at a far lower rate. While trying to understand this disparity, it is important that researchers explore the socio-cultural and historical context around Black Americans’ experiences with depression and help-seeking. This study involved semi-structured in-depth interviews with 17 Black American men and women, aged 21-57, who experienced depression. A thematic analysis revealed that Black Americans’ experiences are often rooted in a socio-cultural and historical context where Black people are seen as a strong people, able to deal with anything, and do not get depressed. These findings suggest that Black Americans may go through a process of reconciling being depressed with certain aspects of their cultural identity as they strive to better understand themselves, their illness, and options to help alleviate their symptoms. Researchers and practitioners alike should pay more attention to this complex process as they attempt to understand the illness experiences and help-seeking behaviors of Black Americans.
Alang, S. M. (2016). “Black folk don't get no severe depression”: Meanings and expressions of depression in a predominantly black urban neighborhood in Midwestern United States. Social Science & Medicine, 157, 1-8. doi: https://doi.org/10.1016/j.socscimed.2016.03.032
Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C., Takeuchi, D., Jackson, J., & Meng, X. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264-1272. doi: https://doi.org/10.1176/ps.2008.59.11.1264
Alegría, M., Lin, J. Chen, C., Duan, N., Cook, B., & Meng, X. (2012). The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Services Research, 47(3 Pt 2), 1322-1344. doi: https://doi.org/10.1111/j.1475-6773.2012.01403.x
Anderson, C. M., Robins, C. S., Greeno, C. G., Cahalane, H., Copeland, V. C., & Andrews, R. M. (2006). Why lower income mothers do not engage with the formal mental health care system: Perceived barriers to care. Qualitative Health Research, 16(7), 926-943. doi: https://doi.org/10.1177/1049732306289224
Angel, R., & Thoits, P. (1987). The impact of culture on the cognitive structure of illness. Culture, Medicine & Psychiatry, 11(4), 465-494. doi: https://doi.org/10.1007/BF00048494
Bagley, S. P., Angel, R., Dilworth-Anderson, P., Liu, W., & Schinke, S. (1995). Panel V: Adaptive health behavior among ethnic minorities. Health Psychology, 14(7), 632-640. doi: https://doi.org/10.1037/0278-622.214.171.1242
Beauboeuf-Lafontant, T. (2007). “You have to show strength”: An exploration of gender, race, and depression. Gender & Society, 21(1), 28-51. doi: https://doi.org/10.1177/0891243206294108
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 1-41. doi: https://doi.org/10.1191/1478088706qp063oa
Broman, C. (1987). Race differences in professional help seeking. American Journal of Community Psychology, 15, 473-489. doi: https://doi.org/10.1007/BF00915215
Burlew, A. K. (2003). Research with ethnic minorities: Conceptual, methodological, and analytical issues. In G. Bernal, J. E. Trimble, A. K. Burlew, & F. T. L. Leong (Eds.), Handbook of racial & ethnic minority psychology (pp. 179-197). Thousand Oaks, CA: Sage.
Capers, C. F. (1991). Nurses’ and lay African Americans’ beliefs about behavior. Western Journal of Nursing Research, 13(1), 123-135. doi: https://doi.org/10.1177/019394599101300109
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Fabrega, H., Jr. (1989). Cultural relativism and psychiatric illness. The Journal of Nervous and Mental Disease, 177(7), 415-425. doi: https://doi.org/10.1097/00005053-198907000-00005
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine.
Good, B. J. (1997). Studying mental illness in context: Local, global or universal? Ethos, 25(2), 230-248. doi: https://doi.org/10.1525/eth.19126.96.36.199
Hines-Martin, V., Malone, M., Kim, S., & Brown-Piper, A. (2003). Barriers to mental health care access in a Black American population. Issues in Mental Health Nursing, 24, 237-256. doi: https://doi.org/10.1080/01612840305281
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602. doi: https://doi.org/10.1001/archpsyc.62.6.593
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627. doi: https://doi.org/10.1001/archpsyc.62.6.617
Keyes, K. M., Hatzenbuehler, M. L., Alberti, P., Narrow, W. E., Grant, B. F., & Hasin, D. S. (2008). Service utilization differences for Axis I psychiatric and substance use disorders between White and Black adults. Psychiatric Services, 59, 893-901. doi: https://doi.org/10.1176/ps.2008.59.8.893
Kleinman, A. (1980). Major conceptual and research issues for cultural (anthropological) psychiatry. Culture, Medicine and Psychiatry, 4(1), 3-13. doi: https://doi.org/10.1007/BF00051939
Kleinman, A. (1988). Rethinking psychiatry: From cultural category to personal experiences. Free Press: New York.
Kleinman, A. (1992). Local worlds of suffering: An interpersonal focus for ethnographies of illness experience. Qualitative Health Research, 2(2), 127-134. doi: https://doi.org/10.1177/104973239200200202
Lopez, S. R., & Guarnaccia, P. J. J. (2000). Cultural psychopathology: Uncovering the social world of mental illness. Annual Review of Psychology, 51, 571-598. doi: https://doi.org/10.1146/annurev.psych.51.1.571
Matthews, A. K., & Hughes, T. L. (2001). Mental health service use by Black American women: Exploration of subpopulation differences. Cultural Diversity and Ethnic Minority Psychology, 7(1), 75-87. doi: https://doi.org/10.1037/1099-9809.7.1.75
Murray, C. B. (2001). Culture as a determinant of mental health. In N. J. Smelser & P. B. Baltes (Eds.), International encyclopedia of the social and behavioral sciences (pp. 3143-3147). Amsterdam: Pergamon. doi: https://doi.org/10.1016/B0-08-043076-7/03837-7
Olafsdottir, S., & Pescosolido, B. A. (2009). Drawing the line: The cultural cartography of utilization recommendations for mental health problems. Journal of Health and Social Behavior, 50, 228-244. doi: https://doi.org/10.1177/002214650905000208
Redmond, M. L., Galea, S., & Delva, J. (2009). Examining racial/ethnic minority treatment experiences with specialty behavioral health service providers. Community Mental Health Journal, 45, 85-96. doi: https://doi.org/10.1007/s10597-008-9164-5
Rostain, A. L., Ramsay, J. R., & Waite, R. (2015). Cultural background and barriers to mental health care for African American adults. Journal of Clinical Psychiatry, 76(3), 279-283. doi: https://doi.org/10.4088/JCP.13008co5c
Scheff, T. (1966). Being mentally Ill: A sociological theory. Chicago: Aldine.
Schnittker, J., Freese, J., & Powell, B. (2000). Nature, nurture, neither, nor: Black-White differences in beliefs about the causes and appropriate treatment of mental illness. Social Forces, 78(3), 1101-1132. doi: https://doi.org/10.1093/sf/78.3.1101
Small, M. L., Harding, D. J, & Lamont, M. (2010). Reconsidering culture and poverty. The Annals of the American Academy of Political and Social Science, 629(1), 6-27. doi: https://doi.org/10.1177/0002716210362077
Stewart, M., Makwarimba, E., Barnfather, A., Letourneau, N., & Neufeld, A. (2008). Researching reducing health disparities: Mixed methods approaches. Social Science & Medicine, 66, 1406-1417. doi: https://doi.org/10.1016/j.socscimed.2007.11.021
Thompson, V. L. S., Bazile, A., & Akbar, M. (2004). Black Americans’ perceptions of psychotherapy and psychotherapists. Professional Psychology: Research and Practice, 35(1), 19-26. doi: https://doi.org/10.1037/0735-7028.35.1.19
U. S. Department of Health and Human Services [USDHHS]. (1999). Mental health: A report of the Surgeon General. Rockville, MD: National Institute of Mental Health. Retrieved from https://profiles.nlm.nih.gov/ps/access/NNBBHS.pdf
USDHHS. (2001). Mental health: Culture race and ethnicity-a supplement to mental health: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Retrieved from http://health-equity.lib.umd.edu/866/1/sma-01-3613.pdf
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629-640. doi: https://doi.org/10.1001/archpsyc.62.6.629
Ward, E. C., & Brown, R. L. (2015). A culturally adapted depression intervention for African American adults experiencing depression: Oh Happy Day. American Journal of Orthopsychiatry, 85(1), 11-22. doi: https://doi.org/10.1037/ort0000027
Williams, D. R., Gonzalez, H. M., Neighbors, H., Neese, R., Abelson, J. M., Sweetman, J., & Jackson, J. S. (2007). Prevalence and distribution of major depressive disorder in Black Americans, Caribbean Blacks, and Non-Hispanic Whites: Results from the National Survey of American Life. Archives of General Psychiatry, 64(3), 305-315. doi: https://doi.org/10.1001/archpsyc.64.3.305