Depression, Sociocultural Factors, and African American Women

Article excerpt

The authors discuss depression in African American women from a sociocultural perspective, including aspects of oppression and racism that affect symptom manifestation. The authors highlight John Henryism as a coping mechanism, the history and continuing role of the African American church as a safe haven, and strategies for culturally competent practice.

Los autores discuten la depresion en mujeres Afroamericanas desde una perspectiva sociocultural, incluyendo los aspectos de opresion y racismo que afectan a la manifestacion de los sintomas. Los autores destacan el John Henry-ismo como mecanismo de afrontamiento, la historia y el papel constante de la iglesia Afroamericana como refugio seguro, y las estrategias para una practica culturalmente competente.

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Numerous challenges continue to plague the U.S. mental health care system. Among the most overlooked challenges is the treatment of depression and other mental disorders in African American women, including etiology, diagnosis, and treatment (D. Brown & Keith, 2003; Waite & Killian, 2008). In this article, we examine the misdiagnosis and underdiagnosis of depression in African American women within the context of race, culture, and discrimination. We also delineate culturally competent practice with African American women who present depressive symptoms.

The intersection of race and gender and the experiences of discrimination and prejudice are paramount in defining and understanding the mental health of African American women (D. Brown & Keith, 2003; Canady, Bullen, Holzman, Broman, & Tian, 2008). Behaviors seen in African American women are adaptations to a complex set of gender, generational, chronic, and extreme life stressors (hooks, 1993) and should be viewed in terms of the psychosocial and cultural factors unique to this population. Symptoms may actually be reactionary and adaptive in nature and may act as a buffer that prevents even greater pathology (C. Brown, Schulberg, Madonia, Shear, & Houck, 1996).

The effect across generations of slavery, Jim Crow laws, and continued discrimination means African American women's life experiences are uniquely different than those of Caucasian Americans and even African American men. African American women experience more unfair treatment, are more disadvantaged, and have always been placed at the bottom of the hierarchy in terms of race, sex, and class (Franklin, 2002). Even when socoioeconomic status is equal, African American women are still viewed by their Caucasian counterparts as inferior (Weis & Hall, 2001). Racism is a part of the daily existence of African American women (D. Brown, Keith, Jackson, & Gary, 2003). As a result, coping strategies (e.g., paranoia) are developed by African American women, but Euro-influenced treatment processes perceive these adaptive reactions to social injustices as pathological. Consequently, mental health diagnosis will be inaccurate and treatment ineffective.

epidemiology: incidence and prevalence

Major depressive disorder occurs in about 15% of the general population, with a lifetime prevalence of about 10%-25% in women (Sadock & Sadock, 2003). Estimates of depression rates among African American women are inconsistent at best and limited in generalizability. Although some research has addressed incidence and prevalence rates, such studies have been limited to very unique and nonrepresentative samples of African Americans. Lipscomb et al. (2007) found that 47.8% of low-income African American women poultry workers in North Carolina had depression. Frank, Matza, Revicki, and Chung (2005) had similar findings in terms of depression rates among African American women, as did Schulz et al. (2006) and Collins-McNeil et al. (2007). Lipscomb et al.'s study sample of poor women in North Carolina was very different from both Collins-McNeil et al.'s study sample of African American women with Type II diabetes and Schulz et al. …