Resilience and Stigma Influence Older African Americans Seeking Care

Article excerpt

Abstract: Background: Stigma affects older adults' willingness to describe depressive symptoms to health care personnel and others. Specific aims targeted associations among depressive symptoms, resilience, stigma and willingness, predictors of willingness, and estimated causal effects. Methods: A cross-sectional, correlational design was used; 1 58 participants from community agencies and churches participated. Multivariate analyses of variance and multiple regression data analyses were used. Principal components analysis was conducted to determine patterns among the items within specified scales. Results: Internal consistency reliability for each scale was 0.84 or above. Significant correlations between depressive symptoms and stigma (p < 0.05), between resilience and willingness (p < 0.0001), and single items were examined. Influences on willingness to seek mental health care for depressive symptoms unrelated to depressive symptom scores were revealed. Conclusions: Resilience influenced older African American 's willingness to seek care for depressive symptoms. Exploration of early interventions to reduce depressive symptom escalation in older adults is warranted.

Key Words: Resilience, Stigma, Older African Americans, Depressive Symptoms, Seeking Care

It is not uncommon for community dwelling older adults to experience chronic illnesses, isolation, and social changes such as retirement, loss of emotional support, loneliness as forms of loss associated with vulnerability and depressive symptoms (Naik, Kunik, Cassidy, Nair, & Coverdale, 2010, Reynolds, Haley, and Kozlenko, 2008). Older adults with depressive symptoms tend to be at risk for inflammation associated with several chronic co-morbid conditions (Hamer, Molloy, Oliveira, & Demakakos, 2009). Estimates of the prevalence of older adults with depressive symptoms and co-morbid conditions vary from 9% to 20% across studies (Gum, King-Kallimanis, & Kohn, 2009). Lifetime estimates for prevalence of mental illness reveal that it affects one of four Americans and is a leading form of disability (Aron, et al., 2009). Associations among chronic medical conditions, including cancer, and depression are well documented, and patients contend with multiple medication regimes (Zhang et al., 2009) mat often result in readmission to acute care facilities (Mills, 2009). Personal communication with healthcare personnel in intensive care units and emergency departments reveal objectifying and disparaging, uninformed labeling of patients who require multiple readmissions as 'frequent flyers' (Mills, 2009). Older adult patients may appear capable of self-care but may choose to alter the recommended plan of care while at home (Gould & Mitty, 2010), which may result in an increase in symptoms, loss of function, and an increase in associated health costs and use of resources (Centers for Disease Control and Prevention, 2008) though treatment may occur outside the inpatient setting (Reynolds, 2008). This paper presents findings from a study exploring relationships among stigma, resilience, and willingness to seek care for depressive symptoms in a sample of community dwelling older African Americans.

The study purpose was to explore influences of stigma, depression, and resilience on willingness among African Americans in Oklahoma, aged 65 and over to seek care for depressive symptoms. Seeking care is defined as talking with a health care worker or provider about depressive symptoms. Identifying the influence of specified variables on 'willingness' may prove useful for developing interventions encouraging older adults to seek professional healthcare for depression and better manage their mental and physical health. Three specific aims and associated research questions (RQ) were proposed:

1) explore potential associations among depressive symptoms, the stigma associated with depression, personal resilience, and willingness to seek mental health care for depressive symptoms: RQ) What are the associations among the specified variables? …