Academic journal article Social Work

Engaging Women Who Are Depressed and Economically Disadvantaged in Mental Health Treatment

Academic journal article Social Work

Engaging Women Who Are Depressed and Economically Disadvantaged in Mental Health Treatment

Article excerpt

Converging evidence suggests that women disadvantaged by poverty or racial and ethnic minority status are more likely to experience depression than the rest of the U.S. population (Bruce, Takeuchi, & Leaf, 1991; Kessler, 2003; Kessler & Neighbors, 1986). At the same time, they are less likely to seek or remain in treatment for depression in traditional mental health settings. What might account for this problem, and what can mental health clinicians do about it? Here we briefly describe the problem and then discuss the practical, psychological, and cultural barriers to seeking and remaining in mental health care for women of color and white women who are depressed and economically disadvantaged. Also presented is a description of the engagement interview--not a therapy, per se, but a brief, therapeutic strategy designed to be implemented before treatment to address and resolve barriers to treatment seeking.

DEPRESSION AND LACK OF TREATMENT ENGAGEMENT AMONG ECONOMICALLY DISADVANTAGED WOMEN

Individuals living on low incomes have higher prevalence rates of mental health problems than the general population (U.S. Department of Health and Human Services [HHS], 1999; Williams & Collins, 1995). Longitudinal data, for example, have indicated that poor individuals have twice the risk of major depression, controlling for age, race, socioeconomic status, and history of psychiatric episodes (Bruce et al., 1991). Moreover, being a woman with low socioeconomic status is associated with increased risk of depression. Depression is the leading cause of disability among women in the world today (Murray & Lopez, 1996), with women having twice the risk of depression as men (Kessler, 2003).

For women disadvantaged by poverty and racial or minority status, however, findings are even more disturbing. Nearly one-fourth of African American and Latina women live in poverty, and more than 33 percent of women who head their own household are poor (U.S. Census Bureau, 2004). Women of color and white women who live at or near the poverty line experience at least twice the rate of depression as do women at the middle income level (Hobfall, Ritter, Lavin, Hulszier, & Cameron, 1995). More specifically, high levels of depressive symptoms are common in young minority women who are economically disadvantaged and in mothers with young children who are living on welfare or low incomes, with 25 percent meeting the criteria for major depression (Miranda, Chung, et al., 2003; Siefert, Bowman, Heflin, Danziger, & Williams, 2000). Indeed, epidemiologic studies have documented a peak in first onsets of depression for women in their childbearing and childrearing years (Kessler et al., 1994), which confers a profound mental health risk on child mental health and functioning (Field, 2000).

Despite this increased risk and prevalence of mental health disorders among disadvantaged individuals, many either do not seek mental health services or drop out after an initial visit or after their distress is alleviated (Greeno, Anderson, Shear, & Mike, 1999; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). One study of 1,636 patients with depressive and anxiety disorders observed that over a one-year period, only 25 percent of patients with depressive disorders received appropriate treatment (either pharmacotherapy or psychotherapy). African Americans were less likely to receive appropriate treatment, and among those entering psychotherapy, only half attended at least four sessions (Young, Klap, Sherbourne, & Wells, 2001). In a 2001 supplement to his mental health report (HHS, 1999), the Surgeon General indicated that racial and ethnic minorities, compared with whites, were less likely to receive mental health care, and when they did receive care, it was more likely to be poor in quality. Similarly, in a recent National Comorbidity Survey replication, Wang and associates (2005) found that most people with mental disorders, especially racial and ethnic minorities and those with low incomes, remained either untreated or did not receive minimally adequate treatment. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.