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Depression Among African Americans

Depression among African Americans is often either under-diagnosed or misdiagnosed and therefore African Americans are less likely to receive appropriate treatment and to achieve successful outcomes. [Bailey 2011] In fact, a study by Williams and colleagues found that fewer than half (45%) of African Americans who met the criteria for requiring treatment of depression actually received any form of therapy. [Williams 2007] Some of this inadequate treatment is due to shortcomings in the US healthcare system, including factors such as: [Primm 2010]

  • Failure of primary care providers to make appropriate referrals to mental health professionals
  • Insufficient cultural competence skills among mental health professionals, limiting their ability to appropriately diagnose and treat mental disorders in African Americans
  • Lack of health insurance coverage, or inadequate coverage, due to poverty or unemployment

African American cultural factors also account for some of the inadequate diagnosis and treatment of depression and other mental disorders. Such factors include:[Das 2006]

  • African American cultural differences regarding how the symptoms of mental disorders are expressed and the degree to which symptoms are tolerated
  • Greater reliance on crisis services, such as emergency departments, for healthcare, which is associated with higher probability of inadequate treatment outcomes
  • Use of alternative sources, rather than healthcare providers, for help with psychological issues—eg, religious institutions, family, folk treatments
  • Dependence on primary care physicians, rather than mental health specialists, when help for mental disorders is in fact sought

Among some African Americans, depression is regarded as inconsistent either with African Americans’ sense of individual and cultural resilience (shaped by centuries of slavery and subsequent socioeconomic disadvantage) or with the teachings of deeply held religious beliefs. As a result, African Americans often lack knowledge of the symptoms of depression or may express what they are feeling in culturally sanctioned ways, which can take a wide variety of forms:

    • Denial of the reality of mental health problems
    • Somatization—ie, the unconscious expression of emotional distress as physical symptoms (For example, tension or other stress may be expressed in the form of a headache.) [Robins 1991]
    • Falling out—ie, fainting or dizziness as a result of emotional distress or anxiety [Weidman 1979]
    • John Henryism—a strategy for coping with prolonged exposure to stresses by expending high levels of effort, resulting in the accumulation of health costs [Neighbors 2007, Angner 2011]

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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center