Depression and African Americans
- Created on May 14th, 2008
- By Annelle Primm, M.D., M.P.H.
Depression is a highly common medical condition affecting nearly one out of 10 adults each year, and twice as many women as men. African Americans are no exception. Depression can cause long-standing changes in feelings, self-esteem, activity level and even sleep and appetite. Depression is treatable with medication, psychotherapy and other treatments, which result in 80-90% of people eventually responding well and almost all gaining some relief from their symptoms. However, African Americans carry a heavy burden when it comes to depression because they are less likely than Caucasians to seek mental health services or to receive proper diagnosis and treatment. They are also more likely to have depression for longer periods, resulting in greater disability.
The disparities in mental health for African Americans are based on factors of economics and cultural experiences. High levels of poverty and marginal incomes just above the poverty line affect many African Americans, making them more likely to wait to seek treatment for mental health needs until they reach a crisis point and emergency intervention is needed. They often do not have ready access to primary care where mental health problems can be identified and treated in the early stages. Often family values and traditions are a barrier to seeking help as well. There is a long practice of being stoic and "toughing out" troubles that implies that seeking mental health services is a sign of weakness.
The prominence of religion in the African American community also plays a factor. Many people who could benefit from professional mental health care are urged to rely on faith and prayer much more than therapy. In many instances, seeking counseling is considered a sign of a lack of faith in God and the healing power of divine intervention.
Another cause of disparity is the tradition of suspicion toward medication in the black community, caused by substandard treatment by health care professionals over the years such as the infamous Tuskegee Syphilis Experiment. This distrust limits the treatment options for African Americans who generally prefer counseling and therapy.
Lack of insurance coverage also contributes to disparities for African Americans. This results in a reliance on government and non-profit agencies offering mental health services that are subject to diminishing or stagnant budgets. Discrimination in reimbursement to mental health service providers can limit the access of even African Americans who have employment-based insurance coverage.
Racism permeates the culture and economy of this country and is the main barrier to mental health care for black Americans, creating economic disparities and social conditions that are truly distressing. Many African Americans living in poverty reside in areas beset by alcohol outlets, open air drug markets, high incarceration rates, high rates of homelessness, and large numbers of children in foster care without permanent homes, which all have an impact on mental health.
Achieving optimal mental health among African Americans will involve overcoming the myth that it is weak to admit that one is depressed and in need of professional help. Institutions from universities to the religious community and health services providers must help eliminate the stigma associated with seeking mental health treatment. A recent book, Black Pain: It Just Looks Like We're not Hurting by Terrie Williams uses celebrities' stories to raise awareness in the black community about the importance of getting help for depression and other mental health needs. The faith community especially must also aid in this effort and encourage their parishioners to seek mental health treatment.
Depression in the African American community is often triggered by social conditions, and a societal solution such as universal health care can help reduce the impact of depression. With finances removed from the healthcare equation, African Americans who are less likely to receive care for depression than their white counterparts and who tend to stay sick longer would benefit most through early screening and intervention. Perhaps even more important, we need to engage in a sustained and massive effort to eliminate the stigma of seeking mental health services. People need to know that depression is real, depression is treatable and that help is available.
Dr. Annelle Primm will appear in an upcoming PBS panel discussion on depression with Jane Pauley, following the broadcast of the documentary DEPRESSION: Out of the Shadows on May 21 at 9 p.m. (check local listings).