Socio-Cultural Barriers to Care and Recovery Among Black Americans with Depression

Purpose: Depression is a major mood disorder affecting up to 8% of the U.S population. Evidence suggests that prognosis and recovery rates for this disorder are very good, given the right treatments and supports. However many do not engage with mental health services. This is especially the case for minorities such as Black Americans, who have the lowest service engagement rates in the country. Also, their symptoms of depression tend to be more severe and persistent. The bulk of the research investigating this disparity tends to focus on financial and structural barriers to care and recovery. Much research indicates that Black Americans are more likely than Whites to be poor, lack insurance, or live in areas where accessing mental health care is difficult. However research has also shown that even among employer-insured, non-poor Black Americans, low rates of service use persist. Thus the aim of this study is to assess self-reported socio-cultural barriers to service engagement and recovery among Black Americans, to better understand low rates of service utilization.

Method: In-depth, semi-structured interviews were conducted with 17 Black American men and women, aged 21-57, who had recently experienced depression.  All interviews were audio-recorded with the participants’ permission using a digital recorder and transcribed verbatim.  HyperResearch software was used to code and analyze the transcribed interviews and to detect relevant themes.  The study was propelled by a grounded theory approach.

Results: Analysis suggested three socio-cultural barriers that impeded service engagement and recovery. These are: 1) conflict between racial/ethnic and illness identities, for example the idea that ‘strong black woman’ should not get depressed; 2) stigma in Black communities impeding service utilization; and 3) culturally-shaped ideas of “help” for depression, for example that religious practices like prayer (‘talking to God’) will help more than talking to a therapist. 

Conclusions and Implications: This study is a detailed examination of the experience of Black Americans with depression.  Not only does it give a voice to the oft silenced Black American depression sufferer, but it also highlights the importance of investigating a wider range of barriers to care and recovery among Black Americans with depression.  It introduces important socio-cultural factors in the treatment and recovery process for clinicians to consider when working with a Black American clientele.  It also offers areas to target for intervention to increase service rates and improve care and recovery among Black Americans with depression.