Barriers to Treatment and Cultural Coping Strategies for African American Older Adults With Depression

Purpose. Despite the gains in research on the stigma associated with mental illness, there continues to be a lack of literature to addresses the impact of stigma on attitudes toward seeking mental health treatment in elderly populations, particularly among African American older adults. In addition, there is a gap in the empirical research which examines the experiences of the stigma associated with having a mental illness from the perceptions of individuals who feel stigmatized themselves. This study aims to qualitatively examine the experiences of depression and stigma among older African Americans with depression and to investigate how experiencing multiple, concurrent stigmas (e.g. mental illness, aging and racial minority status) impacts treatment seeking attitudes and behaviors in this population.

Methods. Study participants included 20 African American older adults, with at least mild depression symptoms who scored 5 or above on the Patient Health Questionnaire (PHQ). Eighty five percent of interview participants were female (n= 17). Participants' age ranged from 67 to 94 years old, with a mean of 77. Face-to-face semi-structured interviews were conducted. The primary analytic approach utilized was theme-based content analysis using the ATLAS.ti qualitative data analysis program. Transcripts were first in-vivo coded (line-by-line), and patterns of codes were combined to form categories of data, which were then expanded into sub-themes and finally into broad themes.

Results. Thematic analysis yielded four broad yet inter-connected themes: 1) depression among older African Americans; 2) barriers to seeking treatment; 3) cultural coping strategies; and 4) outcomes for African American older adults with depression. The experience of depression among older African Americans impacted: the endorsement of cultural beliefs that value keeping mental health private and that reject the biological etiology of the illness and greater stigma in the black community, which at least partially from the lack of information about mental health. Participant experiences created barriers to treatment including: stigma, lack of faith in treatment, access issues, mistrust, and ageism. Therefore, older African Americans in this study engaged in a number of cultural coping strategies to deal with their depression: handling depression on their own, pushing through it, and turning treatment over to God. These experiences, barriers and strategies however led to a number of negative outcomes for sample participants including: difficulty recognizing depression, choosing to deny and hide depression rather than find an effective way to treat it. Participants were however, willing to seek mental health treatment for their grandchildren, creating a unique opportunity to engage older African Americans in treatment.

Implications. This study demonstrates the need for more culturally competent mental health treatment interventions. Social workers can receive more training in developing culturally competent mental health treatment interventions to enhance their skills for working with the population, particularly African American elders, who may have high levels of mistrust, and doubt the effectiveness of mental health treatment. Findings from this study suggest a number of treatment strategies to enhance clinicians competence to work with older African Americans as well as assuage their perceived barriers to care.

Project Funded by Hartford Dissertation Fellowship