Identifying Inequities in Mental Healthcare for African American Women IPV Survivors

Background and Purpose: Depression and post-traumatic stress disorder (PTSD) are the most common adverse mental health outcomes among survivors of intimate partner violence (IPV) and African American women are disproportionately impacted. African American IPV survivors are more likely to be exposed to more lethal forms of abuse, predictive of poorer mental health outcomes. African American IPV survivors are less likely to seek mental health care, which may account for higher rates of homicide. Despite dire outcomes, there is a dearth of literature that examines empirically tested, culturally appropriate mental health interventions for African American women IPV survivors. This systematic review seeks to close this gap.

Methods: Five electronic databases (PubMed, Ebscohost, Social Science Database, Social Sciences Full Text, and Social Work Abstracts) were used with the following search keywords: (1) intimate partner violence, partner violence, or domestic violence (2) depression or anxiety (3) PTSD (4) intervention or therapy; (5) African American women or Black women. Grey literature was conducted as well. A total of 1,276 studies were identified, and studies were selected for the document type (peer-reviewed, journal-article), language (English), and the author’s institutional affiliation (USA). Inclusion criteria were as follows: study that includes (1) African American IPV survivors aged over 18 in the sample (2) interventions related to depression and/or PTSD (3) evaluations of the interventions. Articles about interventions unrelated to African American IPV survivors with depression or PTSD were excluded. Ultimately, 22 articles were included. Data of each article were collected, capturing research design, sample demographics, intervention types, durations, and settings, findings, and cultural adaptation.

Results: Traditional and novel interventions were used to treat depression and PTSD among African American women IPV survivors. Community-based interventions were largely effective to treat depression. A range of cognitive treatments were most effective for remitting PTSD symptomology. Cognitive and mindfulness-based interventions were employed to treat survivors who presented with depression and PTSD. Interventions were effective when they were culturally appropriate, multi-faceted, and employed community-based approaches. Intervention satisfaction was high when delivered within African American communities or by African American female providers. Participation dropout rates were low when services for childcare, food, financial assistance, and transportation were provided.

Conclusions and Implications: This review elucidates the urgent need to deliver mental health services for the most vulnerable population of IPV survivors: African American women. It further underscores the need to provide culturally responsive, community-based interventions. Survivors’ tenuous relationship with the mental health system and their diminished trust in traditional care illuminates survivors’ proclivity towards receiving community-based services that are nested within the Black community. This review has implications to the level and nature that mental health services are delivered to this underserved populations of survivors. Importantly, this review provides insights to reducing mental health inequities among African American women experiencing IPV.