I Don't Want Anybody to Know I'm Struggling: Attitudes and Beliefs about Formal Depression Care Among Older, Church-Attending, African American Men

Background and Purpose: Research demonstrates that Black communities have lower lifetime rates of depression than other racial groups. Despite lower lifetime prevalence, the severity of depression experienced by African Americans is consistently higher. This pattern is also reflected in the experiences of older African Americans, with men being less likely to receive formal depression care. Despite these mental health disparities, our understanding of how African American communities conceptualize and manage their mental health issues is limited. Thus, this study adds to the literature by examining older African Americans men’s attitudes and beliefs about formal depression care.

Methods: This study analyzed in-depth focus group data of church-affiliated, African American men (N=21; aged 50-87). Potential participants were made aware of the study information by clergy in one of three churches in Michigan. Participants provided informed consent to participate in the study and received a compensation of $50 cash for their participation. Participants were asked about their attitudes and beliefs toward depression and depression care in four key content areas: attitudes and beliefs, seeking treatment, physical health treatment versus mental health treatment, and religion and depression. The focus groups were audio-taped and transcribed by a professional transcription company. The classic manual content analysis of the transcribed focus group interviews followed a five-step data analysis procedure.

Results: Results from the focus group data analysis revealed three major thematic foci: 1) shared beliefs regarding barriers to seeking treatment for depression, 2) the modalities in which care is offered, and 3) the interdependence of spirituality and formal depression care. Attitudes about formal depression care varied based on the modality of care (i.e. psychotherapy, psychiatric medication, combination of spiritual and formal depression care). Findings of specific attitudes and beliefs about formal depression care included: emotional and financial barriers to treatment seeking, willingness to attend psychotherapy, medication skepticism, the necessity of mental health professionals, and the interdependence of spirituality and clinical practices for overall depression care.

Conclusions and Implications: Discussed in the context of a lack of trust with formal mental health treatment was participant’s reluctance to use medication as a modality of care for depression. Psychiatric medication is a well-documented concern for African American clientele, with both a reduced desire for this treatment method and some non-adherence presenting as common problems. We recommend mental health programming to address psychiatric medication stigma, mistrust in psychotherapy and unhealthy masculinity and pride when considering formal depression treatment. Furthermore, we encourage the creation of culturally tailored psychoeducation about the benefits of medication for depression care within Black church communities. For future research, we highlight the importance of examining the relationship between historical racial trauma within the healthcare field and present-day beliefs about formal mental healthcare. Future research should also examine additional barriers to treatment faced by older African American men and provide comprehensive assessments of culturally appropriate treatment modalities for this population.