Treatment Disparities among African American Men with Depression: Implications for Clinical Practice

Abstract

A decade has passed since the National Institute of Mental Health initiated its landmark Real Men Real Depression public education campaign. Despite increased awareness, depressed African American men continue to underutilize mental health treatment and have the highest all-cause mortality rates of any racial/ethnic group in the United States. We review a complex array of socio-cultural factors, including racism and discrimination, cultural mistrust, misdiagnosis and clinician bias, and informal support networks that contribute to treatment disparities. We identify clinical and community entry points to engage African American men. We provide specific recommendations for frontline mental health workers to increase depression treatment utilization for African American men. Providers who present treatment options within a frame of holistic health promotion may enhance treatment adherence. We encourage the use of multidisciplinary, community-based participatory research approaches to test our hypotheses and engage African American men in clinical research.

Race/ethnicity and Americans’ experiences with treatment decision making

“…The observed variations in information sharing by patients' race and ethnicity indirectly suggest that physicians' implicit bias may negatively affect their communication and in turn, their relationships with minority patients, which could have negative effects on patient-centered communication and lead to health disparities. Trust has been identified in the literature to be a crucial element in achieving better health outcomes [28][29][30]. As such, our findings indirectly suggest rapport-building behaviors can potentially reduce disparities by enhancing trust between clinicians and racial/ethnic minority patients.…”

Smoking, depression, and hospital costs of respiratory cancers: Examining race and sex variation

“…Further, these higher cost trends held up by race and gender whereby black and male patients had higher costs compared to their white and female peers. The higher costs among black LC patients suggest that black patients may either have poor access to healthcare providers (due to lower insurance, poor symptom recognition, and/or late referrals, 79–82 or reluctant to seek medical care during the early stages of disease especially if depressed, 83 or blacks may experience more aggressive disease, 84 or blacks may get involved late in progression of their disease with the healthcare system). In any case, this late involvement may lead to more complex medical conditions which requires longer hospital stay and thus higher costs for blacks.…”

“…First, since smoking reduction has contributed to reductions in cancer mortality, 87 there is a great need to continue implementing culturally appropriate, evidence-based tobacco cessation programs in the most vulnerable groups; blacks are prominent among such groups. Programs might include American Cancer Society guidelines 83 to reinforce other healthy choices (nutritional and exercise) as well as individualized counseling by service providers that includes both patient empowerment as well as greater use of the “Quit Line” services. Lowering smoking rates through such proven programs would not only be beneficial in reducing healthcare costs (estimated at $12.1 billion for lung cancer 88 ), but may also reduce cancer morbidity and mortality.…”

Depression Treatment Status of Economically Disadvantaged African American Older Adults

“…As suggested by Critical Race Theory (CRT), this finding is linked to the systemic structural underpinning of mental health treatment barriers to depression among AA populations [45,46]. On an institutional level, treatment disparities for older AAs are linked to structural racism and discrimination, cultural mistrust, provider stereotypes and bias [62]. Even though older AAs who have a larger network of health care providers and more chronic conditions are more likely to receive depression treatment, the effects of racial disparities continue to persist.…”

“…Comparing the middle-aged and the oldest (75 years and older) participants, middle-aged participants had a higher probability of belonging to the untreated group of survey respondents. The odds of untreated depression increased 2.471 times (95% CI: 1.187-5.146) for middle aged participants (55)(56)(57)(58)(59)(60)(61)(62)(63)(64), compared with participants with no depression. Similarly, respondents with no high school diploma were 0.542 times (95% CI: 0.591-0.904) less likely to be untreated for depression, compared with participants who have a high school diploma.…”