“You Don't Go Tell White People Nothing”: African American Women's Perspectives on the Influence of Violence and Race on Depression and Depression Care

Abstract

Objectives-We sought to understand how African American women's beliefs regarding depression and depression care are influenced by racism, violence, and social context.Methods-We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization.Results-Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a "White" system. The image of the "strong Black woman" was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use.Conclusions-Although violence and drug use were central to our participants' understanding of depression, racism was the predominant issue influencing their views on depression care. Providers should develop a greater appreciation of the effects of racism on depression care. Depression care programs should address issues of violence, substance use, and racism.Correspondence should be sent to Christina Nicolaidis, MD, MPH, Division of General Internal Medicine, Oregon Health & Science University, L475, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (nicolaid@ohsu.edu). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link. ContributorsC. Nicolaidis originated the project, obtained funding, and supervised all aspects of the study design and implementation and the writing of the article. V. Timmons contributed to the study design, protocol development, recruitment, data collection and analysis, and the writing of the article. M. J. Thomas and A. Star Waters contributed to the study design, protocol development, recruitment, data collection and analysis, and revision of the article. S. Wahab and A. Mejia assisted the group with data synthesis and contributed to the writing of the article. S. R. Mitchell helped interpret findings, led the public awareness campaign that resulted from the study results, and revised the article. Human Participant ProtectionThis study was approved by the Oregon Health & Science University institutional review board. Participants provided written informed consent before taking part in the focus groups. NIH Public Access Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2011 August 1. NIH-PA Author ManuscriptAlthough it is unclear whether racial disparities in depressive symptoms can be explained by cultural or socioeconomic factors, [1][2][3][4][5][6] there is ample evidence that important differences exist in depression care. African Americans are significantly less likely than Whites to receive guideline-appropriate depression care. 7,8 Several studies have shown that in realworld settings primary care physicians ...

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