Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults

Department of Psychiatry, School of Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Aging and Mental Health (Impact Factor: 1.75). 11/2010; 14(8):971-83. DOI: 10.1080/13607863.2010.501061
Source: PubMed


Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services.
A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data.
Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults.
Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

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    • "There are many services available based on geographic region and eligibility: HIV case management, nutrition services, peer support, mental health, home-based medical care, and housing services, among many others. It is especially critical, however, to consider the impact of the range of service utilization in the context of depression, and vice versa, given that the salience and perceived stigma of depression are often shown to be barriers to accessing service (e.g., Conner et al., 2010; Nadeem et al., 2007). Overall, the impact of service utilization, including those addressing substance abuse (e.g., Brown et al., 2006; Selwyn, 1996), mental health problems (e.g., Feldman, Weinberg, & Wu, 2012; Small, 2010), or affordable housing (e.g., Dasinger & Speiglman, 2007; Egan & Hoagland, 2006), can be quite profound for HIVϩ MSM. "
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    ABSTRACT: Stigma and stress may place HIV-positive men who have sex with men (HIVϩ MSM) at risk for depression. Additionally, HIVϩ MSM might utilize multiple HIV-related services as a way to gain support for, and more effectively manage, HIV-related stressors. Although prior research has demonstrated that depression severity and utilizing support services are associated with functional or dysfunc-tional coping strategies, researchers have not investigated the impact of different coping combinations— specifically, the concurrent use of functional and dysfunctional strategies—in this population. Thus, we explored (a) how items on 1 measure of coping, the Brief COPE, capture HIV-related coping of HIVϩ MSM using Principal Components Analysis, (b) how HIVϩ MSM's coping groups into unique combinations , and (c) how these coping combinations relate to depression and the scope of HIV-related support service utilization. Our sample consisted of 170 HIVϩ MSM engaged with medical care. Results indicated the use of both functional and dysfunctional coping strategies. Unique combinations of functional and dysfunctional strategies showed differential associations with depression and the extent of HIV-related support service utilization. Specifically, individuals who engaged in low levels of both functional and dysfunctional coping, compared with individuals who more frequently engaged in functional coping strategies, were significantly less likely to use a range of critical HIV-related services. Individuals who reported frequent use of dysfunctional coping strategies, regardless of functional coping strategy use, reported higher levels of depression. Therefore, providers should continue to focus more closely on identifying functional coping strategies and reducing dysfunctional coping when working with HIVϩ MSM.
    03/2015; 2(1):96-105. DOI:10.1037/sgd0000091
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    • "service use, and the belief that depression is not a disease ; all of these factors have been reported previously (Crabb and Hunsley, 2006; Conner et al., 2010b). In addition , difficulty in performing activities and IADL were also associated with help-seeking behavior, which agrees with the previous factors reported by Evashwick and colleagues in the context of the Andersen's model of health services utilization (Evashwick et al., 1984). "
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    ABSTRACT: Objective Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling that something is wrong and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. MethodsA cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. ResultsA total of 2322 individuals were studied; from these, 67.14% (n=1559) were women, and the mean age was 73.18years (SD=7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help ((2)=81.66, p<0.0001), significant variables were female gender (odds ratio (OR)=0.7, 95% confidence interval (CI) 0.511-0.958, p=0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p=0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. Conclusions Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms. Copyright (c) 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 12/2013; 28(12). DOI:10.1002/gps.3953 · 2.87 Impact Factor
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    • "Depression. Depression was assessed using the validated nine-item Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & Williams, 2001), which has been used extensively among older adults (Arean, Hegel, Vannoy, Fan, & Unuzter, 2008; Connor et al., 2010; Unutzer et al., 2008). A score under 5 indicates minimal to no depression and scores of 5 or higher indicates mild to severe depression. "
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    ABSTRACT: The objective of this article is to test the effectiveness of a multifaceted exercise and nutritional education intervention for chronically ill, community-dwelling older adults. A pre/post cohort design was implemented with measures of physical activity, fitness, depression, and anthropometry collected via 4-month in-person interview and telephone follow-up. The study was conducted at two community-based senior centers in the Los Angeles area and participants (n=62) were older adults aged 60 or older, with multiple chronic conditions, with one or more emergency department visits or hospital admissions in the previous 6 months, and at nutritionally moderate to high risk. The intervention was a fitness program providing nutritional counseling, low-impact exercise, and weight management. Results revealed significant improvements for hours of weekly exercise (Z = −4.3, p < .001), daily walking distance (Z = −5.7, p < .001), performance on fitness tests, depression (Z = 3.9, p < .001), and body measurements were observed. Findings speak to the healthy benefits of exercise and good nutrition as possible alternatives or adjuncts to pharmacotherapy for weight loss and depression.
    Journal of Applied Gerontology 10/2013; 32(7):889-901. DOI:10.1177/0733464812440043 · 0.97 Impact Factor
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