Nursing Focus and Depression in the African American Community

Introduction

Clinicians have traditionally assumed that young African-American mothers who were suffering from depression could receive the appropriate dose of medication as a contemporary psychological treatment,  and be able to live a normal life (Waite, 2008). However, mental illness is an example of the type of challenge that is dealt with in vastly different ways depending on background, community and other socio-economic factors. While the health risks and ailments that face diverse populations require nurses to focus on improving and maintaining health; an evolving view of nursing argues that public health provisions extend beyond sick care and encompass advocacy, education and socio-political reform (Kulbok, Thatcher, Park & Meszaros, 2012).

Patient Advocacy

Patient advocates are any individual or group which serves as a liaison between patients and health care providers or decision making organizations. Advocacy groups can be research and policy-oriented (like the American Cancer Society or Mothers against Drunk Driving) or they can be individuals who wish to raise money and awareness for a cause. African-American women tend to reside in low-income housing, with inadequate access to public transportation and traditional medical care in suitable hospitals and clinics. With good patient advocates, some attention can be given to this issue at a local, state and federal level. Advocacy could help award local communities with another clinic or a non-profit to aid with counseling and the dispensing of medication to those in need. Systemic changes to the conditions that perpetuate stress and depression could also be looked at over time.

For example, African American women are disproportionately affected by single-parent households that face the struggle and frustration of unemployment in an economy that is unfriendly to job creation. In fact, joblessness is a major factor which has increased depression cases as a whole and especially within the African American community (Waite, 2008). Patient advocates could work to link patients with governmental agencies that ease the burden of one’s economic depravity. Too many of life’s decisions seem to be out of an individual’s direct control. Community and patient advocacy on behalf of this at-risk population can improve individual health outcomes and relieve the strain on the health system as a whole (Waite, 2008).

Against Patient Advocacy. When nurses advocate for at-risk populations within schools, hospitals, clinics and other institutions that serve them; they are working to give voice to a silent minority and improve overall health outcomes. In essence, nursing should benefit urban, ethnically diverse, impoverished women across the country with preventative health mechanisms that provide truly holistic care (Doornbos, Zandee, & DeGroot 2012). This is a public health good that anyone would be behind except for its cost. Advocating systemic changes to an already overburdened institution ignores an unhappy reality: social programs aid a few who have greater needs than the average patient and cannot sustain itself. Not only will small segments of the population drive up the total cost of healthcare for everyone, but, these at-risk groups do not add revenue to the system at all and can drain it and cause an eventual collapse (Feldstein, 2005).

Education

Research has shown that women who have children earlier in life tend to have more children and are more susceptible to depression. The number of young black mothers in America versus young white mothers, provide statistical support for the contention that African-American mothers are more apt to encounter depression due to earlier pregnancies and more children, in conjunction with higher rates of infant mortality (Spence, Adkins, & Dupre 2011). Sex education at the middle school and high school level could greatly decrease the incidences of pregnancies among young and ill-prepared mothers.

Notably, education is the key to prevention and to lessening the impact of a negative view of depression diagnosis and the need for treatment. Black women must understand the importance of clinical treatment and the power of a diagnosis as an opportunity to get help and continue to care for children and loved ones. However, for many in the black community, to be perceived as mentally unstable is a sign of weakness. Being taught to assess the relative strength of a healthy person on medication versus an unhealthy person without medication could remedy the feeling of embarrassment, shame, and guilt associated with the condition (Waite, 2008).

Thirty-six African-American women between the ages of eighteen and sixty-four who had been diagnosed with depression were studied in nurse-led focus groups. Women were asked their ideas of depression in general, their own depression, depression treatment and their families’ perceptions of these topics. The basic results of these studies showed that women lacked the vocabulary to identify and define depression. Women negatively judged themselves for something that, according to most medical professionals, is out of a person’s control. For example, “Angela” confessed that she was uncomfortable with the idea because “if you sound too nuts people won’t know how to take you (Waite, 2008).

The study also showed a general distrust of the existing health system. It also showed that eighty-six percent of patients preferred to manage symptoms through the use of alternative methods of treatment: such as professional or pastoral counseling, prayer, meditation, yoga or creative writing. Most of the women combined one or two of these methods with medication, but none of them relied solely on prescriptions to ease their condition. Overall, the results of the study concluded that nurses have the power to help client to seek out their own ways of dealing with depression (Waite, 2008; Spence, Adkins & Dupree, 2011).

Against More Education. Opportunities to provide at-risk populations with more education about their health are few and far between. Patients tend to seek help when they have reached a breaking point or are already in health crisis mode. By respecting the client’s own views on her depression at a time when she is likely not rational, fully educated or accurate, nurses walk a delicate balance between dishonesty and full-out misrepresentation of services. Moreover, nurses must be very careful about referencing the health care system and medication which is likely to be a key component of the patient’s lack of information. By encouraging the client to participate in group sessions rather than suffering in solitude, patients can gain access to information and resources without necessarily compromising the integrity of the system meant to help the patient without adding layers of confusion (Waite, 2008).

Socio-Political Reform

A study was done at the Children’s National Medical Center in the District of Columbia in 2010 by research nurses Stephanie J. Mitchell and Cynthia R. Ronzio. Mitchell and Ronzio (2010) focus on “triggers” for African-American mothers (specifically, mothers of children two to eighteen months old) such as community violence and negative life events by which, research shows, this demographic is disproportionately affected by.

Further, research focuses on three main psychosocial factors: personal strengths, social attachments and a sense of cultural/ethnic identity. This study commenced with a questionnaire with the State-Trait Anxiety Inventory (STAI), a system that has in the past proven to provide internal consistency. The first part used a four-point scale to identify areas of exposure, using questions asking things like how often has the women heard a gunshot, or how often has she seen someone else (not herself) being beaten up. Key data collected in surveys like this one are important in any effort to introduce social and political legislation that can improve the lives of this at-risk demographic (Mitchell & Ronzio, 2010).

Against Socio-Political Reform. The research of Mitchell and Ronzio (2010) serves as a prime example of the problems with allowing new research to set social and political agendas. Researchers admit limitations in testing that hold significant sway over the perception of results. For example, researchers did not factor in over-reporting on events or under-reporting on resources. Researchers also failed to survey mothers to find out their thoughts on or history of instigating or perpetrating violence against other people. Researchers failed to directly address racial and gender discrimination factors, opting instead to focus on violence within the community, and the psychosocial resources employed by women in dealing with it (Mitchell & Ronzio, 2011). In contrast to men in the same position, women were sixty percent more likely to suffer from anxiety and seventy percent more likely to have clinical depression (Mitchell & Ronzio, 2011).

Conclusion

African-American women across the country are a group that is at high risk for depression and anxiety; specifically, mothers. While clinicians may make note of how counseling and drug therapies could benefit a patient who faces mental illness, there is a backstory that should be considered. Social stigma makes the use of antidepressants alone inadequate in the treatment of clinical depression in the African-American community, a fact which is especially problematic in the homes of single mothers who are already faced with low income and other conditions which amplify the mental health condition (Waite, 2008; Doornbos, Zandee & DeGroot 2012). While the health risks and ailments that face diverse populations require nurses to focus on improving and maintaining health; an evolving view of nursing argues that public health provisions extend beyond sick care and encompass advocacy, education and socio-political reform (Kulbok, Thatcher, Park & Meszaros, 2012).

References

Doornbos, M., Zandee, G., & DeGroot, J. (2012). Clinging to any bit of joy: Urban, ethnically diverse, impoverished women's descriptions of anxiety and depression. Archives of Psychiatric Nursing, 26(6), 437-447.

Feldstein, M. (2005). Rethinking social insurance. American Economic Review, 95(1), pp. 1–24.

Kulbok, P.A., Thatcher, E., Park, E. and Meszaros, P.S. (May 31, 2012) Evolving public health nursing roles: Focus on community. Online Journal of Issues in Nursing. Vol. 2.

Mitchell, S., & Ronzio, C. (2011). Violence and other stressful life events as triggers of depression and anxiety: What psychosocial resources protect African American mothers? Maternal & Child Health Journal, 15(8), 1272-1281.

Spence, N., Adkins, D., & Dupre, M. (2011). Racial differences in depression trajectories among older women: Socioeconomic, family, and health influences. Journal of Health and Social Behavior, 52(4), 444-59.

Waite, R. (2008). Perceptions of treatment for depression among underserved African American women. JOCEPS: The Journal of Chi Eta Phi Sorority, 53(1), 14-19.