When Money Isn't the Issue: Socio-Cultural Factors in Help-Seeking among Black Americans with Depression.

Abstract

From in-depth qualitative interviews with 17 African American men and women between the ages of 21 and 57, this dissertation examines how socio-cultural factors impact help-seeking and service use among Black Americans with depression. This dissertation accomplishes three main objectives: 1) better understand low service use rates for depression among Black Americans by looking beyond strict financial or access-related barriers and towards more social-cultural factors related to health behavior; 2) explore how culture influences health behaviors, particularly those around help-seeking and service use for depression among Black Americans; and 3) identify targets for intervention to decrease the stigma associated with depression and service use in Black communities and increase service use rates for Black Americans who feel they might benefit from services.

Chapter 2 of the dissertation highlighted the importance of examining socio-cultural understandings of identity, illness, and help. I find that being “Black” and “depressed” often exist as two conflicting identities that, until reconciled, can prevent and/or delay Black Americans’ entry into mental health treatment for depression. In Chapter 3 of the dissertation, I find that many respondents see Black communities as particularly stigmatizing toward individuals with depression, many times equating depression and treatment with being non-Black and producing fears of social rejection or ridicule. I also find that many respondents were reluctant to adopt another stigmatizing and potentially marginalizing status, resorting to a sort of double-existence where they hid their depression and sought treatment in silence to maintain both social and professional statuses. Chapter 4 of the dissertation discussed the impact of socio-cultural beliefs on help-seeking and service use among Black Americans with depression. I find that most respondents reported some impact on help-seeking behaviors, particularly on those that involved disclosing symptoms to or seeking help from non-professionals. Chapter 5 discusses the directions of future research, namely considerations for intervention research to improve the mental health service use rates among Black Americans with depression.