Search Strategies And Scoring System
An extensive literature search was conducted using the following strategies: electronic searches: Academic Search, ERIC, Psych INFO, Social Sciences full text, PubMed, CINAHL, MEDLINE Plus, and COCHRANE Library. Medical subject headings categories entered singly and in combination were depression, depressive disorder, African American men, and Black men. Manual searching was used to identify references in articles found from electronic searches and to locate these articles in Web of Knowledge. Titles and abstracts were reviewed, and articles meeting inclusion criteria were retrieved and reviewed.
An objective scoring system, adapted from the Jadad criteria to reduce article selection bias, helped determine which articles met inclusion criteria . Using the adapted Jadad scoring system, each study was rated for eligibility. The scoring system included the dimensions listed below, which were scored from 0 to 5 .
- Study conducted in the United States and article published in English.
- Hypotheses or research questions and objective of the study clearly stated.
- Patient population describedâsociodemographic information .
- Data analyses separated by race and ethnicity allowed differential implications for depression in African American men to be determined.
- Study design study procedures .
- Outcome measures .
- ResultsâData collected and analyzed according to each hypothesis or research question, and study results were presented specific to African American men.
Implications For Clinical Practice
There are several entry points through which to engage African American men in depression care. A model that integrates community engagement with improved clinical care was recently cited as a promising way to reduce disparities.69 In line with this care model, we encourage the dissemination of mental health outreach and psycho-education in trusted community settings frequented by men of color, such as barbershops, churches, and fraternities. Engaging African American men in these community settings has improved health outcomes for hypertension and cancer,70,71 but their use in depression is limited.66 We also support the dissemination of depression screenings through the internet. This online platform can anonymously screen a large number of individuals,72 and the confidentiality may be appealing for African American men.
To improve clinical care, we have specific recommendations for frontline mental health workers, e.g., mental health professionals, primary care physicians, and faith leaders who are likely to encounter depressed African American men. We shall subsequently refer to these frontline mental health workers as âproviders.â
Description Of The Current Study
Previously described limitations in depression measurement highlight the importance of engaging Black men directly to determine their depression experience. Concept mapping, a structured mixed methods approach to organize and operationalize stakeholders views on a particular research topic, is one such method that provides further evidence towards clarifying stakeholder-driven narratives about health . The method combines qualitative data collection procedures and quantitative analytic approaches to create a pictorial representation of stakeholder inputs about a topic. In this study, we employed concept mapping to generate conceptualizations of how depressive symptoms were described in a community-based sample of Black men and their stakeholders. By employing a concept mapping approach to refine our understanding of the depression experience, Black men and their stakeholders are directly involved in the critical preliminary stages of scale refinement processes.
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Providers Should Explore Their Own Racial Biases
Many providers hold unconscious stereotypes about African American men that can negatively affect assessment and treatment.33 To address these internalized racial biases, it is important to conduct trainings for providers at multiple time periods across their career. Betancourt et al.94 have implemented a curriculum to increase awareness, impart knowledge, and teach cross-cultural skills to medical students over the four years of their graduate education. Longitudinal courses taught in small groups create safe environments for students to more openly discuss racism and their own internalized biases. We encourage providers to pursue âcultural humility,â which involves a lifelong commitment to self-evaluation and self-critique regarding the position of power that clinicians hold over all patients.95 Providers can attend on-going educational forums to explore their own racial identities and unconscious perceptions about other racial groups. Educational trainings in health care settings have been effective at reducing health care professionalsâ fears, biases, and resistance to working with culturally diverse patients.96
For Black Men Higher Education And Incomes Dont Lower Risks Of Depression Researchers Say
More education and higher incomes are associated with a lower risk of depression and discrimination for white people and black women.
But for high-achieving black men, more success actually increases the likelihood they will experience symptoms of depression and anxiety.
Thats the conclusion of Shervin Assari and T.J. Curry, researchers who have spent decades studying depression in, and discrimination against, black men in the United States.
In an article in The Conversation, they discuss the results of six studies that show an inverse effect between black mens achievement and adverse mental health outcomes.
One long-term study followed 681 black youths over 18 years. For black male participants, an increase in perceived racial discrimination between ages 20 and 23 was correlated with increased anxiety and depression symptoms as they grew older.
Another, which compared black men with black women, white men and white women over the course of 25 years, found that men with higher educational credentials also experienced more depressive symptoms.
According to our studies, regardless of their economic success and personal ambitions, black males are still perceived as more threatening and dangerous than their female counterparts, Assari and Curry write. Race alone may not be the issue here. Instead, it is an issue of race and gender, that may stem from hopelessness, inequality and blocked opportunities.
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Mental Health Resources For Black And African American Communities
- Black Emotional and Mental Health : BEAM is a training, movement building and grant making organization dedicated to the healing, wellness, and liberation of Black communities. BEAM envisions a world where there are no barriers to Black Healing.
- Toolkits & Education: graphics on accountability, self-control, and emotional awareness journal prompts articles on Black mental health
- Videos: trainings and webinars, recorded and available for free
Study Identifies Risk And Protective Factors For Depressive Symptoms In African
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ATLANTAAfrican-American men report an average of eight depressive symptoms in a month, with family support, mastery, self-esteem, chronic stressors and discrimination among the factors that are significant to their psychological health, according to a new study led by researchers at Georgia State University.
Although African-Americans are less likely than whites to meet the criteria for major depressive disorder, they are at increased risk for depressive symptoms. Few studies have focused on identifying the risk and protective factors that contribute to depressive symptoms in African-American men, which this study addresses.
The researchers determined the stress process model, a framework for understanding health and health inequalities, was useful for identifying psychosocial risk and protective factors in African-American men, explaining about half of the depressive symptoms. The findings could be beneficial for directing health initiatives and policies aimed at improving the psychological health of this population.
The findings are published in a special issue on the Psycho-social Influences of African-Americans Mens Health in the Journals of Gerontology: Psychological Sciences.
Various scales were also used to assess socioeconomic status , social stressors, daily discrimination, perceived social support, mastery and self-esteem.
Co-authors of the study include Drs. Ben Lennox Kail and Amy Spring and Ph.D. student George R. Greenidge Jr.
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Build Trust Through A Collaborative Clinical Partnership
Providers must build a therapeutic alliance that preserves African American menâs masculinity and cultural identity, allays cultural distrust associated with the health care system, and acknowledges psychosocial stressors unique to African American men.40 This is no easy task. Providers can ask African American men about previous clinical encounters with the health care system. Providers should allow patients to describe any negative encounters and micro-aggressions they may have had with health care professionals. Providers who use this line of inquiry acknowledge that this kind of disrespect may be subtle and difficult to describe.73,74 This line of inquiry may come as a surprise to most African American men, because it is not something typically addressed by mental health workers. However, it acknowledges the historically negative treatment of African American men in everyday situations.54,75
We encourage providers to explicitly tell African American male patients that they want to earn their trust. Inviting African American men to be active participants in their treatment decision-making process is one way to build trust.76 Though it may be more time consuming in the short-term, encouraging African American men to clearly articulate any reservations about treatment can be extremely empowering and may result in greater compliance in the long-term.
Education Assessment: Depression Among African American Males
Depression is a significant mental health concern for most Americans today. However, not everyone admits to having a mental illness due to various social factors like prejudice and social stigma. For instance, studies document that African American men rarely seek medical assistance when suffering from depression. Friends and families play a crucial role in influencing whether an individual accepts a diagnosis and subsequent treatment. Jones is a sixty-two years old black man from Queensland New York who has suffered mental illnesses for several years. Most recently, he was diagnosed with depression, but he has not accepted this medical diagnosis, nor does he acknowledge that he has a chronic mental illness. An interview revealed the association between ethnicity and the recommended treatment for psychological disorders by friends and families for senior citizens under primary care. Most importantly, this trend among blacks affects their willingness to learn more about mental illnesses.
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Use Of Risk Factor Knowledge
Results of the present review suggest there are a myriad of factors that increase African American menâs risk for MDD, including demographic, socioeconomic status, social issues, and other psychological and medical conditions. As documented by Gary , one could speculate that the interaction of increased sociocultural factors could partly contribute in enhancing the chronicity patterns of depression among Black men in comparison with White men. However, some of these risk factors among African American men include social issues and psychological and medical conditions that might be modifiable. For example, Okwumabua et al.âs findings can be used to stress the importance of and inform prevention work for African American men with specific medical conditions. In doing so, effective, culturally appropriate treatment and after-care planning for Black men with medical problems, including hypertension, arteriosclerosis, and circulatory problems, can be devised to assess and monitor depression. The ultimate goal is to prevent or decrease the likelihood of untreated depression co-occurring with these and other medical conditions that are more common among African American men.
Overview Of Concept Mapping Process
Data was collected from October 2017 to January 2018 in Durham, North Carolina in three phases: brainstorming sorting and interpretation. The lead author facilitated each phase and audio recorded sessions with stakeholders. The brainstorming phase consisted of group discussions during which participants were asked to brainstorm or free list ideas related to the focal question: What are distinct characteristics of depression among Black men? Two brainstorming sessions were conducted in-person with Black men and Black women, respectively. Primary care providers completed the brainstorming activity online due to time constraints. During the sorting phase, participants individually organized the list of brainstormed items into piles based on conceptual similarity. Participants labeled piles independently based on how they perceived the items related to each other. At baseline, participants completed a brief survey comprised of demographic information and an assessment of depressive symptoms using the Center for Epidemiological Studies Depression 12-item scale . The research protocol for our concept mapping study was approved by the Institutional Review Board at University of North Carolina at Chapel Hill and all study procedures were performed in accordance with relevant guidelines and regulations set forth by the institution. Informed written consent to participate in the study was obtained from all participants prior to the study initiation.
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Implications For Research And Practice: Where Do We Go From Here
Nineteen articles focusing on depression among African American men were identified in the current review. However, some of these articles used the same data set , which suggests the number of empirical studies conducted examining depression among African American men in the past 25 years is low we estimate 15 total. However, all of the studies included in the present review make a significant contribution to the literature focusing on African American men and depression.
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Clinical Depression Can Affect Anyone
Anyone can experience clinical depression, regardless of race, gender, age, creed or income. Every year more than 19 million Americans suffer from some type of depressive illness. According to a Surgeon General report, Black Americans are over-represented in populations that are particularly at risk for mental illness. Depression robs people of the enjoyment found in daily life and can even lead to suicide. A common myth about depression is that it is normal for certain people to feel depressedolder people, teenagers, new mothers, menopausal women, or those with a chronic illness. The truth is that depression is not a normal part of life for any Black American, regardless of age or life situation. Unfortunately, depression has often been misdiagnosed in the Black community.
Risk Factors For Depression Among African American Men
Thirteen studies were identified that met inclusion criteria for the present review focusing on risk factors for MDD among African American men. Of these studies, two focused on the role of discrimination as a potential risk factor for depression among African American men. In particular, one study examined the association between discrimination and specific anxiety and depressive symptoms as independent outcomes. This examination used gender as a moderator to illuminate the intersections of gender, mental health, and discrimination. Data for the study derived from the 1995 Detroit Area Study . DAS used a multistage area probability sample involving face-to-face structured interviews in a cross-sectional design. The sample consisted of 570 adult participants, of whom 390 were Black men. The results indicated that although Black men reported more perceived everyday discrimination than did Black women, there were no differences noted in depressive symptoms across gender.
The remaining 14 studies focused on various risk factors for MDD among African American men, including demographics, socioeconomic status, social issues, psychological status, and other medical health problems .
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Use Of Informal Support Networks
Social support networks have a complex role in help seeking for depressed men: they can either facilitate the use of professional services or be a barrier to seeking specialty care.58,59 When African American men do seek help for mental health problems, they are more likely to rely exclusively on informal help.60 Family and social support appear to create a sense of community for health issues among African American men. Studies have found that high levels of intrusive behaviors by family members predicted better mental health outcomes for African Americans compared with Whites.61 African American men also appear to be more likely to seek help from men with whom they share common characteristics, such as similar age and economic status.62
Depression In The Black Male Population
Depression in the Black Male Population
It was found that there was a significantly higher prevalence of depression in Black men when compared to the general population, with many factors involved. In addition, there is an issue of misdiagnosis, because there are culturally expressed Major Depressive Disorder symptoms that many professionals overlook. These findings lead to the conclusion that there needs to be more awareness of these culturally expressed symptoms in order to avoid potential misdiagnoses. With the reduction of stigma around seeking professional help in regards to mental health, there would be more exposure to these culturally expressed symptoms and fewer cases of misdiagnoses.
Stigma
Expectations
Socioeconomics
Discrimination
As seen in recent events, Black men in America face a lot of racism and discrimination. They are judged on their external appearance, but not their internal value, so they do not get the opportunities that their White counterparts may get. Because of the harsh treatment they get or see others that look like them get it is discouraging them from believing they have equal rights as everyone else. The stress from discrimination can very much attribute to depressive symptoms in the population. Simple activities like driving can be life-threatening to them because of what they have seen happen around them.
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