African Americans & Mental Health
Let’s Talk Facts About Mental Health in the African American
Community
African American communities across the United States are more
culturally diverse now that any other time in history with increasing numbers of
immigrants from African nations, the Caribbean, Central America and other countries. To
ensure African American communities have access to adequate and affordable care, a better
understanding of the complex role that cultural backgrounds and diverse experiences play
in mental disorders in these communities is vital.
Access
to Care
According to the National Institute of Mental Health, these and other diverse
communities are underserved by the nation’s mental health system. For example, one
out of three African Americans who need mental health care receives it. Compared to the
general population, African Americans are more likely to stop treatment early and are less
likely to receive follow-up care. Despite recent efforts to improve mental health services
for African Americans and other culturally diverse groups, barriers remain in access to
and quality of care from, insurance coverage to culturally competent services. For those
with insurance, coverage for mental health services and substance use disorders is
substantially lower than coverage for other medical illnesses such as hypertension and
diabetes. Historically, mental health research has been based on Caucasian and European
based populations, and did not incorporate understanding of racial and ethnic groups and
their beliefs, traditions and value systems. Culturally competent care is crucial to
improving utilization of services and effectiveness of treatment for these
communities.
Cultural
Issues
Culture, which is understood to be a combination of common heritage
beliefs, values and rituals are an important aspect of racial and ethnic communities.
African Americans are a resilient people who have withstood enslavement and discrimination
to lead productive lives and build vibrant communities. Throughout U.S. history, the
African American community has faced inequities in accessing education, employment, and
health care. However, strong social, religious, and family connections have helped many
African Americans overcome adversity and maintain optimal mental health. Many Americans,
including African Americans, underestimate the impact of mental disorders. Many believe
symptoms of mental illnesses, such as depression, are “just the blues.” Issues
of distrust in the health care system and mental illness stigma frequently lead African
Americans to initially seek mental health support from non-medical sources. Often, African
Americans turn to family, church and community to cope. The level of religious commitment
among African Americans is high. In one study, approximately 85 percent of African
Americans respondents described themselves as “fairly religious” or
“religious” and prayer was among the most common way of coping with stress.
Because African Americans often turn to community – family, friends, neighbors,
community groups and religious leaders – for help, the opportunity exists for
community health services to collaborate with local churches and community groups to
provide mental health care and education to families and individuals. Studies have shown
that family participation in a support group or a church group can improve the
family’s ability to care for family members with mental disorders and cope with the
emotional distress of being a
caregiver.
Rates
of Mental Disorders
Rates of mental illnesses in African American communities are similar
to those of the general population. Most individuals are able to maintain good mental
health. However, many are in desperate need of mental health treatment. Culturally diverse
groups often bare a disproportionately high burden of disability resulting from mental
disorders. This disparity does not stem from a greater prevalence rate or severity of
illness in African Americans, but from a lack of culturally competent care, and receiving
less or poor quality care. For some disorders, such as schizophrenia and mood disorders,
there is a high probability of misdiagnosis because of differences in how African
Americans express symptoms of emotional distress. And while the rate of substance use
among African American is lower than other ethnicities, alcohol and drugs are responsible
for more deaths in the African American community than any other chronic disease in the
U.S.
Conclusion
Cultural identity encompasses distinct patterns of belief and practices
that have implications for one’s willingness to seek treatment from and to be
adequately served by mental health care providers. More research must be done to better
understand mental health disparities and to develop culturally competent interventions for
African Americans. With proper diagnosis and treatment, African Americans – like
other populations – can increasingly better manage their mental health and lead
healthy, productive lives.
©
Copyright 2008 American Psychiatric Association/See IGBATMHO Disclaimer
Depression and Diabetes
Introduction
Depression can strike anyone, but people with
diabetes, a serious disorder that afflicts an estimated 16 million Americans,1 may be at greater risk. In addition, individuals with depression
may be at greater risk for developing diabetes. Treatment for depression helps people
manage symptoms of both diseases, thus improving the quality of their lives.
Several studies suggest that diabetes doubles
the risk of depression compared to those without the disorder.2
The chances of becoming depressed increase as diabetes complications worsen. Research
shows that depression leads to poorer physical and mental functioning, so a person is less
likely to follow a required diet or medication plan. Treating depression with
psychotherapy, medication, or a combination of these treatments can improve a patient's
well-being and ability to manage diabetes.
Causes underlying the association between
depression and diabetes are unclear. Depression may develop because of stress but also may
result from the metabolic effects of diabetes on the brain. Studies suggest that people
with diabetes who have a history of depression are more likely to develop diabetic
complications than those without depression. People who suffer from both diabetes and
depression tend to have higher health care costs in primary care.3
Despite the enormous advances in brain
research in the past 20 years, depression often goes undiagnosed and untreated. People
with diabetes, their families and friends, and even their physicians may not distinguish
the symptoms of depression. However, skilled health professionals will recognize these
symptoms and inquire about their duration and severity, diagnose the disorder, and suggest
appropriate treatment.
Depression is a serious medical condition that
affects thoughts, feelings, and the ability to function in everyday life. Depression can
occur at any age. NIMH-sponsored studies estimate that 6 percent of 9- to 17-year-olds in
the U.S. and almost 10 percent of American adults, or about 19 million people age 18 and
older, experience some form of depression every year.4,5 Although available therapies alleviate symptoms in over 80
percent of those treated, less than half of people with depression get the help they need.5,6
Depression results from abnormal functioning
of the brain. The causes of depression are currently a matter of intense research. An
interaction between genetic predisposition and life history appear to determine a person's
level of risk. Episodes of depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever its origins,
depression can limit the energy needed to keep focused on treatment for other disorders,
such as diabetes.
Diabetes is a disorder that impairs the way
the body uses digested food for growth and energy. Most of the food we eat is broken down
into glucose, a form of sugar that provides the main source of fuel for the body. After
digestion, glucose passes into the bloodstream. Insulin, a hormone produced by the
pancreas, helps glucose get into cells and converts glucose to energy. Without insulin,
glucose builds up in the blood, and the body loses its main source of fuel.
In type 1 diabetes, the
immune system destroys the insulin-producing beta cells of the pancreas. This form of
diabetes usually strikes children and young adults, who require daily or more frequent
insulin injections or using an insulin pump for the rest of their lives. Insulin
treatment, however, is not a cure, nor can it reliably prevent the long-term complications
of the disease. Although scientists do not know what causes the immune system to attack
the cells, they believe that both genetic factors and environmental factors are involved.
Type 1 diabetes accounts for about 5 to 10
percent of diagnosed diabetes in the United States, occurs equally in males and females,
and is more common in Caucasians. Symptoms include increased thirst and urination,
constant hunger, weight loss, blurred vision, and extreme fatigue. If not treated with
insulin, a person can lapse into a life-threatening coma.
Type 2 diabetes, which
accounts for about 90 percent of diabetes cases in the United States, is most common in
adults over age 40. Affecting about 6 percent of the U.S. population, this form of
diabetes is strongly linked with obesity (more than 80 percent of people with type 2
diabetes are overweight), inactivity, and a family history of diabetes. It is
more common in African Americans, Hispanic Americans, American Indians, and
Asian and Pacific Islander Americans. With the aging of Americans and the alarming
increase in obesity in all ages and ethnic groups, the incidence of type 2 diabetes has
also been rising nationwide.
Type 2 diabetes is often part of a metabolic
syndrome that includes obesity, high blood pressure, and high levels of blood lipids.
People with type 2 diabetes first develop insulin resistance, a disorder in which muscle,
fat, and liver cells do not use insulin properly. At first, the pancreas produces more
insulin, but gradually its capacity to secrete insulin falters, and the timing of insulin
secretion becomes abnormal. After diabetes develops, insulin production continues to
decline.
Symptoms include fatigue, nausea, frequent
urination or infections, unusual thirst, weight loss, blurred vision, and slow healing of
wounds or sores. Some people have no symptoms at all. Researchers estimate that about
one-third of people with type 2 diabetes don't know they have it.
Many people with type 2 diabetes can control
their blood glucose by following a careful diet and exercise program, losing excess
weight, and taking oral medication. However, the longer a person has type 2 diabetes, the
more likely he or she will need insulin injections, either alone or together with oral
medications.
Gestational diabetes develops
during pregnancy. Like type 2 diabetes, it occurs more often in African Americans,
American Indians, Hispanic Americans, and people with a family history of diabetes. Though
it usually disappears after delivery, the mother is at increased risk of getting type 2
diabetes later in life.
Get Treatment for Depression
While there are many different treatments for
depression, they must be carefully chosen by a trained professional based on the
circumstances of the person and family. Prescription antidepressant medications are
generally well-tolerated and safe for people with diabetes. Specific types of
psychotherapy, or "talk" therapy, also can relieve depression. However, recovery
from depression takes time. Antidepressant medications can take several weeks to work and
may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in
the same way. Prescriptions and dosing may need to be adjusted.
In people who have diabetes and depression,
scientists report that psychotherapy and antidepressant medications have positive effects
on both mood and glycemic control.2 Additional trials will
help us better understand the links between depression and diabetes and the behavioral and
physiologic mechanisms by which improvement in depression fosters better adherence to
diabetes treatment and healthier lives.
Treatment for depression in the context of
diabetes should be managed by a mental health professional—for example, a
psychiatrist, psychologist, or clinical social worker—who is in close communication
with the physician providing the diabetes care. This is especially important when
antidepressant medication is needed or prescribed, so that potentially harmful drug
interactions can be avoided. In some cases, a mental health professional that specializes
in treating individuals with depression and co-occurring physical illnesses such as
diabetes may be available. People with diabetes who develop depression, as well as people
in treatment for depression who subsequently develop diabetes, should make sure to tell
any physician they visit about the full range of medications they are taking.
Use of herbal supplements of any kind should
be discussed with a physician before they are tried. Recently, scientists have discovered
that St. John's wort , an herbal remedy sold over-the-counter and promoted as a treatment
for mild depression, can have harmful interactions with some other medications.
Remember, depression is a treatable disorder
of the brain. Depression can be treated in addition to whatever other illnesses a person
might have, including diabetes. If you think you may be depressed or know someone who is,
don't lose hope. Seek help for depression. Reprinted from NIMH. NIMH is not affiliated with
IGBATTMHO in any way.
From Surgeon General's Report
CHAPTER 3
Mental Health Care for African Americans
Conclusions
African Americans have made great strides in
education, income, and other indicators of social well-being. Their improvement in social
standing is marked, attesting to the resilience and adaptive traditions of African
American communities in the face of slavery, racism, and discrimination. Contributions
have come from diverse African American communities, including immigrants from Africa, the
Caribbean, and elsewhere. Nevertheless, significant problems remain:
1. African Americans living in the
community appear to have overall rates of distress symptoms and mental illness similar to
those of whites, although some exceptions may exist. One major epidemiological study found
that the rates of disorder for whites and blacks were similar after controlling for
differences in income, education, and marital status. A later, population-based study
found similar rates before accounting for such socioeconomic variables.
Furthermore, the distribution of disorders may be different between groups, with African
Americans having higher rates of some disorders and lower rates of others.
2. The mental health of African
Americans cannot be evaluated without considering the many African Americans found in
high-need populations whose members have high levels of mental illness and are
significantly in need of treatment. Proportionally, 3.5 times as many African Americans as
white Americans are homeless. None of them are included in community surveys. Other
inaccessible populations also compound the problem of making accurate measurements and
providing effective services.
The mental health problems of persons in
high-need populations are especially likely to occur jointly with substance abuse
problems, as well as with HIV infection or AIDS (Lewin & Altman, 2000). Detection,
treatment, and rehabilitation become particularly challenging in the presence of multiple
and significant impediments to well-being.
3. African Americans who are
distressed or have a mental illness may present their symptoms according to certain idioms
of distress. African American symptom presentation can differ from what most clinicians
are trained to expect and may lead to diagnostic and treatment planning problems. The
impact of culture on idioms of distress deserves more attention from researchers.
4. African Americans may be
more likely than white Americans to use alternative therapies, although differences have
not yet been firmly established. When complementary therapies are used, their use may not
be communicated to clinicians. A lack of provider knowledge of their use may interfere
with delivery of appropriate treatment.
5. Disparities in access to mental
health services are partly attributable to financial barriers. Many of the working poor,
among whom African Americans are overrepresented, do not qualify for public coverage and
work in jobs that do not provide private coverage. Better access to private insurance is
an important step, but is not in itself sufficient. African American reliance on public
financing suggests that provisions of the Medicaid program are also important. Publicly
financed safety net providers are a critical resource in the provision of care to African
American communities.
6. Disparities in access
also come about for reasons other than financial ones. Few mental health specialists are
available for those African Americans who prefer an African American provider.
Furthermore, African Americans are overrepresented in areas where few providers choose to
practice. They may not trust or feel welcomed by the providers who are available. Feelings
of mistrust and stigma or perceptions of racism or discrimination may keep them away.
7. African Americans with
mental health needs are unlikely to receive treatment—even less likely than the
undertreated mainstream population. If treated, they are likely to have sought help from
primary care providers. African Americans frequently lack a usual source of health care as
a focal point for treatment. African Americans receiving specialty care tend to leave
treatment prematurely. Mental health care occurs relatively frequently in emergency rooms
and psychiatric hospitals. These settings and patterns of treatment undermine delivery of
high-quality mental health care.
8. African Americans are
more likely to be incorrectly diagnosed than white Americans. They are more likely to be
diagnosed as suffering from schizophrenia and less likely to be diagnosed as suffering
from an affective disorder. The pattern is longstanding but cannot yet be fully explained.
9. Whether African Americans
and whites benefit from mental health treatment in equal measure is still under
investigation. The limited information available suggests African Americans respond
favorably for the most part, but few clinical trials have evaluated the response of
African Americans to evidence-based treatments. Little research has examined the impact on
African Americans of care delivered under usual conditions of community practice. More
remains to be learned about when and how treatment must be modified to take into account
African American needs and preferences.
Adaptive traditions have sustained African
Americans through long periods of hardship imposed by the larger society. Their resilience
is an important resource from which much can be learned. African American communities must
be engaged, their traditions supported and built upon, and their trust gained in attempts
to reduce mental illness and increase mental health. Mutual benefit will accrue to African
Americans and to the society at large from a concerted effort to address the mental health
needs of African Americans. FYI: Please
read entire report at http://www.mentalhealth.org/cre/toc.asp
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