Health Beliefs regarding Depression among a Cohort of African ...

1. Health Beliefs regarding Depression among a Cohort of African American Women Roberta Waite, EdD, RN, MSN, CS

3. Overview: Depression Depression Is an important public health problem among vulnerable populations The World Health Organization has projected that major depression will be the second highest cause of disability after heart disease in all countries by 2020 The U.S. Surgeon General has brought attention to the problem of unrecognized and untreated depression among underserved groups

4. Depression and Culture The way depression is confronted, discussed, and managed varies among social worlds, and cultural meanings and practices shape its course. Culture influences: the experience of symptoms and shapes the idioms used to report them as well as perceptions of causes decisions about treatment doctor-patient interactions the likelihood of outcomes and the practices of professionals is inextricably connected with economic, political, psychological, and biologic conditions. culture is not a static phenomenon

5. Interplay of Culture and Health Culture: is inextricably connected with economic, political, psychological, and biologic conditions. is not a static phenomenon Beliefs about health are influenced by culture, social background experience of health/illness and exposure to health promotion.

6. Depression Assessment and Treatment Earlier detection Prompt intervention Patient centered care Evidence based practice Prevention of increased mortality Must be aware of how different cultural contexts influence what individuals know and believe about depression

7. Social Contextual Nature of Distress May also influence women�s beliefs about, and preferences for, intervention strategies. African American women experiencing depression may be more likely to view their depressive symptoms as an expected reaction to stress, thereby �normalizing� them. A normalizing attributional style has been associated with the lowest rate of depression detection in primary care patients when compared with those who attributed symptoms to psychological distress or physical problems

8. The Study Cross sectional, exploratory, qualitative study Health Belief Model Focus groups with 14 women diagnosed with depression within the year prior to the study NMHCC Northeast region of the US

9. Purpose To gain an improved understanding of health beliefs regarding depression among African American women It is not the intention of this study to assess the correctness of participants� responses (from the biomedical perspective). The intent is to clearly present their knowledge and beliefs about depression

10. Health Belief To understand how people think about health events, the Health Belief Model offers a useful framework by describing four factors that can be assessed which influence health related decision-making. health motivation one�s susceptibility to depression: perceived vulnerability perceived costs and benefits individual perceptions: perceived seriousness This social-psychological model was chosen because of its focus on considerations of the patient's perceptions of their illness and response to it.

11. Health Motivation The individual�s perception of health matters and the degree to which they are motivated to change it. Varies enormously , � may correlate with personality, social class, ethnic group, religion etc etc.

12. Perceived Vulnerability How vulnerable or threatened one feels about a particular disease.

13. Perceived Costs and Benefits The individual�s estimation of the benefits of treatment weighed against cost, risks and inconvenience.

14. Perceived Seriousness Perceived seriousness of leaving the depression untreated Trigger factors such as alarming symptoms, advice from family or friends, messages from the media, disruption of work or play.

15. Health Beliefs About Depression Difficult to elicit Patients frightened of looking �foolish� or �crazy� Patients may be reluctant to �waste a doctors time� with �personal issues�

16. Questions What is your understanding about the cause of depression? How do some individuals develop depression and other�s do not? (susceptibility) What do you think depression does to you? (seriousness) What are the main problems depression causes? What influences your motivation to seek treatment? (benefits) What type of treatment should be provided? What type of treatment is helpful/expected results? Describe why individual may not seek treatment (risks). Who do you think it�s good to talk to about depression? What do you expect from your healthcare provider if you are depressed? Where do you get information from regarding depression?

17. Findings Snowball effect Womens beliefs and understanding of causes for depression (multiple dimensions): The most common recurring themes were traumatic events, weak spirit, poor health, stressful life circumstances, style of coping �problems in life throw you off balance, they snowball� and not having the support or strength to take care of oneself. One fairly common response was that some people get depression and others do not because �people are just different and have different life experiences.�

18. Findings Challenging circumstances Women had high risk factors that made them susceptible to depression Many had family members affected by depression or another mental health disorder and many experienced high stress due to limited resources �Some of this stuff runs in the family but sometimes you don�t know because it�s not talked about. That on top of other stuff pushes you over the edge.�

19. Findings Silent destruction The women felt that depression was very serious �Depression is very serious. It affects all parts of your life and shapes it.� �It�s nothing to play with. You don�t know what�s happening at first but it affects you physically and mentally. I get palpitations, have insomnia...� �Nothing to play with�I have diabetes and I have to be able to function to take care of myself�

20. Findings Plight to regaining perspective Treatment barriers & initiation Influenced by experiential, supportive, financial, system and trust factors �When I really knew I needed help I went to the clinic and they asked me questions and said they�d call me�no one did. This happened twice. I don�t have much faith in those places. When I need something I�ll come to the center here where they know me and they�ll see to it that I get what I need.�

21. Implications Elicit patient�s health beliefs. If any, counter myths and negative attitudes. Inform patient about causes and prognosis Plan an appropriate collaborative course of action with the client to suit their needs, lifestyle, etc.

22. Conclusion Practice concerns. Integrated service activity in primary care settings are valuable. Health care providers should consider: assessment, intervention and treatment measures for depression should include nonmedical factors (socio-cultural) based on a patient's own health beliefs and values developing strategies to identify and address cultural barriers to accessing care for depression among community members partnering with the community to conduct education related to depression to increase awareness of mental health problems, reduce stigma, and promote mental health services that are available in the community

24. Funding

25. Contact Information Roberta Waite, Ed D, MSN, APRN Postdoctoral Research Fellow Center for Health Disparities Research University of Pennsylvania, School of Nursing Lorene@nursing.upenn.edu