Examining Depression Among African-American Women From a Psychiatric Mental Health Nursing Perspective

Written by Barbara Jones Warren, R.N., M.S., Ph.D.

because she didn't know any better
she stayed alive
among the tired and lonely
not waiting always wanting
needing a good night's rest
-- Nikki Giovanni, "Introspection"

Defining the Roots of Depression

Clinical depression is often a vague disorder for African- American women. It may produce an abundance of "depressions" in the lives of the women who experience its ongoing, relentless symptoms. The old adage of "being sick and tired of being sick and tired" is quite relevant for these women, since they often suffer from persistent, untreated physical and emotional symptoms. If these women consult health professionals, they are frequently told that they are hypertensive, run down, or tense and nervous. They may be prescribed antihypertensives, vitamins, or mood elevating pills; or they may be informed to lose weight, learn to relax, get a change of scenery, or get more exercise. The root of their symptoms frequently is not explored; and these women continue to complain of being tired, weary, empty, lonely, sad. Other women friends and family members may say, "We all feel this way sometimes, it's just the way it is for us Black women."

I remember one of my clients, a woman who had been brought into the emergency mental health center because she had slashed her wrists while at work. During my assessment of her, she told me she felt like she was "dragging a weight around all the time." She said, "I've had all these tests done and they tell me physically everything is fine but I know it's not. Maybe I'm going crazy! Something is terribly wrong with me, but I don't have time for it. I've got a family who depends on me to be strong. I'm the one that everyone turns to." This woman, more conerned about her family than herself, said she "[felt] guilty spending so much time on [her]self." When I asked her if she had anyone she could talk to, she responded, "I don't want to bother my family and my closest friend is having her own problems right now." Her comments reflect and mirror the sentiments of other depressed African-American women I have seen in my practice: They're alive, but barely, and are continually tired, lonely, and wanting.

Statistics regarding depression in African-American women are either non-existent or uncertain. Part of this confusion is because past published clinical research on depression in African-American women has been scarce (Barbee, 1992; Carrington, 1980; McGrath et al., 1992; Oakley, 1986; Tomes et al., 1990). This scarcity is, in part, due to the fact that African-American women may not seek treatment for their depression, may be misdiagnosed, or may withdraw from treatment because their ethnic, cultural, and/or gender needs have not been met (Cannon, Higginbotham, Guy, 1989; Warren, 1994a). I also have found that African-American women may be reticent to participate in research studies because they are uncertain as to how research data will be disseminated or are afraid that data will be misinterpreted. In addition, there are few available culturally competent researchers who are knowledgeable regarding the phenomenon of depression in African-American women. Subsequently, African-American women may not be available to participate in depression research studies. Available published statistics concur with what I have seen in my practice: that African-American women report more depressive symptoms than African-American men or European-American women or men, and that these women have a depression rate twice that of European-American women (Brown, 1990; Kessler et al., 1994).

African-American women have a triple jeopardy status which places us at risk for developing depression (Boykin, 1985; Carrington, 1980; Taylor, 1992). We live in a majority-dominated society that frequently devalues our ethnicity, culture, and gender. In addition, we may find ourselves at the lower spectrum of the American political and economic continuum. Often we are involved in multiple roles as we attempt to survive economically and advance ourselves and our families through mainstream society. All of these factors intensify the amount of stress within our lives which can erode our self-esteem, social support systems, and health (Warren, 1994b).

Clinically, depression is described as a mood disorder with a collection of symptoms persisting over a two-week time. These symptoms must not be attributed to the direct physical effects of alcohol or drug abuse or other medication usage. However, clinical depression may occur in conjunction with these conditions as well as other emotional and physical disorders such as hormonal, blood pressure, kidney, or heart conditions (American Psychiatric Association [APA], 1994). To be diagnosed with clinical depression, an African-American woman must have either depressed mood or loss of interest or pleasure as well as four of the following symptoms:

1. Depressed or irritable mood throughout the day (often everyday)
2. Lack of pleasure in life activities
3. Significant (more than 5%) weight loss or gain over a month
4. Sleep disruptions (increased or decreased sleeping)
5. Unusual, increased, agitated or decreased physical activity (generally everyday)
6. Daily fatigue or lack of energy
7. Daily feelings of worthlessness or guilt
8. Inability to concentrate or make decisions
9. Recurring thoughts of death or suicidal thoughts (APA, 1994).