minority health

Addressing Mental Health in African Americans Through FAITH

By Tiffany Haynes, Ph.D.
Assistant Professor, Department of Health Behavior and Health Education
Fay W. Boozman College of Public Health
University of Arkansas for Medical Sciences, Little Rock, AR

Rural African Americans are disproportionately exposed to numerous stressors, such as poverty, racism, and discrimination,1–that place them at risk for experiencing elevated levels of depressive symptoms.6 Elevated levels of depressive symptoms can lead to a host of negative outcomes, including poor management of chronic illnesses (e.g., hypertension, diabetes), poor social and occupational functioning, and development of clinical depression.7 Although effective treatments for decreasing depressive symptoms exist, structural barriers (e.g., lack of available services, transportation) and perceptual barriers (e.g., stigma, fear of misdiagnosis) impede the use of traditional mental health services within these communities, resulting in a significant unmet psychiatric need. Failure to develop culturally appropriate strategies to provide adequate, timely care to rural African Americans can result in a significant public health crisis.

Dr. Tiffany Haynes, Ph.D.

Dr. Tiffany Haynes, Ph.D.

African American churches have been identified as potential venues for providing depression education and treatment for rural African Americans.8 Within the African American rural community, churches represent a key portal through which as much as 85% of the community can be reached.9 Churches have been used to address physical health outcomes in those communities, but few have focused primarily on addressing mental health outcomes10-11. Through the NIMHD-funded project entitled “Faith Academic Initiatives to Transform Health (FAITH) in the Delta,” our partnership, consisting of faith community leaders and University of Arkansas for Medical Science researchers, conducted formative work in the Arkansas Delta. Data suggested that community members consider elevated depressive symptoms to be a significant unmet need. Furthermore, community members suggested that attempts to improve depressive symptoms should do the following:

  1. Provide education about depressive symptoms. Recognizing when depressive symptoms become a clinical problem is the first step toward receiving adequate treatment. However, rural African Americans report difficulties in differentiating between normal sadness and clinically significant depressive symptoms. Providing education about depressive symptoms allows rural African Americans to make informed treatment decisions.
  2. Address the role that stress from social inequities plays in the development and maintenance of depressive symptoms. Rural African Americans correctly realize that prolonged exposure to stress caused by social inequities is a significant factor in the development and maintenance of depressive symptoms. Treatments that conceptualize depressive symptoms as normal reactions to stress are more culturally acceptable in rural African American communities.
  3. Find ways to increase social support for those experiencing depressive symptoms. Stigma is a significant concern in rural communities. Rural African Americans experiencing depressive symptoms tend to socially isolate themselves, which, in turn, can worsen depressive symptoms.
  4. Provide mental health interventions in community-based settings. Residents suggest that offering mental health services in community settings, such as churches, would allow residents to receive treatment in less stigmatizing places and improve access to mental health care.

    (from left to right): Pastor Johnny Smith, Community PI; Dr. Tiffany Haynes, Academic PI; Dr. Karen K. Yeary, PhD, Academic Co-PI; and Pastor Jerome Turner, Community PI.

    From left to right: Pastor Johnny Smith, Community PI; Dr. Tiffany Haynes, Academic PI; Dr. Karen K. Yeary, PhD, Academic Co-PI; and Pastor Jerome Turner, Community PI

Using this data as a base, researchers worked closely with the faith community to culturally adapt an evidence-based behavioral activation intervention for use with rural African American churches. This eight-session behavioral activation intervention, REJOICE (Renewed and Empowered for the Journey to Overcome in Christ Everyday), was adapted to include faith-based themes, scripture, and other aspects of the rural African American faith culture (e.g., Bible studies, interweaving faith-based messages throughout the intervention materials).

Currently, we are testing the effectiveness of REJOICE and obtaining pilot data about the best ways to implement this intervention in rural African American churches. Collecting data from this project is the first step in providing timely and appropriate care to high-need and underserved communities.

 

References

  1. Harris, R. P., & Worthen, D. (2003). African Americans in rural America. In D. L. Brown & L. E. Swanson (Eds.), Challenges for rural America in the twenty-first century (pp. 32-42). University Park, PA: The Pennsylvania State University Press.
  2. U.S. Department of Agriculture, Economic Research Service (2016). Rural Poverty and Well-Being: Geography of Poverty. Retrieved from https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/
  3. Fitchen, J. M. (1992). On the edge of homelessness: rural poverty and housing insecurity. Rural Sociology, 57, 173-193.
  4. Kusmin, L. (Ed.). (2012). Rural America at a glance, 2012 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
  5. Odom, E. C., & Vernon-Feagans, L. (2010). Buffers of racial discrimination: links with depression among rural African American mothers. Journal of Marriage and the Family, 72, 346-359.
  6. Kusmin, L. (Ed.). (2011). . Rural America at a glance, 2011 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
  7. Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58, 201-225.
  8. Taylor RJ, Chatters LM, Levin J. Religion in the Lives of African Americans: Social, Psychological, and Health Perspectives. Thousand Oaks, CA: Sage Publications, 2004.
  9. Reeves RR, Adams CE, Dubbert PM, Hickson DA, Wyatt SB. Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)? J Relig Health. 2011.
  10. DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. Health programs in faith-based organizations are they effective? Am J Public Health. 2004; 94(6): 1030-6. 1448385
  11. Hankerson, Sidney H., and Myrna M. Weissman. “Church-based health programs for mental disorders among African Americans: a review.” Psychiatric Services 63.3 (2012): 243-249.
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Welcome to NIMHD Insights, the New NIMHD Blog

By Eliseo J. Pérez-Stable, M.D.
Director, NIMHD

At the one-year anniversary of my appointment as director of NIMHD, I’m excited to welcome you to our new blog, NIMHD Insights.

NIMHD leads scientific research in two distinct but overlapping areas: minority health and health disparities. But first of all, what do these terms mean?

Minority health concerns the health of the five U.S. racial and ethnic minorities who have historically faced discrimination and social disadvantage. These groups are defined by the U.S. Census and include African Americans/Blacks, Latinos/Hispanics, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. All of these populations are usually not included as participants of all types of biomedical research and most are also underrepresented as members of the scientific workforce. At NIMHD, we are committed to addressing health issues within each of the minority groups independent of whether the outcome is worse, better or similar to that of the White comparison group. We value research that emphasizes mechanisms by which health differs within these race/ethnic groups, as well as comparisons to each other and Whites.

Health disparities are differences in health outcomes that negatively affect racial and ethnic minorities, persons of less privileged socioeconomic status, and underserved rural populations. All of these persons have historically been subjected to system and individual discrimination that results in social disadvantage and leads to worse health outcomes. NIMHD is focusing on outcomes that reflect a higher incidence/prevalence of diseases, higher or premature mortality from specific causes, a higher burden of illness as reflected by global measures such as disability-adjusted life years (DALYs) and worse results on standardized measures of function, well-being or symptoms. NIMHD postulates that the mechanisms that lead to these health disparities have determinants in the behavioral, biological, social, environmental, and clinical health care system that results in these worse outcomes. Understanding these mechanisms is precisely what will lead to development of interventions to reduce health disparities.

Although social disadvantage is at the core of factors that result in health disparities, it is not the only cause. Behavior and lifestyle affect individual and social outcomes especially in interactions with the biological factors of each person. For example, stress associated with early life adverse events may trigger biological mechanisms that may lead to chronic diseases in adults and this has great implications of how we attend to the health of children. Known carcinogen exposure such as tobacco smoke has an increased risk of causing lung cancer in some populations by race/ethnic category and may help us understand different factors that cause cancer, which would not be possible if only one race/ethnic group was included. Poor persons living in one urban environment appear to live an average of four years more than poor people in a different urban environment and this emphasizes the importance of place and systems in the wellbeing of the most vulnerable members of society. Treatment outcomes for persons with diabetes varies by socioeconomic status, race/ethnicity, and health literacy; interventions need to be attentive to these differences. Understanding the factors that explain these observations will advance our knowledge of minority health and health disparities. Health disparities research seeks to understand the causes and effects of these differences and to use this knowledge to determine the best approaches to improve health outcomes in affected populations.

NIMHD shares and interprets minority health and health disparities research findings, fosters innovative collaborations and partnerships, spearheads NIH’s efforts to increase the racial and ethnic diversity of the scientific workforce, and promotes the inclusion of minorities in clinical trials and registries. “Inclusion” of minorities in and of itself is not an issue of minority health or health disparities. Rather, it is an issue of social justice and good science that clinical studies need to have diverse populations that represent today’s American demographics.

This blog will feature posts by me and NIMHD research and program staff, along with guest contributors from within and outside NIH who represent the many disciplines that contribute to minority health and health disparities. Topics will look at the Institute’s research priorities and programs, scientific discoveries, and research policies and practices that impact program operations, among other related areas.

I look forward to engaging with you to share new insights and raise intriguing questions that encourage scientific discussion as we work to build an America in which all populations will have an equal opportunity to live long, healthy, productive lives.

Visit www.nimhd.nih.gov to learn more about NIMHD and subscribe to our blog.

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