New Tools Needed to Detect Depression in African American Mothers, says Rutgers University‒Camden Nursing Researcher

Rahshida Atkins

Rahshida Atkins

By Jeanne Leong

Screening methods for depression that take context and culture into consideration could be more effective in uncovering clinical depression in African American mothers, according to a study led by a Rutgers University‒Camden nursing professor.

Referencing well-known theories about the “strong woman complex” in Black women and its relation to depression, “they may not admit when they have certain feelings,” says Rahshida Atkins, an assistant professor at the Rutgers School of Nursing‒Camden. “Face to face, they may not answer ‘yes’ to depression screening questions that ask, ‘Are you depressed?’ or ‘Do you feel sad?’”

In these situations, the medical professional may not detect that the patient is depressed and the patient may not receive the treatment that they need. Healthcare providers are required to ask all adults these questions during health visits.

The Rutgers University–Camden researcher has found that Black single mothers experience depressed mood because of stressors created by issues including poverty, unstable relationships and housing, parenting and family stressors, and lack of access to high-quality health care for themselves and their families.

“Growing up with a depressed mom is also an adverse childhood experience,” explains Atkins. “The emotional, cognitive, and social development of children can be hindered when their mothers are depressed and do not receive treatment.”

In the study, “Exploring Expressions of Depression in Black Single Mothers,” Atkins and her team of researchers distributed questionnaires in Camden, Trenton, and Philadelphia at social service agencies, day care centers, pediatric primary care offices, and dance schools.

The questionnaire asked open-ended questions about their feelings of depressed mood, such as, “How do you feel when you are ‘down in the dumps?’”

The women revealed on the questionnaires that they predominantly felt sadness and hopelessness, and, at times, they would cry, which are all symptoms associated with depressive illness.

Atkins was surprised at how the women candidly shared their experiences of sadness and depression. “It appears to go against the theoretical literature about depression in Black women, which often proposes that they don’t readily admit when they are sad—that they have to put up the strong woman complex.”

Atkins, who studies mental health, health equity, and behavioral health, says much of the research on depressive symptoms shows that African American women and other minority populations often report bodily pain symptoms such as stomachaches, headaches, tiredness, or interpersonal difficulties when they are depressed.

She believes the women surveyed were more comfortable expressing their depressed mood symptoms because they were putting responses on paper, and they were assured anonymity and confidentiality.

“This isn’t something they often display in front of others or others of their culture, or even in front of me,” says Atkins, who frequently interacts with Black single mothers when conducting community engagement studies. Since the women did not have to put their name on the forms, “Nobody would know what they were writing, so they’re able to be honest about how they truly feel.”

In addition, Atkins found that expressions of anger were reported almost as frequently as expressions of sadness. Anger is not a symptom asked about on commonly used depression screening tools or listed in the depression diagnostic criteria for adults. The women also indicated they would not want to be around people and felt stressed, tired, and lonely. Atkins says anger and other symptoms reported by these mothers may be misinterpreted, which could cause medical professionals to miss depressive illness.

Atkins hopes the study will help health care professionals to design tools that more accurately detect depression among diverse groups.

“The one-size-fits-all approach isn’t appropriate for diagnosing or detecting mental illness,” she says. “As nurses, we screen for mental illness. We really need to be more in tune with how patients may report their emotions, and the conclusions that we draw about their mental state based on that.”

The article, “Exploring Expressions of Depression in Black Single Mothers,” is available in the journal Issues in Mental Health Nursing. Atkins co-authored the article with Rutgers School of Nursing–Camden colleagues Terri-Ann Kelly and Wanda Williams, and Gale Gage of Essex County College, Paule Joseph of the National Institutes of Health Clinical Research Center, Shanda Johnson of New Jersey City University, and Kafilat Ojo of the Harlem Hospital Center, Columbia University Medical Center.

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