Depressed Immigrant Women Failing to Get Treatment

New findings supply further evidence that stigma plays a role in the lack of mental health treatment for poor, immigrant women with depression. Educating residents of immigrant and minority communities about the importance of treating depression is likely to prove helpful, according to researchers.

According to a study in the December Psychiatric Services, depressed African and Caribbean immigrants to the United States were more than three times and six times as likely, respectively, as U.S.-born white women to endorse stigma-related concerns as reasons for avoiding mental health treatment.

These concerns included being embarrassed to talk about personal matters with others, being afraid of what others might think, and encountering the disapproval of family members.

In addition, compared with U.S.-born white women in the sample, depressed immigrant women from Africa (p<.001) and the Caribbean (p=.001) were significantly less likely to want mental health treatment. The same held true for U.S.-born black women (p<.001).

Depressed immigrant Latina women, in contrast, were more than twice as likely as white women to want treatment, according to the results.

As part of the Women Entering Care depression treatment study, researchers screened 15,383 low-income women for depression between 1997 and 2001 using the Primary Care Evaluation of Mental Disorders instrument, which incorporates DSM-IV criteria for major depressive disorder. They also asked depressed and nondepressed women about stigma concerns relating to mental health treatment and whether they were currently in treatment.

They then compared women from the following racial and ethnic groups: U.S.-born whites, African immigrants, Caribbean immigrants, U.S.-born blacks, immigrant Latinas, and U.S.-born Latinas.

The screenings took place in Women, Infants, and Children clinics in the Washington, D.C., area; these clinics provide nutritional services to low-income pregnant and postpartum women and their children up to age 5 and family-planning clinics for low-income women.

Of the women studied, 1,577 were found to have major depressive disorder. Of the depressed women, only 129 were in treatment at the time of the study.

The majority of depressed women—some 60 percent—cited logistical barriers to care as reasons for not receiving treatment, while 20 percent cited stigma concerns. Logistical barriers included not having insurance coverage for mental health treatment, not being able to afford treatment, and not having transportation to get to treatment facilities.

Lead author Erum Nadeem, Ph.D., a postdoctoral fellow in the departments of psychiatry and health services at the University of California at Los Angeles (UCLA), noted that ethnic differences in stigma were most pronounced among women with depression, particularly black immigrant women, who reported the most stigma concerns. “Immigrant African women had over three times higher odds, and immigrant Caribbean women [had] over six times higher odds, of reporting stigma concerns,” she told Psychiatric News.

Those without depression were also impacted by stigma, however, suggesting that the stigma of mental illness and treatment is deep seeded in their communities.

For instance, when Nadeem compared the entire sample of depressed and nondepressed women, she found that compared with U.S.-born white women, the odds of reporting stigma-related concerns were 26 percent higher among immigrant Latinas, 39 percent higher among immigrant African women, and 45 percent higher among immigrant Caribbean women.

Nadeem and co-author Jeanne Miranda, Ph.D., could only speculate about reasons for increased stigma-related concerns reported by immigrant groups but cited a 2005 study conducted among Caribbean-born black women living in the United Kingdom showing many considered disclosure of mental health problems to be a sign of moral weakness.

Miranda, who assessed and treated many of the women in the sample, is a professor at the UCLA Neuropsychiatric Institute.

Though Latina women were more likely than white women to endorse stigma-related concerns during t heir screening, Miranda noted, many of the Latina immigrants she treated were recent immigrants who had left extended families behind to live in the United States and “were very grateful for the support and services we provided them,” she told Psychiatric News.

This impression may partially account for the fact that Latina women in the study were more than twice as likely as U.S.-born white women to want treatment, she said.

Both Nadeem and Miranda emphasized a need for more intensive efforts to destigmatize depression through educational programs and campaigns offered in immigrant and minority communities around the United States.

“We need to think about creative ways to reach these women,” Nadeem noted, such as having depression information available at local and county entitlement programs and family-planning clinics.

Miranda heartily endorsed the idea of working with community-based organizations serving immigrant and minority women to destigmatize depression.“ It takes a village to treat this problem,” she said.

The study was funded by the National Institute of Mental Health.

An abstract of “Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?” is posted at<ps.psychiatryonline.org/cgi/content/abstract/58/12/1547>.▪