African-American women are especially vulnerable to depression due to a
convergence of societal and biological factors such as stress related to
racial discrimination and high prevalence rates of health problems such as
hypertension and cardiovascular disease.
Depression screening and prevention programs must take into account these
and additional factors in order to be successful, according to Annelle Primm,
M.D., M.P.H., who spoke at the APA Institute on Psychiatric Services in San
Diego in October.
Primm, director of APA's Office of Minority and National Affairs, noted
that several studies have found a higher rate of depressive symptoms and
psychological distress among African-American and Latino women, compared with
white women. The higher prevalence rates remained after controlling for
socioeconomic status, she added.
Some of the risk factors for depression in women, such as low socioeconomic
status and educational attainment, single marital status, and being a working
mother, are more prevalent among African-American women than among white
Annelle Primm, M.D., M.P.H.: "What is good for African-American
women in terms of preventing depression is good for all
Primm pointed out that development of depression is affected by chronic
stress and the "subsequent immuno-regulatory effects associated with
living as a member of a marginalized racial and gender group."
Social forces such as racism and sexism "impose continuous
psychological stress and increase the likelihood of developing physical and
mental illnesses," she noted.
Obesity may also contribute to an increased risk for developing depression
in African-American women, Primm pointed out. "There is a negative
association between obesity and mental well-being," she said.
African-American women have a greater prevalence of obesity (37.7 percent)
when compared with white women (23.5 percent), she said, and overeating may
begin as a strategy to cope with sexual abuse, racism, classism, and poverty
in African-American women.
Primm cited the 2001 report of former Surgeon General David Satcher, M.D.,"
Mental Health: Culture, Race, and Ethnicity," which brought to
light the problems many minority groups have in accessing mental health
"On top of that," she said, "we know that people of color
who are able to access services are less likely to receive quality mental
health care," which can be partially attributed to a lack of culturally
and linguistically competent mental health care clinicians.
On a broad level, policies that target poverty reduction would"
greatly benefit mental health outcomes" for African-American
More specifically, successful depression-prevention campaigns should
incorporate "resiliency factors" employed by many African-American
women, such as spirituality, which may help some to cope with depressive
Preventive strategies should also incorporate nutrition and exercise, Primm
She also recommended that depression screening be implemented to a greater
extent at prenatal clinics located in public health facilities, welfare
programs, and vocational-assistance programs.
In addition, it is crucial that screening programs link women who show
depression symptoms to culturally competent treatment services in their
"What is good for African-American women in terms of preventing
depression is good for all women in general and for the whole country,"
Primm declared. ▪