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
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
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
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
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
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