Regular Research ArticlesMental Health Treatment Seeking Among Older Adults With Depression: The Impact of Stigma and Race
Section snippets
RACE AND AGE DISPARITIES IN TREATMENT UTILIZATION
African American older adults suffer more psychological distress than their white counterparts due to their lifelong exposure to and experiences with racism, discrimination, prejudice, poverty, and violence8; and they tend to have fewer psychological, social, and financial resources for coping with stress than their white counterparts.9 Despite epidemiologic research, which suggests similar rates of depression among African Americans and whites,5 racial disparities continue to exist in mental
THE IMPACT OF STIGMA
The stigma associated with having a mental illness may be an important factor which influences treatment-seeking attitudes and behaviors and may, in part, account for existing disparities in service utilization among African American older adults. According to Goffman,23 stigma is an identified mark or characteristic, which disqualifies those possessing the mark from full social acceptance in society. This includes the negative perceptions, attitudes, and beliefs held about individuals who bear
Research Design
Study participants were recruited by the University Center for Social and Urban Research at the University of Pittsburgh using random digit dialing telephone sampling methodology. Participants were recruited from Allegheny County (Pittsburgh) PA. To attain a representative sample of both African Americans and whites for this study, the area-code/exchanges were divided into two strata for sampling: 1) exchanges with less than 25% estimated African American population and 2) exchanges with an
RESULTS
Eighty-four percent of the sample was female (N = 207). Participants’ age ranged from 60 to 93 years, with a mean age of 72 years (SD = 7.8). Forty percent of the sample was widowed (N = 112), with the additional 42% either married (N = 54) or divorced (N = 49). Sixty-seven percent of the sample participants were high school graduates (N = 82), had a general equivalency diploma (GED) equivalent (N = 13), or had completed at least some college (N = 73), and 81% (N = 201) of the sample
DISCUSSION
Although many studies have examined the association between race, attitudes about mental health treatment, and treatment-seeking behaviors, to date, very few investigations have addressed the impact of stigma on these relationships. Even fewer have examined these relationships in a sample of older adults with depression. This investigation bridges the gap by presenting data on the impact of stigma and race on the mental health treatment-seeking attitudes and behaviors of older adults with
CONCLUSION
This study examined the impact of stigma on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. Results suggest that although perceived public stigma among older adults is fairly high, African American older adults endorsed higher levels of internalized stigma and less positive attitudes toward seeking mental health treatment than their white counterparts. In addition, high level of internalized stigma was related to more negative attitudes toward
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Stigma
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The authors thank the men and women who shared their personal experiences in our survey and interviews.
This work was supported by the John A. Hartford Foundation Dissertation Fellowship (to KOC), University Center for Social and Urban Research University of Pittsburgh, Steven Manners Faculty Development Award (to CB), Center on Race and Social Problems, University of Pittsburgh School of Social Work (to CB), Advanced Center for Interventions and Services Research on Late Life Mood Disorders (P30MH71944; PI: Charles F. Reynolds III, M.D.), and the Commonwealth of Pennsylvania Department of Health (to CFR).