New treatment could reduce the stigma of depression

Earlise Ward knows the unspoken but not-so-little secret of the mental health treatment world:  African-Americans with mental illness are one of the country’s most underserved and undertreated groups.

Ward, a licensed psychologist and assistant professor in the UW–Madison School of Nursing, has come up with a promising new approach to dealing with this disparity, which she has seen for years in her clinical and research work with this population.

“Due to barriers including limited access to mental health services and stigma associated with mental illness, we have struggled to get African-Americans into treatment, and even when we do get them into treatment, they drop out prematurely,” says Ward. “At some of the community agencies where I worked, I saw clients come to the first session or two and then not come back.  We knew they had mental health issues but weren’t continuing treatment. We needed to change that.”

Ward’s alternative approach – a depression class dubbed “Oh Happy Day!” – focuses on treatments that have been tailored to the cultural beliefs and preferences of this group. The approach is a 12-week group-counseling intervention offered to a group of 10 to12 individuals in the community rather than at a provider’s office or a counseling center.  It is administered by two licensed professional therapists working closely with a trained lay provider.

“We provide overviews of what is counseling, discuss medications, the co-morbidity between depression and diabetes and hypertension, stress management, religious coping, and we provide community resources,” Ward says. “It is all done in a group setting, which participants seem to like much better. It combines some of the therapeutic aspects that they were seeking out in talking to family and friends or at church, but under the guidance of a mental health therapist and a lay person.”

Mental illness is a highly stigmatized and misunderstood health problem in the African-American community, according to Ward. In addition, a recent U.S. Surgeon General’s report says nearly one in four African-Americans is uninsured, compared to about 16 percent of the overall U.S. population. Because of these obstacles, people use coping strategies that include prayer, going to church or talking with friends, rather than seeking professional treatment from a mental-health clinician.

For those who do seek treatment, many feel they receive inadequate or culturally insensitive treatment. That may be due in part to the fact that African-Americans account for only 2 percent of psychiatrists and psychologists, and 4 percent of social workers, in the United States.

While research shows that African-Americans and non-Hispanic whites have similar rates of depression within a 12-month period, African-Americans as a group experience higher rates of chronic and disabling depression. Although African-Americans are burdened by depression, a recent study showed they receive adequate mental health care (defined as at least four visits to a mental health specialist over 12 months) only 14 percent of the time.

Although results are still preliminary, Ward says there are already encouraging signs that this community-based group therapy approach gets results.

“We have found a significant reduction in symptoms of depression from baseline to week 12 of the intervention,” Ward says. “Three months after starting treatment, we continue to see a reduction in symptoms.

“People said they thought the intervention was very helpful in learning more about depression, symptoms and treatment options.  They felt that this program had helped them learn some valuable coping strategies for reducing the symptoms.”

Ward’s research is funded by the National Institute of Nursing Research, the University of Wisconsin Center for Patient-Centered Interventions, and UW Institute for Clinical and Translational Research.