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Women and Depression A Multicultural Perspective Dr. Monique Scott DNP, PMHNP-BC

Depression

Depression

�  Depression is a serious mood disorder that has significant effects on an individuals mental and physical health.

�  Neurobiological, psychosocial (environment), hormonal, immunological, and genetic implications

�  Common neurotransmitters include serotonin, norepinephrine, and dopamine

�  Deficits of these transmitters results to depressed mood and the physical symptoms that come along with this disorder

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DSM-5: Major Depressive Disorder

A) Must have 5 or more of the following symptoms for at least 2 weeks: (at least 1 symptom includes depressed mood or loss of interest/pleasure)

�  Depressed mood most of the day, every day

�  Diminished interest in most or all pleasurable activities nearly every day

�  Significant weight loss or gain in a month (5%) increase or decreased in appetite

�  Insomnia or hypersomnia nearly every day

�  Psychomotor agitation, restlessness, or feeling slowed down

�  Feelings of worthlessness, excessive guilt

�  Diminished concentration, indecisiveness

�  Recurrent thoughts of death, suicidal attempt, suicidal ideation, with or with out a plan

DSM-5: Major Depressive Disorder

B) Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

C) Episode not contributed to effects of a substance or other medical condition

D) Not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or any psychotic or unspecified schizophrenia spectrum disorder

E) There has never been an occurrence of a manic or hypomanic episode

Data

�  Women are more likely to report major depression at 4% while men were reporting at 2.7 % (CDC, n.d.).

�  The prevalence of major depressive episodes higher in women 8.7% than males 5.3% (NIMH, 2017)

�  The prevalence of major depressive episodes are highest in adults ages 18-25 at 13.1% (NIMH, 2017)

�  The prevalence of major depressive episode were highest amount adults who reported to be of two or more races (NIMH, 2017)

�  Socioeconomic factors such as poverty and poor access to resources increases stress on an individual and puts them at risk for depression and other mental illnesses (Snowden, 2014).

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Data

Data

Dr. Madeline Leininger

�  Cultural Care Theory �  Provide culturally congruent care by including the

clients own norms in the care of the client �  The nurse must make conscious well thought out

actions for cultural sensitive care to be successful �  Must consider the cultural meaning of healthy in each

individual

�  Founder of the Transcultural Nursing Society-1974

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Leininger’s Sunrise Model

Depression in women

�  Socioeconomic factors

�  Cultural factors

�  Biological factors

Socioeconomic Factors

�  Multiple Role Strain

�  Care giver –children and or other family members

�  Education

�  employment

�  Low income- poor access to resources

�  Inadequate support

�  Racial inequities

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Biological Factors

Biological Implication

�  Menstrual Cycle- Premenstrual Dysphoric Disorder

�  Pregnancy

�  Birth

�  Post Partum– Post Partum Depression

�  Perimenopause- Premenopausal Depression

�  Menopause

Culture

�  Culture influences how a person communicates, trust, how they may perceive themself and those around them

�  Often cultural expression, religion, lack of providers who are culturally competent become barriers to treatment

�  Its almost impossible to memorize every religion, and the hundreds of cultural norms of the people we serve

�  A cultural assessment should be initiated during the first encounter

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Asian

�  Fewer reports of mental health condition than white counterparts

�  More likely to consider and attempt suicide

�  3X less likely to seek mental health treatment

�  Difficulty admitting or acknowledge that there may be a mental health issue

(ADAA, n.d.)

Asian

�  Express negative emotion by describing physical pain (heartache or extreme fatigue)

�  Stereotypes “model minority ” myths that project unrealistic high expectations

�  Mental health issues would equate to weakness and failure

�  Asian women are twice as likely to suffer from depression than Asian men

(Sutter Health, n.d.)

Spanish & Latino

�  Hispanic Community Health Study/Study of Latino Largest study to date– conducted 2008-2011

�  Sampled 16,400 Hispanic/Latino, ages 18-74 in diverse communities in NYC, Chicago, San Diego and Miami

�  Included Cubans, Puerto Ricans, Mexicans, Dominicans, Central and South Americans

(NIH, 2013)

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Spanish & Latino

�  27 % reported high levels of depression symptoms

�  People of Mexican background reported the lowest (22.3%) and Puerto Rican (38%) background reported the highest

�  Only 5% of the study sample use antidepressants

�  Insurance status played a significant role is antidepressant use.

(NIH, 2013)

Spanish & Latino

�  Individuals ages 45-64 were 21 % more likely to have symptoms of depression than those 25-44

�  Women were twice as likely than men to experience high levels of depressive symptoms

�  Cardiovascular disease increased likelihood of depression by 77%

�  Health care providers should take a closer look at subgroups to deliver appropriate mental health services

(NIH, 2013)

African American/Black

�  Historical experiences influenced African American women's view on depression and help seeking behaviors

�  Scholars have traced the origin of having to endure through pain and strife, and over come despite oppressions termed as “the strong black woman” back to the experience of slavery in America (Watson & Hunter, 2015).

�  Care taker rolls during slavery, included tending to plantation work, their children, husbands, slave owner, and slave owners family

�  Post slavery including civil rights era, African American women continued the same role, and were subjected to servant positions (cook, maid, nanny, the help)

�  The historical experience has conditioned African American women to focus on others rather than personal growth, which prevents them from indulging in self-development without guilt (Sohail et al., 2014)

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African American/Black

�  African Americans commonly avoid dealing with psychological problems because of concerns about the stigma associated with mental illness (Ward et al., 2013)

�  Many African Americans are likely to seek religious coping than mental health services (Ward et al., 2013).

�  African American women experience repetitive racism, sexism, and likelihood of poverty, which puts them at highest risk for depression. (Bailey et al., 2011).

African American/Black

�  African American women are also often misdiagnosed, underdiagnosed, or undertreated (Bailey et al., 2011).

�  Older women endorsed religious coping more than younger women (Ward & Heidrich, 2009)

�  African Americans compared to White Americans, in New York State have been identified as having more stigmatized views on mental illness (Gonzales et al., 2017)

�  African American populations are poorly represented in research

Pilot Study 2018

�  Provided education and a safe space for Black/African American women

�  Depression Stigma Scale & Depression Literacy Questionnaire

�  Personal stigma score decreased 61.1%

�  Perceived stigma score increased 44.5%

�  Depression Literacy scores increased 61.1%

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Pilot Study 2018

�  Community based education geared towards underrepresented minority populations is effective

�  Initiates dialog and contributes to lowering stigma

�  Promotes universality which is very important for groups of people who are not the majority

�  Culturally appropriate resources are needed specifically for minority people (brochures, advertisements, etc.)

Cultural Focused Questions

�  How important is religion or spirituality?

�  How do you express emotional pain?

�  How do you find relief from emotional pain?

�  Who is part of your support system?

�  What does healthy mean to you? What does healthy look like?

�  What are your concerns or belief about depression?

Treatment

�  Therapy �  Improve insight �  Encourages healthy thought patterns �  Learn better coping skills �  Increase self-care �  Increase mental health literacy �  Address other issues such as trauma or anxiety that

are correlated �  Increase access to other related services

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Treatment

�  Medication

�  SSRI (selective serotonin reuptake inhibitors)

�  SNRI (serotonin norepinephrine reuptake Inhibitors)

�  TCA (Tricyclic Antidepressants)

�  MAOI (monoamine Oxidase Inhibitor)

�  Atypical Antidepressants

End

References

�  Anxiety and Depression Association of America . (n.d.). Asian-Americans. Retrieved from https://adaa.org/asian-americans

�  Baily, R. K., Patel, M., Barker, N. C., Ali, S., & Jabeen, S. (2011, July). Major depressive disorder in the African American population. Journal of the National Medical Association, 103(7), 548-557.

�  Gonzales, L., Chan, G., & Yanos, P. T. (2017). Individual and neighborhood predictors of mental illness stigma in New York state. Stigma and Health, 2(3), 175-181.

�  Heidrich, S. M., & Ward, E. C. (2009, July). African American women’s beliefs about mental illness, stigma, and preferred coping behaviors. Research in Nursing & Health, 32(5), 480-492.

�  National Institute of Health. (2013). Hispanic community health study study of Latinos data book: A report to the communities . Retrieved from https://www.nhlbi.nih.gov/files/docs/resources/NHLBI-HCHSSOL-English-508.pdf

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References

�  National Institute of Mental Health. (2017). Major depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml#part_155029

�  National Institute of Mental Health. (n.d). Depression in women: 5 things you should know. Retrieved from https://www.nimh.nih.gov/health/publications/depression-in-women/index.shtml#pub5

�  Science Daily. (2018). African-Americans and Latinos are more likely to be at risk for depression than whites. Retrieved from https://www.sciencedaily.com/releases/2018/05/180524174544.htm

�  Snowden, L. R. (2014, November). Poverty, safety net programs, and African American mental health. American Psychologist, 69(8), 773-781.

�  Sohail, Z., Bailey, R. K., & Richie, W. D. (2014, June). Misconceptions of depression in African Americans. frontiers in PSYCHIATRY, 5(65), 1-3.

�  Sutter Health. (n.d.). Depression in South Asian women. Retrieved from http://www.pamf.org/southasian/healthy/women/mentalhealth/depression.html

References

�  Tanap, R. (2018). Why Asian-Americans and pacific islanders don’t go to therapy. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/July-2018/Why-Asian-Americans-and-Pacific-Islanders-Don-t-go

�  Ward, E., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013, May-June). African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research, 62(3), 185-194.

�  Watson, N. N., & Hunter, C. D. (2015, October). Anxiety and depression among African American women: The costs of strength and negative attitudes toward psychological help-seeking. Cultural Diversity and Ethnic Minority Psychology, 21(4), 604-612.

Contact

Email: MoniqueScottPMHNP@gmail.com

LinkedIn: https://www.linkedin.com/in/moniquescottpmhnp/