Barriers to care-seeking for depressed African Americans.

OBJECTIVE: We explored perceived barriers to mental health care-seeking for depressed, low-income African Americans who are already engaged in psychotherapy.

METHODS: During a trial to improve psychotherapy appointment adherence, we asked all African-American participants, "Research shows African Americans with emotional or psychological problems use mental health services at half the rate of whites with similar problems. Why do you think that is?" Responses were captured verbatim.

RESULTS: Of 53 African Americans enrolled, 43 completed the study. We analyzed their responses in the hope of identifying modifiable responses. We used qualitative analytic methods, with four raters achieving consensus in coding responses into 13 thematic categories. Stigma was the most frequent response, followed by dysfunctional coping behavior, shame, denial, and "don't know."

CONCLUSION: While this study supports several barriers to care-seeking reported in the extant literature, our data also underscores the prominence of shame and denial, together with their complex interrelationships to public stigma and depression, respectively. Future research should assess the relationships between these factors to mental health care-seeking behavior in low-income African Americans and ways of modifying them.