Abstract
Low-income and African American patients in women’s health clinics are at risk for depression and under-treatment of their depression. This study aimed to understand women’s health patients’ experiences of depressive symptoms and perspectives on the low uptake of psychotherapy. Twenty-three women with depressive symptoms from a women’s health clinic completed individual qualitative interviews. Women reported risk of harm in the therapeutic relationship as the primary barrier; physical and mental health symptoms and doubt that psychotherapy will help were also described. Women also reported psychotherapy can be helpful by allowing women to express their feelings, gain insight, and make life changes.
Similar content being viewed by others
References
Alvidrez, J., & Azocar, F. (1999). Distressed women’s clinic patients: preferences for mental health treatments and perceived obstacles. General Hospital Psychiatry, 21(5), 340–347.
Andrews, G., & Henderson, S. (2000). Unmet need in psychiatry: Problems, resources, responses. Cambridge: Cambridge University Press.
Arean, P. A., Alvidrez, J., Barrera, A., Robinson, G. S., & Hicks, S. (2002). Would older medical patients use psychological services? Gerontologist, 42(3), 392–398.
Arnow, B. A., Blasey, C., Manber, R., Constantino, M. J., Markowitz, J. C., Klein, D. N., et al. (2007). Dropouts versus completers among chronically depressed outpatients. Journal of Affective Disorders, 97(1–3), 197–202.
Black, H. K., White, T., & Hannum, S. M. (2007). The lived experience of depression in elderly African American women. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62(6), S392–S398.
Brody, D. S., Khaliq, A. A., & Thompson, T. L., 2nd. (1997). Patients’ perspectives on the management of emotional distress in primary care settings. Journal of General Internal Medicine, 12(7), 403–406.
Bruce, M. L., Takeuchi, D. T., & Leaf, P. J. (1991). Poverty and psychiatric status. Longitudinal evidence from the New Haven Epidemiologic Catchment Area study. Archives of General Psychiatry, 48(5), 470–474.
Cooper, L. A., Gonzales, J. J., Gallo, J. J., Rost, K. M., Meredith, L. S., Rubenstein, L. V., et al. (2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical Care, 41(4), 479–489.
Cooper-Patrick, L., Powe, N. R., Jenckes, M. W., Gonzales, J. J., Levine, D. M., & Ford, D. E. (1997). Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine, 12(7), 431–438.
Cruz, M., Pincus, H. A., Harman, J. S., Reynolds, C. F., & Post, E. P. (2008). Barriers to care-seeking for depressed African Americans. International Journal of Psychiatry in Medicine, 38(1), 71–80.
Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008). Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76(6), 909–922.
Dwight-Johnson, M., Unutzer, J., Sherbourne, C., Tang, L., & Wells, K. B. (2001). Can quality improvement programs for depression in primary care address patient preferences for treatment? Medical Care, 39(9), 934–944.
Green, C. R., Baker, T. A., Sato, Y., Washington, T. L., & Smith, E. M. (2003). Race and chronic pain: A comparative study of young black and white Americans presenting for management. Journal of Pain, 4(4), 176–183.
Grembowski, D. E., Martin, D., Patrick, D. L., Diehr, P., Katon, W., Williams, B., et al. (2002). Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. Journal of General Internal Medicine, 17(4), 258–269.
Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52(2), 196–205.
Hill, C. E., & Williams, E. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25(4), 517–572.
Jaycox, L. H., Miranda, J., Meredith, L. S., Duan, N., Benjamin, B., & Wells, K. (2003). Impact of a primary care quality improvement intervention on use of psychotherapy for depression. Mental Health Services Research, 5(2), 109–120.
Karasz, A., Sacajiu, G., & Garcia, N. (2003). Conceptual models of psychological distress among low-income patients in an inner-city primary care clinic. Journal of General Internal Medicine, 18(6), 475–477.
Karasz, A., & Watkins, L. (2006). Conceptual models of treatment in depressed Hispanic patients. Annals of Family Medicine, 4(6), 527–533.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289(23), 3095–3105.
Lin, E. H., Katon, W. J., VonKorff, M., Russo, J. E., Simon, G. E., Bush, T. M., et al. (1998). Relapse of depression in primary care. Rate and clinical predictors. Archives of Family Medicine, 7(5), 443–449.
Lowe, B., Kroenke, K., & Grafe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58(2), 163–171.
Mukherjee, S., Sullivan, G., Perry, D., Verdugo, B., Means-Christensen, A., Schraufnagel, T., et al. (2006). Adherence to treatment among economically disadvantaged patients with panic disorder. Psychiatric Services, 57(12), 1745–1750.
Neighbors, H. W. (1988). The help-seeking behavior of black Americans. A summary of findings from the National Survey of Black Americans. Journal of the National Medical Association, 80(9), 1009–1012.
Riley, J. L., Robinson, M. E., Wade, J. B., Myers, C. D., & Price, D. D. (2001). Sex differences in negative emotional responses to chronic pain. Journal of Pain, 2(6), 354–359.
Roberts, R. E., & Lee, E. S. (1993). Occupation and the prevalence of major depression, alcohol, and drug abuse in the United States. Environmental Research, 61(2), 266–278.
Rost, K., Zhang, M., Fortney, J., Smith, J., Coyne, J., & Smith, G. R., Jr. (1998). Persistently poor outcomes of undetected major depression in primary care. General Hospital Psychiatry, 20(1), 12–20.
Sanders Thompson, V. L., & Bazile, A. (2004). African Americans’ perceptions of psychotherapy and psychotherapists. Professional Psychology: Research and Practice, 35(1), 19–26.
Scholle, S. H., Haskett, R. F., Hanusa, B. H., Pincus, H. A., & Kupfer, D. J. (2003). Addressing depression in obstetrics/gynecology practice. General Hospital Psychiatry, 25, 83–90.
Simon, G. E., & Ludman, E. J. (2010). Predictors of early dropout from psychotherapy for depression in community practice. Psychiatric Services, 61(7), 684–689.
Stecker, T., & Alvidrez, J. (2007). Patient decision-making regarding entry into psychotherapy to treat depression. Issues in Mental Health Nursing, 28(7), 811–820.
Stockdale, S. E., Klap, R., Belin, T. R., Zhang, L., & Wells, K. B. (2006). Longitudinal patterns of alcohol, drug, and mental health need and care in a national sample of US adults. Psychiatric Services, 57(1), 93–99.
Thompson, A., Hunt, C., & Issakidis, C. (2004). Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample. Social Psychiatry and Psychiatric Epidemiology, 39(10), 810–817.
USDHHS. (2001). Mental health: Culture, race, and ethnicity. Washington DC: U.S. Public Health Service.
Van Voorhees, B. W., Fogel, J., Houston, T. K., Cooper, L. A., Wang, N. Y., & Ford, D. E. (2006). Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Social Psychiatry and Psychiatric Epidemiology, 41(9), 746–754.
Waite, R., & Killian, P. (2007). Exploring depression among a cohort of African American women. Journal of the American Psychiatric Nurses Association, 13(3), 161–169.
Wang, P. S., Berglund, P., & Kessler, R. C. (2000). Recent care of common mental disorders in the United States : Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15(5), 284–292.
Wang, J., Langille, D. B., & Patten, S. B. (2003). Mental health services received by depressed persons who visited general practitioners and family doctors. Psychiatric Services, 54(6), 878–883.
Weich, S., & Lewis, G. (1998). Poverty, unemployment, and common mental disorders: Population based cohort study. British Medical Journal, 317(7151), 115–119.
Wilson, K. C., Chen, R., Taylor, S., McCracken, C. F., & Copeland, J. R. (1999). Socio-economic deprivation and the prevalence and prediction of depression in older community residents. The MRC-ALPHA Study. British Journal of Psychiatry, 175, 549–553.
Acknowledgments
This study was supported by National Institute of Mental Health Grant K23MH079347 (PI: ELP) and an anonymous donation to the Department of Obstetrics and Gynecology at the University of Rochester Medical Center. Susan McDaniel, Ph.D., and Nancy Talbot, Ph.D. provided valuable input on earlier drafts of this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Poleshuck, E.L., Cerrito, B., Leshoure, N. et al. Underserved Women in a Women’s Health Clinic Describe Their Experiences of Depressive Symptoms and Why They Have Low Uptake of Psychotherapy. Community Ment Health J 49, 50–60 (2013). https://doi.org/10.1007/s10597-012-9500-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-012-9500-7