Journal of Urban Health

, Volume 90, Issue 4, pp 685–698 | Cite as

Ministers’ Perceptions of Church-Based Programs to Provide Depression Care for African Americans

  • Sidney H. Hankerson
  • Kalycia Trishana Watson
  • Alicia Lukachko
  • Mindy Thompson Fullilove
  • Myrna Weissman


African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers’ perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants’ confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.


African Americans Church Depression Mental health services Community-based participatory research 



In the past 2 years, Dr. Hankerson was supported by grant 5-T32 MH015144 from the National Institute of Mental Health (NIMH) and grant #17694 from the National Alliance for Research on Schizophrenia and Depression (NARSAD). Dr. Lukachko received support from a grant 5-T32-MH13043 from the NIMH. Dr. Weissman received funding from the NIMH, the National Institute on Drug Abuse (NIDA), NARSAD, the Sackler Foundation, the Templeton Foundation, and the Interstitial Cystitis Association and receives royalties from the Oxford University Press, Perseus Press, the American Psychiatric Association Press, and MultiHealth Systems. None of these sources conflict with the content of this manuscript. The remaining authors have no relevant research support and no conflicts of interests to disclose. The results of this manuscript, in part, were presented at a symposium during the 64th Institute on Psychiatric Services Conference in New York, New York on Friday, 5 October 2012.


  1. 1.
    Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 617–627.PubMedCrossRefGoogle Scholar
  2. 2.
    Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005; 62(10): 1097–1106.PubMedCrossRefGoogle Scholar
  3. 3.
    Williams DR, Gonzalez HM, Neighbors H, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007; 64(3): 305–315.PubMedCrossRefGoogle Scholar
  4. 4.
    Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003; 289(23): 3095–3105.PubMedCrossRefGoogle Scholar
  5. 5.
    Breslau J, Aguilar-Gaxiola S, Kendler KS, Su M, Williams D, Kessler RC. Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychol Med. 2006; 36(1): 57–68.PubMedCrossRefGoogle Scholar
  6. 6.
    Satcher D. The initiative to eliminate racial and ethnic health disparities is moving forward. Public Health Rep. 1999; 114(3): 283–287.PubMedCrossRefGoogle Scholar
  7. 7.
    Satcher D, Higginbotham EJ. The public health approach to eliminating disparities in health. Am J Publ Health. 2008; 98(3): 400–403.CrossRefGoogle Scholar
  8. 8.
    Thurston IB, Phares V. Mental health service utilization among African American and Caucasian mothers and fathers. J Consult Clin Psychol. 2008; 76(6): 1058.PubMedCrossRefGoogle Scholar
  9. 9.
    Alegria M, Canino G, Rios R, et al. Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv. 2002; 53(12): 1547–1555.PubMedCrossRefGoogle Scholar
  10. 10.
    Alegria M, Chatterji P, Wells K, et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008; 59(11): 1264–1272.PubMedCrossRefGoogle Scholar
  11. 11.
    Löwe B, Schenkel I, Carney-Doebbeling C, Göbel C. Responsiveness of the PHQ-9 to psychopharmacological depression treatment. Psychosomatics. 2006; 47(1): 62–67.PubMedCrossRefGoogle Scholar
  12. 12.
    Menke R, Flynn H. Relationships between stigma, depression, and treatment in white and African American primary care patients. J Nerv Ment Dis. 2009; 197(6): 407–411.PubMedCrossRefGoogle Scholar
  13. 13.
    Hines-Martin V, Malone M, Kim S, Brown-Piper A. Barriers to mental health care access in an African American population. Issues Ment Health Nurs. 2003; 24(3): 237–256.PubMedCrossRefGoogle Scholar
  14. 14.
    Thompson VLS, Bazile A, Akbar M. African Americans’ perceptions of psychotherapy and psychotherapists. Prof Psychol Res Pract. 2004; 35(1): 19–26.CrossRefGoogle Scholar
  15. 15.
    Wells K, Miranda J, Bruce ML, Alegria M, Wallerstein N. Bridging community intervention and mental health services research. Am J Psychiatry. 2004; 161(6): 955–963.PubMedCrossRefGoogle Scholar
  16. 16.
    Wells KB, Miranda J, Bauer MS, et al. Overcoming barriers to reducing the burden of affective disorders. Biol Psychiatry. 2002; 52(6): 655–675.PubMedCrossRefGoogle Scholar
  17. 17.
    Lincoln CE, Mamiya LH. The Black Church in the African American Experience. Durham: Duke University Press; 1990.Google Scholar
  18. 18.
    Chatters LM. Religion and health: public health research and practice. Annu Rev Public Health. 2000; 21: 335–367.PubMedCrossRefGoogle Scholar
  19. 19.
    DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. Health programs in faith-based organizations: are they effective? Am J Public Health. 2004; 94(6): 1030–1036.PubMedCrossRefGoogle Scholar
  20. 20.
    Ransdell LB. Church-based health promotion: an untapped resource for women 65 and older. Am J Heal Promot. 1995; 9(5): 333–336.CrossRefGoogle Scholar
  21. 21.
    Campbell MK, James A, Hudson MA, et al. Improving multiple behaviors for colorectal cancer prevention among African American church members. Health Psychol. 2004; 23(5): 492–502.PubMedCrossRefGoogle Scholar
  22. 22.
    Duan N, Fox SA, Derose KP, Carson S. Maintaining mammography adherence through telephone counseling in a church-based trial. Am J Public Health. 2000; 90(9): 1468–1471.PubMedCrossRefGoogle Scholar
  23. 23.
    Erwin DO, Spatz TS, Stotts RC, Hollenberg JA. Increasing mammography practice by African American women. Cancer Practice. 1999; 7(2): 78–85.PubMedCrossRefGoogle Scholar
  24. 24.
    Campbell MK, Demark-Wahnefried W, Symons M, et al. Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project. Am J Public Health. 1999; 89(9): 1390–1396.PubMedCrossRefGoogle Scholar
  25. 25.
    Resnicow K, Campbell MK, Carr C, et al. Body and soul: a dietary intervention conducted through African-American Churches. Am J Prev Med. 2004; 27(2): 97–105.PubMedCrossRefGoogle Scholar
  26. 26.
    Resnicow K, Jackson A, Blissett D, et al. Results of the healthy body healthy spirit trial. Heal Psychol. 2005; 24(4): 339–348.CrossRefGoogle Scholar
  27. 27.
    Resnicow K, Jackson A, Wang T, et al. A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial. J Inf. 2001; 91(10): 1686–1693.Google Scholar
  28. 28.
    Resnicow K, Taylor R, Baskin M, McCarty F. Results of go girls: a weight control program for overweight African-American adolescent females. Obesity. 2005; 13(10): 1739–1748.CrossRefGoogle Scholar
  29. 29.
    Young DR, Stewart KJ. A church-based physical activity intervention for African American women. Fam Commun Health. 2006; 29(2): 103–117.CrossRefGoogle Scholar
  30. 30.
    Voorhees CC, Stillman FA, Swank RT, Heagerty PJ, Levine DM, Becker DM. Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit. Prev Med. 1996; 25(3): 277–285.PubMedCrossRefGoogle Scholar
  31. 31.
    Boltri JM, Davis-Smith M, Zayas LE, et al. Developing a church-based diabetes prevention program with African Americans. The Diabetes Educator. 2006; 32(6): 901–909.PubMedCrossRefGoogle Scholar
  32. 32.
    Hankerson SH, Weissman MM. Church-based health programs for mental disorders among African Americans: a review. Psychiatr Serv. 2012; 63(3): 243–249.PubMedCrossRefGoogle Scholar
  33. 33.
    Mynatt S, Wicks M, Bolden L. Pilot study of INSIGHT therapy in African American women. Arch Psychiatr Nurs. 2008; 22(6): 364–374.PubMedCrossRefGoogle Scholar
  34. 34.
    Wang PS, Berglund PA, Kessler RC. Patterns and correlates of contacting clergy for mental disorders in the United States. Health Serv Res. 2003; 38(2): 647–673.PubMedCrossRefGoogle Scholar
  35. 35.
    Neighbors HW, Musick MA, Williams DR. The African American minister as a source of help for serious personal crises: bridge or barrier to mental health care? Health Educ Behav. 1998; 25(6): 759–777.PubMedCrossRefGoogle Scholar
  36. 36.
    Young JL, Griffith EE, Williams DR. The integral role of pastoral counseling by African-American clergy in community mental health. Psychiatr Serv. 2003; 54(5): 688–692.PubMedCrossRefGoogle Scholar
  37. 37.
    Kramer TL, Blevins D, Miller TL, Phillips MM, Davis V, Burris B. Ministers’ perceptions of depression: a model to understand and improve care. J Relig Health. 2007; 46(1): 123–139.CrossRefGoogle Scholar
  38. 38.
    Shelley D, Cantrell MJ, Moon-Howard J, Ramjohn DQ, VanDevanter N. The $5 man: the underground economic response to a large cigarette tax increase in New York City. Am J Publ Health. 2007; 97(8): 1483–1488.CrossRefGoogle Scholar
  39. 39.
    Morgan D. Focus groups. Ann Rev Sociol. 1996; 22: 129–152.CrossRefGoogle Scholar
  40. 40.
    Vidair HB, Boccia AS, Johnson JG, et al. Depressed parents’ treatment needs and children’s problems in an urban family medicine practice. Psychiatr Serv. 2011; 62(3): 317–321.PubMedCrossRefGoogle Scholar
  41. 41.
    Weissman MM, Markowitz JC, Klerman GL. Comprehensive guide to interpersonal psychotherapy. New York: Basic Books; 2000.Google Scholar
  42. 42.
    Weissman MM, Markowitz JC. Interpersonal psychotherapy. Current Status. Arch Gen Psychiatry. 1994; 51(8): 599–606.PubMedCrossRefGoogle Scholar
  43. 43.
    Weissman MM. Recent non-medication trials of interpersonal psychotherapy for depression. Int J Neuropsychopharmacol. 2007; 10(1): 117–122.PubMedCrossRefGoogle Scholar
  44. 44.
    Grote NK, Bledsoe SE, Swartz HA, Frank E. Feasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: a pilot study. Res Soc Work Pract. 2004; 14(6): 397–407.CrossRefGoogle Scholar
  45. 45.
    Shanok A, Miller L. Depression and treatment with inner city pregnant and parenting teens. Arch Women’s Ment Health. 2007; 10(5): 199–210.CrossRefGoogle Scholar
  46. 46.
    Bass J, Neugebauer R, Clougherty KF, et al. Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes randomised controlled trial. British J Psychiatry. 2006; 188(6): 567–573.CrossRefGoogle Scholar
  47. 47.
    Bolton P, Bass J, Neugebauer R, et al. Group interpersonal psychotherapy for depression in rural Uganda. JAMA. 2003; 289(23): 3117–3124.PubMedCrossRefGoogle Scholar
  48. 48.
    Clougherty KF, Verdeli H, Mufson LH, Young JF. Interpersonal psychotherapy: effectiveness trials in rural Uganda and New York City. Psychiatr Ann. 2006; 36(8): 566–572.Google Scholar
  49. 49.
    Bopp M, Webb B. Health promotion in megachurches: an untapped resource with megareach? Health Promot Pract. 2012; 13(5): 679–686.Google Scholar
  50. 50.
    Austin S, Harris G. Addressing health disparities: the role of an African American health ministry committee. Soc Work Public Health. 2011; 26(1): 123–135.PubMedCrossRefGoogle Scholar
  51. 51.
    Stewart DW, Shamdasani PN, Rook DW. Focus groups: theory and practice. Vol 20. 2nd edn. Thousand Oaks: Sage Publications; 2007.Google Scholar
  52. 52.
    Hill C, Thompson B, Williams E. A guide to conducting consensual qualitative research. Couns Psychol. 1997; 25(4): 517–572.CrossRefGoogle Scholar
  53. 53.
    Hill CE, Knox S, Thompson BJ, Williams EN, Hess SA, Ladany N. Consensual qualitative research: an update. J Couns Psychol. 2005; 52(2): 196–205.CrossRefGoogle Scholar
  54. 54.
    Knox S, Hess SA, Williams EN, Hill CE. "Here’s a little something for you": how therapists respond to client gifts. J Couns Psychol. 2003; 50(2): 199–210.CrossRefGoogle Scholar
  55. 55.
    Fullilove MT, Fullilove RE III, Haynes K, Gross S. Black women and AIDS prevention: a view towards understanding the gender rules. J Sex Res. 1990; 27(1): 47–64.CrossRefGoogle Scholar
  56. 56.
    Fullilove M, Fullilove R. Stigma as an obstacle to AIDS action. Am Behav Sci. 1999; 42(7): 1117–1129.CrossRefGoogle Scholar
  57. 57.
    Green LL, Fullilove MT, Fullilove RE. Stories of spiritual awakening: the nature of spirituality in recovery. J Subst Abus Treat. 1998; 15(4): 325–331.CrossRefGoogle Scholar
  58. 58.
    Fullilove MT, Green L, Fullilove RE. Building momentum: an ethnographic study of inner-city redevelopment. Am J Public Health. 1999; 89(6): 840–844.PubMedCrossRefGoogle Scholar
  59. 59.
    Taylor RJ, Chatters LM, Jayakody R, Levin JS. Black and White differences in religious participation: a multisample comparison. J Sci Study Relig. 1996; 35(4): 403–410.CrossRefGoogle Scholar
  60. 60.
    Taylor RJ, Mattis J, Chatters LM. Subjective religiosity among African Americans: a synthesis of findings from five national samples. J Black Psychol. 1999; 25(4): 524–543.CrossRefGoogle Scholar
  61. 61.
    Tripp M, Burleigh D, Wolff DA, Gadomski A. Training clergy: the role of the faith community in domestic violence prevention. J Relig Abuse. 2001; 2(4): 47–62.CrossRefGoogle Scholar
  62. 62.
    Jackson JS, Knight KM, Rafferty JA. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health. 2010; 100(5): 933–939.PubMedCrossRefGoogle Scholar
  63. 63.
    Williams DR. Black-White differences in blood pressure: the role of social factors. Ethn Dis. 1992; 2(2): 126–141.PubMedGoogle Scholar
  64. 64.
    Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2008; 98(9 Suppl): S29–37.PubMedCrossRefGoogle Scholar
  65. 65.
    Fullilove MT, Hernandez-Cordero L, Madoff JS, Fullilove RE 3rd. Promoting collective recovery through organizational mobilization: the post-9/11 disaster relief work of NYC RECOVERS. J Biosoc Sci. 2004; 36(4): 479–489.PubMedCrossRefGoogle Scholar
  66. 66.
    Hernandez-Cordero LJ, Fullilove MT. Constructing peace: helping youth cope in the aftermath of 9/11. Am J Prev Med. 2008; 34(3 Suppl): S31–35.PubMedCrossRefGoogle Scholar
  67. 67.
    Scheirer MA. Is sustainability possible? A review and commentary on empirical studies of program sustainability. Am J Eval. 2005; 26(3): 320–347.CrossRefGoogle Scholar
  68. 68.
    Marcus M, Walker T, Swint J, et al. Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents. J Interprofessional Care. 2004; 18(4): 347–359.CrossRefGoogle Scholar
  69. 69.
    Voorhees CC, Stillman FA, Swank RT, Heagerty PJ, Levine DM, Becker DM. Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit. Prev Med. 1996; 25(3): 277–285.PubMedCrossRefGoogle Scholar
  70. 70.
    Francis SA, Liverpool J. A review of faith-based HIV prevention programs. J Relig Health. 2009; 48(1): 6–15.PubMedCrossRefGoogle Scholar
  71. 71.
    Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. Treatment preferences among depressed primary care patients. J Gen Intern Med. 2000; 15(8): 527–534.PubMedCrossRefGoogle Scholar
  72. 72.
    Cooper LA, Brown C, Vu HT, Ford DE, Powe NR. How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients. J Gen Intern Med. 2001; 16(9): 634–638.PubMedCrossRefGoogle Scholar
  73. 73.
    Verdeli H, Clougherty K, Bolton P, et al. Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda. World Psychiatry. 2003; 2(2): 114–120.PubMedGoogle Scholar
  74. 74.
    Hollander JA. The social contexts of focus groups. J Contemp Ethnogr. 2004; 33(5): 602–637.CrossRefGoogle Scholar
  75. 75.
    Wilkinson S. Focus groups in health research. J Health Psychol. 1998; 3(3): 329–348.PubMedCrossRefGoogle Scholar
  76. 76.
    Minkler M, Wallerstein N, eds. Community based participatory research for health. San Francisco: Jossey-Bass Publishing; 2008.Google Scholar
  77. 77.
    Minkler M. Linking science and policy through community-based participatory research to study and address health disparities. Am J Public Health. 2010; 100(S1): S81–S87.PubMedCrossRefGoogle Scholar
  78. 78.
    Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract. 2006; 7(3): 312–323.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2013

Authors and Affiliations

  • Sidney H. Hankerson
    • 1
    • 2
  • Kalycia Trishana Watson
    • 1
    • 2
  • Alicia Lukachko
    • 3
  • Mindy Thompson Fullilove
    • 1
    • 2
    • 3
  • Myrna Weissman
    • 1
    • 2
    • 3
  1. 1.College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  2. 2.New York State Psychiatric InstituteNew YorkUSA
  3. 3.Mailman School of Public HealthColumbia UniversityNew YorkUSA

Personalised recommendations