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Culturally shaped notions of health and illness have a strong impact on how individuals engage in help seeking and how they view service use when they are ill. The current study was designed to look more closely at the impact of culture, specifically cultural beliefs, on help seeking and service use for depression among black Americans.
Through qualitative interviews with seventeen black men and women, the authors sought to identify culturally shaped beliefs that may be held by black communities and to understand their impact on participants' thoughts about depression and treatment as well as their attitudes about help seeking. Key themes around three culture and culturally shaped beliefs were extracted: (a) black people don't get depressed, (b) I don't trust the doctors and/or the treatment, and (c) you don't need a doctor-it'll go way-just pray. The impact of these culturally shaped beliefs was also discussed; their greatest impact was on how respondents thought about help for their depression and who they spoke with about their distress.
Key words: black Americans; culture; depression; illness experiences; social determinants of mental/behavioral health
Introduction
Depression is a major mood disorder affecting many people in the United States (Kessler, Berglund, et al., 2005, Williams et al., 2007). Although the disorder is quite treatable for most people, many of those suffering from this debilitating illness do not seek help (Neighbors et al., 2007; Williams, et al., 2007). Among those who do seek help, black Americans lag significantly behind white Americans in formal service use (Alegría et al., 2008; Keyes et al., 2008; Williams et al., 2007). Also troublesome is that, although rates of depression are lower among black Americans, when they do experience depression, the symptoms tend to be more severe and persistent (Kessler, Berglund, et al., 2005; Kessler, Chiu, Dernier, & Walters, 2005; Williams et al., 2007).
For many years, researchers have sought to understand and ultimately eliminate racial/ethnic disparities that exist in mental health help seeking and service use. Financial and structural barriers are the factors most often addressed in the literature. However, growing concern that differences in service use persist even after accounting for such factors led scholars to look toward more personal and social factors affecting the use of mental health services. These facilitators and...