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ABSTRACT
Many African American women are heavily burdened by unmet mental health needs yet underuse mental health services. The superwoman schema (SWS) conceptual framework provides a new culturally sensitive framework to enhance researchers', providers', and educators' understanding of the barriers to mental health service use among this group. The "superwoman" role involves perceived obligations to (1) project strength, (2) suppress emotions, (3) resist feelings of vulnerability and dependence, (4) succeed despite limited resources, and (5) prioritize caregiving over self-care. In this study, the SWS framework guided a secondary qualitative analysis of data from eight focus groups comprised of 48 African American women from the southeastern United States and a broad range of age and educational backgrounds. Results suggest that the major components of SWS, as well as perceived stigma, religious and spiritual concerns, and the desire for culturally sensitive providers influenced participants' perceptions and use of mental healthcare. Understanding how SWS operates in African American women may (1) enable researchers to better understand and develop interventions to mitigate disparities in mental health service use; (2) help healthcare professionals to engage and treat this population more effectively; and (3) equip health professions educators to improve the cultural sensitivity of the next generation of providers.
Keywords: ? African American Women ? Disparities ? Mental Health Care Use ? Superwoman Schema
INTRODUCTION
Depression and severe psychological distress are urgent health challenges in the 21st century. Each year, nearly 7 percent of US adults have major depressive disorder (National Institute of Mental Health [NIMH], 2016), and depression is one of the leading causes of disability among US adults (US Burden of Disease Collaborators, 2013). At the same time, findings from the literature on ethnic differences in depression and mental illness are often mixed and difficult to interpret. According to some estimates, African Americans are less likely than non-Hispanic whites to experience major depressive disorder in any given year (NIMH, 2016). However, according to data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES), 8 percent of African Americans suffered from depression compared to slightly less than 5 percent of non-Hispanic white Americans (Pratt & Brody, 2008). Similarly, national data reported by the Centers for Disease Control and Prevention (CDC, 2012) show that African Americans are more likely...