Depression Among Older Immigrant African Women in Metro West Massachusetts

Prevalence of Depression in Massachusetts
Prospectus: Depression Among Older Immigrant African Women in Metro West Massachusetts
Abstract
In West Massachusetts United States, the most common health disorders are anxiety and depression. These health disorders are prevalent in elderly immigrant women aged between 50 and 79 years (Agbemenu, 2016). Despite a variety of efficacious interventions for depression and anxiety, elderly immigrant women experience mental health care disparities in their access to mental health services and the quality of treatment they receive (Sánchez et al., 2014). Researchers have determined that African American heterogeneity influences access to depression and anxiety treatment. In addition, African Americans are becoming an increasingly visible minority within the United States, especially in West Massachusetts. The intention in this current study is to understand the causes and prevalence of depression among older immigrant African American women in Metro West Massachusetts as well as how the older immigrants cope with the depression. A total of 20 self-identified social workers were interviewed about their patients’ mental health problem symptoms and treatment experience, what they thought was their cause of their anxiety, stressors facing their life in West Massachusetts, their access to mental health services, and how they coped with depression. Results were reflective of considerable variability across the two groups, with African American elderly immigrant women endorsing higher rates of depression and anxiety, as well as higher rates of treatment seeking, than White women. Gender, age, marital status, and origin played a major role in the endorsement of anxiety and depression for the immigrants. Finally, although the two groups differed in the extent to which they experienced stigma about mental health issues, stigma did not predict symptom endorsement or treatment-seeking behavior for any of the two groups.
Problem Statement
The intent in this study is to explore the views of social workers in relation to depression among older immigrant African women currently living in west Massachusetts. Older immigrant African women refers to women who are over 55 years of age and they relocated from any African country after winning a green card or getting permanent residency in the United States. Depression among elderly immigrant women stands out as an important phenomenon for study in the context of social work taking into consideration the extent to which the condition affects vulnerable populations. Derr (2017), pointed out immigrants typically face stressors relating to migration experience that may cause or intensify mental health problems. Moreover, Derr (2017) also discussed that immigrants tend to access mental health services at a lower rate as compared to non-immigrants. Subsequently, this situation leaves immigrants at risk of untreated health conditions leading to increased disease burden (Lynch, Berg, Manna, and Schade (2016). As such, this negative health predisposition creates greater need for mental health services among immigrants who seem more susceptible to develop depression. This situation makes it imperative to establish the views of social workers addressing the mental health needs, especially depression, among older immigrant African women in Metro West Massachusetts. In turn, insights gained should play a critical role in the development of comprehensive mental health programs aimed at improving the immigrants’ health outcomes.
As noted, migration can be challenging, and many immigrant women experience challenges that affect their mental health. For example, the changes in practices, values, social factors and cultural identification are considered as factors that contribute to the potential risk of developing mental health issues (Alegría, Álvarez, & DiMarzio, 2017). Similarly, Foo et al. (2018) asserted that migration into a new country leads to drastic changes in essential aspects of normal day life. Here, the process of assimilating to new environments and cultures causes considerable levels of acculturative stress, which researchers have linked to the occurrence of psychiatric disorders (Foo et al., 2018). Therefore, examining stressors surrounding the migrant experiences from the social work perspective should offer excellent insight into the issues faced by this vulnerable population, especially for women aged 50 years and above.
Based on the highlighted problem, it is imperative to determine the views of social workers from West Massachusetts who work with older immigrant African women in Metro West Massachusetts affected by depression (Priebe et al., 2011). Such an undertaking may reveal service modifications such as giving patients with language barriers more time needed to enhance access to quality mental health services (Priebe et al., 2011). As suggested by researchers, immigration can create worry, which may increase the risks of experiencing depression, and this can be exacerbated by cultural factors, such as language barriers that may cause difficulty in diagnosing and treating this disorder among immigrant populations (Landa, Skritskaya, Nicasio, Humensky, & Lewis-Fernández, 2015). Failure to determine appropriately the views of social workers on depression within a certain community translates to neglecting social health and welfare (Baldwin-Clark, Ofahengaue Vakalahi, & Anderson, 2016). In response, the intent of this study is to obtain the perspective of social workers regarding depression within the selected migrant population as well as insights into the ways in which professionals in the healthcare sector can help meet emerging needs.
Purpose of the Study
In this study, the views of social workers regarding depression in older immigrant African women in Metro West Massachusetts will be obtained. Through analyzing these perspectives, insights may be provided into ways that social workers sector can assist to meet the emerging needs of the population. Expected in the results of this study will be any service modification that is needed to meet the needs of the immigrant African women located in Metro West Massachusetts (Takeuchi, 2016). These findings may enhance access to quality mental health services and ensure that women can understand the implication of not seeking mental health services. Having examined the stressors that are faced by the migrant women, insights will be gained into the issues that the women face within the population and solutions can be developed that will be directly targeted to the population (Agbemenu, 2016). Social workers will also benefit in that they will use the findings of the study to determine methods that they can use to reach out to the population under study.
Research Questions
Focused upon in this study will be the following research questions:
1. From the social work perspective, what are the stressors facing older immigrant African women in Metro West Massachusetts?
2. From the social work perspective, what are the health service access disparities faced by older immigrant African women in Metro West Massachusetts?
3. What role do social workers play in bridging mental health service access disparities facing older immigrant African women in Metro West Massachusetts?
4. What service modifications can social workers introduce in practice to enhance mental health service delivery for older immigrant African women in Metro West Massachusetts?
Significance of the Study
The findings of this study will contribute new knowledge to address the gap in research regarding depression in older immigrant African women living in Metro West Massachusetts. Findings will offer insights into ways that social workers can meet the emerging needs of this population. The stressors that older immigrant African women report will be uncovered in the study. The results of this study may be used to address health service access disparities that are faced by older African immigrant women and the strategies that can be employed to seal the health service access disparities or address the disparities. More specifically, the study will focus on social worker who are working with older immigrant African women in Metro West Massachusetts who are experiencing depression. Findings in the study will equip social workers with the knowledge to develop strategies that they can use to treat depression and bring awareness to the unique needs of this target population. With a better understanding of cultural competence, social workers may approach the subject with caution and with consideration of the impact of depression to the women and to their culture.
Theoretical Framework
The theoretical framework that can be used to frame this project is the structural-functional theory. Some theorists such as Cassel (1995) and Cobb (1976) expressed that social support serve as a resistance factor, and play an important role in reducing adverse impact of exposure to negative life events (Thoits, 1985). This theory should play a key role in understanding the onset of depression among older immigrant African women, given the various social demands associated with being a migrant. Further, Kinser and Lyon (2014) emphasized that depressing experiences may increase a person’s possibility to suffer from stressful episodes. Stress and vulnerability add up to the possibility of developing depression, where changes in the environment, lack of coping mechanisms and lack of support have an adverse impact on the mental health outcome of this group (Alegría et al., 2017). Cultural influences can be revealed that will be vital in determining the methods that can be used to treat this population. To become culturally competent when dealing with this population, social workers would need to be familiar with the structural-functional theory. Explained in this theory is why society functions the way it does, and it emphasizes on the relationships between the different social institutions that make up society (Emadpoor, Lavasani, & Shahcheraghi, 2016). Some of these social institutions are education, law, government, religion, and culture. The social worker should understand that society is like a system where all the parts will work together to create a whole society. Therefore, Emadpoor et al. (2016) posit societies will need culture for them to function. Therefore, being culturally informed is beneficial to the social worker and it will allow them to reach out to the community members and approach them in a manner that will be acceptable (Sabbioni et al., 2018).
Literature Review
From the review conducted, a lack of literature exists in which the primary focus was placed on older African immigrant women (Okudo & Ross, 2016). This shortage is due to numerous factors that mostly involve with the perception that African immigrants have regarding depression (Thomson, Chaze, George, & Guruge, 2015). Most times, depressed individuals are stigmatized, and most African communities believe depression is caused by bad spirits. With this notion it becomes difficult for the women to seek professional health services as they would be labelled and judged by other community members harshly (Sánchez et al., 2014). I searched for peer-reviewed publications focusing on mental health among older African immigrant women, from the following sources, MEDLINE, PsycINFO, CINAHL, Health star, and EMBASE. Forty-six articles were found that met the inclusion criteria and from these 46 articles, 10 articles were selected and included in this literature review.
1. Okudo and Ross (2016) offered information on the various health challenges that African Immigrants from different parts of Africa face when they relocate to the US over time and the exploration of the healthy immigrant effect (HIE).
2. Sánchez et al. (2014) identified the most commonly occurring mental health disorder are depression and anxiety. The authors also note there is disparity in the quality of care given and in their access to mental health services. The role of culture and stigmatization was explored in the study.
3. Rashid and Gregory (2014) focused on the experiences of African Immigrant women with a focus on their life before and after their relocation.
4. Thomson et al. (2015) the relocation process can impact the mental health of immigrants and without information on mental health and helpful services many immigrants are denied access to mental health services.
5. Baldwin-Clark et al. (2016) noted depression is major problem among older African immigrant women and since they are understudied, their depression is rarely discussed or researched.
6. As noted by Delara (2016) the mental health of African immigrant women is affected by social, cultural, and the health care system and there is need to embrace different methodologies for promoting mental health among the women.
7. Lazar-Neto, Louzada, de Moura, Calixto, and Castro (2018) assessed the frequency of depression among immigrants living in Massachusetts to determine correlates of depression.
8. The stressors faced by African immigrants and refugees when they relocate to the United States were analyzed by Dow (2011). The authors link the stressors to the development of depression.
9. Foo et al. (2018) was analyzing the extent of depression among immigrants and explored the variations on prevalence based on demographic and educational factors.
10. Ezeobele, Malecha, Landrum, and Symes (2010) explored the portrayal of depression among Nigerian-born immigrant women who were living in the United States.
Nature of the Study
This will be an exploratory study with the aim of uncovering the views of social workers who work with immigrant African women located in Metro West Massachusetts. The focus of the study is to gain insights and become familiar with the situation and the barriers that the social workers face in their day-to-day work. Taking the views of the social workers ensures that the information being presented is reliable because they understand and interact better with the population. Social workers are charged with visiting and addressing the health challenges communities face. With this in mind, vital insights can be revealed by interviewing and gaining their perspective regarding the current situation. The views expressed by the social workers should be analyzed to determine the impact of depression among older immigrant African women. The study will rely mostly on the views expressed by social workers. Data will be collected using face-to-face interviews with social workers working in the community for 3 or more years. This ensures that the researcher will get experienced social workers to provide information that is relevant to the study.
The interviews will be audio recorded and the interviewer will be taking notes as the interview progresses. Transcription will be the first step of data analysis where all the interviews will be transcribed before they are entered to the computer for processing. Transcription will allow us to develop codes that we can use before the data is entered into the system. For this study, the researcher will make use of SPSS software to analyze the data. Data analysis will then be conducted by independent analysts who will not be privy to the participant information. Our analysis will use the constant comparative analysis to compare the accounts of two different social workers. The researcher aims to uncover the differences and similarities in the data collected from the questionnaires and interviews conducted.
Data Types and Sources of Information
The data types of the study will be quantitative as the researchers will rely on face-to-face interviews with the social workers. To conduct the research, samples will be selected from social workers who are currently serving the Ashland community in metro west MA. We will post flyers around the neighborhood inviting social workers to participate in our study. Another method we will use to recruit study participants is handing out flyers to social workers. In this way, a better chance occurs to gain a good understanding of the stressors, and health access disparities faced by older immigrant African women in metro west Massachusetts. The social workers will also be requested to answer certain questions about the role they play in bridging mental health service access disparities facing the selected population as well as service modifications that can help improve health delivery. The data collection process will rely on face-to-face interviews, where 10 questions will be developed to probe for relevant information from 20 social workers working on elderly immigrants in West Massachusetts. The face-to-face interview will last for a maximum of one hour. To ensure that the interviewees will be comfortable during the interview process, we propose to conduct the interviews during their lunch break at a coffee shop close to their office.
Limitations, Challenges, and/or Barriers
Recruiting of the social workers will be a huge challenge for this research mainly due to the fact that most of them do not know the researcher. Getting them to trust us will be an uphill task as the nature of their work is sensitive and they would not be comfortable revealing patient information to a stranger. Another challenge is time limitation, as the social workers might be unavailable for the interviews. Considering that we plan to conduct the interview at a cafe during lunch hour, only one interview can be scheduled each day. Perhaps, some social workers might be willing to take the interviews in their offices which would save time as the interviews could be completed more quickly. Distractions might occur if the interviews were conducted in a cafe. The social worker might struggle to focus on the question as they are also having their lunch. Natural cafe distractions might come to play, and questions might have to be repeated if the cafe is noisy. Another challenge that might occur is that some social workers might have an emergency and, as a result, might have to cancel their interview. This situation would mean the interview would have to be rescheduled, with the possibility that the interview might not occur at all, given time restraints.
Conclusion
The results of this study can be used by other social workers who are dealing with a similar population. Based on the results of this study, other social workers will benefit in that they will find out the strategies that can be employed to reach out to such a population and the strategies that they should avoid. Social work will benefit the most because results may be used to provide suggestions that other social workers can use when dealing with immigrant African women. Considering that the women will have different cultures based on their country of origin, it will be vital that social workers first understand the culture before they can begin offering treatment or counseling to the individual.
Intended in this investigation is to reduce the case of mental health problems that are faced by immigrant African women located in Metro West Massachusetts. According to Saeidimehr, Geravandi, Izadmehr, and Mohammadi (2016), reducing the causes of depression is beneficial to society due to a reduced number of people who need mental health services or are living with mental conditions. Results from this investigation may benefit the community by reducing cases of depression among the immigrant African women that are caused by their migration experience.
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