Levels of Depression in West Massachusetts

Running head: DEPRESSION AMONG OLDER IMMIGRANTS

DEPRESSION AMONG OLDER IMMIGRANTS 38

Depression Among Older Immigrant African Women in Metro West Massachusetts

Bi Toh

Doctor of Social work

Walden University

September 6, 2020

A00671691

Prospectus: Depression Among Older Immigrant African Women in Metro West Massachusetts

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 acquiring 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 which 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 (Foo et al., 2018). For example, the changes in practices, values, social factors and cultural identification are considered as factors contributing to the potential risk of developing mental health issues (Alegría, Álvarez, & DiMarzio, 2017). Similarly, Foo et al. (2018) asserted 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 insights 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 (O’Donnell et al., 2016). 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 (O’Donnell et al., 2016). 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 which 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 can be provided into ways the 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 needed to meet the needs of the immigrant African women located in Metro West Massachusetts (Takeuchi, 2016). These findings can enhance access to quality mental health services and ensure the women understand the implications of not seeking mental health services. Having examined the stressors faced by the migrant women, insights will be gained into the issues the women face within the population and solutions directly targeted to the population can be developed (Agbemenu, 2016). Social workers will also benefit as they will use the findings of this study to determine methods 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 factors influence older immigrant African women’s adaptive capacity in Metro West Massachusetts?

2. From the social work perspective, what mental health services are available for older immigrant African women in Metro West Massachusetts?

3. How do social workers assess the need for mental health services for their clientele, particularly to 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 residing in Metro West Massachusetts. Findings will offer insights into ways social workers can meet the emerging needs of this population. The study results will assist the community social workers to better address the emerging needs and challenges older immigrant African women face when accessing mental health services. More specifically, the study will focus on how the target population is affected by depression when there are barriers to them receiving support. Findings in the study will equip social workers with the knowledge to develop strategies they can use to treat depression and bring awareness to the unique needs of this target population.

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 social support serves as a resistance factor, and plays 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 society is like a system where all the parts will work together to create a whole society. 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 an acceptable manner (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). For this study, search was conducted for peer-reviewed publications focusing on mental health among older African immigrant women, from the following sources, MEDLINE, PsycINFO, CINAHL, EBSCO, Research Gate, ProQuest, SAGE Journals, and EMBASE. The keyword(s) used to search for the appropriate literature for this study was older African American women, older immigrant African women, depression in immigrant African women, depression, and older immigrant women.

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 disorders 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 a 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 a 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 Li, Liddell, and Nickerson (2016). 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. Ekwemalor and Ezeobele (2020) 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 into the barriers older immigrant African women face in accessing mental health resources, which will also include an analysis of the availability of those resources. Due to their understanding of and interaction with this population, the views of the social workers will be examined to ensure the information being presented is reliable. Social workers are responsible for addressing the health challenges that this 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 effect of depression among older immigrant African women. The source of information for this study will come from the responses obtained from the individual interviews with each social worker. Secondary data will come from documents and archival data. The epistemology of this study will focus on exploring the experiences of social workers working with older African immigrant women living in Metro West Massachusetts. Social workers working in the community for 3 or more years, are graduate level social workers or higher, female, and are over 30 years of age will be used for this study. Exclusions will include social workers who meet the above criteria but have not worked with older African immigrants. This inclusion process will ensure experienced social workers are providing information 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 audio recorded interviews will be written down and typed into a word document. This researcher will use transcription to develop codes to use before the data is entered into the system. For this study, the researcher will make use of SPSS Statistics software to analyze the data. The analysis will be used to verify the data and identifying patterns that can answer research questions.

Data Types and Sources of Information

The data types of the study will be qualitative as the researchers will rely on face-to-face interviews with the social workers and if required, using the social distancing protocol. To conduct the research, samples will be selected from social workers who are currently serving the Ashland community in metro west MA, a prior place of employment. This researcher will post flyers around mental health offices, retirement homes, and hospitals inviting social workers to participate in the study. Additional method will be handing out flyers to social workers attending conventions, trainings, and programs within the area. The social workers will also be requested to answer certain questions about the role they play in ensuring the availability of mental health services to the population as well as service modifications that can help improve health delivery. For example, how do you ensure elderly African immigrant women are able to access mental health services? The data collection process will rely on face-to-face interviews, where 10 questions are developed to probe for relevant information from 10-12 social workers working with elderly immigrants in West Massachusetts. As is the case in other studies we foresee there might be some social workers who will leave the study early or might not be interviewed due to time constraints. The face-to-face interview will last approximately 45 minutes to one hour. To ensure the interviewees will be comfortable during the interview process, this researcher will propose conducting the interviews in the social worker's office during their lunch break or another agreed upon space where all information obtained could be kept confidential.

Limitations, Challenges, and/or Barriers

Recruiting of the social workers will be a huge challenge for this research mainly due to having no prior relationship with prospective participants. Getting them to trust the researcher will be an uphill task as the nature of their work is sensitive and their discomfort sharing patient information. Another challenge is time limitation, as the social workers might be unavailable for the interviews. Another challenge that might occur is some social workers might have an emergency and, as a result, might have to cancel their interview. This will result in attrition and reduce the number of study participants. Face-to-face interviews may not be feasible due to COVID 19. To overcome this challenge the researcher proposes to make use of internet services like GoToMeeting, skype, Zoom, or any other web-based service. Some social workers may not be familiar with these technologies.

Summary

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 can benefit the social workers as they will get insights into strategies, they can use to assist older immigrant African women who are suffering with depression to get mental health services. This study aims to uncover the cultural influences faced by social workers when working with this population. By understanding the impact culture has on the community, social workers can develop strategies they will use to become culturally competent.