African Americans' Attitudes and Access to Mental Health Care

Introduction

African Americans, also known as Afro-Americans, are the American ethnic group with partial or total ancestry from any black population in Africa. The term African American primarily signifies the descendants of enslaved Africans in the United States, though some are also immigrants from Africa. African Americans compose the second-largest racial group and a third of the largest ethnic group in the United States. Mental health is defined as behavioral, emotional, and cognitive well-being—broadly, how people feel, behave, and think. Looking after mental health enables individuals to enjoy life, achieved through balancing life responsibilities, daily activities, and efforts to attain psychological resilience. Situations such as anxiety, stress, and depression can significantly affect an individual's mental health (Conner et al., 2010).

In general, mental health conditions occur among African Americans at lower frequency than among white Americans. However, African Americans' lived experience in the United States is more frequently characterized by violence and trauma than that of their white counterparts. Historical oppression, violence, and dehumanization against African Americans have recently evolved into present-day racism (Eisenberg et al., 2007). Mistrust of medical systems also affects the help-seeking behavior of African Americans. However, according to Mental Health America (MHA) screening data, African Americans who screen positive for depression self-identify as seeking help more than any other general population group. Unfortunately, African American providers known for delivering adequate and culturally appropriate care to African American patients represent only a small portion of the behavioral health provider workforce. As a result of these factors, African Americans are more likely to experience persistent and chronic—rather than episodic—mental health conditions (Alvidrez, 1999).

Depression is one of the most widespread mental illnesses in the United States, affecting more than 6 million men and 12 million women within any given year. According to the National Institute of Mental Health, African American women have a higher prevalence of mental health conditions at 13.1% compared to African American men at 7.0% (Conner et al., 2010). However, the lower depression prevalence among African American men is not fully understood, particularly given that African American men have made fewer economic gains than African American women, and that low education and income are considered risk factors for depression. According to a report by Lincoln, Watkins, Taylor, and Chatters, African American men with income levels below the poverty line and formal education below 12 years reported more symptoms of depression than men and women with higher income and formal education (Diala et al., 2000).

Historical Context and Health Disparities

Historically, the first African Americans entered the United States as enslaved people, forced to live in social and physical conditions where their health had very little or no value. As a result, African Americans suffered mental, social, and physical brutalization for more than 250 years (Alvidrez, 1999). Even after the end of slavery, African Americans could not easily live healthy lives. They were subjected to systematic oppression and discrimination for another 150 years following the abolition of slavery, and racial inequities persist to this day. This harsh history appears to have produced two outcomes: those who survived subjugation may be among the most resilient; however, the ongoing racial discrimination African Americans continue to experience significantly contributes to their poor health status overall.

The first comprehensive review of health inequality endured by African Americans was provided in 1984 by Margaret Heckler, then Secretary of Health and Human Services, who was dissatisfied with how health inequalities were being reported to Congress. That report laid the groundwork for eliminating health disparities through health promotion, education, and improved access to healthcare services. One of the most significant outcomes of the Heckler Report was the formation of the Office of Minority Health in 1986, established to improve the health of ethnic minority groups through policy development and programs aimed at eliminating health inequalities. Nevertheless, even after the publication of the Heckler Report, African Americans continue to experience unacceptable health inequalities and a lack of influence over the policies that could change them (Diala et al., 2000).

Epidemiological Evidence and Study Findings

In the 1980s, the Epidemiologic Catchment Area (ECA) study sampled residents of St. Louis, Los Angeles, and Baltimore, assessing samples from both institutions and communities at large—including jails, mental hospitals, nursing homes, and residential alcohol or drug treatment facilities. More recently, the National Comorbidity Survey (NCS) conducted a comparable study. The ECA results indicated that African Americans were more likely to suffer from phobias than whites but less likely to experience depression. The NCS results similarly indicated that African Americans are less likely to suffer from depression (Smith, 2009).

Both studies identified differences in mental illness rates by gender: anxiety disorder, phobia, and depression prevalence rates were all higher in African American women than in African American men. However, based on these findings, it remains difficult to determine conclusively whether a meaningful difference in overall mental illness rates exists between African Americans and white Americans. The ECA found higher lifetime disorder rates among African Americans than among whites (Diala et al., 2000). When researchers controlled for differences in marital status, age, socioeconomic status, and gender, however, those differences narrowed. African Americans in the community appeared to be disproportionately affected by mental illness compared to whites, though the difference was largely attributable to demographic composition and social position (Rastogi et al., 2012).

By contrast, the NCS found that African Americans residing within the community exhibited a lower prevalence of lifetime mental illness than white Americans, irrespective of differences in socioeconomic and demographic status. These major epidemiological surveys thus tentatively conclude that mental illness rates are broadly similar between white and African Americans. Yet this conclusion is also open to challenge due to the overrepresentation of African Americans in high-need populations. People who live in prisons, poor rural areas, psychiatric hospitals, and inner-city neighborhoods are often inaccessible to household survey researchers. When these high-need groups are properly counted, higher rates of mental illness among African Americans become more likely (Rastogi et al., 2012).

Conclusion and Policy Implications

African Americans and whites share biological similarities; therefore, appropriate treatment is equally applicable to both groups in addressing mental illness. From earlier studies, African Americans and whites living in communities exhibit similar mental illnesses and distress symptoms. However, some researchers have not fully accepted this finding, citing economic differences and income disparities between white and African American populations. This research evaluates whether the economic status of African Americans influences their access to mental health care, with the aim of guiding appropriate policies to ensure that universal access to mental health services is guaranteed to all citizens (Alvidrez, 1999).

Ultimately, understanding the intersection of historical trauma, cultural stigma, religious coping, and socioeconomic disadvantage is essential to developing effective, culturally competent mental health interventions for African American communities. Continued research into these factors—and into the persistent gaps identified in the existing literature—is critical to closing the mental health equity gap.

References

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Diala, C., Muntaner, C., Walrath, C., Nickerson, K. J., LaVeist, T. A., & Leaf, P. J. (2000). Racial differences in attitudes toward professional mental health care and in the use of services. American Journal of Orthopsychiatry, 70(4), 455–464.

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