Depression Among Older African Immigrant Women in Massachusetts

Introduction and Overview of the Problem

In Metro West Massachusetts, the most common health disorders are anxiety and depression, which 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 both their access to mental health services and the quality of treatment they receive. Research indicates that African American heterogeneity prevents access to depression and anxiety treatment. In addition, African Americans are becoming an increasingly visible minority within the United States, especially in West Massachusetts, and are often described as Black.

The current study sought to understand the causes and prevalence of depression among older immigrant African American women in Metro West Massachusetts, as well as how older immigrants cope with depression. A total of 12 self-identified social workers were interviewed about their patients' mental health problem symptoms and treatment experiences, perceived causes of patient anxiety, stressors facing patients' lives in West Massachusetts, patient access to mental health services, and how patients coped with depression. Results indicated 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 their White counterparts. An individual's gender, age, marital status, and country of origin played a major role in the endorsement of anxiety and depression among immigrants. 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 either group. These findings underscore the importance of attending to both between-group and within-group differences in the mental health and treatment experiences of different ethnic populations.

In recent years, there has been a growing need for social work services for immigrants, particularly older immigrants aged 65 and above (Social Work Today, n.d.). These individuals experience relocation to an entirely new geographical region where people are strangers to them. Society's acceptability of them is often low, creating negative impacts on their physical and cognitive health. These impacts can manifest as social isolation, loss of independence, cognitive decline, and health problems in old age.

Old age is a critical time of life when elderly people need special care and attention. Their socialization patterns change, especially when they must migrate. The negative effects may emerge in economic, social, psychological, political, and cultural terms (Lotfi, 2020). Immigration has adverse effects on aging people, as they are mentally less equipped to manage the pressures imposed by a variety of changes. Their family and social relations are affected, resulting in complex physical, psychological, and sociological difficulties.

Social work interventions are innovative strategies to support the emotional and physical wellbeing of elderly migrating people. Social workers help elderly individuals through the adaptation process so that social exclusion can be mitigated and social justice can be served (Haidar, n.d.). Because they work with "mixed status" families, social workers must take care to respect individual rights, especially with regard to clients' ethnic backgrounds.

An increase in older African American migrants is expected by 2050, with racial and ethnic needs growing alongside those of populations with low educational levels (Gilmore, 2013). Their social and emotional needs must be addressed by culturally competent social workers so that medical and therapeutic healthcare services can be appropriately provided. However, healthcare access barriers have been observed for racially and ethnically diverse older immigrants (Koehn, 2009). There is a vast disparity in healthcare provision between native-born populations and aging migrants who have relocated, adversely affecting the morbidity and mortality rates of these populations (Kristiansen et al., 2016).

Problem Statement and Purpose of the Study

The intent of 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 who 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, given the extent to which the condition affects vulnerable populations. Derr (2017) pointed out that immigrants typically face stressors related to the migration experience that may cause or intensify mental health problems. Moreover, Derr (2017) noted that immigrants tend to access mental health services at a lower rate compared to non-immigrants. This situation leaves immigrants at risk of untreated health conditions, leading to increased disease burden (Lynch, Berg, Manna, & Schade, 2016). This negative health predisposition creates a greater need for mental health services among immigrants, who appear more susceptible to developing depression. It is therefore imperative to establish the views of social workers addressing the mental health needs — especially depression — among older immigrant African women in Metro West Massachusetts. Metro West Massachusetts comprises a cluster of cities and towns where one of the fastest-growing African American communities in the country is located, with a growth rate of 95% since 2000 (Impact Metro West, n.d.). However, disparities in educational and social gains remain evident for people of color, as they are in other parts of the United States (Rosenberg, 2020). Insights gained from this study should play a critical role in developing comprehensive mental health programs aimed at improving immigrants' health outcomes.

Migration can be challenging, and many immigrant women experience difficulties that affect their mental health (Foo et al., 2018). Changes in practices, values, social factors, and cultural identification are considered contributing factors 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 daily life. 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). Examining the stressors surrounding the migrant experience from the social work perspective therefore offers insights into the issues faced by this vulnerable population, especially women aged 50 and above.

Based on the highlighted problem, it is imperative to determine the views of social workers in West Massachusetts who work with older immigrant African women affected by depression (O'Donnell et al., 2016). Such an undertaking may reveal service modifications — such as allowing patients with language barriers more time — to enhance access to quality mental health services (O'Donnell et al., 2016). As researchers have suggested, immigration can create worry that increases the risk of depression, and this can be exacerbated by cultural factors such as language barriers, which may impede the diagnosis and treatment of this disorder among immigrant populations (Landa, Skritskaya, Nicasio, Humensky, & Lewis-Fernández, 2015). Failure to appropriately determine the views of social workers on depression within a given community translates to neglecting social health and welfare (Baldwin-Clark, Ofahengaue Vakalahi, & Anderson, 2016). In response, this study aims to obtain the perspectives of social workers regarding depression within the selected migrant population, as well as insights into how professionals in the healthcare sector can help meet emerging needs.

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 work sector can assist in meeting the emerging needs of the population. Expected results include identification of any service modifications needed to address the needs of immigrant African women in Metro West Massachusetts (Takeuchi, 2016). These findings can enhance access to quality mental health services and ensure that women understand the implications of not seeking mental health care. Having examined the stressors faced by migrant women, insights will be gained into the issues women face within the population, and solutions directly targeted to this population can be developed (Agbemenu, 2016). Social workers will also benefit, as they will be able to use the findings of this study to determine methods for reaching out to the population under study.

This study focuses on answering the following research questions:

1. From the perspective of social workers, what factors influence older immigrant African women's adaptive capacity in Metro West Massachusetts?

2. From the social work perspective, what mental health services do social workers offer to older immigrant African women in Metro West Massachusetts?

3. How do social workers assess the need for mental health services for 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?

Definition of Key Terms

Culturally informed — Culturally informed care is defined as the offering of services by healthcare professionals that respect, acknowledge, and integrate the patient's cultural values, practices, and beliefs (Health Policy Institute, n.d.). In this study, culture extends beyond identifying the patient and family by race and ethnicity to include variables such as faith, country of origin, education level, socioeconomic status, and level of acculturation. Culturally informed refers to the ability of social workers to offer services that recognize, affirm, and value the worth of clients, their families, and their communities, while preserving and protecting their dignity.

Older immigrant African women — Older immigrant African women refers to women who are over 65 years of age (Noubicier & Charpentier, 2013) and who relocated from any African country to the United States. The women could have come to the US legally or illegally, and the phrase also refers to women who came to the US as refugees and have remained there into advanced age. For this study, the focus is on older immigrant African women living in West Massachusetts who suffer from depression.

Immigrant — According to the Oxford University Press (n.d.-b), an immigrant is a person who comes to permanently live in a foreign country. There are four types of immigration status: citizens, residents, undocumented individuals, and non-immigrants. This study does not focus on the immigrant's legal status, though status is expected to influence how immigrants access mental health services. The study considers all immigrants provided they immigrated from Africa and are living in the selected community.

African women — African women refers to a native or inhabitant woman of Africa, or a woman of African ancestry (Ythera, 2017). In this study, the term refers specifically to older immigrant African women who were born outside of the US in Africa and who migrated to the US — either legally or illegally — and currently reside in West Massachusetts. These women will have lived nearly half their lives in Africa before immigrating to the US.

Coping mechanisms — A coping mechanism is defined as "an adaptation to environmental stress based on conscious and unconscious choice that enhances control over behavior" (Dictionary, n.d.). In this study, coping mechanisms refer to the different cultural strategies the women use to deal with the stressful situations they encounter — the methods they employ to adjust to stress and to maintain their emotional well-being.

Migration — Migration is the movement of people or animals from one place to another (Dictionary, n.d.). In this study, migration refers to the movement of people from any African country to the United States. The focus is on women who have migrated from Africa to the US — either alone, with their family, or with a relative — and who are currently living in West Massachusetts. The migration process itself is not a primary focus, but it may be drawn upon to determine whether it contributes to women's failure to access mental health services.

Host country — According to the Oxford University Press (n.d.-a), a host country is a country that holds a cultural or sporting event to which others are invited. In this study, the term refers to the country accommodating the African immigrants — the United States.

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 results will assist community social workers in better addressing the 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 barriers to support exist. Findings will equip social workers with the knowledge to develop strategies for treating depression and bring awareness to the unique needs of older immigrant African women.