Engaging women who are depressed and economically disadvantaged in mental health treatment

Nancy K Grote, Allan Zuckoff, Holly Swartz, Sarah E Bledsoe, Sharon Geibel, Nancy K Grote, Allan Zuckoff, Holly Swartz, Sarah E Bledsoe, Sharon Geibel

Abstract

Women disadvantaged by poverty, as well as racial or ethnic minority status, are more likely to experience depression than the rest of the U.S. population. At the same time, they are less likely to seek or remain in treatment for depression in traditional mental health settings. This article explores a therapeutic, psychosocial engagement strategy developed to address the barriers to treatment engagement and the application of this strategy to a special population--women of color and white women who are depressed and living on low incomes. The conceptual foundations of this intervention-ethnographic and motivational interviewing--as well as its key techniques and structure are reviewed. Finally, a case example description and promising pilot data demonstrate the usefulness of this strategy.

References

    1. Anderson CM, Reiss DJ, Hogarty GE. Schizophrenia and the family: A practitioner’s guide to psychoeducation and management. New York: Guilford Press; 1986.
    1. Arkowitz H, Westra HA. Integrating motivational interviewing and cognitive–behavioral therapy in the treatment of depression and anxiety. Journal of Cognitive Psychotherapy. 2004;18:337–350.
    1. Armstrong H, Ishike D, Heiman J, Mundt J, Womack W. Service utilization by black and white clientele in an urban community mental health center: Revised assessment of an old problem. Community Mental Health Journal. 1984;20:269–281.
    1. Azocar E, Miranda J, Dwyer EV. Treatment of depression in disadvantaged women. Women & Therapy. 1996;18(3/4):91–105.
    1. Banerjee M, Pyles L. Spirituality: A source of resilience for African American women in the era of welfare reform. journal of Ethnic and Cultural Diversity in Social Work. 2004;13:45–70.
    1. Beck AT, Steer RA. Manual for the Beck Depression Inventory. San Antonio: Psychological Corporation; 1993.
    1. Belle D. Poverty and women’s mental health. American Psychologist. 1990;45:385–389.
    1. Brown C, Abe-Kim JS, Bario C. Depression in ethnically diverse women: Implications for treatment in primary care settings. Professional Psychology: Research and Practice. 2003;34:10–19.
    1. Bruce M, Takeuchi D, Leaf P. Poverty and psychiatric status. Archives of General Psychiatry. 1991;48:470–474.
    1. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology. 2003;71:843–861.
    1. Cepeda L, Davenport D. Person-centered therapy and solution-focused brief therapy: An integration of present and future awareness. Psychotherapy: Theory, Research, Practice, Training. 2006;43:1–12.
    1. Ciechanowski P, Katon W, Russo J, Walker EA. The patient-provider relationship: Attachment theory and adherence to treatment in diabetes. American Journal of Psychiatry. 2001;158:29–35.
    1. Connors GJ, Walitzer KS, Dermen KH. Preparing clients for alcoholism treatment: Effects on treatment participation and outcomes. Journal of Consulting and Clinical Psychology. 2002;70:1161–1169.
    1. Cooper LA, Brown C, Ford DE, Vu HT, Powe NR. How important is intrinsic spirituality in depression care? A comparison of the views of white and African American primary care patients. Journal of General Internal Medicine. 2001;16:634–638.
    1. Corrigan P, River L, Lundin R, Wasowski K, Campion J, Mathisen J, Goldstein H, Bergman M, Gagnon C, Kubiak M. Stigmatizing attributions about mental illness. Journal of Community Psychology. 2000;28:91–103.
    1. Cox J, Holden J, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry. 1987;50:782–786.
    1. Davis K. The policy implications of the Surgeon General’s report on mental health, culture, and ethnicity. In: Bent-Goodley TB, editor. African American social workers and social policy. Binghamton, NY: Haworth Social Work Practice Press; 2003. pp. 93–122.
    1. Field T. Infants of depressed mothers. In: Johnson S, Hayes A, editors. Stress, coping, and depression. Mahwah, NJ: Erlbaum; 2000. pp. 3–22.
    1. Foerster A. Race, identity, and belonging: “Blackness” and the struggle for solidarity in a multiethnic labor union. Social Problems. 2004;51:386–409.
    1. Greeno CG, Anderson CM, Shear MK, Mike G. Initial treatment engagement in a rural community mental health center. Psychiatric Services. 1999;50:1634–1636.
    1. Grote NK, Bledsoe SE, Swartz HA, Frank E. Feasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: A pilot study. Research on Social Work Practice. 2004;14:397–407.
    1. Hall GCN. Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting and Clinical Psychology. 2001;69:502–510.
    1. Hettema J, Steele J, Miller WR. Motivational interviewing. Annual Review of Clinical Psychology. 2005;1:91–111.
    1. Hobfoll S, Ritter C, Lavin J, Hulszier M, Cameron R. Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology. 1995;63:445–453.
    1. Kemp R, Kirov G, Everitt B, Hayward P, David A. Randomized controlled trial of compliance therapy: 18-month follow-up. British Journal of Psychiatry. 1998;172:413–419.
    1. Kessler RC. Epidemiology of women and depression. Journal of Affective Disorders. 2003;74:5–13.
    1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry. 1994;51:8–19.
    1. Kessler RC, Neighbors H. A new perspective on the relationships among race, social class, and psychological distress. Journal of Health and Social Behavior. 1986;27:107–115.
    1. Kulkami S. Interpersonal violence at the cross-roads between adolescence and adulthood: Learning about partner violence from young mothers. Violence Against Women. 2006;12:187–207.
    1. Kupfer DJ. Long-term treatment of depression. Journal of Clinical Psychiatry. 1991;52:28–34.
    1. Maynard C, Ehreth J, Cox G, Peterson P, McGann M. Racial differences in the utilization of public mental health services in Washington state. Administration and Policy in Mental Health. 1997;24:411–424.
    1. Mays V, Caldwell C, Jackson J. Mental health symptoms and service utilization patterns of help-seeking among African American women. In: Neighbors H, Jackson J, editors. Mental health in black America. Thousand Oaks, CA: Sage Publications; 1996. pp. 161–176.
    1. McKay MM, Bannon WM., Jr Engaging families in child mental health services. Child and Adolescent Psychiatric Clinics of North America. 2004;13:905–921.
    1. McKay MM, Hibbert R, Hoagwood K, Rodriguez J, Murray L, Legerski J, Fernandez D. Integrating evidence-based engagement interventions into “real world” child mental health settings. Brief Treatment and Crisis Intervention. 2004;4:177–186.
    1. McKay MM, McCadam K, Gonzales JJ. Addressing the barriers to mental health services for inner city children and their caretakers. Community Mental Health Journal. 1996;32:353–361.
    1. Mickelson KD, Kessler RC, Shaver PR. Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology. 1997;73:1092–1106.
    1. Miklowitz D, Hooley J. Developing family psychoeducational treatments for patients with bipolar and other severe psychiatric disorders: A pathway from basic research to clinical trials. Journal of Marriage and Family Counseling. 1998;24:419–435.
    1. Miller WR, Rollnick S. Motivational interviewing: Preparing people for change. 2nd ed. New York: Guilford Press; 2002.
    1. Miller WR, Yahne C, Moyers T, Martinez J, Pirritano M. A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology. 2004;72:1050–1062.
    1. Miranda J, Azocar F, Komaromy M, Golding JM. Unmet mental health needs of women in public-sector gynecologic clinics. American Journal of Obstetrics and Gynecology. 1998;17:212–217.
    1. Miranda J, Azocar E, Organista KC, Dwyer E, Areane P. Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatric Services. 2003;54:219–225.
    1. Miranda J, Azocar E, Organista KC, Muñoz RF, Lieberman A. Recruiting and retaining low-income Latinos in psychotherapy research. Journal of Consulting and Clinical Psychology. 1996;64:868–874.
    1. Miranda J, Chung J, Green B, Krupnick J, Siddique J, Revicki D, Belin Y. Treating depression in predominantly low income young minority women. JAMA. 2003;290:57–65.
    1. Murray CJL, Lopez AD, editors. The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press; 1996.
    1. Nock MK, Kazdin AE. Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology. 2005;73:872–879.
    1. O’Reilly K. Ethnographic methods. London: Routledge; 2005.
    1. Paschal A, Ablah E, Wetta-Hall R, Molgaard C, Liow K. Stigma and safe havens: A medical sociological perspective on African American female epilepsy patients. Epilepsy and Behavior. 2005;7:106–115.
    1. Pollio DE, North CS, Osborne V. Family-responsive psychoeducation groups for families with an adult member with mental illness: Pilot results. Community Mental Health Journal. 2002;38:413–421.
    1. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and Experimental Research. 1998;22:1300–1311.
    1. Resnicow K, Jackson A, Wang T, De AK, McCarty F, Dudley WN, Baranowski T. A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: Results of the Eat for Life trial. American Journal of Public Health. 2001;91:1686–1693.
    1. Riley D, Eckenrode J. Social ties: Subgroup differences in costs and benefits. Journal of Personality and Social Psychology. 1986;51:770–778.
    1. Robins L, Regier D. Psychiatric disorders in America. New York: Free Press; 1991.
    1. Rogers C. The conditions of change from a client-centered viewpoint. In: Berenson B, Carkhuff R, editors. Sources of gain in counseling and psychotherapy. New York: Holt, Rinehart & Winston; 1967. pp. 71–85.
    1. Saleebey D, editor. The strengths perspective in social work. New York: Longman; 1997.
    1. Schensul SL, Schensul JJ, LeCompte MD. Ethnographer’s toolkit Vol. 2. Walnut Creek, CA: Alta Mira Press; 1999. Essential ethnographic methods: Observations, interviews, and questionnaires.
    1. Scholle SH, Hasket RF, Hanusa BH, Pincus HA, Kupfer DJ. Addressing depression in obstetrics/gynecology practice. General Hospital Psychiatry. 2003;25:83–90.
    1. Shivack IM, Sullivan CW. Use of telephone prompts at an inner-city outpatient clinic. Hospital Community Psychiatry. 1989;40:851–853.
    1. Siefert K, Bowman P, Heflin C, Danziger S, Williams D. Social and environmental predictors of maternal depression in current and recent welfare recipients. American Journal of Orthopsychiatry. 2000;70:510–522.
    1. Simms S, Kazak A. Family systems interventions in pediatric neuropsychiatric disorders. In: Coffey CE, Brumbeck R, editors. Textbook of pediatric neuropsychiatry. Washington, DC: American Psychiatric Press; 1998. pp. 1449–1464.
    1. Simon GE, Ludman EJ, Tutty S, Operskalski B, Von Korff M. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial. JAMA. 2004;292:935–942.
    1. Sirey JA, Meyers BS, Bruce ML, Alexopoulos GS, Perlick DA, Raue P. Predictors of antidepressant prescription and early use among depressed outpatients. American Journal of Psychiatry. 1999;156:690–696.
    1. Spradley JP. The ethnographic interview. New York: Holt, Rinehart & Winston; 1979.
    1. Stenius V, Veysey B. “It’s the little things”: Women, trauma, and strategies for healing. Journal of Interpersonal Violence. 2005;20:1155–1174.
    1. Sue S, Fujino DC, Hu LT, Takeuchi DT, Zane NW. Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology. 1991;59:533–540.
    1. Swartz HA, Zuckoff A, Frank E, Spielvogle HN, Shear MK, Fleming MAD, Scott J. An open-label trial of enhanced brief interpersonal psychotherapy in depressed mothers whose children are receiving psychiatric treatment. Depression and Anxiety. 2006;23:398–404.
    1. Tyrell C, Dozier M, Teague G, Fallot R. Effective treatment relationships for persons with serious mental disorders: The importance of attachment states of mind. Journal of Consulting and Clinical Psychology. 2001;67:725–733.
    1. U.S. Census Bureau. Number in poverty and poverty rate: 1959–2003. Current Population Survey. 2004. [Retrieved August 29, 2004]. from .
    1. U. S. Department of Health and Human Services. Mental health: A report of the Surgeon General. Rockville, MD: Author; 1999.
    1. U. S. Department of Health and Human Services. Mental health: Culture, race and ethnicity, a supplement to Mental health: A report of the Surgeon General. Rockville, MD: Author; 2001.
    1. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62:629–640.
    1. Williams DR, Collins C. U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology. 1995;21:349–386.
    1. Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry. 2001;58:55–61.
    1. Zuckoff A, Swartz HA, Grote NK, Frank E, Bledsoe SE, Spielvogle H. Engagement session treatment manual. 2004 Unpublished manuscript.
    1. Zweben A, Zuckoff A. Motivational interviewing and treatment adherence. In: Miller WR, Rollnick S, editors. Motivational interviewing: Preparing people for change. 2nd ed. New York: Guilford Press; 2002.

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