title: Barriers to care-seeking for depressed African Americans.
abstract: OBJECTIVE
  We explored perceived barriers to mental health care-seeking for depressed, low-income African Americans who are already engaged in psychotherapy.
  
  
  METHODS
  During a trial to improve psychotherapy appointment adherence, we asked all African-American participants, "Research shows African Americans with emotional or psychological problems use mental health services at half the rate of whites with similar problems. Why do you think that is?" Responses were captured verbatim.
  
  
  RESULTS
  Of 53 African Americans enrolled, 43 completed the study. We analyzed their responses in the hope of identifying modifiable responses. We used qualitative analytic methods, with four raters achieving consensus in coding responses into 13 thematic categories. Stigma was the most frequent response, followed by dysfunctional coping behavior, shame, denial, and "don't know."
  
  
  CONCLUSIONS
  While this study supports several barriers to care-seeking reported in the extant literature, our data also underscores the prominence of shame and denial, together with their complex interrelationships to public stigma and depression, respectively. Future research should assess the relationships between these factors to mental health care-seeking behavior in low-income African Americans and ways of modifying them.
authors.affiliation: University of Pittsburgh, Pennsylvania, USA. cruzm@upmc.edu
authors.forename: Mario
authors.initials: M
authors.lastname: Cruz
authors.forename: Harold Alan
authors.initials: HA
authors.lastname: Pincus
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
mesh_terms: D000223:Adaptation, Psychological; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D001294:Attitude to Health; D003717:Denial, Psychological; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010349:Patient Compliance; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D011613:Psychotherapy; D012752:Shame; D013240:Stereotyping; D014505:Urban Population / Q000706:statistics & numerical data