title: "You don't go tell White people nothing": African American women's perspectives on the influence of violence and race on depression and depression care.
abstract: OBJECTIVE
  We sought to understand how African American women's beliefs regarding depression and depression care are influenced by racism, violence, and social context.
  
  
  METHODS
  We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization.
  
  
  RESULTS
  Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a "White" system. The image of the "strong Black woman" was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use.
  
  
  CONCLUSIONS
  Although violence and drug use were central to our participants' understanding of depression, racism was the predominant issue influencing their views on depression care. Providers should develop a greater appreciation of the effects of racism on depression care. Depression care programs should address issues of violence, substance use, and racism.
authors.affiliation: Department of Medicine and Public Health, Oregon Health & Science University, Portland, 97239, USA. nicolaid@ohsu.edu
authors.forename: Christina
authors.initials: C
authors.lastname: Nicolaidis
authors.forename: Vanessa
authors.initials: V
authors.lastname: Timmons
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Thomas
authors.forename: A Star
authors.initials: AS
authors.lastname: Waters
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wahab
authors.forename: Angie
authors.initials: A
authors.lastname: Mejia
authors.forename: S Renee
authors.initials: SR
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D001291:Attitude of Health Personnel / Q000208:ethnology; D055812:Community-Based Participatory Research; D054521:Cultural Competency; D003863:Depression / Q000208:ethnology* / Q000517:prevention & control; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D008960:Models, Psychological; D009922:Oregon / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011287:Prejudice; D011369:Professional-Patient Relations; D012649:Self Concept; D013179:Spouse Abuse / Q000208:ethnology*; D019966:Substance-Related Disorders / Q000208:ethnology; D035502:Trust; D044465:White People / Q000208:ethnology; D014930:Women / Q000523:psychology*