The Impact of Depression on Society

Society has always done an amazing job in molding and shaping the thoughts of individuals. Throughout time, a person's behavior, way of thinking, dressing, and even interaction has always been influenced by whatever society approves of. Unfortunately, although times have changed, many beliefs continue to stand firm; these range from gender, age, and even to race. A woman is to act in a certain manner while a man is to think in another. Now, although women have reforms, activists, and various avenues of support and change, men on the other hand do not always have as many. Even at that, their masculinity may or may not always 'encourage' them to always be a par. There is a stigma that a man is to be strong, manly, bold, unemotional, and numb to many girl-like feelings. Unfortunately, this same stigma has caused many men to have to hold unto so many feelings and act outside of who they really are. Among men, research has found a relationship between adhering to traditional male roles and depression, and studies have found a significant association between gender role conflict and depression (Chapman, Delap, & Williams, 2018, p.16). This causes a major concern especially when dealing with certain mental illnesses in which symptoms are not entirely outwardly expressed. Certain mental illnesses slowly take over a person's life and affect them before it is unfortunately too late. Depression can be seen as one of these mental illnesses.

According to Castonguay and Oltmanns (2016), depression is defined as a disorder of mood or affect. Symptoms vary and may be accompanied by other symptoms such as weight/appetite disturbance as well as sleep disturbance, fatigue, feeling of worthlessness or guilt and so much more (Castonguay & Oltmanns, 2016, p. 18). A serious disorder than can get to the extreme of even causing a disability to individuals, depression has been estimated to have impacted 16 % of the general population and is even seen as a financial burden for many (Castonguay & Oltmanns, 2016, p. 18). Men with depression may be more likely to distract themselves, less likely to seek help, increase conflict and anger in interpersonal relationships, use more alcohol or other mood-altering substances, and express concern about productivity and level of functioning in employment domains (Castonguay & Oltmanns, 2016, p. 18). Now, although there are studies done mainly on age and even gender of the disorder, there is much discrepancies about race. Race is an unfortunate battle in society today but when mixing it with Mental Health, as well as various stressors including social economic status, age, and sexuality, so many other considerations are made.

Race/Equality/Discrimination

In the African American community, like others, there are many challenges that are faced but one stands out among the rest; discrimination. The Cambridge dictionary defines discrimination as being the treatment of a person or particular group of people differently, in a way that is worse than the way people are usually treated (Cambridge Dictionary, n.d.).This relates so heavily to mental health because of the simple matter that discriminating against one could make their mental health worse and stop a person from getting the treatment that they need (NAMI, n.d.). This already is a problem in the African American community in that many do not make the effort to seek out that necessary help; mental illness stigma is a prominent barrier to seeking mental health treatment among African Americans (Cheers, 2018). It is said that there is evidence from studies which show higher rates of depression found in those living in poverty and those in less education (Castonguay & Oltmanns, 2016, pp. 20-21). But it should make one only wonder that if there is doubt and unbelief and unbelief even amongst the people, what the field in general is doing to diffuse such?

It is known that clinicians are to receive multicultural education, but even with the education, it unfortunately does not always stop misconceptions and discrimination. If clinicians continue to view minority groups such as A.A men through the lens of a European-American lens, it would be to no surprise that A.A would hold a greater distrust of both the medical and mental health care because of the racist attitudes of certain establishments (Chapman, Delap, & Williams, 2018, p.16). African Americans are diagnosed less accurately than non-Hispanic Whites when suffering from depression (Chapman, Delap, & Williams, 2018, p.18). Even when considering medications, A.A were less likely to receive an antidepressant, even the newest form, when first diagnosed unlike White patients (Chapman, Delap, & Williams, 2018, p.18). One important aspect to note is that if the research is not being completed on minority groups, there will always continue to be a lack of structure, consistent trust, and assistance to provide. Studies could go a long way but unfortunately much have not been tested, especially when it comes to race. For example, a recent review identified only 17 articles between1980 and 2004 that explicitly examined depression risk factors among African American men (Hammond, 2012).

Although very little research has been done about the beliefs of mental illness in African American men, even with the little that has been done, it is said that men tend to report symptoms congruent with traditionally masculine norms, such as preoccupation with work failure, social withdrawal, avoidance of affect, and self-medication (Cornish, E. K., Bergner, E. M., & Griffith, D. M., 2017). There was a study constructed to understand mental illness, perceptions of stigma, and help-seeking barriers. Researchers attempted to determine the barriers specific to African American men as well as their beliefs and attitude toward mental illness (Ward & Besson, 2013). The study found that participants believed the negative portrayal of African American men in the media can intensify the stigma of a mental illness (Ward & Besson, 2013). One participant stated,

We feel like we are already at the bottom because we're Black and showing everyone that you may not be stable in your mind is out of the question. You got many things against you because you're a Black man (Ward & Besson, 2013).

This speaks much volume to the individual and what he experiences as a man of color. To believe that in this world, he already has various troubles to deal with, therefore, even making it known to a person that mental illness is a problem, to an African American man, in his eyes, is unacceptable. In totality, the results of the study proved that the A.A men believed that having a mental illness can result in negative outcomes including social, psychological, and financial problems (Ward & Besson, 2013).

Social Economic Status

There are many mechanisms that explain why SES is linked to better mental health (Assari, Lankarani, & Caldwell, 2018). High SES promotes a variety of positive things such as education enhancement, reduction of risk behaviors, access to healthcare, promotion of human connections, and even an increase in psychosocial asses such as having a sense of agency and mastery (Assari, Lankarani, & Caldwell, 2018). Yet having a high SES is not universally a protective factor (Assari, Lankarani, & Caldwell, 2018). There was an empirical data done that revealed a high risk of Major Depressive episodes in African American males of high social economic status. Study proposed perceived discrimination (PD) as an underlying mechanism for the positive association between SES and risk of depression in African American males (Assari, Lankarani, & Caldwell, 2018). In fact, for several A. A men in the study, having a high SES meant a high cost of upward social mobility because the residual effect of income beyond employment, marital status, and education became a risk factor for African American men (Assari, Lankarani, & Caldwell, 2018). As described by the Minorities' Diminished Return Theory or MDR, education, income, and employment had smaller protective effects on the physical and mental health for whites more than African Americans (Assari, Lankarani, & Caldwell, 2018). African Americans with high SES did not report better mental health than their low SES counterparts. In contrast, SES was positively associated with the risk of depression in African Americans, particularly African American males (Assari, Lankarani, & Caldwell, 2018).

Age & Stress

Younger A.A males are said to have a more dramatic increase in suicide rate and disproportionate premature mortality from both diseases and intentional injuries with high depression comorbidities (Hammond, 2012). Younger African men tend to follow through to masculine role possibly because of developmental limitations in affect regulation. Masculine role strains and conflicts are robust predictors of diminished psychological well-being among men (Hammond, 2012). There is higher restrictive emotionality associated with more depressive symptoms among men aged 18 to 29 and 30 to 39 years (Hammond, 2012). Self-reliance was also associated with less depressive symptoms among the same age group (Hammond, 2012). Because depressive symptoms have been linked with African American men's educational attainment and career development, family- and mentor-based intervention programs have the potential to help young men find meaningful career pathways during a particularly difficult transition (Kogan, S. M., & Brody, G. H., 2010). In older men, we see again discrimination and depressive symptoms at correlation in that there is high restrictive emotionality in men in the 30 to 39 years and 40 or older age group (Hammond, 2012).

One thing to keep in mind is the fact that African American men certainly perceive depression differently (Cornish et al, 2017). While some may perceive it as stress, others may also see it as feeling extremely sad or sorrowful at a period. So then, what exactly is the difference between stress and depression? In one study, a 45-year-old participant noted that I'm Black. I'm born into depression and stress. I was raised it's nothing unusual, it's just what it is (Cornish et al, 2017). This participant stated this almost as if both stress and depression were part of his normal, everyday life. Regardless, many men in the study had a strong belief that stressors impaired their ability to manage their everyday lives. This significantly distinguished a mental health problem that researchers managed independently from one that may benefit from professional treatment (Cornish et al, 2017). Even in that same study, African American men who had been diagnosed with depression never directly spoke about their diagnosis. They instead downplayed the diagnosis, making it seem more so as if depression was a manageable problem, almost like stress (Cornish et al, 2017). This goes to show that yet still, there are some African American men who have been misconstrued about the seriousness of depression.

Like the findings linking work stress and depression, a series of studies showed that employment, earnings, job stability, and other work-related issues were connected to depression. Work stressors influenced depressive symptoms, but the direct effects of work wore off over time for all groups, except for African American men, whose levels of depressive symptoms remained elevated by work stressors 2 years after their occurrence. Additionally, poor health elevated depressive symptoms among African American men. Whereas retirement decreased depressive symptoms in other groups, it increased depressive symptoms in African American men. Income was found to be a significant protective factor against depressive symptoms among African American men.

Sexuality

Men who have sex with men (MSM) experience greater mental health problems as compared with heterosexual populations. Informal social support plays a critical role in emotional well being (Yang, Latkin, Tobin, Patterson, & Spikes, 2013). Homosexual men are not only discriminated against by others but are often discriminated against by their own; African Americans. Research has suggested interconnections between psychosocial factors, mental health, and HIV risk among MSM, and the high prevalence of depression among African American MSM may have contributed to the health disparity in HIV rates (Yang et al., 2013). With the lack of support from others, as well as medical problems, it would be to little surprise that homosexual A.A men would experience depressive symptoms. Compounded stressors associated with racism and stigma and limited resources available to African American MSM may lead to greater reliance on social support from network members as compared with those who are less marginalized (Yang et al., 2013).

Studies show that women are diagnosed with depression at twice the rate of men, yet men have higher rates of suicide, substance abuse, and externalizing behavior (eg, risk taking, violence, aggression), which suggest that depression may be underdiagnosed in men (Cornish et al., 2017). While African American men tend to experience lower rates of depression than African American women, the high rates of morbidity and mortality from stress-related chronic illnesses suggest that depression and mental health may be underappreciated as a problem in this population.6-8 African American men are exposed to several varying stressors, ranging from social economic status to sexuality, that increase their risk for poor mental health (Cornish et al, 2017). There is a cultural barrier to seeking psychotherapy involving the perception that seeking psychotherapy was associated with weakness and diminished pride. Men are more likely to endorse cultural beliefs such as the need to resolve family concerns within the family and uphold the expectation that African Americans demonstrate strength. Additionally, A.A men believed that in selecting a psychotherapist, the psychotherapist's race mattered.

Considering the negative impact of stigma on treatment seeking among African American men, there is a critical need for educational outreach programs to reduce stigma (Ward & Mengesha, n.d.). For example, local educational outreach programs tailored specifically for African American men at the local or grassroots and national levels could include dissemination of educational materials in community settings such as community centers, churches, barber shops, and men's athletic clubs (Ward & Mengesha, n.d.). Also, using a family-centered approach focusing on Black families could be useful, because marriage and perceived social supports are protective for this group (Ward & Mengesha, n.d.). Lastly, a great source of help and support would be faith filled. Because A.A men trace back depressive symptoms to a variety of things such as both environmental and social factors, the faith community outreach programs would be beneficial to addressing and alleviating the problems experienced by African-American men with depression (Bryant, Haynes, Greer-Williams, & Hartwig, n.d.). Because community services are usually free and very open, that would be a great source for educating A.A men and families on the benefits of seeking-help.

There are organizations however, that work on promoting decreasing mental health stigma and educate the public about mental illness therefore there is hope for progress in years to come (Cheers, 2018).

References

Assari, S., Lankarani, M. M., & Caldwell, C. H. (2018). Does Discrimination Explain High Risk of Depression among High-Income African American Men? Behavioral Sciences (2076-328X), 8(4), N.PAG. https://doi.org/10.3390/bs8040040

Bryant, K., Haynes, T., Greer-Williams, N., & Hartwig, M. S. (n.d.). Too Blessed to be Stressed: A Rural Faith Community's Views of African-American Males and Depression. JOURNAL OF RELIGION & HEALTH, 53(3), 796“808. https://doi-org.proxy-ub.researchport.umd.edu/10.1007/s10943-012-9672-z

Cambridge Dictionary. (n.d.). Definition of ""discrimination"" - English Dictionary. Retrieved from https://dictionary.cambridge.org/us/dictionary/english/discrimination

Chapman, L.K., R.C.T. Delap, & M.T. Williams. ""Impact of Race, Ethnicity, and Culture on the Expression and Assessment of Psychopathology."" Chapter 5 of Adult Psychopathology and Diagnosis. Ed. Beidel, D.C. & B.C. Frueh, eds. Hoboken: John Wiley & Sons, Inc., 2018. Pages 131-156.

Cheers, A. (2018). The impact of contact-based stigma reduction intervention on stigma and attitudes toward treatment seeking behavior among African Americans. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning. Retrieved from https://proxy-ub.researchport.umd.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2017-23163-259&site=eds-live

Cornish, E. K., Bergner, E. M., & Griffith, D. M. (2017). They have said that I was slightly depressed but there are circumstances that bring that on: How Middle-Aged and Older African American Men Describe Perceived Stress and Depression. Ethnicity & Disease, 27(4), 437“442. https://doi.org/10.18865/ed.27.4.437

Hammond, W. P. (2012). Taking It Like a Man: Masculine Role Norms as Moderators of the Racial Discrimination-Depressive Symptoms Association Among African American Men. American Journal of Public Health, 102(S2), S232“S241. https://doi.org/10.2105/AJPH.2011.300485

Kogan, S. M., & Brody, G. H. (2010). Linking parenting and informal mentor processes to depressive symptoms among rural African American young adult men. Cultural Diversity and Ethnic Minority Psychology, 16(3), 299“306. https://doi.org/10.1037/a0018672

NAMI. (n.d.). Stigma and Discrimination. Retrieved from https://www.nami.org/About-NAMI/Policy-Platform/Stigma-and-Discrimination

Ward, E. C., & Besson, D. D. (2013). African American men's beliefs about mental illness, perceptions of stigma, and help-seeking barriers. The Counseling Psychologist, 41(3), 359“391. https://doi.org/10.1177/0011000012447824

Ward, E., & Mengesha, M. (n.d.). Depression in African American Men: A Review of What We Know and Where We Need to Go From Here. AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 83(2), 386“397. https://doi.org/10.1111/ajop.12015

Yang, C., Latkin, C., Tobin, K., Patterson, J., & Spikes, P. (2013). Informal Social Support and Depression among African American Men Who Have Sex with Men. Journal of Community Psychology, 41(4), 435“445. https://doi-org.proxy-ub.researchport.umd.edu/10.1002/jcop.21548

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