Cited by 409Mental Health Treatment and AccessRacial and Ethnic Identity ResearchCultural Competency in Health Care

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Barriers to Effective Mental Health Services for African Americans

Snowden, Lonnie R.·2001·Mental Health Services Research

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Abstract

Many African Americans-especially the most marginal-suffer from mental health problems and would benefit from timely access to appropriate forms of care. However, few seek treatment from outpatient providers in the specialty mental health sector and those who do are at risk of dropping out. African Americans visit providers in the general medical sector, although they use another hypothesized alternative to specialty care, voluntary support networks, less than other groups. These help-seeking tendencies may reflect characteristic coping styles and stigma, as well as a lack of resources and opportunities for treatment. More should be learned about differences in need according to location, social standing, and cultural orientation so as to identify treatments and programs that are especially beneficial to African Americans.

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Cites

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Depression Among Southern Rural African American Women
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“…et al., 2003), their limited access to health and mental health services (Gamble, 1997; Gary, Yarandi, & Rivers, 2001; Oppenheimer & Shultz, 1999; Snowden, 2001), and the stigma of mental illness embedded in some African American communities (Schreiber, Stern, & Wilson, 1998, 2000; Snowden, 2001).”
BackgroundInfluential
Discrimination and Help-Seeking: Use of Professional Services and Informal Support Among African Americans, Black Caribbeans, and Non-Hispanic Whites with a Mental Disorder
Woodward, A. T. (2011) · Race and Social Problems · doi:10.1007/s12552-011-9049-z · Cited by 48
Prevalence and Correlates of Depressive Symptoms and Resiliency among African American Women in a Community-Based Primary Health Care Center
Holden, K. B., Bradford, L. D., Hall, S., & Belton, A. S. (2013) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2014.0012 · Cited by 48
Religious involvement and obsessive compulsive disorder among African Americans and Black Caribbeans
Himle, J. A., Taylor, R. J., & Chatters, L. M. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.02.003 · Cited by 47
Critical Race Theory as a Decisional Framework for the Ethical Counseling of African American Clients
Trahan, D. P., & Lemberger, M. E. (2014) · Counseling and Values · doi:10.1002/j.2161-007x.2014.00045.x · Cited by 50
Screening to Identify Mental Health Problems in Pediatric Primary Care: Considerations for Practice
Brown, J. D., & Wissow, L. S. (2010) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.40.1.a · Cited by 47
“African-American and Latino parents and youth may not wish to discuss mental health problems with a Caucasian PCP or may use terminology that is unfamiliar to Caucasian PCPs to describe mental health problems [41].”
Background
Financial Distress and Depressive Symptoms among African American Women: Identifying Financial Priorities and Needs and why it Matters for Mental Health
Starkey, A. J., Keane, C. R., Terry, M. A., Marx, J. H., & Ricci, E. M. (2012) · Journal of Urban Health · doi:10.1007/s11524-012-9755-x · Cited by 43
Utilization of Mental Health Services Among African-American Male Adolescents Released from Juvenile Detention: Examining Reasons for Within-Group Disparities in Help-Seeking Behaviors
Samuel, I. A. (2014) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-014-0357-1 · Cited by 61
“Although research findings have linked the influence of culture to mental health service use (Snowden 2001), the differential effects of culture on help-seeking attitudes required extensive investigation.”
Background
LENGTH OF STAY, ADMISSION TYPES, PSYCHIATRIC DIAGNOSES, AND THE IMPLICATIONS OF STIGMA IN AFRICAN AMERICANS IN THE NATIONWIDE INPATIENT SAMPLE
Bolden, L. V., & Wicks, M. N. (2005) · Issues in Mental Health Nursing · doi:10.1080/01612840500280703 · Cited by 45
“Misdiagnosis occurs when clinicians who are culturally incompetent automatically classify hallucinations in AAs as a definitive symptom of a diagnosis of schizophrenia rather than considering that hallucinations can occur in depressive disorders as well (Baker & Bell, 1999; Minsky et al., 2003; Neighbors et al., 2003;…”
BackgroundInfluential
Evaluation of Integrated Psychological Services in a University-Based Primary Care Clinic
Sadock, E., Auerbach, S. M., Rybarczyk, B. D., & Aggarwal, A. (2013) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-013-9378-8 · Cited by 48
A Qualitative Study of Black Women’s Experiences in Drug Abuse and Mental Health Services
Jones, L. V., Hopson, L. M., Warner, L., Hardiman, E. R., & James, T. (2014) · Affilia · doi:10.1177/0886109914531957 · Cited by 49
“These barriers include shame and stigma, cultural and language differences, fear and distrust of the treatment system, lack of information, and lack of insurance and transportation (Bowie & Dopwell, 2013; Choi & Gonzales, 2005; Nadeem et al., 2009; Snowden, 2001).”
Background
African Genetic Ancestry is Associated with Sleep Depth in Older African Americans
Halder, I., Matthews, K. A., Buysse, D. J., Strollo, P. J., Causer, V., Reís, S. E., & Hall, M. H. (2015) · SLEEP · doi:10.5665/sleep.4888 · Cited by 40
Help-Seeking Behaviors and Barriers Among Black Women Exposed to Severe Intimate Partner Violence: Findings From a Nationally Representative Sample
Lacey, K. K., Jiwatram-Negrón, T., & Sears, K. P. (2020) · Violence Against Women · doi:10.1177/1077801220917464 · Cited by 51
“Previous research suggests age plays a key role in service utilization among U.S. Black women (Snowden, 2001).”
Background
Disparities in Use of Mental Health and Substance Abuse Services by Persons With Co-occurring Disorders
Havassy, B. E., Alvidrez, J., & Mericle, A. A. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.2.217 · Cited by 42
Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women
Basile, K. C., Smith, S. G., Fowler, D. N., Walters, M. L., & Hamburger, M. E. (2016) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2015.1079283 · Cited by 40
“These findings suggest the disinclination of African American women to seek help from mental health services (Henning & Klesges, 2002; Snowden, 2001) and, in some cases, from law enforcement and the criminal justice system, which might reflect a cultural tendency among this population to distrust…”
Connected Mental Health: Systematic Mapping Study
(2020) · doi:10.2196/19950 · Cited by 33
Multiple Family Groups for Children with Disruptive Behavior Disorders: Child Outcomes at 6-Month Follow-Up
Gopalan, G., Chacko, A., Franco, L. M., Dean-Assael, K., Rotko, L., Marcus, S. M., Hoagwood, K., & McKay, M. M. (2014) · Journal of Child and Family Studies · doi:10.1007/s10826-014-0074-6 · Cited by 41
“For minority families, who have been known to avoid mental health services due to stigma and fears of being blamed for their children’s difficulties, groups which focus on sharing and support may be more acceptable than traditional mental health treatment (Alvidrez 1999; Barrio 2000; Boyd-Franklin 1995; McKay and Bann…”
Background
Knowledge, attitude and behaviours toward mental illness and help‐seeking in a large nonclinical Tunisian student sample
Fekih‐Romdhane, F., Chebbi, O., Sassi, H., & Cheour, M. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.13080 · Cited by 39
“Previous studies found that respondents reported that they were not likely to access mental health services and preferred informal sources of care (Snowden et al., Snowden, 2001; Miranda et al., Miranda & Cooper, 2004).”
Background
Reducing Disparities in Mental Health Care: Suggestions from the Dartmouth–Howard Collaboration
Carpenter-Song, E. A., Whitley, R., Lawson, W. B., Quimby, E., & Drake, R. E. (2009) · Community Mental Health Journal · doi:10.1007/s10597-009-9233-4 · Cited by 44
“Among African Americans with severe mental illness who do receive services, there is also a greater likelihood of being involuntarily hospitalized, using crisis services, entering emergency treatment through law enforcement, and dropping out of treatment than Euro-Americans (Rosenhan 1984; Lindsey and Paul 1989; USDHH…”
Background
Rates and Correlates of Undetermined Deaths among African Americans: Results from the National Violent Death Reporting System
Huguet, N., Kaplan, M. S., & McFarland, B. H. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00081.x · Cited by 40
Enhancing the Cultural Sensitivity of Cognitive Behavioral Interventions for Anxiety in Diverse Populations.
Graham, J. R., Sorenson, S. M., & Hayes‐Skelton, S. A. (2013) · PubMed · Cited by 38
Alcohol and other drug disorders, comorbidity, and violence: comparison of rural African American and Caucasian women
Boyd, M. R., Phillips, K. D., & Dorsey, C. J. (2003) · Archives of Psychiatric Nursing · doi:10.1053/j.apnu.2003.10.003 · Cited by 38
A Paradox of Bias: Racial Differences in Forensic Psychiatric Diagnosis and Determinations of Criminal Responsibility
Perry, B. L., Neltner, M., & Allen, T. S. (2013) · Race and Social Problems · doi:10.1007/s12552-013-9100-3 · Cited by 40
“African Americans are less apt to voluntarily seek or receive psychiatric treatment than whites (Department of Health and Human Services 1999; Snowden and Pingitore 2002; Wang et al. 2005), often resulting in delayed treatment or no treatment for mental illness (Snowden 2001).”
BackgroundInfluential
Factors Leading African Americans and Black Caribbeans to Use Social Work Services for Treating Mental and Substance Use Disorders
Cheng, T. C., & Robinson, M. A. (2013) · Health & Social Work · doi:10.1093/hsw/hlt005 · Cited by 37
Understanding ethnic differences in mental health service use for adolescents’ internalizing problems: the role of emotional problem identification
Verhulp, E. E., Stevens, G. W. J. M., van de Schoot, R., & Vollebergh, W. (2013) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-013-0380-3 · Cited by 38
“Although these studies might give the impression that immigrants themselves may primarily be held responsible for their limited level of mental health service use, the barriers could also be interpreted as a failure of the mental health care system [24].”
Assessing Adolescents' Understanding of and Reactions to Stress in Different Cultures
Nastasi, B. K., Hitchcock, J. H., Burkholder, G. J., et al. (2007) · School Psychology International · doi:10.1177/0143034307078092 · Cited by 34
Rapid Growth of Mental Health Services at Community Health Centers
Bruckner, T. A., Singh, P., Snowden, L. R., Yoon, J., & Chakravarthy, B. (2019) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-019-00947-w · Cited by 32
“This observation may portend an exacerbation of racial/ethnic disparities in access to mental health care (Snowden 2001).”
Self-citation
Racial and Ethnic Disparities in Alzheimer's Disease Pharmacotherapy Exposure: An Analysis Across Four State Medicaid Populations
Gilligan, A. M., Malone, D. C., Warholak, T. L., & Armstrong, E. P. (2012) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2012.09.002 · Cited by 32
PREDICTORS OF TREATMENT OUTCOMES AMONG DEPRESSED WOMEN WITH CHILDHOOD SEXUAL ABUSE HISTORIES
Cort, N. A., Gamble, S. A., Smith, P. N., Chaudron, L. H., Lu, N., He, H., & Talbot, N. L. (2012) · Depression and Anxiety · doi:10.1002/da.21942 · Cited by 31
African American Women’s Perceptions of Depression and Suicide Risk and Protection
Borum, V. (2012) · Affilia · doi:10.1177/0886109912452401 · Cited by 39
“According to Snowden (2001) and Van Hook (1999), self-reliance because of gender socialization among African American women and stigma surrounding mental illness also limit help seeking for distress.”
Background
Receiving Advice About Child Mental Health From a Primary Care Provider: African American and Hispanic Parent Attitudes
Brown, J. D., Wissow, L. S., Zachary, C., & Cook, B. L. (2007) · Medical Care · doi:10.1097/mlr.0b013e31812da7fd · Cited by 29
Barriers to Mental Health Care: A 25‐Year Follow‐Up Study of the Orthodox Jewish Community
Schnall, E., Kalkstein, S., Gottesman, A., Feinberg, K., Schaeffer, C. B., & Feinberg, S. S. (2014) · Journal of Multicultural Counseling and Development · doi:10.1002/j.2161-1912.2014.00052.x · Cited by 30
Effects of a culturally informed intervention on abused, suicidal African American women.
Taha, F., Zhang, H., Snead, K., Jones, A. D., Blackmon, B., Bryant, R. J., Siegelman, A. E., & Kaslow, N. J. (2014) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000018 · Cited by 34
“Research has shown that low-income African American women in particular are less inclined to trust formal mental health resources and thus are more likely to seek out interventions that are more Afrocentric in nature (Nicolaidis et al., 2010; Snowden, 2001).”
Background
Comparison of Users and Non-Users of Mental Health Services Among Depressed, Older, Urban African Americans
Cohen, C. I., Magai, C., Yaffee, R. A., & Walcott-Brown, L. (2005) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200507000-00002 · Cited by 31
Length of stay among multi-ethnic psychiatric inpatients in the United Kingdom
Bruce, M., & Smith, J. (2020) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2020.152201 · Cited by 30
Adolescent Depression
Cronholm, P. F., Barg, F. K., Pailler, M. E., Wintersteen, M. B., Diamond, G. S., & Fein, J. A. (2010) · Pediatric Emergency Care · doi:10.1097/pec.0b013e3181ce2f85 · Cited by 28
A narrative review of mental illness stigma reduction interventions among african americans in the United States
Rivera, K. J., Zhang, J. Y., Mohr, D. C., Wescott, A. B., & Bamgbose Pederson, A. (2021) · Journal of Mental Health & Clinical Psychology · doi:10.29245/2578-2959/2021/2.1235 · Cited by 27
Regional Variation of Racial Disparities in Mental Health Service Use Among Older Adults
Kim, G., Parton, J., DeCoster, J., Bryant, A. N., Ford, K. L., & Parmelee, P. A. (2012) · The Gerontologist · doi:10.1093/geront/gns107 · Cited by 27
“…half the rate of non-Hispanic whites, even after accounting for their mental health status (AHRQ, 2010; Alegría et al., 2002; Cooper-Patrick et al., 1999; Dobalian & Rivers, 2008; Neighbors et al., 2007; Snowden, 1999, 2001; U.S. Department of Health and Human Services, 2001; Wang et al., 2005).”
Background
How People With Serious Mental Illness Seek Help After Leaving Jail
Wilson, A. B. (2013) · Qualitative Health Research · doi:10.1177/1049732313508476 · Cited by 27
“This research has identified a number of individual, cultural, and social factors that influence the pathways people take to receive treatment for their mental health problems (Andersen, 1995; Becker & Maiman, 1975; Lewis, Fein, & Mechanic, 1976; Mechanic, 1986; Pescosolido, 1992; Snowden, 2001; Snowden & Thomas, 2000…”
Background
Treatment Services in the Juvenile Justice System: Examining the Use and Funding of Services by Youth on Probation
White, C. (2017) · Youth Violence and Juvenile Justice · doi:10.1177/1541204017728997 · Cited by 32
Do Social Networks Push Families Toward or Away From Youth Mental Health Services?: A National Study of Families in Child Welfare
Martinez, J. I., & Lau, A. S. (2010) · Journal of Emotional and Behavioral Disorders · doi:10.1177/1063426610377898 · Cited by 28
“example, a coping preference attributed to African Americans in dealing with MH concerns involves turning to significant others in the community, especially family, friends, neighbors, and religious figures for assistance (Snowden, 2001).”
BackgroundInfluential
First-ever admitted psychiatric inpatients in Italy: Clinical characteristics and reasons contributing to admission
Guzzetta, F., Miglio, R., Santone, G., Picardi, A., Norcio, B., Bracco, R., & de Girolamo, G. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2008.11.005 · Cited by 27
“Interestingly, non-treated subjects were more likely to be non-Italian compared with treated ones; previous studies (Johnson and Cameron, 2001; Leong and Lau, 2001; Snowden, 2001; Vega and Lopez, 2001;Wang et al., 2005)have also shown that ethnicitymayact as a barrier to access to care.”
Result
Racial-Ethnic Differences in Mental Health Stigma and Changes Over the Course of a Statewide Campaign
Wong, E. C., Collins, R. L., McBain, R. K., Breslau, J. A., Burnam, M. A., Cefalu, M. S., & Röth, E. (2021) · Psychiatric Services · doi:10.1176/appi.ps.201900630 · Cited by 27
The moderating role of gender in the relationship between religiosity and mental health in a sample of black American college students
Cokley, K., Beasley, S. T., Holman, A. C., Chapman‐Hilliard, C., Cody, B. L., Jones, B. J., McClain, S. E., & Taylor, D. (2012) · Mental Health Religion & Culture · doi:10.1080/13674676.2012.684346 · Cited by 30
“African Americans have historically underutilised mental health services when compared to other ethnic groups (Alegrı́a et al., 2002; Snowden, 2001), and religiosity appears to be an underlying reason (Chandler, 2010).”
Background
Depression and Nigerian-born immigrant women in the United States: a phenomenological study
Ezeobele, I. E., Malecha, A. T., Landrum, P. A., & Symes, L. (2009) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2009.01519.x · Cited by 26
Development of an Innovative Treatment Paradigm for Intimate Partner Violence Victims With Depression and Pain Using Community-Based Participatory Research
Poleshuck, E. L., Mazzotta, C. M., Resch, K., Rogachefsky, A., Bellenger, K., Raimondi, C., Stone, J. T., & Cerulli, C. (2016) · Journal of Interpersonal Violence · doi:10.1177/0886260516628810 · Cited by 33
“Cultural barriers include clinicians’ lack of knowledge or awareness about the consequences of IPV, IPV victims’ distrust of the health care system, disapproval of others if they do seek treatment, and stigma and negative beliefs about depression and depression treatment (Brown, Abe-Kim, & Barrio, 2003; Corrigan, 2004…”
Background
Profiles of Depression Help Seeking Among Black Americans: A Latent Class Approach
Hays, K., & Gilreath, T. D. (2016) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000575 · Cited by 28
“Black Americans with mental health problems, like depression, have lower rates of professional help seeking than other ethnic groups (Barrio et al., 2003; Snowden, 2001; Wang et al., 2005).”
Background
Hematologic Problems in Psychosomatic Medicine
Becker, M. A., Axelrod, D. J., Oyesanmi, O., Markov, D., & Kunkel, E. J. S. (2007) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2007.07.006 · Cited by 26
Exploring Racial Disparity in Posttraumatic Stress Disorder Diagnosis: Implications for Care of African American Women
Seng, J. S., Kohn‐Wood, L. P., & Odera, L. A. (2005) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1177/0884217505278296 · Cited by 28
“, 1997), the utilization of spiritual practices (Broman, 1996; Snowden & Cheung, 1990; Snowden, 2002), or coping via self or family reliance (Snowden, 2003).”
Background
Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components
Eustis, E. H., Graham-LoPresti, J. R., Aguilera, A., & Schueller, S. M. (2023) · Journal of Medical Internet Research · doi:10.2196/45409 · Cited by 27
“For example, significant disparities have been documented between White people and people who are racially and ethnically minoritized in the United States [13,23-26].”
Examining Racial/Ethnic Minority Treatment Experiences with Specialty Behavioral Health Service Providers
Redmond, M. L., Galea, S., & Delva, J. (2008) · Community Mental Health Journal · doi:10.1007/s10597-008-9164-5 · Cited by 25
“…health care, cultural factors, level of problem severity, and the reliance on informal methods of help such as strong social networks, community resources, or spiritual guidance (Alegria et al, 2001; Keefe, 1982; Neighbors & Jackson, 1984; Neighbors, 1984; Peifer, Hu, & Vega, 2000; Snowden, 2001).”
Influential
Differences Between African Americans and Non-Hispanic Whites Utilization of Clergy for Counseling with Serious Personal Problems
Chatters, L. M., Taylor, R. J., Woodward, A. T., et al. (2017) · Race and Social Problems · doi:10.1007/s12552-017-9207-z · Cited by 24
Religion and spirituality among young adults with severe mental illness.
Oxhandler, H. K., Narendorf, S. C., & Moffatt, K. M. (2018) · Spirituality in Clinical Practice · doi:10.1037/scp0000164 · Cited by 31
“…between higher religiosity and lower socioeconomic status (Bhui, Shanahan, & Harding, 2006; Washington, Moxley, Garriott, & Weinberger, 2009) and being a racial minority (Snowden, 2001), but little has been done to understand young adults with mental illness across these particular populations.”
Background
Disagreement in Parent and Primary Care Provider Reports of Mental Health Counseling
Brown, J. D., & Wissow, L. S. (2008) · PEDIATRICS · doi:10.1542/peds.2007-3495 · Cited by 26
Young Adult Outcomes of Juvenile Court–Involved Girls
Bright, C. L., & Jonson‐Reid, M. (2010) · Journal of Social Service Research · doi:10.1080/01488370903577993 · Cited by 24
“This finding is tempered by assertions that, regardless of need, African Americans experience a number of barriers to accessing mental health resources, including a cultural tradition of self-reliance, stigma and embarrassment about symptoms, and lack of cultural competence among mental health providers (Snowden, 2001…”
Background
Intention to Seek Depression Treatment in Adolescent Mothers and a Comparison Group of Adolescent Girls
Logsdon, M. C., Usui, W. M., Pinto, M. D., & Rakestraw, V. (2008) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2008.02.013 · Cited by 24
Strong Like My Mama: The Legacy of “Strength,” Depression, and Suicidality in African American Women
Green, B. “. (2019) · Women & Therapy · doi:10.1080/02703149.2019.1622909 · Cited by 38
“Several factors may be at play here, including African Americans’ use of voluntary support networks rather than professionals (Snowden, 2001), distrust of the health care establishment as racist and designed for “White people” (Nicolaidis et al.”
BackgroundInfluential
Understanding the Association Between Mental Health Knowledge and Mental Health Service Utilization Among Black Adults
Pederson, A. B., Tsai, A. C., Hawkins, D., Moskowitz, J. T., & Dixon, L. B. (2022) · Community Mental Health Journal · doi:10.1007/s10597-022-00988-w · Cited by 27
“…but also more likely to believe mental illness would resolve without treatment (Anglin et al., 2008), thus leading to delayed help seeking, disability and increased morbidity and mortality associated with poorly treated mental illness (Snowden, 2001; Ward et al., 2009, 2013; Williams et al., 2007).”
Background
Inadequate Treatment of Black Americans With Bipolar Disorder
Johnson, K. R., & Johnson, S. L. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201200590 · Cited by 23
Initial and Follow‐Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic
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“mental health) professionals [8, 73].”
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“That family and friends were also perceived as helpful sources of support was not surprising because, historically, African Americans often relied upon informal sources of support for mental health challenges due to lack of resources and opportunities in mainstream America (Snowden, 2001).”
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“Similarly, several reports have already confirmed that various barriers — namely issues of cost and affordability — prevent Black adults [90–92] and Black youth [13, 93] from receiving necessary mental health treatment.”
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“Furthermore, culture bias in the measure may misclassify persons as not having a disorder, for example, does not capture nonpsychological idioms of distress that may be disproportionately found in the African American population (e.g., Snowden 2001).”
Background
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Yorke, C. B., Voisin, D. R., Berringer, K. R., & Alexander, L. S. (2015) · Social Work in Mental Health · doi:10.1080/15332985.2014.943832 · Cited by 33
“In the United States, research indicates that African-American groups in general experience both disproportionately high mental illness as well as more significant barriers to mental health treatment (Snowden, 2001).”
Background
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“Studies have shown that Blacks are more likely than members of other racial–ethnic groups to encounter barriers in access to primary and outpatient mental health care [18, 22, 23].”
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“Members of underserved communities and of racial and ethnic minorities are less likely to seek treatment for PTSD or mental health services in general [8-11].”
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“…than their non-Hispanic white peers to use formal mental health services, but more likely to use traditional self-care regimens and prayer and to turn to their informal support networks and to clergy (AoA, 2001; Husaini, Moore, & Cain, 1994; Mills, 2000; Rodriguez & O’Donnell, 1995; Snowden, 2001).”
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“Despite a lower prevalence of most disorders, a larger percentage of African Americans report the need for mental health services compared to Whites, but significantly fewer receive treatment (approximately one in three), and many more report that their mental health care needs go unmet (Substance Abuse and Mental Hea…”
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“Gaining access to a population who has historical and contemporary experiences of maltreatment from research, medical, mental health institutions can often serve as a barrier to recruiting African American participants (Sharpe, 2008; Snowden, 2001; Snowden & Pingatore, 2002).”
Background
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“…prior research points to evidence of racial and ethnic disparities in access to substance abuse and mental health treatment (Department of Health and Human Services, 1999, 2001; Kales et al., 2000; Snowden, 2001; Wang, Demler, & Kessler, 2002; Weiss, Kung, & Pearson, 2003; Woodward, 2004).”
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“, 2009), seek support from significant others before turning to mental health providers for their emotional needs, and show a preference for facing mental health problems on their own, (i.e., ‘‘John Henryism’’; Adams, Aubert, & Clark, 1999; Snowden, 2001).”
BackgroundInfluential
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“…fewer sessions, contributing to a small yet growing literature linking African Americans and poor PTSD treatment retention even when taking indices of SES, such as education and income, into account as the current study did (e.g., Lester et al., 2010; Snowden, 2001; Spoont et al., 2015).”
BackgroundResult
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“There is also evidence of a greater sharing of resources among African American households and also among neighbors (Snowden, 2001).”
Background
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“Primary-care physicians may misidentify symptoms of depression if they are not presented as mood alterations (Snowden, 2001).”
Background
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Choi, N. G., & Gonzalez, J. M. (2005) · Clinical Gerontologist · doi:10.1300/j018v28n03_02 · Cited by 17
“African Americans tend to use prayer as a coping method due to their strong emphasis on spirituality, and often turn to family, friends, and religious figures for assistance (Baker & Lightfoot, 1993; National Mental Health Association, 2001; Neighbors, 1986; Snowden, 2001; Steffens, Artigues, Ornstein, & Krishnan, 199…”
BackgroundMethod
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Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD
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“Inherent stigma associated with psychological treatment in the Black community may also result in early termination of psychotherapy (Lester, Artz, Resick, & Young-Xu, 2010; Snowden, 2001; Trepasso-Grullon, 2012).”
Background
The fusion of culture and science: Challenges and controversies of cultural competency and evidence-based practice with an African American family advocacy network
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Authors: Snowden, L. R.
Affiliations: University of California, Berkeley (US)
Corresponding author: Snowden, Lonnie R.
ORCID: Snowden, Lonnie R.
Venue: Mental Health Services Research
Publisher: Springer Science and Business Media LLC
Published: 2001-12
Volume: 3
Issue: 4
Pages: 181-187
ISSN: 1522-3434 (ISSN-L)
1573-6636
DOI: 10.1023/a:1013172913880
OpenAlex: W1570230786
Semantic Scholar: cee44c38d282c0452637f2b965812ca6f4567ccc
Cited by: 409
References: 44
Citations by year: 2026: 6 · 2025: 17 · 2024: 18 · 2023: 10 · 2022: 14 · 2021: 6 · 2020: 17 · 2019: 15 · 2018: 18 · 2017: 16 · 2016: 20 · 2015: 21 · 2014: 35 · 2013: 20 · 2012: 29
FWCI: 9.87
Type: journal article
Language: en
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Mental Health Services Research (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5p50mh043694-13)
National Institute of Mental Health (MH43694-13)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
Keywords: African Americans, mental health services, help-seeking, barriers to treatment, general medical care, treatment discontinuation, stigma, coping styles, cultural factors in mental health
MeSH terms: Adaptation, Psychological, Mental Disorders, Black or African American, Culture, Health Services Accessibility, Health Services Research, Humans, Mental Health Services, Patient Acceptance of Health Care, United States

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Barriers to Effective Mental Health Services for African Americans

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