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Losing Faith and Using Faith: Older African Americans Discuss Spirituality, Religious Activities, and Depression

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Abstract

Background and Objectives

Older African Americans are often under diagnosed and under treated for depression. Given that older African Americans are more likely than whites to identify spirituality as important in depression care, we sought to understand how spirituality may play a role in the way they conceptualize and deal with depression in order to inform possible interventions aimed at improving the acceptability and effectiveness of depression treatment.

Design

Cross-sectional qualitative interview study of older African American primary care patients.

Participants and Setting

Forty-seven older African American patients recruited from primary care practices in the Baltimore, MD area, interviewed in their homes.

Measurements

Semi-structured interviews lasting approximately 60 minutes. Interviews were transcribed and themes related to spirituality in the context of discussing depression were identified using a grounded-theory approach.

Main Results

Participants in this study held a faith-based explanatory model of depression with a particular emphasis on the cause of depression and what to do about it. Specifically, participants described depression as being due to a “loss of faith” and faith and spiritual/religious activities were thought to be empowering in the way they can work together with medical treatments to provide the strength for healing to occur.

Conclusions

The older African Americans in this study described an intrinsically spiritual explanatory model of depression. Addressing spirituality in the clinical encounter may lead to improved detection of depression and treatments that are more congruent with patient’s beliefs and values.

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References

  1. Gallo JJ, Marino S, Ford D, Anthony JC. Filters on the pathway to mental health care: II Sociodemographic factors. Psychol Med. 1995;25:1149–60.

    PubMed  CAS  Google Scholar 

  2. Cooper-Patrick L, Gallo JJ, Powe NR, Steinwachs DM, Eaton WW, Ford DE. Mental health service utilization by African-Americans and whites: The Baltimore Epidemiologic Catchment Area Follow-up. Med Care. 1999;37:1034–45.

    Article  PubMed  CAS  Google Scholar 

  3. Gallo JJ, Bogner HR, Morales KH, Ford DE. Patient ethnicity and the identification and active management of depression in late life. Arch Intern Med. 2005;165(17):1962–8.

    Article  PubMed  Google Scholar 

  4. Robins LN, Regier DA. Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press; 1991.

    Google Scholar 

  5. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Study. Arch Gen Psychiatr. 1994;51:8–19.

    PubMed  CAS  Google Scholar 

  6. Blazer DG, Hybels CF, Simonsick CF, Hanlon JT. Marked differences in antidepressant use by race in an elderly community sample: 1986-1996. Am J Psychiatr. 2000;157:1089–94.

    Article  PubMed  CAS  Google Scholar 

  7. Brown C, Schulberg H, Madonia M. Clinical presentations of major depression in African Americans and whites in primary medical care practice. J Affect Disord. 1996;41(3):181–91.

    Article  PubMed  CAS  Google Scholar 

  8. Zubenko GS, Mulsant BH, Rifai AH, et al. Impact of acute psychiatric inpatient treatment on major depression in late life and prediction of response. Am J Psychiatr. 1994;151:987–94.

    PubMed  CAS  Google Scholar 

  9. 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: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 2001.

  10. Givens JL, Houston TK, Van Voorhees BW, Ford DE, Cooper LA. Ethnicity and preferences for depression treatment. Gen Hosp Psychiatry. 2007;29:182–91.

    Article  PubMed  Google Scholar 

  11. Cooper LA, Brown C, Vu HT, Ford DE, Powe NR. How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients. J Gen Intern Med. 2001;16(9):634–8, Sep.

    Article  PubMed  CAS  Google Scholar 

  12. Taylor RJ, Chatters LM, Levin J. Religion in the Lives of African Americans: Social, Psychological, and Health Perspectives. Thousand Oaks: Sage Publications, Inc.; 2004.

    Google Scholar 

  13. Krause N. Religion, Aging and Health: Exploring New Frontiers in Medical Care. South Med J. 2004;97(12):1215–22.

    Article  PubMed  Google Scholar 

  14. Krause N. Common Facets of Religion, Unique Facets of Religion, and Life Satisfaction Among Older African Americans. J Gerontol Ser B: Psychol Sci Soc Sci. 2004;59:S109–17.

    Google Scholar 

  15. Krause N. Church-Based Social Support and Health in Old Age. J Gerontol Ser B: Psychol Sci Soc Sci. 2002;57:S332–47.

    Google Scholar 

  16. Gallo JJ, Bogner HR, Straton JB, et al. Patient characteristics associated with participation in a practice-based study of depression in late life: the Spectrum study. Int J Psychiatr Med. 2005;35(1):41–57.

    Article  Google Scholar 

  17. Bogner HR, Wittink M, Merz JF, et al. Personal characteristics of older primary care patients who provide a buccal swab for APOE testing and banking of genetic material: The Spectrum Study. Comm Genet. 2004;7(4):202–10.

    Article  Google Scholar 

  18. Barg FK, Huss-Ashmore R, Wittink MN, Murray GF, Bogner HR, Gallo JJ. A mixed methods approach to understand loneliness and depression in older adults. J Gerontol: Soc Sci. 2006;61(6):S329–39.

    Google Scholar 

  19. Wittink MN, Barg FK, Gallo JJ. Unwritten rules of talking to doctors about depression: integrating qualitative and quantitative methods. Ann Fam Med. 2006;4(4):302–9, Jul-Aug

    Article  PubMed  Google Scholar 

  20. Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Los Angeles, California: University of California Press; 1980.

    Google Scholar 

  21. Lloyd KR, Jacob KS, Patel V, St Louis L, Bhugra D, Mann AH. The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders. Psychol Med. 1998;28(5):1231–7, Sep.

    Article  PubMed  CAS  Google Scholar 

  22. Bhui K, Bhugra D. Explanatory models for mental distress: Implications for clincial practice and research. Br J Psychiatry. 2002;181:6–7.

    Article  PubMed  Google Scholar 

  23. DiGregorio S. Teamwork using QSR N5 software: An example from a large-scale national evaluation project. QSR NSight Newsletter. 2001.

  24. Using N6 in Qualitative Research [computer program]. Version N6. Doncaster Victoria Austrailia: QSR International; 2002.

  25. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8.

    Article  PubMed  CAS  Google Scholar 

  26. Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New York: Aldine Publishing; 1967.

    Google Scholar 

  27. Koenig HG. Spirituality in patient care: why, how, when and what. Philadelphia: Templeton Foundation Press; 2002.

    Google Scholar 

  28. Koenig H, Cohen D, Blazer H, Kudler K, Krishnan KR, Sibert T. Religious coping and cognitive symptoms of depression in elderly medical patients. Psychosomatics. 1995;36:369–75.

    PubMed  CAS  Google Scholar 

  29. Koenig HG, Meador K, Parkerson G. Religion Index for Psychiatric Research: a 5-item measure for use in health outcomes studies (Letter to the editor). Am J Psychiatry. 1997;154:885–6.

    PubMed  CAS  Google Scholar 

  30. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  31. Comstock GW, Helsing KJ. Symptoms of depression in two communities. Psychol Med. 1976;6:551–63.

    Article  PubMed  CAS  Google Scholar 

  32. Eaton WW, Kessler LG. Rates of symptoms of depression in a national sample. Am J Epidemiol. 1981;114:528–38.

    PubMed  CAS  Google Scholar 

  33. Newmann JP, Engel RJ, Jensen J. Age differences in depressive symptom experiences. J Gerontol: Psychol Sci. 1991;46:P224–35.

    CAS  Google Scholar 

  34. Gatz M, Johansson B, Pedersen N, Berg S, Reynolds C. A cross-national self-report measure of depressive symptomatology. Int Psychogeriatr. 1993;5:147–56.

    Article  PubMed  CAS  Google Scholar 

  35. Katon W, Schulberg HC. Epidemiology of depression in primary care. Gen Hosp Psychiatry. 1992;14:237–47.

    Article  PubMed  CAS  Google Scholar 

  36. Jackson LE, Coursey RD. The relationship of God control and internal locus of control to intrinsic religious motivation, coping and purpose in life. J Sci Study Relig. 1988;27(3):399–410.

    Article  Google Scholar 

  37. Franklin MD, Schlundt DG, McClellan LH, et al. Religious fatalism and its association with health behaviors and outcomes. Am J Health Behav. 2007;31(6):563–72, Nov-Dec.

    PubMed  Google Scholar 

  38. Facione NC. Delay versus help seeking for breast cancer symptoms: A critical review of the literature on patient and provider delay. Soc Sci Med. 1993;36(12):1521–34.

    Article  PubMed  CAS  Google Scholar 

  39. Ohnuki-Tierney E. Illness and Culture in Contemporary Japan: An anthropological view. Cambridge: Cambridge University Press; 1984.

    Google Scholar 

  40. Weaver AJ, Flannelly KJ. The Role of Religion/Spirituality for Cancer Patients and Their Caregivers. South Med J. 2004;97(12):1210–4.

    Article  PubMed  Google Scholar 

  41. Crowther MR, Parker MW, Achenbaum WA, Larimore WL, Koenig HG. Rowe and Kahn's Model of Successful Aging Revisited: Positive Spirituality—The Forgotten Factor. Gerontologist. 2002;42:613–20.

    PubMed  Google Scholar 

  42. Holt C, Lewellyn L, Rathweg M. Exploring religion-health mediators among African American parishioners. J Health Psychol. 2005;10(4):511–27.

    Article  PubMed  Google Scholar 

  43. Pizarro D, Salovey P. Religious systems as "Emotionally Intelligent" organizations. Psychol Inq. 2002;13(3):220–2.

    Google Scholar 

  44. Wittink MN, Dahlberg B, Biruk C, Barg FK. How older adults combine medical and experiential notions of depression. Qual Health Res. 2008;18(9):1174–83, Sep.

    Article  PubMed  Google Scholar 

  45. Astin J. Why Patients Use Alternative Medicine: Results of a National Study. JAMA. 1998;279:1548–53.

    Article  PubMed  CAS  Google Scholar 

  46. King D, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract. 1994;39:349–52.

    PubMed  CAS  Google Scholar 

  47. Anderson J, Anderson L, Felsenthal G. Pastoral needs for support within an inpatient rehabilitation unit. Arch Phys Med Rehab. 1993;74:574–8.

    Article  CAS  Google Scholar 

  48. Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;159(15):1803–06, Aug 9-23.

    Article  PubMed  CAS  Google Scholar 

  49. Maugans T. The spiritual history. Arch Fam Med. 1996;5(1):11–6.

    Article  PubMed  CAS  Google Scholar 

  50. Lo B, Quill T, Tulsky J. Discussing palliative care with patients. American College of Physicians-American Society of Internal Medicine End-of-Life Care Consensus Panel. Ann Intern Med. 1999;130:744–9.

    PubMed  CAS  Google Scholar 

  51. Puchalski C. Taking a spiritual history:FICA Spirituality & Medicine Connection. 1999;3:1–4.

    Google Scholar 

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Acknowledgements

Dr. Wittink was supported by a Mentored Patient-Oriented Research Career Development (K23) Award from the National Institutes of Health (MH019931). The Spectrum Study was supported by grants MH62210-01, MH62210-01S1, and MH67077 from the National Institute of Mental Health.

Conflict of Interest Statement

None disclosed.

Author information

Authors and Affiliations

  1. Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA, 19104, USA

    Marsha N. Wittink MD, MBE & Frances K. Barg PhD, MEd

  2. Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jin Hui Joo MD, MALD

  3. Division of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Lisa M. Lewis PhD, RN

  4. Department of Anthropology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA

    Frances K. Barg PhD, MEd

Authors
  1. Marsha N. Wittink MD, MBE
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  2. Jin Hui Joo MD, MALD
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  3. Lisa M. Lewis PhD, RN
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  4. Frances K. Barg PhD, MEd
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Corresponding author

Correspondence to Marsha N. Wittink MD, MBE.

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Support: National Institute of Mental Health.

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Wittink, M.N., Joo, J.H., Lewis, L.M. et al. Losing Faith and Using Faith: Older African Americans Discuss Spirituality, Religious Activities, and Depression. J GEN INTERN MED 24, 402–407 (2009). https://doi.org/10.1007/s11606-008-0897-1

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  • DOI: https://doi.org/10.1007/s11606-008-0897-1

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