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Abstract

This article reports the findings of a qualitative study that examined the perceptions of depression and suicide risk and protection among 40 African American women. Seven focus groups were conducted. The thematic findings of the focus group discussions included perceptions of depression as a sense of “spiritual forsakenness” and a healthy alternative to suicide. Living in spirit as well as in community with others was viewed as protection against suicide. Having a strong sense of African American heritage, history, and identity was perceived as protection against suicide and depression. Womanist implications for social work research, practice, and education are discussed.

Keywords

black feminist theory/womanism health and mental health qualitative researcher race/ethnicity

Studies, both survey and clinical, have indicated that women are at a higher risk of experiencing depression than are men (Taylor, Henderson, & Jackson, 1991; Waite & Killian, 2008; Williams et al., 2007). Among women, however, specifically African American women, the results have been mixed. For example, some investigators have reported that African American women are at a higher risk of depression than are European American women (Collins-McNeil et al., 2007; Lipscomb et al., 2007; Schulz et al., 2006; Taylor et al., 1991). Other investigators have reported equivalent rates of depression among African American women and European American women (Adebimpe, 1994; Carrington, 2006; Kaslow et al., 2000), whereas some investigators (Carpenter, 2002; Chernoff, 2002) have reported lower incidence rates of depression among African American women than among European American women.

Nevertheless, Anderson et al. (2006) clearly found that African American women were significantly less likely to seek or receive treatment for depression than were European American women because of their distrust of psychiatry and the medical system. Rennison and Planty (2003) explained the differences in the use of mental health services as a result of wealth and economic disparities between African American and European women. 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. Several researchers have explained that the low rates of treatment are a result of primary care physicians’ inability to detect, diagnose, treat, or refer persons whose ethnicity/race differs from the dominant group (Borowsky et al., 2000; Gallo, Bogner, Morales, & Ford, 2005; Harman, Schulberg, Mulsant, & Reynolds, 2001; Leo & Jones, 1998; Skaer, Sclar, Robison, & Galin, 2000). In addition, the use of coping mechanisms by African American women, such as spirituality and prayer (Carrington, 2006; Waite & Killian, 2008), have been identified as explaining the differences in help-seeking behaviors and utilization of treatment for depression.

Major depression increases with age, from 2.8% among persons aged 18–24 to 4.6% among persons aged 45–64. Depression is also a major risk factor in suicide attempts and completion (Centers for Disease Control and Prevention, 2010). Suicide is the eighth leading cause of death in all age groups and is now the third leading cause of death among young people aged 15–24 (Suicide.org, 2005). According to the literature, the reasons for the overall lower rates of suicide among African Americans, 5–6 per 100,000, half the rate of European Americans, 12 per 100,000, and African American women in particular, 1.7 per 100,000, and 5.0 per 100,000 for European American women (Suicide.org, 2005), given their comparable rates of depression, include a history of resilience and spiritual life-affirming aspects in the African American culture (Early & Akers, 1993; Gibbs, 1997; Gooden, 2008). Early and Akers (1993) and Stack (1998) found that a strong belief that suicide is an unacceptable option no matter how dire one’s life circumstances helps to explain the lower rates of suicide among African Americans. Likewise, a strong familial and communal system of support (Gibbs, 1997; Nisbet, 1996) and a strong reliance on one’s extended family, especially elder family members (Gibbs, 1997; Stack, 1998), have been identified as protection against suicide. African Americans’ high rates of participation in churches and/or religious communities have been hypothesized as protective factors against suicide (Carrington, 2006; Early & Akers, 1993; Waite & Killian, 2008). African Americans have also been found to have stronger reasons for living than do European Americans (Ellis & Range, 1991).

The direct mechanism involved in explaining comparable rates of depression and lower rates of suicide among African American women remains unclear and atheoretical. Therefore, a womanist framework is incorporated by this author to organize and elucidate these experiences, particularly since the African American culture appears to provide some protective buffers against suicide. A greater level of religious belief has been suggested as one major protective factor against suicide. Early and Akers (1993), Gibbs (1997), and Molock, Puri, Matlin, and Barksdale (2006) indicated that perhaps religiosity is the most important protective factor for many African Americans, which represents a strong conviction that condemns suicide as sinful (Early & Akers, 1993). In fact, Levin, Chatters, and Taylor’s (1995) four national surveys comparing racial and gender differences in religious beliefs among adults found that women were more religious than men and that African Americans were more religious than European Americans, even when health, family income, age, education, and geographic location were controlled for. According to Mattis (2000, p. 105), “substantial empirical as well as historical evidence indicates that religion is a particularly significant factor in the lives of African American women.”

There continues to be a dearth of research on this cultural paradox of low rates of suicide and comparable rates of depression among African American women in comparison to European American women. Most studies of suicide have included European Americans as their samples, few have focused on African Americans, and even fewer have addressed perceptions of suicide and depression among African American women. Factors and explanations related to suicide and/or depression among European American women may not apply to African American women. For example, marriage among African American women has been found to be less of a protective factor against depression than it has among European American women (Nisbet, 1996; Stack, 1998). Although depression has been identified as a major risk factor for suicide, researchers have indicated that positive, protective cultural factors exist as a buffer among African Americans, in general, and African American women, in particular (Gibbs, 1997; Levin, Chatters, & Taylor, 1995; Van Hook, 1999).

Purpose of the Study

Carrington (2006), Gibbs (1997), Molock et al. (2006), and Waite and Killian (2008) identified the importance of cultural manifestations in suicidal behavior and depression as well as the presentation of symptoms by race/ethnicity and gender. In other words, depression and suicidal behavior may be culturally influenced and/or articulated. Therefore, the purpose of the study presented here was to examine perceptions of risk (e.g., depression) and protection (e.g., the role of spirituality) associated with suicide in the lives of 40 African American women. Examining perceptions of suicide provides further insights into African American women’s expressions and interpretations of risk (e.g., depression) and protective factors (e.g., religion and spirituality) that are associated with suicidal behavior. Such perceptions and perspectives are key factors in the development of culturally sensitive models of coping among African American women. Furthermore, helping professions should be aware of the influence of culture on perceptions of depression and suicidal behavior and its impact on African American women.

Womanism: An Organizing Framework

The term womanist was first used by Alice Walker in 1983 in an effort to demonstrate that the reality of African American women differs from that of European American women so much that a term other than feminist needed to be incorporated. Walker stated that a womanist is “committed to the wholeness of an entire people, male and female” (p. xi). Hill Collins (1990) delineated four dimensions of a womanist epistemology and how these dimensions can be incorporated into research with African American women. The dimensions are (1) experience as a criterion of meaning, (2) the use of dialogue in assessing claims to knowledge, (3) an ethic of caring, and (4) an ethic of personal responsibility.

Womanism places African American history, culture, and an African heritage at the center of the lives of women of African descent (Cannon, 1995; Hill Collins, 1988, 1990; Walker, 1983). To understand African American women, one needs to recognize that history, heritage, and community are central organizing principles that underlie African American culture. The cosmological aspects of a womanist worldview entail viewing reality from the perspective of interdependence, in which all elements of the universe are interconnected. For example, womanism flows from a diunital (both/and) worldview, rather than a dichotomous (either/or) worldview, in which seemingly opposite ways of being (black:female) can coexist harmoniously. One is not either black or female; one is both/and. The ontological aspects (e.g., view of human nature) of womanism assume that all elements of the universe are spiritual—all elements are created from this universal, spiritual substance. Epistemologically, a great deal of emphasis is placed on an affective way of knowing and obtaining information, which underscores that interpersonal relationships have the highest value (Asante, 1990; Cannon, 1995; Hill Collins, 1990; Walker, 1983).

In essence, womanism provides an intersectional framework that emphasizes the unique, mutually constitutive, and holistic integration of race, ethnicity, culture, and gender identities that are related to African American women’s lived experiences (Cannon, 1995; Settles, 2006). For example, Settles (2006) found that the interference in the African American identity (but not interference in the woman identity) was related to depression and lower self-esteem among a sample of 89 African American women. Therefore, I included an intersectional framework to allow for a sociocultural perspective that is unique to the lived experiences of African American women (e.g., collective survival, oral expression, and the centrality of spirituality and religious expression; see Banks-Wallace, 2000; Cannon, 1995; Walker, 1983).

Method

A qualitative, exploratory research study consisting of focus groups with 40 African American female students was reviewed and approved by the institutional review board at the site of the study (a northeastern university). A qualitative, exploratory design was incorporated to ascertain perceptions of suicide risk (e.g., depression) and protection (e.g., spirituality). As Rubin and Babbie (2010) indicated, if there is a dearth of information regarding a particular research area, an exploratory approach is an empirically appropriate vehicle to conduct a study. Furthermore, there is a paucity of research and theoretical perspectives on suicide among African Americans in general, especially African American women; therefore, the application of an exploratory research design based on a qualitative research model (i.e., focus groups) was the most appropriate for the study (Ibrahim & Arrendondo, 1986; Marshall & Rossman, 1999). Qualitative research aims to place the participants’ experiences and perceived or identified needs at the center of the development and validation of knowledge (Kershaw, 1998). Knowledge that is generated from this method can further theoretical relationships and the development of survey measures that are based in a framework of the participants’ understanding of the concepts that are being studied.

Sample and Selection

After approval was obtained from the institutional review board, a purposive sample was recruited. The literature suggests that the nonrandom sampling method is acceptable until a database can be developed that can more adequately assess a population (Bernard, 1995; Brown, 1983; Kershaw, 1998). Flyers were posted at the approved, designated sites for recruiting research participants on the university campus. Eligible participants were African American college students, aged 18 years, who were enrolled at a historically, predominantly white university in a northeastern U.S. state during the spring semester in May 2007. Contact information and an incentive of $45 were included on the flyer with instructions for interested respondents to call me, the principal investigator. I then reviewed the eligibility criteria with the potential respondents and made arrangements for focus groups of five to six participants in the order of received interests to participate in focus group discussions. The mean age of the sample was 26, with ages ranging from 18 to 39 years.

To capture the role of ethnic culture, I recruited only African American students. The study’s focus did not include “race” as a panethnic concept; therefore, Nigerian American, Jamaican American, or South African American students, for example, were excluded. By recruiting African American students specifically, I could more readily ascertain the unique cultural and historical experiences among a “relatively homogeneous” ethnic sample who were inherently diverse.

Data Collection

The primary data collection technique was focus groups, which entailed a purposive sample of 40 African American college students. Focus groups feature informal, structured discussions, rather than formal, closed-ended ones. The researcher explores a few general topics to help uncover the participants’ perspectives, but otherwise takes note of how the participants frame and structure the responses (Bernard, 1995; Marshall & Rossman, 1999; Rubin & Babbie, 2010). The questions for the focus group were established prior to the focus group discussions in an effort to guide the process. These questions or general directions were as follows: What does suicide mean to you? What might make someone attempt suicide? What might prevent someone from committing suicide? What does depression mean to you? What might make someone depressed?

The participants were assured that participation was voluntary and that they could withdraw at any time. After written consent was obtained, a total of seven 60–90 min focus groups were conducted. All the focus group discussions were tape-recorded for transcription purposes, each focus group discussion requiring at least 10 hr to transcribe. Reflexive journaling was used to foster the maximum validity of the findings.

In addition, at the end of each focus group session, as a means to increase the validity of the findings, I used a member-checking strategy (Berg, 2001) by summarizing the focus group discussion and asking the participants to respond to the accuracy of the summary (only in one focus group did the members add to the summary; however, the members of all the other focus groups stated that the summaries were accurate). The participants were compensated $45 each for their participation and received brochures and other information related to the campus’s mental health services, Chaplain services, African American psychological–mental health services in the area, and suicide prevention (such as hotline services and warning signs).

Data Analysis

The grounded theory approach used in the study entailed a content analysis (Glaser & Strauss 1999). I transcribed the focus group interviews verbatim and then analyzed the discussions by identifying and coding topical schema (meaning units) in the form of themes and concepts in the transcript data, which entailed generating a list of key ideas, quotations, words, and phrases that reflected the perceptions of the participants; developing categories that were based on the list; and clustering the categories and topics to indentify themes and meaning units. Coding schemes were derived theoretically according to the study’s framework, with regard to perceptions of depression and suicide risk and protection. I categorized inductive codes into meaningful clusters within this theoretical framework and, in an effort to build theory, incorporated womanism as an overarching framework deductively to organize inductive, emerging themes as a preliminary explanatory model. “Central to misconception is the notion that grounded theory is an entirely inductive process, that it does not verify findings, and that it somehow molds the data to the theory rather than the reverse” (Berg, 2001, p. 244). Categories that researchers use in a modified grounded theory can be decided inductively or deductively or determined by the use of both (Glaser & Strauss, 1999). Inductive and deductive reasoning are not mutually exclusive in interactions between theoretical (e.g., womanism) interests and empirical observations (e.g., focus group discussions). In such instances, culture, language, and behavior—the researcher’s and the participants’—interact (Barker, 1957; Berg, 2001).

Results

The results are discussed for each of the themes on the basis of the guiding focus group questions and themes that emerged from the discussions. To highlight some of the underlying womanist assumptions that are germane to an intersectional framework that allows for a sociocultural perspective that is unique in the lives of African American women, the following three categories of themes are presented: (1) themes that are related to perceptions of depression include a sense of “spiritual forsakenness” and a “healthy alternative” to suicide; (2) themes that are related to perceptions of protection against suicide entail woman(ist) living in spirit and community with others; and “know thyself’ and “racing-gender” represent indigenous perceptions of African American identity, African American history, and African heritage as protection against suicide and depression. At least two to three independent statements from the groups have been included whenever possible (Berg, 2001). As Berg (2001, p. 277) noted, “with regard to qualitative research reports, several options are available for writing about the findings (data) and results (interpretation of the data).”

Theme 1—Depression: Spiritual Forsakenness and a Healthy Alternative to Suicide

A womanist intersectional framework recognizes the complexity of social identities and ways of being. A womanist would argue that depression cannot be defined categorically. For example, depression, a sense of hopelessness, social isolation, and loneliness were described as overlapping and difficult to differentiate. The participants described depression as stemming from a feeling of isolation and a feeling of “spiritual forsakenness.” Womanism is premised on the principle that illness (both mental and physical) is experienced via the “well-being of the soul” (Gooden, 2008). In other words, the mutually constitutive relationship of body, mind, and spirit highlights a culturally derived spirituality among African American women, one that perceives all life and experiences as ontologically (e.g., view of human nature) spiritual—all elements are created from this universal, spiritual substance (Hill Collins, 1990; Walker, 1983). As one participant stated, “I’m gonna turn to God, and He’s gonna help me. But when something doesn’t go right, that can also backfire and be like another source of depression, like ‘Why have you forsaken me?’”

Responses to depression, as described by the participants, may entail crying, talking to others, or simply sleeping for long periods. Although these responses were thematically viewed within two focus groups as unhealthy coping mechanisms, they were also viewed diunitally (both/and) as healthy alternatives to suicide. For example, a womanist appreciates the emotional range and fluidity of women’s culture. As a natural counterbalance to laughter, a womanist also diunitally values tears. One participant put it this way: “I cry about everything. I sleep or stay on the phone with my mother. I just go to bed and get a coping mechanism. It may be that other people may not have those coping mechanisms. It’s not healthy though, but it’s an alternative to suicide.”

The participants further described depression as a sense of hopelessness, a pain that is so deep that one would rather die. For example, one participant stated, “I think ultimately it might be like, I just felt hopeless, or I just felt like I was in so much pain.” Another noted: “Depression itself is, you know, one of the risk factors for suicide.” Still another precipitating factor in depression and thus, a risk of suicide, mentioned by a participant is loneliness:

Loneliness—I’ve thought about it actually, sophomore year was a rough year. Like my uncle died that year, and things were just not going the way I wanted to, and I was just feeling alone, I think it’s like loneliness is a big factor. I had friends, I had everything, but it was just—I still felt alone, and I looked out my window a couple of times, it’s like—I was depressed and not having that solidarity, and you feel like you’re alone. But now I’m fine, I don’t want to kill myself.

Epistemologically, a great deal of emphasis is placed on interpersonal relationships that facilitate a strong support network (Cannon, 1995; Hill Collins, 1990; Walker, 1983). As one participant stated, “It goes back to that support system—[another female student] that’s the strongest part. If you don’t have that solidarity, once you lack that, you know you’re alone.”

Theme 2: Perceptions of Suicide Protection: Woman(ist) in Spirit and Community

In spirit

The ontological aspects (e.g., view of human nature) of womanism assume that all elements of the universe are spiritual—all elements are created from this universal, spiritual substance. Womanist ontology reflects the centrality of spirituality and religious expression (Cannon, 1995; Sanders, 1995). A womanist loves spirit (Walker, 1983). The participants indicated that spirituality, religion, faith, and the view that suicide is a sin are protective factors against suicide; however, protection is manifest via spiritual connectedness in the context of community. As one participant noted, “I have my community, and I go. I have something that I do every Sunday, you know that people maybe would miss me, so suicide is not an option, period.” The participants further stated that the church represents their first line of defense and/or protection against suicide. Suicide, within the context of religion, is simply not an option (Early & Akers, 1993). A strong belief in God and faith in God provide the foundation for life itself as a gift from God. As one participant said, “‘God be with me,’ you know. So, I think it’s a very big protective factor.” Other participants stated:

You know, I would run to the church. That would be my first answer, but that is living on faith.

I would say religion because African Americans have looked to the church for so long, that even though you might not really believe in this, but it’s just how you’ve sort of been raised. And so, suicide, like is like not an option.

I mean, we just saw how people got through Katrina. To me that was an attempted genocide in and of itself, and we still pulled through. God—you know. I think a definite protective factor is if you’re strong in your faith.

The women shared a distinctive African-centered worldview encompassing a strong spiritual and religious identification with a womanist standpoint. As Tate (1992, p. 152) stated, “In a racist and sexist society, the concept of a Black woman empowered by God is doubly radical.” Womanism does not focus exclusively on social agendas; self-healing in the context of spirit-community is also among womanist goals (Cannon, 1995; Hill Collins, 1990; Sanders, 1995).

In community

Womanism recognizes the importance of community and collectivity as central organizing principles underlying African American culture. A strong sense of community also represents a major protective factor against suicide as expressed by the participants. A sense of community is tied to a collective people as a whole on the basis of ethnicity and culture. The community provides a collectivist framework that entails support. For example, in African American culture, the self is not treated as separate from the ethnic group and represents a diunital (both/and) or appositional relationship (Hill Collins, 1990; Sanders, 1995). In other words, the concept of self can be understood by the familiar African proverb, “I am because we are, and because we are therefore I am” (Mbiti 1970, p. 141). The participants described a U.S. emphasis on individualism as socially isolating and contributing factors in depression and suicidal behavior.

America as an institution is not created for black people, you know, but still being individualistic, that is the type of environment that it is, so but as far as like family and collectivism, and church, and school, and community, then that does not match up because within our collective society or culture you are not supposed to be individualistic.

Well, African Americans as a whole are a collectivist society, and Western Europeans, whatever, aren’t—they value individualism. [Agreement]

Beginning with Walker’s (1983) definition of womanism, a womanist is decidedly Afrocentric (Sanders, 1995). Walker’s definition is Afrocentric because Walker tied and built theory by explicating the core of black people’s experiences from a historical point of reference to pull together this definition in her In Search of Our Mothers’ Gardens. The womanist idea involves being committed to the health and survival of an entire people, both female and male.

Thus, womanist experiences entail viewing protection against suicide in the context of community, as these comments illustrate:

I think there is a strong sense of community, and the whole theory of “It Takes a Village to Raise a Child,” and you know just a lot of people take that seriously. [Agreement from another female student who said, “That’s true, that is so true!”]

I mean just to see the suicide rates for African Americans who have surrounded themselves with other African Americans or those who you know were raised around white kids, or just different privileged groups, just to see if it really makes a difference. I think it does, I really think it does . . . you know, just little community-based stuff that only me or another African American can relate to.

Theme 3: “Know Thyself” and “Racing-Gender” as Suicide Protection

Although not explicitly in response to a specific focus group question, an indigenous theme that emerged from the focus group discussions was one related to African American identity, African American history, and African heritage. This was a consistent finding in every focus group discussion. From the perspective of womanism, the central organizing theme of community within a sociocultural context places African American history, culture, and African heritage at the center of women of African descent (Asante, 1990; Hill Collins, 1990; Walker, 1983). Likewise, the participants’ responses illustrated their unique perceptions of suicide protection that were based in their lived experiences as African American women. Their race-gendered perceptions further demonstrate a distinctive perception that is rooted in their unique culture, ethnicity, history, heritage, and communal experiences as women of African American descent. Being African American was essential to their understanding of and identification with their personal identities as women and ways of being in the world.

What often emerged from the focus group data was the stated belief that one’s ability to know thyself in the context of history, culture, heritage, community, and struggle provides protection against suicide, depression, and other mental health concerns. As one participant stated in relation to knowing thyself in the context of peoplehood, “I think that’s really important for self-identity and maintaining a positive self-image.” Another participant said, “Black love is a revolutionary act; it gives you strength to push. It’s more than a feeling or, say, almost an action. It’s just kind of steeped in history.” A theory of womanism locates self and identity development in the context of collectivism. In the context of communal collectivism, African Americans come to know themselves and discover their uniqueness as an ethnic group under the umbrella of African ancestry and heritage (Cannon, 1995; Hill Collins, 1990; Sanders, 1995). Some comments in this regard were as follows:

I’d just go with the community thing, as far as like, you know African Americans, and the history of us here, we’ve been struggling for so long that people would say, “Well we’ve always struggled, look at how much better you have than they had it. You’re not getting hit with fire hoses,” so you just “keep on keeping on.”

Knowing your history—just coming from a whole lineage of strong people.

I think it’s a reason for it—usually to understand the legacy you come from, to understand what that community means, why it’s always been so important, just really loving who you are.

I understand how difficult it could be if you’re at this all-white university, so “know thyself.”

Conclusion

This qualitative study explored the perceptions of depression and suicide risk and protection among 40 African American women who were enrolled in a northeastern predominantly white university in a city with a high level of racial diversity. Within this setting, the following three themes emerged from the focus group discussions: (1) thematic perceptions of depression included “spiritual forsakenness” and depression as a “healthy alternative” to suicide, (2) thematic perceptions of protection against suicide entailed woman(ist) living in spirit and community, and (3) indigenous thematic perceptions included “know thyself” and “racing-gender” (e.g., African American identity, history, and African heritage) as protection against suicide and depression.

The participants clearly articulated perceptions of depression, suicide risk, and suicide protection in the context of their unique experiences, history, heritage, and community as women of African descent. For example, they described depression as stemming from feelings of isolation and of spiritual forsakenness. They further described depression as a sense of hopelessness, a pain that is so deep that one would rather die. Social isolation and the lack of a support system were described as resulting from “America’s emphasis on individualism” and thus were viewed as contributing factors in depression and suicide risk. The participants stated that a strong sense of faith, religiosity, and spirituality in the context of community represents a major protective factor against suicide in the mid of U.S. individualism. They tied a sense of community to ethnicity and culture as well as to a collectivist framework that entails communal support.

Womanism provides an overarching understanding of how self and identity development in a communal context describe the intersectional and mutually constitutive processes through which African American women come to know themselves as women of African ancestry and heritage. In essence, knowledge (intimately lived) of one’s history, along with black pride, black love, and positive images based in a strong sense of community appeared to provide the African American women in this study with a cultural context that moderates risks that are associated with suicide and depression. As one participant stated, “Black love is a revolutionary act.”

Womanist Implications for Social Work Research, Practice, and Education

Research

In 1994, the National Institutes of Health released guidelines requiring researchers to address the “inclusion of women and minorities” in their research plans. Often “women and minority” and “women and racial/ethnic groups” are conceptualized as mutually exclusive categories and ways of being, even when attempts to understand gender, racial, and ethnic diversity are made. Dominant frameworks consisting of categorical and dichotomous thinking (either/or) in understanding diversity are problematic. For example, even though all women belong to racial and ethnic groups (or combinations), categorical thinking makes it difficult to conceive that all feminisms are based in racial, ethnic, and cultural constructions, even among European American women. As a result, womanism has the potential to provide social work with a theoretical foundation that emphasizes and elucidates intersectionality, which can then lead to theories to guide practice with African American women, for example (Cannon, 1995; Carter, Sellers, & Squires, 2002; Hill Collins, 1990; Sanders, 1995; Taylor, 1998).

Practice

To thrive despite racist and sexist impositions requires African American women to define themselves and their own mental health needs (Banks-Wallace, 2000). When theoretical research models are culturally relevant and indigenous to African American women and are translated in models of practice, health-promoting behaviors can then be fundamentally based on the lived experiences and knowledge originating within African American women’s ethnic cultural milieu. Womanism incorporates racial consciousness in underscoring positive aspects of African American culture and life (Cannon, 1995). Mental health assessments can then include the identification of cultural values and associated behaviors that are health promoting for African American women. These cultural values and behaviors may include spiritual and religious beliefs and practices; support networks; and a shared African tradition of community, strength, and coping—all which may serve to moderate depression and the risk of suicide.

Education

Educators can incorporate diversity within diversity by illustrating how diversity is found not only between racial/ethnic groups but within gendered groups. In other words, there is no need to use an “additive” framework in which one is black, female, age specific, and so forth. Womanism, an integrative and intersectional framework, can be used to help students view diversity holistically (e.g., black female in community).

Limitations

The study could have been enhanced by the inclusion of self-administered questionnaires pertaining to depression, suicidal thoughts, or other mental health concerns. However, it was a preliminary investigation of the cultural perceptions and conceptualizations of depression and suicide risk and protection among African American women. Also, as Thomas and Sillen (1993, p. 153) stated, the African American community is rebelling against “proliferating questionnaires and swarming investigators.” Consequently, focus group discussions allow the researcher and participants to participate in research endeavors in which information is collected and analyzed in a culturally sensitive manner. A primary womanist epistemological assumption underlying the use of dialogue in assessing claims to knowledge is that spiritual connectedness, reciprocity, and immersion are essential components of the knowledge-validation process. The use of dialogue also has deep roots in an enduring African-based oral tradition and in African American culture (Cannon, 1995; Hill Collins, 1990). Although member checking was incorporated, there was only one coder for this study, thus a major limitation in obtaining intercoder reliability.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

References

Adebimpe

V. R.

(1994). Race, racism, and epidemiological surveys. Hospital & Community Psychiatry, 45, 27–31.

Anderson

Robins

Greeno

Cahalane

Copeland

Andrews

(2006). Why lower income mothers do not engage with the formal mental health care system. Qualitative Health Research, 16, 926–943.

Asante

M. K.

(1990). Afrocentricity. Trenton, NJ: African World Press.

Banks-Wallace

(2000). Womanist ways of knowing: Theoretical considerations for research with African American women. Advances in Nursing Science, 22, 33–45.

Barker

S. F.

(1957). Induction and hypothesis: A study of the logic of confirmation. Ithaca, NY: Cornell University Press.

Berg

B. L.

(2001). Qualitative research methods for the social scientists. Needham Heights, MA: Allyn & Bacon.

Bernard

H. R.

(1995). Research methods in anthropology: Qualitative and quantitative approaches (2nd ed.). Walnut Creek, CA: AltaMira Press.

Borowsky

S. J.

Rubenstein

L. V.

Meredith

L. S.

Camp

Jackson-Triche

Wells

K. B.

(2000). Who is at risk of nondetection of mental health problems in primary care? Journal of General Internal Medicine, 15, 381–388.

Brown

S. V.

(1983). The commitment and concerns of black adolescent parents. Social Work Research and Abstracts, 19, 27–34.

10.

Cannon

K. G.

(1995). Katie’s canon: Womanism and the soul of the black community. New York, NY: Continuum.

11.

Carpenter

(2002). What can resolve the paradox of mental health disparities? Monitor on Psychology, 102, 46.

12.

Carrington

C. H.

(2006). Clinical depression in African American women: Diagnosis, treatment, and research. Journal of Clinical Psychology, 62, 779–791.

13.

Carter

P. L.

Sellers

Squires

(2002). Reflections on race/ethnicity, class, and gender-inclusive research. African American Research Perspectives, 8, 111–124.

14.

Centers for Disease Control and Prevention. (2010). Current depression among adults—United States, 2006 and 2008. Morbidity and Mortality Weekly Report, 59, 1229–1235.

15.

Chernoff

N. N.

(2002). NIMH study: Blacks mentally healthier. American Psychological Society, 15, 21–36.

16.

Collins-McNeil

Holston

Edwards

Carbage-Martin

Benbow

D. L.

Dixon

T. D.

(2007). Depressive symptoms, cardiovascular risk, and diabetes self-care strategies in African American women with Type 2 diabetes. Archives of Psychiatric Nursing, 21, 201–209.

17.

Early

K. E.

Akers

R. L.

(1993). “It’s a white thing”: An exploration about beliefs about suicide in the African American community. Deviant Behavior, 14, 277–296.

18.

Ellis

J. B.

Range

L. M.

(1991). Differences between blacks and whites, women and men in reasons for living. Journal of Black Studies. 21, 341–347.

19.

Gallo

J. J.

Bogner

H. R.

Morales

K. H.

Ford

D. E.

(2005). Patient ethnicity and the identification and active management of depression in late life. Archives of Internal Medicine, 165, 1962–1968.

20.

Gibbs

J. T.

(1997). African-American suicide: A cultural paradox. Suicide and Life-Threatening Behavior, 27, 68–80.

21.

Glaser

G. G.

Strauss

(1999). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine.

22.

Gooden

(2008). Seeking help for the body in the well-being of the soul. In Mitchem

Townes

(Eds.), Faith, health, and healing in African American life (pp. 147–159). Westport, CT: Praeger.

23.

Harman

J. S.

Schulberg

H. C.

Mulsant

B. H.

Reynolds

C. F.

III . (2001). The effect of patient and visit characteristics on diagnosis of depression in primary care. Journal of Family Practice, 50, 1068–1068.

24.

Hill Collins

(1988). The social construction of black feminist thought. In Black women in America: Social science perspectives (pp. 23–37). Chicago, IL: University of Chicago Press.

25.

Hill Collins

(1990). Black feminist thought: Knowledge, consciousness and the politics of empowerment. Boston, MA: Unwin Hyman.

26.

Ibrahim

F. A.

Arrendondo

P. M.

(1986). Ethical standards for cross-cultural counseling: Counselor preparation, practice, assessment, and research. Journal of Counseling and Development, 64, 349–352.

27.

Kaslow

Thompson

Meadows

Chance

Puett

Hollins

Kellermann

(2000). Risk factors for suicide attempts among African American women. Depression and Anxiety, 12, 13–20.

28.

Kershaw

(1998). Afrocentrism and the Afrocentric method. In Hamlet

J. D.

(Ed.), Afrocentric visions: Studies in culture and communication (pp. 27–44). Thousand Oaks, CA: Sage.

29.

Leo

R. J.

Sherry

Jones

A. W.

(1998). Referral patterns and recognition of depression among African-American and Caucasian patients. General Psychiatry, 20, 175–182.

30.

Levin

Chatters

L. M.

Taylor

R. J.

(1995). Religious effects on health status and life satisfaction among black Americans. Journal of Gerontology: Social Sciences, 50B, S154–S163.

31.

Lipscomb

H. J.

Dement

J. M.

Epling

C. A.

Gaynes

B. N.

McDonald

M. A.

Schoenfisch

A. L.

(2007). Depressive symptoms among working women in rural North Carolina: A comparison of women in low-wage jobs. International Journal of Law and Psychiatry, 30, 285–298.

32.

Marshall

Rossman

G. B.

(1999). Designing qualitative research. Newbury, CA: Sage.

33.

Mattis

(2000). African American women’s definitions of spirituality. Journal of Black Psychology, 26, 101–122.

34.

Mbiti

(1970). African religions and philosophy. New York, NY: Doubleday.

35.

Molock

S. D.

Puri

Matlin

Barksdale

(2006). Relationship between religious coping and suicidal behaviors among African American adolescents. Journal of Black Psychology, 32, 366–389.

36.

Nisbet

P. A.

(1996). Protective factors for suicidal black females. Suicide and Life-Threatening Behavior, 26, 325–341.

37.

Rennison

Planty

(2003). Nonlethal intimate partner violence: Examining race, gender, and income patterns. Violence Victimology, 18, 433–443.

38.

Rubin

Babbie

(2010). Research methods for social work (2nd ed., pp. 37–55). Pacific Grove, CA: Brooks/Cole.

39.

Sanders

C. J.

(1995). Living the intersection: Womanism and Afrocentrism in theology. Minneapolis, MN: Fortress Press.

40.

Schulz

Gravelee

Williams

Israel

B. A.

Mentz

Rowe

(2006). Discrimination, symptoms of depression, and self-rated health among African American women in Detroit: Results from a longitudinal analysis. American Journal of Public Health, 96, 1265–1270.

41.

Settles

I. H.

(2006). Use of an intersectional framework to understand black women’s racial and gender identities. Sex Roles, 54, 589–601.

42.

Skaer

T. L.

Sclar

D. A.

Robison

L. M.

Galin

R. S.

(2000). Trends in the rate of depressive illness by ethnicity/race: Clinical Therapy, 22, 1575–1589.

43.

Snowden

(2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3, 181–187.

44.

Stack

(1998). The relationship between culture and suicide: An analysis of American Americans. Transcultural Psychiatry, 35, 253–269.

45.

Suicide.org. (2005). U.S. suicide statistics. Retrieved from http://www.suicide.org/suicide-statistics.html#2005

46.

Tate

(1992). Domestic allegories of political desire: The black heroine’s text at the turn of the century. New York, NY: Oxford University Press.

47.

Taylor

(1998). Womanism: A methodologic framework for African American women. Advances in Nursing Science, 21, 53–64.

48.

Taylor

Henderson

Jackson

B. B.

(1991). A holistic model for understanding and predicting depressive symptoms in African-American women. Journal of Community Psychology, 19, 306–320.

49.

Thomas

Sillen

(1993). Racism and psychiatry. New York, NY: Carol Publishing Group.

50.

Van Hook

M. P.

(1999). Women’s help-seeking patterns for depression. Social Work Health Care, 29, 15–34.

51.

Waite

Killian

(2008). Health beliefs about depression among African American women. Perspectives in Psychiatric Care, 44, 185–195.

52.

Walker

(1983). In search of our mothers’ gardens: Womanist prose. New York, NY: Harcourt Brace-Jovanovich.

53.

Williams

Gonzalez

Neighbors

Nesse

Abelson

J. M.

Sweetman

Jackson

J. S.

(2007). Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and Non-Hispanic whites. Archives in General Psychiatry, 64, 305–315.

African American Women’s Perceptions of Depression and Suicide Risk and Protection

Abstract

Keywords

Purpose of the Study

Womanism: An Organizing Framework

Method

Sample and Selection

Data Collection

Data Analysis

Results

Theme 1—Depression: Spiritual Forsakenness and a Healthy Alternative to Suicide

Theme 2: Perceptions of Suicide Protection: Woman(ist) in Spirit and Community

In spirit

In community

Theme 3: “Know Thyself” and “Racing-Gender” as Suicide Protection

Conclusion

Womanist Implications for Social Work Research, Practice, and Education

Research

Practice

Education

Limitations

Footnotes

Declaration of Conflicting Interests

Funding

References