Poverty,Mental Health,and Women: Implications for Psychiatric Nurses in Primary Care Settings

Abstract

Poverty is one of the most consistent correlates of depression as well as other mental health disorders. Although poverty has negative health outcomes for men and women, the greater burden falls to women. Thus, the focus of this article is on the experiences of women and the complex intersection between the social and economic correlates of poverty and mental illness. A case study is presented that illustrates these intersections. The article concludes with suggestions to improve the mental health of poor women. J Am Psychiatr Nurses Assoc, 2007; 13(5), 267-274. DOI: 10.1177/1078390307308310

Keywords

depression poor women poverty mental health

Get full access to this article

View all access options for this article.

References

Agency for Health Care Policy and Research (AHCPR) Depression Guidelines Panel. (1993). Depression in primary care, Vol. I. Detection and diagnosis. Rockville: MD: U.S. Department of Health and Human Services, U.S. Public Health Service, Agency for Health Care Policy and Research publication 93-0550.

American Nurses Association (ANA). (2007). Psychiatric-mental health nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org.

Aranda, M.P. , Castaneda, I. , Lee, P.-J. , & Sobel, E. (2001). Stress, social support, and coping as predictors of depressive symptoms: Gender differences among Mexican Americans. Social Work Research, 25, 37-48.

Bassuk, E.L. , Mickelson, K.D. , & Perloff, J.N. (2002). Role of kin and nonkin support in the mental health of low-income women. American Journal of Orthopsychiatry, 72(2), 39-49.

Bassuk, E.L. , Weinreb, L.F. , Buckner, J.D. , Brown, A. , Salomon, A. , & Bassuk, S.S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. Journal of the American Medical Association, 278, 640-646.

Beeber, L.S. , & Canuso, R. (2005). Strengthening social support for the low-income mother: Five critical questions and a guide for intervention. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(6), 769-776.

Belle, D. , & Doucet, J. (2003). Poverty, inequality, and discrimination as sources of depression among U.S. women. Psychology of Women Quarterly , 27, 101-113.

Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems, & Health, 21(2), 121-133.

Brown, J.A. (2004). African American church goers' attitudes toward treatment seeking from mental health and religious sources: The role of spirituality, cultural mistrust, and stigma toward mental illness. Ann Arbor, MI: ProQuest Information and Learning Company (UMI No. 3129678).

10.

Carrasquillo, O. , Himmelstein, D.U. , Woolhandler, S. , & Bor, D.H. (1999). Going bare: Trends in health insurance coverage, 1989 through 1996. American Journal of Public Health, 89(1), 36-42.

11.

Chernomas, W. , Clarke, D. , & Chisholm, F. (2000). Perspectives of women living with schizophrenia . Psychiatric Services, 51(12), 1517-1521.

12.

Chung, E.K. , McCollum, K.F. , Elo, I.T. , Lee, H.J. , & Culhane, J.F. (2004). Maternal depressive symptoms and infant health practices among low-income women. Pediatrics, 113, e523-e539.

13.

Coiro, M.J. (2001). Depressive symptoms among women receiving welfare . Women & Health, 32(1/2), 1-23.

14.

Collins, P. , Geller, P. , Miller, S. , Toro, P. , & Susser, E. (2001). Ourselves, our bodies, our realities: An HIV prevention intervention for women with severe mental illness. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 78(1), 162-175.

15.

Craven, M.A. , & Bland, R. (2006). Better practices in collaborative mental health care: An analysis of the evidence base. A report for the Canadian collaborative mental health initiative. Canadian Journal of Psychiatry, 51(6Suppl.1), 7S-72S.

16.

Cutrona, C.E. , Russell, D.W. , Brown, P.A. , Clark, L.A. , Hessling, R.M. , & Gardner, K.A. (2005). Neighborhood context, personality, and stressful life events as predictors of depression among African American women. Journal of Abnormal Psychology, 14(1), 3-15.

17.

Darden, J.T. , & Kamel, S.M. (2000). Black residential segregation in the city and suburbs of Detroit: Does socioeconomic status matter? Journal of Urban Affairs, 22(1), 1-13.

18.

DeNavas-Walt, C. , Proctor, B.D. , & Hill-Lee, C. (2006). Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: U.S. Census Bureau, U.S. Government Printing Office.

19.

Ennis, N.E. , Hobfoll, S.E. , & Schroder, K.E.E. (2000). Money doesn't talk, it swears: How economic stress and resistance resources impact inner-city women's depressive mood. American Journal of Community Psychology , 28(2), 149-173.

20.

Fiscella, K. (2003). Assessing health care quality for minority and other disparity populations. Prepared for Agency for Healthcare Research and Quality, AHRQ Pub. No. 03-0047-EF.

21.

Lieberman, A. , Adalist-Estrin, A. , Erinle, O. , & Sloan, N. (2006). On-site mental health care: A route to improving access to mental health services in an inner-city, adolescent medicine clinic . Child: Care, Health and Development, 32(4), 407-413.

22.

Making the grade on women's health: A national and state-by-state report card 2004. (2004). Prepared by the National Women's Law Center and Oregon Health & Science University. Available at www.nwic.org

23.

McLennan, J.D. , Kotelchuck, M. , & Cho, H. (2001). Prevalence, persistence, and correlates of depressive symptoms in a national sample of mothers of toddlers. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1316-1323.

24.

National health care disparities report. (2005). Available at www.qualitytools.ahrq.gov/disparitiesreport

25.

New Freedom Commission on Mental Health. ( 2003). Achieving the promise: Transforming mental health care in America. Final report. DHHS Pub. No. SMA-03-3832. Rockville, MD: Department of Health and Human Services.

26.

Nickerson, K.J. , Helms, J.E. , & Terrell, F. (1994). Cultural mistrust, opinions about mental illness, and Black students' attitudes toward seeking psychological help from counselors . Journal of Counseling Psychology, 41, 378-385.

27.

Padgett, D. (1997). Women's mental health: Some directions for research . American Journal of Orthopsychiatry, 67(12), 1634-1636.

28.

Primm, A.B. , Cabot, D. , Pettis, J. , Vu, H.T. , & Cooper, H.A. (2002). The acceptability of a culturally tailored depression education videotape to African Americans. Journal of the National Medical Association, 94, 1007-1016.

29.

Roschelle, A.R. (1997). No more kin: Exploring race, class, and gender in family networks. Thousand Oaks, CA: Sage.

30.

Satcher, D. (1999). Mental health: A report of the Surgeon General—Executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health.

31.

Schulz, A.J. , Israel, B.A. , Zenk, S.N. , Parker, E.A. , Lichtenstein, R. , Shellman-Weir, S. , et al. (2006). Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit's eastside. Social Science & Medicine, 62, 510-522.

32.

Sevak, P. , Weir, D.R. , & Willis, R.J. (2003/2004). The economic consequences of a husband's death: Evidence from the HRS and AHEAD. Social Security Bulletin, 65(3), 31-44.

33.

Siefert, K. , Bowman, P.J. , Heflin, C.M. , Danziger, S. , & Williams, D.R. (2000). Social and environmental predictors of maternal depression in current and recent welfare recipients . American Journal of Orthopsychiatry, 70(4), 510-522.

34.

Siefert, K. , Finlayson, T.L. , Williams, D.R. , & Delva, J. (2007). Modifiable risk and protective factors for depressive symptoms in low-income African American mothers. American Journal of Orthopsychiatry, 77(1), 113-123.

35.

Siefert, K. , Heflin, C.M. , Corcoran, M.E. , & Williams, D.R. (2001). Food insufficiency and the physical and mental health of low-income women. Women & Health, 32(1/2), 159-177.

36.

Stafford, M. , & Marmot, M. (2003). Neighborhood deprivation and health: Does it affect us all equally? International Journal of Epidemiology, 32, 357-366.

37.

Thoits, P.A. (1984). Explaining distributions of psychological vulnerability: Lack of social support in the face of life stress. Social Forces, 63(2), 453-481.

38.

Thoits, P.A. (1995). Stress, coping, and social support processes: Where are we? What next? Journal of Health and Social Behavior , 35, 53-79. Extra issue: Forty Years of Medical Sociology: The State of the Art and Directions for the Future.

39.

U.S. Census Bureau. (2000). 2000 U.S. Census data. Washington, DC: Author.

40.

U.S. Department of Health and Human Services (DHHS). (2001). Mental health: Culture, race and ethnicity—A supplement to mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

41.

Weissman, M.M. (1987). Advances in psychiatric epidemiology: Rates and risks for major depression. American Journal of Public Health , 77(4), 445-451.