Depression Among Older African Immigrant Women in Massachusetts

Introduction and Overview of the Problem

In Metro West Massachusetts, the most common health disorders among elderly immigrant women aged between 50 and 79 years are anxiety and depression (Agbemenu, 2016). Despite a variety of efficacious interventions for these conditions, elderly immigrant women clearly experience mental health care disparities in both their access to services and the quality of treatment they receive. Research has indicated that African American heterogeneity prevents access to depression and anxiety treatment. In addition, African Americans are becoming an increasingly visible minority within the United States, especially in West Massachusetts, and are often identified as Black.

The current study sought to understand the causes and prevalence of depression among older immigrant African American women in Metro West Massachusetts, as well as how older immigrants cope with depression. A total of 12 self-identified social workers were interviewed about their patients' mental health symptoms and treatment experiences, perceived causes of their patients' anxiety, stressors their patients face in West Massachusetts, patients' access to mental health services, and how patients cope with depression. Results indicated considerable variability across two groups, with African American elderly immigrant women endorsing higher rates of depression and anxiety — as well as higher rates of treatment-seeking — than White counterparts. Individual gender, age, marital status, and country of origin all played a major role in the endorsement of anxiety and depression among immigrants. Although both groups differed in the extent to which they experienced stigma about mental health issues, stigma did not predict symptom endorsement or treatment-seeking behavior for either group. These findings underscore the importance of attending to both between-group and within-group differences in the mental health and treatment experiences of different ethnic groups.

In recent years, there has been a growing need for social work services for immigrants, particularly older immigrants aged 65 years and above (Social Work Today, n.d.). They are the ones who experience relocation to an entirely new geographical region where people are strangers to them. Society's acceptability toward them tends to be low, creating negative impacts on their physical and cognitive health — observable in social isolation, loss of independence, cognitive decline, and health problems in old age.

Old age is a critical time of life when elderly people need special care and attention. Their socialization patterns change dramatically when they must migrate. The negative effects may emerge in economic, social, psychological, political, and cultural terms (Lotfi, 2020). Immigration has adverse effects on aging people as they are mentally weakened by the pressures imposed by various changes. Their family and social relations are disrupted, resulting in complex physical, psychological, and sociological difficulties.

Social work interventions are innovative strategies for uplifting the emotional and physical wellbeing of elderly migrants. Social workers help elderly individuals through the adaptation process so that social exclusion can be mitigated and social justice can be served (Haidar, n.d.). Since social workers often work with mixed-status families, they must take care of clients' rights, especially considering their ethnic backgrounds.

An increase in African American older migrants is expected by the year 2050, with rising racial and ethnic needs among those with low educational levels (Gilmore, 2013). Their social and emotional needs must be addressed by culturally competent social workers so that medical and therapeutic healthcare services can be appropriately provided. However, healthcare access barriers for racially and ethnically diverse older immigrants have been well documented (Koehn, 2009). A vast disparity in healthcare provision exists between native populations and aging migrants who relocate to other regions, adversely affecting these populations' morbidity and mortality rates (Kristiansen et al., 2016).

The intent of this study is to explore the views of social workers in relation to depression among older immigrant African women currently living in West Massachusetts. For this study, "older immigrant African women" refers to women over 55 years of age who relocated from any African country after acquiring permanent residency in the United States. Depression among elderly immigrant women stands out as an important phenomenon for study in the context of social work, given the extent to which the condition affects vulnerable populations. Derr (2017) pointed out that immigrants typically face stressors related to the migration experience, which may cause or intensify mental health problems. Moreover, Derr (2017) noted that immigrants tend to access mental health services at a lower rate compared to non-immigrants. This situation leaves immigrants at risk of untreated conditions, leading to increased disease burden (Lynch, Berg, Manna, & Schade, 2016). This negative health predisposition creates a greater need for mental health services among immigrants who seem more susceptible to developing depression.

Problem Statement and Purpose of the Study

This situation makes it imperative to establish the views of social workers addressing the mental health needs — especially depression — of older immigrant African women in Metro West Massachusetts. Metro West Massachusetts encompasses a cluster of cities and towns where one of the fastest-growing African American communities in the United States has emerged, with a growth rate of 95% since 2000 (Impact Metro West, n.d.). However, disparities in educational and social gains are still seen for people of color, as they are in other parts of the United States (Rosenberg, 2020). Insights gained from this study should play a critical role in the development of comprehensive mental health programs aimed at improving immigrants' health outcomes.

As noted, migration can be challenging, and many immigrant women experience difficulties that affect their mental health (Foo et al., 2018). Changes in practices, values, social factors, and cultural identification are considered contributors to the potential risk of developing mental health issues (Alegría, Álvarez, & DiMarzio, 2017). Similarly, Foo et al. (2018) asserted that migration into a new country leads to drastic changes in essential aspects of normal daily life. The process of assimilating to new environments and cultures causes considerable acculturative stress, which researchers have linked to the occurrence of psychiatric disorders (Foo et al., 2018). Examining stressors surrounding the migrant experience from the social work perspective should therefore offer insights into the issues faced by this vulnerable population, especially for women aged 50 years and above.

Based on the highlighted problem, it is imperative to determine the views of social workers from West Massachusetts who work with older immigrant African women affected by depression (O'Donnell et al., 2016). Such an undertaking may reveal service modifications — such as giving patients with language barriers more time — that are needed to enhance access to quality mental health services (O'Donnell et al., 2016). Immigration can create worry that may increase the risk of depression, and this risk can be exacerbated by cultural factors such as language barriers, which may cause difficulty in diagnosing and treating this disorder among immigrant populations (Landa, Skritskaya, Nicasio, Humensky, & Lewis-Fernández, 2015). Failure to determine the views of social workers on depression within a community translates to neglecting social health and welfare (Baldwin-Clark, Ofahengaue Vakalahi, & Anderson, 2016). Accordingly, this study aims to obtain social worker perspectives regarding depression within the selected migrant population, as well as insights into ways healthcare professionals can help meet emerging needs.

In this study, the views of social workers regarding depression in older immigrant African women in Metro West Massachusetts will be obtained. Through analyzing these perspectives, insights can be provided into ways the social work sector can assist in meeting the emerging needs of this population. The study results are expected to identify any service modifications needed to meet the needs of immigrant African women in Metro West Massachusetts (Takeuchi, 2016). These findings can enhance access to quality mental health services and ensure women understand the implications of not seeking mental health care. Having examined the stressors faced by migrant women, insights will be gained into the issues the women face, and solutions directly targeted to this population can be developed (Agbemenu, 2016). Social workers will also benefit by using the findings to determine methods they can use to reach out to the study population.

This study focuses on answering the following research questions:

1. From the perspective and benefits of social workers, what factors influence older immigrant African women's adaptive capacity in Metro West Massachusetts?

2. From the social work perspective, what mental health services do social workers offer to older immigrant African women in Metro West Massachusetts?

3. How do social workers assess the need for mental health services for older immigrant African women in Metro West Massachusetts?

4. What service modifications can social workers introduce in practice to enhance mental health service delivery for older immigrant African women in Metro West Massachusetts?

Key Terms, Significance, and Theoretical Framework

Culturally informed is defined as the offering of care by healthcare professionals that respects, acknowledges, and integrates the patient's cultural values, practices, and beliefs (Health Policy Institute, n.d.). In this study, culture extends beyond identifying the patient and family by race and ethnicity to include variables such as faith, country of origin, education level, socioeconomic status, and level of acculturation. Being culturally informed refers to the ability of social workers to offer services that recognize, affirm, and value the worth of clients, their families, and their communities while preserving and protecting their dignity.

Older immigrant African women refers to women who are over 65 years of age (Noubicier & Charpentier, 2013) and who relocated from any African country to the United States. The women could have come to the US legally or illegally, or they may have arrived as refugees and remained through their advanced age. For this study, the focus is on older immigrant African women who live in West Massachusetts and suffer from depression.

Immigrant: According to Gimeno-Feliu, Calderón-Larrañaga, Díaz, et al. (2019), an immigrant is a person who comes to permanently live in a foreign country. There are four types of immigration status: citizens, residents, undocumented individuals, and non-immigrants. This paper does not focus primarily on immigration status, though that status is expected to influence how immigrants access mental health services. The study will consider all immigrants provided they immigrated from Africa and have been living in the selected community.

African women refers to a native or inhabitant woman of Africa, or a woman who has African ancestry (Ythera, 2017). In this study, African women refers to older immigrant African women who were born in Africa and migrated to the US either legally or illegally and currently reside in West Massachusetts. These women will have lived almost half their lives in Africa before immigrating to the US.

Coping mechanisms refers to the collection of strategies used to cope with stressful events and trauma along with their painful memories (Good Therapy, 2018). In this study, coping mechanisms refer to the different cultural strategies used by the women to deal with stressful situations they encounter — the methods they use to adjust to stress and maintain their emotional wellbeing.

Migration is the temporary or permanent movement of humans or animals from one geographic region to another (Sinha, 2005). In this study, migration refers to the movement of people from any African country to the United States, focusing only on women who have migrated from Africa to the US — either alone, with family, or with a relative — and who are currently living in West Massachusetts.

Host country: According to Yamlaksira, Getachew, Paul, and Beamish (2021), a host country is a country that accommodates visitors or residents from elsewhere. In this study, host country refers to the country accommodating the African immigrants — the United States.

The significance of this research can be assessed from the fact that the African American community has faced racial disparity since the era of slavery, and those disparities persist in modern times (Watkins, Hawkins, & Mitchell, 2019). This form of structural inequality affects living conditions and directly affects health. Among those most affected are older individuals who bear the compounded burden of negative racial experiences over a lifetime. Social workers have come to help the African American community with an ethnic-centered and holistic approach. Therefore, this research will provide social workers with evidence to specifically address the concerns of older immigrants from the African American community.

The increment in social work services for this community has been rising for the past few decades, and theoretical and practical strategies have been developed through continuous research, design, implementation, and evaluation of social work practices within this population segment. The Afrocentric or Africentric paradigm has been established to address the seriousness of oppression and the prolonged cultural legacy of slavery still experienced by this community (Watkins, Hawkins, & Mitchell, 2019). This legacy travels along the lines of physical and mental health, manifesting through loss of identity when people travel to a new region and face changed living conditions. It is for this purpose that the current study addresses social work interventions for the elderly among African American immigrants.

The findings of this study will contribute new knowledge to address the gap in research regarding depression in older immigrant African women residing in Metro West Massachusetts. Findings will offer insights into ways social workers can meet the emerging needs of this population, assist community social workers in better addressing the challenges older immigrant African women face when accessing mental health services, and equip social workers with knowledge to develop strategies for treating depression while raising awareness of the unique needs of this group.

The theoretical framework guiding this project is the structural-functional theory. Theorists such as Cassel (1995) and Cobb (1976) expressed that social support serves as a resistance factor and plays an important role in reducing the adverse impact of exposure to negative life events (Thoits, 1985). This theory plays a key role in understanding the onset of depression among older immigrant African women, given the various social demands associated with being a migrant. Further, Kinser and Lyon (2014) emphasized that depressing experiences may increase a person's susceptibility to stressful episodes. Stress and vulnerability add to the possibility of developing depression, where environmental changes, lack of coping mechanisms, and lack of support have an adverse impact on the mental health outcomes of this group (Alegría et al., 2017).

To become culturally competent when dealing with this population, social workers need to be familiar with structural-functional theory. The theory explains why society functions the way it does, and it emphasizes the relationships between different social institutions — such as education, law, government, religion, and culture (Emadpoor, Lavasani, & Shahcheraghi, 2016). Social workers are trained to understand that society is like a system where all parts work together to create a whole. Emadpoor et al. (2016) posit that societies need culture in order to function. Therefore, being culturally informed is beneficial to the social worker, allowing them to reach out to community members in an acceptable manner (Sabbioni et al., 2018).

From the review conducted, a lack of literature exists in which the primary focus was placed on older African immigrant women (Okudo & Ross, 2016). This shortage is due to numerous factors, most involving the perception that African immigrants hold regarding depression (Thomson, Chaze, George, & Guruge, 2015). Depressed individuals are often stigmatized, and most African communities believe depression is caused by bad spirits. With this notion, it becomes difficult for women to seek professional health services, as they fear being labeled and judged harshly by other community members (Sánchez et al., 2014). A comprehensive search of peer-reviewed publications was conducted for this study focusing on mental health among older African immigrant women, drawing from MEDLINE, PsycINFO, CINAHL, EBSCO, Research Gate, ProQuest, SAGE Journals, and EMBASE. Keywords used included: depression in older women, depression in older immigrant women, older African American women, older immigrant African women, depression in immigrant African women, depression, and older immigrant women.