"You Got to Keep It Secret", Barriers to Mental Health Treatment Among Low-income, Midlife Women: A Qualitative Study.

introductionDisparities in mental health treatment for low-income, Black and Latinx populations have been well recognized. Beyond structural barriers, a noteworthy concern was whether attitudinal barriers played a major role in initiating and maintaining treatment. More specifically, 35- to 60-year-old Black and Latina women have been understudied regarding their attitudes and preferences for mental health treatment. The purpose of this study was to identify attitudinal enablers and barriers that have prevented midlife low-income, Black and Latina women from North Philadelphia from initiating and continuing mental health treatment.

methodsAn inductive thematic analysis approach was utilized to inform the sampling, themes, and sub-themes of this study. Semi-structured interviews were conducted with predominantly 50 midlife Black and Latina women from a larger, longitudinal community-based cohort focused on health improvement in North Philadelphia, whose residents were predominantly minority and low-income. Individual semi-structured interviews, with open-ended questions were performed on our study population. This approach stimulated discussion about the participants' experiences and their feelings that both inhibited and supported accessing mental health treatment. Interviews were conducted, transcribed, and coded to identify themes by the research team. Data analysis was conducted after interviews were coded in 2 research team meetings using flow diagrams.

resultsThe participants had a mean age of 50 years old, and the age range was 35-60 years old; most identified themselves as Black (n = 37) and reported being unemployed (n = 33). Nine overall themes were identified which included considerations of access and sustainability of mental health treatment: attitudinal and structural barriers to treatment, the need for confidentiality, the opportunity to learn coping skills, perceived helpfulness of treatment, medication considerations, therapy as an outlet, prior bad experiences with treatment, and relationships with their mental health professionals. Stigma was influential in discouraging women from seeking mental health treatment. Individual provider-related concerns impacted mental health treatment, including the relationship with the therapist. A prior bad experience with mental health treatment was associated with negative feelings about treatment. Positive feelings about mental health treatment included having an outlet, valuing the relationship with their therapist, and noticing beneficial changes because of treatment.

conclusionThis study provided deeper insight from the unique community of low-income, primarily Black and Latina women in North Philadelphia. Our findings suggested that efforts to decrease stigma and educate this population of women about the significance and prevalence of mental health disorders may improve the disparities in mental health treatment in this population of midlife women. Continued emphasis on strengthening the connection between the woman and her therapist/psychiatrist and improving access to community-based interventions may help address treatment disparities in midlife women in North Philadelphia.