"You don't go tell White people nothing": African American women's perspectives on the influence of violence and race on depression and depression care.

Objectives: We sought to understand how African American women's beliefs regarding depression and depression care are influenced by racism, violence, and social context.
Methods: We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization.
Results: Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a "White" system. The image of the "strong Black woman" was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use.
Conclusions: Although violence and drug use were central to our participants' understanding of depression, racism was the predominant issue influencing their views on depression care. Providers should develop a greater appreciation of the effects of racism on depression care. Depression care programs should address issues of violence, substance use, and racism.