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PMC Articles

“I think we're on a cusp of some change:” coping and support for mental wellness among Black American women

PMCID: PMC11772172

PMID: 39877228

Abstract

Introduction Public discussions in the media (e.g., social media and reality shows) about Black women's mental health have become more common. Notably, celebrities have become more vocal about their own mental health challenges and sought to normalize seeking care. This study aimed to gain a better understanding of Black women's: (1) past and current causes of stress, anxiety, and depression, and coping skills used; (2) their attitudes and perceptions toward mental health and receiving mental health treatment; and (3) times in their life they felt anxious or depressed, and what type of support or resources would have been helpful to have access to. Methods Focus groups were conducted with 20 women (mean age 36.6 years, SD 17.8 years), with 5 participants per group. Descriptive qualitative content analysis of the focus group transcripts was conducted. Results Results consistently showed that intersectional identities of being both Black and a woman resulted in feelings of both hypervisibility and invisibility, representation matters when it comes to mental health providers, an increased openness to therapy across age groups, and a willingness to try digital health tools (e.g., smartphone app) for mental health needs. There is still work to be done to normalize mental health treatment among Black women. Discussion Subgroups within the community (e.g., young adults) have less stigma around mental health and are acting as catalysts for change. Intentional inclusion of Black women in mental health research and evolving treatment paradigms is important to eliminate inequities in access to culturally relevant mental health care.

Full Text

Mental health conditions include a broad range of illnesses and psychosocial disabilities, as well as mental states that can result in substantial distress, functional limitations, or the potential for self-harm (National Institute of Mental Health, 2024). Approximately one in three people have their mental health disturbed at some point throughout their lives (Ginn and Horder, 2012; Steel et al., 2014). Importantly, mood disorders—major depressive disorder in particular—is common among Black women, with an estimated 27% having had depression at some point in their lives (McCall et al., 2023). Black women are particularly impacted by several risk factors, including socioeconomic inequality, prejudice, and increased prevalence of specific illnesses (e.g., type-2 diabetes, obesity, and hypertension) exacerbated by the strain of caregiving, often for multiple generations (Watson and Hunter, 2015). These problems were likely made worse by the COVID-19 pandemic, underscoring the intersectional effects on Black women's mental health of gendered prejudice and stress (McCall et al., 2023; Watson and Hunter, 2015; Okeke, 2013).
In addition to these stressors, Black women encounter obstacles on their way to seeking support and are half as likely to seek mental health treatment in traditional settings than White women. Factors such as stigma, challenges in accessing care, inadequate health insurance, mistrust of healthcare practitioners, and limited health literacy continue to pose substantial obstacles for many in this demographic when trying to receive mental health services (Okeke, 2013). Though uplifting, cultural tropes such as the “Strong Black Woman” and “Superwoman Schemas” can also impede the use of mental health services by encouraging unhealthy coping mechanisms (Watson and Hunter, 2016; Woods-Giscombé, 2010; Watson and Hunter, 2015; Okeke, 2013). The discrepancies in the use of mental health services are especially concerning because untreated depression has serious consequences that include a lowered quality of life, decreased productivity, and poorer health outcomes (Kessler and Bromet, 2013; Chen et al., 2005).
Understanding the state of mental health among Black women necessitates delving deeply into the complex web of their lived experiences in addition to their sociocultural background. There exist two diametrically opposed viewpoints of Black women in America (Allen and Britt, 1983). The first emphasizes inequalities due to less access to economic opportunities, racism, and sexism, portraying Black women as the most disadvantaged group when compared to middle-class White men (Allen and Britt, 1983; Pinderhughes, 1989). According to this viewpoint, Black women are more vulnerable to negative social and psychological experiences because of their intersectional status at the bottom of societal hierarchism (Belle, 1990). On the other hand, a different recognized perspective is the Black women's tenacity, fortitude, and flexibility, recognizing their abilities to work through and overcome structural obstacles to support their families, persevere through adversity, and forge their own paths to empowerment and self-actualization (Stack, 1997). Together, these differing perspectives provide a nuanced picture of the Black woman's experience of race, gender and class in America, highlighting the complexity of their existence and how it is affected by the intersections. Black women experience a particular kind of oppression that cannot be fully comprehended via the lenses of sexism or racism alone, despite experiencing a confluence of difficulties rooted in their intersectional identities (Brown and Keith, 2003; Belle, 1982; Brown et al., 2016).
Focus groups were conducted with women that identified as Black. Participants were recruited via the Attitudes Toward Seeking Mental Health Services and Use of Mobile Technology Survey (McCall, 2020) (i.e., survey respondents indicated if they would like to be contacted about an opportunity to participate in the focus group), posts on social media (e.g., Twitter), and flyers posted in the Durham and Chapel Hill, North Carolina communities inviting women (18 years or older) who identified as Black or African American or multiracial (i.e., Black or African American and another race) and had a history of anxiety or depression to participate in the study. However, study participation did not require a clinical diagnosis of anxiety or depressive disorder. Participants received a screening call to assess eligibility. Results from a study by Guest and colleagues revealed that more than 80% of all themes are discoverable within two to three focus groups, and 90% of themes could be discovered within three to six focus groups (Guest et al., 2017). Therefore, four focus group sessions were conducted. Each session was capped at five participants to allow for all participants to fully engage in the discussions.
A focus group interview guide was developed to help the moderator facilitate the discussions (Appendix A). The interview guide was developed in consultation with a qualitative data expert at Odum Institute for Research in Social Science at UNC to better tailor the questions and improve the flow of the discussion. Characteristics of study participants, such as age, race, and education were collected during the screening call to assess eligibility. The focus of this paper is on the first part of the focus group sessions where participants were asked questions about the following topics: (a) past and current causes of stress, anxiety and/or depression, and coping skills used; (b) their attitudes and perceptions toward mental health and receiving mental health treatment; and (c) times in their life they felt anxious or depressed, and what type of support and/or resources would have been helpful to have access to.
The waveform audio files (.wav) were professionally transcribed and imported into NVivo 12 software for analysis (Ltd QSRIP, 2018). TM (focus group moderator) compared the transcripts to the audio files to confirm accuracy. TM and a licensed clinical mental health counselor served on the analytic team, and independently coded the first interview using a grounded theory approach to inductively produce an initial list of the emerging topics from focus group discussions. A consensus was reached between the coders on the reoccurring topics. The remaining three focus group interview transcripts were coded independently using the agreed upon themes/subthemes, then the analytic team convened to discuss their analyses and explore the data through questions and comparisons of all four interview transcripts for additional themes/subthemes. The coding procedures facilitated a collaborative analytic process (Saldaña, 2021).
Descriptive qualitative content analysis was conducted for all focus group transcripts. “Qualitative content analysis is a dynamic form of analysis of verbal and visual data that is oriented toward summarizing the informational contents of that data” (Sandelowski, 2000). Furthermore, a pragmatic qualitative research approach was employed to offer a “comprehensive summary of events in the everyday terms of those events” (Sandelowski, 2000) for responses to questions that describe personal experiences or opinions. For example, a participant may describe past experiences using mental health apps and events that caused them to be concerned with using the apps. In February 2024, additional secondary data analysis of the transcripts was conducted to further explore previously identified themes and note new themes the coauthors discovered (TM, MF, HT, and BA). Thematic saturation was reached, as there was no new useful information produced after analysis of all transcripts.
Twenty participants (Sandelowski, 2000) attended the focus group sessions. Each focus group consisted of five participants. Participants could only attend one focus group session (approximately 1 h to 1 h and 15 min). Study participants ranged in age from 21 to 79 years (mean age of 36.6 ± SD 17.8 years), and all identified as female and either Black/African American or multiracial. Most participants obtained a bachelor's degree or higher (19/20, 95%). To engage a wide range of women and facilitate intergenerational discussion, half of the focus groups were mixed to include at least two participants aged 50 years or older. For comparison, one focus group consisted of women under the age of 30 years old. Participants' responses were summarized by the most prevalent themes (Appendix B), and a word cloud was created to visualize the most common words from the discussions and participants' sentiments (Figure 1).
Past studies have shown that African American women's double-minority status contributes to increased stress (Greer, 2011; Thomas et al., 2008; Lewis et al., 2016; Newton, 2023; Miller, 2023). The intersectionality of being a double-minority, both Black and a woman, was discussed by all focus groups. The term “intersectionality” was coined by Crenshaw to explain how the “intersectional experience [of being both Black and a woman] is greater than the sum of racism and sexism, [and] any analysis that does not take intersectionality into account cannot sufficiently address the particular manner in which Black women are subordinated” (Crenshaw, 1989). Participants voiced that the compounding effects of having to continuously deal with overt racism and sexism, as well as microaggressions, resulted in feeling negative emotions that are harmful to mental health (e.g., feelings of loneliness, increased stress, and feeling constantly “policed”). African American women are “policed” on everything from hairstyles to how they expressed themselves and have to learn how to navigate “white spaces” (i.e., places where White people are the majority), causing feelings of inadequacy and stress (Robinette, 2019). Therefore, Black women have to create spaces that feel safe, which means a necessity for relationships with individuals that share their socio-cultural background as exemplified by the number of Black participants who prefer a Black woman mental health professional. Furthermore, the biopsychosocial consequences of stress from race, gender, socioeconomic status (SES), and age discrimination are supported by the literature such that Brown et al. (2016) showed racial-ethnic, gender, and SES stratification intersect, which underscores Crenshaw's original theory about intersectionality. In this study we used educational attainment as a proxy for SES; therefore, future studies would benefit from collecting these data. Also, that results differ by age is worth further investigation.
Our findings support previous work, including Newton (2023), which explored the oxymoronic co-occurrence of hypervisibility and invisibility experienced by Black women on predominately white campuses. This research denotes how microaggressions simultaneously acknowledge the physical presence of Black women while ignoring and invalidating their experiences (Newton, 2023). Jones (2020, 2022, 2023) demonstrated the silencing that Black women often face, with rare opportunity to directly confront their perpetrators or express their hurt and anger. The additional stressor of having to be cognizant of how they present themselves (e.g., suppressing emotions to avoid perpetuating harmful stereotypes such as the “angry Black women”), was noted as anxiety inducing, leading to a silencing effect (Kilgore, 2018).
Most of the participants endorsed using mental health services, such as seeing a therapist. However, every group expressed the preference for a Black female therapist. The emphasis on having someone that looks like them was due to negative experiences in the past, or the perceived burden of having to explain to the therapist what Black women, in general, deal with, including the importance of speaking the same “language.” Lack of cultural competency, mistrust, and lack of empathy were the main reasons for not initially seeing a therapist or discontinuing treatment. While some clients may have no preference, Black Americans who indicate higher levels of mistrust of White individuals are more likely to discontinue therapy before treatment goals are reached if they are seen by a White counselor (Terrell and Terrell, 1984).
Respondents identified many barriers to seeking treatment. Most of the barriers were related to cost, not knowing where to get services, lack of time, stigma, concern that they might be committed to a psychiatric hospital or might have to take medicine, difficulty finding a preferred provider (i.e., African American woman), and concerns about confidentiality (McCall, 2020). These barriers are consistent with those documented in the literature (Hines-Martin et al., 2003; Merritt-Davis and Keshavan, 2006; Thompson et al., 2004). Additionally, the findings were consistent with results from a previous study which surveyed Black American women regarding barriers to seeking care. Although survey respondents had favorable views toward seeking mental health services, approximately 40% of respondents indicated that during the past 12 months there was a time when they needed mental health treatment or counseling but didn't get it (McCall, 2020). This finding revealed that lack of awareness of personal need for mental health care may not be the primary reason why Black American women might not seek mental health care. The use of mobile technology may help to eliminate or mitigate some of these barriers to receiving mental health care (McCall et al., 2021, 2022).
Good mental health was primarily viewed as being aware of one's triggers and emotions, and having the ability to control one's emotions and express how you feel. Self-awareness and the importance of having good coping techniques was emphasized by the focus group participants. Conversely, bad mental health was manifested both internally (e.g., negative mood, avoidance of dealing with issues) and externally (e.g., using food or alcohol to cope). Lack of resilience was identified as a major contributor to bad mental health. Ward and Heidrich (2009) found that African American women's preferred coping strategies included praying, using informal support networks (e.g., friends), and seeking treatment. Our findings support this since the focus group participants agreed that talking to their girlfriends and seeking solace in religion were the two most common ways that Black Women maintain good mental health. However, the participants voiced that Black women historically have not prioritized maintaining good mental health. Instead, caregiving responsibilities has been the priority and mental health an afterthought. Additionally, participants emphasize the influence of outdated perspectives on mental health held by church leaders' and elders can deter people from seeking mental health support from licensed professionals. Participants did not discourage the use of spiritual practices, such as prayer, however they recognized the need for trained mental health professionals to provide care for individuals experiencing mental health challenges.
There was a generational difference observed in attitudes toward using social media as a tool to maintain good mental health. The younger focus group participants were more likely to use social media as an outlet and a tool by expressing how they felt, connecting with others, and finding mental wellness resources (e.g., information about podcasts, encouraging or informative tweets). Whereas the older participants were less likely to use social media or deemed it inappropriate to use as an outlet to express oneself. Younger African American women (< 50 years old) are more likely to use social media than their older counterparts (The Nielsen, 2017). Use of social media can foster a sense of greater social connectedness, feelings of belonging, normalize challenges and facilitate sharing of coping strategies by sharing personal stories about dealing with mental illness (Naslund et al., 2016).
Participants voiced that “resiliency” is the top protective factor Black women have to help them to maintain good mental health. Furthermore, the women espoused the idea of the Strong Black Woman/Superwoman role, a phenomenon that affects the experiences and stress reported by African American women. The Superwoman role is characterized by the “obligation to manifest strength, obligation to suppress emotions, resistance to being vulnerable or dependent, determination to succeed despite limited resources, and obligation to help others” (Woods-Giscombé, 2010). However, participants discussed the duality of resiliency in that it can be both helpful and harmful. One can depend on resiliency too much and delay seeking needed mental health care, which can have deleterious effects (Watson and Hunter, 2016), such as increased allostatic load caused by stress that can lead to cardiovascular and neurological consequences (Allen et al., 2019; Geronimus et al., 2006).

Sections

"[{\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B28\", \"B10\", \"B36\", \"B23\", \"B42\", \"B23\", \"B42\", \"B30\"], \"section\": \"Introduction\", \"text\": \"Mental health conditions include a broad range of illnesses and psychosocial disabilities, as well as mental states that can result in substantial distress, functional limitations, or the potential for self-harm (National Institute of Mental Health, 2024). Approximately one in three people have their mental health disturbed at some point throughout their lives (Ginn and Horder, 2012; Steel et al., 2014). Importantly, mood disorders\\u2014major depressive disorder in particular\\u2014is common among Black women, with an estimated 27% having had depression at some point in their lives (McCall et al., 2023). Black women are particularly impacted by several risk factors, including socioeconomic inequality, prejudice, and increased prevalence of specific illnesses (e.g., type-2 diabetes, obesity, and hypertension) exacerbated by the strain of caregiving, often for multiple generations (Watson and Hunter, 2015). These problems were likely made worse by the COVID-19 pandemic, underscoring the intersectional effects on Black women's mental health of gendered prejudice and stress (McCall et al., 2023; Watson and Hunter, 2015; Okeke, 2013).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B30\", \"B43\", \"B44\", \"B42\", \"B30\", \"B17\", \"B7\"], \"section\": \"Introduction\", \"text\": \"In addition to these stressors, Black women encounter obstacles on their way to seeking support and are half as likely to seek mental health treatment in traditional settings than White women. Factors such as stigma, challenges in accessing care, inadequate health insurance, mistrust of healthcare practitioners, and limited health literacy continue to pose substantial obstacles for many in this demographic when trying to receive mental health services (Okeke, 2013). Though uplifting, cultural tropes such as the \\u201cStrong Black Woman\\u201d and \\u201cSuperwoman Schemas\\u201d can also impede the use of mental health services by encouraging unhealthy coping mechanisms (Watson and Hunter, 2016; Woods-Giscomb\\u00e9, 2010; Watson and Hunter, 2015; Okeke, 2013). The discrepancies in the use of mental health services are especially concerning because untreated depression has serious consequences that include a lowered quality of life, decreased productivity, and poorer health outcomes (Kessler and Bromet, 2013; Chen et al., 2005).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B2\", \"B2\", \"B31\", \"B4\", \"B35\", \"B5\", \"B3\", \"B6\"], \"section\": \"Introduction\", \"text\": \"Understanding the state of mental health among Black women necessitates delving deeply into the complex web of their lived experiences in addition to their sociocultural background. There exist two diametrically opposed viewpoints of Black women in America (Allen and Britt, 1983). The first emphasizes inequalities due to less access to economic opportunities, racism, and sexism, portraying Black women as the most disadvantaged group when compared to middle-class White men (Allen and Britt, 1983; Pinderhughes, 1989). According to this viewpoint, Black women are more vulnerable to negative social and psychological experiences because of their intersectional status at the bottom of societal hierarchism (Belle, 1990). On the other hand, a different recognized perspective is the Black women's tenacity, fortitude, and flexibility, recognizing their abilities to work through and overcome structural obstacles to support their families, persevere through adversity, and forge their own paths to empowerment and self-actualization (Stack, 1997). Together, these differing perspectives provide a nuanced picture of the Black woman's experience of race, gender and class in America, highlighting the complexity of their existence and how it is affected by the intersections. Black women experience a particular kind of oppression that cannot be fully comprehended via the lenses of sexism or racism alone, despite experiencing a confluence of difficulties rooted in their intersectional identities (Brown and Keith, 2003; Belle, 1982; Brown et al., 2016).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B21\", \"B12\"], \"section\": \"Procedures\", \"text\": \"Focus groups were conducted with women that identified as Black. Participants were recruited via the Attitudes Toward Seeking Mental Health Services and Use of Mobile Technology Survey (McCall, 2020) (i.e., survey respondents indicated if they would like to be contacted about an opportunity to participate in the focus group), posts on social media (e.g., Twitter), and flyers posted in the Durham and Chapel Hill, North Carolina communities inviting women (18 years or older) who identified as Black or African American or multiracial (i.e., Black or African American and another race) and had a history of anxiety or depression to participate in the study. However, study participation did not require a clinical diagnosis of anxiety or depressive disorder. Participants received a screening call to assess eligibility. Results from a study by Guest and colleagues revealed that more than 80% of all themes are discoverable within two to three focus groups, and 90% of themes could be discovered within three to six focus groups (Guest et al., 2017). Therefore, four focus group sessions were conducted. Each session was capped at five participants to allow for all participants to fully engage in the discussions.\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"SM1\"], \"section\": \"Measures\", \"text\": \"A focus group interview guide was developed to help the moderator facilitate the discussions (Appendix A). The interview guide was developed in consultation with a qualitative data expert at Odum Institute for Research in Social Science at UNC to better tailor the questions and improve the flow of the discussion. Characteristics of study participants, such as age, race, and education were collected during the screening call to assess eligibility. The focus of this paper is on the first part of the focus group sessions where participants were asked questions about the following topics: (a) past and current causes of stress, anxiety and/or depression, and coping skills used; (b) their attitudes and perceptions toward mental health and receiving mental health treatment; and (c) times in their life they felt anxious or depressed, and what type of support and/or resources would have been helpful to have access to.\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B20\", \"B33\"], \"section\": \"Data processing and analysis\", \"text\": \"The waveform audio files (.wav) were professionally transcribed and imported into NVivo 12 software for analysis (Ltd QSRIP, 2018). TM (focus group moderator) compared the transcripts to the audio files to confirm accuracy. TM and a licensed clinical mental health counselor served on the analytic team, and independently coded the first interview using a grounded theory approach to inductively produce an initial list of the emerging topics from focus group discussions. A consensus was reached between the coders on the reoccurring topics. The remaining three focus group interview transcripts were coded independently using the agreed upon themes/subthemes, then the analytic team convened to discuss their analyses and explore the data through questions and comparisons of all four interview transcripts for additional themes/subthemes. The coding procedures facilitated a collaborative analytic process (Salda\\u00f1a, 2021).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B34\", \"B34\"], \"section\": \"Data processing and analysis\", \"text\": \"Descriptive qualitative content analysis was conducted for all focus group transcripts. \\u201cQualitative content analysis is a dynamic form of analysis of verbal and visual data that is oriented toward summarizing the informational contents of that data\\u201d (Sandelowski, 2000). Furthermore, a pragmatic qualitative research approach was employed to offer a \\u201ccomprehensive summary of events in the everyday terms of those events\\u201d (Sandelowski, 2000) for responses to questions that describe personal experiences or opinions. For example, a participant may describe past experiences using mental health apps and events that caused them to be concerned with using the apps. In February 2024, additional secondary data analysis of the transcripts was conducted to further explore previously identified themes and note new themes the coauthors discovered (TM, MF, HT, and BA). Thematic saturation was reached, as there was no new useful information produced after analysis of all transcripts.\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B34\", \"SM2\", \"F1\"], \"section\": \"Results\", \"text\": \"Twenty participants (Sandelowski, 2000) attended the focus group sessions. Each focus group consisted of five participants. Participants could only attend one focus group session (approximately 1 h to 1 h and 15 min). Study participants ranged in age from 21 to 79 years (mean age of 36.6 \\u00b1 SD 17.8 years), and all identified as female and either Black/African American or multiracial. Most participants obtained a bachelor's degree or higher (19/20, 95%). To engage a wide range of women and facilitate intergenerational discussion, half of the focus groups were mixed to include at least two participants aged 50 years or older. For comparison, one focus group consisted of women under the age of 30 years old. Participants' responses were summarized by the most prevalent themes (Appendix B), and a word cloud was created to visualize the most common words from the discussions and participants' sentiments (Figure 1).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B11\", \"B39\", \"B19\", \"B29\", \"B26\", \"B8\", \"B32\", \"B6\"], \"section\": \"Principal findings\", \"text\": \"Past studies have shown that African American women's double-minority status contributes to increased stress (Greer, 2011; Thomas et al., 2008; Lewis et al., 2016; Newton, 2023; Miller, 2023). The intersectionality of being a double-minority, both Black and a woman, was discussed by all focus groups. The term \\u201cintersectionality\\u201d was coined by Crenshaw to explain how the \\u201cintersectional experience [of being both Black and a woman] is greater than the sum of racism and sexism, [and] any analysis that does not take intersectionality into account cannot sufficiently address the particular manner in which Black women are subordinated\\u201d (Crenshaw, 1989). Participants voiced that the compounding effects of having to continuously deal with overt racism and sexism, as well as microaggressions, resulted in feeling negative emotions that are harmful to mental health (e.g., feelings of loneliness, increased stress, and feeling constantly \\u201cpoliced\\u201d). African American women are \\u201cpoliced\\u201d on everything from hairstyles to how they expressed themselves and have to learn how to navigate \\u201cwhite spaces\\u201d (i.e., places where White people are the majority), causing feelings of inadequacy and stress (Robinette, 2019). Therefore, Black women have to create spaces that feel safe, which means a necessity for relationships with individuals that share their socio-cultural background as exemplified by the number of Black participants who prefer a Black woman mental health professional. Furthermore, the biopsychosocial consequences of stress from race, gender, socioeconomic status (SES), and age discrimination are supported by the literature such that Brown et al. (2016) showed racial-ethnic, gender, and SES stratification intersect, which underscores Crenshaw's original theory about intersectionality. In this study we used educational attainment as a proxy for SES; therefore, future studies would benefit from collecting these data. Also, that results differ by age is worth further investigation.\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B29\", \"B29\", \"B14\", \"B15\", \"B16\", \"B18\"], \"section\": \"Principal findings\", \"text\": \"Our findings support previous work, including Newton (2023), which explored the oxymoronic co-occurrence of hypervisibility and invisibility experienced by Black women on predominately white campuses. This research denotes how microaggressions simultaneously acknowledge the physical presence of Black women while ignoring and invalidating their experiences (Newton, 2023). Jones (2020, 2022, 2023) demonstrated the silencing that Black women often face, with rare opportunity to directly confront their perpetrators or express their hurt and anger. The additional stressor of having to be cognizant of how they present themselves (e.g., suppressing emotions to avoid perpetuating harmful stereotypes such as the \\u201cangry Black women\\u201d), was noted as anxiety inducing, leading to a silencing effect (Kilgore, 2018).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B37\"], \"section\": \"Principal findings\", \"text\": \"Most of the participants endorsed using mental health services, such as seeing a therapist. However, every group expressed the preference for a Black female therapist. The emphasis on having someone that looks like them was due to negative experiences in the past, or the perceived burden of having to explain to the therapist what Black women, in general, deal with, including the importance of speaking the same \\u201clanguage.\\u201d Lack of cultural competency, mistrust, and lack of empathy were the main reasons for not initially seeing a therapist or discontinuing treatment. While some clients may have no preference, Black Americans who indicate higher levels of mistrust of White individuals are more likely to discontinue therapy before treatment goals are reached if they are seen by a White counselor (Terrell and Terrell, 1984).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B21\", \"B13\", \"B25\", \"B40\", \"B21\", \"B22\", \"B24\"], \"section\": \"Principal findings\", \"text\": \"Respondents identified many barriers to seeking treatment. Most of the barriers were related to cost, not knowing where to get services, lack of time, stigma, concern that they might be committed to a psychiatric hospital or might have to take medicine, difficulty finding a preferred provider (i.e., African American woman), and concerns about confidentiality (McCall, 2020). These barriers are consistent with those documented in the literature (Hines-Martin et al., 2003; Merritt-Davis and Keshavan, 2006; Thompson et al., 2004). Additionally, the findings were consistent with results from a previous study which surveyed Black American women regarding barriers to seeking care. Although survey respondents had favorable views toward seeking mental health services, approximately 40% of respondents indicated that during the past 12 months there was a time when they needed mental health treatment or counseling but didn't get it (McCall, 2020). This finding revealed that lack of awareness of personal need for mental health care may not be the primary reason why Black American women might not seek mental health care. The use of mobile technology may help to eliminate or mitigate some of these barriers to receiving mental health care (McCall et al., 2021, 2022).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B41\"], \"section\": \"Principal findings\", \"text\": \"Good mental health was primarily viewed as being aware of one's triggers and emotions, and having the ability to control one's emotions and express how you feel. Self-awareness and the importance of having good coping techniques was emphasized by the focus group participants. Conversely, bad mental health was manifested both internally (e.g., negative mood, avoidance of dealing with issues) and externally (e.g., using food or alcohol to cope). Lack of resilience was identified as a major contributor to bad mental health. Ward and Heidrich (2009) found that African American women's preferred coping strategies included praying, using informal support networks (e.g., friends), and seeking treatment. Our findings support this since the focus group participants agreed that talking to their girlfriends and seeking solace in religion were the two most common ways that Black Women maintain good mental health. However, the participants voiced that Black women historically have not prioritized maintaining good mental health. Instead, caregiving responsibilities has been the priority and mental health an afterthought. Additionally, participants emphasize the influence of outdated perspectives on mental health held by church leaders' and elders can deter people from seeking mental health support from licensed professionals. Participants did not discourage the use of spiritual practices, such as prayer, however they recognized the need for trained mental health professionals to provide care for individuals experiencing mental health challenges.\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B38\", \"B27\"], \"section\": \"Principal findings\", \"text\": \"There was a generational difference observed in attitudes toward using social media as a tool to maintain good mental health. The younger focus group participants were more likely to use social media as an outlet and a tool by expressing how they felt, connecting with others, and finding mental wellness resources (e.g., information about podcasts, encouraging or informative tweets). Whereas the older participants were less likely to use social media or deemed it inappropriate to use as an outlet to express oneself. Younger African American women (< 50 years old) are more likely to use social media than their older counterparts (The Nielsen, 2017). Use of social media can foster a sense of greater social connectedness, feelings of belonging, normalize challenges and facilitate sharing of coping strategies by sharing personal stories about dealing with mental illness (Naslund et al., 2016).\"}, {\"pmc\": \"PMC11772172\", \"pmid\": \"39877228\", \"reference_ids\": [\"B44\", \"B43\", \"B1\", \"B9\"], \"section\": \"Principal findings\", \"text\": \"Participants voiced that \\u201cresiliency\\u201d is the top protective factor Black women have to help them to maintain good mental health. Furthermore, the women espoused the idea of the Strong Black Woman/Superwoman role, a phenomenon that affects the experiences and stress reported by African American women. The Superwoman role is characterized by the \\u201cobligation to manifest strength, obligation to suppress emotions, resistance to being vulnerable or dependent, determination to succeed despite limited resources, and obligation to help others\\u201d (Woods-Giscomb\\u00e9, 2010). However, participants discussed the duality of resiliency in that it can be both helpful and harmful. One can depend on resiliency too much and delay seeking needed mental health care, which can have deleterious effects (Watson and Hunter, 2016), such as increased allostatic load caused by stress that can lead to cardiovascular and neurological consequences (Allen et al., 2019; Geronimus et al., 2006).\"}]"

Metadata

"{\"section-at-acceptance\": \"Cultural Psychology\"}"