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54 Seiten, Note: A
LIST OF TABLES
Chapter 1 Introduction to the study
Statement of Problem
Purpose of the Study
Significance of the Study
Assumptions and Limitations
Chapter 2 Literature Review
Overview of Depression
Disparity in Diagnosis and Treatment
Role of the Church in the African American Community
Discussion of Relevant Literature
Chapter 3 Research Methodology
Chapter 4 Research Findings
Research Findings and Discussion
Chapter 5 Integrative Summary, Recommendations, and Conclusion
Implications for Social Change
Recommendations for Further Study
Current research has indicated that there are disparities in mental healthcare treatment that are affecting African Americans. The literature has not strongly supported the use of spiritual leaders as counselors primarily because of a lack of certification in mental health counseling among clergy. However, the literature has shown that religious faith can have a positive effect on quality of life. The purpose of this critical literature review study is to review the existing research related to faith-based counseling and its specific use for treating depression symptoms among African American adults. Forty-seven peer-reviewed articles from the professional literature were selected for review based on relevance to African Americans and faith based organizations. Results of the review indicated the need to critically evaluate efficacy of faith-based programs based on scientifically determined outcomes. The implications for positive social change include increased access to affordable healthcare in a trusting environment, decreased prevalence rates for depression in African Americans, and reduction in disparities in mental healthcare delivery.
The author wishes to express sincere appreciation to professors Dr. Precilla Belin and Dr. Manoj Sharma for their assistance in the preparation of this manuscript. In addition, special thanks go to Ms. Sandra Claude, whose dedication and assistance encouraged me to pursue an in-depth study of faith-based therapy. Thanks also go to my family and friends for their encouraging words and friendly reminders. I also wish to acknowledge Bishop Winfred Hamlet of Gospel Lighthouse Church for motivating me to pursue my graduate degree. Finally, I give special thanks to Jesus Christ for providing me the strength and knowledge to complete my thesis.
Table 1. Primary Studies Relevant to Faith-Based Therapy and Depression 29
Table 2. Comparing Service Providers 22
Current research has indicated that African Americans face a disparity in receiving adequate mental healthcare treatment in spite of advances in technology and mental healthcare (Ojeda & McGuire, 2006). There is a need for alternative treatment options in conjunction with medical treatment to manage depression within the African American community. African Americans suffering from a mental health condition can benefit from resources within their community that are accessible and affordable. The focus of this study is to investigate the role of faith-based therapy in managing depression in African Americans. This subject is significant to African Americans because of the role religion serves in their community.
Faith-based therapy is designed not to impose beliefs on people, but to encourage them to use their existing spiritual beliefs as a coping mechanism to deal with life stressors such as death, divorce, or change in lifestyle. The literature supports the concept of faith-based therapy, which forms the theoretical basis for this study. Daaleman and Kaufman (2006) conducted a study using a cross-sectional analysis examining the correlation between spirituality and symptoms of depression in primary care patients. The study consisted of 401(78.8%) European American and 94(18.5%) African American participants. Daaleman and Kaufman (2006) used the Spiritual Index of Well-Being to gauge the participants’ level of spirituality in relation to episodes of depression.
The data indicated that the primary outpatient group members who reported a higher degree of self-efficacy as part of a significant spiritual well-being also reported less depressive symptoms (Daaleman & Kaufman, 2006).
Carrington (2006) explored clinical depression in African American women in regard to diagnosis, treatment, and research. Carrington indicated that a lack of research on African American women and depression was a major reason for conflicting prevalence rates. The critical literature review will include research involving African American men and women aged 18 to 65 years to provide an understanding of the effects of depression throughout the African American lifespan. Also, the literature review will focus on research comparing other ethnic groups with African Americans to illustrate the significance of faith-based therapy within the African American population. Chapter 1 introduces the structure and foundation of the study, including the problem statement and the significance of the study.
African Americans face a disparity in accessing and receiving healthcare compared to other ethnicities (U.S. Department of Health and Human Services, Office of the Surgeon General, n.d.). African Americans are overrepresented in the population of U.S. adults diagnosed with depression (Williams et al., 2007). They are also less likely to seek treatment and more likely to have a mental disorder than European Americans (Centers for Disease Control and Prevention [CDC], n.d.). This disparity may be related to a lack of trust of medical professionals and access to healthcare in the African American community (Dossett, Fuentes, Klap, & Wells, 2005).
Depression is the seventh leading cause of death which is linked to a risk for suicide in the United States (CDC, n.d.). Researchers have found conflicting prevalence rates of depression among African Americans (Riolo, Nguyen, & King, 2005; Williams et al., 2007). The two most common forms are major depressive disorder (MDD) and dysthymic disorder; they do not affect African Americans equally. Dysthymic disorder is associated with feeling sad all the time for over 2 years and is characterized by symptoms less severe than those of MDD (Riolo et al., 2005). Dysthymia is more prevalent among African Americans than European Americans (the rates are 56.5% and 26.8%, respectively; Williams et al., 2007). MDD is characterized by acute (short-term) episodes of severe depressive symptoms. European Americans have a higher lifetime MDD prevalence rate (17.9%) than Caribbean Blacks (12.9%) and African Americans (10.4%), which Williams et al. (2007) attributed to untreated depression in Caribbean Blacks and African Americans. This data reflects the need to expand the research of mental health care treatment among African Americans. African Americans carry a heavy burden when it comes to depression because they are less likely than European Americans to seek mental health services or to receive proper diagnosis and treatment (Williams et al., 2007). They are also more likely to have depression for longer periods, resulting in greater disability (Williams et al., 2007).
Treatments for depression include antidepressant medications, psychotherapy, and self-help groups. A holistic approach to treatment, which affords the medical or public health professional a broader perspective of the client or target population and encompasses people’s cultural and religious beliefs as well as their past medical history, may be important for African Americans who tend to have strong religious connections. The literature does not strongly support the use of spiritual leaders as counselors because of a lack of healthcare education among clergy. This thesis attempts to provide an understanding of faith as an alternative form of treatment for depression among the African American population through a critical literature review.
Having a supportive network is a key element to managing depression. Self-help groups, including those in the religious sector, can serve as resources for building a network of support. Several studies have been conducted to examine the role of religion in managing mental health disorders. Hodges (2002) examined the relationship between spirituality and human development, focusing on adults’ emotional well-being. Hodges found that the concept of spirituality was a useful indicator of mental health stability and implied that an individual is part of a greater community. Hodges also indicated four dimensions of spiritual well-being that correlated with emotional well-being that included meaning in life, intrinsic values, transcendence, and spiritual community.
The purpose of this study is to examine the concept of faith and its relationship to the treatment of depression. Identification of a relationship between faith-based counseling and depression is beneficial to the secular community’s efforts to build a positive health network. It is hypothesized that faith-based counseling enhances the reduction of depressive symptoms in African American adults.
The primary question this study seeks to answer involves the extent of the impact of faith on treatment of depression. Ai, Peterson, Rodgers, and Tice (2005) conducted a study among 224 middle-aged patients undergoing open-heart surgery. Ai et al. applied social cognitive theory (SCT) to explore the relationship of faith and mental health. The researchers defined locus of control, which is a concept of SCT, as one’s perceived control in regard to a deity as a source of higher power, and primary control as one’s control over the environment (Ai et al., 2005). A secondary control strategy was seeking help from God or some other deity (Ai et al., 2005). Ai et al. measured several factors such as routine of prayer and emotional coping to assess the relationship between faith and stress management and used a goal-oriented spiritual coping measure of prayer to assess individuals’ faith-based personal control. The study found that older-aged minority patients with greater external control used private prayer as a source of coping (Ai et al., 2005).
Though faith has several definitions, it is a concept common to different religions. Star (2008) described faith as self-transformation and willingness of finding one’s emotional truth to accept the unknown. Faith and hope can be used interchangeably to describe a coping mechanism.
To further understand the concept of faith, one must understand faith-based therapy. The term faith-based “is used to describe religious organizations that provide transitional assistance, multi-service with a focus on social services” (Graddy & Ye, 2006, p. 309).
Faith-based therapy is an outreach initiative to help facilitate community health needs among underserved and underrepresented populations.
Faith-based counseling is a form of faith-based therapy. It differs from secular counseling because it is centered on one’s belief in God. “Faith-based counseling helps people find a balance between their life values, goals, and belief system” (Family Christian Counseling, n.d., p.1).
Depression is a state of feeling sad, hopeless, and angry, that interferes with normal daily living and functioning (National Institute of Mental Health [NIMH], 2000). “Depression often co-exists with other illnesses and people do not all experience the same symptoms” (NIMH, 2000, p. 2); it can be a result of environmental or biological factors. Types of depression are classified based on symptoms, severity, and duration. The two most common forms are MDD and dysthymic disorder. For the purposes of this study, the researcher’s discussion of depression refers to dysthymia, or MDD where otherwise indicated.
According to the CDC, 20.9 million Americans suffer from depression annually (CDC, n.d.). Nearly 25% of African Americans are uninsured, compared to only 16% of the general U.S. population (U.S. Department of Health and Human Services, Office of the Surgeon General, n.d.). This represents an inequality in diagnosis and treatment of depression in African Americans. The findings of this study can help to create a standard for faith-based therapy as an alternative form of treatment for depression. This study also can help to expand patients’ health paradigm to include community-based care resources, which can help to ensure African American clients receive adequate healthcare in a trusting environment. Finally, this study helps to define a working relationship between faith-based counselors and secular medical professionals.
It is important to establish a working relationship between faith-based therapy and depression. However, it is imperative to conduct an evaluation of the effectiveness of interventions. This study answers the following research questions based on a critical review of the literature:
1. What is the relationship between faith-based therapy and depression in African American adults?
2. What is the impact of faith-based therapy on depression?
a. The independent variable in this study is faith-based therapy.
b. The dependent variable is depression.
I assume that faith-based therapy is effective in treating depressive symptoms in African Americans based on the centrality of faith and spirituality within the African American community during times of hardship, from slavery to the Civil War. Incorporating faith measures has made African Americans resilient in surviving limitations imposed by society (Bazargan, Bazargan –Hejazi & Baker, 2005). The scope of this study was limited to a critical literature review, which limits generalization of the findings. This research lacked empirical data to validate current literature findings.
Results were based on the current literature with an identified need to improve research that discusses the effectiveness of faith-based counseling, in which the results could be used to create an evaluation tool for faith-based programs. Thus, it would be helpful for care providers to build strong networks with other medical professionals and to increase reliability and accountability of faith-based services.
Chapter 1 described the structure of the proposed study along with the significance of and need for the study. I have identified operational definitions to maintain clarity throughout the study. Chapter 2 contains the key components of the study, which include an overview of depression, the role of the church, and a discussion of relevant literature. Chapter 3 outlines the research methods employed to collect and analyze the data. Chapters 4 and 5 focus on answering the proposed research questions and making recommendations for future research.
This chapter is dedicated to bridging the gap between faith and depression in African American adults. The loss of a loved one, divorce, unemployment and poverty are risk factors for experiencing depression. The effects of depression vary for each individual. Chapter 2 creates the foundation and purpose of this research and continues with the discussion of the African-American church’s impact on treatment of depression. The church is a source of a social network and provides a self-help group. Several important concepts such as depression, faith-based therapy, and the role of the church in the African American community are discussed. Examples of faith-based organizations are presented as supporting data for alternative treatment of depression among African-Americans.
Depression is a mental health disorder that, if left untreated, can lead to suicide (Bazargan et al., 2005). The suicide rate among African Americans between the ages of 10 and 14 years increased by 233% between 1980 and 1995; this compares to a 120% increase among European Americans, which indicates that African American rates are significantly higher than those of European Americans (U.S. Department of Health and Human Services, Office of the Surgeon General, n.d.). Symptoms vary based on the type of depression and include an inability to eat, work, and enjoy life. Other symptoms of depression include a persistent sad mood, feelings of hopelessness, feelings of guilt, decreased energy, difficulty making decisions, changes in appetite and weight, suicide attempts, and persistent physical changes that do not respond to treatment such as digestive disorders and headaches (National Institutes of Mental Health [NIMH], 2000).
Depression has several classifications including MDD, dysthymia, and bipolar disorder. MDD is a combination of symptoms that can occur once or several times throughout one’s life. Dysthymia is less severe than MDD but nevertheless produces chronic symptoms that are detrimental to one’s sense of well-being; it has been shown to be comorbid with MDD (NIMH, 2000). Bipolar disorder is composed of mania and dramatic mood changes.
There is no single cause of depression. However, family history, environment, life stressors, trauma, and certain health conditions may trigger a depressive episode (NIMH, 2000). Women experience depression twice as often as men, which may be related to hormonal changes and pregnancy; men are also less likely to admit they are depressed (NIMH, 2000). Dysthymia is more prevalent in African Americans and Mexican Americans than in European Americans (Riolo et al., 2005). The high prevalence of dysthymia among African Americans and Mexican Americans could be related to a lack of medical treatment upon first noticing changes in mood and thought and other symptoms associated with depression (Riolo et al., 2005).
Ojeda and McGuire (2006) conducted a study to examine the use of outpatient mental health and substance services by depressed adults. Ojeda and McGuire used self-reported data from the 1997–1998 Healthcare for Communities Survey of 1,498 African American, Latino, and European American men and women 18 years of age and older meeting Composite International Diagnostic Interview (CIDI) criteria for major depression or dysthymia. The results indicated that African Americans and Latinos 18 to 44 years of age were less likely to use outpatient mental health services. Forty percent of African Americans and Latinos reported lost pay from work to attend medical appointments as a barrier to seeking or using medical treatment, compared to 12% of European Americans. African Americans also reported other barriers to treatment at a significantly higher rate than did European Americans, 40% stated that their mental healthcare provider did not accept their health insurance, compared to 29% of European Americans, and 47% reported feeling embarrassed to discuss their problems with anyone, compared to 12% of European Americans (Ojeda & McGuire, 2006).
Ojeda and McGuire (2006) concluded, “services used by minorities were more affected by financial and social barriers” (p. 211). This conclusion is significant to this research because it helps to support the use of faith-based therapy with an African American population. Church- or faith-based community health centers can help to reduce barriers to treatment by providing access to healthcare in the community. This research also supports the need to improve mental health treatment for uninsured and underserved populations.
Lack of access to healthcare for African Americans is a common theme in research findings. Bazargan, Bazargan-Hejzai, & Baker (2005) conducted a study among African Americans and Hispanics to examine treatment for depression using the behavioral model for vulnerable populations as the framework for the study. The participants consisted of 391 residents of three public housing communities in Los Angeles. They were on average 45 years of age, and 89% of females who participated acted as head of household. Of the participants, 60% did not have a high school diploma, and 48% reported suffering from depression. Results indicated that one out of three people reporting being depressed also reported never having been diagnosed for depression (Bazargan et al., 2005).
Carrington (2006) discussed the prevalence rate of depression among African American women. Carrington’s literature review revealed that “lack of adequate and sufficient research data on African Americans contributes to the problems of misdiagnoses, under diagnoses, and under treatment of depression in African Americans and more profoundly in African American women” (p. 780). Carrington inferred that holistic treatment could be successful in reducing depressive symptoms in African Americans and suggested the need for more evidence-based treatment approaches for depression, including faith-based therapy. Incorporating faith-based therapy as a part of one’s healthcare plan could help to increase quality of life and improve access to healthcare. Laurencelle, Abell, and Schwartz (2002) examined the link between intrinsic religious faith and psychological well-being and found that people with high faith were lower in anxiety and depression were less likely to show symptoms of character pathology and had significantly stronger egos (p. 109).
For centuries, the church has been a central point of support for the African American community. Throughout U.S. history, the church has served an important role in the lives of African Americans (Markens, Fox, Taub, & Gilbert, 2002, p. 92). NIMH (2007) conducted a survey of 3,570 African Americans, 1,621 Blacks of Caribbean descent, and 891 non-Hispanic Whites 18 years of age and older regarding depression and treatment and showed that treatment rates for depression among African Americans is low. (NIMH, 2007).
The structure of the church promotes safe behaviors such as no smoking, no consumption of alcoholic beverages, encouragement of peaceful relationships with neighbors, family, coworkers, and self-control of one’s life.
Krause (2003) conducted a study to provide a better understanding of the role of faith by analyzing positive and negative aspects of religion. Krause used a conceptual model that included the constructs of church attendance, religious forgiveness, race, connectedness with others, depressed affect, and somatic symptoms. Krause also discussed religious variations by race, stating “there are both historical and cultural reasons for the distinct social emphasis in religion among older Blacks with the church becoming a social center for the Black community because of centuries of discrimination and prejudice” (p. 98). One of Krause’s findings indicated that religion is an important factor in the African American community, which fosters turning religious beliefs into action by forgiving others and promoting a bond among church members.
The National Council of Churches (NCC; n.d.) found increased church growth within the United States and Canada, and it expected membership in the four largest churches to increase by 1.04% annually. Almost 60% of the U.S. population attends church on a regular basis (NCC, n.d.). Churches have a strong impact on affecting health behavior changes in a safe, supportive environment (Peterson, Atwood, & Yates, 2002,). Therefore, the African American community and other ethnic groups might be likely to embrace faith-based therapy, if available. Marks et al. (2005) conducted a qualitative study to identify the relationship between religion and the health of African Americans. The sample consisted of 32 African American married couples who were interviewed together as couples. Interviews focused on active faith involvement, avoiding negative coping, evading violence, social support, and power of prayer. One theme expressed in the study was the belief that “giving up on faith is often equated with giving up on life in faith-based African culture” (Marks et al., 2005, p. 468). Marks et al. concluded that active religious involvement among the African American couples promoted a longer life span because the faith community encourages abstinence from drinking, smoking, and engaging in premarital sex as well as promoting forgiveness.
Markens et al. (2002) conducted a study to evaluate pastoral leadership and church involvement in a three-year health promotion program in Los Angeles. The health promotion program was aimed at increasing mammograms among African American women. The project was funded by the National Cancer Institute to evaluate the effectiveness of churches as a community resource and church based interventions. Markens et al. conducted a process evaluation to determine the church’s influence on promoting mammography screening with a post-intervention interview of the pastors. The findings indicated the need to employ volunteers within the church to promote continuity of church-based health promotion programs (Markens et al., 2002). A common theme surrounding active church involvement was the concept of holism, which is incorporating the care of one’s mind, body, and soul to achieve change. Markens et al. suggested that churches could be important catalysts for promoting health, particularly among the underserved.
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