With coronavirus cases exploding in China, the U.S. is once again responding to a global epidemic. Five years ago, when the Ebola virus infected more than 28,000 people in 10 countries, many people were surprised to learn that four of these cases were diagnosed on U.S. soil.
Based on research I conducted for a book about the Ebola crisis and prejudice against certain groups of people associated with it, I fear that Americans might make immigrants the villain instead of the virus during the coronavirus epidemic.
If the U.S.‘ experience with epidemics tell us anything, it is that these events will be followed by increased public attention aimed at immigrants from China. This is because during epidemics, attention is typically focused on groups from countries where they started. And, this attention is rarely accompanied by an understanding of immigrants’ complicated experiences.
This does not imply that the Ebola virus and the new coronavirus are similar. Yet, there are important facets of African immigrants’ experiences during the Ebola crisis that can inform how Americans think about the current experiences of Chinese immigrants.
Some immigrants experience the devastation firsthand, because they had traveled to their countries of origin when the outbreak occurred. During the 2014 Ebola epidemic, for example, African immigrants visiting West Africa when the outbreak began lived through the ensuing social disorder, witnessed the rising death toll and feared infection from the deadly virus.
More often, however, immigrants experience outbreaks from afar. During the Ebola epidemic, my research shows that immigrants who remained in the U.S. were not spared from these emotional experiences. While advances in global travel and communications technology have helped immigrants maintain connections with these countries, they also provide channels through which the consequences of disease outbreaks abroad are experienced.
News of the mounting deaths of family members created a paralyzing feeling for immigrants in the U.S. who knew that they couldn’t risk traveling to the endemic countries abroad. At the same time, they felt being guilty about their inability to participate in customary burial rites.
But worst of all, blame
In addition to fear and guilt, however, immigrants often experience a great deal of blame. During the Ebola crisis, negative responses from Americans who used caricatures of immigrants’ ethnicity to stigmatize them as carriers of disease only worsened immigrants’ stress and fear. For example, many heard racist tropes about Africans’ presumed penchant for kissing corpses and their habit of consuming exotic beasts.
Stigmatizing immigrants does nothing to contribute to the fight against epidemics. Instead, such actions are usually counterproductive because they fail to incorporate immigrants into broader efforts to combat the spread of disease.
How immigrant communities help
Immigrant communities provide a critical line of defense for detecting, monitoring and preventing the spread of the disease, as I discuss in my book. With Ebola, these included the development of strategies to prevent the spread of the virus and improve public health by African immigrants after the first case of Ebola was discovered in the U.S.
Accordingly, African immigrant communities promoted initiatives to discourage travel to affected countries. They also helped develop systems for ensuring that Africans returning from these countries abide by quarantine period required by the Centers for Disease Control and Prevention.
Beyond these actions, West African immigrants took other practical steps to reduce person-to-person transmissions of Ebola, while also supporting efforts to address the consequences of the disease abroad. In addition, these immigrants promoted the practice of frequent hand-washing with chlorine-based solutions and discouraged social norms of hand-shaking withing their communities. These actions were complemented by efforts to assist in contact tracing, the identification of people who may have come in contact with infected persons.
Building on these initiatives, they also collaborated with local businesses and other mainstream institutions to care for families affected by Ebola and assisted humanitarian organizations working to combat the spread of disease in West Africa.
When a nation responds to epidemics by stigmatizing immigrants, it misses opportunities to build strategic coalitions for preventing the spread of viruses. Now that the first person-to-person transmission of the coronavirus has been confirmed in the U.S., the need for such coalitions has become more urgent.
In my view, our nation’s response to Chinese immigrant communities should be based on actions informed by facts and not fear. Without such actions, we risk failure in our attempts to build the resilient communities needed to prevent the occurrence of a greater public health emergency within our borders.
Also, the 2015 Centers for Disease Control and Prevention’s biennial Youth Risk Behavior Survey reported that, compared to non-Hispanic white boys, black high-school age boys are more likely to have made serious suicide attempts that require medical attention.
Suicide has become a leading cause of death in the U.S. among all age groups, but particularly in youth and young adults. It is the second leading cause of death among 10- to 34-year-olds. Parents, teachers and professionals must be able to both talk about it and understand the risks for vulnerable children of any race. But those of us who work with black youth may also need to address some myths about suicide in the African American community.
For example, one such myth has its start almost three decades ago, Kevin Early and Ronald Akers’ interviews with African American pastors concluded that suicide is a “white thing” and that black people are accustomed to struggling through life challenges without succumbing to suicide. those authors concluded that black people see suicide as a “white thing” but it is a myth that black people do not die by suicide.
Based on anecdotal conversations that many others and I have heard in day-to-day conversations and that sometimes emerge in popular media, this opinion about suicide in the black community has shifted relatively little.
More importantly, black youth at risk may even be more difficult to identify than non-black youth. One study referred to college age racial/ethnic minority people, including African Americans, as “hidden ideators” who are less likely than other youth to disclose thoughts of suicide. Because suicide is occurring and at shockingly young ages, comprehensive efforts are needed to address this public health problem.
Studies suggest that stigma about mental illness and the feeling that one will be outcast further or ignored may keep black youth from sharing their thoughts. Also, public health and mental health experts may be unaware that suicide risk factors could show up differently depending on ethnic group.
Simply put, a one-size-fits-all approach does not work for identifying suicide risk. And little or no action has been taken to address the increasing crisis. As an African American psychologist, I find this frustrating when children’s lives are lost – lives that could be saved.
Unique needs in African American mental health
Most mental health services are not designed with cultural and social nuances in mind. My research team has found consistently that the challenges that black kids face in navigating dual cultural contexts may increase their risk of suicidal thoughts.
In research on adults, we found that black men and women who used more Eurocentric or individualist approaches that was more self-focused rather than managing stress via the belief in a Higher Power were more likely to consider suicide. This was not true for those who used more culturally meaningful, spiritual coping.
When there are cultural differences, therapists must be willing to “think outside of the box” to fully evaluate risk for suicide. As an example, the racism that black Americans encounter increases stress for many. Thus, their stressors and mental health issues will need different solutions and approaches than treatments that work for white people.
In another study published in Comprehensive Psychiatry, we observed different patterns of risk for black adults compared to white adults who were admitted for psychiatric care. We examined sleep-related problems, which are elevated among black Americans, and suicide because sleep issues are a serious but understudied risk factor for suicide crisis. It turns out that inadequate sleep can escalate an emotional crisis. Our research found that problems staying awake for activities such as driving or engaging in social activities, which reveal inadequate sleep, were associated with a four-fold greater risk for suicide crisis compared to non-suicide crisis in black adults who were admitted for psychiatric treatment.
Caring adults are a child’s first line of defense. If a child discloses that he is thinking about dying, it is important to ask him to share more about his ideas and if he knows he might die. If a child has a suicide plan, it is time to get professional help.
The Crisis Text Line at 741741 could be an option for teens who need help to cool down in a crisis.
When it comes to finding a mental health professional, parents need an expansive list of referral options, including university-affiliated mental health clinics that offer evidence-based services on a sliding scale and federally qualified health centers for the uninsured. Regardless of the setting, a well-trained therapist may be of a different race.
Parents and caregivers must be willing to sit, listen and try to fully understand what is most upsetting for a child who is experiencing a difficult situation and a lot of emotions.
For those who believe that the alarming statistics will eventually reverse course without any action, this may be true. In the meantime, saving one life is worth the effort.
Thoughts of suicide do not mean that a child or teen needs to be hospitalized. It means they are in emotional pain and want the pain to end. Adults can investigate the problem and remove it or help the child deal with it. Online resources such as Stopbullying.gov include interactive videos that are useful to parents, educators and youth. Suggesting to a child that she “get over it” is less than helpful. A child who is already in a vulnerable state cannot problem-solve without meaningful support from the caring adults in charge.
Sitting in the afternoon heat on her mom’s porch in Athens, Georgia, Hardy recollected how a recent “crisis” derailed her normal morning routine.
“It was time for my daughter to get on the bus, and she’s too young to go on her own,” Hardy recalled. “I was in so much pain I couldn’t walk. So, she missed school that day.”
Sickle cell disease affects red blood cells, which travel throughout the body carrying oxygen to tissues. Healthy red blood cells are shaped like plump and flexible doughnuts, but in people with sickle cell disease, the red blood cells are deformed, forming C-shaped “sickles” that are rigid and sticky.
These sickle-shaped cells can cause blockages in the blood vessels, slowing or even stopping normal blood flow. An episode of blockage is known as a sickle cell “crisis” — tissues and organs can be damaged because of lack of oxygen, and the patient experiences severe spells of pain.
‘It’s Like Torture’
Hardy tries to manage these crises on her own. She’ll take a hot bath or apply heating pads to try to increase her blood flow. Hardy also has a variety of pain medications she can take at home.
When she has exhausted those options, she needs more medical help. Hardy would prefer to go to a specialized clinic for sickle cell patients, but the closest is almost two hours away, and she doesn’t have a car.
So, Hardy often goes to the emergency room at nearby St. Mary’s Hospital for relief. Until recently, the doctors there would give her injections of the opioid hydromorphone, which she says would stop her pain.
Then, some months ago, the emergency room changed its process: “Now they will actually put that shot in a bag which is full of fluids, so it’s like you’re getting small drips of pain medicine,” Hardy said. “It’s like torture.”
It’s the same for her brother, Rico, who also has sickle cell disease and has sought treatment at St. Mary’s. The diluted medicine doesn’t give the same pain relief as a direct injection, they say.
Striking A Balance
St. Mary’s staffers explain that they’re trying to strike a balance with their new treatment protocol between adequate pain treatment and the risk that opioid use can lead to drug dependence.
It’s a local change that reflects a national concern. The U.S. is in the midst of an addiction and overdose crisis, fueled by powerful opioids like hydromorphone. That crisis has made medical providers more aware of the risks of administering these drugs. More than 47,000 Americans died in 2017 from an overdose involving an opioid, according to the Centers for Disease Control and Prevention.
That has prompted some emergency room leaders to rethink how they administer opioid medications, including how they treat people, such as Hardy, who suffer from episodes of severe pain.
“We have given sickle cell patients a pass [with the notion that] they don’t get addicted — which is completely false,” said Dr. Troy Johnson, who works in the emergency room at St. Mary’s. “For us to not address that addiction is doing them a disservice.”
Johnson proposed the ER’s shift to intravenous “drip delivery” of opioids for chronic pain patients because of personal experience. His son has sickle cell disease, and Johnson said he has seen firsthand how people with the disease are exposed to opioids when very young.
“We start creating people with addiction problems at a very early age in sickle cell disease,” Johnson said.
He brought his concerns to the director of the ER, Dr. Lewis Earnest, and found support for the change. Hospital officials say they also consulted national guidelines for treating sickle cell crises.
“We’re trying to alleviate suffering, but we’re also trying not to create addiction, and so we’re trying to find that balance,” Earnest said. “Some times it’s harder than others.”
St. Mary’s says the new IV-drip protocol is for all patients who come to the emergency room frequently for pain, and most of their sickle cell patients are fine with the change.
Caught In The Crossfire
The national guidelines cited by St. Mary’s also say doctors should reassess patient pain frequently and adjust levels of opioids as needed “until pain is under control per patient report.”
Some people who work closely with sickle cell patients, upon hearing about the new approach to pain management at St. Mary’s, called it “unusual.”
It’s more common for ERs to give those patients direct “pushes” of pain medication via injection, she noted, not slower IV drips.
People with sickle cell disease aren’t fueling the opioid problem, Andemariam said. One study published in 2018 found that opioid use has remained stable among sickle cell patients over time, even as opioid use has risen in the U.S. generally.
“If anything, individuals with sickle cell disease in our country have really been caught in the crossfire when it comes to this opioid epidemic,” Andemariam said.
She suggested that ER doctors and nurses need more education on how to care for people with sickle cell, especially during the painful crisis episodes, which can lead to death.
A study of some 16,000 deaths from 1979 to 2005 related to sickle cell found that men in the group lived to be only 33, on average. Women didn’t fare much better, living to an average age of 37. The same study suggested that a lack of access to quality care is a factor in the short life spans of people with sickle cell disease.
Researchers who study sickle cell say the opioid epidemic has made it harder for patients with the condition to get the pain medication they need. The American College of Emergency Physicians is focusing on the problem, asking federal health officials to speak out about sickle cell pain and fund research on how to treat it without opioids.
“We in the physician community are looking for ways to make sure they get adequate pain relief,” said Dr. Jon Mark Hirshon, vice president of the group. “We recognize that the process is not perfect, but this is what we’re striving for — to make a difference.”
Considering A Move To Find Relief
In the meantime, India Hardy said she feels those imperfections in the process every time she suffers a pain crisis, and she’s not alone.
In addition to her brother, Hardy said she has another friend in Athens with sickle cell disease, and that friend has also reported difficulty in finding pain relief at the St. Mary’s emergency room.
“It’s just really frustrating, because you go to the hospital for help — expecting to get equal help, and you don’t,” Hardy said, her voice breaking. “They treat us like we’re not wanted there or that we’re holding their time up or taking up a bed that someone else could be using.”
Hardy filed a complaint with the hospital but said nothing has changed, at least not yet. She still gets pain medication through an IV drip when she goes to the St. Mary’s emergency room.
At this point, she’s considering leaving her relatives and friends behind in Athens to move closer to a sickle cell clinic. She hopes doctors there will do a better job of helping to control her pain.
California’s head cheerleader on improving statewide health says it’s all about “bringing people together.”
And after almost a year on the job as the state’s first surgeon general, Dr. Nadine Burke Harris exudes optimism, saying she has enjoyed an “absolutely phenomenal outpouring of support” from various factions of California’s vast health care sector.
Harris, 44, a San Francisco Democrat, is a nationally recognized expert on the effects that childhood trauma (Adverse Childhood Experiences, or ACEs) has on victims during their entire lives – even into old age. She was appointed to the position in January by Gov. Gavin Newsom. California is the fourth state to have a surgeon general, joining Arkansas, Pennsylvania and Florida. Michigan eliminated the position in 2o10.
The surgeon general position is Newsom’s brainchild, although the specifics of the job are vague. Harris is sort of an advocate and promoter of the administration’s health care policies.
Separating children from their parents, as has been the practice for illegal immigrants scooped up by federal authorities along the U.S.-Mexico border, “is a recipe for childhood stress,” she told a recent gathering of the Sacramento Press Club. She supports state Atty. General Xavier Becerra’s legal moves against the practice.
In her press club appearance, Harris was careful not to stray outside generally accepted tenants of health care. She and her husband, for instance, have seen to it that all four of their children are vaccinated, not only for the children’s health, but to protect others and gain “herd immunity.”
She also took pains not to create any blaring headlines. Asked specifically whether she supported “Medicare for All,” she said “Access to care is critical, no matter how it happens” and she was willing to “leave it to my policy colleagues as to how to get there.”
The surgeon general position is Newsom’s brainchild, although the specifics of the job are vague.
Harris is sort of an advocate and promoter of the administration’s health care policies. The heavy lifting in California health care, however, is performed by the 16 departments — including the Department of Health Care Services, the Department of Public Health and the Department of Managed Health Care under the jurisdiction of the Health and Human Services Agency. A major player also is Covered California, the state’s entity that puts into effect the federal Affordable Care Act.
Harris, who has a Master’s Degree in public health from Harvard, a medical degree from UC Davis and served a residency at Stanford, is the founding CEO of the Center for Youth Wellness (CYW)
In the Jan. 21 news release announcing Harris’s appointment, Newson said Harris “will urge policymakers at every level of government and leaders across the state to consider the social determinants of health, especially for children. Her work will focus on combating the root causes of serious health conditions — like adverse childhood experiences and toxic stress — and using the platform of Surgeon General to reach young families across the state.”
Harris, who has a Master’s Degree in public health from Harvard, a medical degree from UC Davis and served a residency at Stanford, is the founding CEO of the Center for Youth Wellness (CYW), a group Newsom described as a “national leader in the effort to advance pediatric medicine, raise public awareness, and transform the way society responds to children exposed to adverse childhood experiences and toxic stress.”
She heads the Bay Area Research Consortium on Toxic Stress and Health, a partnership between CYW and UCSF Benioff Children’s Hospitals, to advance scientific screening and treatment of toxic stress, and serves as a member of the American Academy of Pediatrics’ National Advisory Board for Screening and on a committee for the National Academy of Medicine.
Capitol types involved in health care issues have questions.
Will Harris lobby for particular solutions to health care costs? On drug abuse? What about her relationship with the big Department or Public Health? Will there be an occasion where she might engage in head-to-head conflict with the Trump Administration, a la Becerra? (Early indications are she won’t.) Just how much clout will the engaging and idealistic Harris have within the Administration and with the Legislature?
“We are in a critical inflection point,” Harris told a gathering at the south san Francisco campus of Genentech during a discussion about the impacts of childhood trauma and adverse experiences. “Eight years ago, I would go into a room of 1,000 people and and I’d ask, “How many folks have heard of this before?” Literally three hands would go up. Two years ago, I gave a talk at the White House and I asked the same question, and every hand in the room went up. A new generation of scientists, teachers, doctors — people across disciplines — are recognizing the science, and leading the way.
“So, I believe that 20 years from now, we are going to be having a totally different conversation,” she said.
This time of the year brings a lot of changes to the usual day-to-day life of hundreds of millions of people: The weather is colder, trees are naked, snowy days become plentiful and friendly critters are less visible around the neighborhood. Especially in the Western Hemisphere, this time of the year is also linked to a lot of joyous celebrations and traditions. Most children and many adults have been excited for this time of the year to come for months, and they love the aura of celebrations, with their gatherings, gifts, cookies, emails and cards.
Alas, there are also millions who have to deal with darker emotions as the world literally darkens around them.
The holiday blues – that feeling of being in a lower or more anxious mood amid the significant change in our environment and the multitude of stressors that the holidays can bring – is a phenomenon that is yet to be researched thoroughly. However, as academic psychiatrists and neuroscience researchers, we have seen how several factors contribute to this experience.
Why feel blue in the red and green season?
There are many reasons to feel stressed or even downright overwhelmed during this time of year, in addition to the expectations set around us.
Memories of holidays past, either fond or sad, can create a sense of loss this time of year. We may find ourselves missing people who are no longer with us, and carrying on the same traditions without them can be a strong reminder of their absence.
The sense of burden or obligation, both socially or financially, can be significant. We can get caught up in the commercial aspects of gift giving, wanting to find that perfect item for family and friends. Many set their sights on special gifts, and we often can feel stretched thin trying to find a balance between making our loved ones happy and keeping our bank accounts from being in the black.
It’s also a time for gathering with those close to us, which can stir up many emotions, both good and bad. Some may find themselves away from or without close connections and end up isolated and withdrawn, further disconnected from others. On the other hand, many people find themselves feeling overwhelmed by the combination of potlucks and Secret Santas stacking up through multiple invitations, be it at school, work, or from friends and family – leaving us with the difficult position of not wanting to disappoint others, while not getting totally depleted by all the constant socializing.
People often feel disappointed when reality does not meet expectations. The larger the mismatch, the worse the negative feelings. One of us (Arash) often finds himself telling his patients: Childhood fairy tales can set an unrealistic bar in our minds about life. I wish we were told more real stories, taking the bad with the good, as we would get hurt less when faced with difficult realities of life, and learn how to especially appreciate our good fortunes.
These days viewers are showered with Christmas and New Year’s Eve movies, almost all of which sound and feel like fairy tales. People get married, get rich, fall in love or reconnect with their loved ones. Even unhappy events within “A Christmas Carol” conclude with a happy ending. These all, besides exposure to only happy moments and beautiful gifts (courtesy of Santa), dazzling Christmas decorations, and picturesque family scenes on social media, often set an unrealistic expectation for how this time of the year “should” feel.
Reality is different, though, and at its best is not always as colorful. There may be disagreements about hows, wheres, whats and whos of the celebration, and not all family members, friends and relatives get along well at parties. And as we feel lonelier, we may find ourselves spending more time immersed in TV and social media, leading to more exposure to unrealistic views of the holidays and feeling all the worse about our situation.
When is blue a red flag?
While many experience the more transient “holiday blues” this time of year, it is important not to miss more serious conditions like seasonal mood changes, which in its most severe case leads to clinical depression, including Seasonal Affective Disorder. SAD consists of episodes of depression or a worsening of existing depression during the late fall and early winter. The person may feel depressed and hopeless, or they may find it difficult to focus, sleep, or be motivated – they can even feel suicidal. As our emotions can color our thoughts and memories, a depressed person may remember more negative memories, have a more negative perception and interpretation of the events, and feel upset about the holidays.
In such cases, the sadness is “coincident” with the holidays and not caused solely by its circumstances. It is important to seek professional help with SAD, as we have effective treatments available, such as medications and light therapy.
What to do to minimize the blues?
Set realistic expectations: One readily available strategy is simply reframing the beliefs we have about what the holidays “should” be like. Not all parties will go perfectly. Some decorations may break, or kids may wake up grumpy or not be exhilarated by their gifts – but it doesn’t have to stop us from enjoying all the good moments.
Set firm boundaries: Too many invitations to social events? Too many financial demands? Set clear limits about what you are able and willing to do, whether that means declining some social events and setting your own limit on spending this year, focusing more on meaningful experiences over expense. This can be spending time with loved ones or getting creative with homemade gifts.
Feeling alone? There are many ways to steer clear of isolating this time of year. Reaching out to friends, volunteering at animal shelters, local charities or attending community meetups or religious events can be a great way to stay connected while also bringing happiness to ourselves and others.
Making new memories: Starting a new tradition, either solo or with loved ones, can help create fond new memories of the holidays, no longer overshadowed by the past.
Take care of yourself: It’s important to remember the value of self-care, including eating and drinking in moderation (as alcohol can worsen a depressed mood), exercising (even a short walk), and treating yourself this holiday season by doing something you enjoy.
While the holiday blues are most often temporary, it’s important to identify when things have crossed over into clinical depression, which is more severe and longer lasting. It also impairs daily functioning. For these symptoms it is often helpful and necessary to seek professional help. This can consist of counseling or use of medications, or both, to help treat symptoms.
Portia Smith’s most vivid memories of her daughter’s first year are of tears. Not the baby’s. Her own.
“I would just hold her and cry all day,” Smith said.
At 18, Smith was caring for two children, 4-year-old Kelaiah and newborn Nelly, with little help from the partner in her abusive relationship. The circumstances were difficult, but she knew the tears were more than that.
“I really didn’t have a connection for her,” said Smith, now a motivational speaker and mother of three living in Philadelphia. “I didn’t even want to breastfeed because I didn’t want that closeness with her.”
The emotions were overwhelming, but Smith couldn’t bring herself to ask for help.
“You’re afraid to say it because you think the next step is [for the authorities] to take your children away from you,” she said. “You’re young and you’re African American, so it’s like [people are thinking], ‘She’s going to be a bad mom.’”
Smith’s concern was echoed by several black women interviewed for this story. Maternal health experts said some black women choose to struggle on their own rather than seek care and risk having their families torn apart by child welfare services.
Nationally, postpartum depression affects 1 in 7 mothers. Medical guidelines recommend counseling for all women experiencing postpartum depression, and many women also find relief by taking general antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft).
In March, the Food and Drug Administration approved the first drug specifically for the treatment of postpartum depression, which can include extreme sadness, anxiety and exhaustion that may interfere with a woman’s ability to care for herself or her family. The mood disorder can begin in pregnancy and last for months after childbirth.
The consequences of untreated postpartum depression can be serious. A report from nine maternal mortality review committees in the United States found that mental health problems, ranging from depression to substance use or trauma, went unidentified in many cases and were a contributing factor in pregnancy-related deaths. Although rare, deaths of new mothers by suicide have also been reportedacross the country.
For many women of color, the fear of child welfare services comes from seeing real incidents in their community, said Ayesha Uqdah, a community health worker who conducts home visits for pregnant and postpartum women in Philadelphia through the nonprofit Maternity Care Coalition.
News reports in severalstates and studies at the national level have found that child welfare workers deem black mothers unfit at a higher rate than they do white mothers, even when controlling for factors like education and poverty.
During home visits, Uqdah asks clients the 10 questions on the Edinburgh Postnatal Depression Scale survey, one of the most commonly used tools to identify women at risk. The survey asks women to rate things like how often they’ve laughed or whether they had trouble sleeping in the past week. The answers are tallied for a score out of 30, and anyone who scores above 10 is referred for a formal clinical assessment.
Uqdah remembered conducting the survey with one pregnant client, who scored a 22. The woman decided not to go for the mental health services Uqdah recommended.
A week after having her baby, the same woman’s answers netted her a score of zero: perfect mental health.
“I knew there was something going on,” Uqdah said. “But our job isn’t to push our clients to do something they’re not comfortable doing.”
About a month later, the woman broke down and told Uqdah, “I was lying to you. I really did need services, but I didn’t want to admit it to you or myself.”
The woman’s first child had been taken into child welfare custody and ended up with her grandfather, Uqdah said. The young mother didn’t want that to happen again.
Screening Tools Don’t Serve Everyone Well
Another hurdle for women of color comes from the tools clinicians use to screen for postpartum depression.
The tools were developed based on mostly white research participants, said Alfiee Breland-Noble, an associate professor of psychiatry at Georgetown University Medical Center. Often those screening tools are less relevant for women of color.
Research shows that different cultures talk about mental illness in different ways. African Americans are less likely to use the term depression, but they may say they don’t feel like themselves, Breland-Noble said.
It’s also more common for people in minority communities to experience mental illness as physical symptoms. Depression can show up as headaches, for example, or anxiety as gastrointestinal issues.
It took Smith six months after daughter Nelly’s birth to work up the courage to see a doctor about her postpartum depression.
Even then, she encountered the typical barriers faced by new mothers: Therapy is expensive, wait times are long, and coordinating transportation and child care can be difficult, especially for someone struggling with depression.
But Smith was determined. She visited two different clinics until she found a good fit. After several months of therapy and medication, she began feeling better. Today, Smith and her three daughters go to weekly $5 movies and do their makeup together before big outings.
Other mothers never receive care. A recent study from the Children’s Hospital of Philadelphia found that only 1 in 10 women who screened positive for postpartum depression at the hospital’s urban medical practice sites sought any treatment within the following six months. A study examining three years’ worth of New Jersey Medicaid claims found white women were nearly twice as likely to receive treatment as were women of color.
Noticing that gap, the Maternity Care Coalition in Philadelphia tried something new.
In 2018, the nonprofit started a pilot program that pairs mothers with Drexel University graduate students training to be marriage and family counselors. The student counselors visit the women an hour a week and provide free in-home counseling for as many weeks as the women need. Last year, the program served 30 clients. This year, the organization plans to expand the program to multiple counties in the region and hire professional therapists.
It was a game-changer for Stephanie Lee, a 39-year-old who had postpartum depression after the birth of her second child in 2017.
“It was so rough like I was a mess, I was crying,” Lee said. “I just felt like nobody understood me.”
She felt shame asking for help and thought it made her look weak. Lee’s mother had already helped her raise her older son when Lee was a teenager, and many members of her family had raised multiple kids close in age.
“The black community don’t know postpartum,” Lee said. “There’s this expectation on us as women of color that we have to be … superhero strong, that we’re not allowed to be vulnerable.”
But with in-home therapy, no one had to know Lee was seeking treatment.
The counselors helped Lee get back to work and learn how to make time for herself — even just a few minutes in the morning to say a prayer or do some positive affirmations.
“If this is the only time I have,” Lee said, “from the time I get the shower, the time to do my hair, quiet time to myself — use it. Just use it.”