Culture and the Stress Process: Understanding Mental Health Among African Americans

University of Minnesota Ph.D. dissertation. May 2015. Major: Health Services Research, Policy and Administration. Advisor: Donna McAlpine. 1 computer file (PDF); ix, 254 pages.This dissertation explores the role of culture in shaping stress and mental health among African Americans in a disadvantaged urban neighborhood referred to as Upper Lake Heights (ULH). I use ethnographic methods to characterize stressors, identify shared resources and responses to stress, and describe common ways of expressing depression - an outcome of stress. I also employ cultural consensus techniques to quantitatively estimate the degree to which knowledge about stressors, resources, and expressions of depression are common or shared among African Americans living in ULH. In ULH, salient stressors are constructed through mechanisms of social comparison and expectations around social mobility. Salient sources of stress include racism, gun violence, police harassment and role strain. Although traditional stress resources such as mastery and self-esteem are dominant moderators of the effects of stress on health under the stress process paradigm, the main resources employed to manage stressors in ULH are religion and the family. Culturally salient responses to stress include impression management and John Henryism. In general, mental health problems are described and understood in the context of a person’s abilities and roles within their community. Although in some ways consistent with DSM-V categories, depression in ULH is mostly expressed in ways that are neither in the DSM nor operationalized in community surveys. These findings have several implications. First, the context of stress shapes responses and resources, and whether negative mental health is experienced. This context includes racism and discrediting views about Blacks which are associated with impression management and John Henryism. Second, depression is expressed in ways distinct from classic DSM symptoms. Administering standardized instruments and obtaining results consistent with DSM disorders does not mean that symptoms acknowledged by African Americans in ULH are the only or most familiar ways of expressing depression. Third, implementing programs and policies that would improve the living conditions of residents including access to structural resources will reduce vulnerability to stress. Addressing structural racism is crucial. Finally, at the level of clinical practice, knowledge about how culture shapes the expression of psychiatric distress will inform the diagnosis and provision of patient-centered mental health care in ULH