Treating Depression in Single Black Mothers

    • June 4, 2013

Problem: Single Black mothers are a population at high risk for depressive symptoms. However, there is little evidence-based knowledge about how to accurately identify, appropriately treat, and prevent depressive symptoms in this vulnerable group of women to ensure that they, and their children, can lead happier, healthier, and more productive lives.

Background: Raised in a non-traditional, low-income household headed by a single mother in inner-city New Jersey, Rahshida Atkins triumphed over the challenging circumstances of her childhood, and now she’s helping other women and children do the same.

Atkins attended some of the lowest-achieving public schools in New Jersey, but she nevertheless saw education as a path out of poverty. She studied hard, became her high school’s valedictorian, earned a scholarship to Rutgers, the State University of New Jersey, and graduated with a bachelor’s degree in nursing with highest honors and a near-perfect grade-point-average.

Atkins didn’t stop there; while holding jobs as a graduate research assistant, nursing course instructor, and a registered nurse (RN), she earned her master’s degree in nursing. This led to a position as a family nurse practitioner and alternate administrator at a medical day care for children with special needs, and various university-level adjunct teaching positions. She recently completed her doctoral degree as a Robert Wood Johnson Foundation (RWJF) New Jersey Nursing Scholar, supported by the New Jersey Nursing Initiative (NJNI).

Now at the end of her long and successful educational journey, Atkins, PhD, FNP-BC, has not forgotten where she started. For her doctoral dissertation, she studied ways to alleviate depression among single Black mothers. “My mom was a single Black mother, and many female relatives and friends are as well,” Atkins says. “I saw them struggle with psychosocial and mental challenges.”

She wants to help single mothers like her mother, her relatives, and the mothers she encountered at the medical day care where she worked. Many of these women were unable to adequately care for themselves or their children. Some had difficulties keeping appointments with health care providers and adhering to medical recommendations. In one memorable case, a child was malnourished.

Atkins suspected that mental health problems—caused by factors such as poor and unstable living conditions, intermittent employment, short-term relationships, poverty, and other psychosocial challenges, including racism—were to blame. Even when women had outside supports, such as government-provided health insurance coverage or access to free transportation, depression and other mental health challenges robbed them of the motivation they needed to care effectively for themselves and their children, she says.

Identifying and treating depression, however, isn’t easy. For cultural reasons, some women in the Black community who have mental health problems may be reluctant to come forward, and others might be unaware that they may be suffering from mental illness, Atkins says. Even if they are aware, there aren’t clear, evidence-based interventions to treat and prevent the problem in this particular population.

Solution: Atkins, however, is working to change that. As a New Jersey Nursing Scholar, Atkins studied a group of more than 200 single Black mothers in Camden and Trenton, N.J., to develop a theory about the cultural and psychosocial factors that contribute to depression in the population.

She found that anger, stress, perceived racism, and low self-esteem were linked in different ways to the development of depressive symptoms among study participants. Atkins used the findings to develop a theory to guide nursing research and practice in the area. Health care providers, she hopes, will be able to use the theory to better understand the causes of depression in the population and make more informed recommendations for treatment and prevention.

They might, for example, talk to women who exhibit signs of depression about the effects of racism or refer them to someone who can teach them anger management strategies or cognitive behavioral techniques to help overcome stress or low self-esteem.

Atkins hopes to conduct more research on successful treatment and prevention interventions. Her research has the potential to help large numbers of women and children. The percentage of single mothers is surging, according to a May report by the U.S. Census Bureau. Black women had the highest rate of single motherhood, making them particularly vulnerable to depressive symptoms, Atkins says.

“I want to prevent depressive symptoms, or diminish them, and improve quality-of-life so these women can maintain employment, enjoy stable relationships, and become productive members of society,” she says. That, she adds, will be good for their children, and for the country too.

RWJF Perspective: The nation’s largest philanthropy dedicated solely to improving health and health care, RWJF is committed to narrowing health disparities and improving mental health and mental health care. Atkins is helping to advance those goals as a scholar with the New Jersey Nursing Initiative, a project of RWJF and the New Jersey Chamber of Commerce Foundation.

The New Jersey Nursing Initiative runs a Faculty Preparation Program that supports master’s- and doctoral-degree scholars in New Jersey who are interested in becoming nurse faculty. For her part, Atkins plans to teach while pursuing post-doctoral research into depression in single Black mothers.