A culturally adapted depression intervention for African American adults experiencing depression: Oh Happy Day.

Abstract

The purpose of this article is to describe development of a culturally adapted depression intervention (Oh Happy Day Class, OHDC) designed for African American adults experiencing major depressive disorder (MDD). This project included 2 pilot studies testing the feasibility and acceptability of the OHDC and examining short-term effects of the OHDC in reducing symptoms of MDD. The OHDC is a 2.5-hr weekly, culturally specific, cognitive behavioral, group counseling intervention for 12 weeks. Cultural adaptations of the OHDC are based on the ecological validity and culturally sensitive framework, along with an Afrocentric paradigm. Fifty African American participants with MDD were enrolled (15 in Pilot I and 35 in Pilot II). All participants in Pilots I and II received the 12-week intervention and completed assessments at baseline, mid-intervention, end-intervention, and 3 months postintervention. General linear mixed modeling for assessment of pre-post longitudinal data analysis was conducted. Results for Pilot I showed 73% of participants completed the full OHDC, a statistically significant decline in depression symptoms from pre-to postintervention, and a 0.38 effect size. Participants were very satisfied with the OHDC. In Pilot II, 66% of participants completed the full OHDC, and there was a significant pre-post intervention decrease in depression symptoms. For men, the OHDC showed a 1.01 effect size and for women, a 0.41 effect size. Both men and women were very satisfied with the OHDC based on the satisfaction measure. These promising findings are discussed with a focus on future plans for examining efficacy of the OHDC in a large-scale, randomized, control trial. Approximately 40 years ago, Dr. Martin Luther King stated "of all forms of inequality, injustice in health care is the most shocking and inhumane." Dr. King's comment was a call to action, yet inequalities and disparities in mental health care and outcomes remain largely unaddressed, and, sadly, are increasing for African American adults with depression (U.S. Department of Health and Human Services, 2001). For example, although the 12-month prevalence of major depressive disorder (MDD) is similar among African Americans (5.9%) and Whites (6.9%), African Americans report more chronic MDD and associated disability than do Whites (56.5% vs. 38.6%;Williams et al., 2007).Despite the negative impact of depression among African Americans, a recent study showed low usage of any medical care for MDD (pharmacotherapy or psychotherapy; 39.7%) compared with Whites (54.1%;González et al., 2010). Another study found even lower rates of service use among African Americans; only 5.6% of African Americans reported having four or more visits within 12 months compared with 81.6% of Whites (Fortuna, Alegria, & Gao, 2010).Research suggests African Americans' use of mental health services is low in part because of their receipt of poorer quality mental health care (González et al., 2010; U.S. Department of Health and Human Services, 2001;Ward, 2005). Specifically, Africa...

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