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African-American women may not be getting the care they need for depression, U.S. researchers found.

Researchers at Oregon Health & Science University in Portland found racism and the expectation of being a “strong black woman” shape African-American women’s views on depression care.

The researchers looked at four discussion groups — totaling 30 women who were African-American with a score of 15 or higher on Patient Health Questionnaire Depression scale and had experienced intimate partner violence at some time in their lives.

“These women were extremely wary of most depression treatments and providers they associated with ‘White’ systems of care,” principal study investigator Dr. Christina Nicolaidis said in a statement. “Although they acknowledged that violence, depression and substance abuse adversely affected their health, discussions about health care revolved around their perceptions of racism.”

The study, published online in the American Journal of Public Health, suggested African-American women desire community-based depression programs that address violence and drug use staffed by African-Americans with real-life experiences.

The researchers also found the expectation of being a “strong black woman” was a significant barrier to recognizing depression and seeking care.

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