Low Income African American Women Yearn for Effective PAD Treatment

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Low Income African American Women Yearn for Effective PAD Treatment
Delinois, Sabine
Hartzema, Abraham ( Mentor )
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Gainesville, Fla.
University of Florida
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University of Florida
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University of Florida
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Low Income African American Women Yearn for Effective PAD Treatment

Sabine Delinois


"I want to feel like I matter again." This statement is one of many that reveal the distress of African American

women with Panic Attack Disorder (PAD). Little research is available on African American women with PAD. The

social stigma associated with mental illness has caused many black women with PAD to rely on alternative

coping strategies. In fear of being labeled "crazy" patients utilize methods that alleviate symptoms of anxiety

or depression while leaving the source of the problem untreated. This research study describes an assortment

of cultural and social component that hinder effective treatments of PAD in African American women.


"Black people don't get depressed." This statement is often said and a widespread belief within the African

American community. While mental illness is not bound to a particular culture, race, or gender African Americans

are less likely to receive clinical treatment for any type of mental illness instead they depend on various

coping strategies e.g. sleep, denial (Neighbors, Broman, & Jackson, 1996, p.117). According to the National

Institute of Mental Health (1995) over 3 million adults in the United States will experience panic disorder at

some point in their lives. Panic Disorder is described as an event of repeated panic attacks where the individual

has intense feelings of terror that maybe accompanied by physical symptom such as dizziness, nausea and

difficulty breathing (NIMH, 1995).

Current treatments for panic disorder include cognitive-behavior therapy, psycho-treatment, and

prescription medication also known as pharmacotherapy. Each treatment is designed to keep the "disease"

form developing into a latter critical stage that may cause agoraphobia, morbid fear of public spaces. The uses

of pharmaceutical drugs such as MAOI monoaminee oxidase inhibitor) antidepressants expose patients to

possible side effects, which include increased blood pressure, insomnia and dry mouth. In addition patients

must adhere to dietary restrictions to prevent unintended reactions that may obscure blood flow in the

body. Medications that compromise the metabolic and circulatory system may deter continuous and long-term use

of prescription drugs amongst patients. Aside from pharmacotherapy health care providers may choose to treat

panic disorder with cognitive-behavior therapy. The primary goal of cognitive-behavior therapy is to change

the thought patterns and behaviors associated with the onset of an attack (NIMH, 1995).

The American Psychiatric Association reports that Panic Disorder affects whites and African Americans

equally. However Neighbors and Jackson (1996) believe more information is needed on the distribution of

mental health problem in the African American population and the availability of mental health services.

Current treatments of Panic Disorder are not suitable of African American women. Factors that impede

successful treatment include denial of disorder; stigma associated with mental illness, and barrier to care

amongst social and provider networks. "A mental health clinic and these people standing out here looking at me

go in... They're gonna think that I'm crazy" (focus group respondent, personal communication, September 26,

2002). The purpose of this research is to reveal the social and cultural components that impede effective treatment

of PAD in low-income African American women. Perhaps this may help my readers understand two

important concepts, the need for proper treatment of PAD in African American women and society's responsibility

in reducing social stigma and isolation associated with mental illness.



Principal data for this investigation are drawn from pilot focus group transcripts of African American women

who suffer from PAD. A total of three peer support groups occurred where variable N is the number of

different research subjects. The research venue for focus group sessions were in Florida at a primary care

community health clinic. At these meetings participants engaged in discussions of personal experience with PAD

and how it affects their daily lives.


Participants are low-income African American women who are clinically diagnosed or suspected of having PAD.

The prevalence of panic disorder is slightly more than twice as high among women then in men (Griez,

Faravelli, Nutt, & Zohar, 2001, p. 61). Further research of Griez et al. (2001) suggests the correlation of

higher education and the probability of panic. Panic attacks are more likely to occur in persons with less than

12 years of education (p.61). Griez et al. (2001) report that while there is not a direct relationship between the

two, occurrence of panic disorder amongst this population maybe related to stressful situations and the constraints

of seeking and receiving appropriate treatment relative to others (p.61).


Three peer support groups were audio taped, transcribed and later coded. Table 1 was developed as a template

for coding transcripts. Each coding category was assigned a unique highlighter color.


The initial meeting of our peer support group included 5 participants, followed by 9 in both the second and

third sessions. Consequently N equaled 10 in our research sample. Themes of isolation, denial, embarrassment

and hopelessness developed in all three meeting. "Sometimes I cry. I could be getting in a cab to go somewhere

and I might just bust out and start crying" (focus group respondent, personal communication, September 26,

2002). Participants recount continuous narratives of negative experiences with social and provider networks. "But

it hurts when you sit and talk to someone and they look at you like take this pill" (focus group respondent,

personal communication, September 26, 2002). One patient reported, "I could see people look at me, and

whisper. They don't want you to touch them." Participants of the peer support group also expressed their

frustrations with immediate and extended family members who have no knowledge on the subject of PAD.

Informants seemed detached from personal feelings and accustomed to a debilitating lifestyle. Instead of

utilizing mental health facilities they depend on cultural and personal coping strategies. "I was ignoring what

was going on ...and just say well you know it will get better" (focus group respondent, personal

communication, September 26, 2002). Other women rely on spiritual and religious ties such as prayer for comfort.

In the book Mental Health in Black America Broman asserts that some African Americans use prayer as a way

of accepting problem situations that cannot be changed (Neighbors et al., 1996, p. 119). "I pray that's the

only answer. I walk through my house, I mean through the room and everything, and I mean I just call

on Jesus" (focus group respondent, personal communication, September 27, 2002).

In her clinical experience Warren B. (2003) finds that when African American women complain of being tired,

weary, empty, or sad women family members and friends may say, "We all feel this way sometimes, it's just the

way it is for us Black women." Historically women have been viewed as and taken the role of principal caregivers.

B. Warren (2003) explains that black women are often involved in multiple roles while attempting to

advance themselves and their families through mainstream society. An increase in guilt and depressive

symptoms may occur when there is conflict between their family's needs and their own personal development.

In the book Going Off: A Black Woman's Guide for Dealing with Anger and Stress Palmer and Childs (2001) explore

a condition termed the Invincible Black Woman Syndrome (IBWS). Childs and Palmer describe the difficulties

several African American women have with acknowledging and dealing with personal anxiety and depression. In

fact, many black women believe that such emotions represent a lack of strength. Childs and Palmer (2001) created

a scale that illustrates the progression of and methods to recovery from the Invincible Black Woman Syndrome.

This research study refers to Figure 1 as a tool of reference for PAD patients. Use of the scale will allow the

health care provider to gain a better understanding of how black women deal with anger and stress.



Beginning Phase
* Concern fr wha othas think
* Notion of staying strng is important
STrying to rlee older
* Cownng up tdclins of insecuiiy
a* Foar of rating relaVionsap

* Caring for other' needs
* Impossible o sa "no"
* Public irmae is5Cetre erii iipota
S* ln% inc bible inuge isevaggeratid in
f * Reatiaonship p bl[im%: disillusio
\ either pty
* Beg inning addition. o food ak
2C\ it adiCp, etc
0 * DifTiculty llerung lto others

*\ Ernd Phase
N* mernazd frustration an(
anger going off
* PhySLCal syrmpoiims, aimic
a lacks, dJiff1ialt, sleep1in;
* Strong froLnt underlying
depression, crying spells
S\ feelings of isolation and
* Numb emotions
* Spiritual cris
0\ * Serious illness,

Figure 1. Childs, F. & Palmer (2001). Invincible Black Women Syndrome Scale (p.148). Red

Print indicates additional interventions for African American women with Panic Attack Disorder.

Peer support groups allowed participants to meet with other African American women with PAD who share

similar anxieties and frustrations. "I thought I was the only one who felt like that" (focus group respondent,

personal communication, September 27, 2002). Participants found peer support groups beneficial to personal

care and should be consistent with PAD treatment. The design of a peer support group was discussed where

patients preferred a meeting facility off site of mental health clinic. On account of social stigma associated

with mental health informants fear possibility of others knowing about their mental disorder. Patients also desire

to network with individuals who have personal experience with PAD. As one informant stated, "If you haven't

walked a mile in that person's shoes you don't know what a person's gone through." Peer support group

participants were astonished by the possibility of complete recovery from PAD. "So, there are people who

totally recover from all this could we talk to some of them" (focus group respondent, personal

communication, September 26, 2002).


Treatment for African American women with PAD must meet cultural and gender needs. Perhaps the women in

More hamrony in reta, Iship
with self,& oters
Frusrat diminishthes
Become more in mne wit
n Empowermenl setons with PAD
Terns f abili survivors; "Take Your Life Back"
Reestablish relatinships
ohol Develop biweekly personal
runcIIoe# lphs
Redute strs through physical attviy
Peer Supporr Irnups for PAD
IVAccept support fta others
g Comfo~r with seEing limin
& Identify NIMH lstrategie for topnlg
with Ponk
Beoocounscling otslf-help regimen
klen sy orstr
Undemtad the concept ofthe vincible
#wamnan syaltnrome
Education on PAD for patient and Ifmrly
Ability to disiguih being in the invinc ile woman
syndrome and when not
RecogPniz pinic aIlt k symptoms and triggrsz
Acknowede feelings orpowcrlssness
Medimalle when needed for PAD

this research investigation of PAD also confront the unspoken social and cultural necessitate of being invincible.

The subconscious need of being a nucleus of self-sacrificing love, support and understanding that never "falls short

of the mark." Many women of various ethnic groups confront this "Super Women" ambition of being

invincible. However African American women who have fallen into IBWS need appropriate intervention that leads to

a path of recovery.

Several African Americans view families as a significant source of support when physical and mental health

problems arise (Neighbors et al., 1996, p.130). When family ties are broken increased feeling of isolation

may develop. "I feel like that with the people in my family. I feel like I am so pushed back" (focus group

respondent, personal communication, September 27, 2002). Participants revealed lack of knowledge

and understanding of PAD. They also find it difficult to explain the disease to their social and family network.

Future patient education on PAD should include immediate family members.


This study had several limitations. First, the nature of this qualitative study required the researcher to use

deductive reasoning when coding transcripts. Although transcripts were separately reviewed and coded by

three individuals there is a chance of personal bias. Second, a small sample size was used in this investigation

thus research results cannot be used for a larger or general population. Findings in reference to attitudes, beliefs

and coping strategies of focus group participants are specific to this group. However results may strongly

correlate with women from our sample population low-income African American women from a southern region

with panic attack disorder. Third, personal experiences from participants in the three focus groups might

be repetitive. Although informants expound on different issues in each peer support group some participants

took part in more than one research focus group session. This researcher found a small number of reports

that exclusively focus on Panic Attack Disorder in African American women. Further research should be done with

an increased sample size of women. Additionally treatment programs that address the needs of African

American women should be developed.


Research supported by University's Scholars Program and the Department of Pharmacy. Special thanks to my

faculty mentor Dr. Abraham Hartzema who encouraged me to speak up at every meeting. In addition the

research team Dr. Jessica De Leon, Dr. Michael Johnson, Dr. Jennie Tsao and Dr. Terry Mill who helped me believe

in myself. Further support McNairs Scholars Program, Dr. Cothran and Dr. Harry Nyanteh Thank You!


1. Childs, F. & Palmer, N. (2001). Going Off: A Black Woman's Guide for Dealing wih Anger and Stress. New York:

St. Martins Press

2. Greiz, J. L. E., Faravelli, C., Nutt D., & Zohar, J. (Eds.). (2001). Anxiety Disorders: An Introduction to

Clinical Management and Research. New York: John Willy and Sons, Ltd.

3. National Institute of Mental Health (1995). Understanding Panic Disorder [Electronic Version]. NIH Publication

4. Neighbors H. & Jackson S. J. (Eds.). (1996). Mental Health in Black America. Thousand Oaks London New Delhi:

Sage Publications

5. Warren, J. B. (n.d.). Examining Depression Among African- American Women From a Psyhiatri Mental Health

Nursing Perspective. Depression Community. Retrieved August 13, 2003, from http://


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