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Low Income African American Women Yearn for Effective PAD Treatment
"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.
INVINCIBLE BLACK WOMAN SYNDROME SCALE
* 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
Become more in mne wit
n Empowermenl setons with PAD
Terns f abili survivors; "Take Your Life Back"
ohol Develop biweekly personal
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
Beoocounscling otslf-help regimen
klen sy orstr
Undemtad the concept ofthe vincible
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:
5. Warren, J. B. (n.d.). Examining Depression Among African- American Women From a Psyhiatri Mental Health
Nursing Perspective. HealthyPlace.com Depression Community. Retrieved August 13, 2003, from http://
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