Increasing Access To Depression Care For Black Women Survivors Of Intimate Partner Violence

Black women intimate partner violence (IPV) survivors experience a higher burden of depression.1 IPV is any physical, sexual, psychological, or financial abuse, and/or controlling behaviors inflicted by a current or former intimate partner.2 Women bear the brunt of victimization. More than 43 million women in the United States (US) have experienced IPV in their lifetime.2 Every year 12.5 million women are abused.3 Depression is the leading cause of disability in the US affecting more than 20% of the population.6,7 Women are nearly twice as likely as men to suffer from it.8 Black women who are exposed to severe, long-term IPV and are also more likely to suffer from severe depression.1 Depression is especially harmful for IPV survivors because it undermines a woman’s ability to safely escape from an abusive partner.10 Depression is especially pernicious for Black women IPV survivors. Given their race-class-gender intersectionality, they are often misdiagnosed, undertreated, and experience bias from mental health (MH) providers despite experiencing higher rates of psychological distress.8 Notably, existing and long-standing inequities within the mental healthcare system make it especially difficult for them to obtain immediate depression care. However, the Black church is a trusted and novel pathway for providing treatment linkages for depressed community members.14-16 Nearly 80% of Blacks are religiously affiliated and women are the largest population within the Black church.27 Women clergy are already providing crisis support for IPV survivors.28,29 They view this as part of their social responsibility to support other women30 although depression is not currently addressed. Notably, there is a dearth of depression care that has been tailored for Black women IPV survivors in the Black church.36 Current interventions largely omit Black women’s spirituality, despite their preference for incorporating faith-based practices.23,36 In fact, interventions that infuse Black IPV survivors' spiritual and religious practices increase the likelihood of treatment adherence and completion.36 This finding is consistent with cultural norms and reliance upon the Black church as a source of support that includes healthcare promotion and delivery, sociopolitical organizing, as well as educational and childcare services.37,38 Given that tailored interventions increase trust and decrease the likelihood of attrition among this underserved population of survivors in critical need of MH care,26,39 there is an urgent need to tailor an EBI for Black women IPV survivors with depression in the context of the Black church. In this K23 patient- oriented application guided by community-partnered participatory research and Waller’s Model,41 I will apply the ADAPT-ITT Model23 and the PRISM framework48,49 to tailoring and implementing interpersonal counseling (IPC)21 – a brief, structured version of interpersonal psychotherapy22 designed for nonspecialist settings that focuses on interpersonal problems and depressive symptoms21 – for depressed Black women IPV survivors that can be delivered by church leaders in a novel, faith-based setting. The outcomes from this work will provide pilot data for an R01 to evaluate the tailored intervention in a fully powered, cluster-randomized trial in Black churches.