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Articles   |    
Church-Based Health Programs for Mental Disorders Among African Americans: A Review
Sidney H. Hankerson, M.D., M.B.A.; Myrna M. Weissman, Ph.D.
Psychiatric Services 2012; doi: 10.1176/appi.ps.201100216
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Dr. Hankerson and Dr. Weissman are affiliated with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. They are also with the Department of Epidemiology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 24, New York, NY 10032 (hankerss@nyspi.columbia.edu).

Copyright © 2012 by the American Psychiatric Association.

Objective:  African Americans underutilize traditional mental health services, compared with white Americans. The authors conducted a systematic review of studies involving church-based health promotion programs for mental disorders among African Americans to assess the feasibility of utilizing such programs to address racial disparities in mental health care.

Methods:  A literature review of MEDLINE, PsycINFO, CINAHL, and ATLA Religion databases was conducted to identify articles published between January 1, 1980, and December 31, 2009. Inclusion criteria were as follows: studies were conducted in a church; the primary objective involved assessment, perceptions and attitudes, education, prevention, group support, or treatment for DSM-IV mental disorders or their correlates; number of participants was reported; qualitative or quantitative data were reported; and African Americans were the target population.

Results:  Of 1,451 studies identified, only eight met inclusion criteria. Five studies focused on substance-related disorders, six were designed to assess the effects of a specific intervention, and six targeted adults. One study focused on depression and was limited by a small sample size of seven participants.

Conclusions:  Although church-based health promotion programs have been successful in addressing racial disparities for several chronic medical conditions, the literature on such programs for mental disorders is extremely limited. More intensive research is needed to establish the feasibility and acceptability of utilizing church-based health promotion programs as a possible resource for screening and treatment to improve disparities in mental health care for African Americans. (Psychiatric Services 63:243–249, 2012; doi: 10.1176/appi.ps.201100216)

Abstract Teaser
Figures in this Article

Despite important initiatives to eliminate racial-ethnic disparities in mental health care (1), African Americans, compared with white Americans, underutilize traditional mental health services (25). Discouragingly, the 2009 National Healthcare Disparities Report indicates that the gap for depression treatment between African-American and white adults is increasing (6). Among the many factors that may contribute to African Americans' underutilization of traditional mental health services are stigma associated with mental illness (7), distrust of providers (8), and barriers to access, such as lack of insurance (9). Given the debilitating nature of mental disorders (10), especially among African Americans (11), identifying ways to increase mental health service utilization in the black community is a vital public health concern.

Church-based health promotion programs have received increased attention as a way to reduce health disparities among African Americans (12,13). As defined by Ransdell (14), church-based health promotion consists of “a large-scale effort by the church community to improve the health of its members through any combination of education, screening, referral, treatment, and group support.” The Black Church, which encompasses the seven predominantly African-American denominations of the Christian faith, is a trusted, central institution in many African-American communities that has been used as a setting for the delivery of health, social, civic, and political services (15). Church-based health promotion programs have been used successfully in African-American churches to address health disparities for numerous medical conditions, such as cancer (1621), diabetes (2225), obesity (2631), cardiovascular disease and hypertension (3235), asthma (36), and HIV/AIDS (37,38).

DeHaven and colleagues (39) conducted a systematic review of 53 health programs in faith-based organizations from 1990 to 2000 to determine the effectiveness of these programs in providing health care services. Of note, they concluded that faith-based programs can improve health outcomes. However, only two of the articles reviewed identified mental illness as the study's primary focus. In one of these studies (40), all participants were white, and in the other, the ethnicity of participants was not specified (41).

The invaluable role of pastoral counseling and of African-American clergy as “gatekeepers” for mental health referrals has been described in detail (4247). The therapeutic function of services in the Black Church has also been reported (4853). However, these studies do not fall under the rubric of church-based health promotion programs, because they either focus exclusively on the activities of clergy or describe in general terms how the church can be a place of healing for members. Given the success of such programs in addressing health disparities for medical conditions among African Americans, we feel that a review of church-based health promotion programs for mental disorders is warranted. Thus we conducted a systematic review of published studies describing church-based programs for mental disorders among African Americans to assess the feasibility of using such programs as a strategy to reduce racial disparities in mental health service utilization.

We systemically searched MEDLINE, PsycINFO, CINAHL, and ATLA Religion databases for articles that were published in peer-reviewed journals between January 1, 1980, and December 31, 2009. The following search terms, separately or in combination, were used: black/African American, church, church-based, faith-based organization, pastor, clergy, pastoral counseling, minister, mental health resource, mental health service, mental illness, depression, domestic violence, violence, drug use, substance use, treatment, and therapy. Several inclusion criteria were used. To be included in the review, studies had to be conducted in a church, with the primary objective of assessment of DSM-IV mental disorders (including nicotine-related disorders) or their correlates (suicide, trauma, and so forth) or perceptions of and attitudes toward these disorders or conditions. The primary objective could also be education about and prevention of these disorders or conditions or group support for or treatment of them. In addition, the number of participants had to be reported, as well as qualitative or quantitative data, or both. Finally, African Americans had to be the target population.

After duplicate articles were excluded, our initial search produced 1,451 studies for examination. Titles and abstracts were examined to identify studies that met our inclusion criteria. When the race-ethnicity of participants was not reported, we attempted to contact the corresponding author to obtain this information. This search strategy yielded 152 articles for formal review. We also checked bibliographies from articles identified in the search and previous review articles (39,5456) and found an additional 39 studies. In total, 191 articles were eligible for formal review.

The formal review process involved reading the article. Studies that focused exclusively on pastoral counseling and those in which all participants were pastors or clergy were excluded. Descriptive studies, studies not reported in English, and those not conducted in the United States were also excluded. After these exclusions, eight studies remained for inclusion in this review (5764).

Four of the eight studies were randomized controlled trials, two were open trials, and two were observational studies. Six studies were designed to test the effects of a specific intervention, one involved a support group, and one involved focus groups. Across the eight studies, the total number of participants was 910; however, the number in each study varied considerably, from seven to 453. Six studies targeted adults. The psychiatric disorders addressed most commonly were substance-related disorders (in five studies). Only one study focused on depressive and anxiety symptoms; however, it had only seven participants. Table 1 summarizes the studies of church-based health promotion programs included in this review.

Among the randomized controlled clinical trials, Marcus and colleagues (64) conducted a faith-based intervention to reduce substance abuse among African-American adolescents. The 61 participants (54% females) included adolescents who were recruited from two local churches. The intervention, Project BRIDGE, involved risk prevention alternatives and in-depth information about substance abuse. When outcomes were evaluated, the control group endorsed significantly more use of marijuana (p=.024) and more use of any drugs (p=.011) in the past 30 days than the intervention group. Use of any drugs was reported by 19% of the control group and by none of the BRIDGE participants. The authors concluded that the church-based intervention was successful in preventing illicit drug abuse among youths.

Schorling and colleagues (59) conducted a randomized controlled trial to determine whether smoking cessation interventions delivered through a coalition of black churches would increase the smoking cessation rate of church members. The 453 participants, half of whom were women, were from two rural Virginia counties and were assigned randomly by county to the intervention or control group. The intervention involved smoking cessation counseling for the participants as well as distribution of devotional booklets at churches. Participants in the intervention group made significantly more progress along the stages of change from baseline to follow-up than participants in the control group (p=.03). The authors concluded that smoking cessation interventions for African Americans can be implemented successfully through a coalition of black churches.

Stahler and colleagues (61) also utilized a coalition of black churches to provide mentors and settings for a faith-based intervention, Bridges to the Community, to treat African-American women with cocaine abuse or dependence. The 18 female study participants lived at a residential treatment program. The Bridges intervention consisted of interactions with a church mentor and group activities at a nearby church. Compared with women in the control group, significantly more women who received the Bridges intervention remained in the residential program at both three-month (p=.04) and six-month (p=.02) follow-up assessments. Tests of drug use via urinalysis at the six-month follow-up showed that 75% of participants in Bridges and 30% of participants in the control group were drug free (p=.05). The authors concluded that use of black churches to enhance residential drug abuse treatment appears feasible.

Voorhees and colleagues (58) conducted a randomized controlled trial to study smoking quit rates and progression along the stages of change for smoking cessation. The 292 participants (71% female) were recruited from 22 churches in East Baltimore. On the basis of the church they attended, participants were randomly assigned to either an intensive, culturally sensitive, spiritually based intervention (11 churches) or a minimal self-help intervention (ten churches). At one-year follow-up assessments, positive progress along the stages of change was highest among participants from Baptist churches who received the intensive intervention. Baptists in the intensive intervention were 3.2 times more likely than other participants to make positive change progress (p=.01). The authors concluded that the spiritual nature of the intensive intervention, along with structural factors of specific denominations (that is, Baptist), made the church a feasible setting in which to develop health promotion and disease prevention strategies for underserved African-American populations.

In an open trial, Brown and colleagues (62) conducted a three-year study to provide training and technical assistance to black churches to develop and implement alcohol and illicit substance abuse prevention programs. The majority of the research activities—quarterly training workshops, cluster meetings, and technical assistance—tookplace in a church setting. Of the 14 participants, for whom no demographic information was provided, pre- and poststudy scores showed a statistically significant increase in participants' knowledge of developing research proposals (p=.003), recruiting and training volunteers (p=.012), and developing substance abuse prevention programming (p=.001). Most participants (69%) surveyed reported that they provided substance abuse prevention programming at their church as a result of the intervention. The authors concluded that churches can effectively implement substance abuse prevention programming.

Mynatt and colleagues (60) conducted an open trial of group psychotherapy at a church to reduce depressive and anxiety symptoms, hopelessness, and loneliness among African-American women. The 12-week intervention, INSIGHT therapy, is a cognitive-behavioral therapy approach designed specifically for women (65,66). Seven women were recruited by announcements in the church bulletin. Mean length of depressive symptoms among study participants was ten years. Median posttreatment scores on the Beck Depression Inventory II and the State Anxiety Inventory were lower than pretreatment scores. Significant changes in depression were observed when the data were analyzed with paired t tests (p=.02). The authors concluded that developing culturally acceptable interventions that reduce risk of anxiety and depressive disorders among African-American women is paramount.

In an observational study, Molock and colleagues (63) utilized clinical vignettes among African-American adolescents to explore their perceptions of hypothetical help-seeking behaviors if they or someone they knew were confronted with a suicide crisis. The 42 participants (62% female) included adolescents (12–18 years) who participated in 90-minute, coeducational focus groups conducted at two local churches. About three-fourths (32 of the 42 participants) knew of at least one peer who had either attempted or completed suicide. Nearly all participants reported that it was important for suicidal individuals to get immediate help. However, very few selected mental health professionals as helpers. Youths were open to community-based programs located in schools, churches, or other community settings. The authors concluded that suicide prevention programs for African Americans should include an educational component and that youths may be distrustful of traditional mental health care providers.

Pickett-Schenk (57) conducted educational support groups on mental disorders for African-American families. Twenty-three participants (83% female), each of whom had a family member with mental illness, attended support groups held at a metropolitan church. No treatment was provided to participants in the support groups or directly to their family members as part of the study. Prestudy outreach activities conducted at the church included provision of educational booklets on the causes and treatment of mental illness, a telephone hotline for crisis intervention services, and a half-day workshop on mental illness. Nearly all participants (91%) reported that the groups greatly increased their understanding of the causes and treatment of mental illnesses, and 70% felt that support group participation greatly increased their morale. The author concluded that church-based support groups provide families of persons with mental illness with valuable knowledge and emotional support.

Research on church-based health programs for DSM-IV mental disorders and their correlates among African Americans is sparse. Our review covers a 30-year period, and yet we identified only eight studies for inclusion in this review. Most studies included in this review focused on substance-related disorders, making it difficult to make inferences about church-based health programs for other mental disorders. However, the Black Church is a prominent, trusted institution in many African-American communities that already provides “de facto” mental health services for many of its members (67). Because African Americans have higher reported rates of church attendance and religiosity than members of other racial-ethnic groups (68,69), the Black Church may be uniquely positioned to overcome barriers such as stigma, distrust, and limited access that contribute to racial disparities in mental health service utilization. On the basis of our findings, we discuss below themes in church-based health programs for mental disorders and suggest areas of future research.

A common element in many of these studies was that church-based interventions for mental disorders were culturally tailored to emphasize black culture and spirituality. In a study on smoking cessation, Voorhees and colleagues (58) distributed audiotapes of gospel music and booklets with Biblical scriptures. Stahler and colleagues (61) developed a faith-based intervention for women with cocaine addiction that stressed black culture and a spiritual worldview. In view of the hypothesis of Jackson and colleagues (70) that many African Americans may smoke cigarettes, drink alcohol, and use drugs to cope with the chronic stressors of racism and harsh living conditions (for example, poverty, poor housing, and crime), utilizing culturally modified interventions in church-based health promotion programs may have a greater impact than traditional interventions on reducing substance-related disorders among African Americans.

Conversely, many churches may struggle with addressing moral issues, such as illicit sexual and criminal activity, that are associated with substance use disorders (71,72). Such conflicts may limit the ability of church-based health promotion programs to provide comprehensive services to all participants with substance-related disorders. When potentially controversial issues are the main focus of such programs, Thomas and colleagues (72) suggested that secular agencies and public health professionals can be utilized to provide appropriate resources. In addition, researchers can collaborate with church leaders to frame the topic in a manner that is congruent with doctrinal tenets of the church (71,72). The successful implementation of church-based health promotion programs in the studies described in this review suggests that black churches can be used as a setting in which to address sensitive issues such as substance-related disorders.

The one study that focused on depressive and anxiety symptoms was an open trial that included only seven participants (60), which limited the study's power to detect statistically significant differences in outcomes. Participants reported lower depressive and state anxiety symptoms after completing the study. Because only one study with a small sample has been published, it is clear that research on church-based health promotion programs for depression is currently underdeveloped. Acknowledging this limited body of evidence, we suggest that such programs for depression could satisfy cultural preferences for depression treatment among African Americans. For example, in one study African Americans in primary care settings expressed a preference for counseling over taking medications to treat depression (73); in another study, African Americans were three times more likely than whites to cite intrinsic spirituality (that is, prayer) as an extremely important part of depression care (74). Future studies should examine African Americans' attitudes about the feasibility and acceptability of providing church-based depression care.

Only two of the studies targeted adolescents (63). Molock and colleagues (63) focused on suicidality and help-seeking behavior, and Marcus and colleagues (64) conducted a church-based intervention for substance-related disorders. Findings of both studies suggested that community-based resources for mental health care may be more acceptable to black adolescents. Although these studies are encouraging, more research is needed to address suicidality and substance use among black teens. From 1980 to 1995, the suicide rate increased by 119% for African Americans age ten to 19 years, driven largely by a 214% increase in completed suicides by males (63,75). Because adolescent males have lower rates of church attendance than adolescent females (76), church-based health promotion programs are likely insufficient by themselves to address the mental health needs of black males and reduce their suicide rates. We propose that future studies should examine the feasibility of utilizing such programs for black teens and explore the feasibility of other community-based venues as resources in which to engage African-American adolescents in mental health care.

Methodological insights from several studies highlighted the importance of collaborating with the church community. In two studies, investigators developed a coalition of black churches in which pastors collaborated with researchers on ways to best engage their congregants as study participants (59,62). Marcus and colleagues (64) explicitly utilized principles of community-based participatory research (CBPR), in which members of the target population are engaged in the entire research process from planning to implementation, analysis, and evaluation (77). A recent review concluded that CBPR has “great potential for helping reduce mental health treatment disparities among minorities and other underserved populations” (78). Church-based, collaborative research processes could help build trust and reduce stigma associated with research that is especially strong in the African-American community (8,7981).

Our study must be assessed in light of several limitations. First, we did not include descriptive articles; only articles that reported qualitative or quantitative data were reviewed. This eliminated articles that described collaborative efforts between mental health professionals and churches (82). Second, several of the intervention studies had a small number of participants, which limited their ability to detect statistically significant differences between study outcomes. Third, because of the limited number of studies included in this review (N=8) and different types of data, we did not conduct a meta-analysis to assess the effectiveness of the studied interventions. Fourth, because all of the studies were conducted in Christian churches, we cannot comment on the presence or absence of health promotion programs in other religious settings, such as synagogues or mosques.

Reducing racial disparities in mental health service utilization is an important and complex issue for which there is no single solution. The current literature on church-based health promotion programs for mental disorders among African Americans is extremely limited. Therefore, any conclusions about the role of the Black Church in mental health care should be interpreted cautiously at present. We recognize that there may be large, vulnerable groups (such as black adolescent males) who may not be reached by church-based health programs. However, given the success of church-based programs to address disparities for numerous medical conditions, we believe that the Black Church is currently being underutilized as a potential mental health resource. More intensive empirical investigation is needed to establish the feasibility of black churches to provide mental health screening, treatment, education, and other services for African Americans.

This study was supported by grant T32 MH19126 from the Program for Minority Research Training in Psychiatry, American Psychiatric Association; grant T32 MH015144 from the National Institute of Mental Health; and funding from the Templeton Foundation. The authors thank Diane Brown, Ph.D., David Cross, Ph.D., Jennifer Kunst, Ph.D., and Dennis Morgan, Psy.D., for their assistance in clarifying the race-ethnicity of participants in their respective studies. The authors also thank Nicole Stewart, B.A., for her assistance with the preliminary literature search.

Dr. Weisman receives royalties from Oxford University Press, Perseus Press, American Psychiatric Publishing, and MultiHealth Systems. Dr. Hankerson reports no competing interests.

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McRae  MB;  Carey  PM;  Anderson-Scott  R:  Black churches as therapeutic systems: a group process perspective.  Health Education and Behavior 25:778–789, 1998
[CrossRef] | [PubMed]
 
Thompson  DA;  McRae  MB:  The need to belong: a theory of the therapeutic function of the Black church tradition.  Counseling and Values 46:40–53, 2001
[CrossRef]
 
Garzon  F;  Tilley  K:  Do lay Christian counseling approaches work? What we currently know.  Journal of Psychology and Christianity 28:130–140, 2009
 
Smith  KS;  Teasley  M:  Social work research on faith-based programs: a movement towards evidence-based practice.  Journal of Religion and Spirituality in Social Work 28:306–327, 2009
 
Weaver  AJ;  Flannelly  KJ;  Flannelly  LT  et al:  Collaboration between clergy and mental health professionals: a review of professional health care journals from 1980 through 1999.  Counseling and Values 47:162–170, 2003
[CrossRef]
 
Pickett-Schenk  SA:  Church-based support groups for African American families coping with mental illness: outreach and outcomes.  Psychiatric Rehabilitation Journal 26:173–180, 2002
[CrossRef] | [PubMed]
 
Voorhees  CC;  Stillman  FA;  Swank  RT  et al:  Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit.  Preventive Medicine 25:277–285, 1996
[CrossRef] | [PubMed]
 
Schorling  JB;  Roach  J;  Siegel  M  et al:  A trial of church-based smoking cessation interventions for rural African Americans.  Preventive Medicine 26:92–101, 1997
[CrossRef] | [PubMed]
 
Mynatt  S;  Wicks  M;  Bolden  L:  Pilot study of INSIGHT therapy in African American women.  Archives of Psychiatric Nursing 22:364–374, 2008
[CrossRef] | [PubMed]
 
Stahler  GJ;  Kirby  KC;  Kerwin  ME:  A faith-based intervention for cocaine-dependent Black women.  Journal of Psychoactive Drugs 39:183–190, 2007
[CrossRef] | [PubMed]
 
Brown  DR;  Scott  W;  Lacey  K  et al:  Black churches in substance use and abuse prevention efforts.  Journal of Alcohol and Drug Education 50:43–65, 2006
 
Molock  SD;  Barksdale  C;  Matlin  S  et al:  Qualitative study of suicidality and help-seeking behaviors in African American adolescents.  American Journal of Community Psychology 40:52–63, 2007
[CrossRef] | [PubMed]
 
Marcus  M;  Walker  T;  Swint  J  et al:  Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents.  Journal of Interprofessional Care 18:347–359, 2004
[CrossRef] | [PubMed]
 
Gordon  VC;  Ledray  LE:  Growth-support intervention for the treatment of depression in women of middle years.  Western Journal of Nursing Research 8:263–283, 1986
[CrossRef] | [PubMed]
 
Gordon  VC;  Sachs  EG:  Insight: A Cognitive Enhancement Program for Women: Women's Workbook .  Minneapolis, Minn,  University of Minnesota School of Nursing, 2002
 
Fox  J;  Merwin  E;  Blank  M:  De facto mental health services in the rural south.  Journal of Health Care for the Poor and Underserved 6:434–468, 1995
[PubMed]
 
Taylor  RJ;  Mattis  J;  Chatters  LM:  Subjective religiosity among African Americans: a synthesis of findings from five national samples.  Journal of Black Psychology 25:524–543, 1999
[CrossRef]
 
Taylor  RJ;  Chatters  LM;  Jayakody  R  et al:  Black and white differences in religious participation: a multisample comparison.  Journal for the Scientific Study of Religion 35:403–410, 1996
[CrossRef]
 
Jackson  JS;  Knight  KM;  Rafferty  JA:  Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course.  American Journal of Public Health 100:933–939, 2010
[CrossRef] | [PubMed]
 
Francis  SA;  Liverpool  J:  A review of faith-based HIV prevention programs.  Journal of Religion and Health 48:6–15, 2009
[CrossRef] | [PubMed]
 
Thomas  SB;  Quinn  SC;  Billingsley  A  et al:  The characteristics of northern Black churches with community health outreach programs.  American Journal of Public Health 84:575–579, 1994
[CrossRef] | [PubMed]
 
Dwight-Johnson  M;  Sherbourne  CD;  Liao  D  et al:  Treatment preferences among depressed primary care patients.  Journal of General Internal Medicine 15:527–534, 2000
[CrossRef] | [PubMed]
 
Cooper  LA;  Brown  C;  Vu  HT  et al:  How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients.  Journal of General Internal Medicine 16:634–638, 2001
[CrossRef] | [PubMed]
 
Willis  LA;  Coombs  DW;  Cockerham  WC  et al:  Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide.  Social Science and Medicine 55:907–920, 2002
[CrossRef] | [PubMed]
 
Smith  C;  Denton  M;  Faris  R  et al:  Mapping American adolescent religious participation.  Journal for the Scientific Study of Religion 41:597–612, 2002
[CrossRef]
 
Israel  BA;  Schulz  AJ;  Parker  EA  et al:  Review of community-based research: assessing partnership approaches to improve public health.  Annual Review of Public Health 19:173–202, 1998
[CrossRef] | [PubMed]
 
Stacciarini  JM;  Shattell  MM;  Coady  M  et al:  Review: community-based participatory research approach to address mental health in minority populations.  Community Mental Health Journal 47:489–497, 2011
[CrossRef] | [PubMed]
 
Alvidrez  J;  Snowden  LR;  Patel  SG:  The relationship between stigma and other treatment concerns and subsequent treatment engagement among black mental health clients.  Issues in Mental Health Nursing 31:257–264, 2010
[CrossRef] | [PubMed]
 
Hamilton  LA;  Aliyu  MH;  Lyons  PD  et al:  African-American community attitudes and perceptions toward schizophrenia and medical research: an exploratory study.  Journal of the National Medical Association 98:18–27, 2006
[PubMed]
 
Conner  KO;  Koeske  G;  Brown  C:  Racial differences in attitudes toward professional mental health treatment: the mediating effect of stigma.  Journal of Gerontological Social Work 52:695–712, 2009
[CrossRef] | [PubMed]
 
Epstein  J;  Kadela Collins  K;  Bailey-Burch  B  et al:  Space Scouts: a collaboration between university researchers and African American churches.  Journal of Ethnicity in Substance Abuse 6:31–43, 2007
[CrossRef] | [PubMed]
 
References Container
 
Anchor for JumpAnchor for Jump
Table 1

Studies of church-based health promotion programs for mental disorders among African Americans included in the review

Table 1 

Studies of church-based health promotion programs for mental disorders among African Americans included in the review

+

References

Satcher  D:  The Initiative to Eliminate Racial and Ethnic Health Disparities is moving forward.  Public Health Reports 114:283–287, 1999
[CrossRef] | [PubMed]
 
Neighbors  HW;  Caldwell  C;  Williams  DR  et al:  Race, ethnicity, and the use of services for mental disorders: results from the National Survey of American Life.  Archives of General Psychiatry 64:485–494, 2007
[CrossRef] | [PubMed]
 
Keyes  KM;  Hatzenbuehler  ML;  Alberti  P  et al:  Service utilization differences for axis I psychiatric and substance use disorders between white and black adults.  Psychiatric Services 59:893–901, 2008
[CrossRef] | [PubMed]
 
Alegria  M;  Canino  G;  Rios  R  et al:  Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites.  Psychiatric Services 53:1547–1555, 2002
[CrossRef] | [PubMed]
 
Gonzalez  HM;  Vega  WA;  Williams  DR  et al:  Depression care in the United States: too little for too few.  Archives of General Psychiatry 67:37–46, 2010
[CrossRef] | [PubMed]
 
 National Healthcare Disparities Report .  Rockville, Md,  US Department of Health and Human Services, Agency for Healthcare Research and Quality, 2009
 
Menke  R;  Flynn  H:  Relationships between stigma, depression, and treatment in white and African American primary care patients.  Journal of Nervous and Mental Disease 197:407–411, 2009
[CrossRef] | [PubMed]
 
Freimuth  VS;  Quinn  SC;  Thomas  SB  et al:  African Americans' views on research and the Tuskegee Syphilis Study.  Social Science and Medicine 52:797–808, 2001
[CrossRef] | [PubMed]
 
Hines-Martin  V;  Malone  M;  Kim  S  et al:  Barriers to mental health care access in an African American population.  Issues in Mental Health Nursing 24:237–256, 2003
[CrossRef] | [PubMed]
 
Murray  CJ;  Lopez  AD:  Alternative projections of mortality and disability by cause, 1990–2020: Global Burden of Disease Study.  Lancet 349:1498–1504, 1997
[CrossRef] | [PubMed]
 
Williams  DR;  Gonzalez  HM;  Neighbors  H  et al:  Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life.  Archives of General Psychiatry 64:305–315, 2007
[CrossRef] | [PubMed]
 
Peterson  J;  Atwood  JR;  Yates  B:  Key elements for church-based health promotion programs: outcome-based literature review.  Public Health Nursing 19:401–411, 2002
[CrossRef] | [PubMed]
 
Wells  K;  Miranda  J;  Bruce  ML  et al:  Bridging community intervention and mental health services research.  American Journal of Psychiatry 161:955–963, 2004
[CrossRef] | [PubMed]
 
Ransdell  LB:  Church-based health promotion: an untapped resource for women 65 and older.  American Journal of Health Promotion 9:333–336, 1995
[CrossRef] | [PubMed]
 
Lincoln  CE;  Mamiya  LH:  The Black Church in the African American Experience .  Durham, NC,  Duke University Press, 1990
 
Bowie  JV;  Wells  AM;  Juon  H-S  et al:  How old are African American women when they receive their first mammogram? Results from a church-based study.  Journal of Community Health 33:183–191, 2008
[CrossRef] | [PubMed]
 
Campbell  MK;  James  A;  Hudson  MA  et al:  Improving multiple behaviors for colorectal cancer prevention among African American church members.  Health Psychology 23:492–502, 2004
[CrossRef] | [PubMed]
 
Darnell  JS;  Chang  CH;  Calhoun  EA:  Knowledge about breast cancer and participation in a faith-based breast cancer program and other predictors of mammography screening among African American women and Latinas.  Health Promotion Practice 7:201S–212S, 2006
[CrossRef] | [PubMed]
 
Derose  KP;  Fox  SA;  Reigadas  E  et al:  Church-based telephone mammography counseling with peer counselors.  Journal of Health Communication 5:175–188, 2000
[CrossRef] | [PubMed]
 
Ford  ME;  Havstad  SL;  Davis  SD:  A randomized trial of recruitment methods for older African American men in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.  Clinical Trials 1:343–351, 2004
[CrossRef] | [PubMed]
 
Holt  CL;  Wynn  TA;  Litaker  MS  et al:  A comparison of a spiritually based and non-spiritually based educational intervention for informed decision making for prostate cancer screening among church-attending African-American men.  Urologic Nursing 29:249–258, 2009
[PubMed]
 
Boltri  JM;  Davis-Smith  YM;  Seale  JP  et al:  Diabetes prevention in a faith-based setting: results of translational research.  Journal of Public Health Management and Practice 14:29–32, 2008
[PubMed]
 
Davis-Smith  YM;  Davis-Smith  M;  Boltri  JM  et al:  Implementing a diabetes prevention program in a rural African-American church.  Journal of the National Medical Association 99:440–446, 2007
[PubMed]
 
Dodani  S;  Kramer  MK;  Williams  L  et al:  Fit body and soul: a church-based behavioral lifestyle program for diabetes prevention in African Americans.  Ethnicity and Disease 19:135–141, 2009
[PubMed]
 
Samuel-Hodge  CD;  Keyserling  TC;  Park  S  et al:  A randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes.  Diabetes Educator 35:439–454, 2009
[CrossRef] | [PubMed]
 
McNabb  W;  Quinn  M;  Kerver  J  et al:  The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes.  Diabetes Care 20:1518–1523, 1997
[CrossRef] | [PubMed]
 
Kennedy  BM;  Paeratakul  S;  Champagne  CM  et al:  A pilot church-based weight loss program for African-American adults using church members as health educators: a comparison of individual and group intervention.  Ethnicity and Disease 15:373–378, 2005
[PubMed]
 
Sbrocco  T;  Carter  MM;  Lewis  EL  et al:  Church-based obesity treatment for African-American women improves adherence.  Ethnicity and Disease 15:246–255, 2005
[PubMed]
 
Young  DR;  Stewart  KJ:  A church-based physical activity intervention for African American women.  Family and Community Health 29:103–117, 2006
[PubMed]
 
Fitzgibbon  ML;  Stolley  MR;  Ganschow  P  et al:  Results of a Faith-Based Weight Loss Intervention for Black Women.  Journal of the National Medical Association 97:1393–1402, 2005
[PubMed]
 
Kim  KH-C;  Linnan  L;  Campbell  MK  et al:  The WORD (wholeness, oneness, righteousness, deliverance): a faith-based weight-loss program utilizing a community-based participatory research approach.  Health Education and Behavior 35:634–650, 2008
[CrossRef] | [PubMed]
 
Frank  D;  Grubbs  L:  A faith-based screening/education program for diabetes, CVD, and stroke in rural African Americans.  Association of Black Nursing Faculty Journal 19:96–101, 2008
 
Flack  JM;  Wiist  WH:  Cardiovascular risk factor prevalence in African-American adult screenees for a church-based cholesterol education program: the Northeast Oklahoma City Cholesterol Education Program.  Ethnicity and Disease 1:78–90, 1991
[PubMed]
 
Wiist  WH;  Flack  JM:  A church-based cholesterol education program.  Public Health Reports 105:381–388, 1990
[PubMed]
 
Yanek  LR;  Becker  DM;  Moy  TF  et al:  Project Joy: faith based cardiovascular health promotion for African American women.  Public Health Reports 116(suppl 1):68–81, 2001
[CrossRef] | [PubMed]
 
Ford  ME;  Edwards  G;  Rodriguez  JL  et al:  An empowerment-centered, church-based asthma education program for African American adults.  Health and Social Work 21:70–75, 1996
[PubMed]
 
Hatcher  SS;  Burley  JT;  Lee-Ouga  WI:  HIV prevention programs in the black church: a viable health promotion resource for African American women? Journal of Human Behavior in the Social Environment 17:309–324, 2008
[CrossRef]
 
Tyrell  CO;  Klein  SJ;  Gieryic  SM  et al:  Early results of a statewide initiative to involve faith communities in HIV prevention.  Journal of Public Health Management and Practice 14:429–436, 2008
[PubMed]
 
DeHaven  MJ;  Hunter  IB;  Wilder  L  et al:  Health programs in faith-based organizations: are they effective? American Journal of Public Health 94:1030–1036, 2004
[CrossRef] | [PubMed]
 
Toh  YM;  Tan  SY:  The effectiveness of church-based lay counselors: a controlled outcome study.  Journal of Psychology and Christianity 16:263–267, 1997
 
Toh  YM;  Tan  SY;  Osburn  CD  et al:  The evaluation of a church-based lay counseling program: some preliminary data.  Journal of Psychology and Christianity 13:270–275, 1994
 
Wang  PS;  Berglund  PA;  Kessler  RC:  Patterns and correlates of contacting clergy for mental disorders in the United States.  Health Services Research 38:647–673, 2003
[CrossRef] | [PubMed]
 
Young  JL;  Griffith  EE;  Williams  DR:  The integral role of pastoral counseling by African-American clergy in community mental health.  Psychiatric Services 54:688–692, 2003
[CrossRef] | [PubMed]
 
Lowe  DW:  Counseling activities and referral practices of ministers.  Journal of Psychology and Christianity 5:22–29, 1986
 
Moran  M;  Flannelly  KJ;  Weaver  AJ  et al:  A study of pastoral care, referral, and consultation practices among clergy in four settings in the New York City area.  Pastoral Psychology 53:255–266, 2005
[CrossRef]
 
Neighbors  HW;  Musick  MA;  Williams  DR:  The African American minister as a source of help for serious personal crises: bridge or barrier to mental health care? Health Education and Behavior 25:759–777, 1998
[CrossRef] | [PubMed]
 
Taylor  RJ;  Ellison  CG;  Chatters  LM  et al:  Mental health services in faith communities: the role of clergy in the Black church.  Journal of Social Work 45:73–87, 2000
[CrossRef]
 
Griffith  EE;  Young  JL;  Smith  DL:  An analysis of the therapeutic elements in a black church service.  Hospital and Community Psychiatry 35:464–469, 1984
[PubMed]
 
Griffith  EE:  The impact of sociocultural factors on a church-based healing model.  American Journal of Orthopsychiatry 53:291–302, 1983
[CrossRef]
 
Griffith  EE;  Mahy  GE:  Psychological benefits of Spiritual Baptist “mourning.” American Journal of Psychiatry 141:769–773, 1984
[PubMed]
 
Griffith  EE;  English  T;  Mayfield  V:  Possession, prayer, and testimony: therapeutic aspects of the Wednesday night meeting in a Black church.  Psychiatry 43:120–128, 1980
[PubMed]
 
McRae  MB;  Carey  PM;  Anderson-Scott  R:  Black churches as therapeutic systems: a group process perspective.  Health Education and Behavior 25:778–789, 1998
[CrossRef] | [PubMed]
 
Thompson  DA;  McRae  MB:  The need to belong: a theory of the therapeutic function of the Black church tradition.  Counseling and Values 46:40–53, 2001
[CrossRef]
 
Garzon  F;  Tilley  K:  Do lay Christian counseling approaches work? What we currently know.  Journal of Psychology and Christianity 28:130–140, 2009
 
Smith  KS;  Teasley  M:  Social work research on faith-based programs: a movement towards evidence-based practice.  Journal of Religion and Spirituality in Social Work 28:306–327, 2009
 
Weaver  AJ;  Flannelly  KJ;  Flannelly  LT  et al:  Collaboration between clergy and mental health professionals: a review of professional health care journals from 1980 through 1999.  Counseling and Values 47:162–170, 2003
[CrossRef]
 
Pickett-Schenk  SA:  Church-based support groups for African American families coping with mental illness: outreach and outcomes.  Psychiatric Rehabilitation Journal 26:173–180, 2002
[CrossRef] | [PubMed]
 
Voorhees  CC;  Stillman  FA;  Swank  RT  et al:  Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit.  Preventive Medicine 25:277–285, 1996
[CrossRef] | [PubMed]
 
Schorling  JB;  Roach  J;  Siegel  M  et al:  A trial of church-based smoking cessation interventions for rural African Americans.  Preventive Medicine 26:92–101, 1997
[CrossRef] | [PubMed]
 
Mynatt  S;  Wicks  M;  Bolden  L:  Pilot study of INSIGHT therapy in African American women.  Archives of Psychiatric Nursing 22:364–374, 2008
[CrossRef] | [PubMed]
 
Stahler  GJ;  Kirby  KC;  Kerwin  ME:  A faith-based intervention for cocaine-dependent Black women.  Journal of Psychoactive Drugs 39:183–190, 2007
[CrossRef] | [PubMed]
 
Brown  DR;  Scott  W;  Lacey  K  et al:  Black churches in substance use and abuse prevention efforts.  Journal of Alcohol and Drug Education 50:43–65, 2006
 
Molock  SD;  Barksdale  C;  Matlin  S  et al:  Qualitative study of suicidality and help-seeking behaviors in African American adolescents.  American Journal of Community Psychology 40:52–63, 2007
[CrossRef] | [PubMed]
 
Marcus  M;  Walker  T;  Swint  J  et al:  Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents.  Journal of Interprofessional Care 18:347–359, 2004
[CrossRef] | [PubMed]
 
Gordon  VC;  Ledray  LE:  Growth-support intervention for the treatment of depression in women of middle years.  Western Journal of Nursing Research 8:263–283, 1986
[CrossRef] | [PubMed]
 
Gordon  VC;  Sachs  EG:  Insight: A Cognitive Enhancement Program for Women: Women's Workbook .  Minneapolis, Minn,  University of Minnesota School of Nursing, 2002
 
Fox  J;  Merwin  E;  Blank  M:  De facto mental health services in the rural south.  Journal of Health Care for the Poor and Underserved 6:434–468, 1995
[PubMed]
 
Taylor  RJ;  Mattis  J;  Chatters  LM:  Subjective religiosity among African Americans: a synthesis of findings from five national samples.  Journal of Black Psychology 25:524–543, 1999
[CrossRef]
 
Taylor  RJ;  Chatters  LM;  Jayakody  R  et al:  Black and white differences in religious participation: a multisample comparison.  Journal for the Scientific Study of Religion 35:403–410, 1996
[CrossRef]
 
Jackson  JS;  Knight  KM;  Rafferty  JA:  Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course.  American Journal of Public Health 100:933–939, 2010
[CrossRef] | [PubMed]
 
Francis  SA;  Liverpool  J:  A review of faith-based HIV prevention programs.  Journal of Religion and Health 48:6–15, 2009
[CrossRef] | [PubMed]
 
Thomas  SB;  Quinn  SC;  Billingsley  A  et al:  The characteristics of northern Black churches with community health outreach programs.  American Journal of Public Health 84:575–579, 1994
[CrossRef] | [PubMed]
 
Dwight-Johnson  M;  Sherbourne  CD;  Liao  D  et al:  Treatment preferences among depressed primary care patients.  Journal of General Internal Medicine 15:527–534, 2000
[CrossRef] | [PubMed]
 
Cooper  LA;  Brown  C;  Vu  HT  et al:  How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients.  Journal of General Internal Medicine 16:634–638, 2001
[CrossRef] | [PubMed]
 
Willis  LA;  Coombs  DW;  Cockerham  WC  et al:  Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide.  Social Science and Medicine 55:907–920, 2002
[CrossRef] | [PubMed]
 
Smith  C;  Denton  M;  Faris  R  et al:  Mapping American adolescent religious participation.  Journal for the Scientific Study of Religion 41:597–612, 2002
[CrossRef]
 
Israel  BA;  Schulz  AJ;  Parker  EA  et al:  Review of community-based research: assessing partnership approaches to improve public health.  Annual Review of Public Health 19:173–202, 1998
[CrossRef] | [PubMed]
 
Stacciarini  JM;  Shattell  MM;  Coady  M  et al:  Review: community-based participatory research approach to address mental health in minority populations.  Community Mental Health Journal 47:489–497, 2011
[CrossRef] | [PubMed]
 
Alvidrez  J;  Snowden  LR;  Patel  SG:  The relationship between stigma and other treatment concerns and subsequent treatment engagement among black mental health clients.  Issues in Mental Health Nursing 31:257–264, 2010
[CrossRef] | [PubMed]
 
Hamilton  LA;  Aliyu  MH;  Lyons  PD  et al:  African-American community attitudes and perceptions toward schizophrenia and medical research: an exploratory study.  Journal of the National Medical Association 98:18–27, 2006
[PubMed]
 
Conner  KO;  Koeske  G;  Brown  C:  Racial differences in attitudes toward professional mental health treatment: the mediating effect of stigma.  Journal of Gerontological Social Work 52:695–712, 2009
[CrossRef] | [PubMed]
 
Epstein  J;  Kadela Collins  K;  Bailey-Burch  B  et al:  Space Scouts: a collaboration between university researchers and African American churches.  Journal of Ethnicity in Substance Abuse 6:31–43, 2007
[CrossRef] | [PubMed]
 
References Container
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+

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