“We Don’t Have a Lot of Safe Spaces to Talk about These Things”: Designing Digital Mental Health Tools to Support the Needs of Black Adults in the United States (Preprint)

Abstract

BACKGROUND Depression and anxiety are associated with excess morbidity and mortality, constituting a major health care challenge. The prevalence of these conditions is increasing. In the U.S., the health-related burden of depression and anxiety may disproportionately affect Black adults, who face unique stressors impacting their mental health and barriers to accessing treatment. OBJECTIVE This study seeks to explore the mental health experiences of non-treatment seeking Black adults, and how these experiences relate to their needs and preferences for the design of digital mental health (DMH) tools, through user-centered design methods. METHODS This study included 25 non-treatment seeking Black adults (aged 18-61) with experiences of depression or anxiety to share their perspectives on how DMH tools can meet their needs. All 25 Participants engaged in an asynchronous online discussion group and completed a technology probe in which they used an automated mental health self-management text messaging tool for 18 days. A subset of participants (n=6) completed follow-up interviews to elaborate on their impressions of the program and design ideas. RESULTS Participants described how racism and mental health stigma severely limit opportunities to discuss their mental health challenges, both within and outside the Black community. They endorsed text messaging as a convenient way to introduce mental health self-management skills but advocated for the integration of content that highlights and addresses the experiences of Black individuals, creating nonjudgmental spaces for discussing mental health experiences, and linkage to formal mental health treatment for those who want it. CONCLUSIONS Our findings suggest that it is critical to consider the role of racial discrimination and mental health stigma in shaping psychological well-being when designing inclusive and culturally sensitive DMH tools. Furthermore, DMH tools can provide non-treatment seeking Black adults with a supportive environment to address mental health concerns, which may otherwise be difficult to find due to stigma.

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