Refining Black men's depression measurement using participatory approaches: a concept mapping study.

Background: Despite cumulative socioeconomic disadvantage and risk factors, Black Americans have a lower prevalence of depression than whites. Given the emerging focus of depression as a public mental health crisis, culturally informed depression measures and scale development techniques are needed to better alleviate the mental health burden of socially marginalized populations. Yet, for Black men, race- and gender-related factors that position emotional vulnerability as a sign of weakness, may potentially mask the timely identification of mental health needs in this population. Thus, we address these gaps by employing a stakeholder-driven, community-engaged process for understanding Black men's depression experience.

Methods: We use concept mapping, a structured mixed methods approach, to determine how stakeholders of Black men's health conceptualize their depressive symptoms. Thirty-six stakeholders participated in a three-phase concept mapping study conducted in 2018. Three separate stakeholder groups were engaged for this study, including Black men, Black women, and primary care providers.

Results: Participants generated 68 characteristics of Black men's depression which were reflected within five conceptual clusters: (1) physical states; (2) emotional states; (3) diminished drive; (4) internal conflicts; (5) communication with others; and (6) social pressures. Using a content analysis approach, we found that items comprising the "social pressures" cluster were not reflected in any common depression scales.

Conclusions: Findings from this study illustrate the similar and divergent pathways in which Black men express depressed mood. Furthermore, concept mapping results also yield a novel opportunity for culturally informed scale development in future research.