Black Women's Lived Experiences of Depression and Related Barriers and Facilitators to Utilising Healthcare Services: A Systematic Review and Qualitative Evidence Synthesis Co-produced with Experts by Lived Experiences

Depression among Black women is a significant public health concern. However, our understanding of their unique experiences and the barriers and facilitators to utilising healthcare services remains limited. To address these issues, we conducted a qualitative evidence synthesis in collaboration with experts by lived experiences. We searched seven databases (ASSIA, MEDLINE, APA PsycInfo, Sociological Abstracts, CINAHL, AMED and EMBASE) from inception to 9th September 2021 and updated to 29th March 2024 with an English language restriction. Study quality and confidence in findings were assessed using the Critical Appraisal Skills Programme (CASP) and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Of 15025 papers screened, 45 were eligible for inclusion. Data were analysed using thematic analysis. Women reported depression stemming from racial and gender-related stressors, social isolation, and a loss of faith; moreover, the Strong Black Woman schema masked depression symptoms. Mistrust of healthcare providers, stigma, religious coping, and pressure to conform to the Strong Black Woman schema hindered healthcare service utilisation. The rapport between women and their healthcare providers, endorsement from faith leaders, and points of crisis enabled service utilisation. Lived experience experts provided reflections and recommendations for practice. HighlightsO_LIRecognition of depression may be hampered by schemas connected to Black womens identity. C_LIO_LITrust between Black women experiencing depression and clinicians is essential for effective care. C_LIO_LITraining which incorporates antiracist principles is needed for competence in discussing issues surrounding race and gender. C_LIO_LI(Re-)consideration of diagnostic criteria to acknowledge differential presentation and the development of culturally adapted treatments are warranted. C_LIO_LICo-producing research with experts by lived experience ensures it is more impactful. C_LI