Depression can affect anyone, regardless of race or ethnicity. But it doesn’t always look the same across these boundaries. There are serious inconsistencies in the diagnosis and treatment of major depressive disorder in Black and Hispanic communities.

This article discusses some reasons for these gaps and how people in these communities can find the help they need.

Symptoms of depression can mimic those of other mental and physical conditions. Some signs and symptoms of depression are:

  • persistent sadness or anxiousness
  • feeling hopeless, pessimistic, worthless, guilty
  • irritability, frustration
  • lack of interest in enjoyable activities
  • low energy, fatigue
  • problems with concentration, memory, decision making
  • changes in sleep and appetite
  • unexplained aches and pains
  • thoughts of self-harm

According to the National Alliance on Mental Illness (NAMI), a Black person may be more likely to describe physical symptoms, such as aches and pains. This key difference can delay a proper diagnosis.

Some research suggests that when compared to white people, African American people are more likely to have depression that is:

  • prolonged
  • chronic (long-term)
  • severely debilitating

A 2020 study found that severe depression is significantly higher among people who are Black, Hispanic, or of multiple or unspecified races compared to non-Hispanic white people. Black and Hispanic participants had higher levels of:

  • sadness
  • inability to experience pleasure (anhedonia)
  • problems with movements or muscular activity associated with mental processes (psychomotor symptoms)

Researchers don’t know the exact cause of depression. But contributing factors include:

  • genetics
  • family or personal history of depression
  • major life changes, trauma, or stress
  • medication side effects, underlying illnesses, or substance use

Other risk factors are adversity or chronic stress due to:

  • racism
  • discrimination
  • low socioeconomic position

Self-perceived racial discrimination is linked to worsening mental and physical health among African American people. This appears to affect women more than men.

Some research suggests that rates of depression are higher among white people than African American people. Other research indicates that rates are likely the same. But it’s underdiagnosed among Black and Hispanic people.

According to a Blue Cross Blue Shield Association survey of 2,700 adults, barriers to diagnosis and treatment include:

  • Social stigma: The survey found that 54% of Black people and 47% of Hispanic people said that those with mental health conditions in their communities are looked down upon. Only 38% of white respondents said the same.
  • Access to care: When Black and Hispanic respondents had access to mental and behavioral health professionals, the diagnosis rate increased.
  • Need for cultural competence: Black and Hispanic people were more likely to want help from someone of the same race or ethnicity, cultural background, and similar life experiences.
  • Wait-and-see approach: Black and Hispanic respondents were more likely to try to handle things on their own first.
  • Lack of trust in the system: This aspect stems from a long history of prejudice and discrimination. Because of these negative experiences, Black and Hispanic people tended to seek help outside the health system. This generally included friends, family, and community and religious organizations.

A 2020 study involving 25,503 older adults found significant racial and ethnic disparities in late-life depression. Black people in the study were less likely to get medication or counseling for depression relative to symptom levels. And Black women were 80% less likely than non-Hispanic white women to get treatment.

Communication can present another barrier within the Hispanic community. Both language and culture can affect the way you describe symptoms. They can also affect the doctor’s perceptions of your symptoms.

Even subtle communication differences can contribute to misdiagnosis. They can also complicate matters when trying to follow a treatment plan.

Treatment for depression may involve a combination of therapies. This can include medications such as:

  • antidepressants
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)

Psychotherapies, such as cognitive behavioral therapy (CBT), can also help with depression.

Lifestyle factors, such as regular exercise and prioritizing sleep, should also be part of your treatment plan.

It may help to tap into community support. Research suggests that ethnic identity among African American people is a protective factor against mental illness. This may be due to:

  • a sense of commitment and belonging
  • being involved
  • having positive feelings about the group

It’s OK to ask whether a doctor has treated other people of your race, ethnicity, or cultural background. You can also ask whether they’re fluent in your language or whether they’ll work with an interpreter.

Another good question is whether they’ve had cultural competence training. This training focuses on improving the quality of care for people of diverse backgrounds.

Your doctor should be able to:

  • listen carefully and understand your concerns
  • communicate effectively
  • integrate your cultural background into the care plan
  • treat you with respect and dignity

You can start a search for a mental health professional by asking for recommendations from:

  • a primary care doctor or other medical professional
  • family and friends
  • community organizations

You can also find mental health professionals through these searchable databases:

NAMI has a network of more than 600 state organizations and affiliates around the country. This includes free, peer-led support groups where you can connect with others and share experiences. You can use the search tool to find a local NAMI and learn more.

If you, or someone close to you, is in distress or danger of self-harm: Call or text the Suicide & Crisis Lifeline at 988.

Major depressive disorder can affect anyone. But it’s often underdiagnosed and undertreated in Black and Hispanic communities.

Social stigma, different presentation of symptoms, and lack of local mental health professionals can all play a role.

Depression is not your fault. And it can be effectively treated. If you think you may have depression, take the first step and reach out for help. Getting better starts with getting the right diagnosis.