Black folks account for almost 20% of people with depression in the United States, yet they’re less likely to receive treatment.

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Unlearning the desire to handle everything on my own has been a process. After taking the time to do intentional introspection, I’ve learned that a lot of the ways I had historically coped with my own mental illness, I had been taught (both directly and indirectly) by people within my family and community.

I am not alone in this realization and journey. Despite Black folks making up less than 13% of the total U.S. population, we account for almost 20% of those navigating depression. Simultaneously, we’re significantly less likely to receive the treatment we need.

Many Black people in the United States have internalized the need to lean into the expectation to always be strong, always be OK, and always be available for everyone else, despite the severity of what we may be dealing with.

Some of the common potential risk factors for depression include:

  • family history of depression or mental illness
  • chronic stress
  • poor nutrition

Still, in the Black community and other historically marginalized communities, additional risk factors may play a role, including a history of trauma and unresolved feelings around grief or loss.

While these factors are often viewed as the result of an acute situation or set of experiences, for people within historically marginalized communities, trauma and loss can be ongoing and pervasive.

Studies have suggested that the trauma associated with historical and long-standing discrimination, such as systemic racism, can remain within an individual’s DNA and be passed down through generations.

Participants in studies have discussed how navigating the world as a Person of Color can be emotionally and mentally draining, considering the consistent need to advocate for oneself in social and professional settings, in addition to the consistent threat of violence, whether state-sanctioned or overlooked.

Dr. Nekeisha Hammond, author and psychologist with Hammond Psychology and Associates, speaks to this. “Having to deal with the perception that based on the color of your skin, there’s many, many people that are going to judge you. And I know that sounds very simple, but it really takes a toll.

“People at various points of their lives, different ages, different backgrounds — it really takes a toll when you have to constantly be thinking about a social interaction that just happened. ‘Was it because of the color of my skin, or was it because of something else?’”

Racial trauma and adolescence

Adverse Childhood Experience (ACE) scores have a direct correlation to the probability of suicidality and suicide attempts, according to a 2017 study. Considering this, children from neighborhoods with increased violence, poverty, and incarceration rates are more likely to engage in potentially unsafe behavior and have depressive symptoms.

The correlation of continued systematic segregation in our neighborhoods, the increased rate of policing in Black communities through mass incarceration, and ongoing racial trauma heavily impact Black children, which may affect their adulthood.

Though the specific ways symptoms of depression show up can vary from person to person, there are a few common signs, including:

  • loss of interest in activities
  • overall feelings of hopelessness
  • changes in sleep or appetite
  • thoughts of self-harm or suicide

Still, in the Black community, depression symptoms may manifest in additional ways, often due to the effects of racism and being part of a marginalized community.

Hammond describes how insomnia that comes with depression and its prevalence within Black people is centered around police brutality and race-based violence coupled with the continued expectation of “business as usual.”

“In the community, I’ve seen people really struggle with sleep, especially after the death of George Floyd and the inundation of the videos of murders and violence. People, specifically Black patients I’ve spoken with, have really struggled with sleep — with nightmares, can’t fall asleep, can’t stay asleep, can’t function at work. And sleep is very critical,” Hammond says.

Regarding the common issue of Black folks feeling like they must maintain “business as usual” despite events that significantly impact them, “There’s not a clinical term called ‘functional depression,’ but that’s what I call it,” Hammond says.

“It’s the people that you will see on social media, smiling, with the happy pictures. They’re still going to work or school and ‘functioning,’ but deep down, they are struggling emotionally,” she explains.

Self-isolation is an additional symptom of depression, and Hammond addresses its prevalence in the Black community.

Though stay-at-home orders during the COVID-19 pandemic were not self-imposed, they still negatively affected the mental health of many worldwide because of shifting routines and folks’ separation from support systems and leisurely activities during a time of extreme stress.

Also, isolation may have worsened peoples’ depression, which means that COVID-19 has served as a factor during this past year.

However, Hammond adds that the isolation she has seen is not solely connected to the COVID-19 pandemic but includes fear of police interaction and discrimination.

“When you constantly have to be in that mindset and to have to do that on a daily basis, it’s exhausting, and it can really lead to depression,” she says. “Dealing with the discrimination, dealing with the prejudice, dealing with the racism — it takes a toll.”

Prevalence of harmful tropes

Studies show that due to the stigma around masculinity and emotionality, men are less likely to receive treatment or seek help for depression.

Though depression is not a sign of weakness or femininity, symptoms of depression in men are usually anger, irritability, or the use of substances or alcohol to cope.

Still, rates of suicidality, or suicidal ideation, among men are high, and the rates of completed suicide attempts are higher for men than women due to the commonly chosen methods.

The societal pressures of masculinity and the consistent trauma of navigating the world as a Black person make it easy to understand why it can be difficult to discuss and treat depression within the Black community, namely with men.

Black women are also subject to undue pressure, as the “strong Black woman” trope prevails. A 2019 study addresses the ways this stereotype, derived from slavery and misogynoir, has led to an internalization of depressive symptoms within Black women.

This schema, or pattern of thought, has negatively influenced many of us in the realm of mental and emotional health, leading us to stifle our experiences and feelings for the sake of caring for and protecting our loved ones, often despite ourselves.

Though it may look different, this form of self-sacrifice and the internalized need to appear strong doesn’t apply only to Black women. According to a 2013 study, Black participants who identified as men and women were collectively not very open to accepting psychological diagnoses, with 63% believing mental illness is connected to weakness.

Hammond speaks to the ways that the mental health system itself has fallen short in supporting People of Color, especially during a time when there has been increased tension and depression due to the uprisings around George Floyd (among others) and the effects of COVID-19.

“A lot of my Black patients have felt less supported by the mental health system,” Hammond says. “There is plenty of research that shows there’s a lot of provider bias, and there’s lack of cultural competency in the field — which we’re very aware of.

“It is a challenge for people that identify as Black to receive the care that could be most helpful to them. There’s a huge discrepancy in the system with the amount of [Black] providers that are available,” she adds.

Finding the right therapist for you

For people in marginalized communities, finding a culturally sensitive counselor can make a huge difference and may make therapy more effective.

The following organizations may be a good first step to help you find a therapist who shares your identity or lived experiences:

Also, Psych Central has put together some guides to help you find, vet, and choose a suitable therapist:

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The role of faith

When it comes to the needed support for the Black community to thrive, adequate and accessible mental healthcare is a must, but alongside other pillars of the community, including the church.

Religion and spirituality have historically been integral to the inner workings of Black culture, whether rooted in Christianity, Islam, Hoodoo, or anything else. When it comes to the traditional understanding of Christianity, there has been a hesitance to approach topics labeled as uncomfortable, including mental health.

In a 2018 study, researchers concluded that due to the high percentage of Black folks (namely men) who seek out their religious leaders for guidance on personal issues, churches have a responsibility to their congregations to support seeking adequate mental healthcare.

Therapy in combination with prescription medications like selective serotonin reuptake inhibitors (SSRIs) is often the most effective approach for treating depression.

Still, there is no one-size-fits-all solution, and your treatment plan should be tailored to your individual needs. It may include:

By being open about your needs and wants, you and your treatment team can create a plan that works for you.

Wherever you start is OK!

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Hammond suggests leaning into the increased availability of telehealth if you’re new to seeking treatment.

“I’ve found that some individuals find it intimidating to go into a mental health professional’s office, make a phone call, and all that to start,” she says. “But some people have been a little less afraid of starting virtually because it can be in your house. You can be in pajamas but still get the help that you need.”

Wherever you are in your mental health journey, know that you can feel comfortable starting right there.

If you find that you need to start a step before making an appointment, virtual or in-person, Hammond suggests getting an accountability partner by finding folks in your circle who you know are pro-mental health and can aid you in sticking to your goals for self-care.

If you’re considering self-harm or suicide, you’re not alone

Help is available right now:

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Taneasha White (she/her) is a Black, Queer lover of words, inquisition, and community. She loves conversations around gender and sexuality, Black representation, and mental health, and is excited to continue that work with an intersectional approach as a staff writer with Psych Central. You can find some of Taneasha’s work in the mental health and wellness space, as well as pieces on activism and inclusion in Well + Good, Verywell, mindbodygreen, Asparagus Magazine, among others. Taneasha’s dedication to uplifting her community is also shown through her work in The Collab Spot, a QTPOC-focused community hub and co-working space in Richmond, Virginia, and the podcast Critiques for The Culture that she co-hosts. You can view more of Taneasha’s work on her website, including her current projects and creative nonfiction work.