Black women display depression symptoms differently than other women, making it harder to diagnose. In this Well and Good article, Mindpath Health’s Kiana Shelton, LCSW, discusses why this happens and how to seek care.

Black Women Experience Less Obvious Signs of Depression_Kiana Shelton, LCSW_Mindpath Health

Depression is a mood disorder that doctors typically recognize when someone has feelings of sadness or hopelessness. While those symptoms ring true for many people, Black women may display depression symptoms differently than the ones many doctors use to diagnose depression—making it more difficult to diagnose. But the rates of depression in Black people are similar to those in other groups.

In fact, CDC data shows that 11% of Black people report that “everything feels like an effort” compared to around 7% of white people. And, although Black women, 4.7%, experience similar rates of psychological distress to white women, 4.8%, the former are less likely to seek help for depression and tend not to receive adequate care.

According to the 2022 study, Black women with depression were more likely to report physical symptoms such as fatigue and trouble sleeping, as well as emotional symptoms like irritability, self-blame, self-criticism, and an inability to experience pleasure. The researchers concluded that it’s possible for health care providers, who are trained to look for “traditional” symptoms like feeling worthless or losing interest in activities, to overlook depressive symptoms experienced by Black women.

Standard screening tools may not be “getting an accurate picture of Black women’s experiences because the majority of these measures are based on white people’s experiences,” says Amber Samuels, PhD, LGPC. Although researchers can’t apply the findings to all Black women, the study highlights the need for improved screening tools so that women can receive a proper diagnosis and treatment.

Adversity can wear down your mental and physical health

The study also touched on the concept of “biological weathering” to explain the depressive symptoms reported by Black women. “Biological weathering is frequent exposure to socioeconomic adversity, which over time can lead to harmful physical and mental health outcomes,” says Kiana Shelton, LCSW, with Mindpath Health. “This can create a pattern where they look inward to make sense of their experience since others aren’t validating their feelings.”

For example, if a Black woman is feeling “irritable” as opposed to sad and decides to seek help, a health care provider might encourage them to simply reduce their stress or seek treatment for anger, which could further invalidate their experience. This can accelerate the aging process, leaving you more vulnerable to chronic conditions like depression, heart disease, and diabetes.

You may not feel safe displaying or talking about certain emotions

A nationally representative survey found that Black people, 10.4%, are at a higher risk for depression than white people, 7.1%. Shelton explains, it’s not that Black women have an issue acknowledging when they’re feeling sad or hopeless. “Instead, they often struggle to feel safe expressing those feelings and having them validated,” she says. This “creates a space of distrust where you don’t feel like others will believe you,” she adds.

The stigma surrounding mental illness within the Black community may also play a role in why Black women might not feel safe disclosing their symptoms. “Black women are socialized to be strong when navigating challenges like racism and sexism,” says Samuels. So, you might think that seeking help makes you look weak or vulnerable.

Depression can manifest in physical symptoms

As noted in the study, depression can show up in the body as fatigue, insomnia, and decreased libido. One reason that Black women are more likely to report headaches and gastrointestinal issues is that these somatic symptoms tend to receive more attention and validation from clinicians, says Shelton. While we can’t technically see a stomachache, we can palpate someone’s stomach, notice where the pain is most intense, or ask about potential causes like having your period or eating certain foods.

Going to therapy can be a strength

Sometimes Black women are reluctant to seek therapy and delay reaching out until their symptoms are interfering with daily life. “The American medical establishment has a legacy of mistreating and harming Black Americans, so the high levels of mistrust make sense,” says Samuels. “But I want Black women to understand that you can be strong and go to therapy.”

Shelton agrees, adding that you “shouldn’t be afraid to ask for what you need or seek additional opinions.” She also recommends having healthy coping skills like setting boundaries, eating balanced meals, being around people you trust, and engaging in physical activity.

Being an ally doesn’t mean fixing the problem

“Instead of expecting your Black friends or colleagues to volunteer information about their mental health, challenge yourself to pay attention and check in on people around you,” says Samuels.

Remember when Black women share their struggles, they’re often met with “reminders of how strong they are,” says Shelton. “The best thing an ally can do is listen and ask how they can be of help.”

Read the full Well and Good article with sources. Want to learn more about your mental health? Visit our Patient Resources for articles, tips, and education from Mindpath Health’s expert clinicians.

Kiana Shelton, LCSW

Katy, TX

Kiana has over 12 years of experience working with adults. Using person-centered and trauma-informed modalities, Kiana helps patients navigate major life transitions, including birth, adoption, grief, and loss. In addition, she also provides gender-affirming mental health care to those who identify as part of the LGBTQIA+ community. Following Maya Angelou’s quote: “Still I rise,” Kiana uses this as a reminder ... Read Full Bio »

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