Why Overcoming Depression Can Be Harder If You're BIPOC

Depression is a main cause behind poor health outcomes, according to the World Health Organization (WHO). Current research suggests that a staggering 300 million people across the globe struggle with depression. While depression doesn't discriminate — it can happen to anyone, regardless of their age, gender identity, or race — marginalized racial groups feel the weight of this mood disorder the most. Recent studies reveal what many people already experientially know — black, indigenous, and people of color (BIPOC) are extremely affected by depression (via Everyday Health). 

Additionally, a report published by the Blue Cross Blue Shield Association in May 2022 showed that among Black and Hispanic populations, depression is more likely not to be diagnosed — and as a result, many in these communities don't receive the treatment they need. The causes of these racial disparities are multi-layered, resulting from a world and healthcare system deeply entrenched in racism. While anyone can have depression, BIPOC are hit the hardest and struggle to get back up due to racial inequities. The cycle is hard to break. Time and time again, science has linked racism to mental health disparities. As Wizdom Powell, chief social impact and diversity officer at Headspace Health and director of the Health Disparities Institute at UConn Health, stated in Everyday Health: "When white America catches a cold, all the other groups get the flu."

If you or someone you know needs help with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.

The fact that depression goes undiagnosed and untreated at much higher rates in BIPOC communities means that these groups of people are also more susceptible to developing complications from depression. Signs of someone struggling with depression without help or treatment can take on many forms. For example, they might become overweight, which could lead to diabetes, heart disease, or other health issues over time. Or they may struggle with panic attacks or anxiety. Some might turn to drugs or alcohol to cope. Other serious complications of depression include cutting or self-mutilation and suicidal thoughts, attempting suicide, or committing suicide (via My Med). 

The difficulties of depression go beyond the physical in intricate ways. Those struggling with depression are three times more likely to call in sick to work, and even more apt not to be able to hold a job at all (via Med Broadcast). The added financial burden of missing work or being unemployed can fuel stress and make healthcare unaffordable or unattainable, adding to the feelings of depression and further perpetuating the cycle. People suffering from depression also often have low self-esteem, which may affect their relationships with friends, family, coworkers, and loved ones, ultimately leading to feelings of isolation and loneliness.

If you or anyone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline​ by dialing 988 or by calling 1-800-273-TALK (8255)​.

Money: one of the largest causes of mental health issues and one of the biggest barriers to receiving mental healthcare. Some of the risk factors for developing depression include race, socioeconomic standing, and employment status (via Neuropsychiatric Disease and Treatment). In the U.S., Black and Hispanic people experience poverty far more than white people. Unsurprisingly, poverty and low-income are linked to mental struggles — Black people who live below the poverty line have a more than doubled chance of having psychological stress (via Everyday Health). And research has established that living in poverty is a barrier to mental healthcare. Mental healthcare, including therapy and medication, is expensive. If you're low-income or unemployed, treatment may not be an option. The top reason people across all racial groups do not utilize mental healthcare is a lack of health insurance or the high cost of care (via Bennett College). In 2020, more than 10% of Black people in America did not have health insurance.

BIPOC are more likely to experience poverty, and systemic racism is a key cause. One example is the Black-White wealth gap that exists due to historic and continuing discrimination in employment opportunities and mortgage eligibility, among other issues. According to the Center for American Progress, "From slavery to Jim Crow, from redlining to school segregation, and from mass incarceration to environmental racism, policies have consistently impeded or inhibited African Americans from having access to opportunities to realize the American dream."

Mental health stigma exists everywhere: For instance, you may have heard phrases like "boys don't cry," "suck it up," "you're being hysterical," or "just get over it." A stigma is formed when someone has a negative perception of an individual based on some particular quality about that person, such as that they have a mental illness (via Everyday Health). Stigma can also be self-made — someone with depression may feel ashamed or wrongly assume they should be able to control it or they're a failure (via Mayo Clinic). Misunderstandings and a lack of education are key factors behind the stigma.

The stigma of depression can stop anyone from seeking care, regardless of race. But some studies reveal that mental health stigma is heavily experienced in Black communities (via Medical News Today). Research has found that many Black people see depression as a sign of weakness, and that this stigma can stop those with depression from admitting they have mental health issues and seeking treatment. This type of mental health stigma is also seen in Hispanic and Latino communities, with many people avoiding talking about the topic of mental health problems in general because it's considered "taboo" (via Everyday Health). These stigmas stop people from getting the important help they need.

Let's state the obvious: Stress caused by racism increases the risk of depression. Stress and stressful life events have long been linked with depression (via Neuropsychiatric Disease and Treatment). And according to an analysis of almost 300 studies published between 1983 and 2013, racism was connected to mental health issues including depression, anxiety, psychological stress and other problems (per PLoS One). Indeed, Black people have a higher chance of experiencing depression due to racism (via Medical News Today). There are many ways BIPOC experience race-related stress, including personal experiences of discrimination or systemic racism, secondhand stories of racism (such as the murder of George Floyd), and micro-aggressions, just to name a few (via Chicago Psychotherapy). Over time, this chronic stress from racial discrimination can lead to hyper-vigilance — BIPOC who experience racism become conditioned to be on guard for future types of discrimination. Therefore, "BIPOC individuals in a systemically racist society are often continuously experiencing a heightened stress response — consciously or unconsciously — which has direct effects on both physical and psychological well-being over time," according to Chicago Psychotherapy. 

Chronic health conditions seemingly affect almost every aspect of life, depending on the condition. Arthritis can make everyday activities difficult, and cancer, heart disease, and diabetes can lead to life-threatening complications (via Department of Health). About a third of those with chronic health issues also have depression (via WebMD). A multitude of factors — including racial disparities in healthcare, but also issues of systemic racism like exposure to lead or toxins, living near air pollution, poverty, barriers to education, or unavailability of fresh foods — mean that BIPOC populations have higher rates of the kinds of chronic conditions that can be comorbid with depression (per WebMD). 

The chances of BIPOC developing a chronic health issue is as much as double that of a white person. These multi-layered factors, often referred to as social determinants of health, are to blame — not biology. "It's really important to make that distinction. We have no evidence that certain groups are biologically inclined to have more chronic disease. But what we do see are patterns by race and ethnicity," Natalia Linos, executive director of the FXB Center for Health and Human Rights at Harvard University, told WebMD. The weight of depression is heavy — but when you stack other chronic health conditions on top of it, the burden becomes compounded, as each illness comes with its own set of far-reaching physical, emotional, and financial side effects (via the National Institute of Mental Health). 

Poverty and hunger go hand in hand. As BIPOC face higher rates of low-income wages and unemployment, it becomes increasingly difficult to put food on the table (via Economic Policy Institute). Indeed, Black or Hispanic households face food insecurity at double the rate of white households, according to data from 2001 to 2016 (via Family and Community Health). The impacts of food insecurity on a family — especially one with children — include a higher risk of certain chronic health issues; depression in mothers in particular; and stunted development, behavioral issues, and lowered academic performance in children. According to a recent study, food insecurity dramatically increases — by a magnitude of about 250% — someone's chances of developing anxiety or depression (via BMC Public Health).

The term "food desert" describes an area that lacks access to high-quality and low-cost healthy food. Neighborhoods with a high number of minority groups are the most likely to be a food desert, according to 2012 report by the United States Department of Agriculture (USDA). Food deserts also tend to be areas with higher levels of poverty and less reliable public transportation.