Depression Assessment: Ethnic Minorities

Compared to non-Latino whites, racial and ethnic minorities are less likely to receive a diagnosis of depression.  However, when racial and ethnic minorities do receive a diagnosis of depression, they are much less likely to receive mental health treatment than are non-Latino whites.  For example, it is estimated that about 60% of non-Latino whites with a depression diagnosis receive mental health treatment whereas those estimates are much lower for racial and ethnic minorities—36% for Latinos, 31% for Asians, and 41% for Blacks. There is also evidence that racial and ethnic minorities are more likely to receive lower quality of care or to seek care in emergency rooms. This imbalance between racial and ethnic groups in rates of treatment is called a “disparity” and many clinicians and researchers are actively trying to understand the causes of these disparities and what special considerations might reduce these disparities.

Theories About the Causes of Differences in Depression Across Ethnicities and Races

There are several theories that attempt to explain why ethnic minorities are less likely to receive mental health treatment.  Some of the most common ideas are that disparities in mental health treatment are due to:

  • Social characteristics that are more common in racial and ethnic minorities such as income, insurance coverage, and education.  This can be especially true when lost pay from work prevents people from seeking treatment.
  • Cultural characteristics that frame mental health problems like depression as signs of “weakness” or problems to be dealt within the family only.
  • Cultural characteristics that causes variation in how depressive symptoms are presented such that physical symptoms are more commonly reported that mental health symptoms.
  • Provider characteristics such as low representation of racial and ethnic minorities in the mental health professions, assigning source of symptoms to stress in living instead of depression, and miscommunication.
  • Poor past experiences with healthcare services which can decrease trust.

Considerations for Treatment with Racial and Ethnic Minorities

Following the general treatment guidelines for depression is always a good place to start for both non-Latino whites and racial and ethnic minorities. However, if difficulties arise in encouraging a loved one to seek treatment and/or consider treatment options for depression, a logical place to start is to identify barriers, normalize reasons for declining treatment, and problem-solve strategies for overcoming barriers. For example, a common reason for not seeking treatment among racial and ethnic minorities is concern that white, middle- to upper-class therapists “don’t get it”.  A helpful response to this barrier might include normalizing the concern, “Yeah, I wouldn’t want to open to someone who doesn’t understand me either,” and identifying potential solutions such as finding a therapist of the same ethnicity or race, experimenting with 1 or 2 sessions before committing to a full course of treatment, or using self-help materials.  It may also be helpful to use words like “stress” and “support” other than “depression” or “psychotherapy”.  Finally, it can be helpful to find mental health professionals who have multicultural training, which is usually indicated on their website or can be asked prior to setting up any appointments.