There are clear health disparities between Black and white Americans across many indicators, including mortality, disease, health behaviors, and self-rated health, but things are murkier when it comes to mental health. For instance, rates of depression among Blacks are similar or even lower than rates among whites. In a new study, Sirry Alang posits that this puzzling lack of a race gap owes to the diagnostic criteria used by practitioners and researchers. Alang believes the criteria are too narrow and better apply to racially and socioeconomically advantaged groups, thus underreporting rates of depression among African Americans.
Using ethnography and participant observation in an urban Midwestern neighborhood characterized by poverty, unemployment, and crime, Alang found that the meanings and expressions of depression among her participants did not often reflect clinical understandings of the disorder. Although the participants exhibited some classic symptoms of depression, such as feelings of hopelessness and worthlessness, they also expressed symptoms that would not be classified as depression according to commonly used diagnostic criteria. For example, depressed people exhibited rage, violent behavior, or an excessive, almost frantic need to socialize. These behaviors were seen by friends and family members as signs of depression—itself seen as a sign of weakness, that a person was not exhibiting proper strength or resilience. Depression was not considered a “real” illness that should be treated medically, but a series of personal failings to be hidden.
Alang concludes that reticence to seek treatment among low-income Blacks, combined with distinct patterns of expressing major depression, likely conceal rates of depression and the need for mental health services in disadvantaged urban neighborhoods. This study is a reminder to social scientists and clinicians alike that mental health needs to be understood in cultural context, accounting for norms, attitudes, and social statuses including race, class, and gender.