Standard measurements predicting clinical depression not applicable across all races
Anyone can have symptoms of depression, but the measures used to predict a white person’s likelihood of exhibiting signs of clinical depression are not the same as those that should be used for people of color, according to recent University of Michigan research.
The study, published in Frontiers in Public Health, indicates that while a numerical count of depressive symptoms is enough to accurately predict the likelihood of whites having clinical depression in the future, this method is less of an accurate predictor for depression in Black individuals. Rather, self-rated health — or one’s own perception of their overall health — is a better indicator of future depressive symptoms for Black individuals.
“We expect count of depressive symptoms to be a very strong predictor of subsequent clinical disorders,” said Shervin Assari, psychiatric research investigator and lead author of the study. “But we found that that’s not the case for Blacks. If you count the number of symptoms and expect that number of symptoms to be a strong predictor of the disorder, which is the general belief, it’s only true for whites; it isn’t true for Blacks.”
Assari said this research is important because of the stigmas around mental health disorders in the United States for both races. Approximately 18.5 percent of adults in the United States experience mental health illnesses in a given year, according to the National Alliance on Mental Illness.
To explain the racially-dependant discrepancy in depression prediction, Assari noted that depression is treated differently among different races, and life circumstances, values, ways of coping and access to health care are different as well. He said he focuses on how the meaning of depression and sadness, as well as how people respond to certain screening items, such as “I am happy” or “I am hopeful” is affected by one’s culture.
“If you are a minority group, your definition of happiness, definition of joy, definition of being a good person differs in a society that has a structure of racism as a part of it,” Assari said. “The other issue is culture. The definition of self, culture, environment, the messages you get, the opportunities you have — all have implications for your expression of emotion.”
Michael Muhammad, research post-doctoral fellow in the School of Public Health, researches the development of new frameworks to clarify the ways racism is reproduced in modern society. He said many of the racial discrepancies in depression could result from structural racism, due to the social and cultural impact of European immigration.
“The intransigence of structural racism may be due to the failure to recognize majority group traditional values, culture and norms as forms of hegemony that support white racial privilege and status,” Muhammad said.
Julie Allen, graduate student research assistant in the School of Public Health, who focuses on the sources of stress in the lives of adult Black men, says that population reports a range of stressors, including some stemming from racism.
“Black men report a lot of the day-to-day stresses that a lot of people experience — being able to support their families, commuting, frankly, having too many demands on time …” Allen said. “But in addition to some of the stressors that are common across the population, they also report added stressors of being Black men in a racially stratified society.”
These stressors include being faced with negative stereotypes and microaggressions resulting from being both Black and being male, Allen said.
“It is challenging given that a lot of stressors that Black men are dealing with are these larger, social structural challenges,” Allen said. “From an individual standpoint, you can’t just fix it … Racism is not something people can deal with effectively on an individual level.”
Allen said, because of this, much of what is considered socially appropriate coping mechanisms for mental illness, such as counseling and medical attention, may not be able to provide races other than whites with the appropriate attention for their culture’s needs.
“In addition to there being a lot of stigma surrounding (mental health) issues, the appropriateness of providers providing services to Blacks and meeting their needs … may not be equipped to provide them with the support that is assumed to be appropriate,” Allen said.
Ultimately, just because there are factors that affect whites does not necessarily mean they may translate for Black individuals, Allen said.
“It certainly suggested … that indicators of signs of depression may mean different things based on race and ethnicity, and there’s also some other research that really suggest a lot of the mechanisms are different.”
Assari said the research can lead to improvements to the health care system for Black individuals.
“The finding of this research — that counting the number of symptoms doesn’t have the same level of information for Blacks — suggests there is a real need for finding better instruments, better screening tools for minorities, for Blacks who don’t have the level of access and trust to our health care system,” Assari said.