Major Depressive Disorder Among African-Americans

Introduction

This chapter presents an overview of major depressive disorder and highlights the pathways that lead to African Americans being disproportionately affected. It discusses the social determinants of health among African Americans that lead to depression being underreported and undertreated in this demographic group. This discussion extends to reinforce once again how systemic racism “a pandemic in a pandemic” shapes the availability, quality, and use of mental healthcare access. The chapter concludes with a discussion of lessons learned and recommendations on how to aid in equitable and targeted interventions that are culturally relevant and attentive to the unique needs of this population.

Major depressive depression (MDD), frequently referred to as major depression, is a common but serious mood disorder, and the leading cause of disability globally (National Institute of Mental Health [NIMH], 2022; Yelton et al., 2022). It causes severe symptoms that affect “how you feel, think, and manage daily activities, such as sleeping, eating, or working that typically interrupts the ability to sleep, work, or perform additional daily tasks (Mayo Clinic, 2023; NIMH, 2022). In the United States, approximately twenty-one million adults, or 8.4% of the U.S. population have had at least one major depressive episode (NIMH, 2022). Although data on the exact burden of MDD remains ambiguous, those with the highest prevalence rates are women (10.5%), those aged 18-25 (17%), and who report having multiple (two or more) races (15.9%) (NIMH, 2022).

Accurate diagnosis of depression is crucial for also knowing disease burden and ensuring proper response and treatment. For clinicians to properly diagnose an individual with depression, symptoms must be present for at least two weeks. Symptoms include having persistently low or depressed mood, decreased interest in pleasurable activities (anhedonia), feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor retardation or agitation, sleep disturbances, or suicidal thoughts (Bains & Abdijadid, 2022). MDD is a clinical diagnosis and clinicians determine this through specific inquiries; they conduct a physical exam, draw lab tests (blood count, thyroid tests), do a psychiatric evaluation to assess thoughts, feelings, and behavior patterns in greater detail, and lastly, use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to identify depressive disorders (Mayo Clinic, 2023). To ensure accurate diagnosis, the DSM-5 guidelines published by the American Psychiatric Association (APA) stipulate that an individual must have five of the symptoms, one being a depressed mood or anhedonia causing social or occupational impairment (Bains & Abdijadid, 2022). These are important checkpoints to note as depressive symptoms can be secondary to other physical and mental disorders such as Parkinson’s, thyroid disorders, diabetes, schizophrenia or even taking medications that alter mood or behavior (Bains & Abdijadid, 2022).

The main cause of depression is not fully known, but causes are considered multifactorial and include a combination of biological, environmental, genetic, and or even psychological factors. For example, those who have lived through traumatic or stressful events, such as the death of a relative, physical, emotional, and or sexual abuse have an increased risk of depression. Likewise, experiencing a major life change such as financial loss (losing a job), a medical diagnosis or illness, taking certain medications, or using alcohol or drugs can all increase one’s risk for depression (Centers for Disease Control and Prevention [CDC], 2022).