Depression is a mood disorder that doctors typically recognize when someone has feelings of sadness or hopelessness. While those symptoms ring true for many people, Black women may display depression symptoms differently than the ones many doctors use to diagnose depression—making it more difficult to diagnose. But the rates of depression in Black people are similar to those in other groups.

In fact, CDC data shows that 11 percent of Black people report that “everything feels like an effort” compared to around 7 percent of white people. And, although Black women (4.7 percent ) experience similar rates of psychological distress to white women (4.8 percent), the former are less likely to seek help for depression and tend not to receive adequate care.

Now, a new study published in Nursing Research sheds light on these mental health disparities by examining depression symptoms among 227 Black women. The data were originally collected between 2015 and 2020 as part of the Intergenerational Blood Pressure Study. According to the 2022 study, Black women with depression were more likely to report physical symptoms such as fatigue and trouble sleeping, as well as emotional symptoms like irritability, self-blame, self-criticism, and an inability to experience pleasure. The researchers concluded that it’s possible for health-care providers, who are trained to look for “traditional” symptoms like feeling worthless or losing interest in activities, to overlook depressive symptoms experienced by Black women.

Standard screening tools may not be “getting an accurate picture of Black women’s experiences because the majority of these measures are based on white people’s experiences,” says Amber Samuels, PhD, LGPC, a Virginia-based therapist and adjunct professor at George Washington University. Although researchers can’t apply the findings to all Black women—the participants were young (aged 21 to 46) and had low levels of depression—the study highlights the need for improved screening tools so that women can receive a proper diagnosis and treatment.

Adversity can wear down your mental and physical health

The Nursing Research study also touched on the concept of “biological weathering” to explain the depressive symptoms reported by Black women. “Biological weathering is frequent exposure to socioeconomic adversity, which over time can lead to harmful physical and mental health outcomes,” says Kiana Shelton, LCSW, a licensed clinical social worker with Mindpath Health in Austin, Texas. “This can create a pattern where they look inward to make sense of their experience since others aren’t validating their feelings.”

For example, if a Black woman is feeling “irritable” as opposed to sad and decides to seek help, a health-care provider might encourage them to simply reduce their stress or seek treatment for anger, which could further invalidate their experience. Like plant roots that break through rocks over time, repeated exposure to stress can cause wear and tear on your body. This can accelerate the aging process, leaving you more vulnerable to chronic conditions like depression, heart disease, and diabetes.

You may not feel safe displaying or talking about certain emotions

A nationally representative survey of over 12,000 participants found that Black people (10.4 percent) are at a higher risk for depression than white people (7.1 percent). As Shelton explains, it’s not that Black women have an issue acknowledging when they’re feeling sad or hopeless. “Instead, they often struggle to feel safe expressing those feelings and having them validated,” she says. Imagine telling someone that you broke your arm, and their response is, “Are you sure your arm is hurting?” This “creates a space of distrust where you don’t feel like others will believe you,” she adds.

When Black women experience sadness alongside self-criticism and self-blame, they might engage in people-pleasing behaviors or accept responsibility for things outside of their control. For example, if you get passed over for a promotion at a company where none of the management positions are held by Black people, you might blame yourself for not working hard enough instead of acknowledging the role of discriminatory hiring practices.

The stigma surrounding mental illness within the Black community may also play a role in why Black women might not feel safe disclosing their symptoms. “America’s legacy of slavery and colonialism has led to continued emphasis on strength, perseverance, and survival among Black women,” says Dr. Samuels. “Black women are socialized to be strong when navigating challenges like racism and sexism.” So, you might think that seeking help makes you look weak or vulnerable.

Depression can manifest in physical symptoms

When diagnosing depression, therapists typically consult the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or DSM for short. “The signs and symptoms of mental disorders in the DSM are based on studies conducted almost exclusively with white men,” says Dr. Samuels. “There’s cultural bias throughout the DSM, so Black women’s experiences of depression can look different, leading to underdiagnosis and undertreatment.”

As noted in the Nursing Research study, depression can show up in the body as fatigue, insomnia, and decreased libido. One reason that Black women are more likely to report headaches and gastrointestinal issues is that these somatic symptoms tend to receive more attention and validation from clinicians, says Shelton. While we can’t technically see a stomachache, we can palpate someone’s stomach, notice where the pain is most intense, or ask about potential causes like having your period or eating certain foods.

With depression, we can’t just feel around and locate the source of someone’s pain. “For Black women, depression showing up as somatic issues makes their pain valid, even if the initial source was related to mental health,” says Shelton. “Clinically, what we’re noticing is how Black women have found a way to be seen when their words are not enough.”

Going to therapy can be a strength

Sometimes Black women are reluctant to seek therapy and delay reaching out until their symptoms are interfering with daily life. “The American medical establishment has a legacy of mistreating and harming Black Americans, so the high levels of mistrust make sense,” says Dr. Samuels. “But I want Black women to understand that you can be strong and go to therapy.”

To find a Black woman therapist, you can search the national directory at Therapy for Black Girls or locate a provider who specializes in treating depression on Psychology Today or Inclusive Therapists. An important step in seeking culturally competent care is asking a provider the following questions:

• What communities of color have you worked with?
• Have you treated Black women before?
• What training in cultural competence do you have for Black mental health?
• How do you see our cultural backgrounds influencing the therapeutic process and relationship?”

Shelton agrees, adding that you “shouldn’t be afraid to ask for what you need or seek additional opinions.” She also recommends having healthy coping skills like setting boundaries, eating balanced meals, being around people you trust, and engaging in physical activity.

Being an ally doesn’t mean fixing the problem

Since Black women tend to be self-critical, as noted in the Nursing Research study, you can “be supportive as an ally by criticizing less and providing positive feedback,” says Dr. Samuels. “Instead of expecting your Black friends or colleagues to volunteer information about their mental health, challenge yourself to pay attention and check in on people around you.” Learn about the symptoms of depression so you can understand what they’re going through and if they need any accommodations at work.

Remember when Black women share their struggles, they’re often met with “reminders of how strong they are,” says Shelton. “The best thing an ally can do is listen and ask how they can be of help.” Depression can be isolating, so it’s essential to have a community you can lean on whether it’s friends, family, pets, church, or an online support group.

This story is a part of Black [Well] Being, examining the state of Black health and well-being in the U.S.—and those working to change outcomes for the better. Click here to read more.