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Respected experts from various fields have documented the devastating effect systemic racism has on myriad aspects of modern life, including child development, educational progress, physical health, housing, and economic well-being and mental health disorders like depression.

In the past few years, several studies explored how systemic or institutionalized racism impacts the mental health of members of minority communities.

Research examining the mental health impact of racism reveals associations to an elevated risk for a variety of psychological concerns. These include anxiety, depression, post-traumatic stress disorder (PTSD), psychosis, and schizophrenia.

This article focuses on the relationship between exposure to racism and an increased risk of depression. We also address documented racial disparities in the diagnosis and treatment of major depressive disorder.

What Is Systemic Racism?

Individual acts of bias and discrimination can, of course, have a powerful negative effect on the victim. But when discriminatory practices become part social and cultural norms – i.e, structural – the harm they inflict increases exponentially.

The Jim Crow laws prevalent from the late 1800s through the mid-1900s are perhaps the most obvious recent examples of systemic or institutional racism in the United States. However, the dismantling of these laws in the 1960s did not solve the problem.

Redlining (a process of preventing individuals and families of color from buying houses in certain neighborhoods) and racial gerrymandering (intentionally designing voting districts to dilute the political power of minority communities) still remain. These are examples of modern-day systemic racism.

Systemic Racism and Depression Among Students

In September 2022, the journal SSM Population Health published a study that explored the relationship between structural and systemic racism in schools and depression among adolescents:

  • This study included information from 13,364 students (ages 11-21). Researchers collected data from the National Longitudinal Study of Adolescent to Adult Health.
  • All students self-identified as either Non-Hispanic White or Non-Hispanic Black.
  • Researchers assessed mental health with questions from the Center for Epidemiologic Studies Depression Scale (CES-D).
  • Researchers measure the degree of exposure to discrimination with the school contextual disadvantage index (CDI) and the school structural racism index (SRI).

The study team reached the following conclusions:

  • Black students had double the likelihood of attending CDI schools, compared to White students.
  • In schools with increased CDI scores, students of all races and genders exhibited elevated levels of depression.
  • The greatest increase in depression appeared among Black female students.
  • For Black female students, moving from a school with low disadvantage to a school with high disadvantage correlated with a two point increase in depressive symptoms as scored on the CES-D.

The research team reached the following conclusion:

“These findings underscore the importance of measuring structural racism in social contexts in multifaceted ways to study life course health inequities.”

The Long-Term Effects of Early Exposure to Discrimination

Eight months before the SSM Population Health study appeared, the Journal of Urban Health published research on the long-term impact of early exposure to systemic racism on depression:

  • This research involved a survey of 1,612 Black women living in or near Detroit, Michigan.
  • Participants answered questions about their experiences with racism during two periods of their lives: before and after age 20.
  • Researchers used questions from the “past experiences of racism” subscale of the Telephone-administered Perceived Racism Scale (TPRS).
  • Researchers used a shortened version of the CES-D to assess levels of depression.

An analysis of the data collected during this study yielded the following findings:

  • Black women reporting high frequency racism prior to age 20 showed elevated risk of more depressive symptoms as scored by the CES-D.
  • Women reporting higher levels of associated stress as a result of exposure to racism prior to age 20 showed a higher likelihood of depression.
  • Women reporting both high frequency racism and higher levels of associated stress prior to age 20 showed the highest risk of severe depression.
  • Social support received as adults did not improve depressive symptoms.

While the two studies above focused on children, adolescents, and young adults, research also demonstrates the depressive effects of perceived discrimination can endure throughout life.

Discrimination and Depression Among Older Adults

In 2015, the journal Experimental Aging Research published a study on the connection between discrimination and depression in older Black adults:

  • Researchers used data collected from 487 Black adults ages 60-98 via the Minority Aging Research Study (MARS).
  • The research team assessed exposure to discrimination with the Everyday Discrimination Scale (EDS).
  • Researchers assessed depression with the CES-D.

The subjects also completed questionnaires that measured their resilience, sense of purpose in life, social isolation/loneliness, and social network. This allowed the researchers to determine if the link between perceived discrimination and depression could be affected by certain psychological or social influences.

Here’s what they found:

  • Every unit increase on the EDS scale increased the likelihood of increased depressive symptoms 20%.
  • The researchers found no link between perceived depression and symptoms of depression and age, gender, income, or education.
  • The association between discrimination and depression aligned with several prior studies involving younger people.

In addition to further cementing the link between racism and depression, this study also supported prior findings about the inability of so-called protective factors to disrupt this link.

“None of the personal and social resources – resilience, social isolation, purpose in life, or social networks – modified the robust association of discrimination and depressive symptoms,” the researchers wrote.

“The results suggest that social and psychological resources, at least the ones measured in this study, do not influence the relationship between discrimination and depressive symptoms in older African Americans as previous studies have suggested,” they added.

The Impact of Systemic Racism on Depression Treatment

Unfortunately, the effect of racism on depression isn’t limited to an increased risk among certain demographic groups. As detailed in a May 2022 Blue Cross Blue Shield report, distinct racial disparities exist in both the diagnosis and treatment of depressive disorders.

For example, leading organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Centers for Disease Control and Prevention (CDC) have found that the rate of depression among Black and Hispanic individuals is equal to or greater than the prevalence of this disorder among White people.

However, diagnoses of major depressive disorder (MDD) are much more common within predominantly White communities than in communities where Black or Hispanic residents are the majority.

Trends in Depression by Race/Ethnicity

  • In 2020, 8.9% of people in majority White communities reported diagnosis of MDD.
  • Over the same 12-month period, the rate of MDD diagnoses in majority Black communities was 6.1%. This represents a 31% drop in diagnoses when compared to predominantly White communities.
  • In majority Hispanic communities, MDD was diagnosed at a rate of 5.4%, which is 39% lower than the rate in predominantly White communities.

This is not meant to imply that intentional acts of racism are completely responsible for these differences. However, factors such as access to care, social stigma, and unconscious bias among treatment professionals (all of which can be tied back to structural racism) have certainly contributed to this problem.

What Can We Do?

Changing just one of these factors can lead to dramatic improvements. For example, BCBS data revealed that when the number of behavioral healthcare providers within a community rises from seven or fewer to eight or more, the rate of MDD diagnoses increases by 20 percent in majority Hispanic communities and 16 percent in predominantly Black communities.

Sadly, even among people who have been diagnosed with major depressive disorder, there are clear racial disparities in treatment. The Blue Cross Blue Shield report included the following statistics about depression treatment among members of predominantly White, Black, and Hispanic communities:

  • The rate at which MDD patients are prescribed medication to treat their depression is 13% lower in majority Black communities and 33% lower in predominantly Hispanic communities than in communities where White residents are the majority.
  • The frequency of therapy appointments is higher in predominantly White communities (an average of 11.3 sessions per patient) than in Hispanic (10.1) and Black (9.7) communities.

Reversing the influence of systemic racism on the prevalence, diagnoses, and treatment of depressive disorders is a complex challenge. As the authors of the BCBS report noted, understanding the scope of the problem can be a step toward improving the lives of those who have been – and continue to be – negatively affected.

“Our findings on the disparities in diagnosis and treatment of major depression suggest significant under-diagnosis and unnecessary suffering,” they wrote. “Gaining a better understanding of the extent and the drivers of these disparities is critical for achieving more equitable care. So, too, is an unwavering commitment to action.”