Health care providers may overlook symptoms of depression in black women, study finds

Black women with symptoms of depression are more likely to report trouble sleeping, self-criticism and irritability than stereotypical symptoms like depressed mood, according to a new study led by researchers at NYU Rory Meyers College of Nursing and Columbia University School of Nursing.

“Based on our findings, it is possible that health care providers are overlooking symptoms of depression in black women, leading to underdiagnosis and undertreatment,” said Nicole Perez, PhD, RN, psychiatric and mental health nurse and postdoctoral researcher at NYU Rory Meyers College of Nursing and Lead author of study published in nursing research.

Depression is diagnosed based on symptoms that patients report during an examination by a healthcare provider. Common symptoms include a bad mood, loss of interest in activities, problems eating or sleeping, and feelings of hopelessness or worthlessness.

But the symptoms of depression can vary from person to person — and there are more than 1,500 possible combinations of symptoms that meet criteria for a depressive disorder, meaning patients can have the same diagnosis and not have any symptoms in common. As a result, depression is often overlooked and undertreated.

Additionally, research exploring variations in depression symptoms has been overwhelmingly conducted in white people, increasing the likelihood that depression in racial and ethnic minorities will be overlooked.

That nursing research The study aimed to fill this research gap by examining differences in depression symptoms among black women, an understudied population despite an increased risk of depression. The researchers analyzed data from 227 black women who were part of the Intergenerational Impact of Psychological and Genetic Factors on Blood Pressure (InterGEN) study, a study of black mothers and children that attempts to understand the genetic, psychological, and environmental relationships Factors that contribute to high blood pressure have been studied for depression.

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Black women in the study with greater depressive symptoms were more likely to report somatic symptoms (e.g., fatigue, insomnia, decreased libido) and self-critical symptoms (e.g., self-loathing, self-blame) than stereotypical symptoms of depression, such as feelings of hopelessness or depressed mood. They also reported anhedonia (inability to feel pleasure) and irritability.

While the researchers warn that the results cannot be generalized to all Black women, their findings highlight the heterogeneity of depression symptoms and the need for screening tools that account for this variation, given that study participants were younger and had relatively little depression. In particular, in clinical practice, the symptoms experienced by Black women may not be adequately assessed using standard screening tools, particularly those that focus on feeling depressed without addressing somatic and self-critical symptoms.

I hope these findings add to the growing conversation about how depression can appear differently from person to person and raise awareness of the need for more research in historically underrepresented and marginalized populations so we can better identify symptoms and reduce missed treatments and health disparities.”

Nicole Perez, PhD, RN, psychiatric and mental health nurse and postdoctoral fellow at NYU’s Rory Meyers College of Nursing

Jacquelyn Taylor of the Columbia University School of Nursing and Center for Research on People of Color, the nursing research Lead author of the study, co-led the InterGEN study with Cindy Crusto of the Yale School of Medicine and the University of Pretoria. Additional study authors include Gail D’Eramo Melkus, Fay Wright, and Gary Yu of NYU Meyers; Allison Vorderstrasse of the University of Massachusetts Amherst; and Yan Sun of Emory University School of Public Health. The research was supported by the National Institutes of Health (R01NR013520 and TL1TR001447).

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