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Are the current methods for diagnosing depression racist?


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Photo: Stocksy/Michela Ravasio

Despite the strides we’ve made in understanding mental illness—its causes, pervasiveness, and effects—we still have much to learn. The symptoms and their severity vary from person to person, and some people remain undiagnosed for their entire lives. According to a new study, not getting diagnosed, and consequently treated, is disproportionately common for black adolescents, since the standard diagnostic tests for depression specifically cater to the white experience.

The study, published in the Journal of the Society for Social Work and Researchfocused on a common test used in depression screenings—called the Center for Epidemiologic Studies Depression Scale (CES-D)—to examine its effectiveness in diagnosing black youth who live in public housing. After analyzing results from nearly 800 black teens aged between 11 and 21 from four United States cities, the study found that CES-D was not as effective in detecting the presence of depression for the demographic.

The CES-D and similar screening tests “were developed by studying middle-class white women, so the language that was chosen represents that cultural experience.” —Sean Joe, PhD, a professor at Washington University in St. Louis

Sean Joe, PhD, a professor at Washington University in St. Louis, told Tonic that the problem may stem from the fact that the CES-D, as well as similar screening tests, “were developed by studying middle-class white women, so the language that was chosen represents that cultural experience.” Those tests typically categorize how people express depression in four sectors: feeling sadness, experiencing interpersonal problems, experiencing aggression from others, and physical symptoms, like a diminished appetite. But researchers argue that how black adolescents report symptoms doesn’t fit that model—the participants tended to complain of physical pain and interpersonal problems but didn’t explicitly divulge feeling sadness.

The statistics on depression and suicide reflect this disparity. Tonic pointed out that though national surveys consistently register low levels of depression among black Americans, suicide is now the third leading cause of death for black Americans ages 15 to 25. Suicide rates among black children ages 5 to 11 have almost doubled from one time period (1993–97) to the next (2008–12), while the suicide rate for white children fell.

Understanding the biases permeating the systems in place will hopefully be the first step in creating mental-health diagnostics that are more inclusive of the whole spectrum of American lives.

If someone close to you suffers from depression, here are some ways to help them and why you should advise against the depression nap.

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