About five years ago, researchers combed through housing projects in Philadelphia and three other large cities, probing the inner lives of young African Americans living there.
Now, from his office at the NYU McSilver Institute for Poverty Policy and Research, lead researcher Dr. Michael A. Lindsey hopes that what they found could affect classrooms around the country.
Surveying the young people for signs of depression, the researchers found that they expressed depressive symptoms differently from people of other ages and racial groups.
The result of this difference could be that school-age youths who need clinical treatment are not being identified, said Lindsey, executive director of the McSilver Institute.
In particular, he said, although depression is often associated with withdrawn behavior, depressed black youth, particularly males, are more likely to manifest it through aggressive behavior.
Lindsey hastens to add that he is not suggesting that schools ignore aggressive behavior: Students “need to be held to consequences,” he said.
But “what if instead of [immediately] suspending kids, we looked at the underlying reasons?” he said. “We can start earlier in the process.”
The researchers found other differences in the ways black adolescents discuss depressive symptoms, partly because the measurement scales were developed by assessing white adults.
The findings did not surprise Howard Stevenson, a professor of urban education at the Graduate School of Education at the University of Pennsylvania. “We tend to under-report depression for young people … for everybody,” he says. “We definitely do so with kids of color.”
Students demonstrating aggressive behavior “are more likely to be referred to juvenile justice rather than behavioral health,” he says.
It’s a high-stakes issue.
Suicide rates among African American children have doubled in the last two decades, while declining among white children.
Lindsey cites statistics indicating that:
Between 1993 and 2012, there was an 86 percent increase among black children, primarily males.
Black boys ages 5-11 are in the only age group where the rate of suicide among blacks is actually higher than rates among all youth racial and ethnic groups.
Seeds of depression
The likelihood of depression rises in youth who are exposed to substance abuse, violence, and poverty in environments such as urban public housing, said Wenhua Lu, an assistant professor of childhood studies at Rutgers University-Camden and a co-author of Lindsey’s study.
And the researchers noted that youths diagnosed with depression are six times as likely to commit suicide as other young people.
A shortage of behavioral health services is just one obstacle to dealing with depression in the African American community, Stevenson and others say.
They also cite the stigma that mental illness carries in some circles.
Previous research indicates that “African American youth do not recognize depression as a medical disease. … They view it as a concern that can be controlled through strong will and religious faith,” says Alfiee M. Breland-Noble, an associate professor of psychiatry at Georgetown University Medical Center.
Breland-Noble says that, in her work in clinics in three states, she would sometimes encounter children with depressive symptoms who told her, “My parents said, ‘Pray over it.’”
Her response is that “you have to do more than just pray. … If the brain is hurting, there’s a genetic component, there’s a chemical component.”
In her community work in Washington, D.C., Breland-Noble says, “I try to engage people before they have a formal diagnosis. … We’re trying to educate people as to what to look for.”
Depression and distortion
Ironically, says Stevenson, being depressed may make a person less likely to seek help. “One aspect of depression is distortion,” he says. “Not trusting people, not asking for help, creating a sense of hopelessness.”
But he also raises the question of “helping counselors become more culturally competent or perceptive,” particularly when they are dealing with someone with a different background from their own.
Stevenson co-wrote a 2006 research paper that states: “In general, minorities have less access to adequate mental and physical health care, are receiving poorer quality of mental health services and, in fact, are disadvantaged by having less plentiful and qualified culturally relevant and skilled clinicians to aid them in their emotional struggles.”
At Penn, Stevenson heads the Racial Empowerment Collaborative, a research and development program dealing with the intersection of race and behavioral health.
Riana Anderson, an associate of Stevenson’s in the collaborative, says it is unrealistic to deal with issues of diagnosing and treating depression in African American youth without dealing with race.
An assistant professor at the University of Southern California, Anderson says it is sobering for her to be interviewing a 13-year-old black youth and hear him talking about the possibility of “race wars.”
It’s impossible for a behavioral health clinician to deal with a client, she says, “if we’re not tapping into the same language.”