Depression etiology and diagnosis in African American adolescents

Depression in African-American Adolescents

Etiology of Depression

Mental illnesses like depression can be very difficult to diagnose or to recognize: There is no serum to test for when looking for depression. In some real if rather vague way, mental health is simply the absence of mental disorders. And in the reverse we define mental illness as the absence of mental health. The circularity of this definition is certainly confusing, but it reflects the real confusion over the range of what may be considered to be mentally "normal." This vagueness as to definition does not mean that the problem of mental illness and especially depression is not real: Indeed, the difficulty of identifying those with mental illness and so of providing prompt and appropriate treatment to them makes the need to do so more effectively all the more important (Grob, 1991, p. 13). The need to identify mental illness in - and so to treat it in - some populations is even greater than the needs of other populations because these populations are in general underserved in terms of the treatment of both physical and mental health. Among these are members of minority populations, who in addition to having less access to health care for economic reasons are often all the more in need of it because their minority status produces higher-then-usual levels of stress in their lives. This stress can either cause or exacerbate mental illness, especially depression.

In general, as Solomon (2002) suggests, we may view mental disorders as those states of mind that create either distress or a significant impairment in an important way of functioning. A wide range of mental conditions can cause either such distress or such a limitation in the ability to function; depression is simply one of these. Mental illness is, like physical illness, classified into a number of groups that reflect current knowledge both about what causes these conditions and what may be done to treat them. It should be noted that the standard classification of mental disorders is less exact than that afforded to physical disorders, where specific parasites can be identified. (We know without doubt what a tuberculosis bacillus looks like; we do not know how to recognize exactly what a human soul that is being damaged by depression looks like.)

There are two very widely used diagnostic tools to determine what mental illness may be affecting someone: mental health professionals in most countries follow the International Classification of Diseases (which is overseen by the World Health Organization). American mental health professionals use the Diagnostic and Statistical Manual (almost always called the DSM), which is updated and revised every few years as more research and clinical findings change our understanding of different mental illnesses. The causes of depression cited in the DMS-IV include both biological and possibly genetic causes as well as a range of environmental ones. In many individuals, depression is caused by an interaction between biological and environmental (both personal and general) factors.

According to both of these forms of classification, depression is categorized as an affective disorders, which means that it is one of the forms of mental illness in which the defining characteristic is a mood disturbance. The affective changes in depression is a feeling of sadness (which matches with the popular understanding of the disorder) but it is also marked by feelings of guilt, as well as helplessness and hopelessness. It is these last three that are at least as debilitating as the sadness itself.

Mental illness is far more common than many people realize, which makes it all the more important that we each be able to recognize it in others and be able to offer at least some help for the condition. It is impossible to know exactly how many people are afflicted with mental disorders. Certainly, we can gain some sense of the problem from the numbers of admissions to psychiatric facilities, but many, many people who suffer from mental illness never seek treatment. This may be especially true in minority populations in which there is prejudice in the community against being treated for such conditions as well as lack of good information about treatment possibilities (Hickey etal, 1996).

Socially Reactive Depression

One of the reasons that mental illness, and perhaps most especially depression, is so difficult to fight against is that it saps the person's very will to fight, as Yapko (1998) argues. While anyone would be frightened to be diagnosed with cancer, of course, for most people that initial fear is replaced (or at least supplemented) by anger, by a desire to defeat the disease that is trying to defeat one. Depression robs one of the ability to feel that necessary anger. One of the consequences of this fact is that far too few of those who are suffering from depression seek the treatment that they need. And one of the consequences of this is the fact that the incidence of depression in the population at large and to at least as great a degree in minority communities is greatly under-reported:

However, there are some firm figures:

Up to 15% of the U.S. population is likely to suffer from a mental disorder during the course of a year

At any given time, three percent of the U.S. population is under care for mental disorders

Currently in the United States, more patients in hospitals are receiving treatment for mental illness than for any one physical illness

The risk for developing depression is, over one's lifetime, one in ten (Jones, 1994, p. 202).

In minorities, depression can be triggered through the phenomenon of social reactivity. In other words, members of certain groups (children, women, racial minorities) often become depressed because they live in depressing conditions - marked by hopelessness, poverty, racism and other conditions often found in minority communities.

A reactive depression occurs when you develop many of the symptoms of depression in response to the stress of a major life problem, but they are not severe enough to be considered a major depression (http://www.psychologyinfo.com/depression/women.htm).

Reactive depression is frequently prompted by feelings of low self-esteem, which is a problem experienced by many African-Americans (as well as the members of other minority groups), especially during the years of adolescence, which brings its own issues of problematic self-esteem that for minorities may compound already existing self-esteem problems. Certainly some elements of depression lie in the brain chemistry of an individual; certainly other elements of depression lie in the particular experiences of an individual. But other aspects of depression lie in the general conditions that attend the lives of many Americans, and especially of minorities.

People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are more prone to depression. Psychologists often describe social learning factors as being significant in the development of depression, as well as other psychological problems. People learn both adaptive and maladaptive ways of managing stress and responding to life problems within their family, educational, social and work environments. These environmental factors influence psychological development, and the way people try to resolve problems when they occur....If a child grows up in a pessimistic environment, in which discouragement is common and encouragement is rare, that child will develop a vulnerability to depression as well (http://www.psychologyinfo.com/depression/causes.html).

Treatment of Depression Tied to Knowledge About the Disorder

The first step in treating depression is not unlike the first step in treating alcoholism: The person who is afflicted must admit that he or she is in fact in need of help. This is difficult for the alcoholic because he or she may want to avoid the dangers of alcohol but may not want to stop drinking. And it is difficult for the person suffering from depression because such an admission may simply take too much energy.

This is why the intervention of others may be essential to save the person suffering from depression. In many cases, the person best suited to do so may be a minister. This African-American Baptist minister who works with at-risk African-American youths in Kentucky talks about his own work with those who are suffering from mental illness.

I've found that some of the hardest people to help are those who have very serious cases of depression. The problem for them is that they do not have the energy to care about themselves anymore. They are suicidal not just in the sense that they are actively seeking death - and in fact some are while others are not - but because they are no longer connected sufficiently to life.

They have lost the sense of what it means to be fully human, and in my own understanding of the soul, that means that they have also lost sight of what God is. God lies within us, His divinity is a part of us. But people who are clinically depressed cannot see this. It is a form of blindness in them that we cannot blame them for.

They are like infants in this regard. We do not blame an infant for not understanding God's love. And so we must not blame those who are sick at heart. Instead, in addition to trying to help them we must also work to combat the social conditions that lead to such depression. If our young people thought that there would be good jobs for them when they grew up, then maybe they just wouldn't be so hopeless. They're not stupid: They see the conditions of their future all too clearly (Boyer, 2003).

Despite the fact that there are clear social and environmental elements to depression in African-American adolescents - who are responding to depressing environments and the virulence of racism by the rational if terrible reaction of depression. Reactive depression may well require professional treatment, but African-Americans are less likely than members of many other groups to seek treatment because of beliefs within African-American communities about the cause and nature of depression.

The following facts were taken from a National Mental Health Association survey on attitudes and beliefs about depression:

Almost two-thirds of African-Americans believe that depression results from "personal weakness," compared to the overall survey average of 54%.

Only 31% of African-Americans said they believed depression is a "health" problem that can be treated in the same way that other physical or mental health problems can be treated

Close to 30% of African-Americans said they were deal with depression by "handling it" themselves with another 20% said they would seek help for depression from friends and family.

African-Americans are less familiar with the signs that signal depression - such as changes in eating habits and sleeping patterns and increased irritability.

Only one-third of African-Americans said they would take medication described by their physicians for depression, if prescribed by a doctor; 69% of the general population would take such medication.

Almost two-thirds of African-Americans said they believe prayer and faith alone could successfully treat depression some or almost all of the time. While of course the power of faith should not be dismissed or belittled, reactive depression will continue to affect minority communities so long as the conditions in which minorities live and the acceptance that faith urges may even prolong the very conditions that are responsible for depression (after (http://www.nmha.org/ccd/support/africanamericanfact.cfm).

African-American adolescents - because of their race, youth and sometimes sex and gender - are uniquely at risk for depression, including reactive depression in which the conditions of their lives prompt them to respond to the conditions of their lives by withdrawing into depression. A better understanding of the connection between environment and depression for African-American adolescents can help provide the basis for better treatment for this at-risk group.