It was found that there was a significantly higher prevalence of depression in Black men when compared to the general population, with many factors involved. In addition, there is an issue of misdiagnosis, because there are culturally expressed Major Depressive Disorder (MDD) symptoms that many professionals overlook. These findings lead to the conclusion that there needs to be more awareness of these culturally expressed symptoms in order to avoid potential misdiagnoses. With the reduction of stigma around seeking professional help in regards to mental health, there would be more exposure to these culturally expressed symptoms and fewer cases of misdiagnoses.
In the United States, depression is one of the leading disabling psychiatric disorders that happen across all groups. However, studies have shown that there is a higher prevalence of depression in the African American population, especially African American men, compared to the general population. Though they are at a greater risk for depression, they are less likely to participate in mental health care and often differ in how their symptoms present leading to misdiagnoses. Their hesitance in seeking care when it comes to their mental health can be attributed to a number of things including, but not limited to, the stigmas that come with mental health, the expectations they feel they need to fulfill, as well as their socioeconomic position. It is also likely they refrain from seeking help because they have had or heard of negative care experiences when it comes to issues like this. The stigmas tied to mental health are nothing new, as society places a very negative label when it comes to the idea of mental health. Most of the stigma stems from lack of knowledge of the subject and from learned stereotypes that are seen in every day media. Depression often is seen as a personal weakness or just normal reactions to everyday occurrences. It is important to break free of those ideas, as it is a very serious issue and should not be overlooked. For men, they are expected to fulfill the definition of manhood, as it pertains to their family, neighborhood, the media, and general societal expectations. They feel the need to live up to what is expected of them and to stay strong, showing no weakness. In addition to the demanding expectations for their roles, they also deal with a lot of racism and discrimination throughout their lifetime which adds a lot of stress in their lives potentially being a factor in the onset of their depression.
Stigma
A well-known issue, depression is a subject considered to be taboo. A lot of people tend to equate depression to just sadness or general unhappiness in one’s life, something that can just be turned around with some positive thinking. This way of thinking has alienated people who are battling with the disease, whet
her they are aware of it or not. In the case of Black men, those with depression are often perceived as violent and dangerous, so people are more likely to avoid them (Plowden et. al., 2016). Because of this, the potential isolation and social deprivation is something they would rather avoid by never addressing the problems they have. They do not believe they have a problem because depression is something that is experienced by those without friends or have had traumatic events happen to them. If they lash out, it will most likely be attributed to them just being angry or it is a personality trait, rather than recognized as a very serious issue. Because these men do not want to address the issues they have, their symptoms may become worse and worse until it gets to a point that they cannot take it anymore.
Expectations
As a Black man in America, there are expectations that they have to live up to as a man, as a husband, as a son, as a father, as a friend. There are roles they must fill, and these are taught to them from a young age. In the family, they are expected to provide for their family financially and be a strong figure in the household. Through the media, they are expected to be strong and funny and talented in what they do. Not living up to these expectations may be a catalyst for stress and other depressive symptoms. They may try to take on these roles they are told to fill, without thinking about the limits of their abilities or about where their strengths lie. When asking for help, it may be seen as a sign of weakness or they may feel as though they are not enough for their family or friends. It can also be a barrier for them to seek care, as they do not deem themselves worthy of it.
Socioeconomics
Though there are those expectations to fulfill, Black men are more likely to be single or absent from the household, which can be very straining on their families and themselves. This makes it hard for families to have enough for their 
standard of living. Black men have been found to earn less than other racial groups in many different jobs. This can definitely be a factor in symptoms of depression because they are not earning enough, even while doing the same jobs as other people. They are also more likely to be unemployed, making them dependent on others to be able to provide for them while they are trying to find a way to provide for themselves. Not having the means also makes it hard for them to be able to seek help, as it is considered to be an extra expense they do not need to make.
Discrimination
As seen in recent events, Black men in America face a lot of racism and discrimination. They are judged on their external appearance, but not their internal value, so they do not get the opportunities that their White counterparts may get. Because of the harsh treatment they get or see others that look like them get; it is discouraging them from believing they have equal rights as everyone else. The stress from discrimination can very much attribute to depressive symptoms in the population. Simple activities like driving can be life-threatening to them because of what they have seen happen around them.
Healthcare Animosity
Discrimination is a huge barrier in these men seeking the help they need, because there is mistrust between them and the American health care system. It has been shown that some psychiatric nurses lack approp
riate cultural knowledge of African America clients, so it is harder for them to treat them appropriately. A study, done by Jennifer Payne, suggests that doctors in the United States have a less well-developed mental model of depression for Black patients compared to White patients (2012). It was shown that clinicians are more likely to attribute distress in Black patients to critical life events rather than depression. This showed more clinical uncertainty in diagnosing emotional problems and depression in Black men especially. This leads to more misdiagnoses and more mistrust between the patient and the psychiatrist. Because of this, it has been shown that they would rather go to their primary care physician rather than to a psychiatrist. They feel it is safer than going to a mental health facility, and therefore feel it would be more helpful to address their issues.
To solve a problem, there must be acknowledgement and acceptance that there is a problem. It has been seen that African Americans have less access to mental health care in the first place. With the access they do have, studies have shown that they are less likely to receive appropriate treatment. Doctors have a better sense of what depression looks like in a White patient than they do for a Black patient. African Americans with depression have shown differences in symptom expressions than their White counterparts. Some of these different symptoms are that they may be irritable or hostile, are less likely to verbalize their issues, are indifferent to activities, have a decreased appetite or increased weight loss, have difficulty staying asleep or falling asleep, or other increased physical symptoms. Because many health care professionals are not aware or well acquainted with these cultural differences, it can be hard to diagnose or treat the patients, leading to a culture of mistrust and self-consciousness from the patient. It would be very valuable for health care professionals to be more aware of these differences and possibly have more training in identifying these symptoms for the African American population.
Future Directions
Asking for help is difficult in a community that expects more independence, so it is important to know there are many different resources to cope with the depression. It has been shown that community venues such as barbershops, schools, or religious communities can serve as very helpful resources for people to give and gain support in their struggles. Church, especially, has been an initial source of support for African Americans dealing with depression, as they feel supported by that community in particular. It is a safer space for them, as they may not fear the judgment that comes with going to a primary care or mental health facility. Decreasing the stigma that comes with going to these places for help would be instrumental in the movement to better the mental health of the community, especially in regards to depression in the men in particular.
Sources
Payne, Jennifer S. “Influence of Race and Symptom Expression on Clinicians Depressive Disorder Identification in African American Men.” Journal of the Society for Social Work and Research, vol. 3, no. 3, 2012, pp. 162-177, http://du.idm.oclc.org/login?url=http://search.ebscohost.com.du.idm.oclc.org/login.aspx?direct=true&db=psyh&AN=2012-28309-001&site=ehost-live&scope=site, doi:10.5243/jsswr.2012.11 .
Plowden, K. O., Adams, L. T., & Wiley, D. (2016). Black and blue: Depression and African American men.
By: Amy Nguyen, University of Denver Student