5.Ward, Earlise C., Jacqueline Wiltshire, Michelle A. Detry, and Roger L. Brown, 2013. “African American Men and Women’s Attitude Toward Mental Illness, Perceptions Of Stigma, And Preferred Coping Behaviors.” Nursing Research (62), 3:185–194. doi.org/10.1097/nnr.0b013e31827bf533.
6.Lewis, Tamika. 2021. “Black Women and Depression.” WOC Therapy. woctherapy.com/black-women-and-depression.
chapter 3
the prevalence
of mental illness
in the Black
community
“Mental Health is our ‘silent’ crisis. There is no shame in speaking out and seeking help.”
—Viola Davis
In the shadowy recesses of our society, where oppression and inequality often reside, lies an issue of profound significance—the prevalence of mental health disorders in Black women. This issue, neither whispered nor silent, but rather a cry that echoes through generations, speaks to the injustices experienced by an oft-marginalized community that resides in the intersectionality between race and gender. Specifically, major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) serve as haunting refrains within this narrative.
Major depressive disorder, a dark fog that settles on the soul, manifests with particular intensity in Black women. Research demonstrates that they experience this disorder at a rate 50 percent higher than their white female counterparts.7 Here, MDD is not merely a collection of symptoms, but a story woven through the fabric of lives. It tells a tale of inequality, discrimination, and a lack of access to quality mental health care.
In Black women, the symptoms of MDD often paint a more acute and sorrowful picture. The typical symptoms, such as persistent sadness, loss of interest in once-loved activities, and changes in appetite and sleep patterns, merge with an often-heightened sense of worthlessness and hopelessness.8 These emotional caverns are deeper, wider, and more difficult to traverse.
Why this increased prevalence? Why these more profound manifestations? The answer is neither simple nor singular, but a mosaic crafted from various elements.
First, through the historical lens, the legacy of slavery, segregation, and discrimination has left scars that continue to ache. The collective memory of pain and subjugation forms the background against which individual suffering plays out. The echoes of a wounded past reverberate in the psyche, creating an environment ripe for the growth of MDD.
Generational trauma and racism, these ancient and insidious foes, have cast a somber pall on the hearts and minds of Black women. Together, they weave a tale of sorrow, where echoes of the past resonate in the present, shaping the very fabric of the soul. Their influence on the increased incidence of major depressive disorder (MDD) in Black women is profound, complex, and deserving of thoughtful exploration.
In the depths of generational trauma lies the history of a people. Slavery, discrimination, violence—these are not merely chapters in a history book, but wounds carried in the very DNA, passed down from generation to generation. It is a pain not easily forgotten, an ache that continues to reverberate, altering perceptions, attitudes, and emotional well-being.
This trauma molds the mind into a fortress, with thick walls built to protect while simultaneously imprisoning. Inside these walls, despair festers, nurturing the seeds of MDD. These emotional scars shape the way Black women perceive the world and themselves, leading to a sense of hopelessness and worthlessness that finds its manifestation in depression.
Racism—the relentless and pervasive storm—adds to this melancholy narrative. It is the cold wind that chills the soul and the rain that seeps into the bones. In the daily lives of Black women, racism is often an uninvited companion, shaping experiences, limiting opportunities, and draining the spirit.
The subtle and overt expressions of racism, whether in the workplace, healthcare system, or social interactions, pile up like stones, heavy and unyielding. These stones press on the heart and soul, creating an environment where MDD can flourish. It is a garden where the thorns of prejudice and discrimination overshadow the flowers of happiness and self-worth as they struggle to bloom.
Racism is not just an external force; it permeates the psyche, altering self-perception and self-worth. It’s a distorted mirror reflecting a world that often devalues and diminishes the identity and experiences of Black women. This altered reflection can lead to a profound sense of isolation and despair, feeding the vicious cycle of MDD.
Moreover, the mental health of Black women has been profoundly affected by various unfair laws and practices that have emerged and persisted throughout history. These discriminatory policies have not only limited opportunities and access to vital resources, but have also created chronic stressors that can lead to mental health conditions like anxiety, depression, and major depressive disorder (MDD).
One of the primary causes of fatigue, particularly in recent years, has been the high incidence of housing discrimination. This often manifests in a practice known as redlining, where banks and insurance companies refuse or limit loans, mortgages, and insurance within specific geographic areas that predominantly affect Black communities. As a result, many Black women have been forced to live in underfunded and neglected neighborhoods, impacting their mental well-being through increased stress, reduced access to healthcare, and diminished educational opportunities. Unfair rental practices also lead to discrimination in housing rentals and have limited Black women’s ability to move into safer and more prosperous neighborhoods, reinforcing cycles of poverty and contributing to feelings of hopelessness and depression.
An additional burden presents itself for Black women in the form of employment discrimination. They have historically been paid less than their white counterparts for the same work. In the United States, Black women typically earned only a fraction of what white men earned for similar work. According to data from the US Census Bureau and other sources, Black women, on average, earned approximately sixty-one to sixty-three cents for every dollar earned by white, non-Hispanic men. This gap seems even larger when you consider the earnings of white women. While they earn more than Black women, they face their own wage gap relative to white men.
Several factors contribute to this wage gap, including occupational segregation (being concentrated in lower-paying jobs), differences in educational attainment, and direct discrimination in hiring, promotions, and pay. The gap is often even wider for older Black women and those in higher-paying occupations and industries.9
The wage gap’s persistence reflects broader systemic inequalities, and has tangible impacts on the economic security and overall well-being of Black women and their families. These financial disparities can also contribute to stress and other mental health issues, further highlighting the need for comprehensive efforts to understand and address the underlying causes of the wage gap. This wage disparity not only affects economic stability, but also creates feelings of injustice, chronic stress, and anxiety. For those who need additional resources and support due to these disparities, the results can be even more bleak. Some policies have made it harder for Black women to access public assistance.10 This creates barriers to essential resources like food, housing, and healthcare. Such limitations also contribute to chronic stress and anxiety, amplifying mental health challenges.
For Black women who do ascend onto the leadership track in corporate America, there is also a “glass ceiling.” And more recently, studies show they are also encountering a “glass cliff.” The term describes the barriers Black women and other people of color face to advancing in the workplace. Research shows that women and people of color are more likely to be appointed to poorly performing companies than white males.11 Limitations on promotions and career advancement contribute to feelings of frustration and worthlessness, which may lead to MDD.
In addition, Black women often experience disparities in healthcare access and treatment. Implicit biases within the healthcare system can lead to misdiagnosis, undertreatment, or a lack of access to mental health services, further exacerbating mental health conditions. Black women in the United States also suffer disproportionately from maternal mortality. According to the Centers for Disease Control (CDC), Black women are three times more likely to die from a pregnancy-related cause than white women. Multiple factors contribute to these disparities, such as variation in quality healthcare, underlying chronic conditions, structural racism, and racial prejudice.12 The fear, grief, and stress associated with this can have long-lasting mental health impacts.
For Black women who grew up in predominantly Black neighborhoods, predominantly Black schools often receive fewer resources. Lack of access to quality education not only limits economic opportunities, but also contributes to feelings of marginalization and hopelessness, potentially leading to mental health issues. Predominantly Black neighborhoods are also statistically more likely to be heavily policed, which leads to a higher likelihood of Black people being stopped, arrested, convicted, and sentenced, and of receiving longer sentences than their white counterparts.13 The disproportionate arrest and incarceration of Black individuals affects Black women both directly and indirectly. Those who are incarcerated face trauma and mental health challenges, while those with incarcerated family members experience stress, financial hardship, and emotional strain.
It might appear that the solution to many of these challenges is for Black women to become more civically involved by voting. However, according to the League of Women Voters, Black women have played pivotal roles in voter mobilization and voter turnout for years. More than two-thirds of Black women turned out to vote in the 2020 presidential election—the third highest rate of any race or gender group.14 In addition, laws that disproportionately affect Black communities’ ability to vote15 can lead to feelings of disenfranchisement and powerlessness, contributing to broader feelings of marginalization and despair. Studies show that a higher rate of felony voter disenfranchisement in the Black community is also likely to have consequences for population health and overall health equity.16
The cumulative effect of these unfair laws and practices is a complex web of disadvantage, discrimination, and despair. They create an environment where mental health issues can flourish and access to help is limited or nonexistent. By recognizing and addressing these systemic barriers, society can create a pathway toward mental wellness, social justice, and equality for Black women. And for Black women, part of the individual path to healing should involve acknowledgment of how much these laws affect them in the society they navigate. The resulting impact on the mental health and emotional well-being of Black women should not be understated.
The dance between generational trauma and racism is a complex and sorrowful waltz. Together, they craft an environment rife with stressors that is uniquely positioned to foster MDD. They entwine, one feeding the other, in a symbiotic relationship that fuels depression. Yet, understanding this relationship and recognizing the profound ways in which generational trauma and racism impact the mental health of Black women is the first step toward healing. It’s the dawning light that can pierce the shadow in a search for understanding for Black women to heal themselves.
This understanding calls for empathy, compassion, and action. It calls for a mental health care system that acknowledges these unique challenges and provides culturally sensitive treatment. It calls for societal change where the roots of racism are confronted and the echoes of generational trauma are met with empathy and support. It also calls for Black women to empower themselves with more knowledge of the benefits of mental health treatment in conjunction with ancestral and communal methods for self-care.
Next is the societal stage. Systemic racism and inequality continue to impact the lives of Black women, molding their daily existence into a crucible of stress and adversity. Unequal access to healthcare, education, and economic opportunities feeds the roots of depression. Societal judgment, often misunderstood or dismissed, builds walls around the soul, leaving many Black women isolated in their struggle.
Furthermore, the intersectionality of gender and race compounds these challenges. Black women bear the dual burden of racism and sexism, an intersection where oppression multiplies. Their identities as women have an impact on their experiences, in addition to the color of their skin. The societal expectations and roles assigned to them often lead to a complex array of emotional challenges, giving MDD fertile ground to take root.
Kimberlé Crenshaw, a scholar and civil rights advocate, introduced the term “intersectionality” in the late 1980s. Her groundbreaking concept has illuminated our understanding of identity, discrimination, and social dynamics, particularly in the lives of Black women. Through the lens of intersectionality, we gain an in-depth view of how various aspects of identity interconnect and compound, shaping daily experiences and mental well-being.
Crenshaw’s definition of intersectionality recognizes that individuals don’t exist within a single categorization but rather at the nexus of various social identities, such as race, gender, class, and sexuality.17 It is the intersection of these factors that creates a unique and complex web of experiences. These intersections don’t simply add to one another, but often multiply, creating amplified, multifaceted forms of discrimination.
Intersectionality, a concept as complex and multi-layered as the human experience it seeks to define, emerges as a critical framework to understand the unique struggles of Black women, particularly in relation to major depressive disorder (MDD). It’s a prism through which the overlapping identities—race, gender, and class—refract, creating a spectrum of experiences that transcends the sum of its parts. Within this kaleidoscopic perspective, the intricate relationship between intersectionality and MDD in Black women unfolds like an intricate puzzle, riddled with challenges, yet filled with insight.
Black women stand at the crossroads of identities, where the paths of race and gender converge. These are not mere lines on a chart, but dynamic forces that shape lives, mold perceptions, and exert pressure. They form a complex intersection where experiences are amplified and vulnerabilities are heightened.
