Your genes, lifestyle, and overall health impact how you respond to mental health medication, but the disparities go further. Researchers found that socioeconomic factors play a big part in treatment-resistant depression (TRD) diagnosis and treatment.
Compared to those with more social and economic advantages, you have worse mental health outcomes when you have poor socioeconomic status, as experienced by many marginalized racial and ethnic minority groups.
The good news is there are a growing number of treatments that work well against difficult forms of depression. Understanding socioeconomic factors is key to addressing the disparities that come associated with managing TRD in Black and Hispanic populations.
How Do Socioeconomic Factors Affect Access to Depression Treatment?
Many people recover from TRD through a mix of medication, talk therapy, and other treatments. But it can take time and effort to find the right way to manage your symptoms.
You’ll need to work with your regular doctor, psychiatrist, or therapist to manage TRD. If you’re Black or Hispanic, you’re less likely to have access to health insurance and mental health care services.
In addition to low insurance rates, you may not get proper depression treatment if you don’t:
- Have reliable transportation
- Know where to get mental health treatment
- Have a flexible job that allows time off to get medical care
- Live close to mental health services
- Follow- up with a doctor after a mental health care emergency
Other socioeconomic barriers to mental health care include:
Lack of diversity in doctors. Not every mental health provider understands the unique social and cultural needs of racial and ethnic minority communities. This lack of “culturally competent” care may result in the misdiagnosis or undertreatment of TRD.
Distrust or fear of the health care system. The U.S. has a history of discrimination and medical mistreatment of racial and ethnic minority groups. As a result, if you’re from these communities, you may not trust medical care. This may play a part in why fewer Blacks and Hispanics people seek mental health care or stick with treatment.
Less access to effective treatments. You may be less likely to get more aggressive treatments that work better for TRD, including electroconvulsive therapy (ECT).
Cultural stigma. You may not seek medical treatment to manage your depression if you feel shame around your mental illness, or you think you should be able to resolve your symptoms on your own.
How Do Stress, Lifestyle, and Economic Factors Impact TRD?
Ongoing stress from racism and discrimination may raise your chances of depression in the first place. It can also affect how you respond to treatment. But more research is needed to know if chronic stress is the main reason why Black and Hispanic people are more likely to have long-lasting depression, compared to some other groups.
Depression may also be harder to treat if you:
- Aren’t employed
- Don’t have a college education
- Have financial insecurity
- Live with friends or family instead of owning a home
- Have no place to live
- Can’t pay medical copays on top of your rent, food, or other needs
If you’re disadvantaged, you may be more likely to be subject to these things that boost your risk of depression:
- Other health problems like heart disease and chronic pain
- Smoking
- Less physical activity
- Poor diet
- Lack of sleep
- Alcohol misuse
You may be more prone to medical conditions that make depression harder to treat. Those include obesity, heart disease, and cancer.
Why Are Black and Hispanic People Less Likely to Use Antidepressants?
If you have TRD, you may need to try more than one medication or type of treatment to feel better. But studies show people from racial and ethnic minority groups are less likely to take antidepressant drugs or continue with treatment once they get started.
According to some research, young Black men may be the least likely group to respond to common antidepressants, or continue taking medication. But low antidepressant use is common among the Black and Hispanic population in general.
Black and Hispanic people may avoid medical treatments like antidepressants because they don't:
- Think drug treatment will work for them
- Feel comfortable taking mental health medication
- Know there are different kinds of drug treatments
- Get treatment from a psychiatrist who knows a lot about TRD
Tell your doctor if you want to try antidepressant treatment but you’re worried about how it’ll impact your health. Once you start medication, bring up any side effects that bother you. Your doctor can change your dose or switch you to a different medication or type of treatment that works better for you.
How to Find Supportive Care for Treatment-Resistant Depression
If you’re Black or Hispanic, you’re less likely to get follow-up care outside of a hospital or emergency care setting. But once you’re diagnosed with TRD, it’s important to work with your medical team to keep your symptoms at bay.
Tell your care team if you have trouble paying for treatment. They may know about low-cost or free mental health services in your area. A social worker or nurse navigator may point you to community resources that can help.
The National Alliance on Mental Illness (NAMI) can also guide you to resources geared toward Black and Hispanic/Latinx populations.
Show Sources
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SOURCES:
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Mayo Clinic: “Treatment-resistant depression.”
Keith Carter, DNP, APRN, PMHNP-BC, psychiatric nurse practitioner, Relief Mental Health, Orland Park, IL.
Ryan Sultan, MD, assistant professor of clinical psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute.
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