Depressive Symptom Presentation Among White and Black College Students

Background and Purpose: Major Depressive Disorder (MDD) is a serious, but treatable, mental health condition that impacts persons of all ages, genders, racial/ ethnic groups, and socioeconomic statuses.  Many factors contribute to the onset of MDD.  However, college students are particularly vulnerable given their highly transitory life stage.  Beyond developmental stage, existing research identifies cultural differences in diagnosis and symptom presentation. It is important to carefully explore how race impacts depressive symptoms and diagnosis of depression among college students. Two research questions were examined- (1) Does racioethnic identification impact whether or not a student is diagnosed with clinical depression? (2) Does racioethnic identification impact symptom patterns in depressed college students?

Methods: Data were collected at a large, public, Southeastern university over a period of four years. The sample for this study includes 2,548 undergraduate students enrolled full-time at the time of the survey administration..  Chi-square and t-test analyses were conducted to examine differences between White and Black students on self-reported diagnosis of depression, total depression symptoms, and specific symptom endorsement. 

Results: White students reported significantly higher rates of depression diagnosis (6.82%, n = 127), as compared to Black students (1.52%, n = 3;  [df=1] = 6.91, p > .01).  However, there were no differences in the number of reported symptoms and White and Black students had similar symptom endorsement patterns, with minor exceptions.  Further, there were no differences in the proportion of White and Black students who met DSM-V thresholds for diagnosis of depression. The four most frequently reported symptoms of depression in both White and Black students were as follows: feelings of overwhelm, exhaustion, sadness, and loneliness.  The fifth most endorsed symptom differed between White and Black students, with White students endorsing anxiety slightly more than hopelessness, and vice versa for Black students.  Because there is a requirement of no less than five symptoms to be diagnosed with MDD, these are important to note.

Conclusions and Implications: Given the similarities in depression symptom presentation and the existing diagnostic gap, it is important for mental health practitioners working on college campuses to be aware that presentation of symptoms for MDD looks the same between White and Black students. These results support other studies identifying a race disparity in self-reported depression diagnosis, in spite of similar symptom patterns and reflect a diagnostic gap that is becoming a grand challenge in the mental health literature and practice environments.  Because college students may be at an increased risk of experiencing depressive symptoms, a focus on early identification of MDD is important in order to prevent negative educational outcomes.  When providers are aware of the diagnostic similarities between White and Black students, the likelihood of timely identification of depression in Black students may be enhanced. By recognizing, identifying, and treating depression quickly, providers allow students increased opportunity for academic success, and thus, decrease the odds of poor grades and discontinued educational pursuits.