What is Major Depressive Disorder (MDD)?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defined Major Depressive Disorder (MDD) as a mood disorder that is present for at least two weeks, during which there is either a depressed mood or the loss of interest or pleasure in nearly all activities (American Psychiatric Association, 2013). While the diagnostic criteria are consistent for children and adults, adolescents need more attention due to developmental differences in their cognition, emotions, and behaviors (Juul et al., 2021). The studies by Zou et al. (2021) and Kokonyei et al. (2023) found that rumination, self-blame, anger suppression, and increased emotional sensitivity can predict depressive symptoms down below.
Emotional symptoms of MDD:
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hopelessness
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sadness
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worthlessness
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guilt
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irritability
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lethargy
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emptiness
Physical symptoms of MDD:
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eating disorders
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anxiety
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misconduct
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refusal to attend schoo
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a decline in academic performance
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substance misuse
Additional risk factors include low self-esteem, low self-efficacy, and parenting styles such as control-based parenting, permissive parenting, or parental rejection, which might explain why adolescents may feel shame or stigma (Lin & Gua, 2024).
This highlights that early recognition of depression in adolescents is significant since depression-related symptoms are far too frequently overlooked, disregarded, or intentionally neglected by their family and/or their primary care provider. Consequently, the study by Beck et al. (2021) found that adolescents with depression are more likely to have suicidal ideation, attempts, and completion in adulthood.
Defining Cultural Humility & Cultural Competence
Cultural competence refers to counselors’ awareness, knowledge, skills, and actions for delivering competent counseling to culturally diverse clients. In contrast, cultural humility is the counselor's self-reflection, critique, and sensitivity to cultural encounters (Zhu et al., 2023). Huey et al. (2023) identifies three models of cultural competence which look at skills-based models which prioritize therapist characteristics, adaptation models which prioritize treatment characteristics, and process models which prioritize the therapeutic process. In counseling, cultural competence and cultural humility work together to strengthen the effectiveness of therapy.
Provider mistrust, cultural stigma, and systemic inequities add to a lack of treatment engagement among BIPOC adolescents who present with depression.
Clinicians who implement cultural competence and humility in their sessions are more likely to build strong therapeutic alliances and improve clinical outcomes (Rice & Harris, 2020; Orolowski et al., 2024). Policymakers ensure that training programs include cultural humility and competence as a core competency for mental health providers (Rice & Harris, 2020; Zhu et al., 2021; Huey et al., 2023; Orolowski et al., 2024).
Theoretical Frameworks
Social Determinants of Health
The conditions in the environment where people are born, live, learn, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risk (ODPH, 2021).
Intersectionality
Introduced by American civil rights activist and critical race theory scholar Kimberle Crenshaw, provides a framework for explaining how sociodemographic identities and power intersect to shape an individual experiences (Losleben & Musibika, 2023)
Research has shown that depression can harm SDOH in areas such as housing, healthcare, and education, which impacts all generations but is possibly worse for adolescents as they go through phases of development (Kim et al., 2023; Monroe et al., 2023; Robins et al., 2024). For example, adolescents with depression have been found to exhibit low attendance, poor academic performance, and dropping out of school (Zhang et al., 2023). Moreover, experiences of racism can also affect SDOH, which perpetuates cycles of poverty and marginalization and leads to socioeconomic inequalities, a lack of access to education, housing, and healthcare (Hilario et al., 2023; Robins et al., 2023). Consequently, structural racism and lived adverse experiences can increase the likelihood of adolescents engaging in risky health behaviors and lead to a negative impact on health outcomes (Monroe et al., 2023). Promoting health equity for BIPOC adolescents requires confronting and addressing the impacts of racism within the healthcare system, as well as improving their social environment, in their families and schools, to achieve better health outcomes (Kim et al., 2023; Hilario et al., 2023).
Through the lens of intersectionality, race, gender, and social identities intersect with racism, discrimination, and privilege, and highlight the additional barriers to treatment seeking for depressed BIPOC adolescents compared to their White counterparts.
Cultural Norms & Their Impacts on Mental Health Disclosure and Treatment Seeking
Cultural factors such as stigma, shame, identity, mistrust, religious beliefs, and attitudes can significantly shape the mental well-being of BIPOC adolescents. Families with different cultural backgrounds can prevent BIPOC adolescents who are suffering from depression from seeking help. For example, Black adolescents, cultural mistrust and stigma undermine help-seeking beliefs lead to problems with utilization of mental health services (Brooks et al., 2022). Social networks play a pivotal role in shaping BIPOC adolescents' help-seeking behavior (Lindsey et al., 2024). Similarly, Indigenous adolescents' disclosure of mental health challenges “would ruin their lives” due to the adults’ misconceptions about addressing mental health challenges (Garrett et al., 2025). Among Asian, Indigenous, and Hispanic families, mental health is perceived as a loss of face, sign of weakness, a threat to the reputation of the family, and having connotations (i.e., punishment, lack of faith, unholy practices) (Forcen et al., 2023; Garrett et al., 2025; Wang & Havewala, 2025).
These cultural barriers are a result of family reputation and misconceptions of mental health, which can negatively impact on depressed BIPOC adolescents' help-seeking beliefs and discourage them from seeking treatment. Given cultural norms, stakeholders must consider moving beyond Western interventions by incorporating cultural adaptations tailored to the targeted racial or ethnic individual.
The Influence of Family Functioning & Parenting on Adolescent Depression
Adolescents with depressive symptoms have been found to correlate with their family environment, highlighting that family plays an essential role in the development of adolescents (Chiang & Bai, 2022; Huang et al., 2022; Awiszus et al., 2022). Examples of poor family functioning include low family cohesion, high family conflict, and parental depression, which, altogether, can influence depressive symptoms such as withdrawal and emotional dysregulation in adolescents (Huang et al., 2022; Jiang & Zhang, 2024; Jin et al., 2025). This highlights that the role of negative parenting styles (e.g. hostile parenting, authoritarian parenting, overprotective parenting) can affect the development of adolescents and increase their likelihood of mental health issues like depression into adulthood (Awiszus et al., 2022).
The studies by Kang et al (2024) and Yu et al. (2025) define hostile parenting as corporal punishment, poor supervision, and inconsistent discipline, which altogether influence depressive symptoms in adolescents. The study by Awiszus et al. (2022) characterizes authoritarian parenting as little affection, unresponsiveness, strict rules, blind obedience, strong control, and infrequent communication with children. Altogether, this can produce adverse outcomes for adolescents such as lower academic achievement, poor social skills, reduced self-esteem, an increase in anxiety and depression, and drug/alcohol abuse and delinquency. Interestingly, maternal depression has been found to be associated with authoritarian parenting (e.g., high psychological control, guilt induction), which can demonstrate higher levels of depressive symptoms in adolescents (Yu et al., 2025). Furthermore, according to the study by Huang (2024), overprotective parenting has been found to be similar to authoritarian parenting, which exacerbates depressive symptoms in adolescents who struggle to find a balance between their parents' and their own cultural norms. These findings show the importance of promoting mental health awareness and addressing the negative impact of family dynamics on adolescents’ well-being (Huang, 2022; Jiang & Zhang, 2024).
Racism as a Public Health Threat
Racism is defined as an interpersonal, cultural, environmental, and systemic discrimination and aggression against an oppressed racial group by a privileged racial group within a society (Jean et al., 2023). Hilario et al. (2023), highlights that there are different forms of racism, such as “internalized (incorporating ideologies into one’s personal worldview), interpersonal (interactions between people), and structural or institutional (access to resources, services, or opportunities within society).” Hilario et al. (2023) and Budescu et al. (2025) discussed that adolescents are more vulnerable to the impacts of racism because their physical development leads to more explicit experiences of discrimination, while their cognitive development makes them more conscious of racism’s long-term implications.
Exposure to racism can also result in experiences of self-stigma, shame, self-devaluation, and internalized racism, which have been linked to higher rates of depression among BIPOC adolescents (West et al., 2023; Budescu et al., 2025). BIPOC adolescents may internalize negative perceptions of their own race when they experience discriminatory interactions (Archibald et al., 2025). Black adolescents in primary and secondary schools disproportionately receive discipline referrals and suspensions due to racial and ethnic bias (Goldie et al., 2025). Wang & Havewala (2025) found that Asian adolescents experienced greater depression as a result of politicians who had blamed them for COVID-19 and referred to it as the “Chinese virus,” which encouraged fear, distrust, racism, and violence towards Asian communities.
Different forms of racism can lead to BIPOC adolescents developing institutional mistrust and provider mistrust. Lindsey et al. (2024) found that Black adolescents and their families tend to question the therapists’ genuineness and believe they are incapable of resolving their issues. Poor experiences with the system can also negatively influence BIPOC adolescents’ future utilization. Metzger et al. (2023), found that BIPOC adolescents and their families often experience discrimination within the system, are given less access to evidence-based care treatment, and experience disparities in coverage of mental health services (i.e., co-pays, limited sessions) compared to their White counterparts (Metzger et al., 2023; West et al., 2023). As a result, inappropriate therapeutic interventions can occur with non-BIPOC therapists who are reluctant to discuss the problems of race and discrimination due to fear, color blindness, and denial of White privileges (Metzger et al., 2023). Consequently, racism denies racialized populations equal opportunities and privileges (Hilario et al., 2023). The lack of awareness of cultural norms and structural factors among non-BIPOC therapists highlights the need to implement cultural competence and multicultural training in mental health graduate schools (Metzger et al., 2023).
Workforce & Treatment Gaps in Mental Health Services
BIPOC adolescents experiencing depression are less likely to seek psychiatric services in primary care compared to their White counterparts, for multiple factors such as the lack of BIPOC providers, language barriers, insurance-related issues, delay in care, and most importantly, the lack of culturally adapted interventions (West et al., 2023; Metzger et al., 2023). Research points out that BIPOC providers only make up a small minority of practitioners in the United States; for instance, the American Psychological Association (APA) estimates that the current psychology workforce is roughly 84% non-Hispanic White, 4% Black, 5% Hispanic/Latino/a, 4% Asian, and 0.3% Native American (West et al., 2023). Not only is there a shortage of BIPOC providers in the United States, the lack of culturally adapted interventions creates another significant barrier for depressed BIPOC adolescents, resulting in cultural identity erasure (Silveus et al., 2023)
Although Cognitive Behavioral Therapy (CBT) is considered the "gold standard" of psychotherapy (e.g., frontline treatment for Major Depressive Disorder) and is most disseminated in training and clinical settings, many researchers and practitioners characterize CBT as too Westernized to be applied among BIPOC adolescents (Kunorubwe, 2023; Huey et al., 2023; Silveus et al., 2023). Evidence from Mishu et al. (2023) suggests there is promising evidence that culturally adapted interventions have shown practice improvement for BIPOC adolescents experiencing symptoms of depression.
The findings from this research identify the need to increase diversity in the mental health field and incorporate culturally responsive treatment approaches.
Depression in BIPOC adolescents is not often addressed and interventions already identified need to move past just noting the symptoms and look at how to better address the cultural, systemic, and structural barriers.