One in five adolescents aged 12 to 17 has experienced at least one Major Depressive Episode
(Mental Health America, 2024)
In the United States, depression is one of the leading causes of psychiatric illness in adolescents that continues into adulthood. Symptoms of depression impacts functioning at work, school, and/or home. Environmental factors including exposure to violence, family dysfunction, inadequate parenting, and abuse can heighten depression and increase suicide risk in adolescents (Kalin, 2021; Shorey et al., 2022).
Despite its high prevalence, 48.3% of adolescents in the United States with MDE report unmet treatment needs
According to the Mental Health America Report (2024), these common barriers report adolescents believing they can manage depressive symptoms on their own, worrying about what others might say if they received help, fearing a lack of privacy, and not knowing where to seek help. Leaving these concerns unaddressed can lead to severe consequences; for example, the study by Zheng et al. (2023) reports that depressive symptoms among adolescents pose a high risk of suicide.
Black, Indigenous, and People of Color (BIPOC) adolescents are more likely to experience a prolonged, chronic, and severely debilitating depression compared to their White counterparts.
(West et al., 2023; Shaligram et al., 2024)
The study by Metzger et al. (2023) found that BIPOC adolescents are significantly less likely to utilize mental health treatments due to systemic inequities and structural barriers, and the inequality in being able to access service and support in comparison to their White counterparts. Moreover, Racism defined, as “a system of oppression that categorizes and stratifies social groups into races, devalues and disadvantages those considered inferior, and differentially allocates them to valued societal resources and opportunities,” –has been found to have a significant impact on the development of depression in BIPOC adolescents (Yan Li et al., 2022; Yusuf et al., 2022; Rafla-Yuan et al., 2022; Casseus, 2023; Shin et al., 2023; Shaligram et al., 2024; Roulston et al., 2025). Individuals who have experienced discrimination note that mistrust of providers, stigmas surrounding discrimination, and a cultural misunderstanding regarding mental health treatment show the increased risk for persistent depression and suicidality (Yusuf et al., 2022; Casseus, 2023; Shin et al., 2023; Shaligram et al., 2024; Roulston et al., 2025).
In the United States, one of the most significant barriers for BIPOC adolescents who are seeking treatment for depression is the lack of culturally adapted interventions.
Although, randomized controlled trials (RCTs) have demonstrated efficacy in treating depressed patients with Cognitive Behavioral Therapy (CBT), which is “a structured and goal-oriented therapy, focusing on the clients’ presenting problem and processes and maintaining their difficulties” (Herring et al., 2023; Naeem et al., 2023; Kunorbwe, 2023). Cognitive Behavioral Therapy (CBT) is an effective treatment and seen as the “gold standard” (Herring et al., 2023; Naeem et al., 2023; Kunorbwe, 2023; Huey et al., 2023). CBT is based on dominant Western cultural models that do not match up with BIPOC adolescents’ view of culture. When interventions do not take into consideration the client’s values, language, and lived experiences, participating in treatment is not effective. Although culturally adapted interventions can be applied across systems, ages, and racial, ethnic, and cultural groups, they can also be costly, complex, and challenging to implement in mental health care (Weeks, 2022; Nittas et al., 2024). Without cultural adaptations, adolescents stop engaging in treatment and there is an increase in poor outcomes (Naeem et al., 2023).