Depression May Quietly Undermine Willingness to Seek Mental Health Care Among Black Adults

Medical mistrust has long been recognized as one of the most stubborn barriers separating Black adults from the health care system in the United States. Decades of documented discrimination, unethical research practices, and unequal treatment have left a legacy of suspicion that shapes decisions about everything from cancer screening to prescription medication. Yet a new study published in Community Mental Health Journal suggests that the story is more complicated than a simple mistrust-versus-care dichotomy. According to the research, led by Aderonke Bamgbose Pederson of the Depression Clinical and Research Program at Massachusetts General Brigham-Harvard University, the relationship between mistrust and willingness to seek mental health care is neither linear nor uniform—and depressive symptoms may play a decisive, and previously underappreciated, role in determining whether Black adults actually feel willing to reach out for professional help.

The study arrives at a moment when the global burden of depression has never been clearer. The World Health Organization ranks major depressive disorders third among all contributors to the global burden of disease, a ranking that reflects not only how common depression is but how profoundly it erodes quality of life, productivity, and physical health. In the United States, the burden falls unevenly. Black adults experience depression at rates comparable to other groups, yet they are substantially less likely to receive guideline-concordant treatment, less likely to be prescribed antidepressant medication, and less likely to be referred to psychotherapy. Explanations have typically centered on structural barriers, including cost, insurance coverage, and the scarcity of culturally competent providers, alongside psychological barriers such as stigma. The new research adds a nuanced wrinkle: the very symptom profile of depression itself may suppress the willingness to seek care, compounding the effect of mistrust in ways that traditional models of health service utilization have not captured.

To untangle these threads, Pederson and colleagues—including Alya Azman of the University of California, Los Angeles, Jasmin R. Brooks Stephens of the University of California, Berkeley, and Devan Hawkins of the Massachusetts College of Pharmacy and Health Sciences—conducted an online cross-sectional survey of 1,042 Black adults. The survey instruments were carefully chosen. The Group-Based Medical Mistrust Scale, first developed and validated by Thompson and colleagues in 2004, measures suspicion toward health care systems and providers perceived as serving out-group rather than in-group populations. The General Help-Seeking Questionnaire captures respondents’ willingness to seek help from various sources, including mental health professionals such as psychologists, psychiatrists, and counselors. The Patient Health Questionnaire-9, or PHQ-9, a widely used and well-validated nine-item screening tool, quantified depressive symptom severity. Together, these measures allowed the team to model, statistically, how mistrust and depressive symptoms interact to shape help-seeking intentions.

The analytical approach was ordinal logistic regression, a method suited to outcomes that unfold in ordered categories—in this case, increasing levels of willingness to use mental health services. The researchers divided mistrust scores into quartiles, from the lowest levels of suspicion in Quartile 1 to the highest in Quartile 4, and adjusted their models for age, sex, and education. The results defied a straightforward dose-response expectation. Rather than willingness declining steadily as mistrust climbed, the data revealed an inverted pattern: Black adults in the middle quartiles of mistrust reported markedly greater willingness to seek help from a mental health professional than those at the lowest levels of mistrust.

The numbers are striking. Adults in Quartile 2 of mistrust had more than three and a half times the odds of reporting increasing willingness to seek help compared with those in Quartile 1, with an odds ratio of 3.73 and a 95 percent confidence interval spanning 2.69 to 5.19, a difference highly statistically significant at p less than 0.001. The effect was even stronger in Quartile 3, where the odds ratio reached 5.02, with a 95 percent confidence interval of 3.60 to 6.99. Only at the highest level of mistrust did the pattern reverse. Adults in Quartile 4 were substantially less willing to seek help than those in the two middle quartiles, with an odds ratio of 2.38 and a 95 percent confidence interval of 1.75 to 3.25. In other words, moderate skepticism toward the medical establishment did not suppress help-seeking intentions—indeed, it coincided with the greatest willingness—while the deepest levels of suspicion did.

The most consequential finding, however, emerged when the researchers added depressive symptoms to the model. The inclusion of PHQ-9 scores produced an average decrease of 25.7 percent in willingness to seek help from a mental health professional across the sample. This suggests that depression is not merely another condition waiting at the end of the help-seeking pathway; it is an active force that erodes the intention to seek care itself. Clinicians and researchers have long observed that the cognitive and motivational symptoms of depression—hopelessness, fatigue, anhedonia, and pervasive pessimism—can make even the simplest self-care tasks feel insurmountable. This study quantifies that dynamic in the specific context of mental health service use among Black adults, showing that depressive symptoms may blunt or distort the relationship between mistrust and help-seeking rather than simply operating alongside it.

Why might moderate mistrust coincide with greater willingness to seek help? One plausible interpretation is that mistrust is not a monolithic attitude but a spectrum of vigilance shaped by lived experience. Adults with moderate levels of suspicion may be acutely aware of how the health system has failed their communities, and that awareness may coexist with a pragmatic determination to find trustworthy providers and obtain effective care. Skepticism, in this framing, is not the opposite of engagement but a precondition for discerning engagement—people who know the risks are also the people motivated to navigate them. At the extreme end of the mistrust spectrum, however, suspicion may harden into disengagement, a durable expectation that the system cannot or will not help, which previous scholarship has linked to histories of discrimination in medical settings, involuntary psychiatric hospitalization, and well-documented racial disparities in treatment quality.

The findings resonate with a rich body of prior work. Studies have linked experiences of racial discrimination in medical settings to elevated mistrust among Black patients seeking addiction treatment, and researchers have documented how mistrust contributes to delays in preventive health screening among African-American men. Others have examined how stigma interferes with mental health care broadly and how beliefs about the effectiveness and necessity of mental health treatment differ by race. Community-based approaches—including partnerships with African-American clergy and congregations—have been proposed as a pathway for increasing access to evidence-based depression care. The new study complements this literature by isolating, within a single large cohort, the distinct and interactive contributions of mistrust and depressive symptoms, and by demonstrating that interventions targeting either factor in isolation may fall short.

For the authors, the practical implications are clear. Programs designed to increase mental health service utilization and engagement among Black adults should account simultaneously for medical mistrust and for the depressive symptoms that can sap the motivation to seek help in the first place. An outreach campaign that builds institutional trustworthiness—through transparent communication, community partnership, and culturally responsive care—might still fail to reach adults whose depression has already diminished their willingness to walk through the door. Conversely, depression treatment initiatives that ignore the legitimate historical and contemporary reasons for mistrust risk being dismissed before they begin. The research, funded through the National Center for Advancing Translational Sciences and the National Institute of Mental Health under grant number 1K23MH128535-01A1, was conducted in partnership with the United African Organization and the Pan African Association, a collaboration the authors credit in their acknowledgements.

As with all cross-sectional research, the study captures a single moment in time and cannot establish whether mistrust causes reduced help-seeking or depressive symptoms cause the observed attenuation, or whether the relationships run in both directions. Research data are available upon request, and the authors note that future longitudinal work could clarify the temporal ordering of these associations. What the study establishes, with statistical confidence across more than a thousand respondents, is that the path to mental health care for Black adults is shaped by an interplay of suspicion and symptomatology that simple barrier models miss entirely. If the goal is to close the persistent gaps in depression treatment, the message of this research is that trust-building and symptom relief are not competing priorities but intertwined necessities—and that the adults most burdened by depression may be the ones least able, without targeted support, to take the first step toward care.

Subject of Research: The role of depression in the association between medical mistrust and mental health service utilization among Black adults

Article Title: The Role of Depression on Medical Mistrust and Mental Health Service Use in Black Adults

Article References: Bamgbose Pederson, A., Azman, A., R. Brooks Stephens, J., & Hawkins, D. (2026). The Role of Depression on Medical Mistrust and Mental Health Service Use in Black Adults. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01713-7

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01713-7

Keywords: medical mistrust, depression, mental health services, Black adults, help-seeking, health equity, service utilization, PHQ-9, stigma, Community Mental Health Journal, depressive symptoms, cross-sectional study