Racial Disparities in Teen Mental Health Diagnosis

Adolescence is often described as turbulent, but for many teenagers emotional distress goes beyond ordinary growing pains. Mood disorders such as depression and bipolar disorder frequently emerge during the teen years. According to the National Institute of Mental Health, roughly one in seven adolescents in the United States experiences a mood disorder, with girls affected at nearly twice the rate of boys. Yet identifying these conditions is not always straightforward. For some teens, particularly Black youth, receiving an accurate diagnosis can be even more complicated.

Mood disorders do not always look like sadness. While depression is commonly associated with low mood or withdrawal, in adolescents it often presents as irritability, anger, defiance, or behavioral problems. A teenager who is acting out in school, arguing with adults, or skipping class may be struggling with untreated depression rather than willful misconduct. Without careful assessment, these behaviors can be misinterpreted.

Research suggests that misinterpretation does not happen evenly across racial groups. Multiple studies have found that Black adolescents are less likely than white adolescents to receive diagnoses of mood disorders when presenting with similar symptoms. Instead, they are disproportionately diagnosed with conduct disorder, a condition characterized by persistent patterns of violating rules and the rights of others, or in some cases psychotic disorders such as schizophrenia.

For example, research published in the Journal of the American Academy of Child and Adolescent Psychiatry has documented racial disparities in diagnostic patterns among youth receiving psychiatric care, with Black males more likely to be diagnosed with schizophrenia compared to their white peers. Other studies examining adults have found similar trends, with Black patients more frequently diagnosed with psychotic disorders even when presenting with symptoms consistent with major depression or bipolar disorder. Researchers continue to investigate the causes of these disparities, but the pattern itself has been consistently observed.

The consequences of misdiagnosis can be significant. According to Dr. Heather Bernstein, PsyD and clinical expert for the Child Mind Institute, a psychiatric diagnosis shapes treatment decisions, school responses, and even how a young person understands their own behavior. Conduct disorder carries stigma and may limit access to certain therapeutic programs. It can also increase the likelihood of disciplinary action in school settings and, in some cases, involvement with the juvenile justice system. Meanwhile, if underlying depression or bipolar disorder goes untreated, symptoms may worsen over time and increase the risk of academic difficulties, substance use, or self harm.

Experts like Bernstein point to several contributing factors. Implicit bias, or unconscious assumptions that influence decision making, can affect how clinicians interpret behavior. Studies have shown that when identical symptom descriptions are labeled with different racial identities, diagnostic impressions can shift. Cultural misunderstanding may also play a role. Expressions of emotion, communication styles, and responses to authority differ across communities. Without cultural context, behaviors may be pathologized rather than understood.

Systemic stressors further complicate assessment. Research consistently shows that exposure to racism and discrimination is associated with increased psychological stress and poorer mental health outcomes. If a teenager is reacting to chronic stress, neighborhood violence, or racial microaggressions, their anger or withdrawal may reflect distress rather than deliberate defiance.

For parents and caregivers, awareness of these patterns is critical. Significant changes in mood, behavior, sleep, appetite, or school performance warrant a thorough mental health evaluation. Clinicians should assess not only outward behavior but also mood symptoms, trauma exposure, medical conditions, and environmental stressors. Parents can ask providers about their experience working with diverse populations and whether they consider cultural and systemic factors in their assessments. While Bernstein says seeking a second opinion is appropriate if a diagnosis does not seem to fully explain a child’s experience.

The experts say that accurate diagnosis is the gateway to effective treatment. Ensuring that all adolescents are carefully evaluated and understood, regardless of race, is an essential step toward more equitable mental health care.