Black Americans with Hidradenitis Suppurativa Have a High Risk of Depression
People with hidradenitis suppurativa (HS) have a high chance of developing depression–and when compared to white people, this risk is even higher for Black individuals with HS, who tend to experience more severe symptoms of both HS and depression.
Black people in the United States are more likely than white people to have hidradenitis suppurativa (HS), a chronic skin condition that causes lumps and bumps to form under the skin. These bumps can break open and leak pus. Sometimes, tunnels develop between the bumps under the skin and drain blood or pus, too. HS is not a life threatening condition, but it definitely impacts quality of life. Because Black Americans are much more likely to have HS, they are also more likely to experience the complications associated with this health condition, which can include depression.
Depression is characterized by a persistent feeling of sadness, a loss of interest in things you used to enjoy, sleep problems, fatigue, appetite changes, difficulty concentrating, and other symptoms. It is normal to experience some shock and grief after you start developing HS symptoms or receive a diagnosis. However, if those symptoms last weeks or months, you may be experiencing depression, and you can’t just snap out of it or force yourself to feel better. Doctors and mental health professionals can offer you the resources you need, which may include medication and talk therapy, to manage your depression and stay on top of your HS.
Current research suggests that not only is HS more common in Black people than white people, it is also more severe. Studies suggest people with more severe HS symptoms are more likely to develop depression. Research examining how HS affects Black people is limited. However, due to a number of factors related to systemic healthcare inequities, Black Americans on average are less likely to have access to quality healthcare, trained dermatologists, sufficient health insurance, or financial resources needed to effectively diagnose and manage HS.
Doctors may not recognize HS symptoms in skin of color, since medical school textbooks overwhelmingly use images of white patients. Also, Black Americans may find it harder to access dermatologists, who are best qualified to effectively identify and treat HS early, which leads to reduced symptoms and better quality of life. According to a 2017 review of HS studies, although they are more likely to have HS, African Americans with HS make about one-third as many annual dermatology appointments as Caucasians. Often, specialists like dermatologists only accept private health insurance. This is a potential barrier for Black individuals, who are more likely than white people to have Medicaid or Medicare or to be uninsured. More research is needed to identify other factors influencing the lack of dermatology access in the Black population.
For these and other reasons, Black people struggle more with HS symptoms than white people, which reduces their quality of life and increases their chance of developing depression.
HS is not contagious. It is not your fault if you have it. However, if you notice that your quality of life has declined as a result of having the condition, you’re not alone. Many people who have HS struggle with anxiety and embarrassment about their condition. Some are self-conscious about their appearance and worry that others will find them unattractive. Some worry that others will detect an unpleasant odor from their sores. They may struggle with ways to hide their condition so no one will notice. Plus, HS itself can be painful, which presents another coping challenge.
All that worrying and pain can take a toll on a person’s emotional and mental well-being. Some people withdraw from friends, family, coworkers, and romantic partners. Cracks begin to form in their interpersonal relationships. Some feel worn down by the pain and discomfort. Those who are not getting effective treatment can become exhausted by their efforts to feel better and be taken seriously. All of this strain often leads to depression and anxiety disorders. Research also suggests an association between HS and substance misuse, suicide, and other psychiatric conditions.
Unfortunately, research tells us Black people in the U.S. are less likely to receive treatment for depression, which puts them at greater risk of a whole host of other problems. This may be due to a variety of factors, including systemic inequalities contributing to a lack of adequate insurance coverage or financial resources. Also, Black people in the U.S. may have a hard time finding mental health experts who are culturally sensitive or experienced in treating conditions in People of Color. Due to this, Black individuals may decide to stop pursuing depression treatment. For these reasons, among others, depression is more likely to become chronic and more significantly impact day-to-day life for Black people, who are also more likely than white people to view their depression as severe or disabling.
Being aware of the increased risk of depression is only half the battle. Finding resources to help you cope with this stressful condition and seeking out that help is the other half.
If you feel that HS is taking a toll on your mental and emotional well-being, don’t be afraid to admit it or to ask for help. The research confirms that depression is a very real problem associated with your condition, and you should not need to justify it.
Start by talking with your primary care doctor. If you don't have an established relationship with a primary care doctor, ask your dermatologist or the doctor treating your HS to refer you to someone. You could also search online for doctors near you. Many primary care doctors can initiate treatment for depression or point you in the right direction, including referring you to mental health professionals who can provide treatment for depression and anxiety.
Another resource that may help you cope is a support group. Your doctor might be able to point you toward a local support group in your community for people with HS. However, some people prefer the convenience (and relative anonymity) of an online support group. Check out the nonprofit organization Hope for HS, which provides information about mental health resources, including their online support groups. You may also be able to connect with other People of Color with HS, who can offer advice and suggestions about advocating for your health so you can overcome any barriers blocking your access to care.
Something else to consider: You may not recognize the signs and symptoms of depression in yourself, but a friend or loved one might notice that you are struggling. Listen to them if they tell you they are worried about you. There are resources out there that can help. You may find you feel better and more empowered to manage your HS when you are getting the mental healthcare that you need.