A new report adds to growing evidence that depression affects people of color in the United States more drastically than others.

While depression can affect anyone, Blacks and Latinos and other marginalized groups are more likely to experience more severe symptoms of depression, according to a report from Blue Cross Blue Shield Association. They are also less likely to receive treatment for depression.

Depression is the leading cause of illness and disability throughout the world, according to the World Health Organization. If left untreated, depression can worsen and lead to serious health issues, such as chronic pain, substance use, self-harm or suicide.

Because many studies lack participants of color, the risk for depression among certain groups is not understood. While some studies suggest the risk is higher for people of color, others have found the risk to be comparable to that of other groups.

It is true, however that lack of access to health care, mistrust of the medical establishment, language barriers and stigma, contribute to the underdiagnosis of depression among people of color. Furthermore, several studies have found that when people of color do seek help or depression, they often report more serious symptoms compared with white people. For example, a paper published in the Neuropsychiatric Disease and Treatment found that although people of color are less likely to experience episodes of major depression compared with white people, they are more likely to endure chronic and prolonged symptoms that impact their ability to function.

In an Everyday Health article, Wizdom Powell, PhD, MPH, the chief social impact and diversity officer at Headspace Health and director of the Health Disparities Institute at UConn Health, explained, “What this means is the burden of disability from depression is much more pronounced in individuals from Black, Indigenous and communities of color. And the consequences of these mental health conditions are far more significant and negative for these populations.”

Access to quality health care, health insurance, language and cultural barriers and a shortage of mental health professionals of color are some of the reasons people of color are diagnosed and treated less frequently.

Health professionals recommend that Black and Latino communities utilize online therapy if possible. “We’re going to have to reimagine what an inclusive mental health system can look like,” Powell said. According tot Powell, this may include training community health workers and trusted lay members of the community, such as pastors, to screen folks for depression and refer them to help.