Depression is a widespread chronic condition affecting approximately 10 million Americans annually (1, 2). Non-Hispanic Black and Hispanic individuals tend to experience more severe, prolonged, and debilitating episodes of depression compared to non-Hispanic White individuals (3–8). Several factors may explain this disparity, such as socioeconomic status (e.g., higher rates of poverty, lower rates of health insurance coverage) (9), discrimination (10, 11), and inequitable access and use of mental health care services (9, 12). Non-Hispanic Black and Hispanic individuals were also disproportionately affected by depression during the COVID-19 pandemic (13, 14).

The prevalence and presentation of depressive symptoms differ by sex (14–16), age (17–19), and self-reported physical and mental health status (20–23). Women tend to report more classic depressive symptoms, such as depressed mood, more frequently and intensely than men (24). In contrast, men with depression are more likely to exhibit behaviors such as risk-taking, poor impulse control, and substance misuse (25). Although women have higher overall rates of depression (7, 26), men are more often underdiagnosed (27–30) and undertreated (27, 30). This underdiagnosis and lack of treatment among men can lead to a higher recurrence of depression (31) and an increased risk of suicide attempts and completion (31–34).

Men with chronic conditions are at a heightened risk for depression, particularly when they have multiple chronic conditions (35–39). Lifestyle choices such as physical activity or alcohol consumption can either exacerbate or mitigate the risks associated with both depression and chronic conditions (40–43). Other factors, such as social engagement and support (44, 45), may also play a key role in men’s self-management of depressive symptomatology. Social support is a well-known protective factor to mental health conditions and studies consistently demonstrate a robust link between social support and depressive symptoms in chronically ill individuals, either directly or indirectly through self-management behaviors (46, 47).

Despite the existing literature, less is known about depressive symptoms among non-Hispanic Black and Hispanic men with chronic conditions, subgroups who may face significant disparities in mental health. Given the multifaceted nature of depressive symptomatology management, this study aims to investigate the prevalence of self-reported depression and explore associated factors within a national sample of non-Hispanic Black and Hispanic men aged 40 years and older with one or more chronic conditions in the United States.

Table 1 contains sample characteristics compared by self-reported depressive symptom status. Of the men in this study, 24.0% self-reported depressive symptoms. On average, participants were aged 56.72 (±10.03) years. Most men (58.6%) were non-Hispanic Black, had more than a high school education (79.4%), not partnered (52.1%), and lived in urban areas (93.6%). On average, men lived in households with 2.60 (±1.64) people and had annual household incomes of approximately $60,000 (±$33,800). Over 48% of men were employed, with 29.6% being retired, 14.3% disabled, and 8% unemployed or a student. On average, men self-reported 3.53 (±2.56) chronic conditions and taking 3.39 (±2.02) medication daily. About 43% of men were obese and another 35.4% were overweight. Over 35% of participants used tobacco in the past 30 days, 60.9% consumed alcohol in a typical week, and 57.5% reported getting the help/support they needed to manage their health problems.

When comparing participants by self-reported depressive symptoms, a significantly larger proportion of men who were Hispanic (χ² = 10.85, p < 0.001), less educated (χ² = 14.43, p < 0.001), not partnered (χ² = 5.32, p = 0.021), and disabled/unemployed (χ² = 98.27, p < 0.001) reported depressive symptoms. On average, men who reported depressive symptoms were younger (t = 12.21, p < 0.001), lived with more individuals (t = −4.94, p < 0.001), and had lower annual household incomes (t = 5.98, p < 0.001). On average, men who reported depressive symptoms had more chronic health conditions (t = −3.30, p < 0.001). Significantly larger proportions of men who self-reported asthma/emphysema/other chronic lung problems (χ² = 14.80, p < 0.001), arthritis/rheumatic disease (χ² = 5.01, p = 0.025), chronic pain (χ² = 63.24, p < 0.001), obstructive sleep apnea (χ² = 10.71, p = 0.001), and other chronic conditions (χ² = 22.61, p < 0.001) reported depressive symptoms. Significantly smaller proportions of men who self-reported cancer or cancer survivorship (χ² = 7.00, p = 0.008) and kidney disease (χ² = 5.54, p = 0.019) reported depressive symptoms. On average, men who reported depressive symptoms took more medications daily (t = 5.98, p < 0.001), spent more time sitting (t = −4.35, p < 0.001), had lower quality of life (t = −2.35, p = 0.019), had more barriers to self-care (t = −19.27, p < 0.001), and had more healthcare frustrations (t = −16.89, p < 0.001). On average, men who reported depressive symptoms relied more on others to manage their health problems (t = −5.35, p < 0.001), and reported more social disconnectedness (t = −15.80, p < 0.001). A significantly larger proportion of men who had frequent physical distress (χ² = 78.25, p < 0.001), frequent activity limitations due to health problems (χ² = 185.53, p < 0.001), and used tobacco (χ² = 56.75, p < 0.001) reported depressive symptoms.

In a subset analysis of the 458 men with self-reported depressive symptoms (table not reported), 54.1% reported no one in their household (including themselves) needed mental health services, 15.9% reported a household member (including themselves) needed but did not use mental health services, and 29.9% reported a household member (including themselves) needed and used mental health services. Among these 458 men, 35.2% reported their access to mental health care, if needed, was “very poor,” “poor,” or “fair.”

Table 2 contains findings from multivariable logistic regression examining factors associated with self-reported depressive symptoms among all participants. Relative to non-Hispanic Black men, Hispanic men were more likely to report depressive symptoms (OR = 1.39, p < 0.017). On average, for each additional year, men who were older were less likely to report depressive symptoms (OR = 0.97, p < 0.001). On average, for each unit increase, men who lived with more people in their household (OR = 1.13, p = 0.001) and took more medications daily (OR = 1.10, p < 0.010) were more likely to report depressive symptoms. Men who reported frequent physical distress (OR = 3.15, p < 0.001) and used tobacco (OR = 1.56, p = 0.002) were more likely to report depressive symptoms. On average, for each unit increase, men who spent more hours sitting (OR = 1.01, p = 0.030), had more barriers to self-care (OR = 1.16, p < 0.001), reported higher healthcare frustrations (OR = 1.13, p < 0.001), relied more on others to improve/manage health (OR = 1.04, p < 0.001), and had higher social disconnectedness (OR = 1.65, p < 0.001) had greater odds of reporting depressive symptoms.

Table 3 contains findings from two multivariable logistic regressions examining factors associated with self-reported depressive symptoms among non-Hispanic Black men and Hispanic men separately. Commonly across non-Hispanic Black men and Hispanic men, on average, each additional year of age reduced the odds of reporting depressive symptoms, respectively (OR = 0.96, p < 0.001; OR = 0.98, p = 0.044). Commonly across non-Hispanic Black men and Hispanic men, for each unit increase, men who reported frequent activity limitations due to health problems (OR = 2.57, p = 0.002; OR = 2.90, p < 0.001), had more barriers to self-care (OR = 1.19, p < 0.001; OR = 1.15, p < 0.001), reported higher healthcare frustrations (OR = 1.09, p = 0.008; OR = 1.19, p < 0.001), and had higher social disconnectedness (OR = 1.66, p < 0.001; OR = 1.65, p < 0.001) had greater odds of reporting depressive symptoms, respectively. Unique to non-Hispanic Black men, on average, for each unit increase, men who reported higher quality of life had lower odds of reporting depressive symptoms (OR = 0.76, p < 0.001). Non-Hispanic Black men who used tobacco were more likely to report depressive symptoms (OR = 1.58, p = 0.014). Unique to non-Hispanic Black men, on average, for each unit increase, men who relied more on others to improve/manage health had higher odds of reporting depressive symptoms (OR = 1.05, p < 0.001). Unique to Hispanic men, on average, for each unit increase, men who lived with more people in their household had greater odds of reporting depressive symptoms (OR = 1.40, p < 0.001), whereas Hispanic men who reported higher annual household incomes had lower odds of reporting depressive symptoms (OR = 0.94, p = 0.032). On average, for each unit increase, Hispanic men who spent more hours sitting had higher odds of depressive symptoms (OR = 1.03, p = 0.020).

This study investigated the prevalence and determinants of self-reported depression among non-Hispanic Black and Hispanic men aged 40 years and above with chronic conditions. Nearly one-in-four men reported depressive symptoms. Hispanic men were more likely to self-report depressive symptoms compared to non-Hispanic Black men. While existing literature identifies general disparities in depressive symptoms among racial and ethnic groups, specific prevalence data and detailed mechanisms underlying these differences remain underexplored, particularly among non-Hispanic Black and Hispanic men with chronic conditions (75). While non-Hispanic Black and Hispanic men may experience some of the same barriers related to mental health, such as stigma (76, 77) and inconsistent access to healthcare (9, 78), they may also share protective factors like ethnic identity (79–81) and family support (82, 83). Although the current study did not assess variables such as acculturation (84), sub-ethnic origin (e.g., Mexican American, Puerto Rican, Cuban, and other) (75, 85, 86), or language proficiency (76), prior research suggests these factors may play a role in depression prevalence among Hispanic populations.

The subgroup analyses by race and ethnicity in this study revealed differences that could inform targeted interventions. For non-Hispanic Black men, a higher quality of life was associated with a lower likelihood of reporting depressive symptoms, suggesting that efforts to improve life satisfaction through health interventions or lifestyle changes may be particularly beneficial for this group (78). Given these findings, for non-Hispanic Black men, interventions that focus on enhancing quality of life and social engagement, such as community-based programs that foster social connections and improve self-management of chronic conditions, may be effective in reducing depressive symptoms. For Hispanic men, living with more individuals in the household was linked to an increased likelihood of depressive symptoms. This may be due to the additional stress and responsibilities that come with larger households, which can exacerbate the mental health and financial burdens (81, 87). Such findings highlight the need for interventions tailored to specific cultural and social contexts, where the family dynamic plays a central role. For instance, while increased household size might provide emotional and instrumental support in some contexts, it can also introduce stressors such as financial burdens and caregiving responsibilities, which can negatively affect mental health (81). For Hispanic men, programs that address household stressors and promote family support, while also acknowledging the role of cultural factors like familismo, could help mitigate the negative mental health impacts of larger household sizes. While these subgroup analyses help elucidate specific protective or risk factors unique to these populations and inform tailored interventions, future research utilizing larger and more diverse datasets could further explore these differences comprehensively.

Across all models in the current study, older age was associated with lower odds of reporting depressive symptoms. This trend may be due to the development of psychological resilience (88) and more adaptive coping strategies with age, which help reduce the likelihood of depression (88–91). Additionally, while not directly examined in the current study, older men with chronic conditions may have more stable and close social networks and receive support from spouses, family, or friends, which can help alleviate depressive symptoms (83, 92, 93). While these results highlight important findings, a more thorough subgroup analysis examining distinct age-related factors affecting depression among Hispanic and non-Hispanic Black men separately is necessary.

Across all study models, men who felt socially disconnected were more likely to report depressive symptoms, findings that align with existing studies (94, 95). As discussed by Santini et al. (94), perceived isolation, including feelings of loneliness, could predict both depressive symptoms and social withdrawal. Implementing formal and informal strategies to improve perceived isolation and reduce loneliness could help improve men’s mental health outcomes. For example, participating in Chronic Disease Self-Management Education workshops, which meet regularly in small groups to overcome common barriers to disease symptom management, could reduce loneliness among men with chronic conditions and help them feel more socially connected (96).

Residing with more individuals was not a protective factor in the current study, especially for Hispanic men. Men living in larger households were more likely to report depressive symptoms. The increased number of household members may lead to additional responsibilities, chores, and greater financial burden (97). These stressors can contribute to the onset or exacerbation of depressive symptoms, creating a cycle of mental health challenges within the household. Greenberg and colleagues also highlighted the potential for depression to have a spillover effect (98), where the mental health struggles of one household member can influence the well-being of others, thereby increasing overall household stress and exacerbating mental health issues for multiple individuals. These dynamic underscores the need for targeted interventions that consider the mental health of all household members, especially in high-stress environments. In this study’s subset analysis of men with depressive symptoms, despite self-reporting these symptoms, over half reported that no one in their household (themselves included) utilized mental health services, and another 15.9% went without mental health services, even when needed. Further, over one-in-three men reported they had less-than-good access to mental health care. Taken together, these findings highlight the urgency of properly diagnosing and treating depression, and reducing barriers to mental health services, among non-Hispanic Black and Hispanic men and those living within their households. Dedicated efforts are needed to identify, understand, and reduce access barriers, inclusive of inequitable systemic and structural barriers (99, 100), to improve mental health outcomes for men and their families. Such efforts are needed to improve individual access to care and enhance family-level support systems that promote mental well-being.

Barriers to self-care and reliance on others to manage their condition were also associated with more depressive symptoms, which supports the findings that showed a bidirectional relationship between depression and self-care health behaviors (101, 102). Depressive symptoms, such as loss of interest and lack of motivation, can hinder self-care efforts, while neglecting self-care can worsen depressive symptoms. For example, in our study, non-Hispanic Black and Hispanic men with depressive symptoms were found to be more sedentary compared to those without such symptoms. Sedentary behaviors may have increased the risk of depression, or depressive symptoms may have led to increased sedentary behaviors (7, 64–67, 103–105). Cultural values of self-reliance and machismo among non-Hispanic Black and Hispanic men can also explain the association between reliance on others and depression (106, 107). Research has shown that masculine ideals, such as strength, autonomy, and control, often discourage expressions of vulnerability or dependence on others (108). This cultural framework may influence the way men perceive self-care behaviors, such as taking medications or seeking support. Swetlitz et al. (76) proposed redefining depression care to affirm masculine identity, where family and healthcare providers could help reframe self-care behaviors (e.g., taking medications) or reliance on others to assert masculine values (e.g., strength, autonomy, control). Specifically, emphasizing strength, autonomy, and control in self-care practices may reduce stigma and encourage engagement with treatment (76). Furthermore, healthcare-related frustrations, which are common among individuals facing barriers to self-care (72), were also associated with depressive symptoms. Effective patient-provider communication should emphasize maintaining a culturally sensitive dialogue that promotes shared decision-making to alleviate these frustrations, while affirming the male patient’s sense of masculinity (76). Public health professionals, including community health workers, can also play a vital role by providing mental health literacy education to non-Hispanic Black and Hispanic men to empower them to access mental health care for the screening and treatment of depression (109). Mental health literacy campaigns, similar to England’s Every Mind Matters (110, 111), could be organized for non-Hispanic Black and Hispanic men with chronic conditions to raise awareness of mental health and promote self-management of depressive symptoms. To enhance mental health care for non-Hispanic Black and Hispanic men with chronic conditions, policymakers should advocate for culturally responsive leadership in mental health organizations (112). This strategy would promote the recruitment and retention of a diverse mental health workforce, particularly from non-Hispanic Black and Hispanic backgrounds, who can more effectively address the unique needs of their communities.

In bivariate analyses, men with depressive symptoms averaged more comorbid chronic conditions, and larger proportions of men who self-reported certain chronic conditions (i.e., asthma/emphysema/other chronic lung problems, arthritis/rheumatic disease, chronic pain, obstructive sleep apnea) reported depressive symptoms. While the number of self-reported chronic conditions was not significantly associated with depressive symptoms in multivariate analyses, it is recognized that disease comorbidity may shape the onset, recognition, and treatment of depressive symptoms. Symptomatic chronic conditions (e.g., chronic pain, obstructive sleep apnea) can increase the risk for depression (22, 113, 114). These physical symptoms can mask or mirror depressive symptom (115, 116), thus complicating depression diagnosis and treatment (117–119). Those with comorbid chronic conditions and depression may diminish treatment adherence and self-care behaviors (120–123). As such, the interplay between physical and mental health may require a multi-disciplinary and biopsychosocial approach to optimize health outcomes and prevent potentially severe disease complications (124–126).

The current study has limitations warranting acknowledgement. First, it employed a cross-sectional design, which restricts the ability to infer causality over time. Second, only self-reported data were collected, potentially affecting the validity and reliability of the findings. Third, the internet-based survey may have created some selection bias, where those with less internet proficiency or limited internet access may be underrepresented. With the opt-in nature of the Qualtrics panel, it is difficult to determine if those who chose to participate differ systematically from those who were invited but declined to participate in the study. Fourth, the brief PHQ-2 was utilized for assessing depressive symptoms, but it may have underestimated or oversimplified the prevalence and severity of depression symptomatology compared to using longer versions of the tool (e.g., PHQ-8 or PHQ-9). While the PHQ-2 is a well-known screener for depression symptoms, additional clinical efforts are needed to properly diagnose depression among non-Hispanic Black and Hispanic men, including the use of the full PHQ-9. Fifth, because our sample consisted exclusively of non-Hispanic Black and Hispanic men aged ≥40 years with chronic conditions, the findings are not generalizable to women, younger individuals, or those without chronic illness. Although our analysis provided important insights into shared determinants of depressive symptoms among minority men with chronic conditions, future research should assess whether these associations hold across more diverse populations. Sixth, while participants represented all four census quadrants in the United States, geographic heterogeneity across regions was not explored. The United States is diverse, and experiences related to race, ethnicity, social engagement, and lifestyle behaviors may substantially differ based on geographic region (e.g., West Coast, East Coast, Deep South). Future research should incorporate geographic variables to better contextualize findings, which would allow for a more nuanced understanding of depressive symptomatology among non-Hispanic Black and Hispanic men with chronic conditions. Seventh, some of our variables were dichotomized, including depressive symptoms measured with the PHQ-2, which may overlook certain nuances across variable categories and oversimplify the complexity of depressive symptomology. Although variables were dichotomized based on frequency distributions and/or other well-documented thresholds, binary categorizations for depression may mask subtler distinctions in symptom severity and impact, and future studies could benefit from considering a more nuanced approach to assessing depression, potentially using continuous measures or multi-level categorization. Finally, the timing of data collection, which occurred in late 2019, prior to the COVID-19 pandemic, may be a shortcoming to the current study. Given the documented impacts of the pandemic on mental health, including disproportionate effects on racial and ethnic minority groups, the current findings may not reflect subsequent shifts in depressive symptoms, social engagement, or lifestyle behaviors that occurred due to pandemic-related social and economic disruptions. Thus, caution should be exercised when generalizing these findings to post-pandemic contexts.

In conclusion, this study highlights significant racial/ethnic disparities in the prevalence of self-reported depressive symptoms among non-Hispanic Black and Hispanic men aged 40 years and above with chronic conditions. Several factors were identified as determinants of depressive symptoms, including social disconnectedness and healthcare frustrations, underscoring the importance of tailored interventions to empower non-Hispanic Black and Hispanic men with chronic conditions to seek help and engage in self-care to manage their depression.