Black teenagers, especially those from low-income communities, express depressive symptoms differently from other demographic groups, according to new research that included young Philadelphia public housing residents.

The Rutgers University-led study found that depressed African-American adolescents tend to complain about conflicts with others and about having difficulty sleeping, as opposed to feelings of sadness and lack of energy more typically associated with depression.  The researchers suggested these differences should be taken into consideration when creating treatment plans. For some teens, interpersonal psychotherapy may especially be helpful, said Wenhau Lu, an assistant professor of childhood studies at Rutgers-Camden.

"Adolescent depression is a dire public concern in the United States, and an even greater concern among black adolescents where, if left untreated, can disproportionately lead to an escalation of various mental disorders, academic failure, and related issues," Lu said in a statement.

The study was conducted with nearly 800 African-American youth ages 11 to 21 living in nine public housing developments, including two in North Philadelphia. The other cities included New York City, St. Louis, Mo., and Washington, D.C.

Lu said the study did not survey youths from other racial or economic groups, but the researchers used findings of other studies to establish which symptoms were most typical in other teens.

The study, which included researchers from New York University, Washington University and the University of Chicago, was published in the November issue of the Journal of the Society for Social Work and Research.

The assessment tool used in the study was the Center for Epidemiologic Studies Depression Scale (CES-D), a commonly used screening survey of 20 questions. First developed in the 1970s, it was not designed for screening black youths, Lu said.

Individuals taking the survey are asked to give the frequency that certain statements applied to them in the past week. The statements include negative and positive feelings — such as being hopeful about the future — along with experiences of restless sleep, crying spells, poor appetite or finding people unfriendly. The researchers also added two questions about suicidal thoughts, Lu said.

When the black adolescents who took the survey admitted to strong or prolonged feelings of loneliness and sadness, those responses also had a tendency to be coupled with affirmative answers to the questions about suicidal thoughts, Lu said.

Strong agreement with the test's statements of "I feel lonely" and "I feel sad" should "ring a warning bell" for parents and other adults, Lu said.

The study also suggested that sleep complaints among black adolescents should be taken more seriously by family members and other adults.

"Because depression presents differently for these young people, it is important to allow the adolescents to use their terminology when describing their depressive symptoms," the study states.

For example, past research has found that black youth, particularly boys, may express more anger and irritability, the study noted. With these young subjects, poverty and exposure to violence can also be factors in their risk for depression, the researchers noted.

The study also cited past findings that youth diagnosed with depression are six times more likely to commit suicide than their peers and that the rates of suicide among black youth, especially boys, doubled between 1993 and 2012, a greater rate increase than any other group.

"It is imperative, therefore, to identify the ways black adolescents express their symptoms, determine any gender differences in symptom expression, and calibrate existing assessment tools to improve" their usefulness for these young people, the study states.