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Is the Black-White Mental Health Paradox Consistent across Age, Gender, and Psychiatric Disorders?

Citation

Thomas Tobin, Courtney S.; Erving, Christy L.; Hargrove, Taylor W.; & Satcher, Lacee A. (Online ahead of print). Is the Black-White Mental Health Paradox Consistent across Age, Gender, and Psychiatric Disorders?. Aging & Mental Health. PMCID: PMC8187467

Abstract

OBJECTIVES: The Black-White mental health epidemiological paradox (i.e. Black Americans' lower or similar rates of mental disorder relative to Whites) characterizes the literature on race and mental health. Yet, research has generally paid less attention to how such findings may vary across other social statuses that shape mental health. This study assessed whether the Black-White paradox is consistent across gender, age groups, and psychiatric disorders, including lifetime mood, anxiety, and substance use disorders.
METHOD: We used data from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL), 2001-2003 (N = 4,591 African Americans; 6,668 non-Hispanic Whites). Psychiatric disorders were measured with the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI). Binary logistic regression models were conducted to assess racial patterns of lifetime mental disorders across age and gender. Wald tests were performed to assess age and gender group differences in Black-White patterns of mental disorder.
RESULTS: The Black-White mental health paradox generally extends across lifetime mood, anxiety, and substance use disorders and is consistent across age and gender groups. One exception is middle-aged (45-64 years) Black men, who had higher odds of lifetime substance use disorder relative to their White male middle-aged peers. This difference is no longer statistically significant after accounting for education and employment. We also found more similarity in mental disorders between older Blacks and Whites relative to their younger counterparts, suggesting that Black-White mental health differences are most pronounced among younger age groups.
CONCLUSION: Our findings contribute to the broader literature on the Black-White mental health paradox by demonstrating that this epidemiological pattern persists across various mental disorder types and, at times, depends on age group and gender. Given that Black-Whte differences are less pronounced among older adults, future research should consider the ways life course theory might inform our understanding of the paradox. Findings also suggest that substance use services are critical to address the needs of middle-aged Black men of lower socioeconomic status who are disproportionately affected by substance use disorder, yet have relatively lower mental health care utilization rates.

URL

http://dx.doi.org/10.1080/13607863.2020.1855627

Reference Type

Journal Article

Article Type

Regular

Year Published

Online ahead of print

Journal Title

Aging & Mental Health

Author(s)

Thomas Tobin, Courtney S.
Erving, Christy L.
Hargrove, Taylor W.
Satcher, Lacee A.

PMCID

PMC8187467

Data Set/Study

National Comorbidity Survey-Replication (NCS-R)
National Survey of American Life (NSAL)

Continent/Country

United States of America

State

Nonspecific

Race/Ethnicity

Black
White