Do racial patterns in psychological distress shed light on the Black–White depression paradox? A systematic review
Abstract
Purpose Major epidemiologic studies in the US reveal a consistent "paradox" by which psychiatric outcomes such as major depressive disorder (MDD) are less prevalent among Blacks relative to Whites, despite greater exposure to social and economic stressors and worse physical health outcomes. A second paradox, which has received less attention and has never been systematically documented, is the discrepancy between these patterns and Black-White comparisons in psychological distress, which reveal consistently higher levels among Blacks. By systematically documenting the latter paradox, this paper seeks to inform efforts to explain the first paradox. Methods We conduct a systematic review of the literature estimating the prevalence of MDD and levels of psychological distress in Blacks and Whites in the US. Results The literature review yielded 34 articles reporting 54 relevant outcomes overall. Blacks have a lower prevalence of MDD in 8 of the 9 comparisons observed. In contrast, Blacks have higher levels of psychological distress (in terms of "high distress" and mean scores) than Whites in 42 of the 45 comparisons observed. Tests of statistical significance, where available, confirm this discrepant pattern. Conclusions A systematic review of the epidemiologic evidence supports the existence of a "double paradox" by which Blacks' lower prevalence of MDD relative to Whites' is inconsistent with both the expectations of social stress theory and with the empirical evidence regardin…
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The social stress paradigm holds that disadvantaged groups have worse physical and mental health than advantaged groups because they face more stressors, lifetime adversity, and fewer socioeconomic resources.
“The SSP posits that groups of disadvantaged status will have poorer physical and mental health outcomes than groups of advantaged status due to increased exposure to stressors, lifetime adversity, and fewer socioeconomic resources”
From Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans. (2021) · cites this paper as Barnes and Bates 2017
A large body of research documents that Black Americans often report positive mental health despite limited socioeconomic resources, high social stress exposure, and poor physical health.
“A substantial body of research has documented paradoxical health patterns among Black Americans such that this group generally reports positive mental health (i.e., a lower prevalence of psychiatric disorders) despite limited socioeconomic resources, heightened exposure to social stress, and poor physical health outcomes”
From Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans. (2021) · cites this paper as Barnes and Bates 2017
High levels of psychological distress and poor physical health tend to be prevalent among Black Americans.
“At the same time, high levels of psychological distress (i.e., depressive symptoms) and poor physical health tend to be prevalent among this group (Barnes and Bates 2017; Mouzon et al. 2016; Thomas Tobin 2021; Thomas Tobin et al. 2020).”
From Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans. (2021) · cites this paper as Barnes and Bates 2017
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Self-citation
- Authors
- Barnes, D. M., & Bates, L. M.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Columbia University (US)
- Corresponding author
- Barnes, David M.
- ORCID
- Bates, Lisa M.
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2017-05-29
- Volume
- 52
- Issue
- 8
- Pages
- 913-928
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2619634349
- Cited by
- 193
- References
- 110
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 27 · 2023: 33 · 2022: 30 · 2021: 30 · 2020: 14 · 2019: 18 · 2018: 5 · 2017: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, psychological distress, racial disparities, African Americans, White Americans, depression prevalence
- MeSH terms
- Black or African American, Depressive Disorder, Major, Major Depressive Disorder, Humans, Stress, Psychological, United States, Prevalence, White People, Health Status Disparities
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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