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Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States
Open accessAbstract
Background. Recent research in the United States has demonstrated striking health disparities across ethnic groups. Despite a longstanding interest in ethnic disadvantage in psychiatric epidemiology, patterns of psychiatric morbidity across ethnic groups have never been examined in a nationally representative sample. Method. Ethnic differences in psychiatric morbidity are analyzed using data from the National Comorbidity Survey (NCS). The three largest ethnic groups in the United States – Hispanics, Non-Hispanic Blacks and Non-Hispanic Whites – were compared with respect to lifetime risk and persistence of three categories of psychiatric disorder: mood disorder, anxiety disorder, and substance use disorder. Results. Where differences across ethnic groups were found in lifetime risk, socially disadvantaged groups had lower risk. Relative to Non-Hispanic Whites, Hispanics had lower lifetime risk of substance use disorder and Non-Hispanic Blacks had lower lifetime risk of mood, anxiety and substance use disorders. Where differences were found in persistence of disorders, disadvantaged groups had higher risk. Hispanics with mood disorders were more likely to be persistently ill as were Non-Hispanic Blacks with respect to both mood disorders and anxiety disorders. Closer examination found these differences to be generally consistent across population subgroups. Conclusions. Members of disadvantaged ethnic groups in the United States do not have an increased risk for psychiatric disorders. Members of these groups, however, do tend to have more persistent disorders. Future research should focus on explanations for these findings, including the possibility that these comparisons are biased, and on potential means of reducing the disparity in persistence of disorders across ethnic groups.
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“This disproportionate exposure to race-related stressors may partly explain the higher prevalence and persistence rates of mood and anxiety disorders among Black, Asian, and Latinx groups compared with non-Latinx White groups [12,13].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [12]
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Social phobia and perceived friendship quality
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Feroze, U., Martin, D., Kalantar‐Zadeh, K., Kim, J. C., Reina-Patton, A., & Kopple, J. D. (2011) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2011.10.009 · Cited by 113
“In the general population, the prevalence and lifetime incidence have been reported to be about 18%(3) and 25% to 29%,(4) respectively, for anxiety and 2% to 9%(5) and 12% to 20%, respectively, for depression.(4) Women are generally reported to be at the higher end and men to be at the lower end of these rates.”
BackgroundIncreased Risk of Suicide Attempts Among Black and Latino Lesbians, Gay Men, and Bisexuals
O'Donnell, S., Meyer, I. H., & Schwartz, S. (2011) · American Journal of Public Health · doi:10.2105/ajph.2010.300032 · Cited by 112
Gene-environment interaction in posttraumatic stress disorder
Koenen, K. C., Nugent, N. R., & Amstadter, A. B. (2008) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-007-0787-2 · Cited by 118
“However, once they develop a psychiatric disorder, their disorders are more chronic than those of non-Hispanic whites [7].”
BackgroundRacial differences in depression in the United States: how do subgroup analyses inform a paradox?
Barnes, D. M., Keyes, K. M., & Bates, L. M. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0718-7 · Cited by 113
“To date, a range of methodological and substantive hypotheses has been proposed to account for the Black–White depression paradox [15, 18–20].”
BackgroundDisparity in posttraumatic stress disorder diagnosis among African American pregnant women
Seng, J. S., Kohn‐Wood, L. P., McPherson, M. D., & Sperlich, M. I. (2011) · Archives of Women s Mental Health · doi:10.1007/s00737-011-0218-2 · Cited by 112
“Recent reviews of risk for posttraumatic stress disorder (PTSD) by race have, by and large, shown that African Americans are not at increased risk for onset of the disorder, but are at increased risk for persistent disorder (Breslau et al. 2005).”
BackgroundGender differences in major depressive disorder: findings from the Singapore Mental Health Study
Picco, L., Subramaniam, M., Abdin, E., Vaingankar, J. A., & Chong, S. (2016) · Singapore Medical Journal · doi:10.11622/smedj.2016144 · Cited by 116
“Notably, previous research, conducted largely in the United States, found a lower-than-expected prevalence of depression among minority ethnic groups compared to white Americans.”
ResultCoping With Racism: What Works and Doesn’t Work for Black Women?
West, L. M., Donovan, R. A., & Roemer, L. (2009) · Journal of Black Psychology · doi:10.1177/0095798409353755 · Cited by 115
Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?
Erving, C. L., Thomas, C. S., & Frazier, C. (2019) · American Journal of Epidemiology · doi:10.1093/aje/kwy224 · Cited by 109
“In addition to a restricted number of outcomes, previous paradox studies often limited their attention to lifetime psychiatric disorders (1, 6, 15, 18, 20, 21).”
InfluentialRace/ethnicity, nativity, and lifetime risk of mental disorders in US adults
Álvarez, K., Fillbrunn, M. K., Green, J. G., Jackson, J. S., Kessler, R. C., McLaughlin, K. A., Sadikova, E., Sampson, N. A., & Alegria, M. M. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1644-5 · Cited by 117
Self-citationAge and ethnic differences in the onset, persistence and recurrence of alcohol use disorder
Grant, J. D., Verges, A. J., Jackson, K. M., Trull, T. J., Sher, K. J., & Bucholz, K. K. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03721.x · Cited by 107
“For example, as pointed out by others [14], differences in persistence of disorder, unlike new onset of disorder, may indicate unequal access to, lower retention in or differential efficacy of treatment in different ethnic, gender or age subgroups.”
BackgroundSteinberg, J. R., & Finer, L. B. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.10.006 · Cited by 108
“0%) in the past year reported by Cairney et al. (2006) and 1.”
BackgroundTrajectories of Mental Distress Among U.S. Adults During the COVID-19 Pandemic
Riehm, K. E., Holingue, C., Smail, E. J., Kapteyn, A., Bennett, D., Thrul, J., Kreuter, F., McGinty, E. E., Kalb, L. G., Veldhuis, C. B., et al. (2021) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaa126 · Cited by 115
“Sex, age, and race/ethnicity are sociodemographic characteristics that are often associated with mental distress [25, 26].”
BackgroundCan Family Relationships Explain the Race Paradox in Mental Health?
Mouzon, D. M. (2013) · Journal of Marriage and the Family · doi:10.1111/jomf.12006 · Cited by 106
“I replicated past research showing better mental health status among Blacks (e.g., Breslau et al., 2005, 2006) but found little support for Stack’s (1983) findings of denser and more supportive family relationships among Blacks.”
ResultRace, social relationships, and mental health
Kiecolt, K. J., Hughes, M. D., & Keith, V. M. (2008) · Personal Relationships · doi:10.1111/j.1475-6811.2008.00195.x · Cited by 111
Levine, D. S., Taylor, R. J., Nguyen, A. W., Chatters, L. M., & Himle, J. A. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1023-4 · Cited by 105
“A small group of studies indicate that this pattern of lower prevalence but increased severity and persistence also occurs among African Americans and Black Caribbeans with SAD [15, 17].”
BackgroundGraham, J. R., West, L. M., Martinez, J. H., & Roemer, L. (2016) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000073 · Cited by 105
Hispanic drug abuse in an evolving cultural context: An agenda for research
Warner, L. A., Valdez, A., Vega, W. A., Rosa, M. R. D. L., Turner, R. J., & CANINO, G. J. (2006) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.05.003 · Cited by 105
Discontinuation of Antidepressant Medication Among Latinos in the USA
Hodgkin, D., Volpe-Vartanian, J., & Alegria, M. M. (2007) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-007-9070-6 · Cited by 101
“That study reported that 24% of patients did not inform their physician about stopping the antidepressant medication and found that the likelihood of patients_ informing their providers varied according to the patients_ perceptions of the treatment relationship and to their reasons for discontinuing.(26) This study_s…”
BackgroundChae, D. H., Lincoln, K. D., & Jackson, J. S. (2011) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.2011.01122.x · Cited by 104
Depression in Racial and Ethnic Minorities: the Impact of Nativity and Discrimination
Henna Budhwani, P., Hearld, K. R., & Chavez‐Yenter, D. (2014) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-014-0045-z · Cited by 100
“Studies have found that Blacks have similar or better mental health than Whites regardless of economic disadvantages and discrimination [7–10].”
BackgroundEarly Adolescent Risk Behavior Outcomes of Childhood Externalizing Behavioral Trajectories
Thompson, R., Tabone, J. K., Litrownik, A. J., Briggs, E. C., Hussey, J. M., English, D. J., & Dubowitz, H. (2010) · The Journal of Early Adolescence · doi:10.1177/0272431609361203 · Cited by 110
Ethnic inequalities in the use of health services for common mental disorders in England
Cooper, C., Spiers, N. A., Livingston, G., Jenkins, R., Meltzer, H., Brugha, T. S., McManus, S., Weich, S., & Bebbington, P. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0565-y · Cited by 109
“These treatment inequalities may lead to more chronic episodes of depression and greater functional limitation among minority groups [13, 14].”
BackgroundHimle, J. A., Muroff, J. R., Taylor, R. J., Baser, R. E., Abelson, J. M., Hanna, G. L., Abelson, J. L., & Jackson, J. S. (2008) · Depression and Anxiety · doi:10.1002/da.20434 · Cited by 94
“Available information regarding mental health disorders among blacks suggests that mental illness is especially persistent in this group.([33,34]) Although OCD is known to be very persistent in general population samples,([16]) its relative persistence rates across cultural groups in the United States is unclear.”
BackgroundRobinson, J. A., Bolton, J. M., Rasic, D. T., & Sareen, J. (2012) · Depression and Anxiety · doi:10.1002/da.21978 · Cited by 93
“However, it is possible that the higher frequency and risk of anxiety disorders in Whites when compared to other minority groups may partially account for this finding.[29, 30] It is also possible that membership in different religious denominations may mediate risk of specific mental illness, and particular ethniciti…”
BackgroundEducation and race-ethnicity differences in the lifetime risk of alcohol dependence
Gilman, S. E., Breslau, J. A., Conron, K. J., Koenen, K. C., Subramanian, S. V., & Zaslavsky, A. M. (2008) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2006.059022 · Cited by 89
Self-citation
Metadata
- Authors
- BRESLAU, J., KENDLER, K. S., SU, M., GAXIOLA-AGUILAR, S., & KESSLER, R. C.
- Affiliations
- Harvard University (US)
- Virginia Commonwealth University (US)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2004-09-29
- Volume
- 35
- Issue
- 3
- Pages
- 317-327
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC2748985
- OpenAlex
- W2119176293
- Cited by
- 642
- References
- 55
- Citations by year
- 2026: 11 · 2025: 23 · 2024: 31 · 2023: 27 · 2022: 38 · 2021: 33 · 2020: 31 · 2019: 25 · 2018: 44 · 2017: 27 · 2016: 34 · 2015: 31 · 2014: 42 · 2013: 33 · 2012: 34
- FWCI
- 22.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (5 KO1 MH66057-02, K01MH066057)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- ethnic disparities, psychiatric morbidity, lifetime risk, mood disorders, anxiety disorders, substance use disorders, Hispanic Americans, African Americans, social deprivation, National Comorbidity Survey
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Ethnicity, Female, Health Surveys, Humans, Male, Middle Aged, Morbidity, Risk Factors, Social Class, United States
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