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Ethnic Differences in Separate and Additive Effects of Anxiety and Depression on Self-rated Mental Health Among Blacks

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Abstract

Aim

The aim of this study was to explore ethnic differences in the separate and additive effects of anxiety and depression on self-rated mental health (SRMH) of Blacks in the USA.

Methods

With a cross-sectional design, we used data from a national household probability sample of African Americans (n = 3570) and Caribbean Blacks (n = 1621) who participated in the National Survey of American Life, 2001–2003. Demographic factors, socio-economic factors, 12-month general anxiety disorder (GAD) and major depressive disorder (MDD), and current SRMH were measured. In each ethnic group, three logistic regressions were used to assess the effects of GAD, MDD, and their combinations on SRMH.

Results

Among African Americans, GAD and MDD had separate effects on SRMH. Among Caribbean Blacks, only MDD but not GAD had separate effect on SRMH. Among African Americans, when the combined effects of GAD and MDD were tested, GAD but not MDD was associated with SRMH.

Conclusion

The separate and additive effects of GAD and MDD on SRMH among Blacks depend on ethnicity. Although single-item SRMH measures are easy methods for the screening of mental health need, community-based programs that aim to meet the need for mental health services among Blacks in the USA should consider within-race ethnic differences in the applicability of such instruments.

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References

  1. Cano A, Sprafkin RP, Scaturo DJ, Lantinga LJ, Fiese BH, Brand F. Mental health screening in primary care: a comparison of 3 brief measures of psychological distress. Prim Care Companion J Clin Psychiatry. 2001;3(5):206–10.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rohrer JE, Arif A, Denison A, Young R, Adamson S. Overall self-rated health as an outcome indicator in primary care. Eval Clin Pract. 2007;13(6):882–8.

    Google Scholar 

  3. Srole L, Langner TS, Michael ST, Opler MK, Rennie TA. Mental health in the metropolis: the midtown Manhattan study. McGraw-Hill; 1962.

  4. Gurin G, Joseph V, Sheila F. Americans view their mental health, 1957. ICPSR03503-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 1975. http://doi.org/10.3886/ICPSR03503.v1.

  5. Weissman MM, Myers JK, Ross CE, editors. Community surveys of psychiatric disorders. New Brunswick: Rutgers University Press; 1986.

    Google Scholar 

  6. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.

    Article  CAS  PubMed  Google Scholar 

  7. IOM. State of the USA health indicators: letter report. 2009. http://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspx.

  8. Healthy people 2002. https://www.healthypeople.gov/2020/about/foundation-health-measures/General-Health-Status#one.

  9. Ahmad F, Jhajj AK, Stewart DE, Burghardt M, Bierman AS. Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res. 2014;14:398.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Demirchyan A, Petrosyan V, Thompson ME. Gender differences in predictors of self-rated health in Armenia: a population-based study of an economy in transition. Int J Equity Health. 2012;11:67.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatr. 2006;163:101–8.

    Article  PubMed  Google Scholar 

  12. Chamberlain AM, Manemann SM, Dunlay SM, Spertus JA, Moser DK, Berardi C, Kane RL, Weston SA, Redfield MM, Roger VL. Self-rated health predicts healthcare utilization in heart failure. J Am Heart Assoc. 2014 28;3(3):e000931.

  13. Fernández-Olano C, Hidalgo JDL, Cerdá-Díaz R, Requena-Gallego M, Sánchez-Castaòo C, Urbistondo-Cascales L, et al. Factors associated with health care utilization by the elderly in a public health care system. Health Policy. 2006;75:131–9.

    Article  PubMed  Google Scholar 

  14. Wan TTH, Odell BG. Factors affecting the use of social and health services among the elderly. Ageing Soc. 1981;1:95–115.

    Article  Google Scholar 

  15. Katz SJ, Kessler RC, Frank RG, et al. The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care. Am J Public Health. 1997;87(7):1136–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zuvekas SH, Fleishman JA. Self-rated mental health and racial/ethnic disparities in mental health service use. Med Care. 2008;46(9):915–23.

  17. Bosworth HB, Butterfield MI, Stechuchak KM, Bastian LA. The relationship between self-rated health and health care service use among women veterans in a primary care clinic. Womens Health Issues. 2000;10(5):278–85.

    Article  CAS  PubMed  Google Scholar 

  18. Kim C, Vahratian A. Self-rated health and health care use among women with histories of gestational diabetes mellitus. Diabetes Care. 2010;33(1):41–2.

    Article  PubMed  Google Scholar 

  19. Bourne PA. Chronic diseases, self-rated health status, health care utilization and health insurance status of males in a Caribbean nation. J Behav Health. 2013;2(1):66–78.

    Google Scholar 

  20. Boult C, Dowd B, McCaffey BA, Boult L, Hernandez R, Krulewitch H. Screening elders for risk of hospital admission. J Am Geriatr Soc. 1993;41:811–7.

    Article  CAS  PubMed  Google Scholar 

  21. Branch L, Jette A, Evashwick C, Polansky M, Rowe G, Diehr P. Toward understanding elder’s health service utilization. J Community Health. 1981;7:80–92.

    Article  CAS  PubMed  Google Scholar 

  22. Fernandez–de–la-Hoz K, Leon DA. Self-perceived health status and inequalities in use of health services in Spain. Int J Epidemiol. 1996;25:593–603.

    Article  PubMed  Google Scholar 

  23. Perestelo-Perez L, Gonzalez-Lorenzo M, Perez-Ramos J, Rivero-Santana A, Serrano-Aguilar P. Patient involvement and shared decision-making in mental health care. Curr Clin Pharmacol. 2011;6(2):83–90.

    Article  PubMed  Google Scholar 

  24. Kim G, DeCoster J, Chiriboga DA, Jang Y, Allen RS, Parmelee P. Associations between self-rated mental health and psychiatric disorders among older adults: do racial/ethnic differences exist? Am J Geriatr Psychiatry. 2011;19(5):416–22.

    Article  PubMed  Google Scholar 

  25. Fleishman JA, Zuvekas SH. Global self-rated mental health: associations with other mental health measures and with role functioning. Med Care. 2007;45(7):602–9.

    Article  PubMed  Google Scholar 

  26. Jang Y, Park NS, Kang SY, Chiriboga DA. Racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults. Community Ment Health J. 2014;50(3):325–30.

    Article  PubMed  Google Scholar 

  27. Mawani FN, Gilmour H. Validation of self-rated mental health. Health Rep. 2010;21(3):61–75.

    PubMed  Google Scholar 

  28. Kim G, Bryant A, Huang C, Chiriboga D, Ma GX. Mental health among Asian American adults: association with psychiatric. Asian Am J Psychol. 2012;3(1):44–52.

    Article  Google Scholar 

  29. Levinson D, Kaplan G. What does self rated mental health represent. J Public Health Res. 2014;3(3):287.

  30. Rohrer JE, Arif A, Denison A, Young R, Adamson S. Overall self-rated health as an outcome indicator in primary care. J Eval Clin Pract. 2007;13:882–8.

    PubMed  Google Scholar 

  31. May M, Lawlor DA, Brindle P, Patel R, Ebrahim S. Cardiovascular disease risk assessment in older women: can we improve on Framingham? British Women’s Heart and Health prospective cohort study. Heart. 2006;9(2):1396–401.

    Article  Google Scholar 

  32. Katz SJ, Kessler RC, Frank RG, Leaf P, Lin E, Edlund M. The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care. Am J Public Health. 1997;87(7):1136–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cano A, Sprafkin RP, Scaturo DJ, Lantinga LJ, Fiese BH, Brand F. Mental health screening in primary care: a comparison of 3 brief measures of psychological distress. Prim Care Companion J Clin Psychiatry. 2001;3(5):206–10.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, et al. The national survey of American life: a study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res. 2004;13(4):196–207.

    Article  PubMed  Google Scholar 

  35. Assari S. Race and ethnicity, religion involvement, church-based social support and subjective health in United States: a case of moderated mediation. Int J Prev Med. 2013;4(2):208–17.

    PubMed  PubMed Central  Google Scholar 

  36. Manor O, Matthews S, Power C. Dichotomous or categorical response? Analysing self-rated health and lifetime social class. Int J Epidemiol. 2000;29(1):149–57.

    Article  CAS  PubMed  Google Scholar 

  37. Headey BW, Kelley J, Wearing AJ. Dimensions of mental health: life satisfaction, positive affect, anxiety, and depression. Soc Indic Res. 1993;29:63–82.

    Article  Google Scholar 

  38. McDowell I. Measuring health: a guide to rating scales and questionnaires. 3rd ed. New York: Oxford University Press; 2006.

    Book  Google Scholar 

  39. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.

    Article  CAS  PubMed  Google Scholar 

  40. Wittchen HU. Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res. 1994;28:57–84.

    Article  CAS  PubMed  Google Scholar 

  41. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, et al. The composite international diagnostic interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988;45:1069–77.

    Article  CAS  PubMed  Google Scholar 

  42. Kessler RC, Wittchen H-U, Abelson JM, McGonagle KA, Schwarz N, Kendler KS, et al. Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US national comorbidity survey. Int J Methods Psych Res. 1998;7:33–55.

    Article  Google Scholar 

  43. Kessler RC, Calabrese JR, Farley PA, Gruber MJ, Jewell MA, Katon W, et al. Composite international diagnostic interview screening scales for DSM-IV anxiety and mood disorders. Psychol Med. 2013;43(8):1625–37.

    Article  CAS  PubMed  Google Scholar 

  44. Williams DR, Haile R, González HM, Neighbors H, Baser R, Jackson JS. The mental health of Black Caribbean immigrants: results from the National Survey of American Life. Am J Public Health. 2007;97(1):52–9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Assari S, Lankarani MM, Moazen B. Religious beliefs may reduce the negative effect of psychiatric disorders on age of onset of suicidal ideation among blacks in the United States. Int J Prev Med. 2012;3(5):358–64.

    PubMed  PubMed Central  Google Scholar 

  46. Assari S, Moghani Lankarani M, Moghani Lankarani R. Ethnicity modifies the effects of anxiety and drug use on suicidal ideation among black adults in the United States. Int J Prev Med. 2013;4(11):1151.

    Google Scholar 

  47. Assari S. Additive effects of anxiety and depression on body mass index among blacks: role of ethnicity and gender. Int Cardiovasc Res J. 2014;8(2):44–51.

    PubMed  PubMed Central  Google Scholar 

  48. Assari S. Chronic medical conditions and major depressive disorder: differential role of positive religious coping among African Americans, Caribbean Blacks and non-Hispanic Whites. Int J Prev Med. 2014;5(4):405–13.

    PubMed  PubMed Central  Google Scholar 

  49. Assari S, Moghani Lankarani M. Race and ethnic differences in associations between cardiovascular diseases, anxiety, and depression in the United States. Int J Travel Med Global Health 2014;2(3):103–9.

  50. Assari S. Separate and combined effects of anxiety, depression and problem drinking on subjective health among black, Hispanic and non-Hispanic white men. Int J Prev Med. 2014;5(3):269–79.

    PubMed  PubMed Central  Google Scholar 

  51. Assari S. The link between mental health and obesity: role of individual and contextual factors. Int J Prev Med. 2014;5(3):247–9.

    PubMed  PubMed Central  Google Scholar 

  52. Assari S. Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes. J Diabetes Metab Disord. 2014; 21;13(1):36.

  53. Assari S, Lankarani MM, Lankarani RM. Ethnicity modifies the additive effects of anxiety and drug use disorders on suicidal ideation among Black adults in the United States. Int J Prev Med. 2013;4(11):1251–7.

    PubMed  PubMed Central  Google Scholar 

  54. Assari S. Race and ethnicity, religion involvement, church-based social support and subjective health in United States: a case of moderated mediation. Int J Prev Med. 2013;4(2):208–17.

    PubMed  PubMed Central  Google Scholar 

  55. Dejman M, Forouzan AS, Assari S, Rasoulian M, Jazayery A, Malekafzali H, et al. How Iranian lay people in three ethnic groups conceptualize a case of a depressed woman: an explanatory model. Ethn Health. 2010;15(5):475–93.

    Article  PubMed  Google Scholar 

  56. Dejman M, Forouzan A, Assari S, Malekafzali H, Nohesara S, Khatibzadeh N, et al. An explanatory model of depression among female patients in Fars, Kurds, Turks ethnic groups of Iran. Iran J Public Health. 2011;40(3):79–88.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Assari S. Chronic kidney disease, anxiety and depression among American blacks; does ethnicity matter? Int J Travel Med Global Health 2014;2(4):133–9.

  58. Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–21.

    PubMed  Google Scholar 

  59. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008;70(8):890–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Moffitt TE, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory AM, et al. Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry. 2007;64(6):651–60.

    Article  PubMed  Google Scholar 

  61. Mergl R, Seidscheck I, Allgaier AK, Moller HJ, Hegerl U, Henkel V. Depressive anxiety, and somatoform disorders in primary care: prevalence and recognition. Depress Anxiety. 2007;24:185–95.

    Article  PubMed  Google Scholar 

  62. Gaylord-Harden NK, Elmore CA, Campbell CL, Wethington A. An examination of the tripartite model of depressive and anxiety symptoms in African American youth: stressors and coping strategies as common and specific correlates. J Clin Child Adolesc Psychol. 2011;40(3):360–74.

    Article  PubMed  Google Scholar 

  63. Diefenbach GJ, Disch WB, Robison JT, Baez E, Coman E. Anxious depression among Puerto Rican and African-American older adults. Aging Ment Health. 2009;13(1):118–26.

    Article  PubMed  Google Scholar 

  64. Heo JY, Jeon HJ, Fava M, Mischoulon D, Baer L, Clain A, et al. Efficacy of ziprasidone monotherapy in patients with anxious depression: a 12-week, randomized, double-blind, placebo-controlled, sequential-parallel comparison trial. J Psychiatr Res. 2015;62:56–61.

    Article  PubMed  Google Scholar 

  65. Frances A. The new crisis of confidence in psychiatric diagnosis. Ann Intern Med. 2013 19;159(10):720.

  66. Paris J, Phillips J. (eds). Making the DSM-5: concepts and controversies. New York: Springer. 2013. 10.1007/978-1-4614-6504-1.

  67. Gautam M, Agrawal M, Gautam M, Sharma P, Gautam AS, Gautam S. Role of antioxidants in generalised anxiety disorder and depression. Indian J Psychiatry. 2012;54(3):244–7. doi:10.4103/0019-5545.102424.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Strakowski SM, Lonczak HS, Sax KW, West SA, Crist A, Mehta R, et al. The effects of race on diagnosis and disposition from a psychiatric emergency service. J Clin Psychiatry. 1995;56(3):101–7.

    CAS  PubMed  Google Scholar 

  69. Hu WH, Wong WM, Lam CL, Lam KF, Hui WM, Lai KC, et al. Defining anxious depression: going beyond comorbidity. Aliment Pharmacol Ther. 2002;16(12):2081–8.

    Article  CAS  PubMed  Google Scholar 

  70. Assari S. Separate and combined effects of anxiety, depression and problem drinking on subjective health among black, Hispanic and non-Hispanic white men. Int J Prev Med. 2014;5(3):269–79.

    PubMed  PubMed Central  Google Scholar 

  71. Assari S, Lankarani MM, Lankarani RM. Ethnicity modifies the additive effects of anxiety and drug use disorders on suicidal ideation among black adults in the United States. Int J Prev Med. 2013;4(11):1251–7.

    PubMed  PubMed Central  Google Scholar 

  72. Chandola T, Jenkinson C. Validating self-rated health in different ethnic groups. Ethn Health. 2000;5(2):151–9.

    Article  CAS  PubMed  Google Scholar 

  73. First MB, Wakefield JC. Diagnostic criteria as dysfunction indicators: bridging the chasm between the definition of mental disorder and diagnostic criteria for specific disorders. Can J Psychiatry. 2013;58(12):663–9.

    PubMed  Google Scholar 

  74. Neighbors HW, Trierweiler SJ, Munday C, Thompson EE, Jackson JS, Binion VJ, et al. Psychiatric diagnosis of African Americans: diagnostic divergence in clinician-structured and semistructured interviewing conditions. J Natl Med Assoc. 1999;91(11):601–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  75. Zuvekas SH, Fleishman JA. Self-rated mental health and racial/ethnic disparities in mental health service use. Med Care. 2008;46(9):915–23.

  76. Gibbs TA, Okuda M, Oquendo MA, Lawson WB, Wang S, Thomas YF, et al. Mental health of African Americans and Caribbean blacks in the United States: results from the national epidemiological survey on alcohol and related conditions. Am J Public Health. 2013;103(2):330–8.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Woodward AT, Taylor RJ, Abelson JM, Matusko N. Major depressive disorder among older African Americans, Caribbean blacks, and non-Hispanic whites: secondary analysis of the National Survey of American Life. Depress Anxiety. 2013;30(6):589–97.

    Article  PubMed  Google Scholar 

  78. Jackson JS, Neighbors HW, Torres M, Martin LA, Williams DR, Baser R. Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: results from the National Survey of American Life. Am J Public Health. 2007;97(1):60–7.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Hammond WP, Mohottige D, Chantala K, Hastings JF, Neighbors HW, Snowden L. Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life. J Health Care Poor Underserved. 2011;22(1):157–75.

    PubMed  PubMed Central  Google Scholar 

  80. Williams DR, González HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64(3):305–15.

    Article  PubMed  Google Scholar 

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Acknowledgments

This was a secondary analysis on public-access data set of the National Survey of American Life (NSAL). The NSAL is mostly supported by the National Institute of Mental Health, with grant U01-MH57716. Other support came from the Office of Behavioral and Social Science Research at the National Institutes of Health and the University of Michigan. For this analysis, public data set was downloaded from Interuniversity Consortium for Political and Social Research (ICPSR), Institute for Social Research at the University of Michigan.

Conflict of Interest

The authors declare that they have no competing interests.

Ethics

Harold W. Neighbors contributed to the design and the conduct of NSAL. Shervin Assari designed the current work, analyzed the data, and drafted the manuscript. Masoumeh Dejman and Harold W. Neighbors contributed to the interpretation of the results and the drafting and revising of the manuscript. All authors confirmed the final draft.

Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109-2700, USA

    Shervin Assari

  2. Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Shervin Assari & Harold W. Neighbors

  3. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Masoumeh Dejman

  4. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Harold W. Neighbors

  5. Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Harold W. Neighbors

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  1. Shervin Assari
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Correspondence to Shervin Assari.

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Assari, S., Dejman, M. & Neighbors, H.W. Ethnic Differences in Separate and Additive Effects of Anxiety and Depression on Self-rated Mental Health Among Blacks. J. Racial and Ethnic Health Disparities 3, 423–430 (2016). https://doi.org/10.1007/s40615-015-0154-3

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