Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 12, pp 1941–1949 | Cite as

Racial differences in depression in the United States: how do subgroup analyses inform a paradox?

  • David M. BarnesEmail author
  • Katherine M. Keyes
  • Lisa M. Bates
Original Paper



Non-Hispanic Blacks in the US have lower rates of major depression than non-Hispanic Whites, in national household samples. This has been termed a “paradox,” as Blacks suffer greater exposure to social stressors, a risk factor for depression. Subgroup analyses can inform hypotheses to explain this paradox. For example, it has been suggested that selection bias in household samples undercounts depression in Blacks; if selection is driving the paradox, Black–White differences should be most pronounced among young men with low education.


We examined Black–White differences in lifetime major depression in subgroups defined simultaneously by sex, age, and education using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the Collaborative Psychiatric Epidemiology Surveys (CPES).


In NESARC and CPES, Blacks had lower odds than Whites of lifetime major depression in 21 and 23 subgroups, respectively, of 24. All statistically significant differences were in subgroups favoring Blacks, and lower odds in Blacks were more pronounced among those with more education.


These results suggest that hypotheses to explain the paradox must posit global mechanisms that pertain to all subgroups defined by sex, age, and education. Results do not lend support for the selection bias hypothesis.


Major depressive disorder Blacks Whites Socioeconomic status United States 



All authors contributed equally to the article. This research was supported by a fellowship from the National Institute of Mental Health (T32 MH013043, first author) and support from the other authors’ university. The funder had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Conflict of interest

None declared.

Supplementary material

127_2013_718_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)
127_2013_718_MOESM2_ESM.pdf (172 kb)
Online Fig. 1 Forest plot of Black–White subgroup odds ratios for lifetime Major Depressive Disorder in combined data from the National Comorbidity Survey Replication and the National Study of American Life. Subgroups are defined by sex, age group, and education (HS High School) (PDF 172 kb).


  1. 1.
    Blazer DG, Kessler RC (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 151:979–986Google Scholar
  2. 2.
    Breslau J, Aguilar-Gaxiola S, Kendler KS, Su M, Williams D, Kessler RC (2006) Specifying race-ethnic differences in risk for psychiatric disorder in a US national sample. Psychol Med 36:57–68CrossRefGoogle Scholar
  3. 3.
    Hasin DS, Goodwin RD, Stinson FS, Grant BF (2005) Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 62:1097–1106CrossRefGoogle Scholar
  4. 4.
    Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, Jackson JS (2007) 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 64:305CrossRefGoogle Scholar
  5. 5.
    Dohrenwend BP (2000) The role of adversity and stress in psychopathology: some evidence and its implications for theory and research. J Health Soc Behav 41:1–19CrossRefGoogle Scholar
  6. 6.
    Kessler RC (1997) The effects of stressful life events on depression. Annu Rev Psychol 48:191–214CrossRefGoogle Scholar
  7. 7.
    Monroe SM, Slavich GM, Georgiades K (2009) The social environment and life stress in depression. Handbook of depression (2nd ed). The Guilford Press, New York, pp 340–360Google Scholar
  8. 8.
    Boardman JD (2004) Health pessimism among black and white adults: the role of interpersonal and institutional maltreatment. Soc Sci Med 59:2523–2533CrossRefGoogle Scholar
  9. 9.
    Boardman JD, Alexander KB (2011) Stress trajectories, health behaviors, and the mental health of black and white young adults. Soc Sci Med 72:1659–1666CrossRefGoogle Scholar
  10. 10.
    Meyer IH, Schwartz S, Frost DM (2008) Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Soc Sci Med 67:368–379CrossRefGoogle Scholar
  11. 11.
    Schulz A, Israel B, Williams D, Parker E, Becker A, James S (2000) Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area. Soc Sci Med 51:1639–1654CrossRefGoogle Scholar
  12. 12.
    Taylor J, Turner RJ (2002) Perceived discrimination, social stress, and depression in the transition to adulthood: racial constrasts. Soc Psychol Q 65:213–225CrossRefGoogle Scholar
  13. 13.
    Williams DR, Yu Y, Jackson JS, Anderson NB (1997) Racial differences in physical and mental health, socio-economic status, stress and discrimination. J Health Psychol 2:335–351CrossRefGoogle Scholar
  14. 14.
    Breslau J, Javaras KN, Blacker D, Murphy JM, Normand SLT (2008) Differential item functioning between ethnic groups in the epidemiological assessment of depression. J Nerv Ment Dis 196:297–306CrossRefGoogle Scholar
  15. 15.
    Keyes CLM (2009) The black–white paradox in health: flourishing in the face of social inequality and discrimination. J Pers 77:1677–1706CrossRefGoogle Scholar
  16. 16.
    Mays VM, Cochran SD, Barnes NW (2007) Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol 58:201–225CrossRefGoogle Scholar
  17. 17.
    Williams DR (2001) Racial variations in adult health status: patterns, paradoxes, and prospects. In: Smelser NJ, Wilson WJ, Mitchell F (eds) America becoming: racial trends and their consequences. National Academy Press, Washington, pp 371–410Google Scholar
  18. 18.
    Breslau J, Kendler KS, Su M, Gaxiola-Aguilar S, Kessler RC (2005) Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 35:317–327CrossRefGoogle Scholar
  19. 19.
    Brown TN (2003) Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification. J Health Soc Behav 44:292–301CrossRefGoogle Scholar
  20. 20.
    Neighbors HW, Williams DR (2001) The epidemiology of mental disorder. In: Braithwaite RL, Taylor SE (eds) Health issues in the Black community. Jossey-Bass Publishers, San Francisco, pp 99–128Google Scholar
  21. 21.
    Jackson JS, Knight KM, Rafferty JA (2010) Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health 100:933–939CrossRefGoogle Scholar
  22. 22.
    Keyes KM, Barnes DM, Bates LM (2011) Stress, coping, and depression: testing a new hypothesis in a prospectively studied general population sample of US-born whites and blacks. Soc Sci Med 72:650–659CrossRefGoogle Scholar
  23. 23.
    Mezuk B, Rafferty JA, Kershaw KN, Hudson D, Abdou CM, Lee H, Eaton WW, Jackson JS (2010) Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression. Am J Epidemiol 172:1238–1249CrossRefGoogle Scholar
  24. 24.
    Breslau J, Chang DF (2006) Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey. Soc Psychiatry Psychiatr Epidemiol 41:943–950CrossRefGoogle Scholar
  25. 25.
    Dey AN, Lucas JW (2006) Physical and mental health characteristics of US-and foreign-born adults, United States, 1998–2003. Adv Data Vital Health Stat 369:1–20Google Scholar
  26. 26.
    Grant BF (2004) Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic Whites in the United States: results From the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 61:1226CrossRefGoogle Scholar
  27. 27.
    Miranda J, Siddique J, Belin TR, Kohn-Wood LP (2005) Depression prevalence in disadvantaged young black women. Soc Psychiatry Psychiatr Epidemiol 40:253–258CrossRefGoogle Scholar
  28. 28.
    Mays VM, Cochran SD, Ponce NA (2004) Thinking about race and ethnicity in population-based studies of health. In: Beech BM, Goodman M (eds) Race and research: perspectives on minority participation in health studies. American Public Health Association, Washington, pp 79–100Google Scholar
  29. 29.
    Schwartz S, Meyer IH (2010) Mental health disparities research: the impact of within and between group analyses on tests of social stress hypotheses. Soc Sci Med 70:1111–1118CrossRefGoogle Scholar
  30. 30.
    Williams DR, Harris-Reid M (1999) Race and mental health: emerging patterns and promising approaches. In: Horwitz AV, Scheid TL (eds) A handbook for the study of mental health: social contexts, theories, and systems. Cambridge University Press, Cambridge, pp 295–314Google Scholar
  31. 31.
    Bassuk EL, Buckner JC, Perloff JN, Bassuk SS (1998) Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. Am J Psychiatry 155:1561–1564Google Scholar
  32. 32.
    Koegel P, Burnam AM, Farr RK (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry 45:1085–1092CrossRefGoogle Scholar
  33. 33.
    Teplin LA (1990) The prevalence of severe mental disorder among male urban jail detainees: comparison with the Epidemiologic Catchment Area Program. Am J Public Health 80:663–669CrossRefGoogle Scholar
  34. 34.
    Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA (2002) Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry 59:1133–1143CrossRefGoogle Scholar
  35. 35.
    Trestman RL, Ford J, Zhang W, Wiesbrock V (2007) Current and lifetime psychiatric illness among inmates not identified as acutely mentally ill at intake in Connecticut’s jails. J Am Acad Psychiatry Law 35:490–500Google Scholar
  36. 36.
    Gadermann AM, Engel CC, Naifeh JA, Nock MK, Petukhova M, Santiago PN, Wu B, Zaslavsky AM, Kessler RC (2012) Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. Mil Med 177:47–59Google Scholar
  37. 37.
    Armor DJ, Gilroy CL (2010) Changing minority representation in the US military. Armed Forces Soc 36:223–246CrossRefGoogle Scholar
  38. 38.
    Glaze LE (2011) Correctional population in the United States, 2010. US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Washington, DC, pp 1–8Google Scholar
  39. 39.
    Cortes A, Leopold J, Rothschild L, Buron L, Khadduri J, Culhane DP (2011) The 2010 annual homeless assessment report to CongressGoogle Scholar
  40. 40.
    Pettit B, Western B (2004) Mass imprisonment and the life course: race and class inequality in US incarceration. Am Sociol Rev 69:151–169CrossRefGoogle Scholar
  41. 41.
    Williams DR, Takeuchi DT, Adair RK (1992) Socioeconomic status and psychiatric disorder among blacks and whites. Soc Forces 71:179–194Google Scholar
  42. 42.
    Kessler RC, Neighbors HW (1986) A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav 27:107–115CrossRefGoogle Scholar
  43. 43.
    Grant BF, Harford TC, Dawson DA, Chou PS, Pickering RP (1995) The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug Alcohol Depend 39:37–44CrossRefGoogle Scholar
  44. 44.
    Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71:7–16CrossRefGoogle Scholar
  45. 45.
    Hasin DS, Stinson FS, Ogburn E, Grant BF (2007) Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 64:830–842CrossRefGoogle Scholar
  46. 46.
    Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder. JAMA 289:3095–3105CrossRefGoogle Scholar
  47. 47.
    Heeringa SG, Wagner J, Torres M, Duan N, Adams T, Berglund P (2004) Sample designs and sampling methods for the collaborative psychiatric epidemiology studies (CPES). Int J Methods Psychiatr Res 13:221–240CrossRefGoogle Scholar
  48. 48.
    Pennell BE, Bowers A, Carr D, Chardoul S, Cheung G, Dinkelmann K, Gebler N, Hansen SE, Pennell S, Torres M (2004) The development and implementation of the national comorbidity survey replication, the national survey of American life, and the national Latino and Asian American survey. Int J Methods Psychiatr Res 13:241–269CrossRefGoogle Scholar
  49. 49.
    Canino G, Bravo M, Ramirez R, Febo VE, Rubio-Stipec M, Lewis-Fernandez R, Hasin D (1999) The Spanish alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability and concordance with clinical diagnoses in a Hispanic population. J Stud Alcohol 60:790–799Google Scholar
  50. 50.
    Neighbors HW, Trierweiler SJ, Munday C, Thompson EE, Jackson JS, Binion VJ, Gomez J (1999) Psychiatric diagnosis of African Americans: diagnostic divergence in clinician-structured and semi structured interviewing conditions. J Natl Med Assoc 91:601–612Google Scholar
  51. 51.
    Strakowski SM, Keck PE, Arnold LM, Collins J, Wilson RM, Fleck DE, Corey KB, Amicone J, Adebimpe VR (2003) Ethnicity and diagnoses in patients with affective disorders. J Clin Psychiatry 64:747–754CrossRefGoogle Scholar
  52. 52.
    Baker FM (2001) Diagnosing depression in African Americans. Community Ment Health J 37:31–38CrossRefGoogle Scholar
  53. 53.
    Kleinman A (2004) Culture and depression. N Engl J Med 351:951–953CrossRefGoogle Scholar
  54. 54.
    Rogler LH (1999) Methodological sources of cultural insensitivity in mental health research. Am Psychol 54:424–433CrossRefGoogle Scholar
  55. 55.
    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the national comorbidity survey. Arch Gen Psychiatry 51:8–19CrossRefGoogle Scholar
  56. 56.
    Jackson JS, Knight KM (2006) Race and self-regulatory health behaviors: the role of the stress response and the HPA axis in physical and mental health disparities. In: Schaie KW, Carstensen LL (eds) Social structures, aging, and self-regulation in the elderly. Springer, New York, pp 189–207Google Scholar
  57. 57.
    Carpenter KM, Hasin DS, Allison DB, Faith MS (2000) Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Am J Public Health 90:251–257CrossRefGoogle Scholar
  58. 58.
    Grant BF (1995) Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults. J Subst Abus 7:481–497Google Scholar
  59. 59.
    Compton WM, Thomas YF, Stinson FS, Grant BF (2007) Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 64:566–576CrossRefGoogle Scholar
  60. 60.
    Gilman SE, Breslau J, Conron KJ, Koenen KC, Subramanian SV, Zaslavsky AM (2008) Education and race-ethnicity differences in the lifetime risk of alcohol dependence. J Epidemiol Community Health 62:224–230CrossRefGoogle Scholar
  61. 61.
    Grant BF (1997) Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the national longitudinal alcohol epidemiologic survey. J Stud Alcohol 58:464–473Google Scholar
  62. 62.
    Fischer AR, Shaw CM (1999) African Americans’ mental health and perceptions of racist discrimination: the moderating effects of racial socialization experiences and self-esteem. J Couns Psychol 46:395–407CrossRefGoogle Scholar
  63. 63.
    Williams DR, Fenton BT, Livingston IL (1994) The mental health of African Americans: findings, questions, and directions. The Mosaic of Conditions, Issues, Policies, and Prospects. Greenwood Press, Westport, Conn, Handbook of Black American health, pp 253–268Google Scholar
  64. 64.
    Mason PL (1998) Race, cognitive ability, and wage inequality. Challenge 41:63–84Google Scholar
  65. 65.
    Williams DR, Collins C (1995) US socioeconomic and racial differences in health: patterns and explanations. Annu Rev Sociol 21:349–386CrossRefGoogle Scholar
  66. 66.
    Keyes KM, Liu X (in press) Age, period, and birth cohort effects in psychiatric disorders in the United States. Life course epidemiology of mental disordersGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • David M. Barnes
    • 1
    Email author
  • Katherine M. Keyes
    • 2
  • Lisa M. Bates
    • 3
  1. 1.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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