Race/ethnicity, nativity, and lifetime risk of mental disorders in US adults

  • Kiara AlvarezEmail author
  • Mirko Fillbrunn
  • Jennifer Greif Green
  • James S. Jackson
  • Ronald C. Kessler
  • Katie A. McLaughlin
  • Ekaterina Sadikova
  • Nancy A. Sampson
  • Margarita Alegría
Original Paper



There has been no comprehensive examination of how race/ethnicity and nativity intersect in explaining differences in lifetime prevalence of mental disorders among Asian, Black, Latino, and White adults. This study aims to estimate racial/ethnic differences in lifetime risk of mental disorders and examine how group differences vary by nativity.


Survival models were used to estimate racial/ethnic and nativity differences in lifetime risk of DSM-IV anxiety, mood, and substance use disorders in a nationally representative sample of over 20,000 respondents to four US surveys.


Asians had the lowest lifetime prevalence of mental disorders (23.5%), followed by Blacks (37.0%), Latinos (38.8%), and Whites (45.6%). Asians and Blacks had lower lifetime risk than Whites for all disorders even after adjusting for nativity; Latinos and Whites had similar risk after adjusting for nativity. Risk of disorder onset was lowest for foreign-born respondents in years before migration. There were significant race/ethnicity and nativity interactions for mood and substance use disorders. Odds of mood disorder onset were higher for Whites with at least one US-born parent. Odds of substance use disorder onset among Asians were higher for US-born respondents; for Latinos, they were higher for those with at least one US-born parent.


Parental foreign-born nativity is associated with a low risk of mental disorders, but not uniformly across racial/ethnic groups or disorders. Exposure to the US context may be associated with greater mental disorder risk for Latinos and Whites particularly. Investigations of cultural processes, including among Whites, are needed to understand group differences.


Mental health disparities Nativity Race/ethnicity Mental disorder prevalence 



Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health under Award Number R01MD009719. Dr. Kiara Alvarez was supported by the National Institute of Mental Health (NIMH) under Award Number K23MH112841. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of Interest

In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The other authors declare no competing interests.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kiara Alvarez
    • 1
    • 2
    Email author
  • Mirko Fillbrunn
    • 1
    • 2
  • Jennifer Greif Green
    • 3
  • James S. Jackson
    • 4
  • Ronald C. Kessler
    • 5
  • Katie A. McLaughlin
    • 6
  • Ekaterina Sadikova
    • 5
  • Nancy A. Sampson
    • 5
  • Margarita Alegría
    • 1
    • 2
    • 7
  1. 1.Disparities Research Unit, Department of MedicineMassachusetts General HospitalBostonUSA
  2. 2.Department of MedicineHarvard Medical SchoolBostonUSA
  3. 3.Wheelock College of Education & Human DevelopmentBoston UniversityBostonUSA
  4. 4.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  5. 5.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  6. 6.Department of PsychologyHarvard UniversityCambridgeUSA
  7. 7.Department of PsychiatryHarvard Medical SchoolBostonUSA

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