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

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Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

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Acknowledgments

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.

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Correspondence to David M. Barnes.

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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).

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Barnes, D.M., Keyes, K.M. & Bates, L.M. Racial differences in depression in the United States: how do subgroup analyses inform a paradox?. Soc Psychiatry Psychiatr Epidemiol 48, 1941–1949 (2013). https://doi.org/10.1007/s00127-013-0718-7

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