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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Notes

  1. We use the terms Asian, Black, Latino, and White in order to distinguish between racial/ethnic groups in this paper, noting that these terms reflect broad sociopolitical categories in the United States and are not biological categories. In this paper, “Black” means “non-Latino Black” and “White” means “non-Latino White.”

  2. NSAL PI James Jackson is affiliated with the University of Michigan. NCS-R and NCS-2 PI Ronald Kessler is affiliated with Harvard Medical School. At the time of the study, NLAAS study PIs Margarita Alegria and David Takeuchi were affiliated with Cambridge Health Alliance/Harvard Medical School and the University of Washington, respectively.

  3. Nativity is often defined in terms of generation status. First generation refers to people born in another country and now living in the US (this corresponds to our Nativity 4 and 5 categories.) Second generation refers to people born in the US to at least one foreign-born parent (our Nativity 2 and 3 categories), and third generation refers to being born in the US to US born parents (our Nativity 1 category).

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Funding

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.

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Authors and Affiliations

  1. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA

    Kiara Alvarez, Mirko Fillbrunn & Margarita Alegría

  2. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Kiara Alvarez, Mirko Fillbrunn & Margarita Alegría

  3. Wheelock College of Education & Human Development, Boston University, Two Silber Way, Boston, MA, 02215, USA

    Jennifer Greif Green

  4. Institute for Social Research, University of Michigan, 5057 ISR, 426 Thompson St., Ann Arbor, MI, 48104, USA

    James S. Jackson

  5. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, USA

    Ronald C. Kessler, Ekaterina Sadikova & Nancy A. Sampson

  6. Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA

    Katie A. McLaughlin

  7. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Margarita Alegría

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  1. Kiara Alvarez
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  2. Mirko Fillbrunn
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  3. Jennifer Greif Green
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  5. Ronald C. Kessler
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  9. Margarita Alegría
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Correspondence to Kiara Alvarez.

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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.

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Alvarez, K., Fillbrunn, M., Green, J.G. et al. Race/ethnicity, nativity, and lifetime risk of mental disorders in US adults. Soc Psychiatry Psychiatr Epidemiol 54, 553–565 (2019). https://doi.org/10.1007/s00127-018-1644-5

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