Skip to main content

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

Social Psychiatry and Psychiatric Epidemiology volume 54, pages 553–565 (2019)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

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).

References

  1. Grant BF, Stinson FS, Hasin DS, Dawson DA, Chou SP, Anderson K (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(12):1226–1233

    PubMed  Article  Google Scholar 

  2. Canino G, Alegria M (2009) Understanding psychopathology among the adult and child Latino population from the United States and Puerto Rico: An epidemiologic perspective. In: Villarruel F, Carlo G, Grau J, Azmitia M, Cabrera N, Chahin T (eds) Handbook of US latino psychology: developmental and community-based perspectives. SAGE Publications, Inc., Thousand Oaks, pp 31–44

    Google Scholar 

  3. 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 USA national sample. Psychol Med 36(1):57–68. https://doi.org/10.1017/S0033291705006161

    PubMed  Article  Google Scholar 

  4. Alegría M, Fortuna LR, Lin JY, Norris LF, Gao S, Takeuchi DT, Jackson JS, Shrout PE, Valentine A (2013) Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the US. Med Care 51(12):1114

    PubMed  PubMed Central  Article  Google Scholar 

  5. Roberts RE, Chen Y-W (1995) Depressive symptoms and suicidal ideation among Mexican-origin and Anglo adolescents. J Am Acad Child Adolesc Psychiatry 34(1):81–90

    CAS  PubMed  Article  Google Scholar 

  6. Case A, Deaton A (2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA 112(49):15078–15083

    CAS  PubMed  Article  Google Scholar 

  7. Alegría M, Sribney W, Woo M, Torres M, Guarnaccia P (2007) Looking beyond nativity: The relation of age of immigration, length of residence, and birth cohorts to the risk of onset of psychiatric disorders for Latinos. Res Hum Dev 4(1–2):19–47

    PubMed  PubMed Central  Article  Google Scholar 

  8. Takeuchi D, Zane N, Hong S, Chae D, Gong F, Gee G et al (2007) Immigration-related factors and mental disorders among Asian Americans. Am J Public Health 97(1):84–90. https://doi.org/10.2105/AJPH.2006.088401

    PubMed  PubMed Central  Article  Google Scholar 

  9. Alegría M, Canino G, Shrout PE, Woo M, Duan N, Vila D, Torres M, Chen C-n, Meng X-L (2008) Prevalence of mental illness in immigrant and non-immigrant US Latino groups. Am J Psychiatry 165(3):359–369

    PubMed  PubMed Central  Article  Google Scholar 

  10. Marks AK, Ejesi K, García Coll C (2014) Understanding the US immigrant paradox in childhood and adolescence. Child Dev Perspect 8(2):59–64

    Article  Google Scholar 

  11. Breslau J, Aguilar-Gaxiola S, Borges G, Kendler KS, Su M, Kessler RC (2007) Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbidity Survey-Replication. J Nerv Ment Dis 195(3):189

    PubMed  PubMed Central  Article  Google Scholar 

  12. Breslau J, Borges G, Hagar Y, Tancredi D, Gilman S (2009) Immigration to the USA and risk for mood and anxiety disorders: variation by origin and age at immigration. Psychol Med 39(7):1117–1127

    CAS  PubMed  Google Scholar 

  13. Peña JB, Wyman PA, Brown CH, Matthieu MM, Olivares TE, Hartel D, Zayas LH (2008) Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among Latino adolescents in the USA. Prev Sci 9(4):299–310

    PubMed  PubMed Central  Article  Google Scholar 

  14. Williams DR, Haile R, González HM, Neighbors H, Baser R, Jackson JS (2007) The mental health of Black Caribbean immigrants: results from the National Survey of American Life. Am J Public Health 97(1):52–59

    PubMed  PubMed Central  Article  Google Scholar 

  15. Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G (2007) Prevalence of psychiatric disorders across Latino subgroups in the United States. Am J Public Health 97(1):68–75

    PubMed  PubMed Central  Article  Google Scholar 

  16. De La Rosa M (2002) Acculturation and Latino adolescents’ substance use: a research agenda for the future. Subst Use Misuse 37(4):429–456

    Article  Google Scholar 

  17. Blanco C, Morcillo C, Alegría M, Dedios MC, Fernández-Navarro P, Regincos R, Wang S (2013) Acculturation and drug use disorders among Hispanics in the US. J Psychiatr Res 47(2):226–232

    PubMed  Article  Google Scholar 

  18. Alegría M, Shrout PE, Woo M, Guarnaccia P, Sribney W, Vila D, Polo A, Cao Z, Mulvaney-Day N, Torres M (2007) Understanding differences in past year psychiatric disorders for Latinos living in the US. Soc Sci Med 65(2):214–230

    PubMed  PubMed Central  Article  Google Scholar 

  19. Guarnaccia PJ, Angel R, Worobey JL (1989) The factor structure of the CES-D in the Hispanic Health and Nutrition Examination Survey: the influences of ethnicity, gender and language. Soc Sci Med 29(1):85–94

    CAS  PubMed  Article  Google Scholar 

  20. Mossakowski KN (2003) Coping with perceived discrimination: Does ethnic identity protect mental health? J Health Soc Behav 44(3):318–331

    PubMed  Article  Google Scholar 

  21. Kessler R, Merikangas K (2004) The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res 13(2):60–68

    PubMed  Article  Google Scholar 

  22. Alegría M, Takeuchi D, Canino G, Duan N, Shrout P, Meng XL, Vega W, Zane N, Vila D, Woo M (2004) Considering context, place and culture: the National Latino and Asian American Study. Int J Methods Psychiatr Res 13(4):208–220

    PubMed  PubMed Central  Article  Google Scholar 

  23. Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, Trierweiler SJ, Williams DR (2004) 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 13(4):196–207

    PubMed  Article  Google Scholar 

  24. Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR, Sampson N, Kessler RC (2010) Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 105(6):1117–1128

    PubMed  PubMed Central  Article  Google Scholar 

  25. 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(4):221–240

    PubMed  Article  Google Scholar 

  26. Pennell B-E, Bowers A, Carr D, Chardoul S, Cheung G-Q, 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(4):241–269. https://doi.org/10.1002/mpr.180

    PubMed  Article  Google Scholar 

  27. Alegría M, Vila D, Woo M, Canino G, Takeuchi D, Vera M, Febo V, Guarnaccia P, Aguilar-Gaxiola S, Shrout P (2004) Cultural relevance and equivalence in the NLAAS instrument: integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos. Int J Methods Psychiatr Res 13(4):270–288

    PubMed  PubMed Central  Article  Google Scholar 

  28. Kessler RC, Üstün TB (2004) The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13(2):93–121

    PubMed  Article  Google Scholar 

  29. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

    Google Scholar 

  30. American Psychiatric Association (1994) DSM-IV: Diagnostic and statistic manual of mental disorders. American Psychiatric Association, Washington, DC

    Google Scholar 

  31. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602

    PubMed  Article  Google Scholar 

  32. First MB, Spitzer RL, Gibbon M, Williams JB (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute New York, New York

    Google Scholar 

  33. US Census Bureau (2015) 2010 ANSI codes for county subdivisions. https://www.census.gov/geo/reference/codes/cousub.html. Accessed 2 Mar 2017

  34. Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, New York

    Book  Google Scholar 

  35. Halli SS, Rao KV (2013) Advanced techniques of population analysis. Springer Science & Business Media, New York

    Google Scholar 

  36. Willett JB, Singer JD (1993) Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence. J Consult Clin Psychol 61(6):952

    CAS  PubMed  Article  Google Scholar 

  37. Raghunathan TE, Dong Q (2011) Analysis of variance from multiply imputed data sets. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan. Retrieved from http://www-personal.umich.edu/~teraghu/Raghunathan-Dong.pdf. Accessed 25 May 2017

  38. Wang B, Fang Y, Jin M (2014) Combining type-III analyses from multiple imputations. SAS Support Paper 1543-2014. Proceedings of the SAS Global Forum 2014 Conference. SAS Institute Inc., Cary, NC. Retrieved from http://support.sas.com/resources/papers/proceedings14/1543-2014.pdf. Accessed 25 May 2017

  39. 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(03):317–327

    PubMed  PubMed Central  Article  Google Scholar 

  40. Smith TB, Sylva L (2011) Ethnic identity and personal well-being of people of color: a meta-analysis. J Couns Psychol 58:42–46

    PubMed  Article  Google Scholar 

  41. 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(12):943–950

    PubMed  PubMed Central  Article  Google Scholar 

  42. Burnett-Zeigler I, Bohnert KM, Ilgen MA (2013) Ethnic identity, acculturation and the prevalence of lifetime psychiatric disorders among Black, Hispanic, and Asian adults in the US. J Psychiatr Res 47(1):56–63

    PubMed  Article  Google Scholar 

  43. Schwartz SJ, Unger JB, Zamboanga BL, Szapocznik J (2010) Rethinking the concept of acculturation: implications for theory and research. Am Psychol 65(4):237

    PubMed  PubMed Central  Article  Google Scholar 

  44. Alaniz ML, Treno AJ, Saltz RF (1999) Gender, acculturation, and alcohol consumption among Mexican Americans. Subst Use Misuse 34(10):1407–1426

    CAS  PubMed  Article  Google Scholar 

  45. Fortuna LR, Perez DJ, Canino G, Sribney W, Alegria M (2007) Prevalence and correlates of lifetime suicidal ideation and attempts among Latino subgroups in the United States. J Clin Psychiatry 68(4):572

    PubMed  PubMed Central  Article  Google Scholar 

  46. Antecol H, Bedard K (2006) Unhealthy assimilation: why do immigrants converge to American health status levels? Demography 43(2):337–360

    PubMed  Article  Google Scholar 

  47. McDonald JT, Kennedy S (2005) Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada’s immigrants. Soc Sci Med 61(12):2469–2481

    PubMed  Article  Google Scholar 

  48. Leong F, Park YS, Kalibatseva Z (2013) Disentangling immigrant status in mental health: Psychological protective and risk factors among Latino and Asian American immigrants. Am J Orthopsychiatry 83(2pt3):361–371

    PubMed  Article  Google Scholar 

  49. Zhang W, Ta VM (2009) Social connections, immigration-related factors, and self-rated physical and mental health among Asian Americans. Soc Sci Med 68(12):2104–2112

    PubMed  Article  Google Scholar 

  50. Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32(1):20–47

    PubMed  Article  Google Scholar 

  51. 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(3):335–351

    CAS  PubMed  Article  Google Scholar 

  52. Malat J, Mayorga-Gallo S, Williams DR (2018) The effects of whiteness on the health of whites in the USA. Soc Sci Med 199:148–156

    PubMed  Article  Google Scholar 

  53. Vega WA, Aguilar-Gaxiola S, Andrade L, Bijl R, Borges G, Caraveo-Anduaga JJ, DeWit DJ, Heeringa SG, Kessler RC, Kolody B (2002) Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology. Drug Alcohol Depend 68(3):285–297

    PubMed  Article  Google Scholar 

  54. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine J, Angermeyer M, Bernert Sd, De Girolamo G, Morosini P (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291(21):2581–2590

    PubMed  Article  Google Scholar 

  55. Sue S, Cheng JKY, Saad CS, Chu JP (2012) Asian American mental health: a call to action. Am Psychol 67(7):532

    PubMed  Article  Google Scholar 

  56. Hornsey MJ, Bain PG, Harris EA, Lebedeva N, Kashima ES, Guan Y, González R, Chen SX, Blumen S (2018) How much is enough in a perfect world? Cultural variation in ideal levels of happiness, pleasure, freedom, health, self-esteem, longevity, and intelligence. Psychol Sci 29(9):1393–1404

    PubMed  Article  Google Scholar 

  57. Curhan KB, Sims T, Markus HR, Kitayama S, Karasawa M, Kawakami N, Love GD, Coe CL, Miyamoto Y, Ryff CD (2014) Just how bad negative affect is for your health depends on culture. Psychol Sci 25(12):2277–2280

    PubMed  PubMed Central  Article  Google Scholar 

  58. Muntaner C, Eaton WW, Miech R, O’Campo P (2004) Socioeconomic position and major mental disorders. Epidemiol Rev 26(1):53–62

    PubMed  Article  Google Scholar 

  59. Williams DR, Mohammed SA, Leavell J, Collins C (2010) Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann NY Acad Sci 1186(1):69–101

    PubMed  Article  Google Scholar 

  60. Moffitt TE, Caspi A, Taylor A, Kokaua J, Milne B, Polanczyk G, Poulton R (2010) How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 40(06):899–909

    CAS  PubMed  Article  Google Scholar 

  61. Takayanagi Y, Spira AP, Roth KB, Gallo JJ, Eaton WW, Mojtabai R (2014) Accuracy of reports of lifetime mental and physical disorders: results from the Baltimore Epidemiological Catchment Area study. JAMA Psychiatry 71(3):273–280

    PubMed  PubMed Central  Article  Google Scholar 

  62. Lewis T (2013) Analyzing continuous variables from complex survey data using PROC SURVEYFREQ, Paper AA-10-2013. Paper presented at the Midwest SAS Users Group (MWSUG) Conference. Columbus, OH, September 22–24. Retrieved from https://www.mwsug.org/proceedings/2013/AA/MWSUG-2013-AA10.pdf. Accessed 25 May 2017

  63. Berglund P (2010) An introduction to multiple imputation of complex sample data using SAS® v9.2. SAS Support Paper 265-2010. Proceedings of the SAS Global Forum 2010 Conference. SAS Institute Inc., Cary, NC. Retrieved from http://support.sas.com/resources/papers/proceedings10/265-2010.pdf. Accessed 25 May 2017

Download references

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.

Author information

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

Authors
  1. Kiara Alvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mirko Fillbrunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Greif Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James S. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ronald C. Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katie A. McLaughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ekaterina Sadikova
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nancy A. Sampson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Margarita Alegría
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kiara Alvarez.

Ethics declarations

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 KB)

Supplementary material 2 (PDF 122 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-018-1644-5

Keywords

  • Mental health disparities
  • Nativity
  • Race/ethnicity
  • Mental disorder prevalence