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.
Similar content being viewed by others
References
Blazer DG, Kessler RC (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 151:979–986
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 36:57–68
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 62:1097–1106
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 64:305
Dohrenwend BP (2000) The role of adversity and stress in psychopathology: some evidence and its implications for theory and research. J Health Soc Behav 41:1–19
Kessler RC (1997) The effects of stressful life events on depression. Annu Rev Psychol 48:191–214
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 340–360
Boardman JD (2004) Health pessimism among black and white adults: the role of interpersonal and institutional maltreatment. Soc Sci Med 59:2523–2533
Boardman JD, Alexander KB (2011) Stress trajectories, health behaviors, and the mental health of black and white young adults. Soc Sci Med 72:1659–1666
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 67:368–379
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 51:1639–1654
Taylor J, Turner RJ (2002) Perceived discrimination, social stress, and depression in the transition to adulthood: racial constrasts. Soc Psychol Q 65:213–225
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 2:335–351
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 196:297–306
Keyes CLM (2009) The black–white paradox in health: flourishing in the face of social inequality and discrimination. J Pers 77:1677–1706
Mays VM, Cochran SD, Barnes NW (2007) Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol 58:201–225
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 371–410
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 35:317–327
Brown TN (2003) Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification. J Health Soc Behav 44:292–301
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 99–128
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 100:933–939
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 72:650–659
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 172:1238–1249
Breslau J, Chang DF (2006) Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey. Soc Psychiatry Psychiatr Epidemiol 41:943–950
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 369:1–20
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 61:1226
Miranda J, Siddique J, Belin TR, Kohn-Wood LP (2005) Depression prevalence in disadvantaged young black women. Soc Psychiatry Psychiatr Epidemiol 40:253–258
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 79–100
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 70:1111–1118
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 295–314
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 155:1561–1564
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 45:1085–1092
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 80:663–669
Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA (2002) Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry 59:1133–1143
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 35:490–500
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 177:47–59
Armor DJ, Gilroy CL (2010) Changing minority representation in the US military. Armed Forces Soc 36:223–246
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 1–8
Cortes A, Leopold J, Rothschild L, Buron L, Khadduri J, Culhane DP (2011) The 2010 annual homeless assessment report to Congress
Pettit B, Western B (2004) Mass imprisonment and the life course: race and class inequality in US incarceration. Am Sociol Rev 69:151–169
Williams DR, Takeuchi DT, Adair RK (1992) Socioeconomic status and psychiatric disorder among blacks and whites. Soc Forces 71:179–194
Kessler RC, Neighbors HW (1986) A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav 27:107–115
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 39:37–44
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 71:7–16
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 64:830–842
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 289:3095–3105
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 13:221–240
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 13:241–269
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 60:790–799
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 91:601–612
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 64:747–754
Baker FM (2001) Diagnosing depression in African Americans. Community Ment Health J 37:31–38
Kleinman A (2004) Culture and depression. N Engl J Med 351:951–953
Rogler LH (1999) Methodological sources of cultural insensitivity in mental health research. Am Psychol 54:424–433
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 51:8–19
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 189–207
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 90:251–257
Grant BF (1995) Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults. J Subst Abus 7:481–497
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 64:566–576
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 62:224–230
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 58:464–473
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 46:395–407
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 253–268
Mason PL (1998) Race, cognitive ability, and wage inequality. Challenge 41:63–84
Williams DR, Collins C (1995) US socioeconomic and racial differences in health: patterns and explanations. Annu Rev Sociol 21:349–386
Keyes KM, Liu X (in press) Age, period, and birth cohort effects in psychiatric disorders in the United States. Life course epidemiology of mental disorders
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.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
127_2013_718_MOESM2_ESM.pdf
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).
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-013-0718-7