Mental Health of African Americans and Caribbean Blacks in the United States: Results From the National Epidemiological Survey on Alcohol and Related Conditions

摘要

Objectives. Previous epidemiological studies have found lower mood, anxiety, and substance use disorder prevalence in Black Americans, in general, compared with White Americans. We estimated the prevalence and persistence of psychiatric disorders in African Americans, Caribbean Blacks, and non-Hispanic Whites. Methods. We drew data from wave 1 (2001–2002) of the National Epidemiological Survey of Alcohol and Related Conditions, a nationally representative sample of US adults, which included 7529 African Americans, 469 Caribbean Blacks, and 24?502 non-Hispanic Whites. Results. Blacks had equal or lower prevalence than Whites of lifetime (adjusted odds ratio [AOR]?=?0.6 for African Americans; 0.3 for Caribbean Blacks) and 12-month (AOR?=?0.7 for African Americans; 0.4 for Caribbean Blacks) Axis I psychiatric disorders, but higher prevalence of several personality disorders. Among Blacks, Caribbean Blacks had higher prevalence of 12-month psychotic disorders and lower lifetime prevalence of major depressive disorder, alcohol dependence, and drug abuse than African Americans. There were no differences in persistence of disorders between Caribbean Blacks and African Americans. Conclusions. This study yielded new data on prevalence of mental disorders in these groups, which has important implications for clinical work with US Blacks. Race and ethnicity are key factors in the prevalence and clinical presentation of psychiatric disorders. In the United States, Blacks, who constitute 13% of the population, have historically suffered racism and discrimination, and currently have higher rates of poverty, unemployment, exposure to violence, and common chronic medical conditions such as diabetes and heart disease than do non-Hispanic Whites. 1–4 These sociodemographic and medical factors are associated with psychiatric disorders. 5–10 Despite these adversities, with some exceptions, 11 epidemiological studies in the United States have consistently found that Blacks have lower lifetime prevalence of depressive, anxiety, and substance-use disorders than do non-Hispanic Whites, 12–17 although these disorders were more persistent in Blacks. 15 The US Black population is diverse and heterogeneous, largely because of immigration of Blacks from the Caribbean and Africa. Among the 7% of Blacks who are foreign-born, more than half are from the Caribbean. 18,19 Along with their descendents, Caribbean Blacks are an important population subgroup, primarily concentrated in large East Coast cities. 20,21 Although Caribbean Blacks and African Americans share a racial identity and African origin, they differ in their ethnicity, environmental exposures, educational attainment, economic status, and physical health. 22–24 Despite these differences, to date, only 1 national study has examined differences in psychiatric disorders among African Americans, Caribbean Blacks, and non-Hispanic Whites. The National Survey on American Life (NSAL), conducted between 2001 and 2003, found lower lifetime prevalence of major depressive disorder, generalized anxiety disorder, and social anxiety disorder among African Americans and Caribbean Blacks compared with non-Hispanic Whites. 25,26 The NSAL also demonstrated significantly increased persistence of major depressive disorder among both Caribbean Blacks and African Americans compared with non-Hispanic Whites. Important questions remain regarding the mental health of US Blacks in general, and Caribbean Blacks in particular. First, with the exception of the NSAL, existing studies have focused on particular US communities 13 or age groups, and have excluded non–English-speaking participants and those living in group quarters, 15 limiting the generalizability of their findings. 13,27,28 Second, despite evidence of higher rates of paranoid, schizoid, histrionic, schizotypal, and narcissistic personality disorders in Blacks compared with Whites in the United States, 29–33 no studies have examined differences in prevalence of personality disorders among Caribbean Blacks and African Americans. Furthermore, currently available data on persistence of psychiatric disorders among Blacks rely exclusively on limited published persistence data on major depressive disorder from the NSAL 25 and older published results from the National Comorbidity Survey, 21 conducted in 1990 through 1992. The goal of this study was to build upon earlier findings to examine the relationship between race, ethnicity, and psychiatric diagnoses by focusing on African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States. The large sample size of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of the general population, allows a comprehensive analysis of the prevalence, persistence, and correlates of psychiatric disorders among these groups.