Contrary to earlier research, mental health disorders in African Americans occur less often than their white counterparts, according to preliminary epidemiological findings from a study sponsored by the National Institute of Mental Health (NIMH).
The most in-depth study to be conducted on the physical, emotional, mental, structural and economic conditions of African Americans, the National Survey of American Life (NSAL) is expected to shed light on a range of issues related to the quality of life for African Americans. The study is an extensive follow-up to the National Survey of Black Americans (NSBA), a project begun in 1979 that had major impact on social and health sciences, health policy, health practice and training of health scientists to treat the African American community.
Speaking at the prestigious Director’s Lecture Series at the National Institutes of Health, NSAL investigator James S. Jackson presented some initial findings from the study and called attention to a surprising paradox concerning health and mental health disparities in terms of race and ethnicity. Jackson is a Fellow and Charter Member of APS as well as the Daniel Katz Professor and Director of the Research Center for Group Dynamics and the Center for Afroamerican and African Studies at the University of Michigan.
Though progress has occurred in the last century, the NSAL research and data collected through the U.S. Census point to the fact that African Americans on average remain worse off than the general population on almost every important societal indicator – infant mortality, crude death rates (the average annual number of deaths during a year per 1,000 population at midyear), health care, wealth and income, housing and poverty. However, Jackson and his colleagues found a conflicting trend in the rates of serious mental disorders among different racial and ethnic groups. Jackson explained that while overall, African Americans and other ethnic minorities consistently experience significant health disparities compared to whites, the NSAL findings point to lower rates of mental illness among African Americans, and variable rates for other minorities, including evidence pointing to a higher rate of mental disorders in Hispanics in comparison to non-Hispanic whites.
Earlier studies reported that levels of psychological distress and rates of mental disorders in individuals under psychiatric treatment were higher among blacks than whites. But recent community psychiatric epidemiological studies consistently report rates of most major mental disorders that are considerably lower among African Americans than whites. Previous researchers did not measure simultaneous rates of psychological distress, psychiatric symptoms, mental disorders, coping, number of individuals who sought assistance, and physical health conditions and statuses in large, heterogeneous, national samples of blacks and other groups.
“It is hypothesized that coping strategies [such as substance abuse or over-eating] that are effective in preserving mental health [even if they are themselves harmful to general health] may contribute, along with structural inequalities, to observed health disparities,” Jackson said. For both black men and women, he said, studies show that alcohol usage peaks at middle age, while high-blood pressure, heavy cigarette use and obesity climbs to high levels after age 50 in both groups.
Jackson theorizes that structural inequalities (which are defined as disparities in demographic, economic, and social resources) cause both health and mental health disparities. For African Americans those differences most often occur in the areas of income, wealth, employment and educational opportunities. According to national census data, even as the nation develops a more racially and ethnically diverse population, the United States is becoming more unequal in the distribution of economic resources, with African Americans remaining materially disadvantaged and geographically segregated.
Approximately 4,000 African Americans, 1,500 blacks of Caribbean descent and 1,500 non-Hispanic whites were interviewed during face-to-face meetings for NSAL. Jackson said the respondents are asked questions about several areas of their life such as the neighborhood in which they live, religion, psychological resources, health problems, employment, and mental health. In the category of mental health, the surveys request information on depressive symptoms, medication use, formal and informal help-seeking and impairment.
The study also includes a clinical reappraisal component of 700 respondents and a related adolescent study on 200 African American and Afro-Caribbean adolescents, ages 13 through 17. About 11,000 adolescents were interviewed through a series of questionnaires answered by the adolescents, their parents/caretakers and teachers for the National Adolescent Study. The study is the adolescent component of a larger study, the National Comorbidity Survey (NCS), which was originally sponsored by the NIMH and the National Institute on Drug Abuse (NIDA) in the early 1990s to examine co-existing mental health disorders and substance use disorders in 8,000 respondents. Currently, researchers at the University of Michigan are re-interviewing the NCS respondents to study patterns and predictors of the course of mental and substance use disorders and to evaluate the effects of primary mental disorders in predicting the onset and course of secondary substance disorders.
In order to understand the broader connections between race and health and mental health, Jackson said NSAL will be compared to international findings. NSAL investigators will look at how the US stacks up against other countries including Israel, Germany, and Japan as well countries involved in the World Mental Health 2000 (WMH2000) initiative. In addition, Jackson has proposed a multi-generational studying 12,600 samples in several countries.
The study reports that there are large disparities in health care utilization between African Americans and whites and these imbalances differ by gender and geographical location. In terms deaths caused by heart disease, diabetes, and some other illnesses, Jackson explained that large disparities exist among ethnic and racial groups and the differences cannot be attributed to socioeconomic status.
While more research is needed on the influence of discrimination and perceived racism, Jackson said both factors probably affect health and mental health. Through the study, he aims to answer the question about the complex effects of discrimination in the context of social, political, economic and cultural influences.
“Racism and discrimination can lead to differences in life-chances, which in turn affect health,” he explained. “Experiences of specific incidents of racism may have direct effects on health.”
Jackson expects NSAL will yield large enough samples to investigate within-group differences and similarities. He also expects that the study will serve as an important resource for research and training of investigators interested in ethnic and racial diversity and disparities in physical health, mental health, aging and human development research. Moreover, like its predecessor NSBA, he hopes NSAL will produce the social, health, mental health and attitudinal data needed for new public policy initiatives.
“Disparities in physical health and mental health statuses and services do exist, but we do not know exactly why,” Jackson noted. “We hope that the new NSAL and related studies will shed some light on these complex topics.”