Part 1: Mental and physical health
ANN ARBOR, Mich.---A University of Michigan study of more than 6,000 African American, Afro-Caribbean and non-Hispanic white adults---the first known study to include a national probability sample of Blacks of Caribbean ancestry---shows strikingly different patterns of prevalence of major mental and physical disorders within the U.S. Black population.
Those areas include surprisingly low rates of depression, generalized anxiety disorder and panic disorder among African American men and exceptionally low rates of all mental health problems except post-traumatic stress disorder among Afro-Caribbean women.
The study, the most comprehensive survey to date of the mental health of Black Americans, documents significant differences within the Black community that point to explanations for racial and ethnic health disparities. The survey also assessed physical health, experiences of discrimination including police harassment and exposure to everyday stress linked with racial prejudice.
Headed by U-M social psychologist James S. Jackson and funded by the National Institutes of Health, the survey was conducted between February 2001 and March 2003. "Our data show that the simplistic notion of a black-and-white world is no longer tenable," said Jackson, a senior research scientist at the U-M Institute for Social Research (ISR), the world's largest academic survey and research organization. "The picture is very different for African Americans and for Afro-Caribbeans."
The study shows African Americans have lower rates of major depression than Afro-Caribbeans or white Americans (10.6 percent, 11.3 percent and 18.3 percent, respectively).
The study shows surprisingly low rates of several major mental disorders---including panic disorder, social phobia and generalized anxiety disorder in addition to major depression---among African Americans, especially among African American men. The study also shows that African American women are nearly twice as likely as African American men to have suffered a bout of major depression sometime in their lives (13.1 percent vs. 7.4 percent).
By contrast, 10 percent of Afro-Caribbean women and 12.6 percent of Afro-Caribbean men report suffering from major depression sometime in their lives, compared to 20.1 percent of white women and 16.1 percent of white men surveyed.
Overall, 58 percent of the people interviewed were African American, 26 percent were Black with Caribbean ancestry and 16 percent were non-Hispanic whites. About 49 percent of African Americans, 54.3 percent of Afro-Caribbeans and 53.5 percent of whites surveyed were working full-time, while 11.2 percent, 10.8 percent and 6.3 percent, respectively, reported that they were unemployed. African Americans had a significant disadvantage in family income, with just 16.1 percent estimated to have a family income of $60,000 or more, compared with 26.2 percent of Afro-Caribbeans and whites. Educationally, African Americans were disadvantaged as well, with 37.4 percent, compared to 51.9 percent of Afro-Caribbeans and 54.0 percent of whites, reporting that they had attended some college or earned a college degree.
When asked to assess their overall mental health, 37.8 percent of Afro-Caribbeans, 31.1 percent of African Americans and 20.4 percent of whites said that it was excellent. Looking at the lifetime prevalence of specific mental disorders, the researchers found that African Americans had significantly lower rates than whites of panic disorder (2.7 percent vs. 4.2 percent) generalized anxiety disorder (4.5 percent vs. 7.9 percent) and social phobia (7.5 percent vs. 12.6 percent) as well as much lower rates of major depression. Afro-Caribbeans had slightly lower rates than African Americans of social phobia (6percent vs. 7.5 percent), with Afro Caribbean women showing the lowest rates of prevalence for all but one major mental disorder---post-traumatic stress disorder.
African Americans had higher rates than Afro-Caribbeans of two mental disorders: post-traumatic stress disorder (9 percent vs. 7.3 percent) and substance abuse (11.4 percent vs. 8.7 percent). "Afro-Caribbeans experience living conditions and social and economic situations that are very different from those of most native-born African Americans," Jackson said. "These structural inequalities, including disparities in economic and social resources, along with higher levels of major discrimination and everyday stress that African Americans experience may well contribute to mental and physical health disparities.
"If you live under very stressful conditions, you have to work harder to maintain your mental health. Sometimes the strategies you use to cope with this stress become harmful in themselves. Plus, you have to use what's available to you to reduce the stress you're under. And the three resources that are most easily accessible to many residents of African American neighborhoods in this country---liquor stores, fast food outlets, and illegal substances---are potentially harmful."
Jackson noted that the only positive resource readily available in many African American communities is the church and, similar to many other studies, the current study shows religion is a positive coping resource for both African Americans and Afro-Caribbeans. About 95 percent of African Americans and 91 percent of Afro-Caribbeans said that religion was important in their lives, compared with 76.7 percent of whites surveyed. And 96.7 percent of African Americans and 96.6 percent of Afro-Caribbeans said that prayer was very important when they were dealing with stressful situations, compared with 82.6 percent of whites surveyed.
Jackson and colleagues found that 22.8 percent of Afro-Caribbeans surveyed reported that their overall physical health was excellent, compared with 16.3 percent of African Americans and 11.8 percent of whites surveyed.
Nearly half (48.9 percent) of Afro-Caribbeans reported that they had no chronic health conditions, including high blood pressure, heart disease, or diabetes, compared with 41.3 percent of African Americans and 39.0 percent of the whites surveyed. In contrast, 20.1 percent of whites, 18.3 percent of African Americans and 12.8 percent of Afro-Caribbeans reported suffering from three or more chronic health conditions. These findings may reflect the older overall age of the white and African American, as compared to the Afro-Caribbean, populations in the U.S., Jackson speculated.
African Americans had higher rates than both whites and Afro-Caribbeans for three major chronic health problems: high blood pressure, diabetes and stroke. The prevalence of diabetes and high blood pressure was especially high among African American women, with 35.4 percent reporting high blood pressure (compared to 30.3 percent of African American men) and 12.3 percent reporting diabetes (compared to 10.0 percent of African American men). African Americans had lower rates than the whites surveyed for cancer and heart disease.
"These findings, which we plan to explore in further analyses, suggest that the nature of health disparities among ethnic groups in the U.S. are much more complex than previously believed and harder to characterize as due simply to racial differences," Jackson said.
About 61 percent of African Americans and 63.9 percent of Afro-Caribbeans, compared with 70.7 percent of whites said they went to a doctor for medical advice, compared to 14.6 percent, 12.6 percent and 15.0 percent who went to a clinic. But while just 7.4 percent of whites said they went to a hospital for medical advice, 14.9 percent of African Americans and 14.1 percent of Afro-Caribbeans said that they did so.
African Americans were less likely than either Afro-Caribbeans or whites to report using herbal remedies (9.3 percent, 13.1 percent and 11.9 percent, respectively).
Further analyses of the data will focus on the relative singular and joint importance of race, ethnicity, socioeconomic status and gender in understanding the nature of stressful conditions, experienced stress, psychological and social resources, mental health and the likelihood of seeking treatment among the diverse American population, according to Jackson.
"We want to thank the thousands of American men, women and families who were randomly selected to participate in this important study and who agreed to cooperate," Jackson said. "While their identities remain absolutely confidential, their help is invaluable in shedding light on this important challenge to the health status and quality of care among the American public.
"The importance of this study lies in going beyond simplistic categories of race and ethnicity to gain a better perspective on the ways that intra-group dynamics, as well as inter-group differences, and associated environmental, social and personal risk factors, play a role in disparities in physical and mental health and service use," Jackson said.
"The findings should help local and national policy makers to develop new programs to assist individuals from all ethnic and racial groups in using formal, as well as informal and personal resources in their everyday lives to cope with the stresses and strains created by living in the complex world of the 21st century."
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The survey was conducted through face-to-face and some telephone interviews with an integrated national household probability sample of 3,589 African Americans, 1,006 non-Hispanic whites and 1,604 blacks of Caribbean descent, for a total sample of 6,199 individuals age 18 and over. Interviews were conducted with a randomly selected adult in each household. The overall response rate for the study was 71.6 percent. The data reported here are preliminary but they have been weighted to account for sampling effects and cooperation and response rates. Standard errors, reflecting the complexity of the design and the large sample size, are about 1 percentage point for most of the mental disorder rates presented here. Hence, the overall margin of error is estimated to be about 2 percentage points.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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