Nativity, Race-Ethnicity, and Dual Diagnosis among US Adults.

Purpose: This study investigated disparities in dual diagnosis (comorbid substance-use and depressive/anxiety disorders) among US adults by nativity and racial-ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities. Design/methodology: The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial-ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance-use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance-use or psychiatric disorder; substance-use disorder only; depressive/anxiety disorder only; and, dual diagnosis. The data were analyzed using multinomial logistic regression. Findings: The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto-Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial-ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments. Research limitations: The limitations included measures of immigrant status, race-ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities. Practical and Social Implications: This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps. Originality/value: This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial-ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).