Corrie L Vilsaint1, Amanda NeMoyer2, Mirko Fillbrunn3, Ekaterina Sadikova4, Ronald C Kessler5, Nancy A Sampson6, Kiara Alvarez7, Jennifer Greif Green8, Katie A McLaughlin9, Ruijia Chen10, David R Williams11, James S Jackson12, Margarita Alegría13. 1. Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, 151 Merrimac Street 6th Floor, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, United States. Electronic address: cvilsaint@mgh.harvard.edu. 2. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States. Electronic address: anemoyer@mgh.harvard.edu. 3. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street Boston, MA 02114, United States. Electronic address: mfillbrunn@mgh.harvard.edu. 4. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States. Electronic address: sadikova@hcp.med.harvard.edu. 5. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States. Electronic address: ronkadm@hcp.med.harvard.edu. 6. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States. Electronic address: sampson@hcp.med.harvard.edu. 7. Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, United States; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street Boston, MA 02114, United States. Electronic address: kalvarez2@mgh.harvard.edu. 8. Boston University, Wheelock College of Educaion & Human Development, Two Silber Way, Boston, MA 02215, United States.. Electronic address: jggreen@bu.edu. 9. Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, United States. Electronic address: kmclaughlin@fas.harvard.edu. 10. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building Room 615, Boston, MA 02115, United States. Electronic address: ruijia.chen@mail.harvard.edu. 11. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building Room 615, Boston, MA 02115, United States; Department of African and African American Studies, Harvard University, Barker Center, 12 Quincy St., Cambridge, MA 02138, United States. Electronic address: dwilliam@hsph.harvard.edu. 12. Institute for Social Research, 5057 ISR, 426 Thompson St., Ann Arbor, MI 48104, United States. Electronic address: jamessj@umich.edu. 13. Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, United States; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street Boston, MA 02114, United States. Electronic address: malegria@mgh.harvard.edu.
Abstract
BACKGROUND: Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. METHOD: Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. RESULTS: Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. CONCLUSION: Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.
BACKGROUND: Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. METHOD: Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. RESULTS: Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. CONCLUSION: Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.
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