Importance: Rap artists are among the most recognizable celebrities in the US, serving as role models to an increasingly diverse audience of listeners. Through their lyrics, these artists have the potential to shape mental health discourse and reduce stigma. Objective: To investigate the prevalence and nature of mental health themes in popular rap music amid a period of documented increases in mental health distress and suicide risk among young people in the US and young Black/African American male individuals in particular. Design and Setting: Lyric sheets from the 25 most popular rap songs in the US in 1998, 2003, 2008, 2013, and 2018, totaling 125 songs, were analyzed by 2 trained coders from March 1 to April 15, 2019, for references to anxiety, depression, suicide, metaphors suggesting mental health struggles, and stressors associated with mental health risk. Main Outcomes and Measures: Mental health references were identified and categorized based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) and Mayo Clinic definitions. Stressors included issues with authorities, environmental conditions, work, and love life. Descriptive language and trend analyses were used to examine changes over time in the proportion of songs with mental health references. Stressors were analyzed for their co-occurrence with mental health references. Results: Most of the 125 analyzed songs featured lead artists from North America (123 [98%]). Most lead artists were Black/African American male individuals (97 [78%]), and artists' mean (SD) age was 28.2 (4.5) years. Across the sample, 35 songs (28%) referenced anxiety; 28 (22%) referenced depression; 8 (6%) referenced suicide; and 26 (21%) used a mental health metaphor. Significant increases were found from 1998 to 2018 in the proportion of songs referencing suicide (0% to 12%), depression (16% to 32%), and mental health metaphors (8% to 44%). Stressors related to environmental conditions (adjusted odds ratio, 8.1; 95% CI, 2.1-32.0) and love life (adjusted odds ratio, 4.8; 95% CI, 1.3-18.1) were most likely to co-occur with lyrics referencing mental health. Conclusions and Relevance: References to mental health struggles have increased significantly in popular rap music from 1998 to 2018. Future research is needed to examine the potential positive and negative effects these increasingly prevalent messages may have in shaping mental health discourse and behavioral intentions for US youth.
Importance: Rap artists are among the most recognizable celebrities in the US, serving as role models to an increasingly diverse audience of listeners. Through their lyrics, these artists have the potential to shape mental health discourse and reduce stigma. Objective: To investigate the prevalence and nature of mental health themes in popular rap music amid a period of documented increases in mental health distress and suicide risk among young people in the US and young Black/African American male individuals in particular. Design and Setting: Lyric sheets from the 25 most popular rap songs in the US in 1998, 2003, 2008, 2013, and 2018, totaling 125 songs, were analyzed by 2 trained coders from March 1 to April 15, 2019, for references to anxiety, depression, suicide, metaphors suggesting mental health struggles, and stressors associated with mental health risk. Main Outcomes and Measures: Mental health references were identified and categorized based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) and Mayo Clinic definitions. Stressors included issues with authorities, environmental conditions, work, and love life. Descriptive language and trend analyses were used to examine changes over time in the proportion of songs with mental health references. Stressors were analyzed for their co-occurrence with mental health references. Results: Most of the 125 analyzed songs featured lead artists from North America (123 [98%]). Most lead artists were Black/African American male individuals (97 [78%]), and artists' mean (SD) age was 28.2 (4.5) years. Across the sample, 35 songs (28%) referenced anxiety; 28 (22%) referenced depression; 8 (6%) referenced suicide; and 26 (21%) used a mental health metaphor. Significant increases were found from 1998 to 2018 in the proportion of songs referencing suicide (0% to 12%), depression (16% to 32%), and mental health metaphors (8% to 44%). Stressors related to environmental conditions (adjusted odds ratio, 8.1; 95% CI, 2.1-32.0) and love life (adjusted odds ratio, 4.8; 95% CI, 1.3-18.1) were most likely to co-occur with lyrics referencing mental health. Conclusions and Relevance: References to mental health struggles have increased significantly in popular rap music from 1998 to 2018. Future research is needed to examine the potential positive and negative effects these increasingly prevalent messages may have in shaping mental health discourse and behavioral intentions for US youth.