Lifetime and Twelve-Month Prevalence, Persistence, and Unmet Treatment Needs of Mood, Anxiety, and Substance Use Disorders in African American and U.S. versus Foreign-Born Caribbean Women

Abstract

There is growing diversity within the Black population in the U.S., but limited understanding of ethnic and nativity differences in the mental health treatment needs of Black women. This study examined differences in the prevalence of psychiatric disorders, their persistence, and unmet treatment needs among Black women in the U.S. Data were from the National Survey of American Life, a nationally representative survey that assessed lifetime and twelve-month mood, anxiety, and substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria, and mental health service use among those meeting disorder criteria. One in three African American women met criteria for a lifetime disorder, compared to one in three Caribbean women born within the U.S. and one in five Caribbean women born outside the U.S. About half of African American women with a lifetime disorder had a persistent psychiatric disorder, compared to two in five Caribbean women born within the U.S. and two in three Caribbean women born outside the U.S. African Americans had more persisting dysthymia and panic disorder and less persisting social phobia compared to foreign-born Caribbean women. Of the three groups, Caribbean women born within the U.S. were most likely to seek mental health treatment during their lifetime. These results demonstrate, despite a lower prevalence of psychiatric disorders in Black women, that there is a great likelihood their disorders will be marked by persistence and underscores the need for culturally specific treatment approaches. As Black immigrants in the United States are increasing in number, adequate mental health services are needed.

Editors’ Comments on the Special Issue “Social Determinants of Mental Health”

“…The last article analysed the wide variation by ethnicity in the prevalence, course, and unmet treatment needs of their psychiatric disorders. Additionally, it focused on the need to attend to differences in this diversity to target prevention efforts and mental health service planning about the specific needs of these black subpopulations in the USA [ 24 ].…”

Persistence, Impairment, Disability and Unmet Treatment of Lifetime and 12-Month Anxiety Disorders in Black Men and Women, 50 Years of Age and Older

“…In addition, we were unable to estimate ethnic differences (African American vs. Caribbean Black) in severity, impairment, and treatment of anxiety disorders within older Black men and women. In studies of younger populations, ethnic and nativity differences in the chronicity and treatment of mental health disorders have been observed (Jones et al, 2020; Mays et al, 2018) and are likely to be true in older ages as well. Future studies of mental health and aging would benefit from a longitudinal design and larger samples to better elucidate the health service needs of African American and Caribbean Black men and women across the lifespan.…”

“…Persistence, a measure of chronicity, was estimated for the subsample of participants who met the criteria for a lifetime anxiety disorder and who reported an age of onset at least 2 years prior to the interview. We calculated the proportion of this subsample who also met criteria for the same disorder in the 12 months prior to the interview (Jones et al, 2020; Mays et al, 2018). This measure captures chronic and/or recurring disorders spanning more than 12 months.…”

“…Carden et al (2021) cite a difference in the detection rate of generalized anxiety disorders (GAD) in non-Hispanic-Blacks (4.9%) versus that of non-Hispanic Whites (8.6%) as a key factor in the low prevalence rates reported in prior studies. However, in studies of GAD, Blacks in the U.S. tend to suffer greater severity of the illness, high rates of unemployment, and low rates of treatment utilization (Carden et al, 2021; Jones et al, 2020; Mays et al, 2018; Sibrava et al, 2013). Even when treated, non-Hispanic Blacks with GAD have been observed to have a lower 2-year recovery rate compared to non-Hispanic Whites (0.23 vs. 0.39) again indicating that despite the lower prevalence, there may be higher morbidity from GAD in Blacks (Sibrava et al, 2013).…”

“…Nevertheless, few studies have examined the burden of illness associated with anxiety disorders in older Black adults. Population-based studies of anxiety disorder severity, persistence, and functional impairment have typically focused on younger samples (Breslau et al, 2005; Himle et al, 2009; Jones et al, 2020; Mays et al, 2018). Because anxiety disorders often start in early and middle adulthood (Kessler et al, 2005), those disorders lasting into older age are likely to be associated with years of living with a disability and may worsen the prevalence of physical health problems (Byers et al, 2014).…”