Race/Ethnic Differences in Nonspecific Psychological Distress: Evidence from the National Health Interview Survey^*

Abstract

Objective. This article documents the patterns of white‐nonwhite differences in nonspecific psychological distress and explores how acculturation characteristics, social class, marital status, and chronic illness mediate or moderate these differences for eight racial/ethnic populations in the United States. Methods. We analyze data from a five‐year pool of the National Health Interview Survey (NHIS) collected between 1997 and 2001 (N=162,032) and employ multivariate regression techniques to explore level of psychological distress of various ethnic groups relative to non‐Hispanic whites. Results. Nonwhite populations exhibit variable base‐line differences in psychological distress compared to non‐Hispanic whites; however, adjusted estimates show that African Americans and Mexicans have lower levels of distress while distress scores for “other Hispanics,” Asians, and Cubans exhibit statistically similar levels. The highest distress occurs for Puerto Ricans. Interaction models reveal chronic sources of stress (e.g., poverty, chronic illness, nonmarriage) are even more taxing on psychological health of high‐risk groups or have weaker relationships to stress for other groups. Conclusions. This study reveals the need for capturing ethnic variation in studies of mental health. Social class, acculturation, marital status, and chronic illness cannot fully explain white‐nonwhite differences in psychological distress.

Epidemiology of Psychological Distress

“…The transcultural validity of standardized scales has been questioned repeatedly but, as discussed previously, the most popular scales used to assess psychological distress (e.g., GHQ and K6 or K10) have shown their construct validity across various ethnic groups. Bratter and Eschbach (Bratter and Eschbach 2005) have used data from the National Health Interview Survey conducted in the United States of America (USA) to investigate the association between ethnicity and psychological distress. The large sample size (n = 162 032) recruited over the five cross-sectional annual waves (from 1997 to 2001) of the survey allowed them to stratify respondents in 10 self-reported "race/ethnic" groups.…”

Health domains and race in generic preference-based health-related quality of life instruments in the United States literature

“…Individuals in such samples are members of the general population who were asked to value a selection of health states from which a model is estimated to predict preferences for all the health states described by the measure. Among such measures are the EuroQol EQ-5D (EQ-5D), Health Utilities Index Mark 2 and Mark 3 (HUI2 and HUI3), Quality of Well-Being Scale (QWB-SA) and SF-6D, which is computed from the SF-36v2 TM or the SF-12v2 TM (FRYBACK et al, 2007a;FRYBACK et al, 2007b, SHAW et al, 2007DEVERILL, 2002;ROBERTS, 2004). These instruments differ somewhat in the health domains they consider and they produce different scores and disutilities (i.e.…”

“…The NCS results indicate that blacks had lower prevalence rates for the disorders the study assessed (KESSLER et al, 1996). 2 Despite the aforementioned prevalence issues, there is also a large body of literature showing that black Americans have higher rates of psychological distress and depression than whites (SIMPSON et al, 2007), but that relationship becomes less strong, or inverse, when measures of socio-economic status are taken into account (BRATTER; ESCHBACH, 2005;NEIGHBORS, 1986). This purely socioeconomic interpretation became the most widely accepted position, starting in the 1970's, when several studies found that the initial higher levels of distress among blacks were attenuated when social class was taken into account.…”

“…Vitality is a health domain found in the SF-6D, derived from SF-36v2 TM vitality item 2 (BRAZIER et al, 2002). Respondents are asked if they have a lot of energy, all of the time, most of the time, some of the time, little of the time, or none of the time.…”

“…In the SF-6D, this domain specifically addresses the extent to which respondents own health limits social activities, with 5 levels of responses: none of the time, a little of the time, some of the time, most of the time or all of the time (BRAZIER et al, 2002). Very little is known about this domain in relation to race in the general population.…”