Do racial patterns in psychological distress shed light on the Black–White depression paradox? A systematic review

Abstract

A systematic review of the epidemiologic evidence supports the existence of a "double paradox" by which Blacks' lower prevalence of MDD relative to Whites' is inconsistent with both the expectations of social stress theory and with the empirical evidence regarding psychological distress. Efforts to resolve the Black-White depression paradox should account for the discordant distress results, which seem to favor artifactual explanations.

Measuring More Than Exposure: Does Stress Appraisal Matter for Black–White Differences in Anxiety and Depressive Symptoms Among Older Adults?

“…Once we take into account chronic stress exposure, blacks and whites report similar levels of anxiety and depressive symptomology. This is consistent with findings showing higher levels of psychological distress among blacks relative to whites and is in line with prior studies that show similar or lower rates of diagnosed or depressive and anxiety symptomology among blacks despite higher levels of stress exposure ( 12 ). Importantly, despite being exposed to more chronic stressors and reporting more anxiety and depressive symptoms, older blacks in this sample appraise exposure to chronic stressors as less upsetting than older whites.…”

“…Conversely, for depressive symptoms, interactions between race and cumulative stress exposure show blacks reporting greater exposure to chronic stressors report fewer symptoms relative to whites with similar cumulative stress exposure. This finding aligns with studies examining the black–white mental health paradox which has primarily shown the black mental health advantage to be most evident for major depression ( 12 , 14 ). These studies have generally found that despite greater stress exposure, material hardship, and worse physical health, black Americans tend to experience similar or relatively lower rates of depression relative to whites ( 15 , 16 ).…”

“…Racial minorities—with the dual burden of socioeconomic disadvantage and race-related stressors—may be at even greater risk because they have limited access to psychosocial and material coping mechanisms ( 23 ). Generally, studies examining race differences in exposure and vulnerability to stressful life events have found both greater exposure and psychological distress among low-socioeconomic status (SES) nonwhites ( 11 , 12 , 24 ). These theories and prior studies suggest blacks are disproportionately exposed to various social stressors, experience more distress, and should also position blacks to be at higher risk of poor mental health.…”

“…In epidemiological research, black–white patterning in mental health varies by how mental health is measured. Most studies find that blacks have higher levels of psychological distress ( 12 , 13 ) compared to whites, but have a lower risk of most common psychiatric disorders ( 12 , 14 ). For instance, there is evidence of lower rates of depressive and anxiety disorders among blacks relative to non-Hispanic whites despite large disparities in stress exposure and physical health in mid- and late life—commonly referred to as the black–white mental health paradox ( 14–16 ).…”

Age and Gender Differences in Psychological Distress among African Americans and Whites: Findings from the 2016 National Health Interview Survey

“…Though previous studies confirm that rates of major depressive disorder (MDD) are lower for African Americans compared to Whites, some researchers have argued that psychiatric measures for depression may not be the most accurate assessment to use for African Americans [ 8 , 9 , 10 , 11 ]. Community-based studies frequently refer to other symptoms—not captured in psychiatric measures—that may reflect experiences of psychological distress more accurately, rather than depression, for some African Americans [ 12 ]. Though there has not been a comprehensive explanation for the cause and definition of psychological distress, researchers have made various attempts at understanding the term.…”