Examination of the Interaction Between Race and Mental Health

 

 Racial discrimination is often thought of in the context of human rights disparities, legal cases or political campaigns, but little conversation surrounds the effect of racial discrimination on marginalized individual’s mental health and their treatment within the mental health care system.

 Racial discrimination has a multitude of effects and can have severe impacts an individual’s mental health when experienced over a multitude of scenarios for an extended duration of time. Russel et al. (2018) wanted to evaluate the effect of racial discrimination within living situations on the acquisition of major depressive disorder (MDD). Specifically, Russel et al. (2018) examined the impact of neighborhood racial discrimination on the development of MDD in African American women. The authors hypothesized that due to the propagation of racism among biased neighborhoods, individuals living in neighborhoods characterized by high levels of racial discrimination would have an increased probability of developing major depression disorder (Russel et al., 2018).

 Russel et al., (2018) selected 499 African American women participants, all of whom were near 35 years of age. These women were carefully monitored and assessed for any pertinent and persisting mental health changes over the course of nine to 11 years through the use of self-reported symptoms via emotional surveys (Russel et al., 2018). The participants were all from Iowa or Georgia and had no history of MDD at the start of the study (Russel et al., 2018). Additionally, prior to the start of the study, the women were evaluated for extraneous mental health characteristics including: negative life events, financial strain, personal outlook, religious involvement, relationship quality, negative affectivity, and individual experiences of racism (Russel et al., 2018).  

 The levels of neighborhood racial bias were evaluated through a multitude of characteristics including: community social disorder, community cohesion, and community racism (Russel et al., 2018). 

 Statistical analysis, revealed that racial discrimination level within the neighborhood, as well as the extraneous individual variables of negative life effects and financial hardship, produced statistically significant predictions for the acquisition of MDD in the African American participants (Russel et al., 2017). Additionally, statistical analysis demonstrated that the negative impacts of neighborhood discrimination could be reasonably mitigated by individual’s inter-personal relationships  (Russel et al., 2018). Specifically, the higher an individual rated the quality of their inter-personal relationships, the lower the statistical impact of neighborhood discrimination (Russel et al., 2018).

 Russel et al. (2017) demonstrates the far-reaching effects of perpetuated racial discrimination on individual’s mental health, and highlights the role of positive social relationships in mitigating the detrimental effects of marginalization.  

 Although the effects of prolonged racial discrimination within the living environment results in increased susceptibility to mental disorders, the effects of discrimination extends beyond susceptibility, as it also impacts individual’s mental health disorder diagnosis and treatment.

 Pervious research has demonstrated that Black individuals are disproportionally diagnosed with schizophrenia relative to White individuals (Olbert et al., 2018). However, the source of this diagnostic disparity is unknown (Olbert et al, 2018). To quantify the presence of racial disparities in schizophrenic diagnoses Olbert et al. (2018) conducted a meta-analysis of research studies involving schizophrenic diagnosis. Specifically, the authors wanted to determine if structured-interview assessments would mitigate disparities in schizophrenic diagnoses relative to non-structured assessments, while also evaluating additional moderating factors. Due to the necessity of self-reporting of schizophrenic symptoms, the authors hypothesized that clinician bias and differential social norms could be contributing factors to the racial disparity seen with schizophrenic diagnosis (Olbert et al., 2018). 

 Olbert et al. (2018) used a total a total of 55 studies, selected based on their presentation of original data with 95% confidence intervals (CIs) for schizophrenic diagnosis by race. Fourteen of the 55 studies utilized a structured-interview diagnostic assessment and 41 studies used a non-structured assessment (Olbert et al., 2018).

 First, the authors calculated aggregate rates of schizophrenia diagnoses across studies to determine the baseline level of racial diagnosis disparities in schizophrenia (Olbert et al., 2018). Olbert et al. (2018) hypothesized that rates for Black individuals would be significantly higher than the rate for White individuals. Second, the authors examined the effect of structured-instrument diagnoses on racial diagnostic disparities relative to non-structured methods of diagnosis (Olbert et al., 2018), hypothesizing that structured-instrument diagnostic assessment would mitigate racial disparities.

 As predicted, results of the meta-analysis demonstrated significant racial disparities in schizophrenia diagnosis between Black and White individuals (Olbert et al., 2018). A greater proportion of Black individuals were diagnosed with schizophrenia across all studies, including studies using structured-interview assessments as well as studies using non-structured assessments (Olbert et al., 2018). Therefore, in contrast to their hypothesis, the structured-instrument diagnostic assessments did not present a statistically significant decrease in disparities of schizophrenia diagnoses (Olbert et al., 2018).

 Olbert et al. (2018) concluded that their analysis demonstrated that Black individuals are nearly two and a half times as likely to receive a schizophrenia diagnosis compared to White individuals, and that structured diagnostic procedures have no impact on racial disparity of diagnosis. The disparity of mental health treatment between races is an important point of study because it allows us to evaluate reports of disproportional occurrences of mental health disorders in the larger context of potential diagnosis or treatment bias.

 While racial discrimination has proven to have detrimental impacts on individual’s mental and while racial bias appears to play a differential role in mental health disorder diagnosis across difference races, there are mental health disorders that exhibit disparities in prevalence between races and are believed to be reflections of true physiological differences and not a product of discrimination (You could argue the role of clinician bias and racial norms on the diagnoses of these disorders as well, but that would be a topic for another paper). One mental disorder in particular is eating disorders.

 Eating disorders are bigger topic of conversation among millennial as the age of onset of eating disorder symptoms continues to decrease (Swanson et al., 2011). Disorder eating behaviors including dieting, binge eating, and weight concerns have been shown to be a prominent preoccupation of today’s youth (Swanson et al., 2011). Eating disorder are mental health disorders that are known to have a progressive timeline. The current study, Bodell et al. (2017), was interested in identifying the timeline of eating disorder symptom acquisition among youth. Additionally, while previous medical research demonstrated racial differences in the symptomatic display of eating disorders, the interaction between race and eating disorder symptom acquisition over time had not been evaluated (Bodell et al., 2017). Bodell et al. (2017) wanted to determine the timeline of eating disorder symptom development between early childhood and young adulthood years for White and Black girls. Specifically, the author’s aimed to identify any temporal differences in symptom acquisition between races in order to hypothesize an optimal time deploy to culturally sensitive eating disorder prevention programs for White and Black individuals (Bodell et al., 2017).

 Bodell et al. (2017) hypothesized that Black girls would have an increased likelihood of following an increasing trajectory of binge eating disorder symptoms, while having a decreased likely of following an increasing trajectory of dieting and other eating disorder symptoms, relative to White girls. Additionally, Bodell et al. (2017) hypothesized that the interaction between Black race and the increasing acquisition of binge-eating disorder symptoms would be mitigated when financial strain and relative adiposity were accounted for.

 To evaluate the role of race on eating disorder trajectory, Bodell et al. (2017) collected data from over 2,000 Black and White girls, beginning from the age of nine. Data was collected through administration of either the Children’s Eating Attitudes Test (ChEAT) or the Eating Attitudes Test (EAT) (Bodell et al., 2018). Both tests are self-report measures containing 26 questions, intended to assess eating disorder attitudes and behaviors (Bodell et al., 2018). These eating disorder surveys were administered six times over the course of ten years (Bodell et al., 2017). Due the complex nature of eating disorders, extraneous variables including financial strain and weight were added as covariates (Bodell et al., 2017).

 Bodell et al. (2017) discovered that eating disorder symptoms decreased between childhood and mid-adolescence but increased between mid-adolescent and young adulthood. Additionally, in line with their hypothesis, Bodell et al. (2017) reported that racial background does influence eating disorder symptom acquisition timelines, with Black girls having an increased proportion of eating disorder symptoms in childhood and a greater decrease over time, relative to White girls. Overall this study suggests that eating disorder symptoms are not acquired in a uniform pattern between or within racial categories (Bodell et al., 2018). However, while the pattern between racial categories was not uniform, statistically significant differences were determined between eating disorder symptom acquisition timelines for Black and White girls (Bodell et al., 2018), suggesting the impact of race and differential physiology on the development of mental disorders. 

 These studies demonstrate the recent evidence portraying the interaction between race and mental disorders, with race resulting in differential diagnosis, treatment and symptomology. Therefore, these studies support the need for racially sensitive treatment for the associated mental disorders.

 

References

• Bodell, L. P., Wildes, J. E., Cheng, Y., Goldschmidt, A. B., Keenan, K., Hipwell, A. E., & Stepp, S. D. (2018). Associations between race and eating disorder symptom trajectories in black and white girls. Journal of abnormal child psychology, 46(3), 625-638.
• Olbert, C. M., Nagendra, A., & Buck, B. (2018). Meta-analysis of Black vs. White racial disparity in schizophrenia diagnosis in the United States: Do structured assessments attenuate racial disparities?. Journal of abnormal psychology, 127(1), 104.
• Russell, D. W., Clavél, F. D., Cutrona, C. E., Abraham, W. T., & Burzette, R. G. (2018). Neighborhood racial discrimination and the development of major depression. Journal of abnormal psychology, 127(2), 150.
• Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in ado- lescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714– 723.