Do Racial Differences in Coping Resources Explain the Black-White Paradox in Mental Health? A Test of Multiple Mechanisms. Journal of Health and Social Behavior. (Accepted).
A central paradox in the mental health literature is the tendency for Black Americans to report similar or better mental health than White Americans, despite greater exposure to social and economic stressors. However, if Black Americans have higher levels of certain coping resources than White Americans, this may explain this finding. Using data from the Nashville Stress and Health Study, we examine whether Black Americans have higher levels of self-esteem, social support, religious attendance, and divine control than White Americans, and whether these resources in turn explain the Black-White paradox in mental health. In adjusted models, we observe the Black-White paradox for depressive symptoms and any DSM-IV disorder. We then compare the extent to which each resource contributes to the Black-White patterning of depressive symptoms/mental disorder using causal mediation techniques. Findings indicate that Black Americans have higher levels of self-esteem, family social support, and religiosity than White Americans. Furthermore, self-esteem has the largest effect in explaining Black-White differences in depressive symptoms, while divine control has the largest effect in explaining differences in disorder.
Race, Flourishing, and All-Cause Mortality in the United States, 1995–2016. 2021. American Journal of Epidemiology.
This study assessed whether race moderates the association between flourishing and all-cause mortality. We used panel data from the Midlife in the United States Study (MIDUS) (1995–2016) (n = 2851). Approximately 19% of White respondents and 23% of Black respondents of the baseline sample died over the course of the 21-year study period (n = 564). Cox proportional hazard models showed that Blacks had a higher mortality rate relative to Whites and higher levels of flourishing were associated with a lower mortality rate. Furthermore, a significant interaction between flourishing and race in predicting mortality was observed. Blacks with higher levels of flourishing had a mortality rate that was not significantly different from Whites. However, Blacks, but not Whites, with low flourishing scores had a higher mortality rate. As such, health promotion efforts focused on enhancing flourishing among Black populations may reduce the Black-White gap in mortality.
Revisiting the Cost of Skin Color: Discrimination, Mastery, and Mental Health among Black Adolescents. 2020. Society and Mental Health.
This article investigates the association between skin tone and mental health in a nationally representative sample of black adolescents. The mediating influences of discrimination and mastery in the skin tone–mental health relationship also are considered. Findings indicate that black adolescents with the darkest skin tone have higher levels of depressive symptoms than their lighter skin tone peers. This is not the case for mental disorder. For disorder, a skin tone difference appeared only between black adolescents with very dark skin tone and black adolescents with medium brown skin tone. Discrimination partially mediates the association between skin tone and depression, while mastery fully mediates this association, indicating that the impact of skin tone on depression operates primarily through lower mastery. Similar patterns were observed for disorder. By extending the discussion of skin tone and health to black adolescents and treating skin tone as a set of categories rather than a linear gradient, I provide new insights into the patterning of skin tone and depression/disorder.
*Winner, 2019 Best Graduate Student Paper, Sociology of Mental Health Section, American Sociological Association
The Black-White Paradox Revisited: Understanding the Role of Counterbalancing Mechanisms during Adolescence. 2019. Journal of Health and Social Behaviour.
The tendency for blacks to report similar or better mental health than whites has served as an enduring paradox in the mental health literature for the past three decades. However, a debate persists about the mechanisms that underlie this paradox. Drawing on the stress process framework, we consider the counterbalancing roles of self-esteem and traumatic stress exposure in understanding the “black-white paradox” among U.S. adolescents. Using nationally representative data, we observe that blacks have higher levels of self-esteem than whites, but also encounter higher levels of traumatic stress exposure. Adjusting for self-esteem reveals a net higher rate of mood disorders and distress among blacks relative to whites, and differences in traumatic stress exposure mediate this association. In the full model, we show that self-esteem and stress exposure offset each other, resulting in a null association between race and mood disorders and a reduced association between race and distress.
Prevalence and Patterning of Mental Disorder in Three Cohorts of Black and White Americans Through Adolescence. 2018. American Journal of Epidemiology.
The tendency for Blacks to report similar or lower rates of mental disorder than Whites is well-established. However, whether these disparities are stable across cohorts of Black and White Americans is not well understood. In the current study, we examined Black-White differences in the lifetime prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, anxiety, impulse control, substance use and any disorders across 3 cohorts of Blacks and Whites aged 4 to 18. Using merged data from the National Comorbidity Survey Replication (2001-2003) and the National Comorbidity Survey Adolescent Supplement (2001-2004), we observed a change in the Black-White patterning of mental disorder between 1957 and 2004. Blacks born between 1957-1969 reported lower rates of anxiety disorders relative to their White counterparts (odds ratio (OR)=0.69, 95% confidence interval (CI): 0.52-0.91), Blacks born between 1970-1982 reported no difference in the rates of anxiety disorders relative to Whites (OR=0.97, 95% CI: 0.76-1.25), and Blacks born between 1983-1991 reported higher rates of anxiety disorders relative to Whites (OR=1.30, 95% CI: 1.18-1.43). Similar but less distinct trends were observed for mood, impulse control, and any disorders. Our results suggest that the Black-White patterning of mental disorder has changed across cohorts, to the disadvantage of Black Americans.
Featured in The Inquirer, “Black children are suffering higher rates of depression and anxiety. What’s going on?,” December 2018.
Representations of Race and Skin Tone in Medical Textbooks. 2018. Social Science and Medicine.
Although a large literature has documented racial inequities in health care delivery, there continues to be debate about the potential sources of these inequities. Preliminary research suggests that racial inequities are embedded in the curricular edification of physicians and patients. We investigate this hypothesis by considering whether the race and skin tone depicted in images in textbooks assigned at top medical schools reflects the diversity of the U.S. population. We analyzed 4146 images from Atlas of Human Anatomy, Bates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy, and Gray’s Anatomy for Students by coding race (White, Black, and Person of Color) and skin tone (light, medium, and dark) at the textbook, chapter, and topic level. While the textbooks approximate the racial distribution of the U.S. population – 62.5% White, 20.4% Black, and 17.0% Person of Color – the skin tones represented – 74.5% light, 21% medium, and 4.5% dark – overrepresent light skin tone and underrepresent dark skin tone. There is also an absence of skin tone diversity at the chapter and topic level. Even though medical texts often have overall proportional racial representation this is not the case for skin tone. Furthermore, racial minorities are still often absent at the topic level. These omissions may provide one route through which bias enters medical treatment.
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