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Social Psychiatry and Psychiatric Epidemiology

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13.04.2019 | Original Paper

Testing a somatization hypothesis to explain the Black–White depression paradox

verfasst von: David M. Barnes, Lisa M. Bates

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 10/2019

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Abstract

Purpose

Epidemiologic studies document a lower prevalence of major depression in Blacks than Whites in the United States. This is paradoxical from the perspective of social stress theory. A long-standing claim in the (clinical) literature is that Blacks express depression more somatically than Whites. If true, the diagnostic algorithm may undercount depression in Blacks, since the screening symptoms privilege the psychological rather than somatic dimensions of depression. We test hypotheses that (1) Blacks express depression more somatically than Whites which (2) reduces their likelihood of endorsing screening symptoms, thereby undercounting Blacks’ depression and explaining the Black–White depression paradox.

Methods

We use cross-sectional data collected in 1991–92 from the National Longitudinal Alcohol Epidemiologic Survey (n = 42,862) among Blacks and Whites endorsing at least one past-12-month depression symptom. We compare groups on depression somatization and test whether greater somatization in Blacks leads to lower endorsement of psychological screening symptoms, and therefore under-diagnosis.

Results

Blacks have higher mean depression somatization scores than Whites (0.28, SE 0.04 vs. 0.15, SE 0.02), t(122) = − 2.15, p = 0.03. This difference is small and driven by Blacks’ higher endorsement of 1 somatic symptom (weight/appetite change) and Whites’ greater propensity to endorse psychological symptoms. However, Blacks have the same odds as Whites of endorsing screening symptoms, before and after adjusting for somatization.

Conclusions

We find minimal evidence that Blacks express depression more somatically than Whites. Furthermore, this small difference does not appear to inhibit endorsement of diagnostic depression screening symptoms among Blacks, and therefore does not resolve the Black–White depression paradox.

Brown TN (2003) Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification. J Health Soc Behav 44:292–301PubMed

Earl T, Williams D, Anglade S (2011) An update on the mental health of Black Americans: puzzling dilemmas and needed research. J Black Psychol 37:485–498. https://doi.org/10.1177/0095798410396077 CrossRef

Jackson JS, Knight KM, Rafferty JA (2010) Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health 100:933–939PubMedPubMedCentral

Mezuk B, Abdou CM, Hudson D et al (2013) “White Box” epidemiology and the social neuroscience of health behaviors: the environmental affordances model. Soc Ment Health 3:79–95. https://doi.org/10.1177/2156869313480892 CrossRef

Neighbors HW, Njai R, Jackson JS (2007) Race, ethnicity, John Henryism, and depressive symptoms: the national survey of American life adult reinterview. Res Hum Dev 4:71–87

Barnes DM, Bates LM (2017) Do racial patterns in psychological distress shed light on the Black–White depression paradox? A systematic review. Soc Psychiatry Psychiatr Epidemiol 52:913–928. https://doi.org/10.1007/s00127-017-1394-9 CrossRefPubMed

Dressler WW, Oths KS, Gravlee CC (2005) Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthr 34:231–252

Horwitz AV (2002) Outcomes in the sociology of mental health: where have we been and where are we going? J Health Soc Behav 43:143–151PubMed

Pearlin LI, Meneghan EG, Lieberman MA, Mullan JT (1981) The stress process. J Health Soc Behav 22:337–356PubMed

10.

Schwartz S, Meyer IH (2010) Mental health disparities research: the impact of within and between group analyses on tests of social stress hypotheses. Soc Sci Med 70:1111–1118PubMed

11.

Turner RJ (2010) Health disparities and the stress hypothesis: a commentary on Schwartz and Meyer. Soc Sci Med 70:1119–1120PubMed

12.

Aneshensel CS (1999) Outcomes of the stress process. A handbook for the study of mental health: social contexts, theories, and systems. Cambridge University Press, Cambridge, pp 211–227

13.

Aneshensel CS, Phelan JC (1999) The sociology of mental health: surveying the field. Handbook of the sociology of mental health. Plenum Publishers, New York, pp 3–18

14.

Pearlin LI, Bierman A (2013) Current issues and future directions in research into the stress process. In: Aneshensel CS, Phelan JC, Bierman A (eds) Handbook of the sociology of mental health. Springer, Dordrecht, pp 325–340

15.

Thoits PA (1999) Sociological approaches to mental health. A handbook for the study of mental health: social contexts, theories, and systems. Cambridge University Press, Cambridge, pp 121–138

16.

Wheaton B (1999) The nature of stressors. A handbook for the study of mental health: social contexts, theories, and systems. Cambridge University Press, Cambridge, pp 176–197

17.

Platt JR (1964) Strong inference. Science 146:347–353PubMed

18.

Muntaner C, Ng E, Vanroelen C et al (2013) Social stratification, social closure, and social class as determinants of mental health disparities. In: Aneshensel CS, Phelan JC, Bierman A (eds) Handbook of the sociology of mental health. Springer, Dordrecht, pp 205–227

19.

Jordan WD (1968) White over Black: American attitudes toward the Negro, 1550–1812. The University of North Carolina Press, Chapel Hill

20.

Williams DR, Yu Y, Jackson JS, Anderson NB (1997) Racial differences in physical and mental health, socio-economic status, stress and discrimination. J Health Psychol 2:335–351

21.

Williams DR, Jackson PB (2005) Social sources of racial disparities in health. Health Aff (Millwood) 24:325–334. https://doi.org/10.1377/hlthaff.24.2.325 CrossRef

22.

Kochanek KD, Arias E, Anderson RN (2013) How did cause of death contribute to racial differences in life expectancy in the United States in 2010? NCHS data brief 125:1–8

23.

Williams DR, Harris-Reid M (1999) Race and mental health: emerging patterns and promising approaches. In: Horwitz AV, Scheid TL (eds) a handbook for the study of mental health: social contexts, theories, and systems. Cambridge University Press, Cambridge, pp 295–314

24.

Simon GE, VonKorff M, Piccinelli M et al (1999) An international study of the relation between somatic symptoms and depression. N Engl J Med 341:1329–1335PubMed

25.

Lehmann HE (1959) Psychiatric concepts of depression: nomenclature and classification. Can Psychiatr Assoc J 4:1–12PubMed

26.

Cadoret RJ, Wilson D (1983) Somatization among depressed patients in industrialized nations. Am J Psychiatry 140:1103–1104PubMed

27.

Carragher N, Adamson G, Bunting B, McCann S (2009) Subtypes of depression in a nationally representative sample. J Affect Disord 113:88–99. https://doi.org/10.1016/j.jad.2008.05.015 CrossRefPubMed

28.

Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ (1993) Somatization and the recognition of depression and anxiety in primary care. Am J Pyschiatry 150:734–741

29.

Tsai J, Elhai JD, Pietrzak RH et al (2014) Comparing four competing models of depressive symptomatology: a confirmatory factor analytic study of 986,647 U.S. veterans. J Affect Disord 165:166–169. https://doi.org/10.1016/j.jad.2014.04.075 CrossRefPubMed

30.

Schnittker J (2012) The proximity of common unhappiness and misery. Soc Ment Health 2:135–153. https://doi.org/10.1177/2156869312451153 CrossRef

31.

Kirmayer LJ, Young A (1998) Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosom Med 60:420–430PubMed

32.

Kleinman AM (1977) Depression, somatization and the “new cross-cultural psychiatry”. Soc Sci Med 11:3–10PubMed

33.

Ryder AG, Yang J, Heine SJ (2002) Somatization vs. psychologization of emotional distress: A paradigmatic example for cultural psychopathology. Online Read Psychol Cult 10:3

34.

Tseng W-S, Hsu J (1970) Chinese culture, personality formation and mental illness. Int J Soc Psychiatry 16:5–14. https://doi.org/10.1177/002076407001600101 CrossRef

35.

Tylee A, Gandhi P (2005) The importance of somatic symptoms in depression in primary care. Prim Care Companion J Clin Psychiatry 7:167–176PubMedPubMedCentral

36.

Yusim A, Anbarasan D, Hall B et al (2010) Sociocultural domains of depression among indigenous populations in Latin America. Int Rev Psychiatry 22:370–377. https://doi.org/10.3109/09540261.2010.500870 CrossRefPubMed

37.

Prange AJ, Vitols MM (1962) Cultural aspects of the relatively low incidence of depression in southern Negroes. Int J Soc Psychiatry 8:104–112. https://doi.org/10.1177/002076406200800203 CrossRefPubMed

38.

Carter JH (1974) Recognizing psychiatric symptoms in black Americans. Geriatrics 29(11):95–99PubMed

39.

Baker FM (2001) Diagnosing depression in African Americans. Community Ment Health J 37:31–38PubMed

40.

Das AK, Olfson M, McCurtis HL, Weissman MM (2006) Depression in African Americans: breaking barriers to detection and treatment. J Fam Pract 55:30

41.

Hunter LR, Schmidt NB (2010) Anxiety psychopathology in African American adults: literature review and development of an empirically informed sociocultural model. Psychol Bull 136:211–235. https://doi.org/10.1037/a0018133 CrossRefPubMed

42.

Karasz A (2005) Cultural differences in conceptual models of depression. Soc Sci Med 60:1625–1635. https://doi.org/10.1016/j.socscimed.2004.08.011 CrossRef

43.

Breslau J, Javaras KN, Blacker D et al (2008) Differential item functioning between ethnic groups in the epidemiological assessment of depression. J Nerv Ment Dis 196:297–306PubMedPubMedCentral

44.

Uebelacker LA, Strong D, Weinstock LM, Miller IW (2008) Use of item response theory to understand differential functioning of DSM-IV major depression symptoms by race, ethnicity and gender. Psychol Med 39:591. https://doi.org/10.1017/S0033291708003875 CrossRefPubMed

45.

National Institute on Alcohol Abuse and Alcoholism (1998) Drinking in the United States: main findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). National Institute on Alcohol Abuse and Alcoholism, Washington D.C.

46.

Chatterji S, Saunders JB, Vrasti R et al (1997) Reliability of the alcohol and drug modules of the alcohol use disorder and associated disabilities interview schedule—alcohol/drug-revised (AUDADIS-ADR): an international comparison. Drug Alcohol Depend 47:171–185PubMed

47.

Grant BF, Dawson DA, Stinson FS et al (2003) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71:7–16PubMed

48.

Grant BF, Stinson FS, Dawson DA et al (2004) Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 61:807–816PubMed

49.

Canino G, Bravo M, Ramirez R et al (1999) The Spanish alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability and concordance with clinical diagnoses in a Hispanic population. J Stud Alcohol 60:790–799PubMed

50.

Grant BF, Hasin DS, Stinson FS et al (2005) Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions. J Psychiatr Res 39:1–9. https://doi.org/10.1016/j.jpsychires.2004.05.004 CrossRefPubMed

51.

Grant BF, Stinson FS, Hasin DS et al (2004) Immigration and lifetime prevalene of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results fromt he National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 61:1226–1233

52.

Hasin DS, Goodwin RD, Stinson FS, Grant BF (2005) Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 62:1097–1106PubMed

53.

Link B, Dohrenwend BP (1980) Formulation of hypotheses about the true prevalence of demoralization in the United States. Mental illness in the United States: epidemiologic estimates. Praeger Publishers, New York, pp 114–132

54.

Coyne JC (1994) Self-reported distress: analog or ersatz depression? Psychol Bull 116:29–45PubMed

55.

Dohrenwend BP, Shrout PE, Egri G, Mendelsohn FS (1980) Nonspecific psychological distress and other dimensions of psychopathology: measures for use in the general population. Arch Gen Psychiatry 37:1229PubMed

56.

Breslau J, Aguilar-Gaxiola S, Kendler KS et al (2006) Specifying race-ethnic differences in risk for psychiatric disorder in a US national sample. Psychol Med 36:57–68

57.

Williams DR, Gonzalez HM, Neighbors H et al (2007) Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry 64:305

58.

Mouzon DM (2010) Can social relationships explain the race paradox in mental health?. Rutgers University Graduate School, New Brunswick

59.

Bertera EM (2005) Mental health in U.S. adults: the role of positive social support and social negativity in personal relationships. J Soc Pers Relatsh 22:33–48. https://doi.org/10.1177/0265407505049320 CrossRef

60.

Chatters LM, Taylor RJ, Jackson JS, Lincoln KD (2008) Religious coping among African Americans, Caribbean Blacks and Non-Hispanic Whites. J Community Psychol 36:371–386. https://doi.org/10.1002/jcop.20202 CrossRefPubMedPubMedCentral

61.

Ellison CG, Boardman JD, Williams DR, Jackson JS (2001) Religious involvement, stress, and mental health: findings from the 1995 Detroit Area Study. Soc Forces 80:215–249

62.

Fischer AR, Shaw CM (1999) African Americans’ mental health and perceptions of racist discrimination: the moderating effects of racial socialization experiences and self-esteem. J Couns Psychol 46:395

63.

Hettler TR, Cohen LH (1998) Intrinsic religiousness as a stress-moderator for adult Protestant churchgoers. J Community Psychol 26:597–609

64.

Gray BA, Keith VM (2003) The benefits and costs of social support for African American women. In and out of our right minds: the mental health of African American women. Columbia University Press, New York, pp 242–257

65.

Hughes D, Rodriguez J, Smith EP et al (2006) Parents’ ethnic-racial socialization practices: a review of research and directions for future study. Dev Psychol 42:747–770. https://doi.org/10.1037/0012-1649.42.5.747 CrossRef

66.

van Olphen J, Schulz A, Israel B et al (2003) Religious involvement, social support, and health among African-American women on the east side of Detroit. J Gen Intern Med 18:549–557PubMedPubMedCentral

67.

Kiecolt K, Hughes M, Keith VM (2008) Race, social relationships, and mental health. Pers Relatsh 15:229–245

68.

Jackson JS, Knight KM (2006) Race and self-regulatory health behaviors: the role of the stress response and the HPA axis in physical and mental health disparities. In: Schaie KW, Carstensen LL (eds) Social structures, aging, and self-regulation in the elderly. Springer, New York, pp 189–207

69.

Keyes KM, Barnes DM, Bates LM (2011) Stress, coping, and depression: testing a new hypothesis in a prospectively studied general population sample of U.S.-born whites and blacks. Soc Sci Med 72:650–659PubMed

70.

Mezuk B, Rafferty JA, Kershaw KN et al (2010) Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression. Am J Epidemiol 172:1238–1249PubMedPubMedCentral

71.

Neighbors HW, Trierweiler SJ, Munday C et al (1999) Psychiatric diagnosis of African Americans: diagnostic divergence in clinician-structured and semistructured interviewing conditions. J Natl Med Assoc 91:601–612PubMedPubMedCentral

72.

Neighbors HW, Trierweiler SJ, Ford BC, Muroff JR (2003) Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans. J Health Soc Behav 44:237–256PubMed

73.

Strakowski SM, Keck PE, Arnold LM et al (2003) Ethnicity and diagnoses in patients with affective disorders. J Clin Psychiatry 64:747–754PubMed

74.

Kessler RC, McGonagle KA, Zhao S et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19

75.

Ayanian JZ, Weissman JS, Chasan-Taber S, Epstein AM (1999) Quality of care by race and gender for congestiv heart failure and pneumonia. Med Care 37:1260–1269PubMed

76.

Ayanian JZ, Cleary PD, Weissman JS, Epstein AM (1999) The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med 341:1661–1669PubMed

77.

Bach PB, Cramer LD, Warren JL, Begg CB (1999) Racial differences in the treatment of early-stage lung cancer. N Engl J Med 341:1198–1205PubMed

78.

Mayberry RM, Mili F, Ofili E (2000) Racial and ethnic differences in access to medical care. Med Care Res Rev 57:108–145PubMed

79.

Michaud CM, McKenna MT, Begg S et al (2006) The burden of disease and injury in the United States 1996. Popul Health Metr 4:11PubMedPubMedCentral

Titel: Testing a somatization hypothesis to explain the Black–White depression paradox
verfasst von: David M. Barnes
Lisa M. Bates
Publikationsdatum: 13.04.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 10/2019
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-019-01707-9

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Testing a somatization hypothesis to explain the Black–White depression paradox

Abstract

Purpose

Methods

Results

Conclusions

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