Hospitalization Rates Vary Among Black Subgroups

The overrerepresentation of blacks among psychiatric inpatients in the United States has been confirmed over the years by scholarly scrutiny. Now new research, published in the June Psychiatric Services, again has verified the problem but found it to be more nuanced within the black population than previous studies have shown.

Analyzing two completed survey-based, national population data sets, researchers at the University of California, Berkeley (UC Berkeley), and the University of California, San Francisco (UCSF), found that in proportion to their population numbers in the United States, individuals of Caribbean ancestry born in the United States are more likely than foreign-born blacks of Caribbean ancestry, African Americans, and non-Hispanic whites to be hospitalized for a psychiatric illness or complaint in their lifetime.

“It may be that U.S.-born Caribbean blacks experience pressure to accommodate and succeed in mainstream society while adhering to traditional Caribbean values, which might lead to higher levels of serious distress requiring inpatient treatment,” wrote the three-person research team led by Lonnie Snowden, Ph.D., a professor at UC Berkeley's School of Public Health. Other team members were Julia Hastings, Ph.D., an assistant professor at UC Berkeley's School of Social Welfare, and Jennifer Alvidrez, Ph.D., an associate professor in the Department of Psychiatry at UCSF.

“This pattern may parallel the 'Latino health paradox' whereby greater acculturation among Latinos is associated with more general medical problems and mental health problems,” they wrote.

The authors acknowledged that no research definitively proves that“ acculturation stress” leads to increased psychiatric hospitalization in this country. But they suggested that the possibility of its happening among blacks and subgroups of blacks in the country is“ consistent with data indicating that U.S.-born and European-born Caribbean blacks have higher rates of mental illness, particularly schizophrenia, than other groups.”

Caribbean blacks, the authors reported, make up about 4.4 percent of the U.S. black population. Of the U.S. population blacks make up about 13.4 percent and non-Hispanic whites about 66 percent, according to the U.S. Census Bureau.

But for this study, the question was which subgroup among blacks in the United States (those of Caribbean ancestry or African Americans) was“ more likely than whites to be hospitalized for inpatient psychiatric care.”

To begin to answer the question, the team turned to national inpatient prevalence data from two household surveys: the National Survey of American Life and the National Comorbidity Survey Replication. Both were part of a three-part survey, conducted between 2001 and 2003 by the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys.

The researchers analyzed the self-reported responses of 9,371 individuals residing in the community to survey questions about lifetime psychiatric hospitalization history. Snowden and his colleagues divided the database subjects into three distinct groups: 3,570 African Americans, 1,621 U.S. blacks of Caribbean ancestry, and 4,180 non-Hispanic whites. To reveal further differences, if any, within the Caribbean ancestry group, it was further divided into U.S.-born and foreign-born status.

Applying logistic regression and controlling for socieoeconomic differences, Snowden and his team confirmed previous, though dated, research that “both African Americans and Caribbean blacks were significantly more likely to be hospitalized than non-Hispanic whites.”

What's unique about this research is that it also revealed that the“ odds for U.S.-born Caribbean blacks of having any lifetime hospitalization were greater than the odds for non-Hispanic whites and appeared notably higher than the odds for African Americans. On the other hand, the odds of hospitalization for foreign-born Caribbean blacks were not significantly different from those of non-Hispanic whites.”

“We've known about black-white inpatient disparities for years in the field, but frankly, we haven't made much progress in understanding or addressing this problem,” the researchers collectively responded in an e-mailed statement to Psychiatric News.

“Our findings suggest that we need to do a much better job of addressing environmental conditions that put [individual] blacks at greater risk of psychiatric crisis and to improve access to quality mental health care for the diverse black populations in the U.S.”

The study has a number of weaknesses, the researchers noted, among them that the data did not include the respondents' exact official diagnoses and level of functioning and whether the hospitalization was voluntary or involuntary.

Having this “contextual information,” they explained, might help to better understand the racial and intraracial disparities revealed by the data.

“Overrepresentation of Black Americans in Psychiatric Inpatient Care” is posted at<http://ps.psychiatryonline.org/cgi/content/full/60/6/779>.▪