To Understand MH Disparities, Look to R.I.C.E., not Race

Accounting for racial disparities in mental health and mental illness involves more than race.

David Hathcox

“Race matters even if we don’t know what race is,” said James Jackson, Ph.D., a professor of psychology and director of the Institute for Social Research at the University of Michigan, speaking at APA’s 2012 annual meeting in Philadelphia in May.

In brief, the issue is not only about “race,” but R.I.C.E.—Race, Immigration, Culture, and Ethnicity, explained Jackson, who received APA’s Solomon Carter Fuller Award at the meeting.

“There are both biological and social components of ‘race,’ but the genes that produce visible traits evolved late and have little to do with disease,” he said.

Racial discrimination is real, of course, and is associated with differences in schooling, housing, and life opportunities. Discrimination also serves as a confounder in epidemiology, confusing the relationship between independent and dependent variables, he said.

One way to sort out the observed health disparities among racial and ethnic groups is to uncouple race, ethnicity, and immigration status, he said. Afro-Caribbeans make up a useful population for that task, because they share ancestry but not ethnicity with African Americans.

Surveys in both the United States and Great Britain indicate that ancestry, gender, timing of immigration, and age at immigration are all factors in rates of mood disorders.

For instance, drawing on data from the National Survey of American Life in 2004, Jackson and colleagues found that 19.9 percent of white people recorded a lifetime mood disorder, compared with 12.5 percent of African Americans and 13.7 percent of Afro-Caribbeans.

However, those overall figures masked several complexities. The rate for Afro-Caribbean respondents whose parents had been born in the United States was 24.3 percent, while among respondents who had come to this country 11 to 12 years before was just 6.3 percent. Similar variations dependent on immigration status and timing were observed for any lifetime psychiatric disorders among Afro-Caribbeans over age 55.

Gender adds another layer to the inquiry. Among African Americans, women are more likely than men to record 12-month prevalence of mood disorders, a pattern matched by Afro-Caribbeans who arrived in the United States at least 11 years previously. However, rates were higher for men than women among those who were either born in the United States or immigrated within the prior 10 years.

Age of onset of major depression appeared to be younger for Afro-Caribbean males, who also faced a higher risk for major depressive disorder and a greater chance of its persistence compared with other ethnic-gender subgroups.

Jackson also noted that his research has found that among imprisoned populations, Afro-Caribbean males who met criteria for substance abuse were five times more likely than African-American males who met criteria for substance abuse to also have major depression, which suggests there is something going on with the behaviors of these men who are migrating to the United States. It could be the difficulty of finding work or making an adjustment to life in this country, he suggested.

Finally, important differences appear within nominally similar ethnic groups. Patterns differ among Cubans, Puerto Ricans, and Mexicans, who can’t be lumped together uncritically as “Hispanics.”

“There’s no simple story,” Jackson emphasized. “First-generation health protection may not be an adequate explanation, and differences in psychopathology are not reducible in any simplistic way to differences in social and economic statuses among groups.”

So R.I.C.E.—the intersections of race, immigration, culture, and ethnicity—produces a complex, multifaceted, view of the life course.

For a report on Jackson’s research on the relationship between physical and mental health disparities among minority populations, see the March 19, 2010, Psychiatric News at http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=113287.