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
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
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
Having this "contextual information," they explained, might
help to better understand the racial and intraracial disparities revealed by
"Overrepresentation of Black Americans in Psychiatric
Inpatient Care" is posted at<http://ps.psychiatryonline.org/cgi/content/full/60/6/779>.▪