African Americans have largely been identified as the descendants of slaves brought to the Americas during the centuries prior to the Civil War, with their ultimate emancipation, but ongoing degrees of discrimination through the present era. Other groups with origins in Black Africa have continued to arrive, but in smaller numbers and with frequent identification by nation of origin to identify their differing histories and economic circumstances. Most studies in the United States have focused on the former group and few studies, if any, have attempted to differentiate the experience of the more recent immigrants.
The prevalence of mental disorder among African Americans has been a source of ongoing controversy for over a century. Prior to emancipation, treatment for mental disorders was largely not available for slaves and so rates of treated disorder were not representative of true prevalence. Dain (1964) notes that the U.S. Census of 1840 reported a higher frequency of insanity for free northern Blacks (along with the Irish) than for the entire white population, but substantially lower rates for Black slaves of the South. He further discusses the politically motivated arguments of the time that the care provided by slave owners and a simple agrarian life without responsibility would bring low rates. Such arguments ignored the harsh treatment and demeaning elements of slavery.
The realities regarding mental health services appeared in Samuel Gridley Howe's (1863) American Freedmen's Inquiry Commission, which inquired of asylum (Dain, 1964) superintendents in the North about the number of insane Blacks, only to find that most asylums even in the North did not admit Blacks and that insane Blacks were more likely to be found in almshouses (Dain, 1964). Malzberg (1944) points out that after 1910 census data on the insane came primarily from institutions, and that in the South the availability of beds in asylums was considerably less than in the North, and many beds were White only. It was not until 1930 that the census reported rates from state hospitals, and those rates were higher for Blacks than for Whites (Warheit, Holzer, & Arey, 1975). This history of the relationship between service availability and reported prevalence rates continues to be an issue, although prisons have substituted for almshouses as a place to put the mentally ill. Either way, examination of rates of treated disorder usually provide biased estimates of true prevalence.
Faris and Dunham (1939) examined first admission rates for schizophrenia in Chicago and found higher rates (per 100,000) for Blacks (41.4) as compared to native-born Whites (28.0), and foreign-born Whites (38.1). Malzberg (1944, 1959) examined hospitalization rates for New York State, where there was no official segregation or discrimination and found higher rates for Blacks than others even controlling for age. Between 1940 and 1950, Malzberg (1959) reported a decrease in rates of first admissions for Blacks for all illnesses except involutional psychoses and schizophrenia, which he attributed to improved living conditions for Blacks.
Dohrenwend and Dohrenwend (1969) reviewed eight studies with race comparisons and found that four of them reported higher rates for Whites (Lemkau, Tietze, & Cooper, 1942; Roth & Luton, 1943; and Pasamanick et al., 1959) and four with higher rates for Blacks (Cohen, Fairbank, & Greene, 1939; Hyde & Chisholm, 1944; Leighton, Harding, Macklin, Macmillan, & Leighton, 1963; and Rosanoff, 1917). Dohrenwend's review marks a transition from treatment-based statistics to those based on community surveys.
Warheit, Holzer, and Schwab (1973) and Warheit et al. (1975) conducted analyses of symptomatology in a southern community, and found higher mean depressive symptom scores for Blacks than Whites on several symptom measures including depression, anxiety, phobias, and general psychopathology. In regression models that controlled for age, sex, and socioeconomic status, however, the race effect became nonsignificant for all but the phobia scale. Thus, both age and socioeconomic status should be considered in making ethnic comparisons. Similar findings of higher symptom scores for Blacks than Whites but decreased or even reversed comparisons when controls for age and/or socioeconomic status were added (Comstock & Helsing, 1976; Husaini, 1983; Roberts, 1980,1981; Weissman & Myers, 1978). Vernon and Roberts (1982) showed higher depressive symptoms and diagnosed major depression (SADS-RDC) among Blacks and Mexican Americans than Whites in Alameda, California. Overall rates of mental illness, however, were lower in Blacks than Whites or Mexican Americans because of other diagnoses.
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