Descriptive analysis of social determinant of mental health factors in an ethnically diverse Black adult population

Background: Black adults are often seen as homogeneous despite the diversity within the Black population across ethnicity. Understanding the heterogeneity within the Black population will help address mental health disparities. Methods: A cross-sectional descriptive study and analysis was conducted among Black adults in the United States (n = 269, ages 18-65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We calculated mean differences according to ethnicity, citizenship status, age group, and gender in the areas of medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior. Results: African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2), than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Black immigrants across the spectrum of depression scores had greater stigma than African Americans (p = 0.037). Participants who identified as male had a prevalence of mild depression (5-9) that was 1.7 times higher than those who identified as female. Whereas, those who identified as female had a prevalence that was 1.2 times higher for moderate to severe depression (10-19) and 4.7 times higher for severe depression (20-27) compared to males (p = 0.021). Non-United States citizens reported higher medical mistrust (mean value difference = 0.16) compared to United States citizens (p = 0.011). Conclusion: This study shows key variations across social determinant of mental health factors among Black adults.

Racial identity and mental health stigma among Black adults in the United States

Objectives: Mental illness stigma is a barrier to engagement in mental health services. This study assesses our hypothesis that specific racial identity dimensions influences mental health behavior including stigma. Methods: We performed an online cross sectional observational study among Black adults (n = 248, ages 18-65). We examined the relationship between an individual's approach to their racial identity in the community and stigma behavior towards mental health; generalized linear models were performed. We assessed demographic characteristics as moderators of the primary association. Results: Black adults with higher centrality reported lower past stigma behavior (RR=1.57, CI: 1.11-2.21, p=0.01), but higher future intended stigma behavior (RR=0.93, CI: 0.88-0.99, p=0.02). Majority of respondents reported high centrality and high assimilation; however, assimilation did not appear to correlate with mental health stigma behavior. Age, education and ethnicity appeared to have a limited moderating effect on the association between centrality and stigma behavior. Conclusions: Centrality was associated with mental health stigma behavior. By understanding the intersecting characteristics that may increase the likelihood for mental illness stigma, we will be better able to reduce mental illness stigma and optimize engagement in mental health services.