Disparities in Co-occurring Mental Health Problems among Substance Abusing Black Youth with Single- and Multi-race Identities

BACKGROUND: We examined the prevalence of co-occurring mental health problems among mono-racial and mixed-race black youth entering substance abuse treatment programs.

METHODS: We used pooled clinical data from 12-25 year old blacks reporting a single racial identity (n=2,143) and blacks with multi-race identities (n=622) who entered federally-funded substance abuse treatment programs. Using multiple logistic regression analysis, we examined differences in prevalence rates of co-occurring mental health problems between single- and mixed-race blacks controlling for their levels of substance abuse, environmental risk factors, and socio-demographic characteristics.

RESULTS: Multi-racial blacks were significantly more likely than single-race blacks to have externalizing mental health problems (conduct disorders and attention-deficit hyperactivity disorder) even after controlling for covariates (OR=1.43, 95% CI=1.16-1.77, p=.001). Rates of internalizing mental health problems (major depression, general anxiety, traumatic stress, and suicidal tendencies) were significantly higher among mixed-race blacks before controlling for covariates (OR=1.81, 95% CI = 1.49-2.18, p< .001) but became marginal after controlling for covariates (OR =1.22, 95% CI =0.98-1.52, p=.076). Subgroup analysis revealed significantly higher rates of mental health problems among blacks with American Indian identity and those with more than two racial identities when compared to single-race blacks (p<.05).

CONCLUSIONS: Mixed-race black youth may be more likely to suffer co-occurring mental health problems than their single-race counterparts. There may also be differences in prevalence of mental health problems among subgroups of mixed-race blacks Recognition of multi-race identity both as a source of strength and stress may contribute to the effectiveness of intervention programs for youth in substance abuse treatment.