Unraveling mental illness disparities: Cross-cultural differences in the expression of mental health disorders

Notable disparities exist in the proportion of individuals with mental illness across race and ethnicity. These disparities may partly occur because of differences in how minority individuals express and experience mental illness relative to the majority population. Systematic differences in expression of mental illness could lead to underestimates of disparities, limit access to care for minorities, and impede policy. Yet, little research addresses the possibility that systematic differences in the expression of mental illness influence disparities. New methods allow substantially improved approaches to addressing this.

Methods: I used data from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions, a large (n = 43,093), representative survey of US adults and multiple group (MG) multiple-indicator-multiple-cause (MIMIC) models to investigate the extent to which disparities in substance abuse and dependence are affected by differences in the expression of symptomatology across Whites, African-Americans, and Hispanics.

Results: MG-MIMIC including cross-group differences in education and income uncovered statistically significant differences in the expression of substance abuse and dependence symptomatology across race and ethnicity. Findings indicated that these differences lead to substantial underestimates of disparities for Blacks and Hispanics.

Discussion: Results demonstrated that minorities tend to experience and express mental illness symptoms systematically differently than Whites. These differences cause research to underestimate disparities among minorities and may partially account for disparities in the extent to which minorities have access to and receive mental illness treatment. These findings emphasize the value of using culturally sensitive research and sound statistical approaches to develop public mental health policy.