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African Americans, Black Caribbeans, and Whites Differ in Depression Risk, Treatment

Science Update

Although black Americans are less likely than whites to have a major depressive disorder (MDD), when they do, it tends to be more chronic and severe. They are also much less likely to undergo treatment, a major NIMH-funded study of mental-health status shows. The National Survey of American Life also shows striking differences among blacks. Fewer than half of African Americans with MDD undergo treatment, but the rate drops to about one-quarter in Caribbean blacks who emigrated to the U.S. or were born there.

The survey included the largest black population in a study of this kind to date and provides a new picture of MDD’s toll on subgroups of black Americans. It included self-reports from 3,570 African Americans, 1,621 blacks of Caribbean descent, and 891 non-Hispanic whites age 18 and older, interviewed in 2001 through 2003. Results were published in the March issue of the Archives of General Psychiatry by David R. Williams, PhD, and colleagues from the University of Michigan and Wayne State University.

The researchers reported that 10.4 percent of African Americans, 12.9 percent of Caribbean blacks, and 17.9 percent of non-Hispanic whites had MDD at some point in life. However, among participants with depression, the rate of chronic depression was highest in black groups: 56.5 percent in African Americans and 56 percent in Caribbean blacks, compared with 38.6 percent in whites.

Education and income were not linked to higher or lower risk of MDD in any of the groups, but some other variables were. Older African Americans and whites were less likely to have had MDD than were younger people. Compared to those of their male counterparts, rates of MDD were similar in black Caribbean women but higher in African-American women. Marriage was associated with lower rates of MDD in both black groups. For African Americans and whites, lower rates were reported by people from the South, the West, and rural areas. Higher rates were especially noteworthy in African Americans and whites in major metropolitan areas.

Almost all of the respondents, regardless of race, said that MDD interfered with their home, work, or social lives or relationships. Among those who were severely impaired, African Americans and Caribbean blacks reported being unable to function in their daily lives for 71 days of the year; whites reported being unable to function for 63 days of the year.

Previous studies had shown that slightly more than half (57 percent) of adults who have MDD undergo treatment. This study showed that the treatment rate is less than half (45 percent) for African Americans and less than a quarter (24.3 percent) for Caribbean blacks. The treatment rate for African Americans increases slightly when the illness is severe, but in Caribbean blacks falls to 21.9 percent.

These findings “underscore the pressing need to understand the factors underlying racial differences in access and quality of mental health care and the urgency of implementing interventions to eliminate these disparities,” the researchers write.


Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, Jackson JS. Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites. Archives of General Psychiatry, March 5, 2007.