Pursuing a Deeper Understanding of the Black-White Mental Health Paradox: A Sequential, Mixed Methods, Three-Article Dissertation
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Authors
LaMotte, Megan E.
Issue Date
2024
Type
Dissertation
Language
Keywords
Alternative Title
Abstract
Black Americans incur disproportionate stress because of the systemic racial oppression in the United States and their socioeconomic disadvantages. Such stress exposure has significant negative impacts on Black peoples' physical health. One would assume Black Americans' mental health would equally suffer in the face of stress exposure, yet they have lower rates of depression and anxiety than Whites, a phenomenon referred to as the Black-White mental health paradox. This dissertation presents three empirical studies of Black-White differences in mental health and their determinants. Based on the known gender differences in mental health and the unique ways in which Black and White men and women are socialized to express distress, we also took an intersectional approach in each article and dissected patterns by race, by gender, and of specific subgroups. The first article (Chapter 2) uses secondary data representative of the U.S. Black and White populations to examine how the race and mental health relationship is potentially mediated by counterbalancing mechanisms of stressors and psychosocial resources, and how this whole process is moderated by gender. We found that racial identity and religious service attendance slightly benefit the mental health of Black women, but Black men's apparent mental resiliency remained mostly unexplained. Additionally, the greater importance placed on religion among Black Americans relative to White Americans appeared to be a detriment to their mental health. The second article (Chapter 3) describes a study in which we interviewed 51 Black and White men and women to collect their theories as to why the Black-White mental health paradox exists. Participants' explanations mainly suggested that the paradox is a methodological artifact owing to mental illness stigma that biases Black Americans' reports of symptoms. Black women highlighted the role that religious organizations play in perpetuating this stigma towards mental illness and Black peoples' tendency to suffer in silence, and Black men highlighted the similar stigmatizing role played by the medical community. Finally, the third article (Chapter 4) reports on the findings from an online survey-embedded experiment in which Black and White men and women (N=880) were randomized to read one of four vignettes describing a vignette character (Black or White, man, or woman) who was experiencing symptoms characteristic of depression. Results revealed that the intersection of race and gender rendered Black men in a unique position in which the stigma towards mental illness among Black people and among men compound. Black men often were more likely to think depression symptoms were normal, expected more stigmatization, and recommended seeking mental health care less often than other groups. Counterintuitively though, Black men and women were more likely than Whites to consider mental health care for themselves and were more optimistic in its effectiveness. Overall, this dissertation finds mechanisms of the paradox that are shaped by both race and gender; some that are artifactual (i.e., methodological biases) and some that are substantive (e.g., coping mechanisms). More research is needed on these artifactual explanations, and any future research on race differences in mental health should not overlook within-race differences in outcomes or etiology.