Psychiatric and Substance Use Disorders and Related Service Use in the Diverse Black Sub-Populations in the United States

Purpose Existing literature on the epidemiology of psychiatric and substance use disorders and service use among African Americans in the USA has not fully addressed the heterogeneity of Black populations. This study compares the proportions and diverse characteristics of these sub-populations, their mental and substance use diagnoses, and related service use. Methods The data for this study was obtained from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III). Participants who identified as Black/African Americans were categorized into four groups: African-born, Caribbean-born, US-born with at least one immigrant parent, and US-born with both parents born in the USA. Effect sizes were used to evaluate bivariate between-group differences and multinomial logistic regression analysis was used to identify factors that independently differentiated each of the first three groups from the reference group termed US-born. Results This exploratory analysis strengthened the notion of the immigrant paradox as African- and Caribbean-born Black individuals scored significantly higher on all measures of quality of life and had fewer mental health and substance use diagnoses, but this advantage was not observed in the children of immigrants born in the USA. There were few significant differences in service use across the groups after adjusting for clinical characteristics. Conclusion The differences observed in the diverse Black populations of the USA, across measures of mental and physical health, and substance use, deserve attention in future research, policy, and program development.

Automated summary

This study compared the proportions and characteristics of different sub-populations of African Americans in the USA in terms of mental and substance use diagnoses and related service use. The findings suggest that African- and Caribbean-born Black individuals scored significantly higher on quality of life measures and had fewer mental health and substance use diagnoses, indicating an immigrant paradox. Service use did not show significant differences across the groups after adjusting for clinical characteristics.