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ABSTRACT
Objective: This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).
Design: This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) – the co-occurrence of physical and psychiatric health problems – are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.
Results: Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to ‘Psychiatric Only’ health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.
Conclusion: These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.
Acknowledgements
The author would like to thank Pamela Braboy Jackson, Stephanie Robert, Alyn McCarty, Jason Houle, Abigail Sewell, and Eric Anthony Grollman for their invaluable feedback during the writing of this manuscript. The author acknowledges the Robert Wood Johnson Foundation Health & Society Scholars Program and the Ford Foundation Dissertation Fellowship Program for their financial support.
Disclosure statement
No potential conflict of interest was reported by the author.
Key messages
When facing a psychiatric health problem, compared to White women, Black and Cuban women are more likely to also have an accompanying physical health problem.
While social factors like SES, stress exposure, and social support are independently associated with PPC, they do not account for ethnic differences in PPC among women.
Puerto Rican men are at a heightened risk of PPC, and the social factors examined in this study partially account for the Puerto Rican-White male health difference.
Mexican and Asian American women and men consistently have lower rates of PPC compared to their White counterparts.
Notes
1. When considering co-occurring physical and mental health problems, causal ordering is often a key concern (Aneshensel, Frerichs, and Huba Citation1984; Cohen and Rodriguez Citation1995; Hollingshaus and Utz Citation2013). Given the challenges in establishing the age of onset of physical and psychiatric health conditions, it is not possible to completely disentangle the timing of each disease. The data used for this study include information about the age of onset for psychiatric disorders, but not for physical health conditions. Thus, here I examine physical-psychiatric comorbidity (PPC) regardless of the chronological order or causal pathways linking physical and psychiatric health conditions (Druss and Walker Citation2011).
2. I define race as a socially constructed set of categories that historically tend to be based on physical features such as phenotype, hair texture, and facial features (Cornell and Hartmann Citation1998). The U.S. government’s Office of Management and Budget (OMB) classifies five racial categories in the United States: White, Black/African American, American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islander (Office of Management and Budget Citation1997). The OMB also includes either a Hispanic or non-Hispanic ethnic category classification for each racial group. This distinction between race and ethnicity, however, is somewhat arbitrary, particularly because a large proportion of Hispanics would prefer that Hispanic be treated as a ‘racial’ category (Tucker, Kojetin, and Harrison Citation1996; Williams Citation2012). For this study, ‘Hispanic’ or ‘Latino’ is considered a broad racial category. Ethnicity, on the other hand, is defined as group membership adopted by individuals on the basis of similarities in culture or nationality (Jenkins Citation1994). With regard to health and epidemiological research, ethnic categories typically refer to subgroups within racialized groups (Brown et al. Citation2013; Williams Citation2012). For the sake of conceptual and methodological clarity, I align with this perspective and use ethnicity to refer to subgroups within broad racialized groups who share a common national origin. More specifically, the broader racial categories discussed throughout the text include ‘Asian’, ‘Black’, ‘Latino’, and ‘White’. The ethnic groups discussed throughout the text include ‘African American’, ‘Caribbean Black’, ‘Spanish Caribbean Black’, ‘Mexican’, ‘Cuban’, ‘Puerto Rican’, ‘Chinese’, ‘Filipino’, and ‘Vietnamese’.
3. Ethnic differences in the prevalence of each specific physical and psychiatric condition are available upon request.
4. The Hispanic epidemiological paradox describes the pattern of findings whereby Hispanic Americans, though more socioeconomically disadvantaged, on average, experience fewer health problems and lower mortality rates compared to Whites (Lariscy, Hummer, and Hayward Citation2015; Markides and Coreil Citation1986; Hummer et al. Citation1999).