Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=109701
Story Retrieval Date: 5/25/2013 11:50:34 PM CST
African-American life expectancy on average is seven to eight years less than non-Hispanic white Americans according to the Centers for Disease Control, but blacks are also far less likely to self-report major depression and anxiety.
Does that mean African-Americans are living shorter, yet happier lives?
The answer to that question is no, according to the University of Michigan's Director of the Institute of Social Research, Dr. James Jackson.
“The failure to look at [mental and physical health] together has lead us down the wrong roads in regards to thinking about what might be the underlying explanation for such consistent disparities,” he said.
At the University of Illinois at Chicago's School of Public Health last Wednesday, Jackson presented a mental health hypothesis that elicited a firestorm of questions and comments from the audience.
“In comparison to the health statuses in mortality, if you look at mental health disparities, they run exactly in the opposite direction,” he said. “African-Americans, fundamentally, by their more positive mental health in the United States of America, are selling out their physical health.”
According to the National Health and Nutrition Survey III data, the prevalence of major depression is “significantly greater” in whites than in African-Americans, 10.5 percent to 7.5 percent, respectively. This difference was also found in the Epidemiologic Catchment Area study as well as the National Comorbidity Survey of Mental Health.
“For African-Americans, living under highly stressful conditions, engaging in no negative health behaviors – no smoking, no drinking, not obese – is related to an incredible probability of developing a case of major depression. The more negative health behaviors one engages in, the probability (of developing major depression) drops almost to zero," Jackson said of the data.
Since people are more immediately aware of their mental state and stress level than a potential physical health concern, African-Americans prioritize their sanity over potential physical harm, Jackson said, by engaging in negative health behaviors that deactivate the HPA axis, a neurological function that controls stress.
“I think that most of us in the field have known for years that these unhealthy behaviors are reinforcing, that’s why people do them,” said Dr. Robin Mermelstein, director of UIC’s Institute for Health Research and Policy and professor of psychology.
“I think the link he added is that in the African-American community, with no other outlet, they turn to these behaviors.”
For many African-Americans – 20 percent of whom are in the lowest income percentile - the everyday environment is not supportive of positive health behaviors. “Neighborhoods provide coping resources: fast food outlets, liquor stores, and illegal drug distribution,” Jackson said. He added that exercise in a crime-riddled neighborhood isn’t always an option.
That creates a problem for health professionals trying to help individuals change poor health behaviors. If you don’t want to be depressed, have a few martinis. The only problem, Jackson tells patients, “It’s killing you.”
As a result, clinical psychologists and other health professionals need to rework their health behavior advice, said Mermelstein.
“Messages that say, ‘Don’t drink; Don’t smoke; Eat better,’ are what people already know. But rather, acknowledge the real difficulty people have in changing many of these behaviors that are unhealthy because they give some positive benefits for coping. Acknowledge that change is tough and make sure that you have some coping resources to fill in the gap and take the place of those unhealthy behaviors.”
UIC clinical psychologist Ann Wood Washington said it’s premature to use Jackson’s research as a framework for battling health disparities.
“That’s a long, hard road ahead,” Wood Washington said. “I see that in the kinds of things that we try to get our patients to do-just change one thing-and it’s really very difficult. The more pieces that we have to add to the [health disparity] puzzle is helpful, but it’s really a very long process."