Abstract
Aim:
This study aimed to explore cross-ethnic variation in the pattern of the associations between psychiatric disorders and self rated mental health (SRMH) in the United States.
Methods:
This cross sectional study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 2003, a national household probability sample. The study enrolled 18,237 individuals who were either Non-Hispanic White (n=7,587), African American (n=4,746), Mexican (n=1,442), Cuban (n=577), Puerto Rican (n=495), Other Hispanic (n=1,106), Vietnamese (n=520), Filipino (n=508), Chinese (n=600) or Other Asian (n=656). SRMH was the outcome. Independent variables were psychiatric disorders including Major Depressive Disorder [MDD], General Anxiety Disorder [GAD], social phobia, alcohol abuse, binge eating disorders, panic disorder, and Post Traumatic Stress Disorder [PTSD], measured by the Composite International Diagnostic Interview (CIDI). Demographic (age and gender), socioeconomic (education and income) factors were covariates.
Results:
The only psychiatric disorder which was universally associated with SRMH across all ethnic groups was MDD. More psychiatric disorders were associations with poor SRMH in Non-Hispanic Whites than any other ethnic groups. In African Americans, demographic and socioeconomic factors could fully explain the associations between psychiatric disorders and SRMH. Among Mexican and Other Hispanics, demographic and socioeconomic factors could only explain the association between some but not all psychiatric disorders and SRMH. In all other ethnic groups, demographic and socioeconomic factors did not explain the link between psychiatric disorders and SRMH.
Conclusion:
Although SRMH is a useful tool for estimation of mental health needs of populations, poor SRMH may not have universal meanings across ethnically diverse populations. Ethnic groups differ in how their poor SRMH reflect psychiatric conditions and the role of demographic and socioeconomic factors in explaining such links. These ethnic differences may be a source of measurement bias in cross-ethnic health comparisons.
Keywords: ethnic groups, psychiatric disorders, self-rated health
Introduction:
Research and practice in the fields of epidemiology and population health have historically shown an interest toward brief and cost effective methods that can be reliably used to estimate the health needs of a community.1–5 In line with the same need, the Institute of Medicine (IOM) has recently recommended the application of single item self rated health (SRH) measures to monitor the population health in the United States.6,8 SRH measures predict a wide range of health outcomes including help seeking behaviors, 10 adherence to prescriptions,11 chronic medical and psychiatric conditions,1,2,12–14 and mortality.15 The single item self rated mental health (SRMH) measures which ask respondents to rate their overall mental health as “excellent, very good, good, fair, or poor” predict need for mental health care.9,77
Recent studies have shown that SRH measures differently correlate with a wide range of health outcomes such as psychiatric disorders,31,78 body mass index,17 and mortality 18–20 across ethnic groups. According to the Theory of Cultural Psychology, cross-ethnic and cross cultural differences in life histories and values result in major ethnic and culture specific variations in cognitive, emotional, and behavioral processes.21,22 As a result, the meanings and correlates of psychological, cognitive, and emotional constructs such as SRH are not universal but conditional to ethnicity.12,23–25
Factors associated with SRH vary across diverse populations.16,18,19,25–29,78, Stronger associations between poor SRH and health problems are found in Non-Hispanic Whites compared to other ethnic groups.12,16 Ethnic groups may differ in the health correlates of mental as well as physical SRH.12–14,16,18,19,26–29 SRH better predicts mortality for Non-Hispanic Whites than in Non-Hispanic Blacks.18 These association also vary between and within race and ethnic groups;24 for instance, according to one study, East Asians, Filipinos, Vietnamese, and Chinese individuals differed in the association between psychiatric disorders and SRMH.24 While ethnic differences should be expected in what poor SRH reflects,24 very few studies have investigated the heterogeneity of the association between psychiatric conditions and SRMH across ethnic groups.
Perception of one’s own mental health as poor prompts complex cognitive and behavioral processes that are needed for help seeking and the utilization of mental health care services.30,77 Although a wide range of other determinants such as trust, knowledge, access, distance, stigma, financial ability, and insurance also play important roles,31 the process of mental health care utilization would not initiate unless the individuals perceive their own mental health as poor.10,15,30–35 Given the central role of SRMH in the process of seeking mental health care,36 there is a need for understanding if differential associations exist between actual need and perceived need, and whether such variations contributes to underutilization of mental health care services among ethnic minorities.12,23,24,36,37,77
Borrowing data from the Collaborative Psychiatric Epidemiology Surveys (CPES), this study compared ten ethnic groups on the associations between psychiatric conditions and SRMH in the United States.
Methods
Design and Setting
This was a secondary analysis of the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003. The CPES is composed of the National Latino and Asian American Study (NLAAS), the National Survey of American Life (NSAL), and the National Comorbidity Survey – Replication (NCS R). These three surveys are representative of the United States adults and have employed very similar methodologies, including utilizing trained lay interviewers to conduct interviews primarily in person. Data were collected by the Institute for Social Research, University of Michigan, Ann Arbor. Study design and sampling have been described in detail elsewhere.38
Participants
This current study included a national household probability sample of 18,237 individuals including 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1,442 Mexican, 1,106 Other Hispanic, 4,746 African American, and 7,587 Non-Hispanic Whites. All participants were adults (aged 18 or older). These numbers came from NLAAS (n=4,649), NSAL (n=6,082), and NCS-R (n=9,282).
Ethics
The study protocol was approved by the University of Michigan Institutional Review Board. Participants received financial compensation for participating in this study.
Interview
Most interviews were face-to-face and conducted within participants’ homes. A minority of the interviews were conducted via phone. The average response rate of the CPES is 72.7%.
Measures
Race and Ethnicity.
Race and ethnicity in the CPES was measured by the individual’s self-identification. Participants self-identified as Asian, Hispanic, Black/African American, or White/Caucasian. Asians then self-identified as Vietnamese, Filipino, Chinese, or Other Asian. Hispanics identified as Cuban, Puerto Rican, Mexican, or Other Hispanic. Blacks identified as African American or Caribbean Blacks.39
Mental Self-Rated Health.
Participants were asked “How would you rate your overall mental health?” Responses included five categories: excellent, very good, good, fair, and poor. Single-item SRMH measures correlate with psychiatric disorders and psychological distress. Ranging from 0.7 to 0.8 for brief time intervals, test retest reliability for single-items is high.20 These measures also show strong correlations with standard scales on distress and well-being.20
Demographic Factors.
Demographic factors including age (continuous measure) and gender (dichotomous measure, males being the reference category) were measured.
Socioeconomic Characteristics.
Socioeconomic factors, including education level (less than high school [reference category], high school graduate, some college, college graduate) and income (continuous measure), were measured.
Lifetime Psychiatric Disorders.
A modified version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate lifetime Major Depressive Disorder (MDD), General Anxiety Disorder (GAD), social phobia, alcohol abuse, binge eating disorders, panic disorder, and Post Traumatic Stress Disorder (PTSD). All disorders were diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV. The WMH-CIDI was originally developed for the World Mental Health project initiated in 2000.40 The CIDI requires trained lay interviewers to generate diagnoses of lifetime and recent DSM IV /ICD 10 disorders.41 Clinical reappraisal studies have documented good concordance for CIDI diagnoses with diagnoses made by psychiatrists.40,42,43 The CIDI has shown to be valid among several ethnic groups.44–46
Statistical Analysis
To account for the complex sampling design of the CPES, we used Stata 13.0 (Stata Corp., College Station, TX, USA) for data analysis. Standard errors were estimated using the Taylor series approximation technique. We conducted our analyses within each ethnic group. First we used zero order Pearson correlations to calculate bivariate associations between each psychiatric disorder and SRMH. Then we reported the results of two series of multivariable associations, adjusted for age and gender, as well as adjusted for age, gender, education, and income.
In all analyses, SRMH was treated as continuous measure with a higher score indicating worse mental health. Psychiatric conditions were all treated as dichotomous variables. Due to multiple comparisons, we used a more conservative threshold for our p values. A p value of less than 0.01 was considered statistically significant.
Results
Descriptive statistics
Table 1 provides a summary of characteristics across ethnic groups. SRMH was higher in Other Asians compared to Non-Hispanic Whites and African Americans. Table 1 also describes the sample sizes of each ethnic group. As shown in the table, the largest population was composed of Non-Hispanic Whites (41.6%). Our population was representative of over 200 million individuals in the United States.
Table 1:
Vietnamese | Filipino | Chinese | Other Asian | Cuban | Puerto Rican | Mexican | Other Hispanic | African American | Non-Hispanic Whites | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Characteristics | M | SE | M | SE | M | SE | M | SE | M | SE | M | SE | M | SE | M | SE | M | SE | M | SE |
SRMH | 2.40 | 0.05 | 2.00 | 0.04 | 2.41 | 0.04 | 1.86 | 0.04 | 2.17 | 0.05 | 2.22 | 0.05 | 2.32 | 0.03 | 2.11 | 0.03 | 2.15 | 0.02 | 2.18 | 0.02 |
Age | 43.73 | 0.67 | 42.98 | 0.75 | 42.88 | 0.61 | 38.10 | 0.68 | 48.97 | 0.73 | 41.17 | 0.72 | 36.68 | 0.48 | 38.38 | 0.52 | 42.19 | 0.27 | 46.73 | 0.45 |
Gender (Female) | 1.55 | 0.02 | 1.55 | 0.02 | 1.54 | 0.02 | 1.50 | 0.02 | 1.48 | 0.02 | 1.51 | 0.02 | 1.47 | 0.02 | 1.52 | 0.02 | 1.56 | 0.01 | 1.53 | 0.01 |
Education | 2.33 | 0.05 | 2.92 | 0.05 | 2.90 | 0.05 | 3.24 | 0.04 | 2.39 | 0.05 | 2.14 | 0.05 | 1.82 | 0.03 | 2.25 | 0.04 | 2.28 | 0.02 | 2.69 | 0.02 |
Income | 51.25 | 2.18 | 79.01 | 2.54 | 74.32 | 2.56 | 76.07 | 2.59 | 52.22 | 2.25 | 50.52 | 2.18 | 41.40 | 1.30 | 49.43 | 1.54 | 37.12 | 0.54 | 61.72 | 1.08 |
N | 520 | 508 | 600 | 656 | 577 | 495 | 1442 | 1106 | 4746 | 7587 | 520 | 508 | 600 | 656 | 577 | 495 | 1442 | 1106 | 4746 | 7587 |
Weighted | 1156 | 1909 | 2533 | 3452 | 1060 | 1864 | 15763 | 5869 | 22049 | 1.48E | 1156 | 1909 | 2533 | 3452 | 1060 | 1864 | 15763 | 5869 | 22049 | 1.48E |
n | 292 | 580 | 495 | 027 | 586 | 484 | 471 | 754 | 686 | +08 | 292 | 580 | 495 | 027 | 586 | 484 | 471 | 754 | 686 | +08 |
% | 2.85 | 2.79 | 3.29 | 3.6 | 3.16 | 2.71 | 7.91 | 6.06 | 26.02 | 41.6 | 2.85 | 2.79 | 3.29 | 3.6 | 3.16 | 2.71 | 7.91 | 6.06 | 26.02 | 41.6 |
SRNH; Self-Rated Mental Health
Unadjusted associations
Table 2 provides a summary of bivariate correlates of SRMH across ethnic groups. Major ethnic differences were found in correlates of SRMH. MDD was the only psychiatric disorder which was associated with poor SRMH across all ethnic groups. More correlations between psychiatric disorders and SRMH were found in Non-Hispanic Whites, Cubans, and Other Hispanics. In Chinese individuals, other than MDD, no other psychiatric disorder was associated with SRMH. (Table 2)
Table 2:
Vietnamese | Filipino | Chinese | Other Asian | Cuban | Puerto Rican | Mexican | Other Hispanic | African American | Non- Hispanic Whites | |
---|---|---|---|---|---|---|---|---|---|---|
Major Depressive Disorder (MDD) | .196* | .143* | .135* | .268* | .286* | .239* | .143* | .231* | .210* | .343* |
General Anxiety Disorder (GAD) | .144* | .064 | .022 | .175* | .274* | .114 | .077 | .101* | 0.011 | .209* |
Social Phobia (SP) | .106 | .113 | .050 | .136* | .297* | .188** | .142* | .163* | .152* | .188* |
Panic Disorder (PD) | .110 | .120* | .030 | .115 | .189* | .187* | .085* | .137* | .139* | .192* |
Posttraumatic stress disorder (PTSD) | .052 | .021 | .060 | .222* | .238* | .150* | .101* | .068 | .131* | .175* |
Alcohol Use Disorders (AUD) | .046 | .148* | .003 | .129* | .033 | −.013 | .087* | .065 | .100* | .177* |
Binge Eating Disorders (BED) | .074 | .003 | −.022 | .075 | .084 | .079 | −.050 | .134* | .093* | .073 |
SRH; Self-Rated Health, MDD; Major Depressive Disorder, GAD; General Anxiety Disorder, PTSD; Posttraumatic Stress Disorder
p < 0.01
Partially adjusted associations
Table 3 summarizes partially adjusted associations when age and gender are controlled for. This table also describes major ethnic differences found in correlates of SRMH. Still, MDD is shown to be better correlated with SRMH. Demographic factors did not explain the correlation between MDD and SRMH in any ethnic group. With demographic factors controlled, psychiatric disorders better correlated with SRMH in Non-Hispanic Whites, Cubans, and Other Hispanics. (Table 3)
Table 3:
Vietnamese | Filipino | Chinese | Other Asian | Cuban | Puerto Rican | Mexican | Other Hispanic | African American | Non- Hispanic Whites | |
---|---|---|---|---|---|---|---|---|---|---|
Major Depressive Disorder (MDD) | .212* | .159* | .149* | .271* | .283* | .236* | .142* | .233* | .173* | .328* |
General Anxiety Disorder (GAD) | .112 | .063 | .017 | .172* | .259* | .106 | .071 | .091 | .002 | .206* |
Social Phobia (SP) | .117* | .118* | .079 | .134* | .298* | .198* | .141* | .153* | .150 | .178* |
Panic Disorder (PD) | .099 | .121* | .023 | .112 | .174* | .186* | .084 | .167* | .087 | .158* |
Posttraumatic stress disorder (PTSD) | .034 | .017 | .051 | .207* | .240* | .150* | .098* | .030 | .187* | .168* |
Alcohol Use Disorders (AUD) | .065 | .156* | .024 | .173* | .071 | .019 | .096* | .088 | .068 | .179* |
Binge Eating Disorders (BED) | .078 | .009 | −.019 | .079 | .077 | .089 | −.050 | .103* | .026 | .070 |
SRH; Self-Rated Health, MDD; Major Depressive Disorder, GAD; General Anxiety Disorder, PTSD; Posttraumatic Stress Disorder
p < 0.01.
Age and gender are controlled
Fully adjusted associations
Table 4 shows the results of fully adjusted associations when demographic factors as well as SES indicators are controlled. Above and beyond demographic and SES factors, the association between MDD and SRMH was consistent across almost all ethnic groups. Ethnic groups show different patterns in the adjusted associations between other psychiatric disorders and SRMH. More adjusted correlations were found between psychiatric disorders and SRMH in Non-Hispanic Whites, Cubans, Other Asians, and Puerto Ricans, than in other ethnic groups. (Table 4)
Table 4:
Vietnamese | Filipino | Chinese | Other Asian | Cuban | Puerto Rican | Mexican | Other Hispanic | African American | Non- Hispanic Whites | |
---|---|---|---|---|---|---|---|---|---|---|
Major Depressive Disorder (MDD) | .209* | .159* | .157* | .268* | .258* | .202* | .155* | .230* | .181 | .314* |
General Anxiety Disorder (GAD) | .109 | .062 | .029 | .173* | .235* | .090 | .075 | .087 | −.035 | .194* |
Social Phobia (SP) | .117* | .125* | .078 | .139* | .290* | .170* | .153* | .161* | .181 | .155* |
Panic Disorder (PD) | .098 | .128* | .019 | .109 | .178* | .160* | .080 | .159* | .062 | .147* |
Posttraumatic stress disorder (PTSD) | .025 | .022 | .065 | .202* | .225* | .122* | .108* | .037 | .176 | .155* |
Alcohol Use Disorders (AUD) | .059 | .149* | .022 | .171* | .064 | .025 | .101* | .095 | .041 | .130* |
Binge Eating Disorders (BED) | .074 | .003 | −.002 | .069 | .076 | .066 | −.048 | .104* | .018 | .070 |
SRH; Self-Rated Health, MDD; Major Depressive Disorder, GAD; General Anxiety Disorder, PTSD; Posttraumatic Stress Disorder
p < 0.01.
Age, gender, education, and income are controlled
Summary of similarities and differences across ethnic groups
The only psychiatric disorder which was universally associated with SRMH across all ethnic groups was MDD. Other psychiatric disorders should variations in their unadjusted and adjusted associations with SRMH. A higher number of psychiatric disorders were associations with SRMH in Non-Hispanic Whites than other ethnic groups. In African Americans, demographic and socioeconomic factors could fully explain the associations between psychiatric disorders and SRMH. Among Mexican and Other Hispanics, demographic and socioeconomic factors could only explain the association between some but not all psychiatric disorders and SRMH. In other ethnic groups, demographic and socioeconomic factors failed to explain the link between psychiatric disorders and SRMH.
Discussion
This study showed at least three novel findings regarding cross-ethnic variations in the associations between psychiatric disorders and SRMH. First, MDD was the only psychiatric disorder which was consistently linked to poor SRMH across all ethnic groups. Psychiatric disorders other than MDD showed a heterogeneous pattern of association with SRMH across ethnic groups. Second, a larger number of psychiatric disorders were associated with poor SRMH in Non-Hispanic Whites than any other ethnic groups. Third, ethnic groups differed in the role of demographic and social factors in explaining the links between psychiatric disorders and SRMH. In African Americans, demographic and socioeconomic factors fully explained the associations between psychiatric disorders and SRMH. Among Mexican and Other Hispanics, demographic and socioeconomic factors partially explained the association between psychiatric disorders and SRMH. In other ethnic groups, demographic and socioeconomic factors failed to explain the link between psychiatric disorders and SRMH.
Our findings showed that poor SRMH differently reflects the risk of psychiatric disorders across ethnic groups. This finding is consistent with previous research which has documented major ethnic differences in the associations between SRH and psychiatric disorders.12,23,24,78 It is still not clear how poor SRMH reflects past, current, and future health needs of diverse populations.29,37 This result highlights a need for additional research on ethnic differences in the role of culture, SES, and health on shaping health evaluation.47–57
Poor SRH better predicts mortality for Whites than minority groups.18,19,29,59 In a four year follow up study using data from the Health and Retirement Study (HRS), SRH was a weaker predictor of mortality in Blacks than in Whites.29 In a 20 year follow up study of the National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow up Study (n = 6833), baseline SRH predicted mortality in Whites but not in Blacks.19 Over a 6 year period in the Longitudinal Study of Aging (LSOA), SRH failed to predict mortality in Blacks after adjustment for functional limitations.20 In a study by Woo and Zajacova using data from the National Health Interview Survey (NHIS) Linked Mortality Files (1989–2006; N = 289,432), SRH predicted mortality risk less well for Non-Hispanic Blacks and Hispanics than for Non-Hispanic Whites. The study also showed that SES, immigration status, and cause of death do not explain such variations and concluded that “individuals from different racial and ethnic groups may evaluate their heath differently, and thus caution is necessary when using SRH to estimate racial and ethnic health disparities.” 59 (page 2) In another study, SRMH was associated with GAD and MDD in African Americans and Caribbean Blacks, respectively.16
Ethnic minorities, as well as individuals with less education, may have lower reliability of SRH reports, which causes additional measurement error in SRH for low SES and minority groups.60 SRH may also have lower validity for measuring “true” health status among racial and ethnic minorities.61,62 As a result, SRH reflects different aspects of health across ethnic groups.23,24,26 These findings help us explain differential health correlates of SRH across ethnic groups. This literature also explains differential role of demographic and SES in explaining the link between psychiatric disorders and SRMG across ethnic groups.
Based on our results, sole reliance on single-item SRMH measures will result in larger false negative (or false positive) rates for estimation of mental health need of ethnic minority groups.26,60,63 Single item SRMH measures are not ideal indicators of ethnic health disparities, as they do not reflect similar health needs across diverse populations.62 Using SRMH items in surveys to screen individuals with health problems may result in enrollment of populations with different health needs. Currently, SRMH is being employed in some primary care settings as a screening tool to detect individuals at higher risk of psychiatric disorders.64,65 Using other measures in addition to SRMH is recommended for the screening of ethnically diverse populations. Thus, our findings have implications for clinical practice as well as public health practice with ethnic groups.60
Differential patterns of correlation between health problems and SRMH across ethnic groups can be interpreted as differential validity of single-item SRH measures across diverse ethnic groups. Single-item SRMH measures may particularly result in larger false negative rates for Non- Whites.23,66 Such single item measures should not be used as universal screening tools across ethnic groups.67,68 The same is true for application of single-items SRMH measures to compare the efficacy of interventions across ethnic groups.67–69
Our findings have implications for designing screening tools for the detection of individuals with health problems in ethnically diverse settings. Although SRMH can still be considered a useful tool for screening MDD for all ethnic groups, poor SRMH does not universally reflect risk of other psychiatric disorders such as anxiety disorders (e.g. GAD, PTSD, panic disorder, and social phobia), alcohol abuse, and binge eating disorders across all ethnic groups.16,24As poor SRMH does not convey any meaningful information for several ethnic groups regarding the presence of such psychiatric disorders, more comprehensive screening measures are needed to detect disorders other than MDD across ethnic groups. Such variation has important implications for the screening of psychiatric disorders in the community and primary care settings, where SRH is commonly used as a widely accepted screening tool. Single item SRMH measures are still a useful screening tool for the detection of MDD across all ethnic groups studied.
Our findings help us better understand why ethnic groups with similar health needs differ in seeking help.12,23,24,76 Although stigma, knowledge, access, insurance, and several other factors also play a role, perceived health is a central element for linking actual health care need to the utilization of health care services in the community. As health problems differently translate to SRH across ethnic groups, group differences in the effect of health problems in service use and help seeking should be expected, even when we eliminate all barriers. Unfortunately, very little is known about the role of the perception of health in shaping under utilization of health services by ethnic minority groups.33 Both the effects of health need on SRH and also the effect of poor SRH on service use are systematically weaker for ethnic minorities when compared to Whites.70
This study had a number of limitations. First, the CIDI may have differential validity for the diagnosis of psychiatric disorders across ethnic groups. Second, we did not measure whether participants had previously received any psychiatric diagnosis. Third, we only included a limited number of psychiatric disorders; other conditions such as drug abuse and medical conditions were not included. Fourth, single item SRH measures are sensitive to the contextual effects of preceding questions in survey instruments, which vary across CPES surveys.20 Using nationally representative data and a large sample size were two major strengths of this study.
The findings reported here emphasize a need for future research on variation in types of psychiatric conditions that influence evaluation of one’s health.12 These findings may help us understand why different ethnic groups differ in how psychiatric conditions influence their perceived health, which is a pre requirement for mental health care use. Thus, the same psychiatric disorder may have different effects on mental and physical SRH of ethnic groups.24,78 Poor SRH has ethnic specific meanings, and thus require ethnic informed interpretations. Furthermore, SRH should not be used as a tool to compare health status of multiple ethnic groups. It is still unclear to what degree these ethnic differences are shaped by socioeconomic status, historical life experiences, stigma, health literacy, cognitive styles, and memory or attention.44,71–75 Researchers studying ethnic differences in health should consider that poor SRMH reflects different psychiatric conditions across ethnic groups.
Acknowledgement:
This was a secondary analysis on public access data set of the Collaborative Psychiatric Epidemiology Surveys (CPES). The CPES is mainly funded by National Institute of Mental Health (NIMH), and has been conducted by the Institute of Social Research, University of Michigan. Data was downloaded from Interuniversity Consortium for Political and Social Research (ICPSR), University of Michigan.
Footnotes
Ethics:
Shervin Assari declares that he has no conflicts of interest.
Shervin Assari designed the current work, analyzed the data, and drafted the manuscript. He also revised the manuscript and confirmed the final draft.
Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The Collaborative Psychiatric Epidemiology Survey (CPES) program consists of four cooperative agreement grants: U01 MH60220; P.I. Ronald Kessler; U01 MH57716, P.I. James Jackson; U01 MH62209, P.I. Margarita Alegria; and U01 MH62207, P.I. David Takeuchi. For this analysis, public data set was downloaded from Interuniversity Consortium for Political and Social Research (ICPSR), Institute for Social Research at University of Michigan.
Reference
- 1.Cano A, Sprafkin RP, Scaturo DJ, Lantinga LJ, Fiese BH, Brand F.Mental Health Screening in Primary Care: A Comparison of 3 Brief Measures of Psychological Distress. Prim Care Companion J Clin Psychiatry. 2001;3(5):206–210. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rohrer JE, Arif A, Denison A, Young R, Adamson S. Overall self rated health as an outcome indicator in primary care. Eval Clin Pract. 2007;13(6):882–8. [DOI] [PubMed] [Google Scholar]
- 3-.Srole L, Langner TS, Michael ST, Opler MK, Rennie TA. Mental Health in the Metropolis: The Midtown Manhattan Study. McGraw Hill; 1962. [Google Scholar]
- 4-.Gurin Gerald, Veroff Joseph, and Feld Sheila. Americans View Their Mental Health, 1957. ICPSR03503 v1. Ann Arbor, MI: Inter university Consortium for Political and Social Research; [distributor], 1975. 10.3886/ICPSR03503.v1 [DOI] [Google Scholar]
- 5-.Weissman MM, Myers JK, Ross CE, eds. Community Surveys of Psychiatric Disorders. New Brunswick, NJ: Rutgers University Press; 1986. [Google Scholar]
- 6-.Idler EL, Benyamini Y. Self rated health and mortality: A review of twenty seven community studies. J Health Soc Behav. 1997;38:21–37. [PubMed] [Google Scholar]
- 7-.IOM. State of the USA Health Indicators: Letter Report. 2009. http://www.iom.edu/Reports/2008/State-of-the-USA-Health-Indicators-Letter-Report.aspx [PubMed]
- 8-. Healthy People. 2002 https://www.healthypeople.gov/2020/about/foundation-health-measures/General-Health-Status#one.
- 9-.Ahmad F, Jhajj AK, Stewart DE, Burghardt M, Bierman AS. Single item measures of self rated mental health: a scoping review. BMC Health Serv Res. 2014;14:398. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10-.Demirchyan A, Petrosyan V, Thompson ME: Gender differences in predictors of self rated health in Armenia: a population based study of an economy in transition. Int J Equity Health 2012, 11:67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11-.Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. American Journal of Psychiatry 2006; 163:101–8. [DOI] [PubMed] [Google Scholar]
- 12-.Kim G, DeCoster J, Chiriboga DA, Jang Y, Allen RS, Parmelee P. Associations between self rated mental health and psychiatric disorders among older adults: do racial/ethnic differences exist? Am J Geriatr Psychiatry. 2011;19(5):416–22. [DOI] [PubMed] [Google Scholar]
- 13-.Rohrer JE, Arif A, Denison A, Young R, Adamson S: Overall self – rated health as an outcome indicator in primary care. J Eval Clin Pract 2007, 13: 882–888. [DOI] [PubMed] [Google Scholar]
- 14-.May M, Lawlor DA, Brindle P, Patel R, Ebrahim S: Cardiovascular disease risk assessment in older women: can we improve on Framingham? British Women’s Heart and Health prospective cohort Study. Heart 2006, 9 (2): 1396–1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15-.Idler EL, Benyamini Y Self rated health and mortality: a review of twenty seven community studies. J Health Soc Behav, 1997: 38 21–37 [PubMed] [Google Scholar]
- 16-.Assari S, Dejman M, Neighbors HW. Ethnic Differences in Separate and Additive Effects of Anxiety and Depression on Self rated Mental Health Among Blacks. J Racial Ethn Health Disparities. 2016;3(3):423–30. doi: 10.1007/s40615-015-0154-3. [DOI] [PubMed] [Google Scholar]
- 17-.Kim G, Parmelee P, DeCoster J, Bryant AN, Chiriboga DA. The relation between body mass index and self rated mental health among older adults: do racial/ethnic differences exist? Am J Geriatr Psychiatry. 2014;22(7):661–9. doi: 10.1016/j.jagp.2012.08.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18-.Assari S, Lankarani MM, Burgard S. Black white difference in long term predictive power of self rated health on allcause mortality in United States. Ann Epidemiol. 2016;26(2):106–14. doi: 10.1016/j.annepidem.2015.11.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19-.Ferraro KF, Kelley Moore JA. Self rated health and mortality among black and white adults: examining the dynamic evaluation thesis. J Gerontol B Psychol Sci Soc Sci 2001;56(4):S195. [DOI] [PubMed] [Google Scholar]
- 20-.McDowell I Measuring health: a guide to rating scales and questionnaires, (3 ed), Oxford University Press, New York: 2006. [Google Scholar]
- 21-.Löckenhoff CE, De Fruyt F, Terracciano A, McCrae RR, De Bolle M, Costa PT Jr, Aguilar Vafaie ME, Ahn CK, Ahn HN, Alcalay L, Allik J, Avdeyeva TV, Barbaranelli C, Benet Martinez V, Blatný M, Bratko D, Cain TR, Crawford JT, Lima MP, Ficková E, Gheorghiu M, Halberstadt J, Hrebícková M, Jussim L, Klinkosz W, Knezević G, de Figueroa NL, Martin TA, Marusić I, Mastor KA, Miramontez DR, Nakazato K, Nansubuga F, Pramila VS, Realo A, Rolland JP, Rossier J, Schmidt V, Sekowski A, Shakespeare Finch J, Shimonaka Y, Simonetti F, Siuta J, Smith PB, Szmigielska B, Wang L, Yamaguchi M, Yik M. Perceptions of aging across 26 cultures and their culture level associates. Psychol Aging. 2009;24(4):941–54. doi: 10.1037/a0016901. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22-.Thakker J, Ward T, Strongman KT. Mental disorder and cross cultural psychology: a constructivist perspective. Clin Psychol Rev. 1999. November;19(7):843–74. Review. PubMed PMID: 10520438. [DOI] [PubMed] [Google Scholar]
- 23-.Jang Y, Park NS, Kang SY, Chiriboga DA. Racial/Ethnic Differences in the Association Between Symptoms of Depression and Self rated Mental Health Among Older Adults. Community Ment Health J. 2014;50(3):325–30. [DOI] [PubMed] [Google Scholar]
- 24-.Kim G, Bryant A, Huang C, Chiriboga D, Ma GX. Mental Health among Asian American Adults: Association with Psychiatric. Asian American Journal of Psychology, 2012; 3(1): 44–52 [Google Scholar]
- 25-.Lankarani MM, Assari S. Demographic and Socioeconomic Determinants of Physical and Mental Self Rated Health across Ten Ethnic Groups in the United States. Int J Epidemiol Research. 2017. In Press [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26-.Kim G, DeCoster J, Chiriboga DA, Jang Y, Allen RS, Parmelee P. Associations between self rated mental health and psychiatric disorders among older adults: do racial/ethnic differences exist? Am J Geriatr Psychiatry 2011;19(5):416. [DOI] [PubMed] [Google Scholar]
- 27-.Jang Y, Park NS, Kang SY, Chiriboga DA. Racial/ethnic differences in the association between symptoms of depression and self rated mental health among older adults. Community Ment Health J. 2014;50(3):325. [DOI] [PubMed] [Google Scholar]
- 28-.Kim G, Bryant A, Huang C, Chiriboga D, Ma GX. Self Rated Mental Health Among Asian American Adults: Association With Psychiatric Disorders. Asian Am J Psychol 2012;3(1):44 [Google Scholar]
- 29-.Lee SJ, Moody Ayers SY, Landefeld CS, Walter LC, Lindquist K, Segal MR, et al. The relationship between self rated health and mortality in older black and white Americans. J Am Geriatr Soc 2007;55(10):1624. [DOI] [PubMed] [Google Scholar]
- 30-.Fernández Olano C, Hidalgo JDL, Cerdá Díaz R, Requena GallegoM, Sánchez Castaòo C, Urbistondo Cascales L,Otero Puime A: Factors associated with health care utilization by the elderly in a public health care system. Health Policy 2006, 75: 131–139. [DOI] [PubMed] [Google Scholar]
- 31-.Wan TTH, Odell BG: Factors Affecting the Use of Social and Health Services among the Elderly. Ageing and Society 1981, 1: 95–115. [Google Scholar]
- 32-.Katz SJ, Kessler RC, Frank RG, et al. The use of outpatient mental health services in the United States and Ontario : the impact of mental morbidity and perceived need for care. American Journal of Public Health. 1997; 87(7): 1136–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33-.Zuvekas SH, Fleishman JA. Self rated mentalhealth and racial/ethnic disparities in mental health service use. Medical Care 2008; 46(9):915–23. [DOI] [PubMed] [Google Scholar]
- 34-.Bosworth HB1, Butterfield MI, Stechuchak KM, Bastian LA. The relationship between self rated health and health care service use among women veterans in a primary care clinic. Womens Health Issues. 2000;10(5):278–85. [DOI] [PubMed] [Google Scholar]
- 35-.Kim C, Vahratian A. Self rated health and health care use among women with histories of gestational diabetes mellitus.Diabetes Care. 2010;33(1):41–2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36-.Perestelo Perez L, Gonzalez Lorenzo M, Perez Ramos J, Rivero Santana A, Serrano Aguilar P. Patient involvement and shared decision making in mental health care. Curr Clin Pharmacol. 2011;6(2):83–90. [DOI] [PubMed] [Google Scholar]
- 37-.Levinson D, Kaplan G. What does Self Rated Mental Health Represent J Public Health Res. 2014; 2; 3(3): 287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38-.Heeringa SG, Wagner J, Torres M, Duan N, Adams T, Berglund P. Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES). Int J Methods Psychiatr Res. 2004;13(4):221–40. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39-.Gavin AR, Walton E, Chae DH, Alegria M, Jackson JS, Takeuchi D. The associations between socio economic status and major depressive disorder among Blacks, Latinos, Asians and Non-Hispanic Whites: findings from the Collaborative Psychiatric Epidemiology Studies. Psychol Med. 2010;40(1):51–61. doi: 10.1017/S0033291709006023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40-.Wittchen HU. Reliability and validity studies of the WHO Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 1994: 28, 57–84. [DOI] [PubMed] [Google Scholar]
- 41-.Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA, Sartorius N, Towle L. The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 1988: 45, 1069–1077. [DOI] [PubMed] [Google Scholar]
- 42-.Kessler RC, Wittchen HU, Abelson JM, McGonagle KA, Schwarz N, Kendler KS, Kna¨uper B, Zhao S. Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US National Comorbidity Survey. Int J Methods Psych Res 1998: 7, 33–55. [Google Scholar]
- 43-.Kessler RC, Calabrese JR, Farley PA, Gruber MJ, Jewell MA, Katon W, Keck PE, Nierenberg AA, Sampson NA, Shear MK, Shillington AC, Stein MB, Thase ME, Wittchen HU. Composite International Diagnostic Interview screening scales for DSM IV anxiety and mood disorders. Psychol Med. 2013;43(8):1625–37. [DOI] [PubMed] [Google Scholar]
- 44-.Williams DR, Haile R, González HM, Neighbors H, Baser R, Jackson JS. The mental health of Black Caribbean immigrants: results from the National Survey of American Life. Am J Public Health. 2007; 97(1):52–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45-.Assari S, Lankarani MM, Moazen B. Religious Beliefs May Reduce the Negative Effect of Psychiatric Disorders on Age of Onset of Suicidal Ideation among Blacks in the United States. Int J Prev Med. 2012;3(5):358–64. [PMC free article] [PubMed] [Google Scholar]
- 46-.Assari S, Moghani Lankarani M, Moghani Lankarani R, Ethnicity Modifies the Effects of Anxiety and Drug Use on Suicidal Ideation among Black Adults in the United States. Int J Prev Med 2013; 4(11):1151. [PMC free article] [PubMed] [Google Scholar]
- 47-.Assari S Additive Effects of Anxiety and Depression on Body Mass Index among Blacks: Role of Ethnicity and Gender. Int Cardiovasc Res J. 2014;8(2):44–51. [PMC free article] [PubMed] [Google Scholar]
- 48-.Assari S Chronic Medical Conditions and Major Depressive Disorder: Differential Role of Positive Religious Coping among African Americans, Caribbean Blacks and Non-Hispanic Whites. Int J Prev Med. 2014;5(4):405–13. [PMC free article] [PubMed] [Google Scholar]
- 49-.Assari S, Moghani Lankarani M. Race and ethnic differences in associations between cardiovascular diseases, anxiety, and depression in the United States. Int J Travel Med Global Health 2014; 2 (3) [PMC free article] [PubMed] [Google Scholar]
- 50-.Assari S Separate and Combined Effects of Anxiety, Depression and Problem Drinking on Subjective Health among Black, Hispanic and Non-Hispanic White Men. Int J Prev Med. 2014;5(3):269–79. [PMC free article] [PubMed] [Google Scholar]
- 51-.Assari S The link between mental health and obesity: role of individual and contextual factors. Int J Prev Med. 2014;5(3):247–9. [PMC free article] [PubMed] [Google Scholar]
- 52-.Assari S Cross country variation in additive effects of socio economics, health behaviors, and comorbidities on subjective health of patients with diabetes. J Diabetes Metab Disord. 2014; 21;13(1):36. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53-.Assari S, Lankarani MM, Lankarani RM. Ethnicity Modifies the Additive Effects of Anxiety and Drug Use Disorders on Suicidal Ideation among Black Adults in the United States. Int J Prev Med. 2013;4(11):1251–7. [PMC free article] [PubMed] [Google Scholar]
- 54-.Assari S Race and Ethnicity, Religion Involvement, Church based Social Support and Subjective Health in United States: A Case of Moderated Mediation. Int J Prev Med. 2013; 4(2):208–17. [PMC free article] [PubMed] [Google Scholar]
- 55-.Dejman M, Forouzan AS, Assari S, Rasoulian M, Jazayery A, Malekafzali H, Baradaran Eftekhari M, Falahat K, Ekblad S. How Iranian lay people in three ethnic groups conceptualize a case of a depressed woman: an explanatory model. Ethn Health. 2010;15(5):475–93. [DOI] [PubMed] [Google Scholar]
- 56-.Dejman M, Forouzan A, Assari Sh, Malekafzali H, Nohesara Sh, Khatibzadeh N, Falahat K, Ekblad S. An Explanatory Model of Depression among Female Patients in Fars, Kurds, Turks Ethnic Groups of Iran. Iran J Public Health. 2011;40(3):79–88. [PMC free article] [PubMed] [Google Scholar]
- 57-.Assari S Chronic Kidney Disease, Anxiety and Depression among American Blacks; Does Ethnicity Matter? Int J Travel Med Global Health 2014. 2 (3). [PMC free article] [PubMed] [Google Scholar]
- 58-.Assari S Chronic Kidney Disease, Anxiety and Depression among American Blacks; Does Ethnicity Matter? Int J Travel Med Global Health 2014. 2 (3). [PMC free article] [PubMed] [Google Scholar]
- 59-.Woo H, Zajacova A. Predictive Strength of Self Rated Health for Mortality Risk Among Older Adults in the United States: Does It Differ by Race and Ethnicity? Res Aging. 2016. [Epub ahead of print] pii: 0164027516637410. [DOI] [PubMed] [Google Scholar]
- 60-.Zajacova A Dowd JB. Reliability of self rated health in US adults. Am J Epidemiol, 2011: 174 (8), 977–983. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 61-.Finch BK, Hummer RA, Reindl M, Vega WA. Validity of self rated health among Latino(a)s. Am J Epidemiol 2002;155(8):755. [DOI] [PubMed] [Google Scholar]
- 62-.Singh Manoux A, Dugravot A, Shipley MJ, Ferrie JE, Martikainen P, Goldberg M, et al. , GAZEL Cohort. The association between self rated health and mortality in different socioeconomic groups in the GAZEL cohort study. Int J Epidemiol 2007;36(6):1222. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 63-.Chandola T, Jenkinson C. Validating self rated health in different ethnic groups. Ethn Health 2000;5(2):151. [DOI] [PubMed] [Google Scholar]
- 64-.Katz SJ, Kessler RC, Frank RG, Leaf P, Lin E, Edlund M. The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care.Am J Public Health. 1997;87(7):1136–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 65-.Cano A, Sprafkin RP, Scaturo DJ, Lantinga LJ, Fiese BH, Brand F. Mental Health Screening in Primary Care: A Comparison of 3 Brief Measures of Psychological Distress. Prim Care Companion J Clin Psychiatry. 2001;3(5):206–210. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 66-.Chandola T, Jenkinson C. Validating self rated health in different ethnic groups. Ethn Health. 2000; 5(2):151–9. [DOI] [PubMed] [Google Scholar]
- 67-.First MB, Wakefield JC2. Diagnostic criteria as dysfunction indicators: bridging the chasm between the definition of mental disorder and diagnostic criteria for specific disorders. Can J Psychiatry. 2013; 58(12):663–9. [DOI] [PubMed] [Google Scholar]
- 68-.Neighbors HW, Trierweiler SJ, Munday C, Thompson EE, Jackson JS, Binion VJ, Gomez J. Psychiatric diagnosis of African Americans: diagnostic divergence in clinician structured and semistructured interviewing conditions. J Natl Med Assoc. 1999;91(11):601–12. [PMC free article] [PubMed] [Google Scholar]
- 69-.Strakowski SM, Lonczak HS, Sax KW, West SA, Crist A, Mehta R, Thienhaus OJ. The effects of race on diagnosis and disposition from a psychiatric emergency service. J Clin Psychiatry. 1995; 56(3):101–7. [PubMed] [Google Scholar]
- 70-.Zuvekas SH, Fleishman JA. Self rated mental health and racial/ethnic disparities in mental health service use. Med Care. 2008;46(9):915–23. doi: 10.1097/MLR.0b013e31817919e5. [DOI] [PubMed] [Google Scholar]
- 71-.Gibbs TA, Okuda M, Oquendo MA, Lawson WB, Wang S, Thomas YF, Blanco C. Mental health of African Americans and Caribbean blacks in the United States: results from the National Epidemiological Survey on Alcohol and Related Conditions. Am J Public Health. 2013;103(2):330–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 72-.Woodward AT, Taylor RJ, Abelson JM, Matusko N. Major depressive disorder among older African Americans, Caribbean blacks, and Non-Hispanic whites: secondary analysis of the National Survey of American Life. Depress Anxiety. 2013;30(6):589–97. [DOI] [PubMed] [Google Scholar]
- 73-.Jackson JS, Neighbors HW, Torres M, Martin LA, Williams DR, Baser R. Use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: results from the National Survey of American Life. Am J Public Health. 2007;97(1):60–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 74-.Hammond WP, Mohottige D, Chantala K, Hastings JF, Neighbors HW, Snowden L. Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life. J Health Care Poor Underserved. 2011; 22(1):157–75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 75-.Williams DR, González 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: results from the National Survey of American Life. Arch Gen Psychiatry. 2007; 64(3):305–15. [DOI] [PubMed] [Google Scholar]
- 76-.Kim G, DeCoster J, Chiriboga DA, Jang Y, Allen RS, Parmelee P. Associations between self rated mental health and psychiatric disorders among older adults: do racial/ethnic differences exist? Am J Geriatr Psychiatry. 2011;19(5):416–22. [DOI] [PubMed] [Google Scholar]
- 77-.Assari S, Caldwell CH. Mental Health Service Utilization among Black Youth; Psychosocial Determinants in a National Sample. Children (Basel). 2017;4(5). pii: E40. doi: 10.3390/children4050040. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 78-.Assari S Psychiatric Disorders Differently Correlate with Physical Self Rated Health across Ethnic Groups. J Pers Med 2017. Published online July 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]