An Intersectional Approach to Testing Explanations of the Black-White Mental Health Paradox

Researchers have sought to explain Black Americans’ lower rates of common mental illnesses than White Americans, despite greater stress exposure, yet few explanations of this paradox are supported empirically. We examined the extent to which the paradox is owing to: Black Americans’ racial identity and religiosity resources offsetting the ill-effects of stressors, limited empirical attention to externalizing mental health outcomes, and the homogenization of both racial groups by disregarding within-group gender differences. Data came from the 25,454 Black and White men and women of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions. We used structural equation modeling to test for indirect effects of race on mental health via stressors, racial identity, and religiosity, and tested multigroup models by gender. Results indicated that the paradox could reflect the failure to account for Black Americans’ increased risk of substance-use disorders and greater symptoms of poor mental health. Racial identity did not explain variations in mental disorder by race overall, but it protected against all mental disorders for Black women. Findings also indicated complex effects of Black Americans’ greater religiosity. Greater religious importance exacerbated some mental health problems, whereas religious service attendance had protective effects, especially among women. Future research on explanations of the paradox should continue to incorporate multiple mental health outcomes and investigate intersectional identities.