Racial differences in the manifestation of mental illness among older adults

This dissertation seeks to increase understanding about why older African Americans have equal or lower rates of mental illness than whites; despite the general tendency that disadvantaged individuals have worse mental health than advantaged individuals. To explain the unexpected finding from a methodological standpoint, this study uses the 2008 and 2012 Waves of the Health and Retirement Study and examines racial differences in the factor structures of mental illness focusing on symptoms included in the CES-D (Center for Epidemiologic Studies Depression) and the BAI (Beck Anxiety Inventory). To understand the implications of these racial differences in the stress process, this study also examines how discrimination, as a type of stressor, manifests into different mental health outcomes (somatic or mood-based symptoms) between older African Americans and whites. The analysis employs structural equation modeling and finds that modeling CES-D and BAI items as mood-based and somatic constructs of general distress has better model fit than modeling these items than as separate constructs of depression and anxiety (Chapter 2). In regard to racial differences in the factor structure of these models, the analysis finds that the factor structure of the somatic model differs between the racial groups whereas the factor structure of the mood-based model does not differ. When examining how discrimination manifests into different mental health outcomes, the analysis shows that discrimination is related to increased mood-based symptoms among whites and unrelated to mood-based symptoms among African Americans (Chapter 3). Additionally, everyday discrimination and lifetime discrimination are related to increased somatic symptoms among whites. Among African Americans, physical disability and financial status based discrimination are related to increased somatic symptoms, and lifetime discrimination and ancestry-based discrimination are related to decreased somatic symptoms. The findings from this dissertation suggest that current measures of mental illness (e.g., CES-D, BAI, etc.) may not measure the same constructs across racial groups and that modeling mental illness as mood-based and somatic constructs may give better insights into the prevalence of mental illness among older adults. Further, this study sheds light on the potential effects of discrimination on an alternative and more culturally specific expression of mental illness symptoms (somatic symptoms). This study also extends the literature on discrimination and mental health by illustrating how different forms of discrimination impact different mental health outcomes.