Mapping "Race": Critical Approaches to Health Disparities Research

Chapter 10: How Racial-­Group Comparisons Create Misinformation in Depression Research: Using Racial Identity Theory to Conceptualize Health Disparities

146 Janet E. Helms and Ethan H. Mereish A multitude of studies in various physical and mental health domains attests to disparities in health outcomes of African Americans, Latina/Latino Americans, Asian/Pacific Island Americans, Native or Indigenous Americans (ALANAs), and immigrant groups of Color relative to their White American counterparts (U.S. Department of Health and Human Services 2001).1 According to the World Health Organization (WHO 2001), depression is the leading cause of disability in the general population; it damages the quality of life of sufferers, and failure to treat depression places an economic burden on the depressed person as well the communities in which the person lives. Moreover, depression co-occurs with many physical and mental health disorders, which results in slower recovery and increased rates of mortality relative to people who are not depressed (Leentjens 2010). As compared to White Americans, ALANAs and immigrant groups of Color have similar rates of mood disorders, but they are less likely to receive appropriate treatment for them (Miranda, Williams, and Escobar 2002). Also, ALANAs have higher rates of disorders typically associated with depression. These include physical ailments, such as chronic pain and cardiovascular and respiratory health problems among Asian Americans (Gee et al. 2007) and high levels of cigarette smoking (Landrine and Klonoff 2000), alcohol consumption (Taylor and Jackson 1990), high blood pressure, and HIV/AIDS among African Americans (Crane et al. 2010; Krieger and Sidney 1996). Yet no satisfactory explanations exist to account for the between-group disparities. Efforts to explain such disparities have generally involved comparing one or more ALANA samples to White Americans or predominantly White How Racial-Group Comparisons Create Misinformation in Depression Research Using Racial Identity Theory to Conceptualize Health Disparities Chapter 10 Racial-Group Comparisons and Depression 147 aggregated samples on some health- or mental-health-related symptom or outcome measure and then inferring conceptual or systemic reasons for observed between-group differences. Depending on the researcher’s predilections, discovered between-group differences may be attributed to systemic factors (for example, social class differences, institutional racism), racial socialization life experiences (for example, person-level experiences of racism), or deficits in the person or the presumed racial/cultural environment in which the research participant is assumed to have been socialized. That is, in the relevant physical or mental health research, racial or ethnic cultural groupings are used as if they are conceptual constructs or variables rather than the nominal, atheoretical categories that they actually are (Helms, Jernigan, and Mascher 2005). Moreover, different explanatory attributions are made for the same ostensible racial groups without any measurement or manipulations that support such explanations. In psychology, variables or manipulations used to infer reasons for particular results on outcomes or criteria are called “independent” or “predictor” variables. Use of independent/predictor variables presumes an underlying hypothetical construct, which the variable represents. In depression research, the construct of depression is operationally defined in terms of observable symptoms that are often measured by self-report scales, such as the Center for Epidemiologic Studies Depression scale (CES-D; Radloff 1977). Responses to such measures can be observed and tested by others who then decide whether the construct has been adequately represented by scores on the focal depression measure. However, in such research, racial groups consistently have been used as if they were independent variables, although no theoretical constructs underlie them. Conceptual approaches and measures for studying race-related variables exist, but they have not been integrated into the health disparities literature (Helms 1995; Yip, Seaton, and Sellers 2006). In particular, Helms (1984; 1995) proposed models of racial identity development by which she argued that, rather than merely dichotomizing people into ostensibly mutually exclusive racial categories, understanding and measuring the multiple ways in which people respond to such categorization would provide more sensitive race-related independent/predictor variables in health and mental health research and treatment. The purposes of this chapter are to (1) provide a rationale for why racial groups ought to be replaced as independent/predictor variables in mental health research, (2) discuss some research limitations arising from treating race as categories, and (3) suggest how racial identity theory might be used to better investigate health disparities with a specific focus on depression. 148 Janet E. Helms and Ethan H. Mereish Replacing Race with Racial Conceptual Constructs In health research, racial groups often are used as if they are diagnostic categories in a manner similar to, say, DSM...