Race/skin color and mental health disorders in Brazil: a systematic review of the literature

Smolen, Jenny Rose; Araújo, Edna Maria de

doi:10.1590/1413-812320172212.19782016

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Review • Ciênc. saúde colet. 22 (12) • Dec 2017 • https://doi.org/10.1590/1413-812320172212.19782016 linkcopy

Race/skin color and mental health disorders in Brazil: a systematic review of the literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Mental health disorders contribute a significant burden to society. This systematic literature review aims to summarize the current state of the literature on race/skin color and mental health disorders in Brazil. Methods: PubMed and Lilacs were searched using descriptors for mental health disorders (depression, anxiety, Common Mental Disorders, psychiatric morbidity, etc.) and race to find studies conducted in Brazil. Studies of non-population groups, that did not analyze race/skin color, or for which the mental disorder was not the object of study were excluded. After evaluation of quality, 14 articles were selected for inclusion. There was an overall higher prevalence of mental health disorders in non-Whites. Of the six multivariate analyses that found statistically significant results, five indicated a greater prevalence or odds of mental health disorder in non-Whites compared to Whites (measure of association between 1.18-1.85). This review identified the trend in the literature regarding the association between race and mental health disorders. However, important difficulties complicate the comparability of the studies, principally in function of the differences in the mental health disorders studied, the method of categorizing race/skin color, and the screening tools used in the studies analyzed.

Key words
Race; Skin color; Mental health

Authors		Population Studied	Screening Tool	Prevalence by Race	Measure of Association (95% CI)
Studies on Depression
	Munhoz e al., 2013¹⁶	Adults, 20+ (n = 2925)	PHQ-9, cut-off of ≥9	Prevalence not reported	Prevalence Ratio Black: 0.72 (0.56-0.94) Other: 1.12 (0.89-1.41)
	Pavão et al., 2012¹⁷	Adults, 20+ (n = 3863)	Self-report of ever told by a physician you have depression	Prevalence not reported	Odds Ratio Mulatto: 1.00 (ref) Black: 1.35 (0.91-2.01)
	Almeida-Filho et al. 2004¹⁸	Adults (n = 2302)	PSAD subscale of QMPA, cut-off of ≥23 on PSAD combined with ≥13 on depression subscale	White: 9.4% Moreno: 12.0% Mulatto: 15.7% Black: 11.2%† Non-White (combined): 12.7%†	Odds Ratio Moreno: 1.30 (0.85-2.01) Mulatto: 1.78 (1.09-2.90) Black: 1.14 (0.70-1.87) Non-White (combined): 1.40 (0.94-2.09)
Studies of depressive symptoms
	Guimarães et al., 2009¹⁹	Middle-aged women (n = 1249	PRIME-MD, caseness determined by a “yes” to one of three predetermined questions	White: 42.3% Mulatto: 46.4% Black: 52.8%*	--
	Bretanha et al., 2005²⁰	Older adults, 60+ (n = 1593)	GDS-15, cut-off of ≥6	White: 17.0% Black: 17.1% Asian/Mulatto/Indigenous: 25.0%	Prevalence Ratio Black: 0.96 (0.65-1.43) Asian/Mulatto/Indigenous: 1.41 (1.07-1.86)
	Quatrin et al., 2014²¹	Older adults, 60+ (n = 1007)	GDS-30, cut-off of ≥11	White: 27.5% Non-White: 22.7%	--
	Blay et al., 2007²²	Older adults, 60+ (n = 6961)	SPES, cut-off of ≥2	White: 37.8% African-Brazilian: 46.5% Asian: 34.8% Multiracial: 45.7%*	Odds Ratio Afro-Brazilian: 1.22 (0.98-1.53) Asian: 0.90 (0.35-2.32) Multiracial: 1.21 (0.99-1.48)
Studies of Common Mental Disorders
	Anselmi et al., 2008²³	Young adults, 23-24 (n = 4285)	SRQ-20, cut-off of ≥8 for women, ≥6 for men	Men: White: 21.9% Black/Mixed: 26.9%* Women: White: 30.0% Black/Mixed: 41.1%*	Prevalence Ratio Men: Black/Mixed: 1.18 (0.98-1.42) Women: Black/Mixed: 1.25 (1.09-1.43)
	Bastos et al., 2014²⁴	Undergraduat students (n = 424)	GHQ-12, cut-off of ≥3	White: 37.0%; Brown: 32.8%; Black: 51.6%	Odds Ratio Black/Brown: 0.9 (0.5-1.4)
Studies of depression related to pregnancy (pre-natal, post-partum, during pregnancy)
	Faisal-Curry e Menezes, 2007²⁵	Pregnant women (n = 432)	Antenatal depression: BDI, cut-off of ≥16	White: 19.9% Non-White: 19.1%†	Odds Ratio Non-White: 0.95 (0.5-1.81)
	Faisal-Curry e Menezes, 2007²⁵	Pregnant women (n = 432)	Antenatal anxiety: STAI, cut-off of ≥41	White: 58.8% Non-White: 63.0%†	Others: 1.19 (0.70-2.00)
	Melo et al. 2011²⁶	Pregnant women, 18+ (n = 555)	Antepartum Depression: EPDS, cut-off of ≥12	White: 34.9% Non-White: 65.1%	Prevalence Ratio Non-White: 1.48 (1.09-2.01)
	Melo et al. 2011²⁶	Pregnant women, 18+ (n = 555)	Postpartum Depression: EPDS, cut-off of ≥12	White: not reported Non-White: 70.0%	Non-White: 1.85 (1.11-3.08)
	Pereira et al. 2009²⁷	Pregnant women (n = 331)	Depression during pregnancy: CIDI	White: 14.1% Non-White: 14.3%	--
	Tannous et al., 2008²⁸	Women who recently gave birth to live infants (n = 271)	Postnatal depression: EPDS, cut-off of ≥13	Caucasian: 16.6%, Non-Caucasian: 28.1%†	Prevalence Ratio Non-Caucasian: 0.80 (0.49-1.32)
	Ruschi et al. 2007²⁹	Women 15-45 who gave birth to a live infant 31-180 days prior (n = 292)	Postnatal depression: EPDS, cut-off of ≥12	White: 47.8% Black: 17.4% Brown: 34.8%	--

Authors	Study Setting	Racial Distribution Study Sample	Direction of multivariate Associationa
Munhoz et al., 2013¹⁶	Rio Grande do Sul	80.1% White	Black: - *
		12.1% Black	Others: +
		7.8% Other
Pavão et al., 2012¹⁷	Representation from all regions of Brazil	77.2% Mulatto	Mulatto: (ref)
Pavão et al., 2012¹⁷	Representation from all regions of Brazil	22.8% Black	Black: +
Almeida-Filho et al., 2004¹⁸	Bahia	14.9% White	Moreno: +
		45.9% Moreno	Mulatto + *
		15.9% Mulatto	Black +
		20.7% Black
Guimarães et al., 2009¹⁹	Rio de Janeiro	43.3% White	--
		40.1% Mulatto
		16.6% Black
Bretanha et al., 2005²⁰	Rio Grande do Sul	78.6% White	Black: -
		8.7% Black	Asian/Mulatto/
		12.7% Asian/	Indigenous: + *
		Mulatto/Indigenous
Quatrin, et al., 2014²¹	Rio Grande do Sul	95.7% White	--
Quatrin, et al., 2014²¹	Rio Grande do Sul	4.3% Non-White
Blay et al., 2007²²	Rio Grande do Sul	84.2% White	Afro-Brazilian: + *
		6.8% Afro-Brazilian	Multiracial: + *
		8.6% Multiracial
Anselmi et al., 2008²³	Rio Grande do Sul	78.1% White	Black/Mixed: + *
Anselmi et al., 2008²³	Rio Grande do Sul	21.9% Black/Mixed
Bastos et al., 2014²⁴	Rio de Janeiro	51.4% White	Black/Brown: -
		32.8% Brown
		15.2% Black
Faisal-Curry e Menezes 2007²⁵	São Paulo	83.0% White	Non-White (Depression): -
Faisal-Curry e Menezes 2007²⁵	São Paulo	17.0% Non-White	Non-White (Anxiety): +
Melo et al., 2011²⁶	Pernambuco; São Paulo	45.5% White	Non-White: + *
Melo et al., 2011²⁶	Pernambuco; São Paulo	54.5% Non-White
Pereira et al., 2009²⁷	Rio de Janeiro	45.0% White	--
Pereira et al., 2009²⁷	Rio de Janeiro	55.0% Non-White
Tannous et al., 2008²⁸	Porto Alegre	64.6% White	Non-White: -
Tannous et al., 2008²⁸	Porto Alegre	35.4% Non-White
Ruschi et al., 2007²⁹	Espírito Santo	49.0% White	--
		16.8% Black
		34.2% Brown

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[TFN6] If not designated otherwise, Whites are considered the reference group.

[TFN7] ^*
p < 0.05.

[TFN8] ^†
p-value not reported.