Psychological Distress Among US-Born and Non–US-Born Black or African American Adults in the US
Authors: Maryam Elhabashy, David Adzrago, Faustine Williams
Journal: JAMA Network Open (2025)

Importance Limited research explores within-group and between-group differences in the prevalence of and factors associated with psychological distress among Black or African American adults, especially by nativity. Objective To estimate the prevalence of moderate-to-severe (hereafter, moderate-severe) psychological distress and to assess factors associated with increased risk among Black or African American adults according to nativity. Design, Setting, and Participants This cross-sectional study drew data from the 2005 to 2018 National Health Interview Surveys. The study analyzed national household probability samples of the civilian noninstitutionalized Black or African American adult population aged 18 years or older, including US-born and non–US-born subgroups, between January to December 2005 and January to December 2018. Data analysis was performed from November 2023 to January 2025. Exposures Birthplace (ie, US-born if born in the US; non–US-born if born outside the US, including US territories). Risk factors included sociodemographic, socioeconomic, and health behavior factors. Main Outcomes and Measures The primary outcome was moderate-severe psychological distress status based on self-reported responses to the Kessler Psychological Distress Scale. Odds ratios (ORs) with 95% CIs were reported as estimates to determine the computed associations across logistic regression models. Results A total of 49 820 individuals (43 885 born in the US and 5935 born outside the US) were analyzed. Overall, 21.9% of the sample (11 079 individuals) experienced moderate-severe psychological distress, with a higher prevalence among US-born (10 037 individuals [22.6%]) than non–US-born (1042 individuals [17.4%]) individuals. Individuals aged 65 years or older (especially US-born; OR, 0.51; 95% CI, 0.44-0.58) and male individuals (especially non–US-born; OR, 0.68; 95% CI, 0.56-0.82) had lower odds of experiencing moderate-severe psychological distress. Unemployment (OR, 1.91; 95% CI, 1.80-2.03) and having less than a college education were associated with higher odds of moderate-severe psychological distress across the subgroups, especially among US-born individuals. Current and former smoking was associated with higher odds of moderate-severe psychological distress, with greater odds among non–US-born individuals than among US-born and overall Black or African American individuals. Current and former alcohol drinking was associated with higher odds among only the general population (current drinking, OR, 1.37 [95% CI, 1.29-1.47]; former drinking, OR, 1.26 [95% CI, 1.16-1.37]) and US-born individuals (current drinking, OR, 1.45 [95% CI, 1.36-1.56]; former drinking, OR, 1.29 [95% CI, 1.19-1.41]), with higher ORs among US-born population. Conclusions and Relevance In this cross-sectional study of differences in moderate-severe psychological distress by nativity among Black or African American adults, more pronounced risks were observed among US-born individuals. Longitudinal studies and data disaggregation could further elucidate health differences to improve cultural competence and adaptability in mental health research and interventions.