The Race Paradox in Mental Health Among Older Adults: Social Participation As a Mechanism

Background and Purpose:

The race paradox in mental health is a phenomenon in which Blacks generally experience similar or better mental health outcomes compared to non-Hispanic Whites, despite their marginalized social and economic statuses and disproportionate exposure to chronic stressors. Existing research on the race paradox in mental health has identified social relationships (e.g., family relationship, spouse relationship) as an explanatory mechanism. However, this body of literature mainly focuses on the general population rather than older adults. Social participation has been found to be protective against mental health outcomes. Yet, little is known about whether social participation can account for the race paradox in mental health. This study aims to examine the mediating role of social participation in the relationship between race and depressive symptoms among older adults.

Methods:

This study used a cross-sectional research design. The analysis is based on the data from Blacks and non-Hispanic Whites aged 55 or older (N = 3,235) who participated in the third wave (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Race was dichotomized as Blacks and non-Hispanic Whites. Social participation variables included frequency of: volunteering, participating in organized group activities, and attending religious services. Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale. Socio-demographic characteristics such as gender, marital status, annual income, education, and self-rated health were included as covariates. Path analysis was conducted to address the study aim.

Results:

The relationship between race and depressive symptoms was mediated by participating in organized group activities (mediating effect = -.10, p < .01) and attending religious services (mediating effect = -.12, p < .05). Specifically, compared to older non-Hispanic Whites, older Blacks participated in organized group activities more frequently (B = .28, p < .001), which in turn, was associated with lower levels of depressive symptoms (B = -.37, p < .001). Similarly, older Blacks attended religious services more frequently (B = .68, p < .001), which in turn, was associated with lower depressive symptoms (B = -.18, p < .05).

Conclusion:

This study identified social participation as an underlying mechanism that can explain the race paradox in mental health (i.e., Blacks having better or similar mental health compared to non-Hispanic Whites). Findings elucidated two modifiable factors to mitigate depressive symptoms, namely participating in organized group activities and attending religious services. These findings can inform inclusive and culturally sensitive group activities and religious support programs that help older Blacks improve their mental health. The findings also have significant policy implications for promoting an age-friendly community in which older Blacks can have increased access to community engagement activities and thus enhance their mental well-being.