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 copy

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

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Abstract

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., 2013¹⁶16. Munhoz TN, Santos IS, Matijasevich A. Major depressive episode among Brazilian adults: a cross-sec-tional population-based study. J Affect Disord 2013; 150(2):401-407.	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., 2012¹⁷17. Pavão ALB, Ploubidis GB, Werneck G, Campos MR. Discrimination and health in Brazil: Evidence from a population-based survey. Ethn & Disease 2012; 22.	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. 2004¹⁸18. Almeida-Filho N, Lessa I, Magalhães L, Araújo MJ, Aquino E, James SA, Kawachi I. Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Soc Sci Med 2004; 59(7):1339-1353.	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%^† † p-value not reported. Non-White (combined): 12.7%^† † p-value not reported.	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., 2009¹⁹19. Guimarães JMN, Lopes CS, Baima J, Sichieri R. Depression symptoms and hypothyroidism in a population-based study of middle-aged Brazilian women. J Affect Disord 2009; 117(1-2):120-123.	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%^* * p < 0.05.	--
	Bretanha et al., 2005²⁰20. Bretanha AF, Facchini LA, Nunes BP, Munhoz TN, Tomasi E, Thumé E. Depressive symptoms in elderly living in areas covered by Primary Health Care Units in the urban area of Bagé, RS. Rev Bras Epidemiol 2005; 18(1):1-12.	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., 2014²¹21. Quatrin LB, Galli R, Moriguchi EH, Gastal FL, Pattussi MP. Collective efficacy and depressive symptoms in Brazilian elderly. Arch Gerontol Geriatr 2014; 59(3):624-629.	Older adults, 60+ (n = 1007)	GDS-30, cut-off of ≥11	White: 27.5% Non-White: 22.7%	--
	Blay et al., 2007²²22. Blay SL, Andreoli SB, Fillenbaum GG, Gastal FL. Depression morbidity in later life: prevalence and correlates in a developing country. Am J Geriatr Psychiary 2007; 15(9):790-799.	Older adults, 60+ (n = 6961)	SPES, cut-off of ≥2	White: 37.8% African-Brazilian: 46.5% Asian: 34.8% Multiracial: 45.7%^* * p < 0.05.	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., 2008²³23. Anselmi L, Barros FC, Minten GC, Gigante DP, Horta BL, Victora CG. Prevalence and early determinants of common mental disorders in the 1982 birth cohort, Pelotas, Southern Brazil. Rev Saude Publica 2008; 42(Supl. 2):25-32.	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%^* * p < 0.05. Women: White: 30.0% Black/Mixed: 41.1%^* * p < 0.05.	Prevalence Ratio Men: Black/Mixed: 1.18 (0.98-1.42) Women: Black/Mixed: 1.25 (1.09-1.43)
	Bastos et al., 2014²⁴24. Bastos JL, Barros AJD, Paradies Y, Faerstein E. Age, class and race discrimination: heir interactions and associations with mental health among Brazilian university students. Cad Saude Publica 2014; 30(1):175-186.	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, 2007²⁵25. Faisal-Cury A, Menezes PR. Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Womens Ment Health 2007; 10:25-32.	Pregnant women (n = 432)	Antenatal depression: BDI, cut-off of ≥16	White: 19.9% Non-White: 19.1%^† † p-value not reported.	Odds Ratio Non-White: 0.95 (0.5-1.81)
		Pregnant women (n = 432)	Antenatal anxiety: STAI, cut-off of ≥41	White: 58.8% Non-White: 63.0%^† † p-value not reported.	Others: 1.19 (0.70-2.00)
	Melo et al. 2011²⁶26. Melo EF, Cecatti JG, Pacagnella RC, Leite DBF, Vulcani DE, Yakuch MY. The prevalence of perinatal depression and its associated factors in two different settings in Brazil. J Affect Disord 2011; 136(3):1204-1208.	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)
		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. 2009²⁷27. Pereira PK, Lovisi GM, Pilowsky DL, Lima LA, Legay LF. Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil. Cad Saude Publica 2009; 25(12):2725-2736.	Pregnant women (n = 331)	Depression during pregnancy: CIDI	White: 14.1% Non-White: 14.3%	--
	Tannous et al., 2008²⁸28. Tannous L, Gigante LP, Fuchs SC, Busnello EDA. Postnatal depression in Southern Brazil: prevalence and its demographic and socioeconomic determinants. BMC Psych 2008; 8:1.	Women who recently gave birth to live infants (n = 271)	Postnatal depression: EPDS, cut-off of ≥13	Caucasian: 16.6%, Non-Caucasian: 28.1%^† † p-value not reported.	Prevalence Ratio Non-Caucasian: 0.80 (0.49-1.32)
	Ruschi et al. 2007²⁹29. Ruschi GEC, Sun SY, Mattar R, Filho AC, Zandonade E, Lima VJ. Aspectos epidemiológicos da depressão pós -parto em amostra brasileira. Rev Psiquiatr RS 2007; 29(3):274-280.	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 Association^a a Compared to Whites as the reference group.
Munhoz et al., 2013¹⁶16. Munhoz TN, Santos IS, Matijasevich A. Major depressive episode among Brazilian adults: a cross-sec-tional population-based study. J Affect Disord 2013; 150(2):401-407.	Rio Grande do Sul	80.1% White	Black: - ^* * Statistically significant (p < 0.05).
		12.1% Black	Others: +
		7.8% Other
Pavão et al., 2012¹⁷17. Pavão ALB, Ploubidis GB, Werneck G, Campos MR. Discrimination and health in Brazil: Evidence from a population-based survey. Ethn & Disease 2012; 22.	Representation from all regions of Brazil	77.2% Mulatto	Mulatto: (ref)
	Representation from all regions of Brazil	22.8% Black	Black: +
Almeida-Filho et al., 2004¹⁸18. Almeida-Filho N, Lessa I, Magalhães L, Araújo MJ, Aquino E, James SA, Kawachi I. Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Soc Sci Med 2004; 59(7):1339-1353.	Bahia	14.9% White	Moreno: +
		45.9% Moreno	Mulatto + ^* * Statistically significant (p < 0.05).
		15.9% Mulatto	Black +
		20.7% Black
Guimarães et al., 2009¹⁹19. Guimarães JMN, Lopes CS, Baima J, Sichieri R. Depression symptoms and hypothyroidism in a population-based study of middle-aged Brazilian women. J Affect Disord 2009; 117(1-2):120-123.	Rio de Janeiro	43.3% White	--
		40.1% Mulatto
		16.6% Black
Bretanha et al., 2005²⁰20. Bretanha AF, Facchini LA, Nunes BP, Munhoz TN, Tomasi E, Thumé E. Depressive symptoms in elderly living in areas covered by Primary Health Care Units in the urban area of Bagé, RS. Rev Bras Epidemiol 2005; 18(1):1-12.	Rio Grande do Sul	78.6% White	Black: -
		8.7% Black	Asian/Mulatto/
		12.7% Asian/	Indigenous: + ^* * Statistically significant (p < 0.05).
		Mulatto/Indigenous
Quatrin, et al., 2014²¹21. Quatrin LB, Galli R, Moriguchi EH, Gastal FL, Pattussi MP. Collective efficacy and depressive symptoms in Brazilian elderly. Arch Gerontol Geriatr 2014; 59(3):624-629.	Rio Grande do Sul	95.7% White	--
	Rio Grande do Sul	4.3% Non-White
Blay et al., 2007²²22. Blay SL, Andreoli SB, Fillenbaum GG, Gastal FL. Depression morbidity in later life: prevalence and correlates in a developing country. Am J Geriatr Psychiary 2007; 15(9):790-799.	Rio Grande do Sul	84.2% White	Afro-Brazilian: + ^* * Statistically significant (p < 0.05).
		6.8% Afro-Brazilian	Multiracial: + ^* * Statistically significant (p < 0.05).
		8.6% Multiracial
Anselmi et al., 2008²³23. Anselmi L, Barros FC, Minten GC, Gigante DP, Horta BL, Victora CG. Prevalence and early determinants of common mental disorders in the 1982 birth cohort, Pelotas, Southern Brazil. Rev Saude Publica 2008; 42(Supl. 2):25-32.	Rio Grande do Sul	78.1% White	Black/Mixed: + ^* * Statistically significant (p < 0.05).
	Rio Grande do Sul	21.9% Black/Mixed
Bastos et al., 2014²⁴24. Bastos JL, Barros AJD, Paradies Y, Faerstein E. Age, class and race discrimination: heir interactions and associations with mental health among Brazilian university students. Cad Saude Publica 2014; 30(1):175-186.	Rio de Janeiro	51.4% White	Black/Brown: -
		32.8% Brown
		15.2% Black
Faisal-Curry e Menezes 2007²⁵25. Faisal-Cury A, Menezes PR. Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Womens Ment Health 2007; 10:25-32.	São Paulo	83.0% White	Non-White (Depression): -
	São Paulo	17.0% Non-White	Non-White (Anxiety): +
Melo et al., 2011²⁶26. Melo EF, Cecatti JG, Pacagnella RC, Leite DBF, Vulcani DE, Yakuch MY. The prevalence of perinatal depression and its associated factors in two different settings in Brazil. J Affect Disord 2011; 136(3):1204-1208.	Pernambuco; São Paulo	45.5% White	Non-White: + ^* * Statistically significant (p < 0.05).
	Pernambuco; São Paulo	54.5% Non-White
Pereira et al., 2009²⁷27. Pereira PK, Lovisi GM, Pilowsky DL, Lima LA, Legay LF. Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil. Cad Saude Publica 2009; 25(12):2725-2736.	Rio de Janeiro	45.0% White	--
	Rio de Janeiro	55.0% Non-White
Tannous et al., 2008²⁸28. Tannous L, Gigante LP, Fuchs SC, Busnello EDA. Postnatal depression in Southern Brazil: prevalence and its demographic and socioeconomic determinants. BMC Psych 2008; 8:1.	Porto Alegre	64.6% White	Non-White: -
	Porto Alegre	35.4% Non-White
Ruschi et al., 2007²⁹29. Ruschi GEC, Sun SY, Mattar R, Filho AC, Zandonade E, Lima VJ. Aspectos epidemiológicos da depressão pós -parto em amostra brasileira. Rev Psiquiatr RS 2007; 29(3):274-280.	Espírito Santo	49.0% White	--
		16.8% Black
		34.2% Brown

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[1] Collaborations

JR Smolen and EM Araújo designed the study and search string. JR Smolen carried out the search of the literature. Both EM Araújo and JR Smolen interpreted the results. JR Smolen drafted the article, and EM Araújo assisted with the introduction and discussion, as well as a critical review of the draft and methodology. EM Araújo approved the final draft of the paper. JR Smolen and EM Araújo designed the study and search string. JR Smolen carried out the search of the literature. Both EM Araújo and JR Smolen interpreted the results. JR Smolen drafted the article, and EM Araújo assisted with the introduction and discussion, as well as a critical review of the draft and methodology. EM Araújo approved the final draft of the paper.