Is Anxiety a White-People Thing?

In 2010, Harvard psychiatry and global health professor Devon Hinton and others used three nationally-representative surveys to measure the mental health of more than 16,000 people. They wanted to figure out if certain races were more prone to anxiety than others. Previous research hinted at racial differences—for example, a small study in 1993 found that white children were more likely to miss school due to anxiety than black children. But this was one of the first large-scale studies on anxiety specifically.

Hinton and his collaborators found that white Americans were more likely to experience generalized anxiety disorder, panic disorder, and social anxiety than black Americans, Hispanic Americans, and Asian Americans. The differences were significant: 8.6 percent of White Americans will experience symptoms of generalized anxiety disorder in their lifetimes, compared to just 5.8 percent of Hispanics, 4.9 of black Americans, and 2.4 of Asian Americans. Black Americans rate higher than white Americans on only one dimension of anxiety: post-traumatic stress disorder. (Here's a chart.)

According to another large mental health study from 2005, black Americans are 20 percent less likely, and Hispanics are 30 percent less likely, than white people to experience any anxiety disorder in their lifetimes. White people are also much more likely to actually get diagnosed with an anxiety disorder.

These differences apply not just to Americans but across the world. For example, 6.5 percent of Nigerians will experience anxiety in their lifetimes, compared to 31 percent of Americans. There are even variations within races. Puerto Rican Americans have significantly higher rates of anxiety disorders than Mexican Americans, for instance.

Anxiety is partly influenced by socioeconomic class. Social anxiety, one of the most common anxiety disorders, appears to be more prevalent among the lower class and less educated. Likewise, people who make less than $70,000 a year are slightly more likely to have co-morbid social anxiety and alcohol dependence.

But, interestingly, class and race are independent predictors of anxiety. Even after controlling for demographic variables such as age, gender and socioeconomic status, Hinton and his team found that white people were significantly more likely than people of other races to report symptoms of various anxiety disorders. Why are white people more anxious?

Some mental health differences could be cultural. Strongly identifying with your culture or heritage could buffer against symptoms of anxiety, particularly in the face of adversity. One study found that for, African Americans, strong ethnic identity was correlated to reduced anxiety and depression, whereas this was not true for European Americans. “A strong, positive ethnic identity may serve a protective role among African Americans,” researchers explain. Or maybe, having typically faced less adversity than minorities, white people are simply less resilient.

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There are innumerable cultural explanations for why some races experience more anxiety than others. But it’s also possible that these differences don’t actually exist. Instead, differing anxiety rates could be the byproduct of insufficient and culturally-oblivious measurements. For one, people with mental illnesses are less likely to participate in surveys at all. Even when they do respond, they can be hesitant to admit their condition or symptoms. This may be especially true for people belonging to cultures with heavy stigmas or stereotypes around mental illness.

Charting the prevalence of anxiety across races is also difficult because cultures sometimes experience symptoms of mental illness differently. Researchers don’t just ask subjects, “Do you have anxiety?” or “Have you ever experienced anxiety?” But the questions they ask to try to understand how someone really feels might be framed in a way that’s not culturally comprehensible or resonant.

For example, Asian cultures have a different understanding of social anxiety than do Western cultures. Japanese and Korean cultures understand social anxiety as “taijin kyofusho,” which is fear of offending or embarrassing someone. Western psychologists define social anxiety, by contrast, as fear of embarrassing oneself. A study questionnaire centered on symptoms of self-embarrassment may yield an inaccurately low prevalence of social anxiety among Asians.

Likewise, Latinx Americans see anxiety as “ataques de nervios,” which are dramatic episodes that often include shouting and aggression. Another word for anxiety, “susto,” is better characterized as “fright.” Both these types of anxieties may feel completely unlike some white girl’s debilitating career anxiety.

How researchers word questions critically affects the end empirical results. Psychologists found that removing certain questions from a social anxiety survey for just black people eliminated the different rates of anxiety between black and whites. “It is possible that these items are either irrelevant in the measurement of social and evaluative anxiety or represent a separate construct for African Americans,” they write. Of course, there’s an obvious hangup with simply removing certain questions for certain races: not all blacks, nor members of any race, share exactly the same culture or conception of anxiety. Eliminating questions that might confound an accurate picture of anxiety could skew the results in other, equally wrong ways.

Such measurement difficulties can be partially controlled for by using in-depth, in-person interviews, as Hinton's surveys did. But this has its own challenges: admitting or describing a mental health condition in-person may be more difficult for some races or cultures than it is for others. A subject’s honesty may also depend on whether they identify with their interviewer. If most interviewers are white, perhaps minorities will give more guarded answers.

Finally, accidental measurement errors aren’t just semantic. Sometimes mental illnesses physically feel different to people depending on their culture, which can skew results. For example, research suggests that Asians feel mental illness in their bodies more than Europeans or Americans do. In one study, Chinese people reported more physical symptoms of mental illness, whereas Euro-Canadians reported more psychological symptoms. A questionnaire aimed at capturing psychological rather than physical symptoms of anxiety could result in more white people than Asians getting pegged as anxious.

In short, anxiety could be a white problem because it’s a white concept, at least how typically white, Western psychologists are measuring it. So either there are significant differences in how races feel—or significant improvements needed in how we research them.

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