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Nativity, Race–Ethnicity, and Dual Diagnosis Among US Adults

Health and Health Care Concerns Among Women and Racial and Ethnic Minorities

ISBN: 978-1-78743-150-8, eISBN: 978-1-78743-149-2

Publication date: 10 August 2017


This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).




This study was funded by a grant from the National Institute on Drug Abuse (R01-1DA023615). Preliminary analyses for this project were supported through funding from the Peter F. McManus Charitable Trust and a faculty research development grant from the University of Cincinnati Research Council.


Szaflarski, M., Bauldry, S., Cubbins, L.A. and Meganathan, K. (2017), "Nativity, Race–Ethnicity, and Dual Diagnosis Among US Adults", Health and Health Care Concerns Among Women and Racial and Ethnic Minorities (Research in the Sociology of Health Care, Vol. 35), Emerald Publishing Limited, Leeds, pp. 171-191.



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