Ethno-racial differences in anxiety and depression impairment among emerging adults in higher education

Background Despite having higher exposure to stressors, many ethno-racial groups report similar or lower prevalence of clinical depression and anxiety compared to their white counterparts, despite experiencing greater psychosocial risk factors for poor mental health outcomes, thus presenting an epidemiological paradox. Ethno-racial differences in impairment, a diagnostic criterion, may in part explain this paradox. Methods We analyzed data from the Healthy Minds Study (2020-2021) and using survey-weighted linear mixed effects models, we tested whether there were ethno-racial differences in impairment across multiple ethno-racial groups at various levels of severity for anxiety and depression. Results Black students reported lower mean impairment scores relative to white students at moderate and severe anxiety. Hispanic/Latino students only reported lower impairment relative to white students at severe anxiety. Asian students reported relatively lower mean impairment than white students at mild anxiety, and this difference continued to grow as anxiety severity increased. Similar trends were observed for depression. Black and Hispanic/Latino students reported lower mean impairment scores at moderate depression to severe depression. Asian students reported lower mean impairment scores beginning at mild depression to severe depression. Conclusion Self-reported anxiety and depression related impairment varies by ethno-racial group, with Black, Hispanic/Latinx, and Asian students reporting lower impairment compared to white students at higher levels of symptom severity. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some of the racial paradox.