While the literature on Black-white differences in major depressive disorder (MDD) and depressive symptoms is robust, less robust is the literature on how these outcomes are patterned within the US Black population and why differences exist. Given increasing numbers of first-generation immigrants from the Caribbean, sub-Saharan Africa, Latin America, among other regions of the world, as well as increasing numbers of second- and third-generation immigrants, continued aggregation has the potential to mask intra-racial differences between these ethnic-immigrant groups and Black Americans with more distant ancestral ties to Africa (i.e., African Americans). Among these subgroups, the extremely limited data disaggregating the US Black population suggest the following patterns. First, foreign-born Black immigrants have lower levels of MDD and related symptoms relative to US-born Black Americans, a finding which is consistent with theories of foreign-born health advantage. Second, among the US-born, Caribbean adults have higher levels of MDD and related symptoms relative to all other Black Americans, a finding which is inconsistent with theories related to intergenerational declines in health toward convergence to native-born levels. Lastly, and contrary to results among adults, first- and second-generation Caribbeans have lower levels of depressive symptoms relative to all other Black youth. This dissertation sought to better understand how depression and its related symptoms are patterned within the US Black population, as well as how mechanisms causing these outcomes may vary across subgroups defined by domains related to immigration. Chapter 1 was a systematic review, which comprehensively synthesized depression and related symptoms within the US Black population across these domains, including a summary of mechanisms proposed toward explaining intra-racial variation. Using longitudinal data, Chapter 2 examined whether, and if so when, growth curve models of depressive symptoms varied by immigrant generation contrasts among a representative sample of Black youth followed into adulthood. And using representative data from the largest study of Black mental health, Chapter 3 examined whether the relationship between racial identity, a presumed protective factor against depression and related symptoms, and MDD varied between US-born Caribbeans and all other US-born Black Americans. The systematic review of Chapter 1 revealed substantial variation in the prevalence of depression and its related symptoms within the US Black population by nativity, region of birth, age at immigration, and Caribbean ethnic origin. Results additionally confirmed that much of what is known about intra-racial heterogeneity comes from a single data source, the National Study of American Life (NSAL). Using longitudinal data of youth followed into adulthood, Chapter 2 found evidence of diverging depressive symptoms trajectories among Black respondents by immigrant generation (first/second-generation compared with third and higher generations); notably, contrasts among Black respondents varied from those of other racial/ethnic groups (Asian, Hispanic/Latinx, non-Hispanic white). Lastly, results from Chapter 3 suggest aspects of racial identity may not be protective for US-born Caribbeans, pointing to variations in racialization experiences as a distal cause. Additional research using larger sample sizes, more diverse subgroups of Black ethnic immigrants, as well as longitudinal data, is needed to further understand patterns of and additional sources underlying heterogeneity of depression and its related symptoms within the US Black population.

Mass incarceration is a public health issue that impacts millions of Americans. Draconian drug laws, over-policing, and unfair sentencing policies rooted in racism have led to the incarceration of millions of Black and Latinx people in the past four decades. Mass incarceration not only has collateral consequences for the health of the incarcerated, but also fortheir partners and children across multiple dimensions. This cross-sectional study recruited participants using social media, email, and text messages. Those who identified as Black or Latinx, age 20 or older, and who had a partner who was incarcerated for at least three months were eligible for study participation. The study was novel in asking for ratings of physical and mental/emotional health for four time periods: before their partner’s incarceration, after their partner’s incarceration, the year after their partner’s release, and “now”/currently. Results showed significant declines in both physical and mental/emotional health (e.g., a decline in ratings for during their partner’s incarceration from the pre-incarceration level), as well as improvements (e.g., improvement for the period “now”/currently from the during incarceration level). Also, when rating their children for the same four time periods for physical health, mental/emotional health, behavioral conduct, and school performance, a similar pattern of both declines and improvements was found. Findings argued for the importance of a methodology using multiple time periods for obtaining ratings, and for a resilience framework to accommodate interpretation of improvements. Further, having a greater number of children, being currently employed, having a lower income, and a lower rating of mental health during their partner’s incarceration were four significant predictors found in the regression models for both study outcome variables: i.e., (1) a higher negative impact from a partner’s incarceration on multiple dimensions; and (2) more harmful mental health consequences for partners of the incarcerated. Findings provided evidence for an especially underserved at-risk subset within the population of diverse male and female partners of the incarcerated: i.e., Black and Latinx women with a high number of children who are employed yet earning low wages—while suffering from severe mental health symptoms. Implications of the findings and recommendations are discussed.

While the mental health impacts of the COVID-19 pandemic on the general U.S. public health workforce have been well described, the effects of the COVID-19 response on Black, Indigenous, and People of Color (BIPOC) working in public health have not been adequately characterized. BIPOC public health professionals may have suffered, potentially, greater stress and more negative health impacts during the pandemic due to being part of communities experiencing severe COVID-19 health inequities and the potential for racism-related stress in the workplace. This study utilized a cross-sectional design to investigate the associations between risk factors/predictors and higher levels of burnout among BIPOC public health professionals working during the COVID-19 pandemic. Survey data was collected using the Qualtrics survey platform and SPSS was used for data analysis. Survey items measured multiple domains including professional experience (i.e., years of experience, job functions, hours worked, volunteer work), mental and physical health status (i.e., co-morbidities, BMI, COVID-19 diagnosis, insomnia, anxiety, depression, trauma, burnout), professional and personal stress (before and during the pandemic), and racism-related stress (i.e., discrimination, harassment, heightened vigilance, cultural taxation). Of the total respondents (n = 486), 80% experienced insomnia, 68.5% experienced depression, 81.7% experienced anxiety and 61.3% experienced trauma. BIPOC public health professionals suffered a moderately high overall level of burnout (mean = 2.578, SD = 0.486, min = 1, max = 3.9) and a high level of exhaustion (mean = 2.744, SD = 0.532, min = 1, max = 4). Paired t-tests found respondents’ physical and mental health status were each significantly worse during the pandemic (p < .000). Respondents also had significantly worse professional and personal stress during the pandemic (p < .000). Backward stepwise regression found higher burnout significantly predicted by: not having sought counseling; lower rating of mental health during COVID-19; higher past year mental distress (i.e., depression, anxiety, insomnia and trauma); higher past month perceived stress; and higher vigilance. These findings emerge as important in informing the public health field regarding the current and future needs of BIPOC public health professionals during the pandemic and beyond.