1. Introduction
Socioeconomic status (SES) resources are associated with better mental health [
1,
2,
3]. Education attainment, one of the most important SES indicators, shapes the social patterning of depressive symptoms and psychological distress [
4]. It is unclear if the protective effect of education against depression and psychological distress depends on tertiary factors such as race and ethnicity.
According to the Minorities’ Diminished Return (MDR) theory [
5,
6], SES indicators show weaker effects on the physical and mental health of African American and other racial and ethnic minority groups as compared to whites. Education attainment and income have smaller protective effects with respect to depression [
4], diet [
7], smoking [
8], alcohol use [
9], impulse control [
10], obesity [
11,
12], chronic disease [
13,
14], and mortality [
15] for African Americans as compared to whites. In a 25-year follow up study, African American men with the highest education attainment were the only group who experienced an increase in depressive symptoms over time, a phenomenon which was not present for white men, white women, or African American women [
4]. In a study of African American boys, high income was associated with an increased risk of major depressive disorder [
2]. In another study, high-SES youth experienced more depressive symptoms over time [
16,
17]. In another study, family type protected white but not African American youth from anxiety [
18]. In a study among Michigan residents, high income reduced risk of poor self-rated mental health for whites but not African Americans [
19]. Finally, another study showed that high education was a risk factor for risk of suicidal ideation for black Caribbean females [
20].
Although MDR theory [
5,
6] suggests that education attainment and other SES indicators have a smaller protective effect on African Americans than whites, it is unclear why this pattern is more pronounced for males than females [
2,
3,
4]. To fill this knowledge gap in the literature, the current study explored gender differences in the protective effects of education attainment on depressive symptoms and psychological distress in a nationally representative sample of African American adults in the United States.
4. Discussion
In a nationally representative sample, education attainment unequally reduced depressive symptoms and psychological distress for male and female African American adults. African American males were found to be at a relative disadvantage compared to African American females in terms of gaining mental health from their education attainment.
The finding of this study extends the MDR theory [
5,
6] from a literature which is almost exclusively between race and ethnic groups to examine patterns within race and ethnicity, and suggests that it is also the intersection of other social identities such as gender that determine how much health groups and individuals gain from their SES resources. Regardless of their age, whether they are children [
11,
33], youth [
16,
34,
35], adults [
8], or older adults [
36], SES generates less improved health for non-whites as compared to whites. Among African Americans, males are at an increased disadvantage regarding gaining mental health from the very same SES resources. As mentioned before, most previous studies built on the MDR theory have focused on a comparison of race and ethnic minority groups with whites, and less information is available on differences between gender within a particular race.
Effects of education attainment [
15] and employment [
37] on mortality are weaker for African Americans as compared to whites. Education attainment [
4] and income [
2,
3,
38] better reduce risk of depression for whites as compared to African Americans. Income promotes positive emotions [
39] and self-rated mental health [
19] of whites but not African Americans.
African American men gain fewer psychological benefits from their education attainment and income because of the pervasive racism and discrimination [
3,
5,
17,
38,
40]. As the SES of African American males increases, they are subject to more contact with whites, [
38,
40], which in turn increases their discriminatory experiences [
16,
17]. High-SES African American boys attend predominantly white schools [
38] and high-SES African American men work in predominantly white work places [
40].
Discrimination, which is shown to reduce the health gain of SES [
41], is more common towards male than female African Americans [
17,
22]. Furthermore, African American males are more prone to the effects of discrimination and environmental stressors on distress and depression [
23,
24,
42].
A very recent study by Chetty et al. showed that even amongst African Americans, males are the least likely to enjoy upward social mobility out of poverty. In their study on the intersection of race and gender on intergenerational social mobility, African American men and boys were more likely to experience downward mobility compared to African American women and girls [
43]. African American males find themselves in an inescapable societal circumstance, where they are more likely to decline socially and economically despite education. Even if they do maintain their SES, however, this does not protect them from depression and other psychological ills as it does other groups. The contribution of these studies questions the idea that higher education and income improves the plight of African American men in the United States.
There is a well-established literature that helps us understand the current findings. The works of Robert Staples [
44,
45,
46], Tommy Curry [
47], Daphne Watkins [
48,
49,
50,
51], and others [
52,
53] on African American men are some examples. Staples argued that there is a specific disadvantage of African American males that requires specific investigation [
44,
45,
46]. Curry mentioned that being African American and male creates a unique social matrix of oppression that nullifies many of the theories we have of gender, race, and class [
47]. Daphne Watkins argues that depression manifests itself through John Henryism, where African American men are high functioning and productive, yet still psychologically suffering [
48,
49,
50,
51]. Other researchers have also published on the same issues among African American men [
52,
53].
The results could also be explained by the Subordinate Male Target hypothesis [
54,
55] and Social Dominance Theory (the Intergroup Theory of Social Hierarchy and Oppression) [
56], as well as Curry’s black male vulnerability thesis [
47], and the work on black masculinity by Wizdom Powell [
57,
58] and Derek Griffith [
59,
60,
61,
62].
African American males experience more interpersonal discrimination than African American females across U.S. institutions including but not limited to the labor market, banking, the justice system, and police [
16,
17,
63,
64]. Discrimination reduces the health gains from available SES resources, particularly education attainment [
41]. Due to discrimination in the labor market, the very same education attainment generates less income for African American men than other groups [
39], a pattern which also explains why employment generates less physical health for African American men [
37]. Despite high education, African Americans have a higher chance of staying beneath the poverty line [
65]. In a 10-year longitudinal study, high levels of education attainment predicted a larger increase in income for whites but not African Americans [
39]. In the same study, neither education attainment nor income generated positive affect for African Americans, yet these effects could be seen for whites [
39]. In a study using data from the Health Information National Trends Survey (HINTS), income fully explained why education attainment generated less self-rated health for African Americans compared to whites [
57].
Highly educated and high-income African Americans are at an increased risk of depression [
3,
66]. In a longitudinal study of a representative sample, African American men were at a risk for an increased risk of depressive symptoms over time [
4]. African American boys from high income families were at an increased risk of depression [
2], and most educated black Caribbean women were at a higher risk of suicidal ideation [
20]. In another study on a representative sample of adults from Michigan, an increase in income enhanced self-rated mental health of whites but not African Americans [
19].
Our results suggest that highly educated African American males are at high risk of depressive symptoms and psychological distress. Upward social mobility is more costly for African Americans than whites [
41]. In a recent study, whites’ stress was a function of social mobility, however, African Americans experienced high levels of stress regardless of social mobility [
67]. In another study among American men, income reduced perceived discrimination of whites but not African Americans [
68]. Thus, for African Americas, successful upward social mobility (e.g., high education attainment) is not similarly rewarded in terms of life conditions, income, purchase power, and health.
These weak effects of education attainment in reducing depressive symptoms and psychological distress for African American men are in line with previous research [
1,
4] and may explain why education attainment and income better reduce risk of chronic medical disease [
14], obesity [
11], health risk behaviors [
7,
8], and mortality [
15] for whites as compared to African Americans, particularly males [
2,
3,
22]. More research is needed to understand why the diminished return of SES on health is worse for males than females.
4.1. Implications
The results suggest that highly educated African Americans men still show depressive symptoms and psychological distress, however, high-SES female African Americans gain mental health due to education attainment. These findings suggest the need for screening, diagnosis, and treatment of mental distress and depression for highly educated African American men. Such investment is not, however, necessary for highly educated African American women, given they gain mental health protection from each additional year of schooling. This is troubling for policy makers and program planners because traditionally, high SES is assumed to signal low risk for behavioral problems [
69]. In other words, although high SES generally allows a lower investment for prevention, education, and treatment of mental health problems for populations, this is not the case for African American men. Education attainment conveys less information regarding psychological distress and depressive symptoms for male than female African American adults. This is another reason that clinical and public health interventions and programs should be tailored for the intersection of race, gender, and class. Such approach may be superior to universal programs that ignore specific needs of subsections of the society [
32].
4.2. Limitations
The current study had a few limitations. First, the cross-sectional design limits any causal inferences. While low SES impacts psychological well-being, psychopathology may also cause downward social mobility. However, the reverse causation is more relevant to SES indicators that are more subject to change later in life (such as income, marital status, and employment) compared to educational attainment, which is commonly stable in adulthood. Second, sample size was not balanced between the gender groups, with a lower number of males being a part of this study. Differential sample size results in differential statistical power, especially for gender-stratified models. This issue was not a concern in our study because association were significant in all groups. Third, the outcome of the current study was based on symptoms rather than clinical disorders diagnosed by psychiatrists, and data were collected based on a structured clinical interview. Fourth, very few confounders were controlled for in this study. Additional individual level factors as well as contextual factors may confound the association between personal SES and psychological distress [
70]. Fifth, self-report measures of distress and depression may be prone to different levels of measurement bias by gender. We cannot rule out possibility that females have a higher tendency to disclose their emotional symptoms. Sixth, gender may affect access to the health care, stigma, social desirability, and several other factors that have implications regarding distress. In addition, this study did not assess the beliefs of African American men and women with regard to structural racism, oppression, and justice [
71,
72,
73]. Last but not least, as a large proportion of African American males are institutionalized (e.g., imprisoned), selection bias may be more problematic for males than females. There is a need to replicate these findings using longitudinal design, with other SES indicators, other age groups, and using more robust outcomes such as physician diagnosis of psychiatric disorders (e.g., depression).