Bipolar Disorder and Mental Health in African-Americans

Introduction

Bipolar disorder is the sixth leading cause of disabilities worldwide, underscoring the importance of strong and early intervention techniques (Colombo, Fossati, & Colom, 2012). Bipolar disorder within the African-American community, similar to many other health issues, is a highly polarizing and contentious subject. Nearly 2.3 million African-Americans have bipolar disorder (Pary et al., 2006). Bipolar disorder has crippling effects on the Black community, heavily related to wealth, income, and employment statistics. This paper presents two important aspects of mental health disorders affecting African-Americans: the prevalence and misdiagnosis of bipolar disorder and the elevated risk of suicide, along with an examination of barriers to accurate diagnosis and treatment.

Understanding Bipolar Disorder

Frequent highs and lows characterize bipolar disorder. As human beings, many individuals experience these highs and lows daily. However, what differentiates those who have bipolar disorder is the overall magnitude of these occurrences. Those with bipolar disorder often experience manias characterized by excessive energy and rapid talking (National Institute of Mental Health, n.d.). Likewise, depression results when the individual feels deep emotions of sadness and lack of energy — common consequential behaviors in this emotional state (Kanter et al., 2008). The switch between euphoria and sadness can occur within a matter of hours or days.

Bipolar Disorder Among African-Americans and Misdiagnosis

The prevalence rates of bipolar disorder for African-Americans, Hispanics, and non-Hispanic Whites have been studied to fall between 2% and 4% (Gonzalez et al., 2010). Compared with the general population, African-Americans have a life expectancy reduction of roughly 10 to 20 years (Wheatley, 2012). Unfortunately, a contributing factor to these lower life expectancies is often a misdiagnosis of the initial condition. Treatment misdiagnosis frequently leads to treatment non-response and inappropriate care that ultimately exacerbates bipolar disorder for African-Americans. Mistreatment and non-response also contribute to a general mistrust of the healthcare field and its treatment options overall. As a result, many African-Americans go undiagnosed, electing not to use traditional methods — a consequence of the health access disparity that exists between Black and non-Black communities (Akinhanmi et al., 2017).

Factors Affecting Diagnosis and Effects of the Disorder

Various factors prevent racial minorities like African-Americans from receiving accurate diagnoses of mental health disorders, including bipolar disorder. These factors include cultural barriers, cultural incompetency among health professionals in understanding African-American mental health problems, an inability to engage with patients' religious beliefs, failure by medical caregivers to maintain consistent contact with patients' families, and a perceived inefficacy of available treatments — all of which lead minorities to make less use of psychiatric services (Maura & Mamani, 2017). The receipt of less than optimal care has contributed to a mental healthcare crisis for African-Americans, exacerbated by limited access to improved services. Research has further identified that Black patients receive less than minimally adequate mood-stabilizing treatment for bipolar disorder compared to White patients with the same diagnosis (Johnson & Johnson, 2014). The primary explanation was racial disparity, though the mechanisms involving service use, sociodemographic factors, and symptom expression remained unclear.

Those who have bipolar disorder are affected in numerous ways. For example, the disorder impacts a patient's sleep, causing them to fall and stay asleep at inopportune periods throughout the day. During a manic phase, the patient typically experiences very little sleep (Gold & Sylvia, 2016). Lack of sleep impairs work performance and undermines personal relationships. The opposite occurs during depressive episodes: the patient sleeps for longer periods, becoming drowsy and unproductive (Steardo Jr. et al., 2019).

From a physical health perspective, bipolar disorder can adversely impact the cardiovascular system (De Hert, Detraux, & Vancampfort, 2018). Common occurrences include heart palpitations, rapid heart rate, and elevated pulse. The issue of high blood pressure is further exacerbated because African-Americans have historically suffered disproportionately from hypertension (Fuchs, 2011). The African-American community also has higher rates of heart attack and stroke incidents related to poor dietary decisions and lower levels of physical activity. These risks are compounded by the manic episodes that characterize bipolar disorder. Additionally, the disorder can contribute to heavy alcohol and drug use, partly attributable to the depressive phase's association with low self-esteem and a diminished sense of self-worth (Moore, 2013).

African-Americans face unique historical barriers to bipolar disorder diagnosis. One such barrier is the general mistrust that many African-Americans have developed toward healthcare professionals. African-American history contains numerous instances of exploitation for others' gain (Ikard, 2013). Moreover, in many studies, this mistrust has been attributed to lower education levels; however, simply being Black has contributed significantly to distrust of medical caregivers, even when the education variable is controlled (Wells & Gowda, 2020).

Trust has also contributed to the non-diagnosis of bipolar disorder among African-Americans, given that racism has been a primary factor affecting this community for decades. Research findings have revealed a considerable gap between the trust that Black and White patients place in their doctors, with racism identified as the chief reason for Black patients' mistrust (Guffey & Yang, 2012). Empirical evidence on this issue remains limited and is sometimes treated as anecdotal, given that trust in doctors may or may not be directly affected by race in all cases. It has also been noted that doctors serving the Black community have frequently changed over time, preventing the development of sustained doctor-patient trust (Guffey & Yang, 2012). Consequently, visiting emergency departments rather than primary care providers is common in this community, driven by factors related to education, income, age, gender, and insurance status (Sullivan, 2020). This pattern indicates that lack of trust represents a major barrier to the adequate diagnosis of bipolar disorder among African-Americans.