To put these data into perspective, several issues must be considered. First, the lower rate of suicide for Blacks compared to Whites is consistent with other mental health data and reflects a well-documented paradox in the health literature. Blacks tend to rate higher than Whites on indicators of physical health problems, and Blacks rate lower than Whites on indicators of subjective well-being, such as life satisfaction and happiness (Hughes and Thomas, 1998); but Blacks have comparable or better rates than Whites on other indicators of mental health. Community-based studies using measures of psychological distress show an inconsistent pattern of Black-White differences. Some studies show that Blacks have higher rates of distress compared to Whites, while other studies show higher rates of psychological distress for Whites compared to Blacks (Dohrenwend and Dohrenwend, 1969; Neighbors, 1984; Williams, 1986; Vega and Rumbaut, 1991; Williams and Harris-Reid, 1999).

The Epidemiologic Catchment Area study (ECA), the largest study of psychiatric disorders ever conducted in the United States, is based on interviews of some 20,000 adults in five communities. ECA estimated the prevalence and incidence of specific psychiatric disorders in the general population in the five communities—people both in treatment and not in treatment (see Table 14–9; Robins and Regier, 1991). Data show that there are few differences among the groups in rates of either current or lifetime psychiatric disorders. Especially striking is the absence of a substantial racial difference in drug-use history or alcohol and drug abuse. On the other hand, anxiety disorders, especially phobias, stand out as one area in