Association between skin tone and mental health status in the National Longitudinal Survey of Youth 1997 cohort

While the relationship between race and mental health has been studied extensively, skin tone also contributes to social stratification and experiences of colorism can result in poor mental health. This study evaluated the association between skin tone, a proxy for colorism, and mental health status, and whether race and ethnicity modified the association. Methods: This study used data from the National Longitudinal Survey of Youth 1997 cohort (N=2,177). Mental health was measured in 2010 with the Mental Health Inventory (MHI-5) which asks about mental health factors in the past month. Scores ranged from 0-15 with higher scores indicating worse mental health status. Mental health was evaluated continuously and dichotomously, using a cut point at 46. Interviewers identified skin tone in 2010 ranging from 1-10, with 1 as the lightest skin tone and 10 as the darkest. Skin tone was evaluated continuously and categorically (light skin tone (1); medium skin tone (2-4); and dark skin tone (5-10)). Poisson and binomial regression analyses were used to compute prevalence ratios and relative risks. Effect modification was assessed using a Wald test. Stratified models were used to compute stratum-specific PRs for racial and ethnic groups. Results: For the continuous MHI-5 score, the prevalence of poor mental health was null among participants with medium skin tone and slightly lower among participants with dark skin tone compared to participants with light skin tone (PR=0.92, 95% CI=0.85,1.00). For the dichotomous MHI-5 score, the risk of poor mental health was lower for both medium and dark skin tones compared to light skin tone (medium vs. light: RR=0.83, 95% CI=0.68,1.02; dark vs. light: RR=0.88, 95% CI=0.68,1.14). The association was null after examining skin tone continuously for both continuous and dichotomous MHI-5 score. Race and ethnicity did not appear to modify the association (medium vs. light p=0.98; dark vs. light p=0.99). Post-hoc analyses of MHI-5 indicators and categorical skin tone produced mixed results for participants with dark skin tone. Conclusion: The association between continuous MHI-5 score and skin tone was close to null or null. The association between dichotomous MHI-5 score and skin tone showed a protective effect for individuals with darker skin tones. Hypothesized protective factors for Black or African American individuals may also serve as protective factors for individuals with darker skin tones. Alternatively, in settings where individuals are around others with similar skin tones, perceived skin tone may not impact mental health to the same degree as other factors.