Rising Anxiety Disorder Rates in Black Canadian: Understanding the Challenges and Pathways to Treatment

Anxiety disorders are among the most common mental health conditions worldwide. In Canada, the prevalence of these disorders has significantly increased over the past decade. As of 2022, over 5 million Canadians aged 15 and older met the diagnostic criteria for mood disorders, including anxiety disorders. The COVID-19 pandemic exacerbated this issue, with large increases in anxiety symptoms reported between 2020 and 2021, particularly among women and young people. A 2022 study also noted a lower proportion of Black people living with anxiety disorders compared to other racialized and non-racialized groups, except for Filipino, Chinese, and South Asian groups.

Conversely, a study by Kogan and colleagues in 2022 found that close to 30% of Black participants reported clinically significant anxiety symptoms, with higher rates among young people and men. The study also highlighted a link between anxiety and exposure to racism, including racial microaggressions and discrimination.

In my private psychotherapy practice and previous work with the Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) at CAMH, I have observed a growing number of Black individuals presenting with various anxiety disorders. These include social anxiety, generalized anxiety, and panic disorders. Assessing these disorders can be challenging due to societal and cultural factors that influence the willingness and ability of Black individuals to disclose their psychological distress.

Understanding Anxiety

Anxiety and fear are natural emotions regulated by our limbic system, essential for survival. Fear is the reaction to a real and imminent threat, such as an approaching car, while anxiety is the reaction to an anticipated threat, like the fear of being hit by a car. Both emotions activate the fight-flight-freeze response. When fear and anxiety intensify, they can lead to panic or anxiety attacks. Though often used interchangeably, these terms differ. Anxiety attacks arise from identifiable threats, whereas panic attacks are typically spontaneous, with no direct stimulus and more severe psychological and physical symptoms.

Anxiety disorders, including phobias, are characterized by excessive and uncontrollable worry or fear, co-occurring with other symptoms. The Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) lists 11 anxiety disorders, with social anxiety disorder and generalized anxiety disorder being the most common. Symptoms include excessive worry, muscle tension, sleep disturbances, and difficulty concentrating. These disorders are associated with chronic diseases like hypertension and kidney disease, due to the endocrine system’s prolonged stress response, and often co-occur with substance use disorders.

Causes of Anxiety Disorders

Anxiety disorders can affect anyone, but certain genetic, psychological, and emotional factors increase susceptibility. Genetic predisposition plays a significant role, as anxiety disorders often run in families. The largest genome-wide association study (GWAS) on anxiety traits linked various genetic variants to an increased risk of anxiety disorders. These genes are associated with the hypothalamic-pituitary-adrenal (HPA) axis, which regulates stress response.

Psychologically, individuals with anxiety disorders struggle with distress intolerance, an inability to manage unpleasant emotions healthily. Distress intolerance can be exacerbated by psychosocial factors like adverse childhood experiences, neighborhood violence, racial discrimination, and frequent relocations.

Anxiety Disorders in Black Individuals

Black individuals across the African Diaspora frequently face challenges in receiving adequate mental health care. Anxiety and panic attacks can lead to intense, dysregulated presentations, often misinterpreted as aggression due to racial bias and negrophobia. This misperception can result in poor treatment and unjustified use of restraints.

Cultural idioms of distress also play a role. Black patients may describe anxiety using terms like “my spirit isn’t right” or “I’m just in my head a lot,” which clinicians might overlook. Alexithymia, the inability to describe or identify emotions, is prevalent among many Black men, who are often socialized to suppress emotions other than anger. This emotional repression can lead to panic disorder and other health issues.

Treatment for Anxiety Disorders

The goal of treatment is to help patients regulate their anxiety and regain balance. Treatment may involve psychotropic medications, such as antidepressants, and possibly antipsychotics or mood stabilizers. Alternative treatments like Chamomile are also being explored.

Traditional psychotherapy, or talk therapy, helps patients explore triggers, develop new thinking patterns, and adopt healthy coping mechanisms like breathing exercises. For those with alexithymia, therapy focuses on identifying and confronting distressing emotions. Alternative therapies may include prayer, nature walks, and community gatherings.

Anxiety disorders can be overwhelming, but there is hope. Recognizing symptoms, understanding underlying factors, and seeking appropriate treatment are crucial steps toward recovery. It is essential to learn and practice healthy coping mechanisms before anxiety symptoms become severe. By confronting and managing our emotions, we can prevent anxiety from controlling our lives.