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Purpose: With little research addressing mental health, ethnicity/race, and income within specific gender and age groups, the purpose of this study was to examine whether mental health differs by ethnicity/race and income in middle-aged women in the general population. Methods: This cross-sectional analysis used 2016 Behavioral Risk Factor Surveillance System data for females ages 40-64 years from Alabama (N=1455), Mississippi (N=1082), North Carolina (N=1215), South Carolina (N=2277), and Tennessee (N=1263). Ordered logistic regression analysis by state was used to assess the relationship between mental health and ethnicity/race and income, while controlling for demographic and health factors. Results: Over one-third of middle-aged women reported having low to moderate mental health (38-45%), half or more reported white race (54-81%), and more than half reported an income of less than $50,000 per year (52-66%). The results of this study indicated that mental health did not differ significantly by income, but did differ significantly by ethnicity in 3 of 5 states, with white, non-Hispanic middle-aged women reporting more mental health issues. In addition, mental health was related to physical health, tobacco use, and age categories across states. Conclusion: Overall, mental health differed by ethnicity/race, but not by income, across samples of middle-aged women in the general population. Limitations of this study include an underrepresentation of various ethnicity/race groups. Because over one-third of this target population may have low to moderate mental health, practitioners in a primary care should screen all middle-aged women for mental health, with special consideration for white patients and those 40-55 years of age. In addition, because tobacco use and physical health were moderatelyto highly-related to mental health in this target population, practitioners should screen for all if middle-aged females present with any. Any treatment for mental and physical health issues should be coordinated and smoking cessation should be encouraged. *Correspondence to: Jessica L Hartos, Department of Physician Assistant Studies, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, Texas, USA, Tel: (817)735-2454, Fax: (817)735-2529, E-mail: jessica.hartos@unthsc.edu

Is mental health related to ethnicity/race and income in middle-aged females in the general U.S. population?