Discrimination, symptoms of depression, and self-rated health among african american women in detroit: results from a longitudinal analysis

Effects of perceived racial discrimination on health status and health behavior: a differential mediation hypothesis

OBJECTIVE

Prospective data tested a "differential mediation" hypothesis: The relations (found in previous research) between perceived racial discrimination and physical health status versus health-impairing behavior (problematic substance use) are mediated by two different types of affective reactions, internalizing and externalizing.

METHOD

The sample included 680 African American women from the Family and Community Health Study (M age = 37 years at Time 1; 45 years at Time 4). Four waves of data were analyzed. Perceived discrimination was assessed, along with anxiety and depression (internalizing) and hostility/anger (externalizing) as mediators, and physical health status and problematic substance use (drinking) as outcomes.

RESULTS

Structural equation modeling indicated that discrimination predicted increases in both externalizing and internalizing reactions. These affective responses, in turn, predicted subsequent problematic substance use and physical health status, respectively, also controlling for earlier reports. In each case, the indirect effects from discrimination through the affective mediator to the specific health outcome were significant and consistent with the differential mediation hypothesis.

CONCLUSIONS

Perceived racial discrimination is associated with increases in internalizing and externalizing reactions among Black women, but these reactions are related to different health outcomes. Changes in internalizing are associated with self-reported changes in physical health status, whereas changes in externalizing are associated with changes in substance use problems. Discussion focuses on the processes whereby discrimination affects health behavior and physical health status.

Discrimination hurts, but mindfulness may help: Trait mindfulness moderates the relationship between perceived discrimination and depressive symptoms

Discriminatory experiences are not only momentarily distressing, but can also increase risk for lasting physical and psychological problems. Specifically, significantly higher rates of depression and depressive symptoms are reported among people who are frequently the target of prejudice. Given the gravity of this problem, this research focuses on an individual difference, trait mindfulness, as a protective factor in the association between discrimination and depressive symptoms. In a community sample of 605 individuals, trait mindfulness dampens the relationship between perceived discrimination and depressive symptoms. Additionally, mindfulness provides benefits above and beyond those of positive emotions. Trait mindfulness may thus operate as a protective individual difference for targets of discrimination.

The pathways from perceived discrimination to self-rated health: an investigation of the roles of distrust, social capital, and health behaviors

Although there has been extensive research on the adverse impacts of perceived discrimination on health, it remains unclear how perceived discrimination gets under the skin. This paper develops a comprehensive structural equation model (SEM) by incorporating both the direct effects of perceived discrimination on self-rated health (SRH), a powerful predictor for many health outcomes, and the indirect effects of perceived discrimination on SRH through health care system distrust, neighborhood social capital, and health behaviors and health conditions. Applying SEM to 9880 adults (aged between 18 and 100) in the 2008 Southeastern Pennsylvania Household Health Survey, we not only confirmed the positive and direct association between discrimination and poor or fair SRH, but also verified two underlying mechanisms: 1) perceived discrimination is associated with lower neighborhood social capital, which further contributes to poor or fair SRH; and 2) perceived discrimination is related to risky behaviors (e.g., reduced physical activity and sleep quality, and intensified smoking) that lead to worse health conditions, and then result in poor or fair SRH. Moreover, we found that perceived discrimination is negatively associated with health care system distrust, but did not find a significant relationship between distrust and poor or fair SRH.

Using community-based participatory research to explore social determinants of women's mental health and barriers to help-seeking in three urban, ethnically diverse, impoverished, and underserved communities

Depression and anxiety are significant mental health issues that affect urban, ethnically diverse, impoverished women disproportionately. This study sought to identify social determinants of mental health and barriers to help-seeking for this population. Using community based participatory research and focus groups, sixty-one Black, Hispanic, and White women identified economic, family, cultural, and neighborhood issues as perceived determinants of their depression/anxiety. They identified practical, psychosocial, and cultural barriers to their help-seeking behavior. These results can promote women's health by fostering an understanding of social factors as perceived determinants of depression/anxiety and shaping practice and policy initiatives that foster positive aggregate outcomes.

Interpersonal discrimination and depressive symptomatology: examination of several personality-related characteristics as potential confounders in a racial/ethnic heterogeneous adult sample

BACKGROUND

Research suggests that reports of interpersonal discrimination result in poor mental health. Because personality characteristics may either confound or mediate the link between these reports and mental health, there is a need to disentangle its role in order to better understand the nature of discrimination-mental health association. We examined whether hostility, anger repression and expression, pessimism, optimism, and self-esteem served as confounders in the association between perceived interpersonal discrimination and CESD-based depressive symptoms in a race/ethnic heterogeneous probability-based sample of community-dwelling adults.

METHODS

We employed a series of ordinary least squares regression analyses to examine the potential confounding effect of hostility, anger repression and expression, pessimism, optimism, and self-esteem between interpersonal discrimination and depressive symptoms.

RESULTS

Hostility, anger repression, pessimism and self-esteem were significant as possible confounders of the relationship between interpersonal discrimination and depressive symptoms, together accounting for approximately 38% of the total association (beta: 0.1892, p < 0.001). However, interpersonal discrimination remained a positive predictor of depressive symptoms (beta: 0.1176, p < 0.001).

CONCLUSION

As one of the first empirical attempts to examine the potential confounding role of personality characteristics in the association between reports of interpersonal discrimination and mental health, our results suggest that personality-related characteristics may serve as potential confounders. Nevertheless, our results also suggest that, net of these characteristics, reports of interpersonal discrimination are associated with poor mental health.

Mediators of discrimination and self-rated health among African Americans

OBJECTIVES

To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans.

METHODS

A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male).

RESULTS

Greater discrimination was associated with poorer self-rated health (β =-.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05).

CONCLUSIONS

Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.

Discrimination and psychological distress among recently released male prisoners

Though theoretical perspectives suggest experiences of stigma and discrimination after release may be one pathway through which incarceration leads to poor mental health, little research considers the relationship between discrimination and mental health among former inmates. In this article, data from a sample of men recently released from prison to Oakland or San Francisco, California (N = 172), are used to consider how criminal record discrimination and racial/ethnic discrimination are independently and cumulatively associated with psychological distress. Results indicate that (a) the frequency of criminal record discrimination and racial/ethnic discrimination are similar; (b) both forms of discrimination are independently, negatively associated with psychological distress; and (c) the level of racial/ethnic discrimination does not alter the association between criminal record discrimination and psychological distress. The results highlight that criminal record discrimination is an important social stressor with negative implications for the mental health of previously incarcerated individuals.

Professional women's well-being: the role of discrimination and occupational characteristics

This study examined the association between perceived discrimination, workplace racial composition, and three outcomes-psychological distress, life dissatisfaction, and job dissatisfaction-among a sample of Black (n = 72) and White (n = 74) professional women. As a comparison, these relationships were analyzed to determine if they varied from those observed in more traditionally studied populations: Whites and non-professional Blacks, using data from a population of working women in the 1995 Detroit Area Study (N = 533). Perceived discrimination was associated with differences in psychological distress and job dissatisfaction but not with life dissatisfaction. The correlation between perceived discrimination and psychological distress was larger for White professional women than for Black professional women (White women odds ratio [OR]: 1.99; Black women OR: 0.80). A larger correlation between race and job dissatisfaction was observed for Black professional women than for Black non-professional women. The racial composition of the workplace was unrelated to any of the outcomes. Study results emphasized the importance of decreasing the frequency of discrimination for positive mental health and underscored the need for more systematic research on discrimination and health among Black women of higher socioeconomic status, a growing sub-population in the United States.

Comparing measures of racial/ethnic discrimination, coping, and associations with health-related outcomes in a diverse sample

Discrimination is detrimental to health behaviors and outcomes, but little is known about which measures of discrimination are most strongly related to health, if relationships with health outcomes vary by race/ethnicity, and if coping responses moderate these associations. To explore these issues, the current study assessed race/ethnic differences in five measures of race/ethnic discrimination, as well as emotional and behavioral coping responses, within a population-based sample of Whites, African Americans, Mexicans, and Puerto Ricans (n = 1,699). Stratified adjusted logistic regression models were run to examine associations between the discrimination measures and mental, physical, and health behavior outcomes and to test the role of coping. Overall, 86 % of the sample reported discrimination. Puerto Ricans were more likely than Mexicans and Whites to report most types of discrimination but less likely than Blacks. Discrimination was most strongly related to depression and was less consistently (or not) associated with physical health and health behaviors. Differences by measure of discrimination and respondent race/ethnicity were apparent. No support was found to suggest that coping responses moderate the association between discrimination and health. More work is needed to understand the health effects of this widespread social problem. In addition, interventions attempting to reduce health disparities need to take into account the influence of discrimination.

Impact of social discrimination, job concerns, and social support on Filipino immigrant worker mental health and substance use

BACKGROUND

The personal and social impact of mental health problems and substance use on workforce participation is costly. Social determinants of health contribute significantly to health disparities beyond effects associated with work. Guided by a theory-driven model, we identified pathways by which social determinants shape immigrant worker health.

METHOD

Associations between known social determinants of mental health problems and substance use (social discrimination, job and employment concerns, and social support) were examined using structural equation modeling in a sample of 1,397 immigrants from the Filipino American Community Epidemiological Study.

RESULTS

Social discrimination and low social support were associated with mental health problems and substance use (P < 0.05). Job and employment concerns were associated with mental health problems, but not substance use.

CONCLUSIONS

The integration of social factors into occupational health research is needed, along with prevention efforts designed for foreign-born ethnic minority workers.

Effects of social ties on self-rated physical health among African American adults

OBJECTIVES

To examine associations between social ties and self-rated physical health among midlife and older African Americans.

METHODS

Cross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with betterself-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH: this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality.

RESULTS

In adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval (CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99).

DISCUSSION

Results suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.

Chronic exposure to everyday discrimination and sleep in a multiethnic sample of middle-aged women

OBJECTIVE

Researchers have suggested that poor sleep may play a role in the association between discrimination and health, but studies linking experiences of discrimination to sleep are limited. The authors examined associations between reports of everyday discrimination over 4 years (chronic everyday discrimination) and subjective and objective indicators of poor sleep.

METHOD

Participants were 368 African American, Caucasian, and Chinese women from the Study of Women's Health Across the Nation Sleep Study. Everyday discrimination was assessed each year from baseline through the third follow-up exam via questionnaire with the Everyday Discrimination Scale (intraclass correlation coefficient over 4 years = .90). Subjective sleep complaints were measured beginning in Year 5 with the Pittsburgh Sleep Quality Index. Objective indices of sleep continuity, duration, and architecture were assessed via in-home polysomnography, beginning in Year 5.

RESULTS

In linear regression analyses adjusted for age, race/ethnicity, and financial strain, chronic everyday discrimination was associated with more subjective sleep complaints (Estimate = 1.52, p < .001) and polysomnography-assessed wakefulness after sleep onset (Estimate = .19, p < .02), a marker of sleep continuity. Findings did not differ by race/ethnicity and remained significant after adjusting for menopausal status, body mass index, medication use, and depressive symptoms.

CONCLUSION

Experiences of chronic everyday discrimination are independently associated with both subjective and objective indices of poor sleep. Findings add to the growing literature linking discrimination to key markers of biobehavioral health.

Perceived discrimination is a potential contributing factor to substance use and mental health problems among primary care patients in Chile

OBJECTIVES

Perceived discrimination is a prevalent problem that has been linked to negative health outcomes for victims. The goal of this research was to examine whether perceived discrimination within the past 6 months was related to 6-month prevalence of problem drinking, illicit drug use, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) in a sample of primary care patients in Chile.

METHODS

Structured diagnostic assessments were administered to assess for MDD and PTSD using the Composite International Diagnostic Interview. The Alcohol Use Disorders Identification Test assessed hazardous alcohol use. Additional measures captured illegal drug use and discrimination in the past 6 months. Measures were administered to 2839 participants between the ages of 15 to 98 in primary care centers in the Chilean cities of Concepcion and Talcahuano.

RESULTS

Controlling for demographic variables and previous trauma victimization, patients who reported discrimination in the past 6 months were significantly more likely to engage in hazardous alcohol use, illegal drug use, be diagnosed with MDD, and PTSD within this same time period than patients not reporting discrimination.

CONCLUSIONS

This study highlights the importance of considering discrimination as a potential contributing factor to substance use and mental health problems in a Latin American sample.

Race/Ethnicity and self-reported levels of discrimination and psychological distress, California, 2005

Introduction

Little is known about the relationship between discrimination and distress among multiple racial groups because previous studies have focused primarily on either blacks or Asian Americans. The objective of this study was to assess the association between self-reported experiences of racial discrimination and symptoms of psychological distress among 5 racial/ethnic groups in California.

Methods

I used data from the 2005 California Health Interview Survey describing an adult sample of 27,511 non-Hispanic whites, 8,020 Hispanics, 1,813 non-Hispanic blacks, 3,875 non-Hispanic Asians, and 1,660 people of other races/ethnicities. The Kessler 6-item Psychological Distress Scale determined symptoms of psychological distress. I used a single-item, self-reported measure to ascertain experiences of racial discrimination.

Results

Reports of racial discrimination differed significantly among racial groups. Self-reported discrimination was independently associated with psychological distress after adjusting for race/ethnicity, age, sex, education level, employment status, general health status, nativity and citizenship status, English use and proficiency, ability to understand the doctor at last visit, and geographic location. The relationship between discrimination and psychological distress was modified by the interaction between discrimination and race/ethnicity; the effect of discrimination on distress was weaker for minority groups (ie, blacks and people of other races/ethnicities) than for whites.

Conclusion

Self-reported discrimination may be a key predictor of high levels of psychological distress among racial/ethnic groups in California, and race appears to modify this association. Public health practitioners should consider the adverse effects of racial discrimination on minority health.

Relationships between discrimination in health care and health care outcomes among four race/ethnic groups

Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.

Changes in waist circumference and body mass index in the US CARDIA cohort: fixed-effects associations with self-reported experiences of racial/ethnic discrimination

Prior studies examining the association between self-reported experiences of racial/ethnic discrimination and obesity have had mixed results and primarily been cross-sectional. This study tests the hypothesis that an increase in self-reported experiences of racial/ethnic discrimination predicts gains in waist circumference and body mass index in Black and White women and men over eight years. In race/ethnicity- and gender-stratified models, this study examined whether change in self-reported experiences of racial/ethnic discrimination predicts changes in waist circumference and body mass index over time using a fixed-effects regression approach in SAS statistical software, providing control for both measured and unmeasured time-invariant covariates. Between 1992-93 and 2000-01, self-reported experiences of racial/ethnic discrimination decreased among 843 Black women (75% to 73%), 601 Black men (80% to 77%), 893 White women (30% to 23%) and 856 White men (28% to 23%). In fixed-effects regression models, controlling for all time-invariant covariates, social desirability bias, and changes in education and parity (women only) over time, an increase in self-reported experiences of racial/ethnic discrimination over time was significantly associated with an increase in waist circumference (β=1.09, 95% CI: 0.00-2.19, p=0.05) and an increase in body mass index (β=0.67, 95% CI: 0.19-1.16, p=0.007) among Black women. No associations were observed among Black men and White women and men. These findings suggest that an increase in self-reported experiences of racial/ethnic discrimination may be associated with increases in waist circumference and body mass index among Black women over time.

John Henryism, Depression, and Perceived Social Support in Black Women

John Henryism, a construct developed to describe high effort coping, may help explain the observed health disparities between Blacks and Whites. Previous research suggests that John Henryism is associated with negative physical health factors. However, little research has focused on the relationship between John Henryism and psychological distress. Accordingly, in this exploratory study, we examined the relationships between John Henryism, psychological distress, and well-being in a diverse sample of Black women. Results indicate that there is a negative correlation between John Henryism and depressive symptomatology. This finding is in contrast to past research and suggests that John Henryism may be maladaptive to physical health but not mental health. The limitations and implications of the findings are discussed.

Racial Discrimination and Depressive Symptoms Among African-American Men: The Mediating and Moderating Roles of Masculine Self-Reliance and John Henryism

Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.

Perceived racial discrimination and mental health in low-income, urban-dwelling whites

This study examined the relationship between perceived racial discrimination and the presence of anxiety and depression in a sample of low-income, urban-dwelling whites. Data were analyzed from a cross-sectional survey of low-income whites living in an inner-city neighborhood in the mid-Atlantic United States. Perceived racial discrimination was reported by 39 percent of participants. Rates of depression in the population exceed prevalence rates in the general U.S. population. Those who perceived racial discrimination and were bothered by it experienced significantly greater odds of being depressed (OR = 2.78, 95% CI 1.60-4.82) and had higher anxiety scores (b = 2.02, SE 0.55, p = 0.000) than those who did not perceive racial discrimination. Low-income, urban white populations have been largely ignored in public health research. This study demonstrates that perceived racial discrimination is common in poor urban whites. Further, exposure to discrimination that is perceived as a stressor is associated with mental illness.

Racial discrimination, response to unfair treatment, and depressive symptoms among pregnant black and African American women in the United States

PURPOSE

To assess the association between self-reported racial discrimination and prenatal depressive symptoms among black women.

METHODS

Our study population consisted of two cohorts of pregnant women: the Asthma Coalition on Community, Environment, and Social Stress project (ACCESS) and Project Viva. We measured self-reported racial discrimination among black women using a modified Experiences of Discrimination scale (score 0-8). We assessed elevated depressive symptoms (EDS) with the Edinburgh Postnatal Depression Scale (≥13 on a 0-30 scale).

RESULTS

Fifty-four percent of ACCESS and 78% of Viva participants reported experiencing racial discrimination. After adjusting for age, marital status, income, education, and nativity, a 1-U increment in Experiences of Discrimination score was associated with 48% increased odds of EDS (odds ratio, 1.48; 95% confidence interval, 1.24-1.76) for ACCESS participants but was not significantly associated among Viva participants (odds ratio, 1.12; 95% confidence interval, 0.92-1.37). In both cohorts, responding to unfair treatment by talking to others was associated with the lowest odds of EDS.

CONCLUSIONS

Our findings suggest that higher levels of perceived racial discrimination may increase depressive symptoms during pregnancy among U.S. black women. Interventions involving talking to others may aid in reducing the risk of depressive symptoms among black women experiencing higher levels of racial discrimination.

Perceived discrimination and DSM-IV-based alcohol and illicit drug use disorders

OBJECTIVES

We examined the relationship between everyday and major discrimination and alcohol and drug use disorders in a nationally representative sample of African Americans and Black Caribbeans.

METHODS

With data from the National Survey of American Life Study, we employed multivariable logistic regression analyses--while controlling for potential confounders--to examine the relationship between everyday and major discrimination and substance use disorders on the basis of Diagnostic and Statistical Manual of Mental Disorders criteria.

RESULTS

Every 1 unit increase in the everyday discrimination scale positively predicted alcohol (odds ratio [OR] = 1.02; P < .01) and drug use (OR = 1.02; P < .05) disorders. Similarly, each additional major discrimination event positively predicted alcohol (OR = 1.10; P < .05) and drug use (OR = 1.15; P < .01) disorders.

CONCLUSIONS

To our knowledge, this study is the first to examine problematic usage patterns rather than infrequent use of alcohol and drugs in a national sample of African American and Black Caribbean adults and the first to examine this particular relationship in a national sample of Black Caribbeans.

Interpersonal discrimination and health-related quality of life among black and white men and women in the United States

OBJECTIVE

We assessed associations between discrimination and health-related quality of life among black and white men and women in the United States.

METHODS

We examined data from the National Health Measurement Study, a nationally representative sample of 3,648 adults aged 35-89 in the non-institutionalized US population. These data include self-reported lifetime and everyday discrimination as well as several health utility indexes (EQ-5D, HUI3, and SF-6D). Multiple regression was used to compute mean health utility scores adjusted for age, income, education, and chronic diseases for each race-by-gender subgroup.

RESULTS

Black men and women reported more discrimination compared to white men and women. Health utility tended to be worse as reported discrimination increased. With a few exceptions, differences between mean health utility scores in the lowest and highest discrimination groups exceeded the 0.03 difference generally considered to be a clinically significant difference.

CONCLUSIONS

Persons who experienced discrimination tended to score lower on health utility measures. The study also revealed a complex relationship between experiences of discrimination and race and gender. Because of these differential social and demographic relationships caution is urged when interpreting self-rated health measures in research, clinical, and policy settings.

Perceived discrimination and cognition in older African Americans

Existing evidence suggests that psychosocial stress is associated with cognitive impairment in older adults. Perceived discrimination is a persistent stressor in African Americans that has been associated with several adverse mental and physical health outcomes. To our knowledge, the association of discrimination with cognition in older African Americans has not been examined. In a cohort of 407 older African Americans without dementia (mean age = 72.9; SD = 6.4), we found that a higher level of perceived discrimination was related to poorer cognitive test performance, particularly episodic memory (estimate = -0.03; SE = .013; p < .05) and perceptual speed tests (estimate = -0.04; SE = .015; p < .05). The associations were unchanged after adjusting for demographics and vascular risk factors, but were attenuated after adjustment for depressive symptoms (Episodic memory estimate = -0.02; SE = 0.01; Perceptual speed estimate = -0.03; SE = 0.02; both p's = .06). The association between discrimination and several cognitive domains was modified by level of neuroticism. The results suggest that perceived discrimination may be associated with poorer cognitive function, but does not appear to be independent of depressive symptoms. (JINS, 2012, 18, 1-10).

Self-reported discrimination and health-related quality of life among Whites, Blacks, Mexicans and Central Americans

This study investigates whether self-reported racial discrimination is related to poor health-related quality of life (HRQoL). Analyses focused on Whites (n = 52,571), Blacks (n = 4,343), Mexicans (n = 12,336), Central Americans (n = 1,504), Multi-ethnic Latinos (n = 1,102), and Other Latinos (n = 1,828) who participated in the 2003 and 2005 California Health Interview survey. Logistic and negative binomial regression was used to examine the association between HRQoL (assessed with the CDC unhealthy days measures) and self-reported racial discrimination. Discrimination was reported by 10% of Whites, 57% of Blacks, and 24-31% of the Latino groups. These reports were associated with increased number of unhealthy days, disability days, and poor self-rated health, even after, controlling for education and other factors. This association did not consistently vary by race/ethnicity. Racial discrimination may be a risk factor for poor HRQoL among diverse groups. Future research should examine the factors that may reduce potential exposure to racial discrimination.

Perceived positive impact of cancer among long-term survivors of childhood cancer: a report from the childhood cancer survivor study

OBJECTIVE

Investigations examining psychosocial adjustment among childhood cancer survivors have focused primarily on negative effects and psychopathology. Emergent literature suggests the existence of positive impact or adjustment experienced after cancer, as well. The purpose of this study is to examine the distribution of Perceived Positive Impact (PPI) and its correlates in young adult survivors of childhood cancer.

METHODS

6425 survivors and 360 siblings completed a comprehensive health survey, inclusive of a modified version of the Post-traumatic Growth Inventory (PTGI) as a measure of PPI. Linear regression models were used to examine demographic, disease and treatment characteristics associated with PPI.

RESULTS

Survivors were significantly more likely than siblings to report PPI. Endorsement of PPI was significantly greater among female and non-white survivors, and among survivors exposed to at least one intense therapy, a second malignancy or cancer recurrence. Survivors diagnosed at older ages and fewer years since diagnosis were more likely to report PPI. Income, education and marital/relationship status appeared to have varied relationships to PPI depending upon the subscale being evaluated.

CONCLUSIONS

The existence and variability of PPI in survivors in this study suggest that individual characteristics, inclusive of race, gender, cancer type, intensity of treatment, age at diagnosis and time since diagnosis, have unique and specific associations with different aspects of perceived positive outcomes of childhood cancer.

The Relationship between Sexual Minority Verbal Harassment And Utilization of Health Services: Results from Countywide Risk Assessment Survey (CRAS) 2004

We examined the prevalence of and associations between sexual orientation-based verbal harassment and reported utilization of health services across levels of sexual orientation in a diverse sample of adult recipients of Los Angeles County-funded HIV-related health and social services. Thirty-two percent reported they had experienced verbal harassment, the majority (80.3%) of whom identified as lesbian, gay, orbisexual. Those who reported being verbally harassed received significantly more services overall than those who were not verbally harassed, and service utilization varied by sexual orientation. These findings inform future efforts to identify and assess social discrimination in health and social service settings.

Taking it like a man: masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men

OBJECTIVES

I examined the association between everyday racial discrimination and depressive symptoms and explored the moderating role of 2 dimensions of masculine role norms, restrictive emotionality and self-reliance.

METHODS

Cross-sectional survey data from 674 African American men aged 18 years and older recruited primarily from barbershops in 4 US regions (2003-2010) were used. Direct and moderated associations were assessed with multivariate linear regression analyses for the overall sample and different age groups. Models were adjusted for recruitment site, sociodemographics, masculine role norms salience, and general social stress.

RESULTS

Everyday racial discrimination was associated with more depressive symptoms across all age groups. Higher restrictive emotionality was associated with more depressive symptoms among men aged 18 to 29 and 30 to 39 years. Self-reliance was associated with fewer depressive symptoms among men aged 18 to 29 years and 40 years and older. The positive association between everyday racial discrimination and depressive symptoms was stronger among men with high restrictive emotionality, but this moderated effect was limited to men older than 30 years.

CONCLUSIONS

Interventions designed to reduce African American men's depression instigated by racism should be life-course specific and address masculine role norms that encourage emotion restriction.

Methods for the scientific study of discrimination and health: an ecosocial approach

The scientific study of how discrimination harms health requires theoretically grounded methods. At issue is how discrimination, as one form of societal injustice, becomes embodied inequality and is manifested as health inequities. As clarified by ecosocial theory, methods must address the lived realities of discrimination as an exploitative and oppressive societal phenomenon operating at multiple levels and involving myriad pathways across both the life course and historical generations. An integrated embodied research approach hence must consider (1) the structural level-past and present de jure and de facto discrimination; (2) the individual level-issues of domains, nativity, and use of both explicit and implicit discrimination measures; and (3) how current research methods likely underestimate the impact of racism on health.

Methods for the scientific study of discrimination and health: an ecosocial approach

The scientific study of how discrimination harms health requires theoretically grounded methods. At issue is how discrimination, as one form of societal injustice, becomes embodied inequality and is manifested as health inequities. As clarified by ecosocial theory, methods must address the lived realities of discrimination as an exploitative and oppressive societal phenomenon operating at multiple levels and involving myriad pathways across both the life course and historical generations. An integrated embodied research approach hence must consider (1) the structural level-past and present de jure and de facto discrimination; (2) the individual level-issues of domains, nativity, and use of both explicit and implicit discrimination measures; and (3) how current research methods likely underestimate the impact of racism on health.

Investigating the Relationship between Perceived Discrimination, Social Status, and Mental Health

A growing body of evidence suggests that experiences with discrimination have implications for mental health and that these associations may vary by social status. We use data from the Chicago Community Adult Health Study (CCAHS) to examine how two types of perceived discrimination, chronic everyday discrimination and major lifetime discrimination, are linked to mental health, and how this association varies by race/ethnicity, gender, and socioeconomic status. Results indicate that everyday discrimination is generally independently linked to greater depressive symptoms, loneliness, and hostility across all social status groups. Major discrimination is not associated with depressive symptoms or loneliness after adjusting for a host of covariates, but is associated with hostility, especially for certain groups. These findings highlight the need to examine multiple indicators of discrimination and mental health, and to pay attention to both differences and similarities in these associations by social status.

Determinants of perceived sexism and their role on the association of sexism with mental health

The authors of this study sought to compare the socioeconomic factors related to perceived sexism in employed and non-employed Spanish women and to examine whether the relationship of perceived sexism with mental health outcomes is reduced when such factors are taken into account. Data were taken from the 2006 Spanish Health Survey, including women aged 20-64 years (n=10,927). Multivariate logistic regression models were used to analyze the independent relationships between socioeconomic variables and perceived sexism and also between perceived sexism and poor mental health. In this latter case, socioeconomic variables were included by blocks in the logistic models. Perceived sexism was higher among employed women (3.9% vs. 2.8% among non-employed) and mainly among those in a managerial position (11.35%; adjusted OR: 2.71, 95% CI: 1.30-5.67) and having irregular working hours (5.5%; adjusted OR: 1.60, 95% CI: 1.10-2.34). Socioeconomic and family characteristics were associated with perceived sexism among women. Perceived sexism was associated with poor mental health, and this remained the case when different independent variables were taken into account. These results highlight the importance of taking into account gender discrimination in different aspects of our society, such as work and family organization, and in planning mental health interventions.

Racial Disparities in Pain Management in Primary Care

This descriptive, cross-sectional, secondary data analysis was conducted to examine racial disparities in pain management of primary care patients with chronic nonmalignant pain using chronic opioid therapy. Data from 891 patients, including 201 African Americans and 691 Caucasians were used to test an explanatory model for these disparities. We predicted that: (1) African American patients would report worse pain management and poor quality of life (QOL) than Caucasians; (2) the association between race and pain management would be mediated by perceived discrimination relating to hopelessness; and (3) poor pain management would negatively affect QOL. Results revealed significant differences between African Americans and Caucasians on pain management and QOL, with African Americans faring worse. The proposed mediational model, which included race, perceived discrimination, hopelessness, and pain management was supported: (1) African Americans compared to Caucasians had higher perceived discrimination, (2) perceived discrimination was positively associated with hopelessness, and (3) higher hopelessness was associated with worse pain management. Further, pain management predicted QOL. This is the first study in which an explanatory model for the racial disparities in pain management of primary care patients with chronic nonmalignant pain was examined. Perceived discrimination and hopelessness were implicated as explanatory factors for the disparities.

Differential effects of perceived discrimination on the diurnal cortisol rhythm of African Americans and Whites

The current study considered the influence of perceived discrimination on the diurnal cortisol rhythm of 50 African American older adults and a matched comparison groups of 100 Whites (M(age)=56.6; 58% female). The role of socioeconomic status (SES) as a moderator of the effects of discrimination on the diurnal decline was also considered for each group. In support of the idea that perceptions of unfair treatment take on a unique meaning for stigmatized minority groups, results suggest that perceived discrimination is associated with a flatter (less healthy) diurnal slope among Whites but a steeper (more healthy) diurnal slope among African Americans. Perceived discrimination was also found to be more strongly associated with a steepening of the diurnal slope among lower SES African Americans than higher SES African Americans.

A Longitudinal Study of Social Status, Perceived Discrimination, and Physical and Emotional Health Among Older Adults

This study examines the relationships between social status, perceived discrimination, and physical and emotional health using a nationally representative sample of 6,377 older adults from the 2006 and 2008 waves of the Health and Retirement Study. About 63% of older adults reported at least one type of everyday discrimination and 31% reported at least one major discriminatory event during lifetime. Blacks, those separated, divorced, or widowed, and those with lower household assets have higher levels of perceived discrimination than Whites, the married or partnered, and those with more assets. Perceived discrimination is negatively associated with changes in health over 2 years, and everyday discrimination has stronger effects than major discriminatory events, especially on emotional health. The effects of perceived everyday discrimination on changes in depressive symptoms and self-rated health are independent of general stress. Efforts to reduce discrimination, including perceptions of discrimination, can be beneficial for health in old age.

Racial discrimination, mood disorders, and cardiovascular disease among black americans

PURPOSE

To examine associations between racial discrimination, mood disorders, and cardiovascular disease (CVD) among Black Americans.

METHODS

Weighted logistic regression analyses were performed on a nationally representative sample of Black Americans (n = 5022) in the National Survey of American Life (NSAL; 2001-2003). Racial discrimination and CVD were assessed via self-report. Mood disorder was measured with the World Health Organization Composite International Diagnostic Interview.

RESULTS

Model-adjusted risk ratios (RRs) revealed that participants with a history of mood disorder had greater risk of CVD (RR, 1.28; 95% confidence interval (CI), 1.12-1.45). This relationship was found specifically among those younger than 50 years of age (RR, 1.56; 95% CI, 1.27-1.91). There was a significant interaction between racial discrimination and mood disorder in predicting CVD in the total (F = 2.86, 3 df, p = .047) and younger sample (F = 2.98, 3 df, p = .047). Participants with a history of mood disorder who reported high levels of racial discrimination had the greatest risk of CVD.

CONCLUSIONS

The association between racial discrimination and CVD is moderated by history of mood disorder. Future studies may examine pathways through which racial discrimination and mood disorders impact CVD risk among Black Americans.

Discrimination, attribution, and racial group identification: implications for psychological distress among Black Americans in the National Survey of American Life (2001-2003)

There is increasing evidence that experiencing discrimination may contribute to poor mental health among Black Americans. However, few studies have distinguished between discrimination attributed to race versus other forms of discrimination or have compared differences in their psychological implications. Using nationally representative data on 5,191 Black Americans in the National Survey of American Life (NSAL; 2001-2003), this study examined serious psychological distress (SPD) in relation to discrimination attributed to racial versus nonracial causes and also investigated whether racial group identification may be a buffer. We found that discrimination was associated with greater odds of SPD, regardless of attribution. Racial attributions were associated with higher odds of SPD compared with attributions to nonracial causes for each level of discrimination. High racial group identification buffered the negative effect of moderate levels of both racially and nonracially attributed discrimination. Our results provide evidence for the negative influence of discrimination on SPD among Black Americans and indicate that high racial group identification may somewhat mitigate their negative mental health effects. Our study suggests that discrimination and racial group identification should be addressed to protect against psychological distress among Black Americans.

Review: Community-based participatory research approach to address mental health in minority populations

In this review, a synthesis of studies employing community-based participatory research (CBPR) to address mental health problems of minorities, strengths and challenges of the CBPR approach with minority populations are highlighted. Despite the fact that minority community members voiced a need for innovative approaches to address culturally unique issues, findings revealed that most researchers continued to use the traditional methods in which they were trained. Moreover, researchers continued to view mental health treatment from a health service perspective.

Associations Between Social Relationships and Emotional Well-Being in Middle-Aged and Older African Americans

Social relationships may enhance emotional health in older age. The authors examined associations between social relationships and emotional health using data from the Milwaukee African American sample of the second Midlife Development in the United States (MIDUS II) study, 2005-2006 ( n = 592). Self-reports indicated good, very good, or excellent emotional health, distinguished from fair or poor. Social relationships were measured by relationship type (family or friend), contact frequency, and levels of emotional support and strain. Control variables included demographic characteristics, types of lifetime and daily discrimination, neighborhood quality, and other social factors. In adjusted results, each increase on a family emotional support scale was associated with 118% greater odds of reporting better emotional health (odds ratio [OR] = 2.18, 95% confidence interval [CI] [1.43, 3.32]). Friend emotional support also was associated with better emotional health (OR = 1.59, CI [1.07, 2.34]). Daily discrimination substantially reduced reported emotional health; family and friend support buffered this effect.

Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators

BACKGROUND

Many details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood.

PURPOSE

The purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators.

METHODS

Asian, Black, and Latino(a) adults (N=734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility.

RESULTS

The association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat.

CONCLUSIONS

Our results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms.

Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born Black Americans

OBJECTIVES

We investigated associations among racial discrimination, psychological distress, and self-rated health among US-born and immigrant Black Americans.

METHODS

We conducted a cross-sectional analysis of a cohort of employed working-class Black Americans (193 US-born, 275 foreign-born).

RESULTS

Both US-born and foreign-born Black participants had high levels of exposure to poverty (51% and 57%, respectively) and racial discrimination (76% and 60%) and reported high levels of severe psychological distress (14% and 16% had a Kessler 6 [K6] score of 13 or greater); 17% and 7% reported fair or poor health. After controlling for relevant covariates, their risk parameters for racial discrimination (high vs no exposure) were 4.0 (95% confidence interval [CI] = 2.3, 5.6) and 3.3 (95% CI = 2.1, 4.5), respectively, for continuous K6 score; corresponding odds ratios for severe psychological distress were 6.9 (95% CI = 1.4, 35.7) and 6.8 (95% CI = 2.5, 18.3). No associations existed between racial discrimination and self-reported health, suggesting that an underlying propensity to report adversity does not account for our psychological distress findings.

CONCLUSIONS

Our results attest to the salience of racial discrimination, nativity, and socioeconomic position in understanding the experiences and psychological health of Black Americans.

The intersection of school racial composition and student race/ethnicity on adolescent depressive and somatic symptoms

Schools are one of the strongest socializing forces in the U.S. and wield considerable influence over individuals' social and economic trajectories. Our study investigates how school-level racial composition, measured by the percentage non-Hispanic white students in a school, affects depressive and somatic symptoms among a representative sample of U.S. adolescents, and whether the association differs by race/ethnicity. We analyzed Wave I data from the US National Longitudinal Study of Adolescent Health, resulting in a sample size of 18,419 students attending 132 junior and senior high schools in 1994/5. After controlling for individual and school characteristics, our multilevel analyses indicated that with increasing percentages of white students at their school, black students experienced more depressive symptoms and a higher risk of reporting high levels of somatic symptoms. After including students' perceptions of discrimination and school attachment, the interaction between black student race and school-level racial composition was no longer significant for either outcome. Our findings suggest that attending predominantly-minority schools may buffer black students from discrimination and increase their school attachment, which may reduce their risk of experiencing depressive and somatic symptoms.

Integration of social epidemiology and community-engaged interventions to improve health equity

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.

Racial/ethnic residential segregation: framing the context of health risk and health disparities

An increasing body of public health literature links patterns of racial/ethnic residential segregation to health status and health disparities. Despite substantial new empirical work, meaningful understanding of the pathways through which segregation operates to influence health remains elusive. The literature on segregation and health was appraised with an emphasis on select conceptual, methodological, and analytical issues. Recommendations for advancing the next generation of racial/ethnic residential segregation and health research will require closer attention to sharpening the methodology of measuring segregation, testing mediating pathways and effect modification, incorporating stronger test of causality, exploring factors of resilience in segregated areas, applying a life-course perspective, broadening the scope of the investigation of segregation to include nativity status in blacks and other racial/ethnic groups, and linking segregation measures with biological data.

Racism, health status, and birth outcomes: results of a participatory community-based intervention and health survey

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.

Exposure to trauma and the clinical presentation of first-episode psychosis in South Africa

OBJECTIVE

To evaluate the relationship between a history of traumatic experiences and the clinical features of first-episode psychosis (FEP).

METHOD

We tested associations between trauma variables and duration of untreated psychosis (DUP), age of onset (AO), PANSS-rated positive and negative symptoms and depressive symptoms (Calgary Depression Scale) in a sample of 54 FEP patients.

RESULTS

Mean DUP was 34.4 weeks, while mean AO was 24.7 years. Witnessing a seriously violent assault (49%) was associated with high positive symptoms (p = 0.002), while a significant personal experience of racism and discrimination (39%) was associated with high depressive (p = 0.042) symptoms. Previous sexual assault (44% of females) was associated with high positive (p = 0.028) and negative (p = 0.035) symptoms with a trend association with depressive symptoms (p = 0.092).

CONCLUSION

Our findings suggest that previous traumatic experience is associated with positive and affective symptoms in FEP.

The association of optimism and perceived discrimination with health care utilization in adults with sickle cell disease

OBJECTIVE

We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD).

METHODS

Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year.

RESULTS

A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization.

CONCLUSIONS

African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.

Does health care setting matter in reports of discrimination?

We investigated the associations between the health care setting types that California adults report as their regular source of care, socioeconomic status, and perceived racial/ethnic medical care-related discrimination. Data were analyzed from the 2005 California Health Interview Survey (n = 36,694). Adults who identified clinics/health centers/hospital clinics or "other settings" as their usual source of health care had increased odds for perceived racial/ethnic discrimination compared with those who utilized private and health maintenance organizations doctors' offices, although this was true only for middle, but not lower or higher, socio-economic respondents. We suggest several explanations for these findings and improvements for assessing health care-based racial discrimination.