Discrimination Matters: Relations of Perceived Discrimination to Student Mental Health

The recent trends in discrimination and health among ethnic minority adolescents: an integrative review

BACKGROUND

Experiences of racial discrimination during adolescence can negatively affect lifelong health. Although many ethnic minority adolescents face discrimination in common worldwide, there are few updated review studies that explored how discrimination affected health status and behavior among ethnic minority adolescents.

METHODS

Comprehensive searches of the PubMed, Embase, PsycINFO, and CINAHL were conducted, integrating keywords about adolescent, ethnic groups, discrimination, and health. The search encompassed articles published between January 2016 and March 2021, following Whittemore and Knafl's integrative literature review method. Quality appraisal was evaluated by the Risk of Bias Assessment Tool.

RESULTS

After conducting the initial screening of 167 studies, eleven studies met the inclusion criteria and were included in the review. More than 80% of the studies were conducted African-American/Black adolescents in the United States. There were clear associations between group discrimination and mental health problems. Discrimination was also linked to the low overall health, high substance use, high emotional eating, and high behavioral problems, and low ethnic identity. Of the six studies investigating gender differences, two each reported that discrimination was linked to higher substance use in boys and stronger internalizing symptoms in girls.

CONCLUSION

This integrative review provides insights into the discrimination experiences of ethnic minority adolescents, with particular implications for mental health, overall health, substance use, and behavioral problems. This review contributes evidence for need of integrative health promotion programs to mitigate racial discrimination against ethnic minority adolescents for health equity.

Relation Between the Negative Cognitive Triad, Perceived Everyday Discrimination, Depressive Symptoms, and TNF-⍺ in Adolescents

Our study is guided by Beck's cognitive stress-vulnerability model of depression. We examined the associations between perceived everyday discrimination (PED) and TNF-⍺, an inflammatory biomarker associated with risk for severe illness, through the negative cognitive triad (NCT; negative thoughts about the self, world, and future) and depressive symptoms in adolescents. We utilized a sample of 99 adolescents (36.4% female; ages 13-16, M = 14.10, SD = 0.52) in our cross-sectional study. We used PROCESS and AMOS to compute regressions and direct, indirect, and total effects of PED, NCT aspects and depressive symptoms on TNF-⍺. Negative views of the self and world mediated between PED and depressive symptoms and that negative views of the self and future mediated between PED and TNF-⍺. In conclusion, Beck's theory can be expanded to physical health providing directions for addressing mental and physical health simultaneously by restructuring adolescents' negative view of the self.

Strategies to overcome mental health stigma: Insights and recommendations from young people with major depressive disorder (MDD)

BACKGROUND

Young people with depression are met with stigma related to their mental health, which exacerbates loneliness, social isolation, and depression symptoms. While disclosing depression could improve one's mental health, stigma can also make social interactions more challenging and reduce the likelihood of receiving treatment. This research explored young people's experiences with stigma and recommendations for addressing it.

METHODS

Semi-structured interviews conducted with N = 35 young people aged 18-25 years (Mage = 20.09) were analyzed with thematic analysis. Participants met the criteria for clinical depression using the Mood and Feelings Questionnaire (score >27) or had recently obtained a medical diagnosis (N = 18) of depression by a medical professional.

RESULTS

Participants faced stigma when deciding to disclose their depression, which fed into a vicious cycle influencing feelings of loneliness, social isolation, and withdrawal. Their recommendations for others to avoid this cycle can be summarized under three main themes: (1) Social affirmation: identify allies and build meaningful connections; (2) Self-affirmation: build a constructive relationship with the self; and (3) Societal affirmation: structural changes are needed.

CONCLUSIONS

The current research indicates that social, self-, and societal affirmation are considered important for reducing the detrimental impacts of stigma. Policies and programs are needed that provide mental health support to young people, and public awareness campaigns that guide young people to appropriate resources (i.e., support and intervention) via governmental public health bodies.

New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey

In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.

Discrimination, cognitive styles, and their associations with adolescents' mental and physical health

This study is based on the hopelessness theory of depression and previous research on perceived everyday discrimination (PED) and both depressive symptoms and Interleukin-6 (an inflammatory cytokine; IL-6) in adolescents. The purpose of this study is to examine the negative attribution, self, and consequence cognitive styles (CSs) proposed in the hopelessness theory as a possible mechanism underlying the association between PED and inflammation in adolescents and expand our understanding of the comorbidities between depressive symptoms and systemic inflammation (IL-6). This cross-sectional study featured a sample of 102 adolescents aged 13-16 (M = 14.10, SD = 0.52) who identified as White (47.5%), Black (41.4%), Mixed Race (7.1%), Latino (2%), and other (2%). Data analysis was conducted using PROCESS to compute regressions and effects between PED, negative CSs, depressive symptoms, and Interleukin-6. Results showed that negative attribution CS is the only negative CS associated with PED, depressive symptoms, and IL-6. Negative attribution CS is also the only negative CS of the three negative CSs that mediates both the association between PED and depressive symptoms and PED and IL-6 in our adolescent sample. Overall, these results indicate that individual negative CSs proposed in the hopelessness theory impact adolescents' physical and mental outcomes differently, which can inform targeted treatments. Nurses should provide cognitive-based interventions and promote societal-level change to reduce the experience and impact of PED on the mental and physical health of their adolescent patients.

Racial Discrimination of Adolescents With Special Healthcare Needs

PURPOSE

Examine racial discrimination of adolescents of color by type of special healthcare need (SHCN).

METHODS

Pooled cross-sectional data of youth over 10 years of age from 2018 to 2020 National Surveys of Children's Health were used (n = 48,220). Rates of discrimination by SHCN diagnoses within racial and ethnic groups were examined.

RESULTS

Adolescents of color with SHCNs were almost twice as likely to experience racial discrimination as peers of color without SHCNs. Asian youth with SHCNs were over 3.5 times likely to experience racial discrimination as peers without. Youth with depression experienced highest rates of racial discrimination. Compared to peers without, Black youth with asthma or a genetic disorder, and Hispanic youth with autism or intellectual disabilities, experienced higher rates of racial discrimination.

DISCUSSION

SHCN status heightens racial discrimination for adolescents of color. However, this risk was not uniform by racial or ethnic group for every SHCN type.

Expanding School-Based Motivational Interviewing Through Delivery by Paraprofessional Providers: A Preliminary Scoping Review

The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.

Influence of perceived discrimination on problematic smartphone use among Chinese deaf and hard-of-hearing students: Serial mediating effects of sense of security and social avoidance

BACKGROUND

Reducing the rate and impact of problematic smartphone use (PSU) among deaf and hard-of-hearing (DHH) students has become a social issue. Research has suggested that perceived discrimination is associated with PSU, although the underlying mechanism of this association for DHH students is not clear.

AIMS

This study explored the mediating roles of sense of security and social avoidance in the association between perceived discrimination and PSU among Chinese DHH students.

METHOD

Five hundred and seventy DHH students, selected through simple random sampling, participated in an online survey, which included measurements of perceived discrimination, sense of security, social avoidance, and PSU. The results were analyzed with SPSS 25.0 and Mplus 7.0.

RESULTS

(1) Perceived discrimination, sense of security, and social avoidance were significantly associated with PSU among DHH students; (2) sense of security and social avoidance played mediating roles separately in the association between perceived discrimination and PSU; (3) sense of security and social avoidance played serial mediating roles in the relationship between perceived discrimination and PSU.

CONCLUSIONS

The findings suggest that discriminatory experiences of DHH students are related to a relatively low sense of security and high social avoidance, which may lead to PSU. The results have important implications for the prevention of and intervention for PSU among DHH students.

Future Directions in Mental Health Treatment with Stigmatized Youth

Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma - defined as laws/policies and norms/attitudes that hurt stigmatized people - have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.

Adolescents’ Characteristics and Peer Relationships in Class: A Population Study

Background: This study aimed to investigate differences in adolescents’ social relationships with classmates of diverse gender, socioeconomic status, immigrant background, and academic achievement. Methods: A population of 10th-grade students (N = 406,783; males = 50.3%; M_age = 15.57 years, SD_age = 0.75) completed the Classmates Social Isolation Questionnaire (CSIQ), an instrument specifically designed to measure two distinct but correlated types of peer relationships in class: peer acceptance and peer friendship. To obtain reliable comparisons across diverse adolescent characteristics, the measurement invariance of the CSIQ was established by means of CFAs and then latent mean differences tests were performed. Results: Immigrant background, academic achievement, and socioeconomic status all proved to be important factors influencing relationships with classmates, while being a male or a female was less relevant. Being a first-generation immigrant adolescent appears to be the foremost risk factor for being less accepted by classmates, while having a low academic achievement is the greatest hindrance for having friends in the group of classmates, a finding that diverges from previous studies. Conclusions: This population study suggests that adolescent characteristics (especially immigrant background, socioeconomic status, and academic achievement) seem to affect social relationships with classmates.

Perceived Epidemic Risk and Depression Symptoms during the COVID-19 Pandemic: The Mediating Role of Security and the Moderation Role of Perceived Discrimination

The 2019 coronavirus disease pandemic has resulted in a significant increase in the incidence and prevalence of mental health problems such as anxiety and depression, posing a threat to peoples' lives and health safety all over the world. Research suggests some potential relationships among perceived risk, discrimination, security, and depression symptoms. However, little attention has been paid to the complex mechanisms of the associations between these variables. This study aimed to examine the mediating role of security and moderation role of perceived discrimination in the prediction of perceived epidemic risk on depression symptoms. Thus, we aimed to identify if perceived epidemic risk is a positive predictor of depression. A cross-sectional study was conducted through an anonymous online survey in China during the COVID-19 pandemic which measured perceived epidemic risk, discrimination, security, and depression symptoms. A total of 3443 valid questionnaires were obtained. The results indicated that depression symptoms were predicted by perceived epidemic risk through the mediating role of security, and this mediating role of security was moderated by perceived discrimination. Specifically, high levels of perceived discrimination may lead to a significant decrease in personal security, thus clustering depressive symptoms. These findings shed light on the influence of the perceived risk of the epidemic on depression symptoms in the context of the epidemic situation, which may help to develop targeted interventions.

African American Children's Racial Discrimination Experiences and Mental Health

The current study examined how African American children's experiences of perceived personal racial discrimination and perceived vicarious racial discrimination were linked with depressive and anxiety symptoms, and whether there were significant sex differences in these relations. The sample included 73 African American children (48% male), ranging from 7 to 12 years of age (M = 8.82, SD = 2.06). Models specified children's personal discrimination and vicarious discrimination as predictors of depressive and anxiety symptoms. Nested model comparisons were also used to examine whether associations varied as a function of children's sex. The current study hypothesized that both forms of discrimination would be associated with greater anxiety and depressive symptoms. Findings indicated that children's personal racial discrimination significantly predicted greater child anxiety symptoms for both boys and girls. No significant sex differences emerged. Neither personal nor vicarious discrimination significantly predicted depressive symptoms. Our findings highlight that racialized experiences occur early in childhood and have important implications for children's mental health.

Perceived Racial/Ethnic Discrimination, Physical and Mental Health Conditions in Childhood, and the Relative Role of Other Adverse Experiences

Adverse childhood experiences (ACEs) are associated with poor health. Childhood experiences of racial/ethnic discrimination and other forms of racism may underlie or exacerbate other ACEs. We explored health-related associations with perceived racial/ethnic discrimination relative to other ACEs, using data from 2016-2019 National Survey of Children's Health, an annual cross-sectional, nationally representative survey. Parent responses for 88,183 children ages 6-17 years with complete data for ACEs (including racial/ethnic discrimination) were analyzed for associations between racial/ethnic discrimination, other ACEs, demographics, and physical and mental health conditions with weighted prevalence estimates and Wald chi-square tests. To assess associations between racial/ethnic discrimination and health conditions relative to other ACEs, we used weighted Poisson regressions, adjusted for exposure to other ACEs, age, and sex. We assessed effect modification by race/ethnicity. Prevalence of other ACEs was highest among children with racial/ethnic discrimination, and both racial/ethnic discrimination and other ACEs were associated with having one or more health conditions. Adjusted associations between racial/ethnic discrimination and health conditions differed by race/ethnicity (interaction P-values < 0.001) and were strongest for mental health conditions among Hispanic/Latino (adjusted prevalence ratio (aPR)=1.62, 95% confidence interval (CI): 1.24-2.10) and non-Hispanic/Latino Asian American (aPR=2.25, 95% CI: 1.37-3.71) children. Results suggest racial/ethnic discrimination and other ACEs are associated with child health conditions, with differences in relative associations by race/ethnicity. Public health efforts to prevent childhood adversity, including racial/ethnic discrimination and other forms of racism could be associated with improvements in child health.

“We’re All Equal” But Not Really: Perceptions of Racial Inequity Among Racial-Ethnic Minoritized Youth in the U.S

Racial-ethnic inequity is deeply entrenched in U.S. social systems, yet adolescents’ voices and understanding around inequity are not often directly examined. The current qualitative study uses focus group data from African American ( n = 21), Chinese- ( n = 17), Indian- ( n = 13), and Mexican- ( n = 17) origin adolescents ( Mage = 12.93 years; SD = 1.23; 51% boys) to provide insight on how youth navigate their attitudes and beliefs about these issues. Using a racial-ethnic socialization lens, we explore proximal (e.g., parents, peers, teachers) and distal (e.g., media, society) ways in which adolescents come to understand racial-ethnic inequity. Three themes characterized adolescents’ discussions. School diversity, of peers and of thought, and messages around egalitarianism were two prominent influences on their perceptions. A third theme related to perceptions of social hierarchies, which appeared to be shaped by stereotypes, peer interactions, and ideas about inequity itself. Emergent themes suggest that the school context is a particularly salient social setting that encompasses multiple sources of socialization (e.g., teachers, classmates, academics, climate), and parents, peers, and the media also play prominent roles.

Developmental Prevention of Prejudice: Conceptual Issues, Evidence-Based Designing, and Outcome Results

This article reviews conceptual and empirical issues on the developmental prevention of prejudice in childhood and adolescence. Developmental prejudice prevention is defined as interventions that intentionally change and promote intergroup attitudes and behavior by systematically recognizing theories and empirical results on the development of prejudice in young people. After presenting a general conception of designing evidence-based interventions, we will discuss the application of this model in the field of developmental prejudice prevention. This includes the legitimation, a developmental concept of change, and the derivation of intervention content and implementation. Finally, we summarized recent evaluations results by reviewing meta-analytical evidence of programs and discuss important issues of future research and practice.

Which Anxiety Symptoms are Associated with Perceived Ethnic Discrimination in Adolescents With an Immigrant Background?

This study assesses the specific anxiety symptoms that are present in the context of perceived ethnic discrimination in 696 (M age = 13.3, σ = .77, 57% girls) seventh and eighth-grade students with immigrant backgrounds from four different Canadian high schools. Multiple hierarchical linear regressions were conducted to determine the association between perceived ethnic discrimination and specific anxiety symptoms. Results demonstrate that perceived ethnic discrimination is significantly associated with more anxiety symptoms, such as panic/somatic, generalized anxiety, social phobia, and school phobia. Findings provide a better understanding of the association between perceived ethnic discrimination and anxiety symptoms reported by adolescents with an immigrant background. These findings could help school-based mental health professionals in the implementation of prevention and intervention measures aimed at reducing specific anxiety symptoms that are often present in the context of perceived ethnic discrimination.

Experiences of cultural clashes at home and ethnic victimization in school: "I live between two cultures, and neither of them understands me"

The present study aims to examine the extent to which adolescents of immigrant background experience acculturative stress (i.e., cultural clashes with parents and ethnic victimization in school) in multiple contexts, and the reasons why such stress takes a toll on their psychological functioning and views of themselves. The analytic sample includes adolescents of immigrant background residing in Sweden (N = 423, M_age = 13.19, SD = 0.51). Cluster analysis revealed five distinct groups of adolescents, based on their reports of cultural clashes with parents and ethnic victimization in school: (1) low on both acculturative stressors, (2) average on both acculturative stressors, (3) high on cultural clashes only, (4) high on ethnic victimization only, and (5) high on both acculturative stressors. Mediation analysis showed that adolescents who experienced cultural clashes at home and who were also victimized by their peers in school reported higher levels of feeling in between cultures than adolescents in all the other clusters (except those high on cultural clashes only), and in turn reported higher levels of depressive symptoms and lower levels of self-esteem. The present study highlights the importance of understanding immigrant youth's experiences across multiple contexts simultaneously in order to develop a holistic perspective on their adjustment and integration processes.

Family cohesion and school belongingness: Protective factors for immigrant youth against bias-based bullying

This study explores the protective effects of family cohesion and school belongingness against the negative consequences of bullying. 481 immigrant and nonimmigrant US middle-school students (Mage = 13.28(0.87), 49% female; 36% ethnic minority) self-reported their experiences being bullied, school belongingness, family cohesion, and socioemotional well-being measured as externalizing, internalizing, and prosocial behaviors. First- or second-generation immigrant youth (n = 72) came from 30 countries in Europe, Asia, Africa, South America, and the Caribbean. Family cohesion served as a protective factor for both immigrant and nonimmigrant youth, but for different outcomes of bullying experiences. For immigrant youth who experienced more bullying, having a more cohesive family was associated with decreased levels of internalizing problems. Additionally, stronger school belongingness and especially family cohesion related to more prosocial behaviors among more frequently bullied immigrant youth. Nonimmigrant youth who experienced bullying, however, reported fewer externalizing problems when they had stronger family cohesion and especially school belongingness. The findings highlight the importance of considering the interacting systems in which immigrant youth are embedded and suggest that family cohesion as a protective factor may work differently for immigrant than for nonimmigrant youth experiencing bias-based bullying.

School Dropout Intention and Self-esteem in Immigrant and Native Students Living in Poverty: The Protective Role of Peer Acceptance at School

The psychological well-being at school of immigrant students living in poverty is currently an understudied topic in developmental psychology. This is an important shortcoming because this population, which is rapidly increasing in many western countries, is in a double minority condition and has a greater risk of experiencing psychological distress at school, in comparison with their native peers. In order to improve our understanding on this issue, the present two-wave study investigated the prospective relationships between peer acceptance and two aspects of well-being at school—intention to drop out of school and negative self-esteem—specifically focusing on the differential effect of having (vs. not having) an immigrant background. The participants were 249 preadolescents and adolescents living in poverty (Mage = 12.76; SDage = 2.34; 41.8% girls; 19.3% immigrants) who were attending educational centres for disadvantaged minors. The poverty status of the participants was an inclusion criterion. A multilinear regression model with multigroup analysis was tested. As expected, the results showed that peer acceptance had a significant negative association with school dropout intentions and negative self-esteem only for immigrants, but not for natives. For immigrant students, the protective effect of peer acceptance was comparable to the stability over time of dropout intention and self-esteem, a result that has promising implications for prevention programs. The applied implications of the study for educational and clinical contexts are discussed.

From social adversity to sympathy for violent radicalization: the role of depression, religiosity and social support

BACKGROUND

Discrepancies among studies suggest that the relation between social adversity and sympathy for violent radicalization (SVR) is multifaceted and may differ according to social context. This paper examines the role of depression, religiosity and social support in the relation between social adversity (i.e., discrimination and exposure to violence) and SVR among college students in Quebec, Canada.

METHODS

A total of 1894 students responded to an online questionnaire posted on the internet of eight colleges. Multilevel analyses were first conducted to account for the clustered nature of the data, followed by mediation and moderation analyses.

RESULTS

First generation migrants reported less SVR than second generation youth and non-immigrants. The mediating and/or moderating role of depression, religiosity and social support was examined through causal inference models. Depression mediated the relation between social adversity and SVR, with depression scores accounting for 47% and 25% of the total effect between discrimination and exposure to violence and SVR scores, respectively. Religiosity and social support moderated the association between social adversity and SVR.

CONCLUSIONS

These results suggest that prevention programs should consider violent radicalization as a systemic issue which involves both minorities and the majority, although the specific balance between risk and protective factors may be influenced by local dynamics. They also question intervention measures targeting specifically migrants or ethno-cultural communities because of the risk of increasing profiling and stigmatization. Prevention programs should prioritize decreasing discrimination in colleges, as well as the provision of psychosocial support to depressed youth who experience social adversity.

School-Based Interventions for Reducing Youths’ Racial and Ethnic Prejudice

Minoritized youth encounter racial and ethnic prejudice and discrimination in a variety of settings, including schools. Prejudice refers to harboring negative attitudes and beliefs toward targeted social groups; discrimination reflects translating those attitudes into actions that marginalize targeted groups. Exposure to racial and ethnic discrimination has been associated with numerous detrimental outcomes for youth, including poorer mental health outcomes and lower levels of academic performance. This article describes the nature of racial and ethnic discrimination encountered by minoritized youth as well as its impact on these populations. It also reviews research on prejudice reduction interventions for youth, with a focus on those interventions designed for school settings. In light of existing research, several policy recommendations support high-quality, evidence-based programming in schools.