Summary: Data from a new study shows experiencing discrimination every day is associated increased likelihood of receiving higher scores on tests for depression and anxiety compared to people who don’t experience discrimination every day.
Key Points:
- Researchers designed the study Discrimination, Depression, and Anxiety Among US Adults to assess the impact of discrimination on various demographic groups
- Black people and multiracial people reported the highest levels of daily discrimination
- Asian people and White people reported the lowest levels of daily discrimination
- The American Psychological Assocation (APA) labels discrimination is a public health issue
Measuring the Impact of Discrimination on Mental Health
In the study, the research team examined records from over thirty thousand participants in the United States National Health Information Survey, and used reliable, verified statistical methods to make generalizations that apply to our entire adult population of roughly two hundred sixty million people.
The team used the following standard psychiatric diagnostic tools to assess depression and anxiety:
- Depression: Patient Health Questionnaire-2 (PHQ-2)
- Anxiety: Generalized Anxiety Disorder-2 (GAD-2)
To assess the experience of discrimination, they used the 5-Item Daily Discrimination Scale. The daily discrimination scale measures levels of discrimination by asking the following questions:
- How often are you treated with less courtesy or respect than others?
- How often do you receive poorer service at restaurants or stores compared to others?
- How often do people act as if they think you are not smart?
- How often do people act as if they are afraid of you
- How often are you threatened or harassed?
Choices included: 0 – never, 1 – less than once a year, 2 – a few times a year, 3 – a few times a month, and 4 – at least once a week. Low levels of discrimination were associated with scores of 1-10, while high levels of discrimination were associated with scores of 11-20, while a score of (0) was associated with no experience of discrimination.
That’s how they conducted the study:
- Collected data from 30,000 people
- Assessed levels of depression, anxiety, and discrimination
- Analyzed impact of demographic factors such as race, gender, and income
Before we take a look at what they found, let’s clarify what we mean when we say discrimination and what it has to do with physical and mental health.
Discrimination and Health
The American Psychological Association (APA) defines discrimination as follows:
Discrimination is the unfair or prejudicial treatment of people and groups based on characteristics such as race, gender, age, or sexual orientation.
Here’s the first thing to know about discrimination in the United States:
Most forms of discrimination are illegal.
The following two laws protect people in the United States from employment discrimination and housing discrimination:
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- Passed in 1968
- Prohibits discrimination in sale, rental, or financing of housing based on race, color, national origin, religion, sex, familial status, and disability.
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- Passed in 1964
- Prohibits discrimination in voting, public accommodations, public facilities, education, and any federally assisted programs based on race, color, national origin, religion, sex, familial status, and disability.
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- Passed in 1967
- Prohibits discrimination in employment based on age.
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- Passed in 1990
- Prohibits discrimination in employment, government services, public transportation, public businesses, and communication/telecommunication based on disability status.
While this article is primarily about interpersonal discrimination in noninstitutional settings, it’s important to understand that as a country, we’ve passed laws banning any type of official discrimination enacted by our government or businesses that offer public services. The APA offers another important insight about discrimination:
Discrimination is a public health issue.
Here are several basic facts about the prevalence of discrimination in the U.S.:
- 81% of American Indian/Alaska Natives report daily interpersonal discrimination
- 76% of Black people report daily interpersonal discrimination
- 74% of Asian American people report daily interpersonal discrimination
- 72% of Hispanic people report daily interpersonal discrimination
- 71% of Black people report daily interpersonal discrimination
- 39% of black men report being unlawfully discriminated against by police, including being illegally stopped/pulled over, searched, questioned, physically threatened, and physically abused.
- 23% of LGBTQIA+ people report being unlawfully discriminated against by police, including being illegally stopped/pulled over, searched, questioned, physically threatened, and physically abused.
That’s why our nationwide commitment to diversity, equity, and inclusion is essential. Although we’ve taken steps on the long road toward eliminating discrimination in the U.S., the data above show us we’ve still got a long way to go.
Now we’re ready to look at the data on the impact of discrimination on mental health. Specifically, on likelihood of experiencing increased levels of depression and anxiety.
The Impact of Experiencing Discrimination on Depression and Anxiety
First, let’s look at the levels of discrimination experienced by different ethnic groups. These percentages refer to discrimination based on the five-question scale we share above.
Experience of Discrimination, By Race/Ethnicity: Low or High Levels?
Asian:
- Low: 50%
- High: 2.1%
Black:
- Low: 58%
- High: 8.6%
Hispanic/Latino:
- Low: 44%
- High: 3.1%
White:
- Low: 53%
- High: 2.9%
Multiracial/Other:
- Low: 59.6%
- High: 6.4%
Those results show the highest levels of high daily discrimination appear among Black people and Multiracial people, while the lowest levels of high daily discrimination appear among Asian people and White people.
The highest levels of low daily discrimination also appear among Multiracial and Black people, while the lowest levels of low daily discrimination also appear among Asian people and White people.
Now let’s learn how the experience of daily discrimination affects levels of depression and anxiety, as measured by the two metrics we list above.
Low/High Exposure to Discrimination: Impact on Depression, Anxiety:
Odds Ratio (OR) and Percentage
Depression
Low and high exposure to discrimination were associated with increased odds of positive screening results for depression:
- Low exposure: OR 2.2, 69% increased risk
- High exposure: OR 5.4, 84% increased risk
Anxiety
Low and high exposure to discrimination were associated with increased odds of positive screening results for anxiety:
- Low exposure: OR 1.97, 66% increased risk
- High exposure: OR 4.98, 84% increased risk
Co-occurring Anxiety and Depression
Low and high exposure to discrimination were associated with increased odds of positive screening results for co-occurring anxiety and depression:
- Low exposure: OR 2.60, 72% increased risk
- High exposure: OR 8.84, 89% increased risk.
We’ll discuss these results below.
Experiencing Discrimination Can Increase Likelihood of Depression and Anxiety
From what we see above, it’s clear that the results of the study show the daily experience of daily discrimination is associated with significant increases in rates of depression and anxiety, compared to people who have no experience of daily discrimination in their lives.
Here’s a helpful way to understand these outcomes. With every single unit increase in the experience of discrimination:
- Likelihood of depression increased by 15%
- Likelihood of anxiety increased by 14%
- For co-occurring depression and anxiety, likelihood increased by 19%
The data clearly show that discrimination has a negative impact on mental health, specifically on depression and anxiety. This new information can help us help our patients during our intake and assessment process. If we add questions about the experience of daily discrimination, and use the responses to calibrate our understanding of each individual patient, then we can create treatment plans more directly tailored to their individual needs, and offer a truly comprehensive and holistic treatment experience that addresses all the factors involved, including discrimination.
Gianna Melendez
Jodie Dahl, CpHT