Article Archive
July/August 2021

Mental Health: Mental Health and Discrimination — Understanding the Link
By Lindsey Getz
Today’s Geriatric Medicine
Vol. 14 No. 4 P. 6

A new study shows that discrimination plays a role in the risk of developing anxiety disorders.

A growing body of research demonstrates how discrimination can have a negative impact on health. Included is a 2019 review of literature published in Health Services Research that looks at 29 studies showing experiences of discrimination were adversely related to mental health and indicators of physical health. Even more recently, a team led by researchers from Tufts University, University of Minnesota, and Harvard T.H. Chan School of Public Health found that exposure to discrimination plays a significant role in the risk of developing anxiety and related disorders. This was true even after accounting for genetic risks.

According to the first author of the study, Adolfo G. Cuevas, PhD, an assistant professor of community health and director of the Psychosocial Determinants of Health Lab at Tufts’ School of Arts and Sciences, even after controlling for genetic risk for anxiety, depression, and neuroticism, reports of discrimination experiences remained associated with higher scores of anxiety and related disorders.

“There has been a lot of work in the past that has shown compelling evidence that discrimination experiences—such as interpersonal unfair treatment in different social contexts—may be a risk factor for mental health disorders,” Cuevas says. “However, an important question remained unaddressed. That is, does an individual’s genetic susceptibility to anxiety affect their perception of the outside world? In other words, does that genetic liability affect how the person perceives negative interaction?”

According to Cuevas, the discriminatory experiences could range from social interactions in which the individuals felt they were slighted in some way—that they were treated in a less courteous manner—to even more impactful events such as being overlooked for a promotion at work due to race, gender, or sexual identity. By adjusting for these predispositions, researchers can have clearer evidence that experiences of discrimination are indeed risk factors for poor mental health.

To study how these discriminatory interactions influenced mental health, researchers used data from a national probability sample of more than 1,100 noninstitutionalized adults aged 25 to 74. The data came from three self-report scales used to measure discrimination and other forms of social exclusion. These interactions, Cuevas explains, included everyday discrimination (being treated with less courtesy than others), major discrimination (such as being discouraged by a teacher from seeking higher education), and chronic job discrimination (such as having a boss that uses racial or sexual jokes or slurs). Even after accounting for genetic predisposition to anxiety disorders, researchers still found a high degree of interdependence between discrimination and anxiety.

Making Conversations Around Discrimination Part of the Patient Dialogue
Cuevas says that the study findings present an opportunity for clinicians to bring discrimination into the conversation in order to facilitate more effective discussions around mental health.

“The issue of discrimination has not been a central conversation between clinicians and their patients, even when talking about mental health,” he says. “It can admittedly be uncomfortable for some clinicians to talk about how discrimination has impacted their patients, but knowing that discrimination is a prevalent issue, particularly for racial/ethnic minorities, it must become a more regular part of the dialogue. Some studies suggest that around 30% of the population reports experiencing discrimination in some form—and that’s higher for stigmatized groups like people who are nonwhite, women, or those with low socioeconomic status. Without talking about these things, the clinician is missing a major component of someone’s experiences of the world and how it affects their mental health.”

By having a much more open conversation around patients’ experiences with discrimination, Cuevas says, clinicians can potentially open new doors for ways to cope with the stressor and with patients’ mental health.

These findings, he adds, are certainly significant to the older adult population.

“Discrimination is a traumatic experience, and clinicians should be bringing it into conversations about the patient’s overall health,” he continues. “I think in order to fully understand someone’s experience, this cannot be overlooked. Older adults have lived a longer lifespan and are more likely to have been exposed to more discrimination.”

But this could mean that patients of this age group also have more life experience to pull from. This can be extremely valuable information that may even help other patients.

“This age group has likely also found effective ways to cope with these discriminatory experiences and clinicians have an opportunity to obtain valuable wisdom from their patients that can in turn be translated to the wider population,” Cuevas explains.

Clinicians, he says, can also play a significant role on a policy level. As they are on the front lines, they have an opportunity to share what they observe for the purposes of bringing about real change.

“Health care providers are in a unique position to identify the drivers of poor mental health as well as to connect that information with policymakers to find ways to change the system,” Cuevas continues. “We must work toward policies that not only reduce systemic discrimination but also begin to remove stigmas surrounding mental health.”

Looking Ahead
In looking to the future, Cuevas acknowledges that there’s still quite a bit of work to be done concerning how discrimination and mental health intersect.

“Currently, what we’ve accomplished was adjusting for genetic risk,” Cuevas says. “We know that genes do play an important role in mental health—but how does the environment interact with genes? For instance, how much more at risk are people who have been exposed to discrimination and already have a genetic risk factor at play? We have yet to really know.” Cuevas is also researching whether adolescents and young adults exposed to discrimination are at more risk than older adults—and how much a person’s life experiences and developed coping skills come into play, adding that the magnitude of mental health disorders among adolescents and young adults makes these areas of exploration more important than ever.

“Poor mental health, particularly anxiety disorder, impacts an incredibly large portion of our society,” he adds. “Right now, it is estimated that 40 million people have anxiety disorder—and that’s likely an underestimation as it doesn’t even fully account for those that have poor access to health care. These numbers show that the conversations around anxiety and discrimination are incredibly important. If we’re truly going to begin to address anxiety, we need to start talking about the factors that contribute to it in the first place. Discrimination is a big one, and it needs to start becoming part of the mental health conversation now.”

— Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.

A report covering 3,795 incidents received by the Stop AAPI Hate organization has found that anti-Asian discrimination—including acts of violence—is on the rise. Verbal harassment accounted for the majority of the incidents (68.1%), followed by shunning—deliberate avoidance—(20.5%). Physical assault comprises the third-largest category of total incidents at 11.1%, followed by civil rights violations (8.5%) and finally, online harassment (6.8%). In the report, women reported incidents 2.3 times more often than did men.

Experts say these incidents have been on the rise since the start of the pandemic. In fact, Stop AAPI Hate was formed in March 2020 in response to attacks related to perception that Asians were responsible for the COVID-19 outbreak. AAPI is a term used to include both Asian Americans and Pacific Islander Americans. Stop AAPI Hate began as a reporting center to track and respond to incidents of hate, violence, harassment, discrimination, shunning, and child bullying.

A Pew Research Center study reports similar findings. About 3 out of 10 Asian adults (31%) reported being the subject to slurs or jokes because of their race or ethnicity since the start of the pandemic. In addition, a majority of Asian Americans (58%) reported that it was more common for people to share racist views toward their ethnic group since the pandemic began.

It’s believed that more incidents occur than are even reported, meaning these numbers could be even higher. Stop AAPI Hate urges that people act now and begin to mitigate this progression.

Clinicians should be aware of the potential health hazards their Asian American and Pacific Islander American patients may face as a result of discrimination.

— LG