The Impact of Discrimination on Mental Health

Source

Informatio

Health Services Research (NIH)

David R Williams, Jourdyn A Lawrence, Brigette A Davis, Cecilia Vu

• Review of 29 other studies
• Discrimination affects physical health, disease, health behaviors, utilitarian of care, adherence to medical regimes.
• Discrimination also may affect children and adolescence mitigated by psychosocial resources
• Emerging risk factor for disease
• Contributor to racial health disparities
• Need to research effective interventions
• Racial disparities in health large, pervasive and persistent – affecting both onset of disease and severity
• Cultural racism embeds inferiority of nonwhites into belief systems that devalue and marginalize. Lessens support for egalitarian policies, triggers damaging psychological responses and restricts access to healthcare.
• Structural racism: reduce opportunities and resources for stigmatized groups, including radial segregation, forced removal to reservations, segregation,
• Individual racism: differential treatment by individuals and institutions – rentals, buying homes and cars, medical care, hailing taxis. Stark inequalities remains.
• Effect of self-reported discrimination reflected in brain activity
• Analyzed 29 out of 1,289 studies screened
• Health risks included, depression, distress, anxiety, hostility, anger, blood pressure, substance use, smoking, polysubstance use, stress, self-esteem, self efficacy, well being, PTSD, generalized anxiety, eating disorders, suicide, diabetes, weight, mood disorders, obesity, heart disease risk factors, risky sex behavior,
• International evidence – cross national studies
• Area of study only three decades old – but evidence growing

Pediatrics:

ARTICLES

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DECEMBER 01 2021

Discrimination and Subsequent Mental Health, Substance Use, and Well-being in Young Adults 

Pediatrics

(2021) 148 (6): e2021051378.

https://doi.org/10.1542/peds.2021-051378

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OBJECTIVES

Discrimination has been shown to have profound negative effects on mental and behavioral health and may influence these outcomes early in adulthood. We aimed to examine short-term, long-term, and cumulative associations between different types of interpersonal discrimination (eg, racism, sexism, ageism, and physical appearance discrimination) and mental health, substance use, and well-being for young adults in a longitudinal nationally representative US sample.

Yvonne Lei, BA , Vivek Shah, BA, BS, Christopher Biely, MS; Nicholas Jackson, PhD, MPH (et all)

• Discrimination (especially racism, sexism) associated with stress, poor health, psychological distress, psychiatric diagnosis, increased substance use.
• Effect cumulative over the life course
• 75% of lifetime mental disorders present by age of 24
• Long-running national sample PSID and TAS
• Relied on Everyday discrimination Scale (questions like, how often were you treated with less courtesy, receive poorer service, treated as though you were stupid, others were afraid of you, others acted superior to you…)
• 1834 participants ages 18 to 28
• 93% reported some discrimination including 93% of whites, 91% of blacks, — 26% ageism, 19% physical appearance, 14% sexism, 13% racism.
• Higher levels of discrimination assorted with languishing, psychological distress, severe psychological distress, drug use, poor health,
• Study suggests discrimination has long term association with mental health and treatment.
• HEALTH + BEHAVIOR

Discrimination can be harmful to your mental health

UCLA experts view mental health status of victims as a public health concern

• Decades of research shows link to stress-related disorders, anxiety and depression…(Vickie Mays, UCLA health professor)
• Affects parenting
• 2007 study by Gilbert Gee found clear link to mental health disorders
• 70% of Latino and Asian immigrants in California they face workplace discrimination, according to UCLA study. Affects health and well-being.
• 2014 study found discrimination among Latinos increased risk of alcohol abuse in women and drug abuse in men.
• 2015 study of 300 global studies found consistent link with poor mental health.
• Brain scan while people read their own statements about discrimination found activity in the part of the brain controlling emotion and stress.
• UCLA study of 1800 young Americans found the more discrimination people reported the higher their risk of mental health and behavioral challenges.
• Study: discrimination over time changes the way the brain processes information, including areas responsible for decision-making and planning.

NAMI – analysis of discrimination against people with mental health conditions

• Medicaid and Medicare discriminate against people with mental health conditions. For instance, Medicaid funding prohibited for non-elderly patients in psychiatric care facility with more than 16 beds Medicare limited to 190 days of lifetime inpatient care. No similar limitation for other illnesses.
• Health insurance refuses to cover certain medications – especially for mental health conditions.
• People with SMI die 25 years sooner than general population – mostly from conditions in which health care discrimination plays a role. Doctors and nurses often attribute physical symptoms to mental illness – rather than correct diagnosis.
• Study: health care providers think mental health patients less likely to adhere to treatment – and so less likely to refer to a specialist or refill medications.
• Under and un-employment rates much higher than general population.
• More likely to be perceived as incompetent and less promotable – and receive lower wages and less access to promotion.
• Less likely to get response to inquiry about housing, notice a unit is available, or invited to inspect an available unit.
• Higher rates of incarceration, lack of treatment when incarcerated, and after being books stay 2-3 times longer in pretrial and face longer sentences. Less likely to make parole – more likely to die by suicide.
• Three times as many SMI housed in jails as in hospitals – but only one in three receive any treatment in detention.

Translational Psychiatry (2022)

Effects of Social Isolation and Discrimination on Mental Health:

• Animal models: social isolation activates hypothalamic-pituitary-adrenal axis and interacts with neurotransmitter system, producing long-term reductions in serotonin and dopamine receptor sensitivity.
• Children vulnerable to long-lasting effects of social isolation and discrimination stress on the developing brain.
• Isolation has short and long-term effects, indicating importance of social inclusion and outreach with telemedicine and digital interventions for mental health care.
• Infants display altruistic attempt to help even strangers, but over time provide offers of assistance only to people who may return the favor – like parents. May explain why social isolation linked to mood disorders, psychosis, drug dependence. Especially children suffering neglect.
• Meta analysis in 2015 found line between racism and poorer mental health – including depression, anxiety and stress. Effect was twice as great for mental health as for physical health.

Mental health stigma across cultures:

Cureus – open access journal

• Stigma, prejudice, discrimination, significant impediment to psychiatric care but is pervasive in all aspects of care: delayed treatment, increased morbidity, diminished quality of life.
• Studies show the effect across different societies – depending on who is stigmatized – women, certain minorities, religious groups –
• Asian cultures see mental health issues as sign of weakness or failure of self-control – a loss of face and shame for the family.
• African cultures in some cases attribute mental illness to a curse or possession by evil spirits, leading to high level of stigma.
• Arab cultures see mental illness as divine punishment, leading to stigma and delay in seeking treatment.
• Latin American Cultures attribute mental illness to personal weakness and lack of will power.
• Western cultures suggest people with mental illness are dangerous or unpredictable – resulting in exclusion and discrimination.
• Some native American cultures link mental illness to ghost sickness, characterized by terror, weakness, sense of impending doom – linked to the supernatural.
• Conclusion: “stigma is a complex and pervasive issue that affects individuals with mental illness across ethnic and cultural contexts…” need to develop cultural sensitivity to reverse the stigma.

American Psychiatric Association:

• More than half of people with mental disorders receive no treatment
• People delay or avoid treatment due to fear of stigma and discrimination.
• Studies show people accept the “disease” model – but still have a negative view of people with a mental health disorder.
• Public stigma and self-stigma both play a role.
• Cultural barriers to seeking help, like shame in Asian cultures and distrust of the medical system in black culture.
• Effects of stigma include reluctance to seek treatment, isolation, lack of understanding by family and friends, trouble finding housing, treatment, insurance, belief you’ll never succeed at anything.
• Family and friends also face stigma – blaming themselves, fear of rejection, reluctance to seek care.
• Poll: 48% say cant discuss mental health with a supervisor, 52% say they don’t feel comfortable using mental health services from employer, 36% worry about retaliation if they take time off – but those numbers have improved since 2020.
• Actions to reduce stigma:
  • Talk openly about mental health, such as sharing on social
  • Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences. Be conscious of language – remind people that words matter.
  • Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or
  • Show compassion for those with mental illness.
  • Be honest about treatment – normalize mental health treatment, just like other health care treatment.
  • Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.
  • Choose empowerment over shame – “I fight stigma by choosing to live an empowered life. To me, that means owning my life and my
  • story and refusing to allow others to dictate how I view myself or how I feel about ” – Val Fletcher.
  •  

American psychological association website:

Impact of discrimination:

• 70% of adults say they’ve experienced discrimination
• Linked to anxiety, depression, stress
• 61% experience day to day discrimination
• People with a disability twice as likely to report discrimination.
• Most common complaints related to employment
• Includes police stops, neighbors, teachers, healthcare
• –39% black men vs 19% of all men report unfair police treatment
• 35% of Asian men vs 24% of all men report unfairly denied promotion.
• 34% Asians, 23% blacks, 19% blacks, 11% whites report slights almost every day or at least once a week.
• 71% blacks, 64% Asians, 56% Hispanics blame race – but 33% of whites blame age.
• 23% LGBT say they’ve been unfairly stopped or treated by police. 33% being unfairly not hired and 24% are discouraged by a teacher to continue their education.
• Younger adults are most likely to report discrimination including 75% millennials, 72% Gen Xers, 67i% boomers, 56% matures.
• 34% of women cite gender, 8% of men.

n from source here.