The harmful health-related effects of racial discrimination are well documented in the literature. Acting as a toxic stressor, experiences of discrimination have been shown to cause adverse physiological changes leading to complications such as cardiovascular disease, adult-onset asthma, low birthweight deliveries, obesity, and ‘racial battle fatigue‘ – a condition similar to the debilitating stress of soldiers returning from the battlefield. Now, researchers have determined that African Americans and Caribbean blacks who experience multiple types of discrimination are at far greater risk for a variety of mental disorders including anxiety, depression and substance abuse.
The new research — co-authored by professor Christopher Salas-Wright at The University of Texas at Austin’s School of Social Work and published in the August 2014 edition of the journal Addictive Behaviors — suggests that experiences of interpersonal discrimination (prejudice) in the form of disrespect and condescension do not alone appear to significantly increase the risk for most mental disorders. However, hostile and character-based discrimination in combination with disrespect and condescension place African American and Caribbean black adults at considerable risk for mental health problems, the team found.
“When it comes to mental health, our results suggest that the type and frequency of discrimination matters,” says Dr. Salas-Wright. “It seems that it is the ongoing experience of multiple types of discrimination, including disrespect, condescension, hostile and character-based discrimination, which negatively impacts mental health.”
Dr. Salas-Wright co-authored the study with lead researcher Dr. Trenette Clark from the School of Social Work at the University of North Carolina, Chapel Hill, along with co-investigators Dr. Michael G. Vaughn of the College for Public Health and Social Justice at Saint Louis University, and Dr. Keith E. Whitfield of the Center for Biobehavioral Health Disparities Research at Duke University.
The many faces of discrimination
Much of the existing research on racial discrimination and health has conceptualized discrimination as a unidimensional concept. However, more recent studies have shown that racial discrimination is actually a multifaceted, multidimensional phenomenon that manifests in four distinct classes of discrimination:
- Individual racism, defined as actions of a personal, degrading nature that promote inferiority beliefs among minority individuals.
- Cultural racism, which occurs when beliefs of the dominant group are regarded as superior to those of the subordinate group.
- Institutionalized racism, defined as systematic inequality based on race that is reinforced by differential access to societal resources, services, and opportunities.
- Collective racism, which occurs when members of the dominant group work to restrict or deny basic rights and privileges of minority group members.
Individual racism is also referred to as everyday discrimination, meaning that it is experienced in the normal course of daily events for many racial/ethnic minorities. In the same way that the larger concept of discrimination is heterogeneous, everyday discrimination can also be heterogeneous, the researchers say. Likewise, the health-related effects of everyday discrimination are thought to be similarly diverse.
Half of participants experience recurrent discrimination of all types
In the new study, researchers set out with three goals in mind: First, to investigate the types and frequency of experiences of everyday discrimination among African Americans and Caribbean blacks. Next, the team sought to classify participants into categories based on their experiences everyday discrimination. The final step, then, was to look at the effects of these different types of discrimination on the health and well-being of African Americans and Caribbean blacks.
Researchers used data from the National Survey of American Life, a comprehensive survey of the mental health of black and non-Hispanic white populations in the United States funded by the National Institute of Mental Health. Findings are based on a nationally representative sample of 4,462 African American and Caribbean black respondents between 18 and 65 years of age.
The study measured the frequency of perceived discrimination across multiple domains by asking participants questions such as “How often do you receive poorer service than others at restaurants or stores?” (disrespectful discrimination), “How often do people act as if they’re better than you are” (condescending discrimination), “How often are you viewed as dishonest?” (character-based discrimination), and “How often are you threatened or harassed?” (hostile discrimination).
Overall, the vast majority of respondents (83 percent) reported having experienced some type of discrimination during the past year. Using a statistical technique called latent class analysis, the team categorized participants into four classes characterized by the frequency with which they experienced everyday discrimination and the type(s) of discrimination they experienced.
Approximately 17 percent of participants fell into Class 1, labeled the “Low Discrimination” group, which was characterized by very low levels of perceived discrimination across all domains (e.g., frequency of less than once per year). An additional 17 percent of participants were categorized in Class 2 (“Disrespect and Condescension”), which was characterized by recurrent (i.e., at least a few times per year) experiences of disrespectful and condescending discrimination but virtually no experience of hostile or character-based discrimination.
Half (50 percent) of respondents fell into Class 3 (“General Discrimination”), which was characterized by recurrent experiences of discrimination of all types. The final category, Class 4 (“Chronic Discrimination), comprised approximately one-seventh (14.7 percent) of the total sample and was characterized by frequent experiences of discrimination of all types, including disrespectful discrimination at least a few times per month, condescending discrimination at least once per week, and character-based or hostile discrimination at least a few times per year.
Dose-response relationship between discrimination and substance use disorders
Members of these last two groups (Classes 3 and 4) were significantly more likely to report symptoms of major depressive disorder, and to meet the diagnostic criteria for alcohol-use and illicit drug-use disorders, the researchers found.
Furthermore, the analysis revealed a dose-response relationship between everyday discrimination and substance use disorders, meaning that participants who experienced the most discrimination also had the highest risk for the conditions. For instance, risks for alcohol-use and illicit drug-use disorders were approximately 2 to 2.5 times greater among adults who experienced general discrimination and approximately 4 times greater among those who experienced chronic discrimination compared to those in the “Low Discrimination” group.
“Perceived discrimination is an often overlooked but major source of health-related stress, with effects comparable to other major stressors such as the death of a loved one or the loss of a job,” Dr. Clark said. “Our study shows that the risk for mental health and behavioral disorders varies according to the types and frequency of discriminatory experiences.”
Individuals who experience frequent discrimination may turn to drugs and alcohol to cope with the psychological distress associated with experiences of racial discrimination, the researchers explain. However, Dr. Clark adds, “[a]lthough most of our sample reported recent discrimination, most did not report substance use disorders, which speaks to their strength and resilience.”
Past research indicates that factors such as ethnic identity, spirituality or religiosity, and social support may help to protect against the harmful psychological effects of everyday discrimination, the team says. Research also shows that techniques such as cognitive behavioral therapy and stress inoculation training may be an effective approach for reducing some of the negative mental and physical health consequences of experiencing chronic racial discrimination and prejudice.
Furthermore, these same factors have also been shown to mitigate the adverse physical health conditions associated with discrimination. For instance, a study published in March found that emotional support from parents and peers can protect African American youth from stress-related damage stemming from experiences of racism, and may prevent the development of stress-related conditions such as heart disease, high blood pressure, diabetes, and stroke.
Of course, the optimal way to prevent these detrimental effects is to tackle the underlying problem — the racial discrimination that causes damaging levels of psychosocial and physiological stress. To do so, however, requires us to recognize the pervasiveness of the problem, and to counter anyone’s claims that race no longer matters — because we know it does, and this new study is only the latest to document just how much it matters.