The psychological impact of discrimination on health refers to the cognitive pathways through which discrimination impacts mental and physical health in marginalized, and lower-status groups (e.g. racial and sexual minorities). Research on the relationship between discrimination and health grew in the 1990s, when researchers proposed that persisting racial/ethnic disparities in health outcomes could be explained by racial or ethnic differences in experiences with discrimination. While much research focuses on the interactions between interpersonal discrimination and health, researchers studying discrimination and health in the United States have proposed that institutional discrimination and cultural racism also create conditions that contribute to persisting racial and economic health disparities.
A stress and coping framework is applied to investigate how discrimination influences health outcomes in racial, gender, and sexual minorities, as well as on immigrant and indigenous populations. The research indicates that experiences of discrimination are associated with worse physical and mental health conditions and lead to increased participation in unhealthy behaviors. Evidence of the inverse link between discrimination and health has been observed consistently across multiple population groups and various cultural and national contexts. Such observations have been studied and organized into theoretical frameworks in the field of public health to work towards understanding and achieving health equity.
From discrimination to health
Understanding frameworks There are several models that provide explanation to how stress impacts individuals and understanding on where that stress comes from. Three primary frameworks are the Minority Stress Theory, Allostatic Load, and Social Determinants of Health. Each of these are highly referenced in psychological and health disparities research.
The Minority Stress Theory created by Ilan Meyer describes the added stress experienced by minority groups in both experienced discrimination, and fear of being discriminated against. This stress is higher in groups who experience prejudice and exclusion based on factors such as race, ethnicity, or sexual orientation. With higher levels of stress, these groups are subjected to negative health affects that other people outside of these groups are not.
In Allostatic Load, this framework describes how constant stress and exposure to stressors has harmful repercussions on the body. This refers to both mental and physical health. Similarly, those stressors are more common in minority groups who are subjected to frequent experiences of distress.
One final framework that is beneficial to understanding the psychological impact of discrimination on health is the Social Determinants of Health Model. This brings forward intersectionality and the idea that a person is shaped from their background and is unique to themselves. Categories of gender, race, economic status, environment, etc. are all factors in this model which contribute to an individuals access to health and experience receiving medical care.
Stress response Research conceptualizes discrimination as stress-inducing experiences that have negative consequences on mental and physical health, as well as health behaviors. In experimental studies, stress in response to discrimination has been measured using a range of both psychological (e.g. perceived stress) and physiological (e.g. cardiovascular reactivity) indicators; evidence indicates that this heightened stress response is associated with poorer mental and physical health and impaired decision-making in relation to health behaviors such as substance use or visits to the emergency department.
Some researchers argue that everyday experiences with discrimination can cause chronic and cumulative stress that contributes to physical strain on the body. Instances of discrimination tend to be ambiguous and unpredictable, which research suggests may be particularly harmful. Studies show that anticipating discrimination, experiencing stress as a result of hypervigilance and anxiousness, and ruminating over the experience of discrimination can aggravate and prolong the adverse impacts of discrimination on health.
The impact of discrimination-related stress can be long-term. For example, one study on Black adolescents found that perceived discrimination between age 16-18 predicted stress hormone levels, blood pressure, inflammation, and BMI at age 20. The cumulative physiological impact of chronic stress was demonstrated by the longitudinal study, Brody et al., which showed that greater levels of perceived discrimination during adolescence were linked to heightened allostatic load in early adulthood. Furthermore, the study indicated that protective parenting throughout adolescence acted as a buffer against the detrimental health impacts of stress connected to prejudice.
Health behaviors Discrimination impacts health by inducing negative emotions and lowering self-control, which increases participation in unhealthy behaviors such as smoking, alcohol and substance use, reduced physical activity, and overeating. Research also indicates that discrimination lowers participation in preventative care behaviors, such as cancer screening, diabetes management, and condom use, which are important for maintaining overall health. Disenfranchised groups are concentrated in communities with limited resources due to racial and ethnic residential segregation, an institutional form of discrimination. In addition to exposing people to higher levels of stress and risk-promoting situations, these surroundings frequently lack access to leisure areas, wholesome food alternatives, and high-quality healthcare. This systemic disadvantage emphasizes how social environment shapes personal health chances and choices by reinforcing the connection between discrimination and unhealthy behaviors.
Yin Paradies (2006) conducted a thorough meta-analysis of 138 empirical research and discovered a continuous correlation between self-reported racism and unhealthy behaviors. According to the research, being exposed to racism was substantially linked to higher rates of alcohol and tobacco use, lower levels of physical activity, and lower health care usage. This comprehensive data emphasizes how prejudice not only has an impact on mental and emotional health but also leads to behavioral patterns that jeopardize long-term health results.
Interpersonal discrimination
Measurement Studies assessing the link between interpersonal, or individualized, discrimination and health have been both experimental and observational in nature. Studies have explored this relationship by manipulating perceptions of discrimination in a number of ways, including exposing participants to racist film clips, asking them to write about their prior experiences with discrimination, and providing them with articles detailing discrimination against their ingroup. Observational studies make use of large datasets such as the National Survey of Black Americans and the New Zealand Health Survey to make deductions about the relationship between discrimination and health.
In several cases, perceived discrimination is measured by asking participants to self-report on the frequency with which they experience discrimination daily (chronic); the number of times that they've been the target of severe discrimination (acute); the amount of discrimination experience over their lifetime (lifetime); or whether they had recently experienced discrimination (recent). Various scales have been developed to capture different types of discrimination, with over 90% of scales designed by researchers in the U.S. Racism, for instance, is often measured using the Perceived Racism Scale, the Schedule of Racists Events, the Index of Race Related Stress, and the Racism and Life Experiences Scale.
Across studies, there is consistent evidence for the negative impact of discrimination on mental health and health-related behaviors, but a meta-analysis by Elizabeth Pascoe and Laura Richman Smart in 2009 examined 134 samples which show evidence of an inverse link between discrimination and physical health. Comparisons between the impact of chronic, lifetime, and recent experiences of discrimination on mental health shows recent discrimination to have a stronger negative impact than lifetime discrimination; differences in impact based on type of discrimination measured were absent for physical health.
Mental health A meta-analysis of over 300 articles published between 1983 and 2013 finds evidence of a strong association between discrimination and poor mental health. According to the research, there was a substantial increase in psychological distress, sadness, anxiety, and other signs of poor mental health among those who reported experiencing racial prejudice. The study's conclusions, which highlight the ways in which interpersonal and systemic discrimination fuel health inequalities among racial and ethnic groups, lend credence to the expanding understanding of racism as a significant social predictor of health. This meta-analysis supports the claim that racism has real, detrimental consequences on mental health and that systemic measures are required to address racial disparities in healthcare, policy, and society at large by methodically analyzing data from several research. Specifically, perceived discrimination has been linked to a range of mental health outcomes including depression, anxiety, posttraumatic stress disorder, psychological distress, positive and negative affect, and general well-being. Self-reported discrimination has also been linked to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) psychological disorders such as psychosis, paranoia, and eating disorders. Some studies suggest that the relationship between perceived discrimination and clinical mental illness becomes stronger as perceptions of discrimination and instances of experienced discrimination increases. A meta-analysis conducted by Pascoe and Richman Smart in 2009 concluded that the link between discrimination and mental health is a broad phenomenon, with targets of discrimination experiencing poorer mental health regardless of ethnicity or gender. Additionally, the research demonstrated that unfavorable psychological consequences, such as elevated anxiety, psychological distress, and depressive symptoms, were consistently linked to perceived prejudice. The investigators also indicated that stress reactions and coping mechanisms had a role in mediating these effects, underscoring the influence of both behavioral and physiological processes on health outcomes.
However, a more recently published meta-analysis, whose samples were primarily U.S. based, finds evidence of a moderating effect of ethnicity, such that the link between discrimination and mental health appears to be stronger in Asian Americans and Latino Americans, as compared to Black Americans. The protocol itself, Paradies et al. (2013), does not provide results, but it does point out that previous studies show differences in the ways that various racial and ethnic groups encounter and absorb racism, which might influence their psychological reactions. According to the authors, certain groups, such as Asian Americans and Latino Americans, may react to prejudice with increased psychological discomfort because of things like cultural stigma around mental health, acculturation variations, or different coping mechanisms. This implies that ethnicity may serve as a moderating factor, influencing how much discrimination affects mental health outcomes. Aiming to further investigate these complex impacts, the proposed meta-analysis highlights the necessity of subgroup studies in order to comprehend the diversity of experiences among racial and ethnic minorities in the United States.
Physical health