This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

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Discrimination and racial disparities in health: evidence and needed research

ContextSuicide is a leading cause of death in the United States, but identifying
persons at risk is difficult. Thus, the US surgeon general has made suicide
prevention a national priority. An expanding body of research suggests that
childhood trauma and adverse experiences can lead to a variety of negative
health outcomes, including attempted suicide among adolescents and adults.ObjectiveTo examine the relationship between the risk of suicide attempts and
adverse childhood experiences and the number of such experiences (adverse
childhood experiences [ACE] score).Design, Setting, and ParticipantsA retrospective cohort study of 17 337 adult health maintenance
organization members (54% female; mean [SD] age, 57 [15.3] years) who attended
a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997)
and completed a survey about childhood abuse and household dysfunction, suicide
attempts (including age at first attempt), and multiple other health-related
issues.Main Outcome MeasureSelf-reported suicide attempts, compared by number of adverse childhood
experiences, including emotional, physical, and sexual abuse; household substance
abuse, mental illness, and incarceration; and parental domestic violence,
separation, or divorce.ResultsThe lifetime prevalence of having at least 1 suicide attempt was 3.8%.
Adverse childhood experiences in any category increased the risk of attempted
suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted
suicide during childhood/adolescence and adulthood (P<.001).
Compared with persons with no such experiences (prevalence of attempted suicide,
1.1%), the adjusted odds ratio of ever attempting suicide among persons with
7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1).
Adjustment for illicit drug use, depressed affect, and self-reported alcoholism
reduced the strength of the relationship between the ACE score and suicide
attempts, suggesting partial mediation of the adverse childhood experience–suicide
attempt relationship by these factors. The population-attributable risk fractions
for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and
childhood/adolescent suicide attempts, respectively.ConclusionsA powerful graded relationship exists between adverse childhood experiences
and risk of attempted suicide throughout the life span. Alcoholism, depressed
affect, and illicit drug use, which are strongly associated with such experiences,
appear to partially mediate this relationship. Because estimates of the attributable
risk fraction caused by these experiences were large, prevention of these
experiences and the treatment of persons affected by them may lead to progress
in suicide prevention.

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Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span Findings From the Adverse Childhood Experiences Study

Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people. We conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes. Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54–2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51–4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97–5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88). LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.

/pdf/a-systematic-review-of-mental-disorder-suicide-and-4nfjmodyug.pdf

A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

/pdf/racism-as-a-determinant-of-health-a-systematic-review-and-5b9bfaoy6w.pdf

Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

Past research suggests that children who experience multiple transitions in family structure may face worse developmental outcomes than children raised in stable two-parent families and perhaps even children raised in stable, single-parent families. However, multiple transitions and negative child outcomes may be associated because of common causal factors such as parents' antecedent behaviors and attributes. Using a nationally-representative, two-generation longitudinal survey that includes detailed information on children's behavioral and cognitive development, family history, and mother's attributes prior to the child's birth, we examine these alternative hypotheses. Our results suggest that, for white children, the association between the number of family structure transitions and cognitive outcomes is largely explained by mother's prior characteristics but that the association between the number of transitions and behavioral outcomes may be causal in part. We find no robust effects of number of transitions for black children.

Family Instability and Child Well-Being

This report is an examination of a theoretical model of risk amplification within a sample of 255 homeless and runaway adolescents. The young people were interviewed on the streets and in shelters in urban centers of four Midwestern states. Separate models were examined for males (n = 102) and females (n = 153). Results indicated that street experiences such as affiliation with deviant peers, deviant subsistence strategies, risky sexual behaviors, and drug and/or alcohol use amplified the effects of early family abuse on victimization and depressive symptoms for young women. These street adaptations significantly increased the likelihood of serious victimization over and above the effects of early family history for both young men and women. Similarly, street behaviors and experiences increased the likelihood of depressive symptoms for young women over the effects of early family abuse, but not for young men. The risk-amplification model from the life course theoretical perspective is discussed as an example of the cumulative continuity of maladaptive behaviors.

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A risk-amplification model of victimization and depressive symptoms among runaway and homeless adolescents.

This developmental study uses event history analysis to investigate the effects of established predictors of early coitus on a sample of 457 rural European American adolescents who experienced sexual intercourse for the first time in the 8th 9th or 10th grade. Analyses were run for separate variables to isolate change in individual predictors across time when controlling only for the effects of family structure pubertal development and gender. The significant main effects for early intercourse and interactions with gender and grade level were then entered into a final model to assess the relative strength of each predictor when controlling for other significant factors. Results indicate a significant decrease in the effect of mother monitoring by the 10th grade. Depressed affect increased the likelihood of early intercourse among young women but not young men. Results for the full model suggest that when controlling for all other influences the primary predictors of early intercourse were age opportunity (being in steady relationship) sexually permissive attitudes association with delinquent peers and alcohol use.

Early Adolescent Sexual Activity: A Developmental Study

This study used a high-risk population of runaway and homeless adolescents to investigate the effects of a history of caretaker abuse and deviant subsistence strategies on victimization among adolescents. Based on a multisite sample of 974 homeless and runaway adolescents, logistic regression models were used first to examine factors predicting involvement in sexual and nonsexual deviant subsistence strategies and then to investigate the effects of deviant subsistence strategies on physical and sexual victimization when adolescents were on the streets. Results indicated that when controlling for all other factors, including histories of physical and sexual maltreatment in families of origin, street behaviors, sexual orientation, and informal support systems, engaging in nonsexual deviant subsistence strategies increased the likelihood of physical victimization more than two times. Engaging in sexual deviant subsistence strategies increased the likelihood of sexual victimization almost four times. The resu...

/pdf/deviant-behavior-and-victimization-among-homeless-and-48y6r39toi.pdf

Deviant Behavior and Victimization Among Homeless and Runaway Adolescents

This study examined correlates of suicidal ideation among 212 American Indian youth who lived on or near three reservations in the upper Midwestern United States. The youths were, on average, 12 years old, and 9.5% reported current thoughts about killing themselves. Females were over 2 times more likely than males to think about suicide. Multivariate logistic regression results indicated that gender, enculturation, negative life events, perceived discrimination, self-esteem, and drug use were related to the likelihood of thinking about suicide. Drug use was the strongest correlate of suicidal ideation, and both enculturation and perceived discrimination emerged as important culturally specific variables. It was suggested that suicide prevention programs should draw on the strengths of American Indian culture.

https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=2091&context=rtd

Suicidal Ideation Among American Indian Youths

This study considers variables that best distinguish among attempters, ideators, and nonsuicidal youth in a sample of 527 homeless and runaway adolescents from four Midwestern states. Univariate results indicate that attempters are significantly more likely than ideators and nonsuicidal youth to have experienced physical or sexual abuse by an adult caretaker, to have experienced sexual victimization while on their own, and to have a friend who attempted suicide. Multivariate analyses reveal five variables that best distinguish among the three groups: self-esteem, depression, physical abuse, sexual abuse, and having a friend who attempted suicide. Further analysis suggests that the accumulation of these risk factors greatly increases the chance that these youth will engage in suicidal behavior.

Kevin A. Yoder

Papers

A risk-amplification model of victimization and depressive symptoms among runaway and homeless adolescents.

Early Adolescent Sexual Activity: A Developmental Study

Deviant Behavior and Victimization Among Homeless and Runaway Adolescents

Suicidal Ideation Among American Indian Youths

Comparing Suicide Attempters, Suicide Ideators, and Nonsuicidal Homeless and Runaway Adolescents