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Journal Article•DOI•

The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.

Ronald C. Kessler1, Kristin D. Mickelson, David R. Williams•
Harvard University1
01 Sep 1999-Journal of Health and Social Behavior (J Health Soc Behav)-Vol. 40, Iss: 3, pp 208-230
TL;DR: Results show that perceived discrimination is common in the total population, and given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.
Abstract: The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.
Citations
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Journal Article•DOI•
Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence

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Ilan H. Meyer1•
Columbia University1
01 Sep 2003-Psychological Bulletin
TL;DR: It is shown that LGBs have a higher prevalence of mental disorders than heterosexuals and a conceptual framework is offered for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems.
Abstract: In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications. The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating— even equating— claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental

8,696 citations

Journal Article•DOI•
Perceived discrimination and health: a meta-analytic review.

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Elizabeth A. Pascoe1, Laura Smart Richman1•
Duke University1
01 Jul 2009-Psychological Bulletin
TL;DR: Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health.
Abstract: Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.

3,278 citations

Cites background from "The prevalence, distribution, and m..."

  • ...Examination of the funnel plot suggested that these studies were representative of both positive and negative stress responses....

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  • ...…sufficient data for meta-analyses, we could not examine this relationship quantitatively (T. Brown et al., 2000; Gee, Spencer, Chen, Yip, & Takeuchi, 2007; Karlsen & Nazroo, 2002; Kessler et al., 1999; Loo et al., 2001; Mays & Cochran, 2001; Seifert, Bowman, Heflin, Danziger, & Williams, 2000)....

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  • ...We also determined whether the type of perceived discrimination had an influence on our outcomes of interest....

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  • ...2007) or as effects of lifetime discrimination and day-to-day discrimination are compounded (Kessler et al., 1999)....

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  • ...These analyses suggest that the negative relationship between perceived discrimination and health is robust, even when controlling for potential confounding variables....

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Journal Article•DOI•
Discrimination and racial disparities in health: evidence and needed research

[...]

David R. Williams1, Selina A. Mohammed2•
Harvard University1, University of Washington2
01 Feb 2009-Journal of Behavioral Medicine
TL;DR: Advancing the 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.
Abstract: 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.

2,688 citations

Cites background or result from "The prevalence, distribution, and m..."

  • ...Banks et al. (2006) 570 Blacks Cross-sectional Anxiety & depressive symptoms Positive association Beiser and Hou (2006) 647 SE Asian refugees Cross-sectional Depressive symptoms Positive association Bhui et al. (2005) 2054 UK workers Cross-sectional Anxiety & depression Positive association Birman et al. (2005) 269 Soviet immigrant teens in US Cross-sectional Russian identity Positive association American identity Inverse association Brody et al. (2006) 714 Black adolescents Longitudinal Conduct problems & depressive symptoms Positive association Brook et al. (2006a) 210 Black and Puerto Rican elementary kids Cross-sectional Rebellious behavior Positive association Brondolo et al. (2005) 420 Blacks & Latinos Cross-sectional Emotions of threat, harm, & anger Positive association Broudy et al. (2007) 113 Multiethnic adults Cross-sectional Daily moods (anger, sadness & nervousness) Positive association Bynum et al. (2007) 247 Black freshmen Cross-sectional Psychological distress Positive association Crouter et al. (2006) 218 Mexican American families Cross-sectional Depressive symptoms Positive association Dyrbye et al. (2007) 3,080 U.S. medical students Cross-sectional Burnout, depressive symptoms, low QOL Positive association Gee et al. (2006b) 666 U.S. blacks, black & Latino immigrants Cross-sectional Mental Health Inverse association Gee et al. (2007b) 2,047 Asian American adults Cross-sectional Past year mental disorders Positive association Greene et al. (2006) 136 High school students Longitudinal Depressive symptoms self- esteem Positive association Self-esteem Inverse association Karlsen et al. (2005) 3,446 from 5 UK ethnic immigrants Cross-sectional Psychosis Positive association Anxiety or depressive disorder Positive association Khaylis et al. (2007) 91 Undergrad students Cross-sectional PTSD symptoms Positive association Lam (2007) 122 Vietnamese college students Cross-sectional Depression & anxiety symptoms Positive association Lam et al. (2005) 1,451 Teens in Hong Kong Cross-sectional Depressive symptoms Positive association Life satisfaction & purpose Inverse association Lincoln et al. (2007) 4,915 African Americans & Caribbean Blacks Cross-sectional Depressive symptoms Conditional association Major et al. (2007) 3 Samples of Latino students (n = 191) Cross-sectional Self-esteem Inverse association Miller and Travers (2005) 208 UK minority ethnic teachers Cross-sectional Psychological symptoms (GHQ) Positive association Job satisfaction Inverse association Montgomery and Foldspang (2007) 131 Middle Eastern refugees in Denmark Cross-sectional Internalizing symptoms Positive association Externalizing symptoms No association Noh et al. (2007) 180 Adult Korean immigrants, Toronto Cross-sectional Positive affect Inverse association Depressive symptoms Positive association Oppedal et al. (2005) 1,275 Immigrant 10th graders in Norway Cross-sectional Psychiatric problems Positive association Pantzer et al. (2006) 1,246 Native and immigrant adolescents in Spain Cross-sectional Health related quality of life Inverse association Pole et al. (2005) 668 Hispanic, white and black police officers Cross-sectional PTSD symptoms Positive association Table 1 Continued Study Sample size Design Outcome variables Findings Poyrazli and Lopez (2007) 439 International & U.S. college students Cross-sectional Homesickness Positive association Romero et al. (2007) 519 Latino & non-Latino teens Cross-sectional Depressive symptoms, drug use & violence Positive association Salvatore and Shelton (2007) 250 University students Laboratory Cognitive functioning Inverse association Schulz et al. (2006b) 700 Black women Cross-sectional Depressive symptoms Positive association Sheridan (2006) 222 British Muslims Cross-sectional Depressive symptoms Positive association Siefert et al. (2007) 824 Black mothers Cross-sectional Probable depression Positive association Simons et al. (2006) 332 Black teen males Longitudinal Violent delinquency Positive association Smokowski and Bacallao (2007) 323 Latino teens Cross-sectional Internalizing problems and low self-esteem Positive association Steffen and Bowden (2006) 168 Hispanic-American immigrants Cross-sectional Depressive symptoms Positive association Sleep disturbance Positive association Stevens et al. (2005a) 1,127 Moroccan immigrant teens in Netherlands Cross-sectional Externalizing behaviors Positive association Stevens et al. (2005b) 1,127 Moroccan immigrant teens in Netherlands Cross-sectional Internalizing problems Positive association Umaña-Taylor and Updegraff (2007) 273 Latino adolescents Cross-sectional Depressive symptoms Positive association Utsey and Hook (2007) 215 Black college students Cross-sectional Psychological distress Positive association Utsey et al. (2006) 323 U.S. black adults Cross-sectional Quality of life Conditional association Veling et al. (2007) 459 Ethnic minorities in The Netherlands Cross-sectional Incidence of psychotic disorders Positive association Vines et al. (2006) 476 Black women Cross-sectional Negative emotions Positive association Wadsworth et al. (2007) 626 Blacks, whites, & Bangladeshis Cross-sectional Psychological distress Conditional association Wagner and Abbott (2007) 120 Diabetic blacks Cross-sectional Depression Positive association Waltermaurer et al. (2006) 88 Black women Cross-sectional Intimate partner violence Positive association Wamala et al. (2007b) 33,328 Swedish adults Cross-sectional Psychological distress Positive association Yoder et al. (2006) 212 American Indian youth Cross-sectional Suicidal ideation Positive association...

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  • ...We wish to thank Steven Beeber and Gabriel Sirota for assistance with preparing the manuscript and Manuela Costa for assistance with the research....

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  • ...Studies in Norway (Oppedal et al. 2005), Denmark (Montgomery and Foldspang 2007), the Netherlands (Veling et al. 2007; Stevens et al. 2005a), Spain (Pantzer et al. 2006), Bosnia, Croatia and Austria (Sujoldzic et al. 2006), Hong Kong (Lam et al. 2005) and Canada (Beiser and Hou 2006; Noh et al. 2007; Etowa et al. 2007) have examined the association between perceived discrimination and health for multiple immigrant groups....

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  • ...In contrast, the approach of Williams and his colleagues (Williams et al. 1997; Kessler et al. 1999) frames the questions about discrimination in terms of unfair treatment and asks about attribution only after a behaviorally descriptive experience, without emotionally charged language, has been…...

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  • ...…Bowden (2006) 168 Hispanic-American immigrants Cross-sectional Depressive symptoms Positive association Sleep disturbance Positive association Stevens et al. (2005a) 1,127 Moroccan immigrant teens in Netherlands Cross-sectional Externalizing behaviors Positive association Stevens et al. (2005b)…...

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Journal Article•DOI•
The social psychology of stigma.

[...]

Brenda Major1, Laurie T. O’Brien1•
University of California, Santa Barbara1
01 Jan 2005-Annual Review of Psychology
TL;DR: This chapter addresses the psychological effects of social stigma by reviewing and organizing recent theory and empirical research within an identity threat model of stigma, which posits that situational cues, collective representations of one's stigma status, and personal beliefs and motives shape appraisals of the significance of stigma-relevant situations for well-being.
Abstract: This chapter addresses the psychological effects of social stigma. Stigma directly affects the stigmatized via mechanisms of discrimination, expectancy confirmation, and automatic stereotype activation, and indirectly via threats to personal and social identity. We review and organize recent theory and empirical research within an identity threat model of stigma. This model posits that situational cues, collective representations of one's stigma status, and personal beliefs and motives shape appraisals of the significance of stigma-relevant situations for well-being. Identity threat results when stigma-relevant stressors are appraised as potentially harmful to one's social identity and as exceeding one's coping resources. Identity threat creates involuntary stress responses and motivates attempts at threat reduction through coping strategies. Stress responses and coping efforts affect important outcomes such as self-esteem, academic achievement, and health. Identity threat perspectives help to explain the...

2,680 citations

Cites result from "The prevalence, distribution, and m..."

  • ...Studies that attempted to disentangle these effects have produced mixed results (Kessler et al. 1999, Magley et al. 1999, Taylor & Turner 2002, Williams 1997)....

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Journal Article•DOI•
Racial/ethnic discrimination and health: findings from community studies.

[...]

David R. Williams1, Harold W. Neighbors, James S. Jackson1•
University of Michigan1
01 Feb 2003-American Journal of Public Health
TL;DR: The authors review the available empirical evidence and indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status, but the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease.
Abstract: The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health. (Am J Public Health. 2003;93:200-208)

2,433 citations

References
More filters
Reference Entry•DOI•
Diagnostic and Statistical Manual of Mental Disorders

[...]

Janet B. W. Williams
11 Jun 2013

113,134 citations

Journal Article•DOI•
The central role of the propensity score in observational studies for causal effects

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Paul R. Rosenbaum, Donald B. Rubin
01 Apr 1983-Biometrika
TL;DR: The authors discusses the central role of propensity scores and balancing scores in the analysis of observational studies and shows that adjustment for the scalar propensity score is sufficient to remove bias due to all observed covariates.
Abstract: : The results of observational studies are often disputed because of nonrandom treatment assignment. For example, patients at greater risk may be overrepresented in some treatment group. This paper discusses the central role of propensity scores and balancing scores in the analysis of observational studies. The propensity score is the (estimated) conditional probability of assignment to a particular treatment given a vector of observed covariates. Both large and small sample theory show that adjustment for the scalar propensity score is sufficient to remove bias due to all observed covariates. Applications include: matched sampling on the univariate propensity score which is equal percent bias reducing under more general conditions than required for discriminant matching, multivariate adjustment by subclassification on balancing scores where the same subclasses are used to estimate treatment effects for all outcome variables and in all subpopulations, and visual representation of multivariate adjustment by a two-dimensional plot. (Author)

23,744 citations

Journal Article•DOI•
The stress process.

[...]

L I Pearlin, Morton A. Lieberman, Elizabeth G. Menaghan, J T Mullan
01 Dec 1981-Journal of Health and Social Behavior
TL;DR: This study takes involuntary job disruptions as illustrating life events and shows how they adversely affect enduring role strains, economic strains in particular, which erode positive concepts of self, such as self-esteem and mastery.
Abstract: This study uses longitudinal data to observe how life events, chronic life strains, self concepts, coping, and social supports come together to form a process of stress. It takes involuntary job disruptions as illustrating life events and shows how they adversely affect enduring role strains, economic strains in particular. These exacerbated strains, in turn, erode positive concepts of self, such as self-esteem and mastery. The diminished self-concepts then leave one especially vulnerable to experiencing symptoms of stress, of which depression is of special interest to this analysis. The interventions of coping and social supports are mainly indirect; that is, they do not act directly to buffer depression. Instead, they minimize the elevation of depression by dampening the antecedent process.

5,694 citations

Journal Article•DOI•
Racial Differences in Physical and Mental Health

[...]

David R. Williams1, Yan Yu1, James S. Jackson1, Norman B Anderson2•
University of Michigan1, National Institutes of Health2
01 Jul 1997-Journal of Health Psychology
TL;DR: Findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.
Abstract: This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.

3,541 citations

Book•
Shattered Assumptions: Towards a New Psychology of Trauma

[...]

Ronnie Janoff-Bulman
01 Apr 1992
TL;DR: The authors investigates the psychology of victimization and shows how fundamental assumptions about the world's meaningfulness and benevolence are shattered by traumatic events, and how victims become subject to self-blame in an attempt to accommodate brutality.
Abstract: This book investigates the psychology of victimization. It shows how fundamental assumptions about the world's meaningfulness and benevolence are shattered by traumatic events, and how victims become subject to self-blame in an attempt to accommodate brutality. The book is aimed at all those who for personal or professional reasons seek to understand what psychological trauma is and how to recover from it.

3,259 citations

Related Papers (5)
Racial Differences in Physical and Mental Health

[...]

01 Jul 1997-Journal of Health Psychology
David R. Williams, Yan Yu, James S. Jackson, Norman B Anderson 
Racial/ethnic discrimination and health: findings from community studies.

[...]

01 Feb 2003-American Journal of Public Health
David R. Williams, Harold W. Neighbors, James S. Jackson
Perceived discrimination and health: a meta-analytic review.

[...]

01 Jul 2009-Psychological Bulletin
Elizabeth A. Pascoe, Laura Smart Richman
Discrimination and racial disparities in health: evidence and needed research

[...]

01 Feb 2009-Journal of Behavioral Medicine
David R. Williams, Selina A. Mohammed
Racism as a stressor for African Americans. A biopsychosocial model

[...]

01 Oct 1999-American Psychologist
Rodney Clark, Norman B Anderson, Vernessa R. Clark, David R. Williams