Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 2, pp 165–173 | Cite as

The DRUID study: exploring mediating pathways between racism and depressive symptoms among Indigenous Australians

  • Yin C. Paradies
  • Joan Cunningham
Original Paper



Racism is an important determinant of mental and physical health for minority populations. However, to date little is known about the relationship between racism and ill-health outside of the U.S. or the causal pathways between racism and poor health. This paper focuses on the relationship between racism and depression in a non-U.S. indigenous population, including examination of novel mediators and moderators.


One hundred and eighty-five adults in the Darwin Region Urban Indigenous Diabetes study responded to a validated instrument assessing multiple facets of racism. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as possible mediators and moderators in linear regression models.


Interpersonal racism was significantly associated with depression after adjusting for socio-demographic factors (β = 0.08, p < 0.001). Lack of control, stress, negative social connections and feeling ashamed, amused or powerless as reactions to racism were each identified as significant mediators of the relationship between racism and depressive symptoms. All examined mediators together accounted for 66% of the association between interpersonal racism and depressive symptoms.


This study demonstrates that racism is associated with depressive symptoms in an indigenous population. The mediating factors between racism and depressive symptoms identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health.


Indigenous Racism Mental health Depression Australia 



The authors gratefully acknowledge the support of DRUID study participants, study staff, members of the Indigenous Steering Group, and partner organisations. Ms Hannah Reich provided research assistance in the drafting of this manuscript. The DRUID Study was funded by the National Health and Medical Research Council (NHMRC Project Grant #236207), with additional support from the Australian Government Department of Employment and Workplace Relations, the Clive and Vera Ramaciotti Foundation, the Vincent Fairfax Family Foundation, the International Diabetes Institute (AusDiab Partnership), and Bayer HealthCare. The DRUID Study is an in-kind project of the Cooperative Research Centre for Aboriginal Health (CRCAH). The first author was supported by an NHMRC Population Health Capacity-Building Program (#236235). The second author was supported by an NHMRC Career Development Award (#283310) and an NHMRC Research Fellowship (#545200).


  1. 1.
    Berman G, Paradies Y (2008) Racism, disadvantage and multiculturalism: towards effective anti-racist praxis. Ethn Racial Stud 33:214–232CrossRefGoogle Scholar
  2. 2.
    Paradies Y (2006) A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 35:888–901PubMedCrossRefGoogle Scholar
  3. 3.
    Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32:20–47PubMedCrossRefGoogle Scholar
  4. 4.
    Pascoe EA, Richman LS (2009) Perceived discrimination and health: a meta-analytic review. Psychol Bull 135:531–554PubMedCrossRefGoogle Scholar
  5. 5.
    Moussavi S, Chatterji S, Verdes E et al (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370:851–858PubMedCrossRefGoogle Scholar
  6. 6.
    De Santis AS, Adam EK, Doane LD et al (2007) Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents. J Adolesc Health 41:3–13CrossRefGoogle Scholar
  7. 7.
    Richman LS, Jonassaint C (2008) The effects of race-related stress on cortisol reactivity in the laboratory: implications of the Duke lacrosse scandal. Ann Behav Med 35:105–110PubMedGoogle Scholar
  8. 8.
    Tull ES, Sheu YT, Butler C et al (2005) Relationships between perceived stress, coping behavior and cortisol secretion in women with high and low levels of internalized racism. J Natl Med Assoc 97:206–212PubMedGoogle Scholar
  9. 9.
    Thomas KS, Bardwell WA, Ancoli-Israel S et al (2006) The toll of ethnic discrimination on sleep architecture and fatigue. Health Psychol 25:635–642PubMedCrossRefGoogle Scholar
  10. 10.
    Bennett GG, Wolin KY, Robinson EL et al (2005) Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health 95:238–240PubMedCrossRefGoogle Scholar
  11. 11.
    Chae DH, Takeuchi DT, Barbeau EM et al (2008) Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the National Latino and Asian American Study. Am J Public Health 98:485–492PubMedCrossRefGoogle Scholar
  12. 12.
    Guthrie BJ, Young AM, Williams DR et al (2002) African American girls’ smoking habits and day-to-day experiences with racial discrimination. Nurs Res 51:183–189PubMedCrossRefGoogle Scholar
  13. 13.
    Landrine H, Klonoff EA (2000) Racial discrimination and cigarette smoking among blacks: findings from two studies. Ethn Dis 10:195–202PubMedGoogle Scholar
  14. 14.
    Okamoto J, Ritt-Olson A, Soto D et al (2009) Perceived discrimination and substance use among Latino adolescents. Am J Health Behav 33:718–727PubMedGoogle Scholar
  15. 15.
    Choi Y, Harachi TW, Gillmore MR et al (2006) Are multiracial adolescents at greater risk? Comparisons of rates, patterns, and correlates of substance use and violence between monoracial and multiracial adolescents. Am J Orthopsychiatry 76:86–97PubMedCrossRefGoogle Scholar
  16. 16.
    Gee GC, Delva J, Takeuchi D (2007) Relationships between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence among Filipino Americans. Am J Public Health 97:933–940PubMedCrossRefGoogle Scholar
  17. 17.
    Gibbons FX, Gerrard M, Cleveland MJ et al (2004) Perceived discrimination and substance use in African American parents and their children: a panel study. J Pers Soc Psychol 86:517–529PubMedCrossRefGoogle Scholar
  18. 18.
    Gibbons FX, Yeh HC, Gerrard M et al (2007) Early experience with racial discrimination and conduct disorder as predictors of subsequent drug use: a critical period hypothesis. Drug Alcohol Depend 88:S27–S37PubMedCrossRefGoogle Scholar
  19. 19.
    Steffen PR, Bowden M (2006) Sleep disturbance mediates the relationship between perceived racism and depressive symptoms. Ethn Dis 16:16–21PubMedGoogle Scholar
  20. 20.
    Chen C, Lin K (2009) Health consequences of illegal drug use. Curr Opin Psychiatry 22:287–292PubMedCrossRefGoogle Scholar
  21. 21.
    Mathers M, Toumbourou J, Catalano RF et al (2006) Consequences of youth tobacco use: a review of prospective behavioural studies. Addiction 101:948–958PubMedCrossRefGoogle Scholar
  22. 22.
    Paradies Y, Williams DR, Heggenhougen K et al (2008) Racism and Health. In: Encyclopedia of public health. Academic Press, San Diego, pp 474–483Google Scholar
  23. 23.
    Steering Committee for the Review of Government Service Provision (2009) Overcoming indigenous disadvantage: key indicators 2009. Productivity Commission, CanberraGoogle Scholar
  24. 24.
    Paradies Y, Harris R, Anderson I (2008) The impact of racism on indigenous health in Australia and Aotearoa: towards a research agenda. Cooperative Research Centre for Aboriginal Health, DarwinGoogle Scholar
  25. 25.
    Cunningham J, O’Dea K, Dunbar T et al (2006) Study protocol: diabetes and related conditions in urban indigenous people in the Darwin, Australia region: aims, methods and participation in the DRUID Study. BMC Public Health 6Google Scholar
  26. 26.
    Paradies Y, Cunningham J (2008) Development and validation of the measure of indigenous racism experiences (MIRE). Int J Equity Health 7Google Scholar
  27. 27.
    Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a re-evaluation of the life orientation test. J Pers Soc Psychol 67:1063–1078PubMedCrossRefGoogle Scholar
  28. 28.
    Manson S, Beals J (1995) Indian services utilization and psychiatric epidemiology risk and protective factors project: survey instrument and coding guide. Section G. University of Colorado, DenverGoogle Scholar
  29. 29.
    Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  30. 30.
    Wald A (1943) Tests of statistical hypothesis concerning several parameters when the number of observations is large. Trans Am Math Soc 54:426–482CrossRefGoogle Scholar
  31. 31.
    Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40:879–891PubMedCrossRefGoogle Scholar
  32. 32.
    Pituch KA, Stapleton LM (2008) The performance of methods to test upper-level mediation in the presence of nonnormal data. Multivar Behav Res 43:237–267CrossRefGoogle Scholar
  33. 33.
    Ender P (2010) How can I perform mediation with binary variables? UCLA, Academic Technology Services, Statistical Consulting GroupGoogle Scholar
  34. 34.
    Chandola T, Kuper H, Singh-Manoux A et al (2004) The effect of control at home on CHD events in the Whitehall II study: gender differences in psychosocial domestic pathways to social inequalities in CHD. Soc Sci Med 58:1501–1509PubMedCrossRefGoogle Scholar
  35. 35.
    Griffin J, Fuhrer R, Stansfeld S et al (2002) The importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class? Soc Sci Med 54:783–798PubMedCrossRefGoogle Scholar
  36. 36.
    Moradi B, Hasan NT (2004) Arab American persons’ reported experiences of discrimination and mental health: the mediating role of personal control. J Couns Psychol 51:418–428CrossRefGoogle Scholar
  37. 37.
    Rodriguez MS (2004) Effects of perceived discrimination on mental health: exploring intervening relationships. Kent State UniversityGoogle Scholar
  38. 38.
    Chakraborty AT, McKenzie KJ, Hajat SA (2009) Racism, mental illness and social support in the UK. Social Psychiatry Psychiatr Epidemiol (epub ahead of print)Google Scholar
  39. 39.
    Gee GC, Chen J, Spencer MS et al (2006) Social support as a buffer for perceived unfair treatment among Filipino Americans: differences between San Francisco and Honolulu. Am J Public Health 96:677–684PubMedCrossRefGoogle Scholar
  40. 40.
    Brondolo E, VerHalen NB, Pencille M et al (2009) Coping with racism: a selective review of the literature and a theoretical and methodological critique. J Behav Med 32:64–84PubMedCrossRefGoogle Scholar
  41. 41.
    Broudy R, Brondolo E, Coakley V et al (2007) Perceived ethnic discrimination in relation to daily moods and negative social interactions. J Behav Med 30:31–43PubMedCrossRefGoogle Scholar
  42. 42.
    Utsey SO, Lanier Y, Williams O et al (2006) Moderator effects of cognitive ability and social support on the relation between race-related stress and quality of life in a community sample of Black Americans. Cult Divers Ethn Minor Psychol 12:334–346CrossRefGoogle Scholar
  43. 43.
    Finch BK, Vega WA (2003) Acculturation stress, social support, and self-rated health among Latinos in California. J Immigr Health 5:109–117PubMedCrossRefGoogle Scholar
  44. 44.
    Liang CTH, Alvarez AN, Juang L et al (2007) The role of coping in the relationship between perceived racism and racism-related stress for Asian Americans: gender differences. J Couns Psychol 54:132–141CrossRefGoogle Scholar
  45. 45.
    Alvarez AN, Juang L (2010) Filipino Americans and racism: a multiple mediation model of coping. J Couns Psychol 57:167–178PubMedCrossRefGoogle Scholar
  46. 46.
    Larson A, Gilles M, Howard PJ et al (2007) It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Aust N Z J Public Health 31:322–329PubMedCrossRefGoogle Scholar
  47. 47.
    Ong AD, Edwards LM (2008) Positive affect and adjustment to perceived racism. J Soc Clin Psychol 27:105–126CrossRefGoogle Scholar
  48. 48.
    Sellers R, Caldwell CH, Schmeelk-Cone KH et al (2003) Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Soc Behav 44:302–317PubMedCrossRefGoogle Scholar
  49. 49.
    Ong AD, Fuller-Rowell T, Burrow AL (2009) Racial discrimination and the stress process. J Pers Soc Psychol 96:1259–1271PubMedCrossRefGoogle Scholar
  50. 50.
    Din-Dzietham R, Nembhard WN, Collins R et al (2004) Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, 1999–2001. Soc Sci Med 58:449–461PubMedCrossRefGoogle Scholar
  51. 51.
    Mossakowski KN (2003) Coping with perceived discrimination: does ethnic identity protect mental health? J Health Soc Behav 44:318–331PubMedCrossRefGoogle Scholar
  52. 52.
    Banks KH, Kohn-Wood L (2007) The influence of racial identity profiles on the relationship between racial discrimination and depressive symptoms. J Black Psychol 33:331–354CrossRefGoogle Scholar
  53. 53.
    Krieger N, Carney D, Lancaster K et al (2010) Combining explicit and implicit measures of racial discrimination in health research. Am J Public Health 100:1485–1492PubMedCrossRefGoogle Scholar
  54. 54.
    Mellor D, Bynon G, Maller J et al (2001) The perception of racism in ambiguous scenarios. J Ethn Migr Stud 27:473–488Google Scholar
  55. 55.
    Bennett GG, Merritt MM, Edwards CL et al (2004) Perceived racism and affective responses to ambiguous interpersonal interactions among African American men. Am Behav Sci 47:963–976CrossRefGoogle Scholar
  56. 56.
    Juang LP, Cookston JT (2009) Acculturation, discrimination, and depressive symptoms among Chinese American adolescents: a longitudinal study. J Prim Prev 30:475–496PubMedCrossRefGoogle Scholar
  57. 57.
    Barnes LL, Mendes De Leon CF, Lewis TT et al (2008) Perceived discrimination and mortality in a population-based study of -older adults. Am J Public Health 98:1241–1247PubMedCrossRefGoogle Scholar
  58. 58.
    Gee G, Walsemann K (2009) Does health predict the reporting of racial discrimination or do reports of discrimination predict health? Findings from the National Longitudinal Study of Youth. Soc Sci Med 69:1676–1684CrossRefGoogle Scholar
  59. 59.
    McClelland GH, Judd CM (1993) Statistical difficulties of detecting interactions and moderator effects. Psychol Bull 114:376–390PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Menzies School of Health Research, Institute of Advanced StudiesCharles Darwin UniversityDarwinAustralia
  2. 2.Onemda Unit and McCaughey Centre, Melbourne School of Population HealthUniversity of MelbourneMelbourneAustralia

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