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Personal-Level and Group-Level Discrimination and Mental Health: the Role of Skin Color

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objective

This study investigates the association between personal-level and group-level discrimination and common mental disorders (CMDs) among Afro-Brazilian women, aiming to explore the role of skin color on this association.

Methods

This is a cross-sectional study involving 1130 women who were participating in the Social Change, Asthma and Allergy in Latin America (SCAALA) study, whose children were recruited from 24 geographical micro-regions representative of the population without sanitation. Measures of discrimination were defined by: experiences (personal-level) and concern about discrimination (group-level) using the Experiences of Discrimination Scale. Skin color was registered by self-declaration, being classified as white, brown, and black. The association between “self-reported” discrimination and CMDs was evaluated using Poisson regression analysis.

Results

Prevalence of CMDs was high (38.3%), especially in the group exposed to discriminatory experiences and black women. Experiences and concern about discrimination were positive and significantly associated with mental health, before and after adjustment for potential confounders. The effect of discrimination on CMDs was lower among black women, suggesting the development of other strategies to confront racism.

Conclusion

This study emphasizes the use of both personal- and group-level discrimination measures, as well as skin color, for the evaluation of mental disorders in public health research. Further studies of health consequences of discrimination will require investigation of protective factors for mental disorders in the population suffering discrimination and racism.

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References

  1. Goldberg D, Huxley P. Common mental disorders: a biosocial model. Tavistock/Routledge: London; 1992.

    Google Scholar 

  2. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476–93. https://doi.org/10.1093/ije/dyu038.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gonçalves DA, Mari JJ, Bower P, Gask L, Dowrick C, Tófoli LF, et al. Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors. Cad Saúde Públ. 2014;30(3):623–32. https://doi.org/10.1590/0102-311X00158412.

    Article  Google Scholar 

  4. Almeida-Filho NA, Lessa I, Magalhaes L, Araújo MJ, Aquino E, James SA, et al. Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity and social class. Soc Sci Med. 2004;59(7):1339–53. https://doi.org/10.1016/j.socscimed.2003.11.037.

    Article  PubMed  Google Scholar 

  5. Santana V, Almeida-Filho NA, Roberts R, Cooper SP. Skin colour, perception of racism and depression among adolescents in urban Brazil. Child Adolesc Mental Health. 2007;12(3):125–31. https://doi.org/10.1111/j.1475-3588.2007.00447.x.

    Article  Google Scholar 

  6. Turner R, Wheaton B, Lloyd D. The epidemiology of social stress. Am Sociol Rev. 1995;60(1):104–25. https://doi.org/10.2307/2096348.

    Article  Google Scholar 

  7. Klonoff EA, Landrine HI. Skin color a marker for racial discrimination? Explaining the skin color-hypertension relationship. J Behav Med. 2000;23(4):329–38. https://doi.org/10.1023/A:1005580300128.

    Article  CAS  PubMed  Google Scholar 

  8. Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006;35(4):888–901. https://doi.org/10.1093/ije/dyl056.

    Article  PubMed  Google Scholar 

  9. Krieger N, Kosheleva A, Waterman PD, Chen JT, Koenen K. Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born black Americans. Am J Public Health. 2011;101(9):1704–13. https://doi.org/10.2105/AJPH.2011.300168.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Clark TT. Perceived discrimination, depressive symptoms, and substance use in young adulthood. Addict Behav. 2014;39(6):1021–5. https://doi.org/10.1016/j.addbeh.2014.01.013.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Harrell SPA. Multidimensional conceptualization of racism-related stress: implications for the Weil-being of people of color. Am J Orthopsychiatry. 2000;70(1):42–57.

    Article  CAS  PubMed  Google Scholar 

  12. Karlsen S, Nazroo JY. Fear of racism and health. J Epidemiol Community Health. 2004;58(12):1017–8. https://doi.org/10.1136/jech.2004.020479.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Perreira KM, Telles EE. The color of health: skin color, ethnoracial classification, and discrimination in the health of Latin Americans. Soc Sci Med. 2014;16:241–50. https://doi.org/10.1016/j.socscimed.2014.05.054.

    Article  Google Scholar 

  14. Hunter M. The persistent problem of colorism: skin tone, status, and inequality. Sociol Compass. 2007;1(1):237–54. https://doi.org/10.1111/j.1751-9020.2007.00006.x.

    Article  Google Scholar 

  15. Williams DR, Sternthal M. Understanding racial/ethnic disparities in health: sociological contributions. J Health Soc Behav. 2010;51(Suppl):S15–27. https://doi.org/10.1177/0022146510383838.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pascoe EA, Richman LS. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531–54. https://doi.org/10.1037/a0016059.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511. https://doi.org/10.1371/journal.pone.0138511.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Weich S. Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC study of ethnic minority groups in the United Kingdom. Am J Public Health. 2005;95(3):496–501. https://doi.org/10.2105/AJPH.2003.033274.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Monk EP. The cost of color: skin color, discrimination, and health among African-Americans. Am J Sociol. 2015;121:2,396–444.

    Google Scholar 

  20. Perry BL, Stevens-Watkins D, Oser CB. The moderating effects of skin color and ethnic identity affirmation on suicide risk among low-SES African American women. Race Soc Probl. 2013;5(1):1–14. https://doi.org/10.1007/s12552-012-9080-8.

    Article  PubMed  Google Scholar 

  21. Byrd DR. Race/ethnicity and self-reported levels of discrimination and psychological distress, California, 2005. Prev Chronic Dis 2012; E156. doi: https://doi.org/10.5888/pcd9.120042.

  22. Borrell LN, Kiefe CI, Williams DR, Diez-Roux AV, Gordon-Larsen P. Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Soc Sci Med. 2006;63(6):1415–27. https://doi.org/10.1016/j.socscimed.2006.04.008.

    Article  PubMed  Google Scholar 

  23. Keith VM, Lincoln KD, Taylor RJ, Jackson JS. Discriminatory experiences and depressive symptoms among African American women: do skin tone and mastery matter. Sex Roles. 2010;62(1–2):48–59. https://doi.org/10.1007/s11199-009-9706-5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Travassos C, Williams DR. The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States. Cad. Saúde Públ. 2004;20(3):660–78. https://doi.org/10.1590/S0102-311X2004000300003.

    Article  Google Scholar 

  25. Heringer R. Desigualdades sociais no Brasil: Síntese de indicadores e desafios no campo das políticas públicas. Cad Saúde Públ. 2002;18(Suppl):57–65. https://doi.org/10.1590/S0102-311X2002000700007.

    Article  Google Scholar 

  26. Telles E. Race in another America: the significance of skin color in Brazil. Princeton: Princeton University Press; 2004.

    Google Scholar 

  27. Barreto ML, Cunha SS, Alcântara-Neves N, Carvalho LP, Cruz AA, Genser B, et al. Risk factors and immunological pathways for asthma and other allergic diseases in children: background and methodology of a longitudinal study in a large urban center in Northeastern Brazil (Salvador-SCAALA study). BMC Pulm Med. 2006;6(1):15. https://doi.org/10.1186/1471-2466-6-15.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Barreto ML, Genser B, Strina A, Assis AMO, Rego RF, Teles CA, et al. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. The Lancet. 370(9599):1622–8.

    Article  Google Scholar 

  29. Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61(7):1576–96. https://doi.org/10.1016/j.socscimed.2005.03.006.

    Article  PubMed  Google Scholar 

  30. Fattore GL, Teles CA, Santos DN, Santos LM, Reichenheim ME, Barreto ML. Validity of the Experiences of Discrimination scale in a Brazilian population. Cad Saúde Públ. 2016;32(4):e00102415. https://doi.org/10.1590/0102-311X00102415.

    Article  Google Scholar 

  31. Fattore GL, Amorim LDAF, Santos LM, Barreto ML. Racial discrimination and skin color in Salvador: a latent class analysis. Rev Bras Epidem. 2017 (in press)

  32. Gonçalves DM, Stein AT, Kapczinski F. Performance of the self-reporting questionnaire as a psychiatric screening questionnaire: a comparative study with structured clinical interview for DSM-IV-TR. Cad Saúde Públ. 2008;24(2):380–90. https://doi.org/10.1590/S0102-311X2008000200017.

    Article  Google Scholar 

  33. Mari JJ, Williams PA. Validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry. 1986;148:23–6.

    Article  CAS  PubMed  Google Scholar 

  34. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14. https://doi.org/10.1016/0277-9536(91)90150-B.

    Article  CAS  PubMed  Google Scholar 

  35. Griep RH, Chor D, Faerstein E, Werneck GL, Lopes CS. Validade de constructo de escala de apoio social do Medical Outcomes Study adaptada para o português no Estudo Pró-Saúde. Cad Saúde Públ. 2005;21(3):703–14. https://doi.org/10.1590/S0102-311X2005000300004.

    Article  Google Scholar 

  36. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21. https://doi.org/10.1186/1471-2288-3-21.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kessler RC. Stress, social status, and psychological distress. J Health Soc Behav. 1979;20(3):259–72. https://doi.org/10.2307/2136450.

    Article  CAS  PubMed  Google Scholar 

  38. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200–8. https://doi.org/10.2105/AJPH.93.2.200.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47. https://doi.org/10.1007/s10865-008-9185-0.

    Article  PubMed  Google Scholar 

  40. Nazroo JY. The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. Am J Public Health. 2003;93(2):277–84. https://doi.org/10.2105/AJPH.93.2.277.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tummala-Narra P, Claudius M. Perceived discrimination and depressive symptoms among immigrant-origin adolescents. Cult Divers Ethnc Minor Psychol. 2013;9(3):257–69. https://doi.org/10.1037/a0032960.

    Article  Google Scholar 

  42. Versey HS, Curtin N. The differential impact of discrimination on health among Black and White women. Soc Sci Res. 2016;57:99–115. https://doi.org/10.1016/j.ssresearch.2015.12.012.

    Article  PubMed  Google Scholar 

  43. Harrell CJ, Burford TI, Cage BN, Nelson TM, Shearon S, Thompson A, et al. Multiple pathways linking racism to health outcomes. Du Bois Rev. 2011;8(1):143–57. https://doi.org/10.1017/S1742058X11000178.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Goffman E. Estigma: La identidad deteriorada. (1th ed.) Buenos Aires: Amorrortu; 2006.

  45. Sawyer PJ, Major B, Casad BJ, Townsend SSM, Mendes WB. Discrimination and the stress response: psychological and physiological consequences of anticipating prejudice in interethnic interactions. Am J Public Health. 2012;102(5):1020–6. https://doi.org/10.2105/AJPH.2011.300620.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Stuber J, Meyer I, Link B. Stigma, prejudice, discrimination and health. Soc Sci Med. 2008;67(3):351–7. https://doi.org/10.1016/j.socscimed.2008.03.023.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Krieger N. Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Services. 1999;29(2):295–352. https://doi.org/10.2190/M11W-VWXE-KQM9-G97Q.

    Article  CAS  Google Scholar 

  48. Taylor DM, Wright SC, Moghaddam FM, Lalonde RN. The personal/group discrimination discrepancy: perceiving my group, but not myself, to be a target for discrimination. Pers Soc Psychol B. 1990;16(2):254–62. https://doi.org/10.1177/0146167290162006.

    Article  Google Scholar 

  49. James D. Internalized racism and past-year major depressive disorder among African-Americans: the role of ethnic identity and self-esteem. J Racial Ethn Health Disparities. 2016;4(4):659–70. https://doi.org/10.1007/s40615-016-0269-1.

    Article  PubMed  Google Scholar 

  50. Travassos C, Laguardia J, Marques PM, Mota JC, Szwarcwald CL. Comparison between two race/skin color classifications in relation to health-related outcomes in Brazil. Int J Equity Health. 2011;10(1):35. https://doi.org/10.1186/1475-9276-10-35.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bianchi FT, Zea MC, Belgrave FZ, Echeverry JJ. Racial identity and self-esteem among black Brazilian men: race matters in Brazil too. Cultur Divers Ethnic Minor Psychol. 2002;8(2):157–69. https://doi.org/10.1037/1099-9809.8.2.157.

    Article  PubMed  Google Scholar 

  52. Brown TN, Williams DR, Jackson JS, Neighbors HW, Torres M, Sellers SL, et al. “Being black and feeling blue”: the mental health consequences of racial discrimination. Race & Society. 2000;2(2):117–31. https://doi.org/10.1016/S1090-9524(00)00010-3.

    Article  Google Scholar 

  53. Beale F. Double jeopardy: to be Black and female. In: Guy-Sheftall B, editor. Words of fire: an anthology of African American feminist thought. New York: New Press; 1995. p. 146–56.

    Google Scholar 

  54. Nazroo JY. Genetic, cultural or socio-economic vulnerability? Explaining ethnic inequalities in health. Soc Health Illness. 1998;20(5):710–30. https://doi.org/10.1111/1467-9566.00126.

    Article  Google Scholar 

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Acknowledgements

We are very grateful to the women who have answered the EOD questionnaire; without whose generous participation, this study would not have been possible.

Funding

This study is part of the SCAALA (Social Change, Asthma and Allergy in Latin America) program. Complementary funds were received from the INCT/MCTI/CNPq program, contract no. 5737862008-9.

Author information

Authors and Affiliations

  1. Departamento de Salud Comunitaria, Universidad Nacional de Lanús, 29 de Septiembre 3901 (1826) Remedios de Escalada, Lanús, Argentina

    Gisel Lorena Fattore

  2. Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n—Canela, Salvador, BA, 40110-040, Brazil

    Gisel Lorena Fattore, Darci Neves dos Santos & Mauricio Lima Barreto

  3. Departamento de Estatística, Universidade Federal da Bahia, Avenida Ademar de Barros s/n, Campus de Ondina, Salvador, BA, 40170-110, Brazil

    Leila D Amorim

  4. Instituto de Humanidades Artes e Ciências Professor Milton Santos, Universidade Federal da Bahia, Rua Barão de Jeremoabo, s/n, PAF-V.—Ondina, Salvador, BA, 40170-115, Brazil

    Letícia Marques dos Santos

  5. Centro de Pesquisas Gonçalo Moniz, FIOCRUZ, R. Waldemar Falcão, 121—Candeal, Salvador, BA, 40296-710, Brazil

    Mauricio Lima Barreto

Authors
  1. Gisel Lorena Fattore
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  2. Leila D Amorim
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  3. Letícia Marques dos Santos
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  4. Darci Neves dos Santos
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  5. Mauricio Lima Barreto
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Corresponding author

Correspondence to Gisel Lorena Fattore.

Ethics declarations

All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. The study was approved in 2005 by the Research Ethics Committee of the Institute of Collective Health at the Federal University in Bahia, under registration number 047-05/CEP-ISC. All participants signed a free and informed consent form, which contained detailed information about the data collection procedures for the research.

Conflict of Interest

The authors declare that they have no competing interests.

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Fattore, G.L., Amorim, L.D., dos Santos, L.M. et al. Personal-Level and Group-Level Discrimination and Mental Health: the Role of Skin Color. J. Racial and Ethnic Health Disparities 5, 1033–1041 (2018). https://doi.org/10.1007/s40615-017-0451-0

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  • DOI: https://doi.org/10.1007/s40615-017-0451-0

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