A group of men and women sat close together in a conference room at Asian Counseling and Referral Service (ACRS) in Rainier Valley recently, sharing stories about anti-Asian hate and other suffering they’d experienced during the pandemic.
Several credited therapy and other support from ACRS — a nonprofit that primarily serves low-income, immigrant, refugee and American-born Asians and Pacific Islanders — for helping them get relief from symptoms of depression and anxiety they’d developed.
Many at the May meeting spoke of past traumas. But the past couple of years had given rise to additional stressors, like isolation, inflation, racist attacks and increased prejudice.
A large national study published Wednesday helps quantify the serious and widespread emotional toll of such everyday experiences of discrimination during the pandemic. The U.S.-based study, which is the largest and most diverse on this topic during the pandemic era, found that the more often someone faces discrimination, the higher likelihood they’ll also experience depressive symptoms and suicidal thoughts.
One of the most striking findings, the researchers say, is that people who faced discrimination nearly every day were just as likely to experience depressive symptoms early in the pandemic as was someone previously diagnosed with a mood disorder. The research was published Wednesday in the Journal of the American Medical Association (JAMA) Psychiatry.
When race, ancestry or birthplace were the main reasons for discrimination, the association with depression and suicidal thoughts was even stronger, especially among Asian, Hispanic and Latino people, adding urgency to calls for expanding access to mental health care for such underserved communities. Lack of diversity among the mental health workforce, cultural and structural barriers such as stigma, and discrimination by health professionals are among the reasons why such groups lack access to care.
The Seattle Times spoke with the study’s lead researcher, Dr. Jordan Smoller, associate chief for research in Massachusetts General Hospital’s Department of Psychiatry, about the importance of measuring the mental health consequences wrought by racial prejudice — and what lessons local communities should consider as they combat hate. This interview has been edited for length and clarity.
What motivated your interest in looking at the ties between mental health concerns and discrimination?
We’ve seen increasing rates of depression and anxiety, and in some studies, suicidal thinking, since the start of the pandemic. The causes of those increases are probably a mixture of things. But we do know from prior research that there’s this increasing demonstration of the toll that discrimination and racism can take on mental and physical health.
The beginning of the pandemic was a time when the awareness of the impact of discrimination and structural racism was spotlighted, especially following the high-profile killings of George Floyd, Breonna Taylor and others. It was also a time when there was a documented increase in Asian attacks online and physically.
Why was it important to look specifically at discrimination experienced during the pandemic?
One of the things I’ve been very concerned about is this rising prevalence of significant mental health problems during the pandemic. It has really become, in many places and for many age groups, a real crisis. For those of us in health care, recognizing the potential health consequences [of discrimination] is important in trying to help support the communities that we serve.
More than 62,000 people participated in this study. How did you measure the level or types of discrimination they experienced?
We used data from the All of Us Research Program (a National Institutes of Health data repository that researchers can draw from). It is particularly committed to including communities that have historically been underrepresented in medical research.
At the start of the pandemic, participants were invited to complete three monthly surveys. Included in it was a measure of everyday discrimination. The things that it asked about: Were you treated with less courtesy than other people? [Were] you treated with less respect? You received poorer service at restaurants or stores, people acted as if you weren’t smart, they acted as if they were afraid of you, or as if you were dishonest. They acted as if they were better than you. Or they called you names or insulted you or they actually threatened or harassed you.
Which group reported the highest and lowest levels of discrimination? And what were the most frequently reported reasons for discrimination?
The highest levels of discrimination were reported by Black or African American participants. The lowest were non-Hispanic white [participants].
For white participants, age and gender were given as the main reasons that they were experiencing discrimination. Whereas for Asian or Black or African American participants, it was ancestry or national origins and race. A limitation of the study is that although we’re able to look at different groups, there can be variations regionally or within communities, since none of these communities are themselves homogeneous.
You found the link between everyday discrimination and depressive symptoms was particularly strong among Asian, Latino and Hispanic people when the type of discrimination they faced was based on race. Why is it important to quantify this relationship?
That [kind of discrimination] appears to have a toxic effect on mental health. Among people who reported that they experienced the highest frequency of discrimination, compared to those who didn’t experience discrimination, there was a more than 17-fold increased odds of moderate to severe depressive symptoms and more than a 10-fold increased odds of suicidal thinking. When people reported that that discrimination was based on race or ancestry or country of origin, those associations were even higher.
What should communities take away from these findings, especially those that are actively working to combat race-based violence and discrimination?
What we’re looking at here is everyday discrimination: that repeated experience in small and large ways of being devalued and discriminated against. It’s important to have sensitivity to that, and to understand that it is not only an injustice, but a health issue — and [a] mental health issue.