While previous studies have linked different types of discrimination to a higher risk of mental illness, psychological distress, and drug use, this new study, published November 1 in the journal Pediatrics, is the first to focus on this formative period in a young adult’s life with continued follow-up on the same individuals over a 10-year period. “With 75 percent of all lifetime mental health disorders presenting by age 24, the transition to adulthood is a crucial time to prevent mental and behavioral health problems,” said Yvonne Lei, a medical student at the David Geffen School of Medicine at UCLA and the study’s corresponding author, in a press release. Researchers looked at 1,834 adults, using data from 2007 to 2017 from the University of Michigan’s Transition to Adulthood Supplement of the Panel Study of Income Dynamics survey. Participants were 18 to 28 years old, 53 percent were male, 67 percent were white, 15 percent were Black, 14 percent were Hispanic, and 3 percent were Asian American, Native Hawaiian, or other Pacific Islander. Experiences of interpersonal discrimination were measured using the Everyday Discrimination Scale, a well-validated and widely used discrimination scale. Assessment questions included “How often …
Were you treated with less courtesy?Did you receive poorer service?Did others treat you as stupid?Did others act afraid?Did others treat you as dishonest?Did others act superior to you?
The authors found that approximately 93 percent of participants in the study reported experiencing discrimination; the most common factors they cited were age (26 percent), physical appearance (19 percent), sex (14 percent), and race (13 percent). “Participants who experienced frequent discrimination — a few times per month or more — were roughly 25 percent more likely to be diagnosed with a mental illness and twice as likely to develop severe psychological distress as those who had not experienced discrimination or who had experienced it a few times per year or less,” says Adam Bennett Schickedanz, MD, PhD, a researcher and pediatrician at the UCLA Department of Pediatrics. “Also, young adults who experienced any amount of discrimination had a 26 percent greater risk for poor health than people who said they did not experience discrimination,” he says. During the 10-year period of the study, the young adults who had experienced multiple successive years of high-frequency discrimination showed a much more pronounced cumulative risk of mental illness, psychological distress, drug use, and worse overall health, says Dr. Schickedanz. “This pervasive pattern showing the link between discrimination and worse mental and behavioral health over time, and cumulatively with greater exposure, suggests that discrimination is a driver of worse health outcomes, not just that the two travel together in an unrelated fashion,” he says. This study confirms existing evidence that interpersonal discrimination impacts longer-term well-being and outcomes for those on the receiving end of that dynamic, says Tyehimba Hunt-Harrison, MD, MPH, a child and adolescent psychiatrist and the director of mental health equity in the UNC Department of Psychiatry in Chapel Hill, North Carolina. “It is not surprising that experiencing high frequency discrimination impacts young people, as they are in the process of solidifying their sense of self, figuring out who they are and who they can be, and starting their journey through the realities of adulthood,” says Dr. Hunt-Harrison. It makes sense that those external and internal forces can contribute significantly to poorer overall health and well-being, she adds.
Effects of Discrimination Are Intertwined With Disparities in Mental Health Care and Overall Care
This study is a good reminder that discrimination is not just a larger systemic issue that is void of a human face but that it is experienced at the individual level, says Hunt-Harrison. “To me, that is a significant takeaway message. It is often easier for people to focus on the system because we can portray it as being an issue of others. This article brings attention back to the individual, hopefully with the impact of increased desire for self-awareness and care for others,” she says. The authors suggest that the effects of discrimination in young adults are intertwined with disparities in care for mental health problems and institutional discrimination in healthcare overall, including inequities in diagnosis, treatment, and health outcomes. These findings are particularly relevant in light of the stresses young adults are facing nationwide today, according to Lei. “The COVID-19 pandemic has brought to the forefront new mental health challenges — particularly for vulnerable populations,” she said. “We have the opportunity to rethink and improve mental health services to acknowledge the impact of discrimination, so we can better address it to provide more equitable care delivery.”
