Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston.
Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Boston, Massachusetts.
JAMA Psychiatry. 2022 Sep 1;79(9):898-906. doi: 10.1001/jamapsychiatry.2022.1973.
The COVID-19 pandemic has coincided with an increase in depressive symptoms as well as a growing awareness of health inequities and structural racism in the United States.
To examine the association of mental health with everyday discrimination during the pandemic in a large and diverse cohort of the All of Us Research Program.
DESIGN, SETTING, AND PARTICIPANTS: Using repeated assessments in the early months of the pandemic, mixed-effects models were fitted to assess the associations of discrimination with depressive symptoms and suicidal ideation, and inverse probability weights were applied to account for nonrandom probabilities of completing the voluntary survey.
The exposure and outcome measures were ascertained using the Everyday Discrimination Scale and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Scores for PHQ-9 that were greater than or equal to 10 were classified as moderate to severe depressive symptoms, and any positive response to the ninth item of the PHQ-9 scale was considered as presenting suicidal ideation.
A total of 62 651 individuals (mean [SD] age, 59.3 [15.9] years; female sex at birth, 41 084 [65.6%]) completed at least 1 assessment between May and July 2020. An association with significantly increased likelihood of moderate to severe depressive symptoms and suicidal ideation was observed as the levels of discrimination increased. There was a dose-response association, with 17.68-fold (95% CI, 13.49-23.17; P < .001) and 10.76-fold (95% CI, 7.82-14.80; P < .001) increases in the odds of moderate to severe depressive symptoms and suicidal ideation, respectively, on experiencing discrimination more than once a week. In addition, the association with depressive symptoms was greater when the main reason for discrimination was race, ancestry, or national origins among Hispanic or Latino participants at all 3 time points and among non-Hispanic Asian participants in May and June 2020. Furthermore, high levels of discrimination were as strongly associated with moderate to severe depressive symptoms as was history of prepandemic mood disorder diagnosis.
In this large and diverse sample, increased levels of discrimination were associated with higher odds of experiencing moderate to severe depressive symptoms. This association was particularly evident when the main reason for discrimination was race, ancestry, or national origins among Hispanic or Latino participants and, early in the pandemic, among non-Hispanic Asian participants.
COVID-19 大流行恰逢抑郁症状增加，以及人们越来越意识到美国的健康不平等和结构性种族主义。
在 All of Us 研究计划的一个大型和多样化队列中，检查大流行期间心理健康与日常歧视之间的关联。
设计、设置和参与者：使用大流行早期的重复评估，混合效应模型用于评估歧视与抑郁症状和自杀意念的关联，并应用逆概率权重来解释完成自愿调查的非随机概率。
使用日常歧视量表和 9 项患者健康问卷（PHQ-9）分别确定暴露和结局测量。PHQ-9 得分大于或等于 10 分被归类为中度至重度抑郁症状，而 PHQ-9 量表第九项的任何阳性反应被认为是出现自杀意念。
共有 62651 人（平均[SD]年龄，59.3[15.9]岁；女性出生，41084[65.6%]）在 2020 年 5 月至 7 月之间至少完成了 1 次评估。随着歧视水平的升高，观察到与中度至重度抑郁症状和自杀意念显著增加的关联。存在剂量反应关联，每周经历一次以上歧视的中度至重度抑郁症状和自杀意念的几率分别增加 17.68 倍（95%CI，13.49-23.17；P<.001）和 10.76 倍（95%CI，7.82-14.80；P<.001）。此外，在所有 3 个时间点，西班牙裔或拉丁裔参与者中歧视的主要原因是种族、祖先或民族，以及 2020 年 5 月和 6 月的非西班牙裔亚洲参与者中，这种关联与抑郁症状的关联更大。此外，高水平的歧视与中度至重度抑郁症状的关联与大流行前情绪障碍诊断史一样强烈。
在这个大型和多样化的样本中，歧视程度的增加与出现中度至重度抑郁症状的几率增加有关。这种关联在西班牙裔或拉丁裔参与者中歧视的主要原因是种族、祖先或民族时尤为明显，并且在大流行早期，在非西班牙裔亚洲参与者中也尤为明显。
