Wang Monica L, Narcisse Marie-Rachelle
Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2025 Mar 3;8(3):e252404. doi: 10.1001/jamanetworkopen.2025.2404.
Examining how discrimination is associated with mental health across different demographic groups can guide efforts to improve mental well-being.
To analyze associations between discrimination and mental health and explore how these associations may vary by race and ethnicity and sex.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional data of 29 522 adults weighted to represent a population of 258 237 552 US adults from the 2023 US National Health Interview Survey were analyzed.
Exposure to discrimination was measured using the Everyday Discrimination Scale, which assesses frequency of being treated with less courtesy, receiving poor service, being treated as not smart, being feared, and experiencing harassment. A summative scale and a nominal variable (none, low, and high) measured degree and levels of discrimination exposure.
Outcomes included depression (measured with the Patient Health Questionnaire-2 scale) and anxiety (measured with the Generalized Anxiety Disorder-2 scale), with scores of 3 or greater indicating positive screening results for each scale. Multinomial logistic regression analyses examined associations of interest and tests of interaction explored effect modification by race and ethnicity and sex.
Among a sample of 29 522 adults weighted to represent a population of 258 237 552 US adults (mean age, 48.1 years [95% CI, 47.8-48.4 years]; 51.1% female; 17.5% Hispanic or Latino, 2.5% multiracial or other, 6.2% non-Hispanic Asian, 11.6% non-Hispanic or non-Latino Black, and 62.2% non-Hispanic or non-Latino White), each unit increase in exposure to discrimination was associated with increased odds of positive screening results for depression (odds ratio [OR], 1.15 [95% CI, 1.12-1.17]), anxiety (OR, 1.14 [95% CI, 1.12-1.16]), and both depression and anxiety (OR, 1.19 [95% CI, 1.16-1.21]). Compared with no exposure to discrimination, low and high exposure to discrimination were associated with increased odds of positive screening results for depression (low exposure: OR, 2.20 [95% CI, 1.77-2.72]; high exposure: OR, 5.39 [95% CI, 3.61-8.04]), anxiety (low exposure: OR, 1.97 [95% CI, 1.66-2.33]; high exposure: OR, 4.98 [95% CI, 3.59-6.91]), and both depression and anxiety (low exposure: OR, 2.60 [95% CI, 2.13-3.18]; high exposure: OR, 8.84 [95% CI, 6.44-12.14]). Associations between discrimination and positive screening results for depression alone (F4,607 = 3.35; P = .01) and between discrimination and positive screening results for both depression and anxiety (F4,607 = 2.80; P = .03) varied by race and ethnicity. Associations of interest did not differ by sex.
Findings of this cross-sectional study suggest an association between discrimination and mental health across US adults, emphasizing the need for further evaluation and increased awareness of how these associations may vary across different demographic groups.
研究不同人口群体中歧视与心理健康之间的关联，可为改善心理健康状况的努力提供指导。
分析歧视与心理健康之间的关联，并探讨这些关联如何因种族、族裔和性别而有所不同。
设计、背景和参与者：分析了2023年美国国家健康访谈调查中29522名成年人的横断面数据，这些数据经过加权以代表258237552名美国成年人的总体。
使用日常歧视量表测量歧视暴露情况，该量表评估受到不礼貌对待、接受劣质服务、被视为不聪明、受到恐惧和遭受骚扰的频率。一个汇总量表和一个名义变量（无、低和高）测量歧视暴露的程度和水平。
结局包括抑郁（用患者健康问卷-2量表测量）和焦虑（用广泛性焦虑障碍-2量表测量），各量表得分3分或更高表明筛查结果为阳性。多项逻辑回归分析检验了感兴趣的关联，交互作用检验探讨了种族、族裔和性别的效应修正。
在加权后代表258237552名美国成年人总体的29522名成年人样本中（平均年龄48.1岁[95%CI，47.8 - 48.4岁]；51.1%为女性；17.5%为西班牙裔或拉丁裔，2.5%为多种族或其他，6.2%为非西班牙裔亚裔，11.6%为非西班牙裔或非拉丁裔黑人，62.2%为非西班牙裔或非拉丁裔白人），歧视暴露每增加一个单位，抑郁筛查结果为阳性的几率增加（优势比[OR]，1.15[95%CI，1.12 - 1.17]）、焦虑筛查结果为阳性的几率增加（OR，1.14[95%CI，1.12 - 1.16]），抑郁和焦虑筛查结果均为阳性的几率增加（OR，1.19[95%CI，1.16 -
