Ethnic Minority-Majority Status and Mental Health: The Mediating Role of Perceived Discrimination
Cokley, Kevin, Hall-Clark, Brittany, Hicks, Dana, Journal of Mental Health Counseling
This study examines the role of perceived discrimination as a mediator of the relationship between ethnic minority-majority status and mental health in a sample of college students, of whom 246 were members of an ethnic minority (African American, Latino American, or Asian American) and 167 were European Americans. Ethnic minority students were significantly higher in perceived discrimination and significantly lower in mental health. African Americans were most likely to perceive racial discrimination, followed by Latino Americans, Asian Americans, and European Americans. Asian Americans reported the poorest mental health. Results of mediational analyses by ethnic status (minorities and majority) and across ethnic group pairings (Americans and European Americans, Latino Americans and European Americans, Asian Americans and European Americans) confirmed in every instance that perceived discrimination accounts for a modest part of the relationship between ethnic minority-majority status and mental health. We address the implications for mental health practice on college campuses.
It is well documented that the differential experiences of ethnic minorities lead to differential life outcomes. Minorities are disproportionately likely to have worse jobs and lower incomes, live in less desirable areas, and experience slights and indignities (e.g., racial micro-aggressions) than those in the European American majority (Marger, 2008; Sue, Bucceri, Lin, Nadal, & Torino, 2007; Sue, Capodilupo, & Holder, 2008). Ethnic minority students often attend substandard schools, receive poorer instruction, and are exposed to more violence (Massey, 2006). On predominantly White college campuses minority students report more negative experiences (e.g., faculty racism, racial conflict, racial harassment) than majority students (Ancis, Sedlacek, & Mohr, 2000; Rankin & Reason, 2000). Given these negative experiences, the cumulative effects of life stressors experienced by minorities might be expected to undermine their mental health (Smith, 1985). Perceived discrimination has been consistently linked to mental and physical health outcomes (Pascoe & Smart Richman, 2009; Williams, Yu, Jackson, & Anderson, 1997). However, while researchers seek the pathways linking perceived discrimination to health outcomes, most research on perceived discrimination either uses homogenous ethnic/racial samples or samples that compare two ethnic/racial groups. Few studies have compared multiple ethnic or racial groups, and virtually none has explicitly examined perceived discrimination as a mediating mechanism that links ethnic minority-majority status to mental health outcomes for multiple ethnic groups. Yet history shows that discrimination varies in type, frequency, intensity, and duration depending on the ethnic group examined (Takaki, 1993). The purpose of this study is to address this research gap by examining the role of perceived discrimination in differences in self-reported mental health in an ethnically diverse sample.
ETHNIC MINORITIES AND MENTAL HEALTH
Several theories offer explanations of why the mental health of ethnic and racial minorities may be poorer. Critical race theory is one of the more provocative theories offered (Brown, 2003). This theory suggests that racial stratification can cause mental health problems because stressful circumstances exacerbate emotional distress (Brown, 2003). Brown argues that standard definitions of mental health do not account for racial stratification and thus may not be nuanced enough to capture mental health in non-White samples. Examples of mental health problems caused by racial stratification are nihilistic tendencies, anti-self issues, and expression of suppressed anger. Eliminating racial stratification should therefore eliminate these mental health problems (Brown, 2003).
A related theory is social stress theory (Aneshensel, 1992), which encompasses several perspectives that demonstrate how different socio-environmental conditions evoke stress. Much of the research applying social stress theory emphasizes a single stressor, life-event changes (Aneshensel, 1992). Popular checklists of such changes typically include marriage, divorce, death, serious illness and injury, and being laid off. While social stress is a useful theoretical framework, one limitation of the life-event changes approach is that certain events are oversampled from young adults and undersampled from ethnic minorities (Aneshensel, 1992). It is difficult to draw reliable conclusions about ethnic differences in exposure to social stressors if chronic stressors like racism and discrimination are not studied.
However, there is as yet no agreement that a general theory can be used to explain the mental health situation of ethnic minorities. Sue and Chu (2003) propose an inductive process of studying ethnic minority groups separately, which may then lead to a more general theory. An inductive process allows for identification of specific constructs that may apply more to certain groups. It also allows for comparing the salience of a single construct (e.g., perceived discrimination) for different ethnic minority groups.
In the most comprehensive review of ethnic minorities and mental health to date, Vega and Rumbaut (1991) critique the definition of mental health, and specifically ethnic minority mental health, typically found in epidemiological studies. They argue that although mental health was originally conceptualized to reflect well-being and resilience, the influence of psychiatrists has resulted in a more narrow definition that emphasizes mental disorders. As a result, mental health research tends to be from a non-normative perspective rooted in a disease model. Because this has led to a de-emphasis of cultural and social explanations of mental illness, ethnic minority mental health has been understudied. When it has been studied, symptom checklists have been used that were not developed with minority populations. One problem with this is the role of health complaints: Many ethnic minorities manifest mental health problems somatically. Failure to list health complaints on symptom checklists likely results in underreporting of minority mental health problems (Vega & Rumbaut). In short, more research is needed on the methodology of using self-report symptom checklists with ethnic minorities. The use of symptom checklists and the narrow definition of mental health partly explain the current state of the literature on ethnic minorities and mental health.
Ethnic Differences in Mental Health: Fact or Fiction?
While numerous studies have examined the relationship between minorities and mental health, findings related to ethnic differences have been inconsistent (Ulbrich, Warheit, & Zimmerman, 1989). In the 1980s, while there had been few studies of mental health outcomes for minorities, it was generally acknowledged that mental health disorders were as prevalent among minority groups as among the White population (Somervell, Leaf, Weissman, Blazer & Bruce, 1989). Over the next two decades racial and ethnic disparities in the use of mental health services were recognized. According to the National Health Interview Survey, from 1997-2002 ethnic minority participants displayed no significant increase in contact with mental health professionals (Mojtabai, 2005). In fact, African American and Latino participants had less demand for mental health services in general.
Among college students there has been limited research linking mental health outcomes with ethnic minorities. Bertocci, Hirsch, Sommer and Williams (1992) concluded after reviewing major studies of college student mental health in the 1970s and 1980s that 50% to 75% of students who did not use mental health services had significant emotional difficulties and 10% to 40% suffered from a psychological impairment (Bertocci et al.). It is reasonable to think that these percentages cover a number of ethnic minority students. However, after a review of the literature on mental health outcomes and college students, Walden (1994) concluded that the ethnic minority populations reported were usually too small to generalize the results. In one of the few empirical studies that examined differing levels of psychological symptomatology among a large sample of ethnic minority college students, Rosenthal and Schreiner (2000) found that less than 15% of the students reported clinically significant levels of anger, anxiety, or depression and that the evidence for ethnic differences in mental health was inconclusive. The 2001 supplement to the 1999 Surgeon General's report also concluded that there are no ethnic differences in the prevalence of mental disorders (U.S. Department of Health and Human Services, 2001).
However, this notion has been challenged (Sue & Chu, 2003). Several studies suggest that there are ethnic differences in mental health and the prevalence of mental disorders (Hudson, Towey, & Shiner, 2008; Kessler et al., 1994; Kessler et al., 1996; Okazaki, 1997). As previously mentioned, one reason for inconsistent findings and conclusions is the use of symptom checklists; clinical interviews are a more comprehensive method for diagnosing mental disorders. Some studies of ethnic differences use symptom checklists and others clinical interviews.
Another problem is the discrepancy between reporting symptoms of mental disorders and reporting prevalence rates (Sue & Chu, 2003). Sue and Chu state that Asian Americans often report many serious mental health symptoms yet have lower prevalence rates than the symptoms would imply. They suggest that symptoms "reflect a level of functioning that is subclinical and yet indicative of discomfort, anxiety, depression, anger, uncertainty, powerlessness, and helplessness" (p. 461).
The findings related to ethnic minority mental health and differences with majority individuals are equivocal. On the one hand, given negative experiences with discrimination and the well-documented fact that ethnic minorities generally experience higher rates of poverty and poorer physical health, minorities might be expected to have poorer mental health than the majority. However, most ethnic minorities report lower rates of mental disorders, both lifetime and in the past year, than the White majority (McGuire & Miranda, 2008). Based on the evidence, it seems that efforts to find evidence of poorer mental health among minorities may be misdirected. Instead, there should be more examination of symptoms of mental disorders rather than rates, because ethnic minorities often report more symptoms even though they have lower rates of mental disorders (U.S. Department of Health and Human Services, 2001).
Sue and Chu (2003) offer several recommendations for future ethnic minority mental health research, such as (1) distinguishing between symptoms and prevalence rates, (2) doing direct comparisons of the mental health of several ethnic groups in a single study, and (3) using measures of racism to determine if ethnic groups have similar or different experiences and to see how these experiences directly or indirectly impact mental health.
PERCEIVED DISCRIMINATION AND MENTAL HEALTH
Perceived discrimination as related to various aspects of mental health and psychological well-being has been studied with several ethnic and racial groups, including African Americans (Browman, Mavaddat, & Hsu, 2000; Landrine & Klonoff, 1996); Asian Americans (Lee, 2003, 2005); Latino/a Americans (Finch, Kolody, & Vega, 2000; Moradi & Risco, 2006); and Arab Americans (Awad, 2010; Moradi & Hasan, 2004). Perceived discrimination is often conceptualized within the context of ethnic minority status and race (Williams et al., 1997) because members of ethnic minority groups regularly face discrimination in spite of significant sociopolitical advances in race relations (Pettigrew, 2008; Prelow, Mosher, & Bowman, 2006; Swim, Hyers, Cohen, Fitzgerald, & Bylsma, 2003). Racial discrimination is thus the most commonly studied type of perceived discrimination, followed by gender discrimination (Pascoe & Smart Richman, 2009). This study focuses on perceived racial discrimination.
Perceived discrimination is most often measured using the Perceived Racism Scale, the Schedule of Racist Events, the Index of Race-Related Stress, the Schedule of Sexist Events, and the Perceived Discrimination Scale (Pascoe & Smart Richman, 2009). Regardless of how it is measured, its relationship to mental health has been studied most extensively in African Americans, with relatively little attention given to other ethnic minority groups (Hwang & Goto, 2008).
Though comparative studies of perceived discrimination across ethnic minority groups are rare, one such study by Landrine, Klonoff, Corral, Fernandez, and Roesch (2006) found that African and Asian Americans reported experiencing the highest level of recent racial discrimination, followed by Latino and then White Americans. African Americans also reported the highest level of lifetime discrimination of all ethnic groups, and Asian and Latino Americans reported higher lifetime discrimination than White Americans. African Americans were also more likely than all other ethnic groups to appraise racial discrimination as stressful, and Latino and Asian Americans rated discrimination as more distressing than Whites.
The literature reflects the tendency for African Americans to report more racial discrimination than other ethnic groups, but since racial discrimination also affects the lives of Latino and Asian Americans and other ethnic minority groups, research on more diverse samples is needed. Another limitation is that because research on the relation of perceived discrimination to mental health has understandably been conducted on primarily ethnic minorities, there has been little attention to the perceived discrimination experiences of White Americans (Williams et al., 1997).
In a diverse sample of ethnic minorities and European Americans, Landrine et al. (2006) found that perceived ethnic discrimination was the strongest predictor of psychiatric symptoms, accounting for 7.84% of the variance beyond demographic variables. Perceived discrimination also accounted for 4.84% of the variance of psychiatric symptoms for White Americans, though for ethnic minorities it was nearly triple that (11.56%).
Regardless of minority or majority status, perceived discrimination can negatively impact mental and physical health (BMJ Specialty Journals, 2007; Jackson, Williams, & Torres, 1995). Because racial discrimination is more prevalent in the lives of racial and ethnic minorities, it can reasonably be assumed that its effects are more salient for them than for European Americans. However, when perceived discrimination is framed in the context of unfair experiences rather than race (Williams et al., 1997), that assumption is less obvious.
Hwang and Goto (2008) conceptualize the negative impact of perceived discrimination as "etic," or universal, and differences in the types of discrimination experienced as "emic," or group-specific. They found that both Asians and Latinos who experienced greater discrimination also experienced more depression, state and trait anxiety, suicidal ideation, and psychological distress.
However, Latinos were more likely to identify these events as stressful, and for them there were closer linkages between discrimination, depression, and suicidal ideation. Moradi and Risco (2006) also found that for Latinos perceived discrimination is both directly and indirectly related to psychological distress. Hwang and Goto found that Latinos and Asians experienced different types of discrimination, with Latinos more often accused of wrongdoing. For these reasons, it is important to compare how perceived discrimination may affect different ethnic groups.
PURPOSE OF THIS STUDY
Given the inconsistencies in the literature related to ethnic differences in mental health, one purpose of this study was to examine whether there are ethnic differences between ethnic minorities and Whites and between different minority groups. We were specifically interested in examining symptoms that are consistent with poorer mental health (emotional distress) rather than examining diagnoses of mental illness or rates of mental disorders. We hypothesized that ethnic minorities would be higher in emotional distress than the ethnic majority. Following the recommendations of Sue and Chu (2003), we also hypothesized that there would be no differences in emotional distress among ethnic minorities. We also were interested in whether different ethnic groups would have similar or different perceptions of discrimination, and whether perceived discrimination would account for any differences in mental health. We hypothesized that minorities would perceive more discrimination than the ethnic majority. Finally, we hypothesized that perceived discrimination would mediate the relationship between ethnic minority-majority status and emotional distress. As a point of clarification, we do not use ethnic minority-majority status because of an assumption that the majority ("European Americans") is the norm to which ethnic minorities must be compared--an assumption made in many comparative research studies (Azibo, 1988). Rather, ethnic minority-majority status is used because of the likelihood that perceived discrimination is an important differentiating experience. This satisfies Azibo's requirement that comparative research is appropriate when ethnic or racial differences are an inherent part of the construct, as would be expected with perceived discrimination.
Participants were 413 students--20% African American (n = 83), 19% Asian American (n = 81), 20% Latino American (n = 82), and 40% European American (n = 167)--attending a large, public Southwestern university. The enrollment at that campus is 53.5% European American, 4.9% African American, 18.2% Asian American, and 18.5% Latino American. The sample consisted of 195 males and 217 females, ranging in age from 16 to 41 (M = 20.37, SD = 2.21). There were 81 freshmen, 98 sophomores, 88 juniors, and 144 seniors (2 unidentified); and 42% identified as middle class (64% ethnic minority, 36% ethnic majority), 35% as upper middle class (45% minority, 55% majority), 18% as working class (89% minority, 11% majority), and 4% as upper class (78% minority, 22% majority).
The study was approved by the University of Texas at Austin Institutional Review Board. Participants were recruited from the subject pool in the Educational Psychology Department. Data were collected using SurveyMonkey, an online system. Before taking the survey participants were prompted first to enter their student ID and email address, then to read the consent form; their participation in the study indicated their informed consent. The data were collected as part of a larger survey of measures of religiousness, spirituality, social dominance orientation, right-wing authoritarianism, and prejudicial attitudes. Respondents who completed the surveys received course credit.
Perceived Discrimination Scale (PDS). The PDS (Williams et al., 1997) was developed to assess everyday discrimination, which was defined as routine, less overt, chronic experience of unfair treatment (Essed, 1991). It consists of 10 Likert items scaled 0 (never), 1 (rarely), 2 (sometimes), and 3 (often) that assess the frequency of day-to-day experiences like being treated with less courtesy than others, receiving poorer service in restaurants or stores, being treated as less intelligent, and being called names or insulted. Scores can range from 0 to 3. A Cronbach's alpha of .90 has been reported (Ryff, Keyes, & Hughes, 2003). Cronbach's alphas for the current study were .83 for European Americans, .89 for African Americans, .90 for Asian Americans, and .90 for Latino Americans.
Mental Health Inventory-5 (MHI-5). The MHI-5 (Berwick et al., 1991), a self-report symptom scale that assesses emotional distress in general populations, is a short form of the RAND Mental Health Inventory (MHI; Veit & Ware, 1983) that consists of 5 items scored from 1 (All of the time) to 6 (None of the time). Scores are linearly transformed to a common metric, ranging from 0, the poorest mental health, to 100, optimal mental health (Hays, Sherbourne, & Mazel, 1995). The cutoff score for defining emotional distress is less than or equal to 67 (Barnet, Duggan, Devoe, & Burrell, 2002; Mistry, Stevens, Sareen, Vogil, & Halfon, 2007; Wenzel, Leake, & Gelberg, 2000). Respondents are asked how much of the time during the past month they have been (1) happy, (2) calm and peaceful, (3) nervous, (4) downhearted and blue, and (5) so down in the dumps that nothing could cheer them up. A Cronbach's alpha of .82 has been reported (Wenzel et al., 2000). Cronbach's alphas for the current study were .82 for European Americans, .85 for African Americans, .83 for Asian Americans, and .74 for Hispanic/Latino Americans.
The MHI-5 has compared favorably with the 18-item MHI and a 30-item General Health Questionnaire for detecting major depression, affective disorders, and anxiety disorders (Berwick et al., 1991). It has been found to be effective for screening mood disorders (Rumpf, Meyer, Hapke, & John, 2001). While much of the research using the MHI-5 does not report the ethnicity of the participants, it has been used with African Americans (Barnet et al., 2002; Wenzel et al., 2000). Wenzel et al. showed that African American women who reported rape were more likely to experience psychological distress and depression.
Demographic Sheet. Demographic information covered ethnicity, sex, age, and social class.
To examine ethnic minority-majority differences in mental health and perceived discrimination, we conducted an analysis of variance. There were significant differences in mental health, F(1, 411) = 15.40, p < .001, with a small to modest effect size ([[eta].sup.2]=.04). Overall, ethnic minorities reported lower mental health (M = 4.36, SD = .84) than the European American majority (M = 4.67, SD = .67). To examine within-group ethnic minority differences, we conducted another analysis of variance and found no significant differences in mental health, F(2, 245) = 1.67, p >.05, [[eta].sup.2]=.01, between Asian Americans (M = 4.23, SD = .90), African Americans (M = 4.43, SD = .88), and Latino Americans (M = 4.43, SD = .79).
There were significant differences in perceived discrimination, F(1, 41l) = 15.54, p < .001, with a small to modest effect size ([[eta].sup.2]=.04). Overall, ethnic minorities were higher in perceived discrimination (M = 2. l 3, SD = .57) than the European American majority (M = 1.93, SD = .43). To examine within-group ethnic minority differences, we conducted an additional analysis of variance and found no significant differences in perceived discrimination, F(2, 245) = .440, p > .05, [[eta].sup.2]=.00 between Asian Americans (M = 2.08, SD = .51), African Americans (M = 2.16, SD = .61), and Latino Americans (M = 2.16, SD = .57).
The types of experiences listed as perceived discrimination varied by ethnic group. Of the African American students, 81% thought that they had been discriminated against because of race, compared to 67% of the Latino Americans, 61% of the Asian Americans, and 11% of the European Americans. Of the European American students, 41% thought they had been discriminated against because of gender, compared to 37% of the African Americans, 30% of the Latino Americans, and 20% of the Asian Americans.
We were also interested in exploring whether there was a cumulative effect of perceived discrimination, that is, examining the effects of having multiple identities and experiencing multiple oppressions (Reynolds & Pope, 2001). Multiple oppressions are based on the idea that an individual's identity has multiple dimensions, all of which constitute a core sense of personal identity (Jones & McEwen, 2000). Each dimension is a potential source of oppression that must be examined uniquely but also cumulatively. We also sought an answer to whether individuals who identify multiple reasons for being discriminated against (e.g., race, gender, religion, sexual orientation) differ in mental health and perceived discrimination from individuals who identify fewer reasons. To do so, we added the following item after the perceived discrimination items: "In the instances where you have experienced these events, choose the reasons you think you were treated this way." The response options included (1) race or ethnicity, (2) nationality (e.g., not being American), (3) gender, (4) sexual orientation, and (5) religion; respondents could choose more than one.
There were no significant differences in mental health based on number of reasons chosen, F(3, 309) = .67, p > .05, but there were significant differences in perceived discrimination, F(3,308) = 5.51, p < .001. Students who identified two reasons (N=73; M = 2.24, SD = .51) or three (N= 24; M = 2.41, SD = .35) for being discriminated against were significantly higher in perceived discrimination than those who identified only one (N = 207; M = 2.04, SD = .51).
Correlations were also conducted between perceived discrimination and mental health/emotional distress. Tables 1 and 2 show the correlations disaggregated by ethnicity. The correlation between perceived discrimination and mental health/emotional distress was -.28 for ethnic majority members and -.26 for ethnic minorities collectively, and -.15 for African Americans, -.38 for Asian Americans, and -.31 for Latino Americans.
Given the ethnic minority-majority status differences in mental health, we sought to find out why the differences existed, using the guidelines of Baron and Kenny (1986) to test whether perceived discrimination mediated the relationship between ethnic minority-majority status and mental health. The following conditions must be met to establish mediation: (a) the independent variable (ethnic minority-majority status) must be related to the dependent variable (mental health); (b) the independent variable must be related to the mediator (perceived discrimination); (c) the mediator must be related to the dependent variable; and (d) the effect of the independent variable on the dependent variable must be reduced to zero (for full mediation) or non-zero (for partial mediation). The Sobel Test is then conducted to determine if the full or partial mediation is statistically significant (Preacher & Leonarelli, 2001).
Ethnic minority-majority status was significantly related to mental health, [beta] = -.19, p < .001. Ethnic minorities were lower in mental health than European Americans. Ethnic minority-majority status was also significantly related to perceived discrimination, [beta] = .19, p < .001. Ethnic minorities were higher in perceived discrimination than the ethnic majority. Next, perceived discrimination was found to be significantly related to mental health, [beta] = -.26, p < .001; but after controlling for the effect of perceived discrimination, the relationship between ethnic minority-majority status decreased, [beta] = -.14, p < .001 (see Figure 1).
[FIGURE 1 OMITTED]
Previous thinking about mediation stated the steps in terms of statistical significance (Baron & Kenny, 1986); however, problems with small coefficients being statistically significant with large samples and large coefficients being non-significant with small samples has led to an emphasis on coefficients being reduced to zero or nonzero (Kenny, 2009). Thus, as Kenny argues, the data are consistent with the hypothesis that perceived discrimination partially mediates the relationship between ethnic minority-majority status and mental health. A reduction in the coefficient is necessary, but not sufficient, to confirm mediation. The Sobel Test was conducted to statistically determine if perceived discrimination was partially responsible for the relationship between ethnic status and mental health and confirmed that it did partially mediate the relationship, Sobel's statistic = -3.26, p < .001.
Because Sue and Chu (2003) found intra-ethnic differences in mental health symptoms and prevalence of mental disorders, mediational analyses were conducted in which ethnicity was disaggregated using the combinations of African American--European American, Latino American--European American, and Asian American--European American. Evidence of mediation in all three ethnicity pairings would provide further documentation that ethnic minority status, regardless of ethnicity, carries more emotional distress due in part to perceived discrimination.
African American--European American
For this pairing, ethnicity was significantly related to mental health, [beta] = -.15, p < .001, with African Americans lower in mental health than European Americans. Ethnicity was also significantly related to perceived discrimination, [beta] = .21, p < .001, with African Americans higher. Next, perceived discrimination was found to be significantly related to mental health, [beta] = -.22, p < .001. After controlling for the effect of perceived discrimination, the relationship between ethnicity and mental health decreased, [beta] = -.10, p = .11. The Sobel Test confirmed that perceived discrimination partially mediated the ethnicity-mental health relationship, Sobel's statistic = -3.26, p < .001.
Latino American--European American
Ethnicity was again significantly related to mental health, [beta] = -.16, p < .001, with Latino Americans lower than European Americans. It was also significantly related to perceived discrimination, [beta] = .22, p < .001, with Latino Americans higher. Next, perceived discrimination was again found to be significantly related to mental health, [beta] = -.29, p < .001. After controlling for the effect of perceived discrimination, the relationship between ethnicity and mental health decreased, [beta] = -.10, p = .12. The Sobel Test confirmed that perceived discrimination partially mediated the ethnicity-mental health relationship, Sobel's statistic = -3.03, p < .01.
Asian American--European American
Ethnicity was again significantly related to mental health, [beta] = -.27, p < .001, with Asian Americans lower in mental health than European Americans. It was also significantly related to perceived discrimination, [beta] = .16, p < .001, with Asian Americans higher. Next, perceived discrimination was again found to be significantly related to mental health, [beta] = -.31, p < .001. After controlling for the effect of perceived discrimination, the relationship between ethnicity and mental health decreased, [beta] = -.22, p = .001. The Sobel Test confirmed that perceived discrimination partially mediated the ethnicity-mental health relationship, Sobel's statistic = -2.38, p < .05.
Despite conflicts in the literature on ethnic minorities and mental health, recent research suggests that minorities report lower rates of mental disorders than the ethnic majority. However, when mental health symptoms (emotional distress) are examined rather than prevalence rates or more comprehensive clinical interviews, there is evidence that some minorities (e.g., Asian Americans) report more serious mental health symptoms (Sue & Chu, 2003). There is also considerable evidence of a link between perceived discrimination and both mental and physical health (Pascoe & Smart Richman, 2009). This study sought to examine the degree to which perceived discrimination mediated the link between ethnicity and mental health symptoms. Perceived discrimination was measured by both scores on the PDS and the percentages of each ethnic group reporting discrimination due to race or ethnicity, gender, religion, or sexual orientation.
Based on the PDS scores, perceived discrimination was found to be a significant, though weak, mediator of the link between ethnicity and emotional distress. Less than 2% of the variance was partialled out in each mediation analysis. The ethnicity-emotional distress link was very small for African and Latino Americans (-.1) but somewhat larger for Asian Americans (-.22). These results, combined with an effect size of .04, indicate that the effect of ethnicity on emotional distress was small. This modest effect implies there was not much variance to be mediated. Overall, these results suggest that future research should seek to establish a closer link between ethnicity and emotional distress so as to provide a stronger statistical test of perceived discrimination as a significant mediator. The relatively stronger effect of Asian American ethnicity suggests there may be important differences among ethnic minorities that should be explored.
The results of the correlations indicate that perceived discrimination has a slightly stronger direct relationship with emotional distress (-.29) than having a mediational effect (-.26). These results provide additional evidence of the small effect that ethnicity has on emotional distress once it is considered along with perceived discrimination. Surprisingly, an examination of the perceived discrimination-emotional distress correlations disaggregated by ethnic minority-majority status showed a stronger relationship for the ethnic majority (-.28) than for ethnic minorities (-.26).
To better understand this finding, ethnic minority status was further disaggregated. Though not significant for African Americans (-.15), the perceived discrimination-emotional distress correlation was significant for Asian Americans (-.38) and Latino Americans (-.3l). Thus, the stronger relationship found for the ethnic majority can be explained by the fact that the non-significant relationship among African Americans lowered the correlation for ethnic minorities in general.
This surprising finding is not easily explained. Previous research with African Americans found a significant relationship between perceived discrimination and mental health (Browman et al., 2000; Landrine & Klonoff, 1996). It may be that the African Americans in this sample have been buffered from the negative effects of perceived discrimination because of factors not covered in the study (e.g., religiousness, spirituality). Nevertheless, in light of previous research and the counterintuitive nature of our findings, we believe that the current results may be idiosyncratic to this specific sample of African Americans. However, we do note that although the correlation was non-significant for African Americans, the negative correlation was still in the expected direction.
Based on the percentage of each group reporting perceived racial discrimination, the current study confirms previous findings that perceived discrimination occurs regularly in the lives of minorities (Kessler, Mickelson, & Williams, 1999; Williams et al., 1997). This is evidenced by the fact that 81% of African Americans, 67% of Latino Americans, and 61% of Asian Americans in the study reported perceived racial discrimination, compared to only 11% of the European Americans. Williams et al. (1997) have noted that perceived discrimination is a source of stress after general stress has been taken into account, suggesting that perceived discrimination is a unique stressor that merits serious examination. Kessler et al. (1999) reported that one-third of a sample of socially disadvantaged groups (e.g., ethnic minorities, women, and the poor) reported experiencing discrimination, and that about 60% reported experiencing everyday discrimination.
Also, in line with previous research (Williams et al.), members of minorities in our sample were more likely to report perceived racial discrimination than members of the majority. Our study also corroborates findings that African American college students are the most likely group to report perceived racial discrimination (Landrine et al., 2006). In our sample, 81% of the African American sample reported experiencing discrimination due to race, which is
similar to previous rates reported (Banks, Kohn-Wood, & Spencer, 2006).
However, some researchers have failed to find racial or ethnic differences in perceived discrimination (Kessler et al., 1999, Taylor & Turner, 2002). This may be because Kessler et al. (1999) operationalized discrimination broadly to include any type of discrimination and did not assess reasons for discrimination. In our study, race-based and gender-based discrimination were reported most frequently. As expected, European Americans were the least likely to report perceived racial discrimination, but reports of perceived gender discrimination were more equal, with European Americans reporting the highest rate (41%) but being closely followed by African Americans (37%), Latino Americans (30%), and Asian Americans (19%). These findings suggest that greater ethnic differences appear when the reason for discrimination is emphasized.
Another important consideration is the role of socioeconomic status. Minorities sampled were disproportionately working- and middle class, while majority students were disproportionately upper-middle and upper class. Kessler et al. (1999) found that differential exposure to discrimination was important in explaining associations between poor mental health and low income. Furthermore, Taylor and Turner (2002) and Williams et al. (1997) found that ethnic differences in mental health problems diminish in the presence of SES and are largely explained by income and education. However, Taylor and Turner (2002) also noted regional differences in their sample, referencing recent shifts in political power that could have contributed to the similar rates of discrimination between European and African Americans they found in their study.
The common occurrence of discrimination is of concern; researchers have consistently found that everyday perceived discrimination is associated with poorer physical and mental health (Gee, Spencer, Chen, Yip, & Takeuchi, 2007; Kessler et al. 1999; Williams et al., 1997). However, Williams et al. (1997) have found that discrimination is related more closely to mental than physical health. Our findings are in line with past findings (Gee et al., 2007; Landrine et al., 2006; Kessler et al., 1999; Taylor & Turner, 2002) that self-reported perceived discrimination is associated with poorer mental health. Kessler et al. (1999) linked perceived discrimination with diagnoses of generalized anxiety disorder and major depression. Although this relationship holds true for both majority and minority groups, our study confirms previous findings (Landrine et al., 2006); Williams et al. (1997) also found that perceived discrimination tends to exert a greater emotional toll on people of color than on European Americans. In our sample, ethnic minority groups reported a higher incidence of discrimination and lower mental health (emotional distress). As mentioned earlier, the link between perceived discrimination and emotional distress was actually slightly stronger for ethnic majority individuals than all ethnic minority individuals combined; however, once African Americans were removed from the ethnic minority sample, the link became stronger for minority individuals. Stated another way, perceived discrimination was generally worse (i.e., larger correlations with mental health/emotional distress) for Asian Americans and Latino Americans, and ethnic minority individuals had more reported instances of perceived discrimination than ethnic majority individuals.
Several features of the current study contribute significantly to the literature. Our study testifies to the importance of examining proximal variables beyond race and ethnicity. Perceived discrimination partially accounted for the relationship between ethnic minority-majority status and mental health. The study also adds to the growing literature on everyday racism. As Araujo and Borrell (2006) noted, previous research has often focused on acute discriminatory events, such as employment discrimination. Several scholars (Araujo & Borrell; Burgess et al., 2008) argue for more research on chronic stressors, which have been linked to mental health more than acute events.
Our study also adds to the limited literature on the relationship of perceived discrimination and mental health for Latino and Asian Americans. Several scholars (Burgess et al., 2008; Hwang & Goto, 2008; Gee et al., 2007; Perez, Fortuna, & Alegria, 2008) have stressed a need for studies of other ethnic minority groups as well as African Americans. Our study confirms that perceived discrimination is associated with emotional distress for many Latino and Asian Americans; there seemed to be a stronger relationship of mental health with Asian American ethnicity than African American and Latino American, although our sample size suggests that this interpretation be viewed cautiously. As Gee et al. (2007) note, despite the fact that Asian Americans are often considered "model" minorities, they still regularly experience perceived discrimination that is associated with poorer mental health. Our study suggests that they may be at more risk for negative mental health than some other minorities. In our study, the relationship between perceived discrimination and mental health was lower for African Americans than for Latino and Asian Americans. Banks et al. (2006) have suggested that because African Americans experience discrimination more regularly, they have had to develop coping strategies, which may have buffered the impact of perceived discrimination in this sample.
Finally, our study addresses the recommendations of Sue and Chu (2003) about ethnic minority mental health research. We distinguished between symptoms and disorders; a failure to do so, Sue and Chu believe, may contribute to differing conclusions being drawn about ethnic differences in mental health. Unlike most studies, which tend to compare a single ethnic group with European Americans (Sue & Chu), our study made direct comparisons of multiple ethnic minority groups.
Implications for Practice
Brinson and Kottler (1995) drew up a comprehensive set of recommendations for addressing underutilization by ethnic minorities of counseling center mental health services. Their recommendations include (1) developing mentoring programs to help ethnic minority students who are struggling academically, socially, emotionally, or financially; (2) expanding services to include consultation outreach, which may reach more ethnic minority students; (3) hiring more ethnic minority mental health professionals; and (4) developing counseling models that are more culturally responsive to ethnic minorities.
Mental health counselors should also receive continuing education about the negative effects of racism and discrimination. Our study suggests that the majority of ethnic minorities believe they have been discriminated against because of race or ethnicity. Even when perceived discrimination is not the presenting issue, discrimination is likely to be a reality that has impacted an ethnic minority client. Carter (2007) argues that discrimination causes psychological and emotional damage. Mental health professionals should be equipped to skillfully address racism and discrimination with clients even if it is not an explicit presenting issue.
Our results also indicate that among ethnic minority students, Asian Americans are especially vulnerable to mental health challenges. Though they are more likely to report serious mental health symptoms (Sue & Chu, 2003), their cultural values may prevent them from seeking professional help to relieve them (Shea & Yeh, 2008). Mental health professionals should target outreach programs to all ethnic minority students, especially Asian American. Outreach programs to them should demonstrate familiarity with Asian values and coping strategies.
One limitation of our study is sample size. The number of ethnic minority participants, while virtually equal, was somewhat smaller than the number of European Americans. Caution should be used in interpreting the results of the meditational analyses involving the ethnicity pairings.
Another limitation of our study is that we did not assess the relative stressfulness of perceived discrimination. Landrine et al. (2006) note that, in addition to frequency, how racial incidents are appraised affects how they impact mental health. Future studies should incorporate the stressfulness of perceived discrimination into research designs.
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Kevin Cokley, Brittany Hall-Clark, and Dana Hicks are affiliated with the University of Texas at Austin. Correspondence concerning this article should be directed to Kevin Cokley, University of Texas, 1 University Station D5800, Austin, TX 78712. E-mail: email@example.com.
Table 1. Correlations Between Perceived Discrimination and Mental Health by Ethnic Minority-Majority Status Variable PD MH PD -- -0.26 ** MH -.28 -- Note. Correlations above the diagonal represent ethnic minority students (N=246); correlations below represent European American majority students (N=167). PD= perceived discrimination; MH=mental health. * p < .05. ** p < .01. Table 2. Correlations Between Perceived Discrimination and Mental Health by Ethnic Group Ethnic Group African American Asian American (n=83) (n=81) PD MH PD MH PD -- -0.15 -- -.38 ** MH -.28 ** -- -.28 ** -- Group Ethnic Group Latino American (n=82) PD MH PD -- --.31 ** MH -.28- -- Note. Correlations above the diagonal represent ethnic minority groups (n=246); correlations below represent European American students (n=167). PD= perceived discrimination; MH=mental health. * p < 05. ** p < 01.…
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Publication information: Article title: Ethnic Minority-Majority Status and Mental Health: The Mediating Role of Perceived Discrimination. Contributors: Cokley, Kevin - Author, Hall-Clark, Brittany - Author, Hicks, Dana - Author. Journal title: Journal of Mental Health Counseling. Volume: 33. Issue: 3 Publication date: July 2011. Page number: 243+. © 2009 American Mental Health Counselors Association. COPYRIGHT 2011 Gale Group.
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