Everyday discrimination and mood and substance use disorders: A latent profile analysis with African Americans and Caribbean Blacks

Highlights

• Most African American and Caribbean Black adults reported past-year discrimination

• Results yielded 4 classes of perceived everyday discrimination

• Greater frequency of discrimination increases risk for mood disorders

• Greater frequency of discrimination increases risk for substance-use disorders

• Mood and substance-use disorders relate to type and frequency of discrimination

Abstract

Background

Perceived discrimination is a major source of health-related stress. The purpose of this study was to model the heterogeneity of everyday-discrimination experiences among African American and Caribbean Blacks and to identify differences in the prevalence of mood and substance use outcomes, including generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder among the identified subgroups.

Method

The study uses data from the National Survey of American Life obtained from a sample of African American and Caribbean Black respondents (N = 4,462) between 18 and 65 years. Results: We used latent profile analysis and multinomial regression analyses to identify and validate latent subgroups and test hypotheses, yielding 4 classes of perceived everyday discrimination: Low Discrimination, Disrespect and Condescension, General Discrimination, and Chronic Discrimination. Findings show significant differences exist between the Low Discrimination and General Discrimination classes for major depressive disorder, alcohol-use disorder, and illicit drug-use disorder. Moreover, we find significant differences exist between the Low Discrimination and Chronic Discrimination classes for the four disorders examined. Compared with the Chronic Discrimination class, members of the other classes were significantly less likely to meet criteria for generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder.

Conclusions

Findings suggest elevated levels of discrimination increase risk for mood and substance-use disorders. Importantly, results suggest the prevalence of mood and substance-use disorders is a function of the type and frequency of discrimination that individuals experience.

Introduction

An often overlooked but major source of health-related stress stems from perceived discrimination (Whitbeck, Hoyt, McMorris, Chen, & Stubben, 2001), the effects of which are comparable to other major stressors such as death of a loved one, divorce, or job loss (Kessler, Mickelson, & Williams, 1999). Evidence suggests that a powerful link exists between experiences of discrimination and mood and substance-use disorders among racial/ethnic minority populations in the United States, including African Americans and Caribbean Blacks (Gibbons et al., 2004, Seaton et al., 2008). In particular, studies have highlighted the direct relationship between discrimination and both anxiety (Gaylord-Harden & Cunningham, 2009) and depressive disorders (Schulz et al., 2006). Recent research with a large sample of African Americans and Caribbean Blacks demonstrated the association between discrimination and higher odds of lifetime anxiety disorders (Soto, Dawson-Andoh, & BeLue, 2011), although the association was significant only for African Americans. Similarly, perceived discrimination has been shown to be positively associated with depression among African American and Caribbean Black adults (Clark, 2014, Schulz et al., 2006). This association is noteworthy because anxiety disorders are the most common type of mental disorder in the United States (Kessler, Chiu, Demler, & Walters, 2005) and major depressive disorder is a leading cause of disease burden worldwide (Ferrari et al., 2013).

The effects of perceived discrimination have also been linked with use of alcohol and illicit drugs in that substance use has been identified as a means of coping with the stress of everyday discrimination (Clark, 2014, Martin et al., 2003). For example, Hunte and Barry (2012) found that every one unit increase in everyday discrimination predicted increases of alcohol- and drug-use disorders. Repeated or ongoing experiences of discrimination can be a chronic stressor, elevating distress and negative physical arousal, which in turn, can deplete psychological resources (Gee, Spencer, Chen, & Takeuchi, 2007) and lead to stress-sensitive disorders, such as generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder (Hunte and Barry, 2012, Schulz et al., 2006, Soto et al., 2011).

Although an increasing amount of research has examined the effects of discrimination on mental and physical health, much of this research has conceptualized discrimination as a continuous construct. However, emerging research has suggested that discrimination can manifest as a multifaceted, multidimensional phenomenon across four types of discrimination: individual racism (i.e., actions of a personal, degrading nature that promote inferiority beliefs among minority individuals), cultural racism (i.e., beliefs of the dominant group are regarded as superior to those of the subordinate group), institutionalized racism (i.e., systematic inequality based on race that is reinforced by differential access to societal resources, services, and opportunities), and collective racism (i.e., members of the dominant group work to restrict or deny basic rights and privileges of minority group members; Jones, 1997). Jones’ (1997) conceptualization of individual racism can be referred to as everyday discrimination, meaning it is found in the normal course of events, and, in the same way that the larger domain of discrimination is heterogeneous, everyday discrimination can be heterogeneous.