Racial Discrimination Linked to Increase in Depressive Symptoms During COVID-19 Pandemic

Younga H. Lee, PhD

An increase in racial and ethnically discrimination is increasing the rates of moderate-to-severe depressive symptoms during the COVID-19 pandemic.

A team, led by Younga H. Lee, PhD, Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, identified the association of mental health with everyday discrimination during the COVID-19 pandemic.

One of the byproducts of the COVID-19 pandemic has been an increase in depressive symptoms, as well as growing awareness of health inequalities and structural racism in the US.

“The COVID-19 pandemic continues to have far-reaching health and economic consequences for the US public, particularly for communities that face structural racism, such as American Indian and Alaska Native, Asian, Black, Hispanic or Latino, and Pacific Islander populations,” the authors wrote. “During the pandemic, these communities have experienced higher rates of unemployment and food and housing insecurity than other groups.”

The Cohort

In the large and diverse cohort, the investigators used data from the All of Us Research Program. The team used repeated assessments in the early months of the pandemic and fitted mixed-effects models to assess the associations of discrimination with depressive symptoms and suicidal ideation. They also applied inverse probability weights to account for nonrandom probabilities of completing the voluntary survey.

They also ascertained exposure and outcome measures using the Everyday Discrimination Scale and the 9-item Patient Health Questionnaire (PHQ-9), respectively. The team classified scores for PHQ-9 greater than or equal to 10 as moderate to severe depressive symptoms and considered any positive response to the ninth item of the PHQ-9 scale as presenting suicidal ideation.

There were 62,651 participants included in the study with a mean age of 59.3 years.

Racism and Depression

The results show an association with significantly increased likelihood of moderate to severe depressive symptoms and suicidal ideation as the levels of discrimination increased.

There was also a dose-response association and a 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.

The investigators also noted the association with depressive symptoms was greater when race, ancestry, or national origins among Hispanic or Latino participants was the main reason for discrimination at all 3 time points and among non-Hispanic Asian participants in May and June 2020.

High levels of discrimination and history of prepandemic mood disorder diagnosis were strongly associated with moderate to severe depressive symptoms.

“In this large and diverse sample, increased levels of discrimination were associated with higher odds of experiencing moderate to severe depressive symptoms,” the authors wrote. “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.”

The study, “Association of Everyday Discrimination With Depressive Symptoms and Suicidal Ideation During the COVID-19 Pandemic in the All of Us Research Program,” was published online in JAMA Psychiatry.