Interpersonal discrimination associated with poorer mental health, wellbeing, and substance use in young adults

by Rebecca Seliga, Alex Gipsman, MD

Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. This large study of a nationally representative sample of young adults found that over 90% had experienced some form of interpersonal discrimination including ageism, sexism, racism, discrimination based on physical appearance, or other.

2. All forms of discrimination were associated with poorer mental health, wellbeing, and substance abuse outcomes, and these associations persisted up to six years after the discrimination event.

Evidence Rating Level: 2 (Good)

Study Rundown:

The negative impacts of discrimination on an individual’s health and wellbeing have been well-established by cross-sectional studies, however studies of its longitudinal effects are lacking. This study aimed to investigate the effects of interpersonal discrimination on mental health, wellbeing, and substance use in a nationally representative sample of young adults. Overall, the vast majority of young adults had experienced some form of interpersonal discrimination, including ageism, sexism, racism, discrimination based on physical appearance, and other discrimination. Regardless of the type of discrimination, all were associated with poorer mental health, wellbeing, and substance use outcomes even years after the reported event. This data highlights the need for both physical and mental health care to focus on addressing interpersonal discrimination and supporting young adults who have experienced it. This study is strengthened by its use of a large nationally representative sample and its assessment of both cross-sectional and longitudinal outcomes. Nevertheless, this study has several weaknesses including its reliance on self-reports which makes it prone to significant recall bias and misinterpretation by participants. Lastly, this study was not able to comment on institutional and structural discrimination, which likely have a significant impact on health as well.

In-Depth [prospective cohort]:

This study gathered survey data via telephone interview from 1834 participants aged 18-28 enrolled in the Panel Study of Income Dynamics, Transition to Adulthood Supplement. Experiences of interpersonal discrimination were measured using the Everyday Discrimination Scale and categorized as racial and ethnic identity or ancestry discrimination, sex discrimination, age discrimination, physical appearance discrimination, or other. Mental health and wellbeing were assessed using mental illness diagnoses, the Kessler Psychological Distress Scale (K6) score, and the Languishing and Flourishing (L/F) score. Self-reported health was assessed using a scale, and drug use was assessed as a binary variable. Logistic regression was used to account for correlation and data were reported as relative risk (RR). Overall, 93% of study participants experienced some form of discrimination, with ageism being the most prevalent (26%), followed by physical appearance discrimination (19%), sexism (14%), and racism (13%). In both cross-sectional and longitudinal analyses, discrimination of all forms was significantly associated with a higher prevalence of languishing, psychological distress, mental illness, drug use, and poorer self-reported health. RR from discrimination of any form was highest for psychological distress (2.03 95%CI 1.7–2.4), and this association persisted up to 6 years after the discrimination exposure. There were no statistically distinguishable differences between the different types of discrimination.

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