It’s well established that the drastic changes wrought by the pandemic, such as physical distancing and isolation, dealt a blow to our collective mental health. During this same time period, hate crimes and racist rhetoric against Asians spiked, and the killings of George Floyd and Breonna Taylor inspired a mass social movement for racial justice. It was a time when the pandemic and the salience of racism converged. That convergence had a pronounced effect on the mental health of Americans of color, says study author Jordan W. Smoller, MD, associate chief of research at Massachusetts General Hospital and a professor at Harvard Medical School. “There was a direct or dose-response relationship between the amount of discrimination they reported experiencing and the likelihood that they had moderate to severe depressive symptoms or suicidal thoughts,” he says. This association between discrimination and depression was especially strong when race, ancestry, or national origin was the reason for discrimination, as opposed to age or gender.
Race-Based Discrimination Caused a Tenfold Increase in the Risk of Suicidal Thoughts Early in the Pandemic
For this study, researchers analyzed data collected by the All of Us Research Program, a cohort study from the National Institutes of Health. The program began soliciting health data from volunteers in the United States in 2018, with the goal of recruiting at least one million participants. The program will run for a decade. A subset of people in the All of Us program also took the COVID-19 Participant Experience (COPE) survey. Dr. Smoller’s study analyzed COPE survey responses from May, June, and July 2020, including responses to the Everyday Discrimination Scale. “If you compared people who experienced none to people who experienced it everyday, there was a seventeenfold increase in moderate to severe depressive symptoms and more than a tenfold increase in reporting suicidal thoughts,” says Smoller. Overall, Black Americans reported the highest levels of discrimination, and non-Hispanic white people reported the least. When non-Hispanic white people reported discrimination, it was mainly on the basis of age and gender. Meanwhile, race and ancestry were the primary reasons that Latino and Asian people reported discrimination. According to Smoller, regularly experiencing discrimination puts you at the same risk of symptoms of depression or suicidal ideation as having a previous mental health diagnosis, such as a depressive disorder.
Researchers Still Need More Inclusive Data
Elena Cyrus, PhD, MPH, assistant professor of population health sciences at the University of Central Florida College of Medicine, says that a limitation of the study was the data that researchers had to work with. She says that using broad categories, such as combining all Asian Americans and Pacific Islanders, skews the average. “We need accurate data to understand the true landscape of the problem, to pinpoint priority geographic areas and communities,” says Dr. Cyrus, who was not involved in the study. Van Ta Park, PhD, MPH, professor of community health systems at the University of California in San Francisco School of Nursing, agrees. “On the one hand, a strength of the study has to do with diversity,” says Dr. Park, who was also not involved in the study. “On the other hand, that’s a limitation because diversity in the U.S. should include more categories than we typically present in terms of findings.” Park says that this is a common problem research faces and is not unique to this study. The All of Us data the study used, while seeking to diversify biomedical data, uses broad racial and ethnic categories. And the study is only available in English and Spanish, for participants who have email addresses. This leaves out people who don’t speak those languages — including the millions of Americans who only speak Chinese, Hindi, Urdu, or Tagalog. Smoller says that while future research can do a better job of capturing the nuance of demographic differences, the findings are important. “Recognizing and understanding the impact of discrimination better is important for all of us. Including us in the healthcare world — understanding what people are facing is important,” says Smoller. “[Our study] really points out the toxic effects of discrimination and that this isn’t just equity and justice, but a health issue.”
