Effects of COVID‐19‐Related Racial Discrimination on Depression and Life Satisfaction Among Young, Middle, and Older Chinese Americans

A scoping review on the operationalization of intersectional health research methods in studies related to the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic began in early 2020 and became a global health crisis with devastating impacts. This scoping review maps the key findings of research about the pandemic that has operationalized intersectional research methods around the world. It also tracks how these studies have engaged with methodological tenets of oppression, comparison, relationality, complexity, and deconstruction.

METHODS

Our search resulted in 14,487 articles, 5164 of which were duplicates, and 9297 studies that did not meet the inclusion criteria were excluded. In total, 14 articles were included in this review. We used thematic analysis to analyse themes within this work and Misra et al. (2021) intersectional research framework to analyse the uptake of intersectional methods within such studies.

RESULTS

The research related to the COVID-19 pandemic globally is paying attention to issues around the financial impacts of the pandemic, discrimination, gendered impacts, impacts of and on social ties, and implications for mental health. We also found strong uptake of centring research in the context of oppression, but less attention is being paid to comparison, relationality, complexity, and deconstruction.

CONCLUSIONS

Our findings show the importance of intersectional research within public health policy formation, as well as room for greater rigour in the use of intersectional methods.

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19

OBJECTIVES

This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group.

METHOD

A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested.

RESULTS

The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively.

CONCLUSION

This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan

The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID-19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21-2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36-2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.

Prevalence and predictors of perceived COVID-19 stigma within a population-based sample of adults with COVID-19

BACKGROUND

Growing evidence suggests that individuals with COVID-19 face stigmatization, which is associated with poor health outcomes and behaviors. However, very few population-based studies have examined risk factors for experiencing COVID-19 stigma. This study examined prevalence and predictors of perceived COVID-19 stigma using a population-based probability sample of adults with COVID-19.

METHODS

We included adults with polymerase chain reaction-confirmed SARS-CoV-2 in Michigan between January 1, 2020 and July 31, 2021. Perceived COVID-19 stigma was considered present if a respondent answered affirmatively to any of the following items due to people thinking they might have COVID-19: "you were treated badly," "people acted as if they were scared of you," and "you were threatened or harassed." We conducted modified Poisson regression with robust standard errors to estimate associations between perceived COVID-19 stigma and potential predictors, including sex, age, race and ethnicity, household income, education, employment, smoking status, body mass index, preexisting diagnosed physical or mental comorbidities, and COVID-19 illness severity.

RESULTS

Perceived COVID-19 stigma was commonly reported among our respondents (38.8%, n = 2,759). Compared to those over 65 years, respondents who were 18 - 34 (adjusted prevalence ratio (aPR): 1.41, 95% confidence intervals (CI): 1.12 - 1.77) and 35 - 44 years old (aPR: 1.66, 95% CI: 1.31 - 2.09) reported higher perceived stigma. Female respondents had 1.23 times higher prevalence of perceived COVID-19 stigma (95% CI: 1.10 - 1.37) than male respondents and non-Hispanic Black respondents had 1.22 times higher prevalence of perceived COVID-19 stigma (95% CI: 1.04 - 1.44) than non-Hispanic White respondents. Moreover, respondents with pre-existing diagnosed psychological or psychiatric comorbidities were more likely to report perceived COVID-19 stigma (aPR: 1.29, 95% CI: 1.13 - 1.48) compared to those without diagnosed comorbidities. Respondents with very severe COVID-19 symptoms were also more likely to report perceived COVID-19 stigma (aPR: 1.47, 95% CI: 1.23 - 1.75) than those with asymptomatic or mild symptoms.

CONCLUSIONS

We found that populations who are marginalized in United States, such as females, non-Hispanic Black adults, or individuals with chronic conditions, are more likely to report perceived COVID-19 stigma. Continuing to monitor COVID-19 stigma, especially in vulnerable populations, may provide useful insights for anti-stigma campaigns and future pandemics.

The impact of racial discrimination on the health of Asian Americans during the COVID-19 pandemic: a scoping review

ABSTRACTObjective: Cases of discrimination and hate crimes against Asian Americans have surged ever since the beginning of the COVID-19 pandemic, with deleterious effects. This scoping review synthesizes the literature on how pandemic-related discrimination is associated with the health of Asian Americans.Design: First, application search terms were entered into selected databases. Next, using a set of inclusion criteria, the articles were screened and assessed for eligibility. Data from the selected articles were extracted and summarized to answer the research questions.Results: Thirty-five studies were included. Almost all the studies examined psychological well-being. The remaining studies examined physical and workplace well-being. All the studies found that discrimination was associated with poorer health outcomes.Conclusion: Further research is needed to address the gaps in knowledge about how pandemic-related discrimination is associated with various domains of health among Asian Americans.

COVID-19 Racism and Chinese American Families' Mental Health: A Comparison between 2020 and 2021

This study compared rates of multiple forms of COVID-19 racism-related discrimination experiences, fear/worries, and their associations with mental health indices among Chinese American parents and youth between 2020 and 2021. Chinese American parents of 4- to 18-year-old children and a subsample of their 10- to 18-year-old adolescents completed surveys in 2020 and 2021. A high percentage of Chinese American parents and their children continued to experience or witness anti-Chinese/Asian racism both online and in person in 2021. Parents and youth experienced less vicarious discrimination in person but more direct discrimination (both online and in person) and reported poorer mental health in 2021 than in 2020. Associations with mental health were stronger in 2021 than in 2020 for parents' and/or youth's vicarious discrimination experiences, perceptions of Sinophobia, and government-related worries, but weaker only for parents' direct discrimination experiences. The spillover effect from parents' vicarious discrimination experiences and Sinophobia perceptions to all youth mental health indices were stronger in 2021 than in 2020. Chinese American families experienced high rates of racial discrimination across multiple dimensions, and the detrimental impacts on their mental health were still salient in the second year of the pandemic. Vicarious and collective racism may have even stronger negative impacts on mental health and well-being later in the pandemic. Decreasing health disparities for Chinese Americans and other communities of color requires extensive, long-term national efforts to eliminate structural aspects of racism.

The scar that takes time to heal: A systematic review of COVID-19-related stigma targets, antecedents, and outcomes

COVID-19, as a crucial public health crisis, has affected our lives in nearly every aspect. Besides its major health threats, COVID-19 brings severe secondary impacts, one of which is the rise of social stigma. Although numerous studies have examined the antecedents and outcomes of COVID-19-related stigma, we still lack a systematic understanding of who is being stigmatized during the COVID-19 pandemic, what exacerbates COVID-19-related stigma, and what impacts COVID-19-related stigma has on victims. Therefore, this review aims to provide a systematic overview of COVID-19-related stigma. With 93 papers conducted with 126,371 individuals in more than 150 countries and territories spanning five continents, we identify three targets that have received the most research: Chinese/Asian people, (suspected) patients and survivors, and healthcare workers. Furthermore, we find that for each stigma target, characteristics of the stigmatized, stigmatizer, and context contribute to COVID-19-related stigma and that this stigma negatively influences victims' health and non-health outcomes. We call for future research to provide a more integrative, balanced, and rigorous picture of COVID-19-related stigma via conducting research on neglected topics (e.g., contextual factors that contribute to stigma toward HCWs) and stigma interventions and using a longitudinal design. In practice, we urge governments and institutions (e.g., ministries of public health, hospitals) to pay close attention to stigma issues and to promote safe and inclusive societies.

Disaggregating the data: Diversity of COVID-19 stressors, discrimination, and mental health among Asian American communities

Much of the public discourse as well as research regarding the negative impact of COVID-19-related anti-Asian discrimination has been conducted at the broad racial group level, yet data aggregation masks critical points of diversity among Asian Americans. We conducted an online survey of 620 Asian American adults in December 2020 and examined whether there were any demographic differences-including by ethnic subgroup and Chinese street race (being Chinese or being mistaken as Chinese)-in their experiences of COVID-19-related stress, direct and vicarious discrimination, and psychological outcomes. Our analyses found that younger age was correlated with higher reports of pandemic stress, discrimination, distress, and worry. Female and U.S.-born participants reported higher levels of pandemic stress and vicarious discrimination, but there were no gender or nativity differences in levels of direct discrimination. Being uninsured was also related to higher levels of pandemic stress, discrimination, and distress. East Asian Americans reported significantly lower frequencies of direct anti-Asian discrimination than did South Asian or Southeast Asian Americans, but the ethnic subgroups did not differ in their reports of vicarious discrimination. Of note, Chinese street race was not associated with either direct or vicarious discrimination. Separate hierarchical regression analyses for East Asian, South Asian, and Southeast Asian participants revealed that, regardless of ethnicity, racial discrimination significantly contributed to psychological distress and worry beyond the effects of pandemic stress. However, the three groups varied in the demographic indicators and COVID-19 stressors that were associated with psychological outcomes. Pandemic stress was more strongly associated with negative outcomes among South Asian Americans than East Asian and Southeast Asian Americans, and neither direct nor vicarious discrimination were associated with mental health among South Asian Americans. Direct discrimination, compared to vicarious discrimination, was a particularly robust predictor of both distress and worry among East Asian Americans. For Southeast Asian Americans, direct discrimination significantly predicted higher levels of distress, whereas vicarious discrimination predicted higher levels of worry. Vicarious discrimination was not significantly related to distress across ethnic subgroups. Results suggest that practitioners and policy makers would benefit from attending to these within-group differences in Asian Americans' experiences during the pandemic.

The #StopAsianHate Movement on Twitter: A Qualitative Descriptive Study

Evidence-based intervention and policy strategies to address the recent surge of race-motivated hate crimes and other forms of racism against Asian Americans are essential; however, such efforts have been impeded by a lack of empirical knowledge, e.g., about racism, specifically aimed at the Asian American population. Our qualitative descriptive study sought to fill this gap by using a data-mining approach to examine the contents of tweets having the hashtag #StopAsianHate. We collected tweets during a two-week time frame starting on 20 May 2021, when President Joe Biden signed the COVID-19 Hate Crimes Act. Screening of the 31,665 tweets collected revealed that a total of 904 tweets were eligible for thematic analysis. Our analysis revealed five themes: "Asian hate is not new", "Address the harm of racism", "Get involved in #StopAsianHate", "Appreciate the Asian American and Pacific Islander (AAPI) community's culture, history, and contributions" and "Increase the visibility of the AAPI community." Lessons learned from our findings can serve as a foundation for evidence-based strategies to address racism against Asian Americans both locally and globally.