Revisiting the relationship between perceived discrimination and health: Evidence from sibling models with multiple health measures

Assessment of unmeasured confounding in the association between perceived discrimination and mental health in a predominantly African American cohort using g-estimation

BACKGROUND

Perceived discrimination in health care settings can have adverse consequences on mental health in minority groups. However, the association between perceived discrimination and mental health is prone to unmeasured confounding. The study aims to quantitatively evaluate the influence of unmeasured confounding in this association, using g-estimation.

METHODS

In a predominantly African American cohort, we applied g-estimation to estimate the association between perceived discrimination and mental health, adjusted and unadjusted for measured confounders. Mental health was measured using clinical diagnoses of anxiety, depression and bipolar disorder. Perceived discrimination was measured as the number of patient-reported discrimination events in health care settings. Measured confounders included demographic, socioeconomic, residential and health characteristics. The influence of confounding was denoted as α1 from g-estimation. We compared α1 for measured and unmeasured confounding.

RESULTS

Strong associations between perceived discrimination in health care settings and mental health outcomes were observed. For anxiety, the odds ratio (95% confidence interval) unadjusted and adjusted for measured confounders were 1.30 (1.21, 1.39) and 1.26 (1.17, 1.36), respectively. The α1 for measured confounding was -0.066. Unmeasured confounding with α1=0.200, which was over three times that of measured confounding, corresponds to an odds ratio of 1.12 (1.01, 1.24). Similar results were observed for other mental health outcomes.

CONCLUSION

Compared with measured confounding, unmeasured that was three times measured confounding was not enough to explain away the association between perceived discrimination and mental health, suggesting that this association is robust to unmeasured confounding. This study provides a novel framework to quantitatively evaluate unmeasured confounding.

From classroom to life: Gender differences in the persistent effect of learning disabilities on adult depressive symptoms

Despite the well-established link between adolescent learning disabilities (LD) and mental health, little is known about its long-term consequences. This study examines the relationship between adolescent LD and adult depressive symptoms, with a focus on gender differences and underlying mechanisms. Using a sibling sample from the National Longitudinal Study of Adolescent to Adult Health (N = 3,414), this study estimated sibling fixed effects models to account for unobserved family-level characteristics such as genes and early childhood family and social context. Sobel mediation analyses were conducted to examine social-psychological mechanisms, including the student-teacher relationship, the student-student relationship, and a sense of school belonging. LD in adolescence was positively associated with depressive symptoms in adulthood (b = 0.823, p < 0.05). This association remained robust when controlling for unobserved family-level confounders as well as educational attainment in adulthood. Gender-stratified models showed that only the association for women is statistically significant (b = 1.935, p < 0.05), and its magnitude is nearly three times that of the association for men. Sobel mediation tests indicate that a decline in a sense of school belonging mediates approximately 17% of the association between adolescent LD and adult depressive symptoms. This study's findings suggest that LD in adolescence is associated with an increase in depressive symptoms in adulthood, particularly in women, and a low sense of school belonging may be a potential mediator. Implementing interventions to improve the school integration of girls with LD could be an effective means of improving their long-term mental health.

Children's bullying victimization and maternal suicidal ideation among multicultural families in South Korea: Heterogeneity by family socioeconomic status

RATIONALE

Children from multicultural families in Korea are vulnerable to bullying victimization. Despite growing evidence on the mental health consequences of bullying victimization for victims, little is known about the spillover effects on their immigrant mothers.

OBJECTIVE

This study examined the association between children's bullying victimization and their immigrant mothers' suicidal ideation. The potential moderating role of family socioeconomic status was also investigated.

METHODS

Using nine waves of the Multicultural Adolescents Panel Study spanning from 2011 to 2019 (N = 1466), this study estimated individual fixed effects models to control for unobserved individual-level heterogeneity. Interaction models were used to investigate potential heterogeneity by family socioeconomic status, including maternal education, household income, and maternal occupational status.

RESULTS

Fixed effects estimates revealed that children's bullying victimization is associated with an increased likelihood of suicidal ideation among marriage migrant mothers (b = 0.012, p < 0.05), even after controlling for unobserved time-invariant confounders as well as a set of time-varying covariates. Family socioeconomic status moderated this association. The association between children's bullying victimization and immigrant mothers' suicidal ideation was stronger for those with low levels of education and household income. No such moderating effects were observed for maternal occupation.

CONCLUSIONS

The findings of this study suggest that efforts to address the mental health consequences of bullying victimization among multicultural family children should extend beyond the victim to their immigrant mothers. When developing interventions to reduce suicidal ideation among immigrant mothers whose children have been victimized, policymakers may wish to consider the moderating role of family socioeconomic status.

The influence of perceptions of gender discrimination in the workplace on depressive symptoms among Korean working women: The moderating role of job satisfaction

RATIONALE

While previous research has primarily examined the mental health implications of experiencing racial or gender discrimination in the workplace within a Western context, there remains a gap in understanding the impact of perceptions of workplace gender discrimination (WGD) on mental health in Asian countries. Additionally, the potential moderating role of job satisfaction in this relationship is yet to be thoroughly explored.

OBJECTIVE

The purpose of this study was to determine whether there is an association between perceptions of WGD and depressive symptoms, independent of an individual's personal experiences of workplace discrimination. This study also examined whether this association is moderated by job satisfaction, distinguishing between intrinsic satisfaction (related to recognition of performance and achievement) and extrinsic satisfaction (related to wages, workplace relationships, and welfare).

METHODS

The data utilized for this study were collected from 2170 employed women over four waves (eight years) of the Korea Women Longitudinal Survey of Women and Families, between 2012 and 2020. Fixed effects (FE) models were utilized to account for unobserved individual heterogeneity.

RESULTS

FE estimates indicated that perceptions of WGD is significantly associated with an increase in depressive symptoms (b = 0.577, p < 0.001), even after controlling for personal experiences of workplace discrimination. Interaction analyses further revealed that this association is moderated by extrinsic job satisfaction (b = -0.318, p < 0.05), but not intrinsic job satisfaction.

CONCLUSION

The perceptions of WGD may be a potential pathway by which gender inequalities at the workplace harms women's mental health. Interventions to reduce gender discrimination and enhance extrinsic job satisfaction may contribute to improving the mental health of working women.

Longitudinal association between perceived discrimination and sleep problems among young adults in the United States: Tests of moderation by race/ethnicity and educational attainment

RATIONALE

Although perceived discrimination is known to affect sleep, the findings of previous research are limited because they are mostly based on either cross-sectional data or non-generalizable samples, such as clinical samples. There is also little evidence on whether perceived discrimination differently affects sleep problems across different groups.

OBJECTIVE

This study examines whether perceived discrimination is related to sleep problems when considering unmeasured confounding factors and how that relationship varies by race/ethnicity and socioeconomic status from a longitudinal perspective.

METHODS

This study uses Waves 1, 4, and 5 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and conducts hybrid panel modeling to estimate both within- and between-individual effects of perceived discrimination on sleep problems.

RESULTS

First, the results of the hybrid modeling show that increased perceived discrimination in daily life is related to poorer sleep quality when accounting for unobserved heterogeneity as well as time-constant and time-varying covariates. Moreover, the moderation analyses and the subgroup analyses demonstrate that the association was not found among Hispanics and among those with a bachelor's degree or more. That is, Hispanic origin and college attainment weaken the associations between perceived discrimination and sleep problems, and the differences by race/ethnicity and socioeconomic status are statistically significant.

CONCLUSIONS

This study suggests a robust link between discrimination and sleep problems and further elaborates on whether this association varies among different groups. Efforts to reduce interpersonal and institutional discrimination (e.g., discrimination at the workplace or in the community) can help to improve sleep problems and thereby promote overall health. We also suggest that future research consider the moderating roles of susceptible and resilient factors in the relationships between discrimination and sleep.

The Gendered Pathways Through Which Intimate Partner Violence Affects Health: Exploring the Role of Unmet Healthcare Needs

The aim of this study was to examine the relationships between intimate partner violence (IPV), gender, unmet healthcare needs, and health. Specifically, this study identified how unmet healthcare needs mediate the relationship between IPV and health, and how this mediation is moderated by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (N = 15,425), we first estimated ordinary least squares regression models to investigate the association between IPV and self-rated health. Then, we used structural equation models to examine how unmet healthcare needs mediate this relationship. Lastly, we conducted a moderated mediation model to investigate whether gender moderates these mediation patterns. The results of this study showed that experiencing IPV was associated with a decrease in self-rated health and an increase in the unmet need for medical care (but not in unmet need for routine health check-ups). Unmet need for medical care explained about one-quarter of the negative association between IPV and self-rated health. A moderated mediation model revealed that indirect effects of IPV on health via unmet medical care needs were more pronounced among victimized women than victimized men. This study filled knowledge gaps about the mechanisms underlying the association between IPV and poor health status. Unmet healthcare needs partially mediated the relationship between IPV victimization and health. This mechanism was more salient for the health of victimized women than victimized men. Interventions designed to improve the health of IPV victims may focus on addressing unmet healthcare needs and could be tailored according to the gender of patients.

Mexican-origin parents' workplace discrimination and well-being: The roles of familism values, family conflict, and gender

OBJECTIVE

This study examined Mexican-origin parents' perceived workplace discrimination, familism, family conflict, and gender as related to parents' well-being (i.e., self-esteem, depressive symptoms, and general physical health) over a 2-year period during the 2007-2009 "Great Recession" in the U.S.

METHOD

Data were drawn from two waves of a larger study of 246 Mexican-origin predominantly immigrant families with adolescents. Using a matched-pairs sample of mothers and fathers, path analyses were conducted to test the hypothesized relations.

RESULTS

Moderation analyses revealed that high levels of familism weakened the link between workplace discrimination and parents' depressive symptoms, whereas high levels of parent-youth conflict exacerbated the association to parents' psychosocial well-being. There was variation by parent gender, with parent-youth conflict being more strongly associated with fathers' self-esteem than mothers'.

CONCLUSIONS

Findings indicate that Mexican-origin parents' familism can mitigate and family conflict can exacerbate the risks of workplace discrimination on parents' psychosocial well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Gender differences in the relationship between perceived discrimination and personality traits in young adulthood: Evidence using sibling fixed effects

RATIONALE

Although perceived discrimination (PD) is known to be associated with personality traits, family background characteristics may confound this association. Moreover, little is known about whether the relationship differs by gender.

OBJECTIVE

This study investigates whether the association between PD and personality traits is confounded by family background characteristics. Given gender differences in contexts and perceptions of discrimination as well as personality traits, this study also explores whether the association between PD and personality traits differs for men and women.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, this study examines the association between PD and Big Five personality traits among young adults. This study uses sibling fixed effects models with a lagged dependent variable to account for unobservable family-level characteristics, such as genetics, parental characteristics, family environment, and childhood social contexts.

RESULTS

Sibling fixed effects estimates showed that PD was associated with lower levels of conscientiousness and extraversion and higher levels of neuroticism. There were also gender differences such that PD was associated with lower conscientiousness only for women and lower extraversion only for men. The positive association with neuroticism was apparent for both men and women.

CONCLUSION

This study suggests that the association between PD and personality traits is generally not confounded by stable family-level characteristics shared by siblings. This study also documents gender differences in the relationship between PD and personality traits. Given substantial implications of personality for a broad range of outcomes, especially among young adults, the findings of this study reaffirm the commitment of the whole society to eradicate any form of discrimination.