Perceived discrimination and self-rated health in Europe: evidence from the European Social Survey (2010)

Feeling discriminated means poor self-perceived health: a gender analysis using SHARE

Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.

A Co-Created Assessment Framework to Measure Inclusive Health and Wellbeing in a Vulnerable Context in the South of Europe

Rapid urbanisation exacerbates health and wellbeing disparities in vulnerable contexts and underscores the imperative need to develop innovative and participatory co-creation approaches to understand and address the specificities of these contexts. This paper presents a method to develop an assessment framework that integrates top-down dimensions with bottom-up perspectives to monitor the impact of inclusive health and wellbeing interventions tailored to the neighbourhood's needs in Las Palmeras, a vulnerable neighbourhood in Cordoba (Spain). Drawing upon studies in the literature examining urban health and wellbeing trends, it delineates a participatory and inclusive framework, emphasising the need for context-specific indicators and assessment tools. Involving diverse stakeholders, including residents and professionals, it enriches the process and identifies key indicators and assessment methods. This approach provides valuable insights for managing innovative solutions, aligning them with local expectations, and measuring their impact. It contributes to the discourse on inclusive urban health by advocating for participatory, context-specific strategies and interdisciplinary collaboration. While not universally applicable, the framework offers a model for health assessment in vulnerable contexts, encouraging further development of community-based tools for promoting inclusive wellbeing.

The relationship between gender discrimination and wellbeing in middle-aged and older women

BACKGROUND

Emerging evidence suggests that perceived gender discrimination negatively impacts mental wellbeing in young women.

PURPOSE

This study explored whether a similar relationship exists in middle-aged and older women.

METHODS

A total of 3081 women (aged ≥52 years) from the English Longitudinal Study of Ageing provided data on perceived gender discrimination in 2010/11. Depressive symptoms, loneliness, quality of life and life satisfaction were assessed in 2010/11 and in 2016/17.

RESULTS

Perceived gender discrimination was reported by 282 (9.2%) participants. Cross-sectionally, women who perceived gender discrimination reported more depressive symptoms (β = 0.34, 95% CI 0.11 to 0.57) and had higher loneliness scores (β = 0.14, 95% CI 0.08 to 0.20) than women who did not perceive gender discrimination. They also reported significantly lower quality of life (β = -2.50, 95% CI -3.49 to -1.51) and life satisfaction (β = -1.07, 95% CI -1.81 to -0.33). Prospectively, perceived gender discrimination was associated with greater loneliness scores (β = 0.08, 95% CI 0.02 to 0.14), as well as lower ratings of quality of life (β = -0.98, 95% CI -0.09 to -1.86), and life satisfaction (β = -1.04, 95% CI -0.34 to -1.74), independent of baseline values.

CONCLUSIONS

Middle-aged and older women who perceive gender discrimination report poorer mental wellbeing than those who do not perceive discrimination. Further, this type of discrimination may be predictive of declining mental wellbeing over time. These findings highlight the need for interventions to target gender-based discrimination to improve the wellbeing of women at mid- and older age.

Perceived discrimination and mental health in the Japanese general population

BACKGROUND

Research has shown that discrimination is prevalent in many countries and associated with poorer mental health. However, little is known about discrimination and its effects in Japan.

AIMS

To address this deficit this study examined the association between perceived discrimination and mental health outcomes in the Japanese general population and the role of general stress in these associations.

METHOD

Data were analyzed from 1,245 individuals (age 18-89) that were collected in an online survey in 2021. Perceived discrimination was assessed with a single-item measure as was lifetime suicidal ideation. Depressive and anxiety symptoms were respectively measured with the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale. General stress was assessed with the Perceived Stress Scale (PSS-14). Logistic regression was used to assess associations.

RESULTS

Perceived discrimination was prevalent (31.6%) in the study sample. In fully adjusted analyses discrimination was associated with all of the mental health outcomes/general stress with odds ratios (ORs) ranging from 2.78 (suicidal ideation) to 6.09 (general stress) among individuals with a high level of discrimination. When the analyses were adjusted for general stress (as a continuous score) there was a large reduction in the ORs although high discrimination continued to be significantly associated with anxiety (OR: 2.21), while a mid level of discrimination was related to depressive symptoms (OR: 1.87) and had a borderline association with suicidal ideation.

CONCLUSION

Perceived discrimination is common in the Japanese general population and associated with worse mental health, with stress possibly playing a role in this association.

Public stigma toward fatigue-do social characteristics of affected persons matter? Results from the SOMA.SOC study

Objectives

Although public stigma imposes a great burden on those affected with manifold negative consequence there is not much known about public stigma related to fatigue. Therefore, this study addresses the following research questions: (1) What is the magnitude of public stigma toward individuals with fatigue? (2) Are there differences in public stigma depending on the social characteristics of the affected person (sex, occupation, and migration)?

Methods

Analyses are based on a national telephone survey in Germany (N = 1,209). A vignette describing a person with symptoms of fatigue was presented to the respondents. Vignettes were varied according to sex, occupational status, and migration status. Stigma toward the person presented in the vignette was measured by stereotypes and negative emotional reactions (anger).

Results

Of the stereotypes under study, "hypersensitive" was most frequently endorsed by the respondents (35.7%), followed by "weak will" (27.2%). About 15-20% of the respondents agreed that they react with anger, annoyance or incomprehension. There were considerable differences in fatigue stigma according to the social characteristics of the affected person. In two social groups public stigma was particularly pronounced: (1) male persons with a low occupational status and a migration background; (2) female persons with a high occupational status and without a migration status. In contrast, women with a low occupational status and a migration background were less stigmatized.

Conclusion

Individuals suffering from fatigue symptoms are confronted with stereotypes and negative emotional reactions by the public. Magnitude of public stigma considerably varies according to social characteristics of the afflicted person. Future studies should consider applying an intersectional approach to identify groups that are at risk of multiple stigma.

Disability, program access, empathy and burnout in US medical students: A national study

OBJECTIVE

The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students.

METHODS

The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability-related questions, including self-reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related and learning environment measures.

RESULTS

Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69] and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97-1.22]).

CONCLUSIONS

Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.

Nurses' experiences of discrimination in health care: A qualitative study in Iran

BACKGROUND

Justice in health is one of the main concerns of health organizations, and discrimination in health care is one of the negative outcomes to achieving this goal. Hence, a full understanding of the phenomenon of discrimination in health care and adopting strategies to eliminate it is necessary. The present study was conducted to explore and describe the experiences of nurses of discrimination in health care.

MATERIALS AND METHODS

The present qualitative content analysis study was conducted between 2019 and 2020. Data were collected through semi-structured interviews with 18 participants (two physicians, three nursing supervisors, two head nurses, four clinical nurses, two nursing assistants, and three hospitalized patients) in one public and one private hospital in the city of Tehran. The participants were selected by purposive sampling, which continued until saturation of data. Data obtained were analyzed using the Graneheim and Lundman method.

RESULTS

Four main categories and 14 subcategories were extracted from data analysis: 1) habitual discrimination (everyday discrimination in health centers, ignoring patient rights, low levels of trust in medical staff); 2) interpersonal relationships (expectations of associates, respect for colleagues and friends, the possibility of the occurrence of similar situations, reciprocating people's favors); 3) shortage of health-care resources (shortage of medical equipment, heavy workload, infrastructure of medical centers, lack of access to physicians); and 4) favoritism (ethnicity, favoritism as a common method, and favoritism as the ultimate solution to treatment problems).

CONCLUSION

The present study revealed certain dimensions of discrimination in health care that remain hidden in many quantitative studies. It appears that health system managers will be able to move toward eliminating discrimination in health care. Thus, designing effective models to reduce discrimination in health care based on the underlying concepts of this study is recommended.

Experiences of conflict, non-acceptance and discrimination are associated with poor mental well-being amongst LGBTQ-identified individuals in Singapore

Purpose

Health disparities affecting lesbian, gay, bisexual, transgender and queer (LGBTQ) populations have been reported in many countries. For Singapore, no large quantitative studies on mental health and well-being in the local LGBTQ community have been published. The authors conducted a community-based survey (National LGBT Census Singapore, 2013; NLCS2013) that covered a comprehensive set of demographic, social and health indicators. Here, the authors investigated mental health status and its correlates in 2,350 LGBTQ individuals within the NLCS2013 sample.

Design/methodology/approach

The NLCS2013 was an anonymous online survey conducted amongst self-identified LGBTQ adults (aged ≥ 21 years) residing in Singapore. The survey included the World Health Organisation Well-being Index (WHO-5) as a measure of mental well-being, with low WHO 5 scores (<13/25) indicating poor mental well-being. The authors analysed relationships between low WHO-5 score and a range of respondent characteristics using multivariate logistic regression.

Findings

Strikingly, 40.9% of 2,350 respondents analysed had low WHO-5 scores, indicating poor mental well-being. Parental non-acceptance, experience of conflict at home and bullying/discrimination in the workplace or educational environments were all significantly associated with poor mental well-being. Conversely, community participation appeared protective for mental well-being, as respondents who participated in LGBTQ community organisations or events were less likely to have poor mental well-being than non-participants.

Originality/value

The NLCS2013 represents one of the first broad-based efforts to comprehensively and quantitatively capture the sociodemographic and health profile, including mental health status, within Singapore’s resident LGBTQ population. These findings affirm the need to address the mental health needs of LGBTQ individuals in Singapore and to foster safe spaces and allyship.

Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study

BACKGROUND

Limited research exists on pain and especially the co-occurrence of pain and mental ill health in general refugee populations. The present study aimed to approximate the prevalence of chronic pain (CP) among adult refugees from Syria resettled in Norway; investigate the association between CP and mental ill health; and explore how CP and mental ill health associate with both perceived general health and functional impairment. Gender as potential effect modifier in these associations was also examined.

METHODS

Cross-sectional, postal survey questionnaire.

INCLUSION CRITERIA

≥ 18 years old; refugee from Syria; and arrived in Norway between 2015 and 2017. Study sample was randomly drawn from full population registries, and n = 902 participated (participation rate ≈10%). CP was measured with 10 items on pain lasting for ≥ 3 consecutive months last year. Symptoms of anxiety, depression and PTSD were measured with the HSCL and HTQ scales, respectively. Ordered and binomial logistic regressions were used in analyses. Gender was tested as effect modifier with Wald test for interaction.

RESULTS

In the sample overall, the proportion of participants who reported severe CP was 43.1%. There was strong evidence that anxiety, depression and PTSD were associated with higher levels of CP. In fully adjusted regression models, including both CP and mental health variables, CP was strongly associated with poor perceived general health whereas mental health showed much weaker associations. The association between mental health (anxiety and PTSD) and functional impairment was highly gender specific, with strong associations in men but not in women. CP was strongly associated with functional impairment with no difference across gender.

CONCLUSION

The study shows a high burden of CP in a general population of adult refugees from Syria with likely substantial adverse consequences for daily functioning. The strong association between CP and mental ill health suggests personnel working with refugees' health should be attuned to their co-occurrence as both problems may need to be addressed for either to be effectively mitigated. A clear mismatch exists between the burden on health caused by pain in general refugee populations and the amount of available evidence to guide mitigating strategies.

TRIAL REGISTRATION

NCT03742128.

Perceived discrimination, health, and well-being among adults with and without pain: a prospective study

ABSTRACT

Discrimination negatively influences health and well-being in the general population, but its impact on people with pain is unclear. This study assessed discrimination, health, and well-being in people with and without pain. Data were from 5871 participants from the English Longitudinal Study of Ageing. Experiences of discrimination were reported in 2010 to 2011. Pain, self-rated health, depressive symptoms, quality of life, life satisfaction, and loneliness were assessed in 2010 to 2011 and 2016 to 2017. A quarter (26%, n = 1524) of the sample reported pain at baseline. Participants with pain were more likely to report discrimination than those without pain (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.13-1.46). Cross-sectionally, those with pain who perceived discrimination had poorer self-rated health (OR = 1.28, 95% CI 1.02-1.61), greater depressive symptoms (OR = 1.90, 95% CI 1.48-2.45), were more likely to be lonely (β = 0.21, 95% CI 0.15-0.26), and had lower quality of life (β = -4.01, 95% CI -4.88 to -3.14), and life satisfaction (β = -1.75, 95% CI -2.45 to -1.06) than those with pain who did not perceive discrimination. Prospectively, discrimination in those with pain was associated with greater depression (OR = 1.67, 95% CI 1.19-2.34) and loneliness (β = 0.11, 95% CI 0.05-0.17), adjusting for baseline values. In those without pain in 2010 to 2011, discrimination predicted pain in 2016 to 2017, controlling for covariates (OR = 1.29, 95% CI 1.06-1.56). People with pain are more likely to report discrimination than those without pain, and this experience is associated with increased depression and loneliness. Discrimination was predictive of incident pain in pain-free adults. These findings highlight the need to tackle discrimination to improve well-being in those with pain and to potentially reduce the risk of pain onset.

Transnational ties with the home country matters: the moderation effect of the relationship between perceived discrimination and self-reported health among foreign workers in Korea

Background

Little attention has been paid to the relationship between perceived discrimination and self-rated health (SRH) among foreign workers in Korea. Transnational ties with the home country are known to be critical among immigrants, as they allow the maintenance of social networks and support. Nonetheless, as far as we know, no studies have examined the impact of transnational ties on SRH itself and the relationship between perceived discrimination and SRH, which the current study tries to examine.

Methods

Logistic regression analyses were conducted using the 2013 Survey on Living Conditions of Foreign Workers in Korea. Adult foreign workers from different Asian countries (n = 1,370) participated in this study. The dependent variable was good SRH and the independent variable was perceived discrimination. Transnational ties with the home country, as a moderating variable, was categorized into broad (i.e., contacting family members in the home country) vs. narrow types (i.e., visiting the home country).

Results

Foreign workers who perceived discrimination had a lower rate of good SRH than those who did not perceive discrimination. Broad social transnational ties moderated the relationship between perceived discrimination and SRH; narrow social transnational ties did not.

Conclusions

In line with previous studies, an association was found between perceived discrimination and SRH. Broad social transnational ties can be a good source of social support and buffer against the distress of perceived discrimination.

Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom

Background

Racism has been linked with poor health in studies in the United States. Little is known about prospective associations between racial discrimination and health outcomes in the United Kingdom (UK).

Methods

Data were from 4883 ethnic minority (i.e. non-white) participants in the UK Household Longitudinal Study. Perceived discrimination in the last 12 months on the basis of ethnicity or nationality was reported in 2009/10. Psychological distress, mental functioning, life satisfaction, self-rated health, physical functioning and reports of limiting longstanding illness were assessed in 2009/10 and 2011/12. Linear and logistic regression analyses adjusted for age, sex, income, education and ethnicity. Prospective analyses also adjusted for baseline status on the outcome being evaluated.

Results

Racial discrimination was reported by 998 (20.4%) of the sample. Cross-sectionally, those who reported racial discrimination had a greater likelihood on average of limiting longstanding illness (odds ratio (OR) = 1.78, 95% confidence interval (CI) 1.49; 2.13) and fair/poor self-rated health (OR = 1.50; 95% CI 1.24; 1.82) than those who did not report racial discrimination. Racial discrimination was associated with greater psychological distress (B = 1.11, 95% CI 0.88; 1.34), poorer mental functioning (B = − 3.61; 95% CI -4.29; − 2.93), poorer physical functioning (B = − 0.86; 95% CI -1.50; − 0.27), and lower life satisfaction (B = − 0.40, 95% CI -0.52; − 0.27). Prospectively, those who reported racial discrimination had a greater likelihood on average of limiting longstanding illness (OR = 1.31, 95% CI 1.01; 1.69) and fair/poor self-rated health (OR = 1.30; 95% CI 1.00; 1.69), than those who did not report racial discrimination. Racial discrimination was associated increased psychological distress (B = 0.52, 95% CI 0.20; 0.85) and poorer mental functioning (B = − 1.77; 95% CI -2.70; − 0.83) over two-year follow-up, adjusting for baseline scores.

Conclusions

UK adults belonging to ethnic minority groups who perceive racial discrimination experience poorer mental and physical health than those who do not. These results highlight the need for effective interventions to combat racial discrimination in order to reduce inequalities in health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09792-1.

Perceived group discrimination based on one's gender and the gender gap in depression in Europe

BACKGROUND

Gender discrimination is one of the most significant psychosocial stressors. This study examined whether the relationship between perceived group discrimination against one's gender (PGD) and the gender gap depression varied by societal levels of gender inequality.

METHODS

The current study used data from three waves (2006, 2012 and 2014) of the European Social Survey and applied multilevel linear regression methods. We assessed depressive feelings through the eight-item version of the Centre for Epidemiological Studies Depression Scale. The sample contained 71,419 respondents living in 22 countries.

RESULTS

While only a small percentage of people were confronted with PGD, this group consistently reported more depressive feelings. PGD had a similar effect on the mental health of men and women, except for men in more gender-egalitarian societies. When confronted with PGD, the latter group reported more depressive feelings in comparison to men in more gender unequal societies.

CONCLUSIONS

Our research found a strong association between PGD and depression. In addition, this relationship varied by societal levels of gender equality. More pronounced gender equality strengthened this relationship in men. Research that ignores this social context might, therefore, be limited in terms of generalization.

How does ageism influence frailty? A preliminary study using a structural equation model

Background

Based on the Stereotype Embodiment Theory (SET), this study aims to examine the mechanism of ageism on frailty through the proposed framework of “Experiences of Ageism (EA) → Age Stereotypes (AS) → Attitudes to Ageing (AA) → Frailty” using a structural equation model (SEM).

Methods

A community-based study involving 630 participants aged 60 years and older was conducted in Shanghai. EA, AS, AA and frailty status were assessed by validated scales. In particular, EA included three parts in this study, as the first part was the experiences of explicit prejudice or discrimination because of age, another two parts were the experiences of witnessed and encountered implicit negative age-based stereotypes. A SEM was performed to examine whether the proposed paths from EA to frailty were supported.

Results

EA had a significant indirect effect (β’ = .360*-.456*-.576 = .095, p < .001) on frailty through the path of “EA → AS → AA → Frailty” after controlling for covariates. AA had a direct effect (β = −.576, p < .001) on frailty; AS fully mediated the association between EA and AA (indirect effect = .360*-.456 = −.164, p < .001), and AA fully mediated the association between AS and frailty (indirect effect = −.456*-.576 = .263, p < .001).

Conclusions

These findings demonstrated a mechanism from ageism to frailty, and highlighted the potential threat of negative AS on health. Ageism and frailty are both great challenges for the process of healthy ageing.

Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured

Background:Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system.

Methods and Analysis: A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography.

Discussion: The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.

Examining the Effect of Self-Rated Health on the Relationship Between Race and Racial Colorblindness in Germany

This exploratory study sought to test the relationship among race, self-rated health (SRH), and colorblindness, conceptualized as the belief that race/ethnicity should not and does not matter. Independently, SRH, a multidimensional concept entailing physical and psychological health and one's affiliation in an ethnic/racial group, may contribute to racial attitudes. However, little is known about how SRH and racial/ethnic identity in combination may affect colorblind racial attitudes. It was thus hypothesized that SRH would moderate the relationship between race/ethnicity and colorblind racial attitudes. The research sample consisted of 136 autochthonous adults and "individuals with migration backgrounds" residing in Bavaria (Germany), who were divided by self-identified race (whites, n = 85; non-whites, n = 51). The results show that SRH moderates the relationship between race and racial colorblindness. More specifically, it was found that the greater the SRH of the white participants, the less they embraced a colorblind ideology. Conversely, the greater the SRH of the non-white participants, the greater their colorblind racial attitudes. These results suggest that stronger SRH may reduce colorblindness among whites and intensify it among non-whites. The implications of the obtained results may be useful in addressing how surmount barriers to data collection, measurements, and research related to racial and ethnic health disparities in "colorblind" Germany may contribute to health inequalities. Thus, this paper's contribution lies in tracking such disparities to aid their reduction or elimination.

Disability discrimination and well-being in the United Kingdom: a prospective cohort study

OBJECTIVES

Disability discrimination is linked with poorer well-being cross-sectionally. The aim of this study was to explore prospective associations between disability discrimination and well-being.

DESIGN

Prospective cohort study.

SETTING

The United Kingdom Household Longitudinal Study.

PARTICIPANTS

Data were from 871 individuals with a self-reported physical, cognitive or sensory disability.

PRIMARY OUTCOME MEASURES

Depression was assessed in 2009/10. Psychological distress, mental functioning, life satisfaction and self-rated health were assessed in 2009/10 and 2013/14.

RESULTS

Data were analysed using linear and logistic regression with adjustment for age, sex, household income, education, ethnicity and impairment category. Perceived disability discrimination was reported by 117 (13.4%) participants. Cross-sectionally, discrimination was associated with depression (OR=5.40, 95% CI 3.25 to 8.97) fair/poor self-rated health (OR=2.05; 95% CI 1.19 to 3.51), greater psychological distress (B=3.28, 95% CI 2.41 to 4.14), poorer mental functioning (B=-7.35; 95% CI -9.70 to -5.02) and life satisfaction (B=-1.27, 95% CI -1.66 to -0.87). Prospectively, discrimination was associated with increased psychological distress (B=2.88, 95% CI 1.39 to 4.36) and poorer mental functioning (B=-5.12; 95% CI -8.91 to -1.34), adjusting for baseline scores.

CONCLUSIONS

Perceived disability-related discrimination is linked with poorer well-being. These findings underscore the need for interventions to combat disability discrimination.

Income-related health inequalities among the migrant and native-born populations in Greece during the economic crisis: a decomposition analysis

Background

The economic crisis has induced detrimental socio-economic and health effects in Greece. This study aims to measure overall income-related health inequalities and examine their determinants, and to compare the respective within estimates for major subpopulations defined by citizenship (Greece, Albania, other countries) in Greece.

Methods

Data for 1332 cases were collected from a cross-sectional observational survey (MIGHEAL) conducted at a national level in 2016. Income-related inequalities in poor subjective health, limiting long-standing illness, elevated depressive symptoms and non-communicable diseases were measured with the standard and Erreygers concentration indices. Decomposition analysis identified key factors explaining the inequalities.

Results

Overall, significant inequalities favouring the better-off were established in all ill-health indicators, particularly in depression. Greek citizens were associated with consistent health inequalities, while, concerning the other groups, significant disparities were found only in depression for Albanians. Decomposition analyses identified socio-economic status, income in particular, as the main contributor to overall income-related health inequalities, followed by barriers to healthcare access, adverse family background and hazardous working conditions. Risk behaviours and discrimination were relatively less important, whereas area of residence was mainly reducing inequality. Citizens from Albania and other countries were found to be poorer, but with fewer health problems, hence, different citizenship decreased inequalities.

Conclusion

Socio-economic health inequalities in Greece can be mitigated by means of appropriate multi-sectorial policy interventions, by focussing primarily on the most socio-economically disadvantaged groups. The overall inequality-producing mechanisms and the different health needs of ethnic groups should be taken into account when formulating such policies.

Measuring the impact of multiple discrimination on depression in Europe

BACKGROUND

The study of the health effects of perceived discrimination based on ethnic and social traits has a long-standing and widespread tradition in epidemiological research, but less attention has been paid to the study of multiple discrimination, particularly its effects on mental health. The present work aims to analyse the association between multiple discrimination and depressive symptoms in Europe, and the impact of contextual socioeconomic circumstances on this relationship.

METHODS

In this study, data from the 7th Round of the European Social Survey was used. Given that the outcome variable, CES-D8, is a depression scale from 0 to 24 possible values and the hierarchical organisation of individuals (level-1 units) clustered within countries (level-2 units), a linear multilevel model was carried out.

RESULTS

Our findings suggest that multiple discrimination increases our risk of suffering depressive disorder, but in addition this work provides an important step forward to explain and understand how the relationship between multiple discrimination and depression might vary depending the socioeconomic context. In particular, we can observe that differences in the prevalence of depressive symptoms along multiple discrimination levels decrease as GDP per capita increases among European countries.

CONCLUSION

This study is relevant since provides new evidence on how the association between multiple discrimination and depression operates at the micro and macro-level context, which is fundamental to understand how macro-economic fluctuations of countries may determine depressive disorders through the effect of single and combined forms of discrimination.

Perceived discrimination and psychological distress in nine countries of the former Soviet Union

BACKGROUND

Perceived discrimination has been linked to worse mental health. However, little is known about this association in the countries of the former Soviet Union (fSU).

AIM

To address this deficit, this study examined the link between perceived discrimination and psychological distress in nine fSU countries.

METHODS

Data were analyzed from 18,000 adults aged ⩾18 years obtained during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010 and 2011. A single-item measure was used to assess discrimination. Psychological distress was measured with a 12-item scale. Logistic regression analysis and meta-analysis were used to examine associations.

RESULTS

After adjusting for all potential confounders, when using none/little discrimination as the reference category, moderate and strong discrimination were associated with significantly increased odds for psychological distress in the total population and in men and women separately with odds ratios ranging from 1.93 to 2.64. Meta-analysis based on country-wise estimates showed that the level of between-country heterogeneity was negligible.

CONCLUSION

Perceived discrimination is associated with psychological distress in countries throughout the fSU. Quantitative and qualitative research is now warranted to determine its specific forms and impact on population health in individual fSU countries.

Public stigma towards individuals with somatic symptom disorders - Survey results from Germany

OBJECTIVE

The study aims to investigate (1) the magnitude of public stigma towards individuals with somatic symptom disorder (SSD), (2) differences in public stigma between SSD and depression, and (3) predictors of social distance towards individuals with SSD.

METHODS

Analyses are based on a national telephone survey in Germany (N = 1004). Two vignettes with symptoms of SSD were used. Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Stigma was measured by stereotypes, negative emotional reactions, and desire for social distance.

RESULTS

There were no significant differences in public stigma regarding type of symptom and existence of an earlier somatic disease. Two of three components of public stigma under study (stereotypes and desire for social distance) showed higher values in case of depression compared to SSD (both vignettes pooled). Age and negative emotional reactions were positively associated with desire for social distance in case of both SSD vignettes, whereas associations with stereotypes and experience (own affliction and contact to persons afflicted) were inconsistent. Education was not associated with social distance towards people with SSD.

CONCLUSIONS

Results indicated public stigma towards people affected by SSD in Germany. Compared with depression, SSD stigma was lower in most components. Magnitude of SSD stigma was similar, irrespective of main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Reducing SSD stigma could help to improve illness behaviour and prevent chronification.

The Relation Between Discrimination, Sense of Coherence and Health Varies According to Ethnicity: A Study Among Three Distinct Populations in Israel

Self-reported experiences of discrimination and sense of coherence (SOC) have been found to be associated with health. A face-to-face survey of Long Term Jewish Residents (LTJR), Arabs and former Soviet Union (fSU) immigrants in Israel was performed. Respondents reported their physical and mental health, self-reported experiences of discrimination, SOC and socioeconomic status. Multivariable logistic regressions and bootstrapping path analyses were performed. Discrimination was associated with health after adjusting for all other variables. SOC was also associated with health. SOC did not mediate the strong association between discrimination and health among Israeli LTJR, but was a significant mediator among Arabs and fSU immigrants. Discrimination seems to have a direct effect on health only among the majority and not among minority populations. High levels of SOC may reduce the negative effects of discrimination on health by serving as a coping resource, however only among minorities.

The association between perceived discriminations and well-being in Korean employed workers: the 4th Korean working conditions survey

Background

Around the globe, discrimination has emerged as a social issue requiring serious consideration. From the perspective of public health, the impact of discrimination on the health of affected individuals is a subject of great importance. On the other hand, subjective well-being is a key indicator of an individual’s physical, mental, and social health. The present study aims to analyze the relationship between Korean employed workers’ subjective health and their exposure to perceived discrimination.

Methods

The Fourth Korean Working Conditions Survey (KWCS, 2014) was conducted on a representative sample of the economically active population aged 15 years or older, who were either employees or self-employed at the time of interview. After removing inconsistent data, 32,984 employed workers were examined in this study. The data included general and occupational characteristics, perceived discrimination, and well-being. Well-being was measured through the WHO-Five index (1998 version). Multiple logistic regression analysis was used to examine the association between perceived discrimination and well-being.

Result

As a group, employed workers who were exposed to discrimination had a significantly higher likelihood of “poor well-being” than their counterparts who were not exposed to discrimination. More specifically, the workers exposed to age discrimination had an odds ratio(OR) of 1.51 (95% CI: 1.36–1.68), workers exposed to discrimination based on educational attainment had an OR of 1.43 (95% CI: 1.26–1.61), and workers exposed to discrimination based on employment type had an OR of 1.68 (95% CI: 1.48–1.91) with respect to poor well-being.

Furthermore, workers exposed to a greater number of discriminatory incidents were also at a higher risk of “poor well-being” than their counterparts who were exposed to fewer such incidents. More specifically, the workers with three exposures to discrimination had an OR of 2.60 (95% CI: 1.92–3.53), the workers with two such exposures had an OR of 1.69 (95% CI: 1.44–1.99), and the workers with one such exposure had an OR of 1.32 (95% CI: 1.20–1.45).

Conclusion

The present study found that discrimination based on age, educational attainment, or employment type put workers at a higher risk of “poor well-being,” and that the greater the exposure to discrimination, the higher the risk of poor well-being.

Perceived social support as a moderator between perceived discrimination and subjective well-being among people with physical disabilities in Israel

PURPOSE

Perceived social support has gained importance as a significant preventive factor of depressive symptoms and as helpful for rebuilding feelings of self-worth and subjective well-being among people with physical disabilities. The current study examined whether perceived social support moderates the association between perceived discrimination and subjective well-being among people with physical disabilities in Israel.

MATERIALS AND METHODS

Data were collected by means of structured questionnaires among a convenience sample of 433 people with physical disabilities in Israel and hierarchical multiple regression was performed.

RESULTS AND CONCLUSIONS

The findings reveal that perceived social support has a moderating role in the association between perceived discrimination and subjective well-being among people with physical disabilities, such that those with low and moderate levels of perceived social support showed a negative association between perceived discrimination and subjective well-being, while those with high levels of perceived social support showed no association between perceived discrimination and subjective well-being. Findings are discussed in light of the social model of disability, and practical implications are suggested. Implications for Rehabilitation A negative association was found between perceived discrimination and subjective well-being among people with physical disabilities with low and moderate levels of perceived social support. Professionals working with people with physical disabilities must acknowledge the importance of social support for people with physical disabilities and for their families. Professionals working with people with physical disabilities should take a proactive approach to locating disabled people who do not receive or do not have adequate social support and offer them assistance. Professionals working with people with physical disabilities should engage in wide social activities aimed at providing resources and opportunities to service beneficiaries. Society bears the collective responsibility to act in order to reduce the social problem of discrimination against people with disabilities, as well as to raise public awareness of this issue.

[Psychometric assessment of a brief Modern Racism Scale]

Objective To find the internal consistency of the Modern Racism Scale (MRS) among medical students in Bucaramanga, Colombia. Methods A total of 352 medical students, mean age=20.0 years (SD=1.9) reported their attitudes towards Afro-Colombians; 59.4 % were women. Students completed the 10-item version of MRS. Cronbach alpha and McDonald omega were calculated. Exploratory factor analyses were done to propose a brief version of the MRS. Results The 10-item version showed a Cronbach alpha of 0.48 and a McDonald omega of 0.15. The short version, the Brief Modern Racism Scale (BMRS) (items 1, 4, 5, 7 and 8) presented a Cronbach alpha of 0.64 and McDonald omega of 0.65. The BMRS showed one salient factor responsible of 41.6 % of the total variance. Conclusions A Spanish-language short version of the MRS shows better psychometric performance than the original version. Further study is needed to corroborate these findings or make adjustments for Colombian cultural regions.

Association between perceived discrimination and healthcare-seeking behavior in people with a disability

BACKGROUND

Experiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner.

OBJECTIVES

To determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types.

METHODS

We performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability.

RESULTS

Most of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04-1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07-1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03-1.34).

CONCLUSIONS

People with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination.

[A Brief Homophobia Scale in Medical Students From Two Universities: Results of A Refinement Process]

BACKGROUND

The process of evaluating measurement scales is an ongoing procedure that requires revisions and adaptations according to the characteristics of the participants. The Homophobia Scale of seven items (EHF-7) has showed acceptable performance in medical students attending to two universities in Colombia. However, performance of some items was poor and could be removed, with an improvement in the psychometric findings of items retained.

OBJECTIVE

To review the psychometric functioning and refine the content of EHF-7 among medical students from two Colombian universities.

METHODS

A group of 667 students from the first to tenth semester participated in the research. Theirs ages were between 18 and 34 (mean, 20.9±2.7) years-old, and 60.6% were females. Cronbach alpha (α) and omega of McDonald (Ω) were calculated as indicators of reliability and to refine the scale, an exploratory (EFA) and confirmatory factor analysis (CFA) was performed.

RESULTS

EHF-7 showed α=.793 and Ω=.796 and a main factor that explained 45.2% of the total variance. EFA and CFA suggested the suppression of three items. The four-item version (EHF-4) reached an α=.770 and Ω=.775, with a single factor that accounted for 59.7% of the total variance. CFA showed better indexes (χ²=3.622; df=1; P=.057; Root-mean-square error of approximation (RMSEA)=.063, 90% CI, .000-.130; Comparative Fit Indices (CFI)=.998; Tucker-Lewis Index (TLI)=.991).

CONCLUSIONS

EHF-4 shows high internal consistency and a single dimension that explains more than 50% of the total variance. Further studies are needed to confirm these observations, that can be taken as preliminary.

Differences in depression stigma towards ethnic and socio-economic groups in Germany - Exploring the hypothesis of double stigma

BACKGROUND

Ethnic minorities and people with a low socio-economic status (SES) are often mentioned groups potentially affected by double stigma when faced with the burden of mental illness. Against this background we examine differences in public attitudes towards a) migrant vs. non-migrant persons with depression and b) low vs. high SES persons with depression.

METHOD

Analyses are based on data of a representative cross-sectional telephone survey among the adult population in Germany (N=2013). To compare the four groups, different depression vignettes were presented to the respondents. Three components of stigma were assessed in the survey: (1) characteristics ascribed to persons with a depression, (2) emotional reactions to people afflicted by depression, and (3) desire for social distance.

RESULTS

Respondents less often felt annoyed when the person in the depression vignette was a migrant coming from Turkey. However, differences are not statistically significant in the vast majority of the analyzed items. In terms of the comparison between high and low SES persons, analyses reveal small and inconsistent differences in public depression stigma.

LIMITATIONS

The study focusses on two deprived groups (ethnic minorities and people with a low SES) and is restricted to Germany.

CONCLUSIONS

Individuals with a low SES (compared to those with a high SES) and migrants (compared to non-migrants) with depression do not seem to be confronted with double public stigma in terms of stereotypes, emotional reactions, and desire for social distance.

Hospital admissions among immigrants from low-income and foreign citizens from high-income countries in Spain in 2000-2012

Over the last decade, the number of foreign nationals in Spain has increased. Our aim was to report the trends in hospital admissions, differentiating between foreign nationals from high-income countries (HICs) and from low- and middle-income countries (LMICs) in a public hospital. A retrospective analysis of hospital admissions in patients aged ⩾15 years between 2000 and 2012 was performed by means of hospital information systems at a public hospital in the city of Alicante, Spain. During the period of the study, 387,862 patients were admitted: 32,020 (8.3%) were foreign, 22,446 (5.8%) were from LMICs, and 9574 (2.5%) were from HICs. The number of foreign nationals, foreign nationals from LMICs, and foreign nationals from HICs admitted increased from 1019, 530, and 489 in 2000 to 2925, 2097, and 828, respectively in 2012. A total of 27.5% of patients were admitted for pregnancy, childbirth, and puerperium, especially foreign nationals from LMICs (34.3%), and 14.1% of foreign nationals were admitted for cardiovascular diseases (14.1%), which were more common in those from HICs (26.3%). The number of admissions among foreign nationals from LMICs increased significantly in all the diagnoses, but in pregnancy, childbirth, and puerperium, the increase was higher. In conclusion, nearly one out of 10 adult patients admitted to our hospital was foreign, mainly from LMICs, and the main reason for admission was diagnoses related to pregnancy, childbirth, and puerperium.

The association between perceived discrimination and depression/anxiety disorders among Korean workers: analysis of the third Korean Working Conditions Survey

Background

Discrimination is a long-standing social problem, and interest in the health effects of discrimination has been increasing. Unfortunately, Korean workers experience various types and combinations of discrimination. This study aimed to examine the association between perceived discrimination and depression/anxiety disorders among Korean workers.

Methods

Data from 33,530 paid workers were extracted from the third Korean Working Conditions Survey. The data included general characteristics, occupational characteristics, perceived discrimination, and depression/anxiety disorders. To examine the relationship between perceived discrimination and depression/anxiety disorders, multiple logistic regression analysis was used to evaluate depression/anxiety disorders as the dependent variable and perceived discrimination as the independent variable, after adjusting for relevant general and occupational characteristics.

Results

After adjusting for the relevant general and occupational characteristics, we observed that male and female workers who had experienced perceived discrimination exhibited a significantly higher likelihood of having depression/anxiety disorders. The odds ratios among male and female workers were 3.25 (95 % confidence interval: 2.45–4.32) and 4.56 (95 % confidence interval: 3.45–6.03), respectively.

Conclusions

Perceived discrimination was significantly related to depression or anxiety disorders among Korean workers. The risk of depression or anxiety was higher among female workers, compared to male workers.

Discovering complex interrelationships between socioeconomic status and health in Europe: A case study applying Bayesian Networks

Studies assume that socioeconomic status determines individuals' states of health, but how does health determine socioeconomic status? And how does this association vary depending on contextual differences? To answer this question, our study uses an additive Bayesian Networks model to explain the interrelationships between health and socioeconomic determinants using complex and messy data. This model has been used to find the most probable structure in a network to describe the interdependence of these factors in five European welfare state regimes. The advantage of this study is that it offers a specific picture to describe the complex interrelationship between socioeconomic determinants and health, producing a network that is controlled by socio-demographic factors such as gender and age. The present work provides a general framework to describe and understand the complex association between socioeconomic determinants and health.

Changes in depression stigma after the Germanwings crash - Findings from German population surveys

BACKGROUND

Media coverage of the Germanwings plane crash intensely focused on the co-pilot's mental illness and was criticized for potentially increasing depression stigma. We explored whether stigma beliefs towards persons with depression changed in April 2015 (about one month after the crash) compared to 2014.

METHOD

Telephone surveys among the adult population were conducted in Munich, Germany (N=650 in 2014 and N=601 in 2015). In both surveys, four components of stigma were assessed: (1) characteristics ascribed to persons with a depression, (2) belief in a continuum of symptoms from mental health to mental illness, (3) emotional reactions to people afflicted by depression (fear, anger, and pro-social reactions), and (4) desire for social distance.

RESULTS

Some stigmatizing attitudes have increased after the crash. More specifically, we found more pronounced changes in the attributes ascribed (stereotypes) and in the perceived separation from persons afflicted (continuum beliefs) than in the emotional reactions and the desire for social distance. However, overall increase in depression stigma was smaller than expected as changes were not statistically significant in the majority of the analyzed items.

LIMITATIONS

Due to the study design no causal interpretation of results is possible. Moreover, evidence presented is confined to a regional German sample.

CONCLUSIONS

A single devastating event and related media coverage seem to have a limited impact on public stigmatizing attitudes.

Measuring the effect of ethnic and non-ethnic discrimination on Europeans' self-rated health

OBJECTIVES

The study of perceived discrimination based on race and ethnic traits belongs to a long-held tradition in this field, but recent studies have found that non-ethnic discrimination based on factors such as gender, disability or age is also a crucial predictor of health outcomes.

METHODS

Using data from the European Social Survey (2010), and applying Boolean Factor Analysis and Ordered Logistic Regression models, this study is aimed to compare how ethnic and non-ethnic types of discrimination might affect self-rated health in the European context.

RESULTS

We found that non-ethnic types of discrimination produce stronger differences on health outcomes. This result indicates that the probabilities of presenting a poor state of health are significantly higher when individuals feel they are being discriminated against for social or demographic conditions (gender, age, sexuality or disability) rather than for ethnic reasons (nationality, race, ethnicity, language or religiosity).

CONCLUSIONS

This study offers a clear comparison of health inequalities based on ethnic and non-ethnic types of discrimination in the European context, overcoming analytical based on binary indicators and simple measures of discrimination.

Which environmental factors are associated with lived health when controlling for biological health? - a multilevel analysis

Background

Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework.

Methods

We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people’s biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models.

Results

Social support, being able to maintain one’s job, the extent to which one’s health needs are addressed and being discriminated against due to one’s health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health.

Conclusions

This study identified environmental factors associated with people’s lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.

Social capital and reported discrimination among people with depression in 15 European countries

PURPOSE

Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels.

METHOD

A total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network.

RESULTS

Significant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination.

CONCLUSIONS

Higher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression.

Pathways between perceived discrimination and health among immigrants: evidence from a large national panel survey in Germany

OBJECTIVE

Discrimination is an important determinant of health, and its experience may contribute to the emergence of health inequalities between immigrants and nonimmigrants. We examine pathways between perceived discrimination and health among immigrants in Germany: (1) whether perceptions of discrimination predict self-reported mental and physical health (SF-12), or (2) whether poor mental and physical health predict perceptions of discrimination, and (3) whether discrimination affects physical health via mental health.

DESIGN

Data on immigrants come from the German Socio-Economic Panel (SOEP) from the years 2002 to 2010 (N = 8,307), a large national panel survey. Random and fixed effects regression models have been estimated.

RESULTS

Perceptions of discrimination affect mental and physical health. The effect of perceived discrimination on physical health is mediated by its effect on mental health. Our analyses do not support the notion that mental and physical health predict the subsequent reporting of discrimination. Different immigrant groups are differentially exposed to perceived discrimination.

CONCLUSION

In spite of anti-discrimination laws, the health of immigrants in Germany is negatively affected by perceived discrimination. Differential exposure to perceived discrimination may be seen as a mechanism contributing to the emergence of health inequalities in Germany.

Effect of the Time to Change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003-13: an analysis of survey data

BACKGROUND

Understanding trends and effective mechanisms that are likely to reduce public stigma and discrimination towards people with mental illness is important. We aimed to assess changes in public stigma in England after the introduction of the Time to Change anti-stigma campaign.

METHODS

We used data from the 2003 and 2007-13 national Attitudes to Mental Illness surveys to investigate 10-year trends in public attitudes across England before and during the Time to Change anti-stigma campaign. We present annual mean scores for attitude items related to prejudice and exclusion, and tolerance and support for community care. We also present an extrapolated linear trend line for the years 2009-13 and estimate population attitude scores without the campaign. We present unadjusted and adjusted linear regression models. In addition, we used multivariable linear regression models fitted to data aggregated by region to investigate whether a dose-effect response exists between campaign awareness and regional outcomes related to knowledge, attitudes, and intended behaviour.

FINDINGS

About 1700 respondents were surveyed each year. Significant increases in positive attitudes related to prejudice and exclusion occurred after the Time to Change campaign. In the multivariable analysis, we noted a significant increase in positive attitudes in relation to prejudice and exclusion after the launch of Time to Change (reverse-coded Z score 0·02, 95% CI 0·01 to 0·05; p=0·01), but not for tolerance and support for community care (Z score 0·01, -0·01 to 0·03; p=0·27). We also found evidence for a dose-effect relation between campaign awareness and regional improvement in knowledge (p=0·004) and attitudes (tolerance and support p<0·0001; prejudice and exclusion p=0·001), but not intended behaviour (p=0·20).

INTERPRETATION

The positive effects of Time to Change seem to be significant and moderate. Although attitudes are probably more at risk of deterioration during times of economic hardship, anti-stigma programmes might still play an active part in long-term reduction of stigma and discrimination, especially in relation to prejudice and exclusion of people with mental health problems.

FUNDING

UK Department of Health, Comic Relief, Big Lottery.