Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

01-02-2012 | Original Paper

The DRUID study: exploring mediating pathways between racism and depressive symptoms among Indigenous Australians

Authors: Yin C. Paradies, Joan Cunningham

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 2/2012

Abstract

Purpose

Racism is an important determinant of mental and physical health for minority populations. However, to date little is known about the relationship between racism and ill-health outside of the U.S. or the causal pathways between racism and poor health. This paper focuses on the relationship between racism and depression in a non-U.S. indigenous population, including examination of novel mediators and moderators.

Methods

One hundred and eighty-five adults in the Darwin Region Urban Indigenous Diabetes study responded to a validated instrument assessing multiple facets of racism. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as possible mediators and moderators in linear regression models.

Results

Interpersonal racism was significantly associated with depression after adjusting for socio-demographic factors (β = 0.08, p < 0.001). Lack of control, stress, negative social connections and feeling ashamed, amused or powerless as reactions to racism were each identified as significant mediators of the relationship between racism and depressive symptoms. All examined mediators together accounted for 66% of the association between interpersonal racism and depressive symptoms.

Conclusions

This study demonstrates that racism is associated with depressive symptoms in an indigenous population. The mediating factors between racism and depressive symptoms identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health.

Berman G, Paradies Y (2008) Racism, disadvantage and multiculturalism: towards effective anti-racist praxis. Ethn Racial Stud 33:214–232CrossRef

Paradies Y (2006) A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 35:888–901PubMedCrossRef

Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32:20–47PubMedCrossRef

Pascoe EA, Richman LS (2009) Perceived discrimination and health: a meta-analytic review. Psychol Bull 135:531–554PubMedCrossRef

Moussavi S, Chatterji S, Verdes E et al (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370:851–858PubMedCrossRef

De Santis AS, Adam EK, Doane LD et al (2007) Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents. J Adolesc Health 41:3–13CrossRef

Richman LS, Jonassaint C (2008) The effects of race-related stress on cortisol reactivity in the laboratory: implications of the Duke lacrosse scandal. Ann Behav Med 35:105–110PubMed

Tull ES, Sheu YT, Butler C et al (2005) Relationships between perceived stress, coping behavior and cortisol secretion in women with high and low levels of internalized racism. J Natl Med Assoc 97:206–212PubMed

Thomas KS, Bardwell WA, Ancoli-Israel S et al (2006) The toll of ethnic discrimination on sleep architecture and fatigue. Health Psychol 25:635–642PubMedCrossRef

10.

Bennett GG, Wolin KY, Robinson EL et al (2005) Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health 95:238–240PubMedCrossRef

11.

Chae DH, Takeuchi DT, Barbeau EM et al (2008) Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the National Latino and Asian American Study. Am J Public Health 98:485–492PubMedCrossRef

12.

Guthrie BJ, Young AM, Williams DR et al (2002) African American girls’ smoking habits and day-to-day experiences with racial discrimination. Nurs Res 51:183–189PubMedCrossRef

13.

Landrine H, Klonoff EA (2000) Racial discrimination and cigarette smoking among blacks: findings from two studies. Ethn Dis 10:195–202PubMed

14.

Okamoto J, Ritt-Olson A, Soto D et al (2009) Perceived discrimination and substance use among Latino adolescents. Am J Health Behav 33:718–727PubMed

15.

Choi Y, Harachi TW, Gillmore MR et al (2006) Are multiracial adolescents at greater risk? Comparisons of rates, patterns, and correlates of substance use and violence between monoracial and multiracial adolescents. Am J Orthopsychiatry 76:86–97PubMedCrossRef

16.

Gee GC, Delva J, Takeuchi D (2007) Relationships between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence among Filipino Americans. Am J Public Health 97:933–940PubMedCrossRef

17.

Gibbons FX, Gerrard M, Cleveland MJ et al (2004) Perceived discrimination and substance use in African American parents and their children: a panel study. J Pers Soc Psychol 86:517–529PubMedCrossRef

18.

Gibbons FX, Yeh HC, Gerrard M et al (2007) Early experience with racial discrimination and conduct disorder as predictors of subsequent drug use: a critical period hypothesis. Drug Alcohol Depend 88:S27–S37PubMedCrossRef

19.

Steffen PR, Bowden M (2006) Sleep disturbance mediates the relationship between perceived racism and depressive symptoms. Ethn Dis 16:16–21PubMed

20.

Chen C, Lin K (2009) Health consequences of illegal drug use. Curr Opin Psychiatry 22:287–292PubMedCrossRef

21.

Mathers M, Toumbourou J, Catalano RF et al (2006) Consequences of youth tobacco use: a review of prospective behavioural studies. Addiction 101:948–958PubMedCrossRef

22.

Paradies Y, Williams DR, Heggenhougen K et al (2008) Racism and Health. In: Encyclopedia of public health. Academic Press, San Diego, pp 474–483

23.

Steering Committee for the Review of Government Service Provision (2009) Overcoming indigenous disadvantage: key indicators 2009. Productivity Commission, Canberra

24.

Paradies Y, Harris R, Anderson I (2008) The impact of racism on indigenous health in Australia and Aotearoa: towards a research agenda. Cooperative Research Centre for Aboriginal Health, Darwin

25.

Cunningham J, O’Dea K, Dunbar T et al (2006) Study protocol: diabetes and related conditions in urban indigenous people in the Darwin, Australia region: aims, methods and participation in the DRUID Study. BMC Public Health 6

26.

Paradies Y, Cunningham J (2008) Development and validation of the measure of indigenous racism experiences (MIRE). Int J Equity Health 7

27.

Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a re-evaluation of the life orientation test. J Pers Soc Psychol 67:1063–1078PubMedCrossRef

28.

Manson S, Beals J (1995) Indian services utilization and psychiatric epidemiology risk and protective factors project: survey instrument and coding guide. Section G. University of Colorado, Denver

29.

Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRef

30.

Wald A (1943) Tests of statistical hypothesis concerning several parameters when the number of observations is large. Trans Am Math Soc 54:426–482CrossRef

31.

Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40:879–891PubMedCrossRef

32.

Pituch KA, Stapleton LM (2008) The performance of methods to test upper-level mediation in the presence of nonnormal data. Multivar Behav Res 43:237–267CrossRef

33.

Ender P (2010) How can I perform mediation with binary variables? UCLA, Academic Technology Services, Statistical Consulting Group

34.

Chandola T, Kuper H, Singh-Manoux A et al (2004) The effect of control at home on CHD events in the Whitehall II study: gender differences in psychosocial domestic pathways to social inequalities in CHD. Soc Sci Med 58:1501–1509PubMedCrossRef

35.

Griffin J, Fuhrer R, Stansfeld S et al (2002) The importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class? Soc Sci Med 54:783–798PubMedCrossRef

36.

Moradi B, Hasan NT (2004) Arab American persons’ reported experiences of discrimination and mental health: the mediating role of personal control. J Couns Psychol 51:418–428CrossRef

37.

Rodriguez MS (2004) Effects of perceived discrimination on mental health: exploring intervening relationships. Kent State University

38.

Chakraborty AT, McKenzie KJ, Hajat SA (2009) Racism, mental illness and social support in the UK. Social Psychiatry Psychiatr Epidemiol (epub ahead of print)

39.

Gee GC, Chen J, Spencer MS et al (2006) Social support as a buffer for perceived unfair treatment among Filipino Americans: differences between San Francisco and Honolulu. Am J Public Health 96:677–684PubMedCrossRef

40.

Brondolo E, VerHalen NB, Pencille M et al (2009) Coping with racism: a selective review of the literature and a theoretical and methodological critique. J Behav Med 32:64–84PubMedCrossRef

41.

Broudy R, Brondolo E, Coakley V et al (2007) Perceived ethnic discrimination in relation to daily moods and negative social interactions. J Behav Med 30:31–43PubMedCrossRef

42.

Utsey SO, Lanier Y, Williams O et al (2006) Moderator effects of cognitive ability and social support on the relation between race-related stress and quality of life in a community sample of Black Americans. Cult Divers Ethn Minor Psychol 12:334–346CrossRef

43.

Finch BK, Vega WA (2003) Acculturation stress, social support, and self-rated health among Latinos in California. J Immigr Health 5:109–117PubMedCrossRef

44.

Liang CTH, Alvarez AN, Juang L et al (2007) The role of coping in the relationship between perceived racism and racism-related stress for Asian Americans: gender differences. J Couns Psychol 54:132–141CrossRef

45.

Alvarez AN, Juang L (2010) Filipino Americans and racism: a multiple mediation model of coping. J Couns Psychol 57:167–178PubMedCrossRef

46.

Larson A, Gilles M, Howard PJ et al (2007) It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Aust N Z J Public Health 31:322–329PubMedCrossRef

47.

Ong AD, Edwards LM (2008) Positive affect and adjustment to perceived racism. J Soc Clin Psychol 27:105–126CrossRef

48.

Sellers R, Caldwell CH, Schmeelk-Cone KH et al (2003) Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Soc Behav 44:302–317PubMedCrossRef

49.

Ong AD, Fuller-Rowell T, Burrow AL (2009) Racial discrimination and the stress process. J Pers Soc Psychol 96:1259–1271PubMedCrossRef

50.

Din-Dzietham R, Nembhard WN, Collins R et al (2004) Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, 1999–2001. Soc Sci Med 58:449–461PubMedCrossRef

51.

Mossakowski KN (2003) Coping with perceived discrimination: does ethnic identity protect mental health? J Health Soc Behav 44:318–331PubMedCrossRef

52.

Banks KH, Kohn-Wood L (2007) The influence of racial identity profiles on the relationship between racial discrimination and depressive symptoms. J Black Psychol 33:331–354CrossRef

53.

Krieger N, Carney D, Lancaster K et al (2010) Combining explicit and implicit measures of racial discrimination in health research. Am J Public Health 100:1485–1492PubMedCrossRef

54.

Mellor D, Bynon G, Maller J et al (2001) The perception of racism in ambiguous scenarios. J Ethn Migr Stud 27:473–488

55.

Bennett GG, Merritt MM, Edwards CL et al (2004) Perceived racism and affective responses to ambiguous interpersonal interactions among African American men. Am Behav Sci 47:963–976CrossRef

56.

Juang LP, Cookston JT (2009) Acculturation, discrimination, and depressive symptoms among Chinese American adolescents: a longitudinal study. J Prim Prev 30:475–496PubMedCrossRef

57.

Barnes LL, Mendes De Leon CF, Lewis TT et al (2008) Perceived discrimination and mortality in a population-based study of -older adults. Am J Public Health 98:1241–1247PubMedCrossRef

58.

Gee G, Walsemann K (2009) Does health predict the reporting of racial discrimination or do reports of discrimination predict health? Findings from the National Longitudinal Study of Youth. Soc Sci Med 69:1676–1684CrossRef

59.

McClelland GH, Judd CM (1993) Statistical difficulties of detecting interactions and moderator effects. Psychol Bull 114:376–390PubMedCrossRef

Title: The DRUID study: exploring mediating pathways between racism and depressive symptoms among Indigenous Australians
Authors: Yin C. Paradies
Joan Cunningham
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 2/2012
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-010-0332-x

At a glance: The STEP trials

Springer Medicine

The DRUID study: exploring mediating pathways between racism and depressive symptoms among Indigenous Australians

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2012

Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review

Prevalence and childhood antecedents of depersonalization syndrome in a UK birth cohort

Attempted suicide among immigrants in European countries: an international perspective

Predicting outcome of assertive outreach across England

Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2

The impact of media reporting of the suicide of a singer on suicide rates in Taiwan