Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Barrier or stressor? The role of discrimination experiences in health service use

Authors: Billy Gazard, Zoe Chui, Lisa Harber-Aschan, Shirlee MacCrimmon, Ioannis Bakolis, Katharine Rimes, Matthew Hotopf, Stephani L. Hatch

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences.

Methods

Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented.

Results

Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use.

Conclusions

This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
Literature
1.
Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014;140(4):921.CrossRefPubMed
2.
Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychological Bulletin; Psychological Bulletin. 2009;135(4):531.CrossRefPubMed
3.
Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407–40.CrossRefPubMedCentralPubMed
4.
Hatch SL, Gazard B, Williams DR, Frissa S, Goodwin L, Hotopf M. Discrimination and common mental disorder among migrant and ethnic groups: findings from a South East London community sample. Soc Psychiatry Psychiatr Epidemiol. 2016;51(5):689-701.
5.
Wallace S, Nazroo J, Bécares L. Cumulative effect of racial discrimination on the mental health of ethnic minorities in the United Kingdom. Am J Public Health. 2016;106(7):1294–300.CrossRefPubMedCentralPubMed
6.
Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: a systematic review and meta-analysis. PLoS One. 2017.
7.
Campbell C, McLean C. Ethnic identities, social capital and health inequalities: factors shaping African-Caribbean participation in local community networks in the UK. Soc Sci Med. 2002;55(4):643–57.CrossRefPubMed
8.
Canvin K, Jones C, Marttila A, Burström B, Whitehead M. Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study. J Epidemiol Community Health. 2007;61(11):984–9.CrossRefPubMedCentralPubMed
9.
Warfa N, Bhui K, Craig T, Curtis S, Mohamud S, Stansfeld S, McCrone P, Thornicroft G. Post-migration geographical mobility, mental health and health service utilisation among Somali refugees in the UK: a qualitative study. Health & place. 2006;12(4):503–15.CrossRef
10.
Shavers VL, Fagan P, Jones D, Klein WMP, Boyington J, Moten C, Rorie E. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102(5):953–66.CrossRefPubMedCentralPubMed
11.
Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504–10.CrossRefPubMedCentralPubMed
12.
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013.
13.
Henderson C, Williams P, Gabbidon J, Farrelly S, Schauman O, Hatch S, Thornicroft G. Mistrust of mental health services: ethnicity, hospital admission and unfair treatment. 2015;24(3):258-65.
14.
Sawyer PJ, Major B, Casad BJ, Townsend SS, Mendes WB. Discrimination and the stress response: psychological and physiological consequences of anticipating prejudice in interethnic interactions. Am J Public Health. 2012;102(5):1020–6.CrossRefPubMedCentralPubMed
15.
Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009;373(9661):408–15.CrossRefPubMed
16.
Carter RT, Forsyth J. Reactions to racial discrimination: emotional stress and help-seeking behaviors. Psychol Trauma Theory Res Pract Policy. 2010;2(3):183.CrossRef
17.
Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, Hsu R, Katbamna S, Olsen R, Smith L. Conducting a critical interpretive synthesis of the literature on access tohealthcare by vulnerable groups. BMC Med Res Methodol. 2006;6(1):1.CrossRef
18.
Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med. 2005;60(6):1251–66.CrossRefPubMed
19.
Goddard M, Smith P. Equity of access to health care services:: theory and evidence from the UK. Soc Sci Med. 2001;53(9):1149–62.CrossRefPubMed
20.
Klein J, Hofreuter-Gätgens K. von dem Knesebeck O: socioeconomic status and the utilization of health services in Germany: a systematic review. In: Health Care Utilization in Germany. Edn: Springer; 2014. p. 117–43.
21.
Stirbu I, Kunst AE, Mielck A, Mackenbach JP. Inequalities in utilisation of general practitioner and specialist services in 9 European countries. BMC Health Serv Res. 2011;11(1):288.CrossRefPubMedCentralPubMed
22.
Kapadia D, Brooks HL, Nazroo J, Tranmer M. Pakistani women's use of mental health services and the role of social networks: a systematic review of quantitative and qualitative research. Health & social care in the community. 2015;25(4):1304-17.
23.
Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford law review. 1991:1241–99.
24.
Gazard B, Frissa S, Nellums L, Hotopf M, Hatch SL. Challenges in researching migration status, health and health service use: an intersectional analysis of a South London community. Ethnicity & health. 2014:1–30.
25.
Goodwin L, Gazard B, Aschan L, MacCrimmon S, Hotopf M, Hatch S. Taking an intersectional approach to define latent classes of socioeconomic status, ethnicity and migration status for psychiatric epidemiological research. Epidemiology and Psychiatric Sciences. 2017:1–12.
26.
Hatch S, Frissa S, Verdecchia M, Stewart R, Fear N, Reichenberg A, Morgan C, Kankulu B, Clark J, Gazard B. Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: the South East London community health (SELCoH) study. BMC Public Health. 2011;11(1):861.CrossRefPubMedCentralPubMed
27.
Borrell C, Palència L, Bartoll X, Ikram U, Malmusi D. Perceived discrimination and health among immigrants in Europe according to National Integration Policies. Int J Environ Res Public Health. 2015;12(9):10687–99.CrossRefPubMedCentralPubMed
28.
Simons AMW, Groffen DAI, Bosma H. Income-related health inequalities: does perceived discrimination matter? International journal of public health. 2013;58(4):513–20.CrossRefPubMed
29.
Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health socio-economic status. Stress and Discrimination Journal of Health Psychology. 1997;2(3):335–51.
30.
Williams DR, Haile R, Mohammed SA, Herman A, Sonnega J, Jackson JS, Stein DJ. Perceived discrimination and psychological well-being in the USA and South Africa. Ethnicity & health. 2012;17(1–2):111–33.CrossRef
31.
Office of population cencuses and surveys: Classification of occupations In.; 1980.
32.
Lewis G, Pelosi AJ, Araya R, Dunn G. Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med. 1992;22(02):465–86.CrossRefPubMed
33.
Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66.CrossRefPubMed
34.
Turner RJ, Lloyd DA. Lifetime traumas and mental health: the significance of cumulative adversity. J Health Soc Behav. 1995:360–76.
35.
36.
Hagenaars JA, McCutcheon AL. Applied latent class analysis: Cambridge University Press; 2002.
37.
Muthén LK. Muthén BO: Mplus. The comprehensive modelling program for applied researchers: User’s guide. 2012.
38.
Gee GC, Walsemann KM, Brondolo E. A life course perspective on how racism may be related to health inequities. Am J Public Health. 2012;102(5):967–74.CrossRefPubMedCentralPubMed
39.
LaVeist TA, Thorpe RJ, Pierre G, Mance GA, Williams DR. The relationships among vigilant coping style, race, and depression. J Soc Issues. 2014;70(2):241–55.CrossRefPubMedCentralPubMed
40.
Benjamins MR, Whitman S. Relationships between discrimination in health care and health care outcomes among four race/ethnic groups. J Behav Med. 2014;37(3):402–13.CrossRefPubMed
41.
Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G. Ethnic variations in pathways to and use of specialist mental health services in the UK systematic review. Br J Psychiatry. 2003;182(2):105–16.CrossRefPubMed
42.
Grollman EA. Multiple disadvantaged statuses and health the role of multiple forms of discrimination. J Health Soc Behav. 2014;55(1):3–19.CrossRefPubMed
43.
Cairney J, Veldhuizen S, Vigod S, Streiner DL, Wade TJ, Kurdyak P. Exploring the social determinants of mental health service use using intersectionality theory and CART analysis. J Epidemiol Community Health. 2013.
44.
Durbin A, Moineddin R, Lin E, Steele LS, Glazier RH. Examining the relationship between neighbourhood deprivation and mental health service use of immigrants in Ontario, Canada: a cross-sectional study. BMJ Open. 2015.
45.
Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):603–13.CrossRefPubMed
46.
Adams RJ, Stocks NP, Wilson DH, Hill CL, Gravier S, Kickbusch I, Beilby JJ. Health literacy: a new concept for general practice? Aust Fam Physician. 2009;38(3):144.PubMed
47.
Cooper C, Spiers N, Livingston G, Jenkins R, Meltzer H, Brugha T, McManus S, Weich S, Bebbington P. Ethnic inequalities in the use of health services for common mental disorders in England. Soc Psychiatry Psychiatr Epidemiol. 2013;48(5):685–92.CrossRefPubMed
Metadata
Title
Barrier or stressor? The role of discrimination experiences in health service use
Authors
Billy Gazard
Zoe Chui
Lisa Harber-Aschan
Shirlee MacCrimmon
Ioannis Bakolis
Katharine Rimes
Matthew Hotopf
Stephani L. Hatch
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6267-y

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study

Research article

Factors associated with social casino gaming among adolescents across game types

Study protocol

Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design

Research article

Reported incidence and risk factors of childhood pneumonia in India: a community-based cross-sectional study

Research article

Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review

Research article

Mediating role of emotional labor in the association between emotional intelligence and fatigue among Chinese doctors: a cross-sectional study