Association of Everyday Discrimination With Depressive Symptoms and Suicidal Ideation During the COVID-19 Pandemic in the All of Us Research Program | Depressive Disorders | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Association of Everyday Discrimination With Depressive Symptoms and Suicidal Ideation During the COVID-19 Pandemic in the All of Us Research Program

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How did everyday discrimination affect mental health during the early phase of the COVID-19 pandemic among individuals residing in the United States?

Findings  In this cohort study, everyday discrimination was associated with significantly increased odds of moderate to severe depressive symptoms and suicidal ideation between May and July 2020. Notably, this association was stronger among participants self-identifying as Hispanic or Latino or non-Hispanic Asian when the main reason for discrimination was race, ancestry, or national origins.

Meaning  Our findings suggest everyday discrimination linked to race, ancestry, or national origins as a possible contributor to the significant toll on mental health and well-being of Hispanic or Latino or non-Hispanic Asian individuals during the early phase of the pandemic.

Abstract

Importance  The COVID-19 pandemic has coincided with an increase in depressive symptoms as well as a growing awareness of health inequities and structural racism in the United States.

Objective  To examine the association of mental health with everyday discrimination during the pandemic in a large and diverse cohort of the All of Us Research Program.

Design, Setting, and Participants  Using repeated assessments in the early months of the pandemic, mixed-effects models were fitted to assess the associations of discrimination with depressive symptoms and suicidal ideation, and inverse probability weights were applied to account for nonrandom probabilities of completing the voluntary survey.

Main Outcomes and Measures  The exposure and outcome measures were ascertained using the Everyday Discrimination Scale and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Scores for PHQ-9 that were greater than or equal to 10 were classified as moderate to severe depressive symptoms, and any positive response to the ninth item of the PHQ-9 scale was considered as presenting suicidal ideation.

Results  A total of 62 651 individuals (mean [SD] age, 59.3 [15.9] years; female sex at birth, 41 084 [65.6%]) completed at least 1 assessment between May and July 2020. An association with significantly increased likelihood of moderate to severe depressive symptoms and suicidal ideation was observed as the levels of discrimination increased. There was a dose-response association, with 17.68-fold (95% CI, 13.49-23.17; P < .001) and 10.76-fold (95% CI, 7.82-14.80; P < .001) increases in the odds of moderate to severe depressive symptoms and suicidal ideation, respectively, on experiencing discrimination more than once a week. In addition, the association with depressive symptoms was greater when the main reason for discrimination was race, ancestry, or national origins among Hispanic or Latino participants at all 3 time points and among non-Hispanic Asian participants in May and June 2020. Furthermore, high levels of discrimination were as strongly associated with moderate to severe depressive symptoms as was history of prepandemic mood disorder diagnosis.

Conclusions and Relevance  In this large and diverse sample, increased levels of discrimination were associated with higher odds of experiencing moderate to severe depressive symptoms. This association was particularly evident when the main reason for discrimination was race, ancestry, or national origins among Hispanic or Latino participants and, early in the pandemic, among non-Hispanic Asian participants.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: June 1, 2022.

Published Online: July 27, 2022. doi:10.1001/jamapsychiatry.2022.1973

Corresponding Author: Jordan W. Smoller, MD, ScD, 185 Cambridge St, 6th Floor, Boston, MA 02114 (jsmoller@mgh.harvard.edu).

Author Contributions: Dr Lee had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Lee, Fatori, Brunoni, Smoller.

Acquisition, analysis, or interpretation of data: Lee, Liu, J. Bauermeister, Luh, Clark, S. Bauermeister, Smoller.

Drafting of the manuscript: Lee, Brunoni, Smoller.

Critical revision of the manuscript for important intellectual content: Lee, Liu, Fatori, J. Bauermeister, Luh, Clark, S. Bauermeister, Smoller.

Statistical analysis: Lee, Liu, Fatori, S. Bauermeister.

Administrative, technical, or material support: Lee, J. Bauermeister, Luh, Brunoni, Smoller.

Supervision: Clark, Brunoni, Smoller.

Conflict of Interest Disclosures: Dr Smoller reported grants from International HundredK+ Cohort Consortium during the conduct of the study and honoraria from Biogen and Tempus Labs, serving on scientific advisory boards for Sensorium Therapeutics and Leon Levy Foundation, and serving as principal investigator for a collaborative study sponsored by 23andMe of the genetics of depression and bipolar disorder (for which 23andMe provides analysis time as in-kind support but no payments) outside the submitted work. No other disclosures were reported.

Funding/Support: The All of Us Research Program is supported by grants through the National Institutes of Health, Office of the Director: Regional Medical Centers (1 OT2 OD026549, 1 OT2 OD026554, 1 OT2 OD026557, 1 OT2 OD026556, 1 OT2 OD026550, 1 OT2 OD026552, 1 OT2 OD026553, 1 OT2 OD026548, 1 OT2 OD026551, 1 OT2 OD026555, IAA AOD 16037); Federally Qualified Health Centers (HHSN 263201600085U); Data and Research Center (5 U2C OD023196); Biobank (1 U24 OD023121); The Participant Center (U24 OD023176); Participant Technology Systems Center (1 U24 OD023163); Communications and Engagement (3 OT2 OD023205; 3 OT2 OD023206); and Community Partners (1 OT2 OD025277, 3 OT2 OD025315, 1 OT2 OD025337, 1 OT2 OD025276). In addition to the funded partners, the All of Us Research Program would not be possible without the contributions made by its participants. All authors are supported by the International HundredK+ Cohorts Consortium (IHCC), which has been created in collaboration with the Global Alliance for Genomics and Health (GA4GH) and the Global Genomics Medicine Collaborative (G2MC) with support from the National Institutes of Health and the Wellcome Trust. In addition, Mr Bauermeister and Dr Bauermeister are supported by Dementias Platform UK (DPUK) funded by the Medical Research Council (MR/T0333771). Dr Smoller is supported in part by a gift from the Demarest Lloyd Jr, Foundation.

Role of the Funder/Sponsor: The IHCC reviewed and approved the manuscript but had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication. All other funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Nhi-Ha Trinh, MD, MPH, Massachusetts General Hospital, for her valuable input to this article.

References
1.
Mude  W , Oguoma  VM , Nyanhanda  T , Mwanri  L , Njue  C .  Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: a systematic review and meta-analysis.   J Glob Health. 2021;11:05015. doi:10.7189/jogh.11.05015PubMedGoogle ScholarCrossref
2.
Williams  DR , Cooper  LA .  COVID-19 and health equity: a new kind of “herd immunity.”   JAMA. 2020;323(24):2478-2480. doi:10.1001/jama.2020.8051PubMedGoogle ScholarCrossref
3.
Getachew  Y , Zephyrin  L , Abrams  MK , Shah  A , Lewis  C , Doty  MM . Beyond the case count: the wide-ranging disparities of COVID-19 in the United States. The Commonwealth Fund. Published September 10, 2020. Accessed October 26, 2021. https://www.commonwealthfund.org/publications/2020/sep/beyond-case-count-disparities-covid-19-united-states
4.
Wolfson  JA , Leung  CW .  Food insecurity and COVID-19: disparities in early effects for US adults.   Nutrients. 2020;12(6):E1648. doi:10.3390/nu12061648PubMedGoogle ScholarCrossref
5.
Yip  SW , Jordan  A , Kohler  RJ , Holmes  A , Bzdok  D .  Multivariate, transgenerational associations of the COVID-19 pandemic across minoritized and marginalized communities.   JAMA Psychiatry. 2022;79(4):350-358. doi:10.1001/jamapsychiatry.2021.4331PubMedGoogle ScholarCrossref
6.
Novacek  DM , Hampton-Anderson  JN , Ebor  MT , Loeb  TB , Wyatt  GE .  Mental health ramifications of the COVID-19 pandemic for Black Americans: clinical and research recommendations.   Psychol Trauma. 2020;12(5):449-451. doi:10.1037/tra0000796PubMedGoogle ScholarCrossref
7.
Ruiz  NG , Horowitz  JM , Tamir  C . Many Black, Asian Americans say they have experienced discrimination amid coronavirus. Pew Research Center. Published July 1, 2020. Accessed August 17, 2021. https://www.pewresearch.org/social-trends/2020/07/01/many-black-and-asian-americans-say-they-have-experienced-discrimination-amid-the-covid-19-outbreak/
8.
Covid-19 fueling anti-Asian racism and xenophobia worldwide. Published May 12, 2020. Accessed September 27, 2021. https://www.hrw.org/news/2020/05/12/covid-19-fueling-anti-asian-racism-and-xenophobia-worldwide
9.
Hswen  Y , Xu  X , Hing  A , Hawkins  JB , Brownstein  JS , Gee  GC .  Association of "#covid19" versus "#chinesevirus" with anti-Asian sentiments on Twitter: March 9-23, 2020.   Am J Public Health. 2021;111(5):956-964. doi:10.2105/AJPH.2021.306154PubMedGoogle ScholarCrossref
10.
Wang  P , Catalano  T . Social media, right-wing populism, and COVID-19: a multimodal critical discourse analysis of reactions to the “Chinese Virus” discourse. In: Musolff  A , Breeze  R , Kondo  K , eds.  Pandemic and Crisis Discourse. Bloomsbury Publishing; 2022. doi:10.5040/9781350232730.ch-018
11.
Darling-Hammond  S , Michaels  EK , Allen  AM ,  et al.  After “the China virus” went viral: racially charged coronavirus coverage and trends in bias against Asian Americans.   Health Educ Behav. 2020;47(6):870-879. doi:10.1177/1090198120957949PubMedGoogle ScholarCrossref
12.
Ta Park  VM , Dougan  MM , Meyer  OL ,  et al.  Discrimination experiences during COVID-19 among a national, multi-lingual, community-based sample of Asian Americans and Pacific Islanders: COMPASS findings.   Int J Environ Res Public Health. 2022;19(2):924. doi:10.3390/ijerph19020924PubMedGoogle ScholarCrossref
13.
Jeung  R , Yellow Horse  A , Popovic  T , Lim  R .  Stop AAPI Hate National Report.   Ethn Stud Rep. 2021;44(2):19-26. doi:10.1525/esr.2021.44.2.19Google ScholarCrossref
14.
Saw  A , Yellow Horse  AJ , Jeung  R . Stop AAPI Hate mental health report. Accessed April 2, 2022. https://stopaapihate.org/wp-content/uploads/2021/05/Stop-AAPI-Hate-Mental-Health-Report-210527.pdf
15.
Lurie  N , Dubowitz  T .  Health disparities and access to health.   JAMA. 2007;297(10):1118-1121. doi:10.1001/jama.297.10.1118PubMedGoogle ScholarCrossref
16.
Centers for Disease Control and Prevention (CDC).  Health disparities experienced by black or African Americans--United States.   MMWR Morb Mortal Wkly Rep. 2005;54(1):1-3.PubMedGoogle Scholar
17.
Cyrus  E , Clarke  R , Hadley  D ,  et al.  The impact of COVID-19 on African American communities in the United States.   Health Equity. 2020;4(1):476-483. doi:10.1089/heq.2020.0030PubMedGoogle ScholarCrossref
18.
Abedi  V , Olulana  O , Avula  V ,  et al.  Racial, economic, and health inequality and COVID-19 infection in the United States.   J Racial Ethn Health Disparities. 2021;8(3):732-742. doi:10.1007/s40615-020-00833-4PubMedGoogle ScholarCrossref
19.
Galea  S , Abdalla  SM .  COVID-19 pandemic, unemployment, and civil unrest: underlying deep racial and socioeconomic divides.   JAMA. 2020;324(3):227-228. doi:10.1001/jama.2020.11132PubMedGoogle ScholarCrossref
20.
Taylor  DB . George Floyd protests: a timeline. New York Times. Published September 7, 2021. Accessed September 23, 2021. https://www.nytimes.com/article/george-floyd-protests-timeline.html
21.
Williams  DR , Yu  Y , Jackson  JS , Anderson  NB .  Racial differences in physical and mental health: socio-economic status, stress and discrimination.   J Health Psychol. 1997;2(3):335-351. doi:10.1177/135910539700200305PubMedGoogle ScholarCrossref
22.
Gee  GC , Ro  A , Shariff-Marco  S , Chae  D .  Racial discrimination and health among Asian Americans: evidence, assessment, and directions for future research.   Epidemiol Rev. 2009;31:130-151. doi:10.1093/epirev/mxp009PubMedGoogle ScholarCrossref
23.
Chou  T , Asnaani  A , Hofmann  SG .  Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups.   Cultur Divers Ethnic Minor Psychol. 2012;18(1):74-81. doi:10.1037/a0025432PubMedGoogle ScholarCrossref
24.
Paradies  Y , Ben  J , Denson  N ,  et al.  Racism as a determinant of health: a systematic review and meta-analysis.   PLoS One. 2015;10(9):e0138511. doi:10.1371/journal.pone.0138511PubMedGoogle ScholarCrossref
25.
Carlisle  SK .  Perceived discrimination and chronic health in adults from nine ethnic subgroups in the USA.   Ethn Health. 2015;20(3):309-326. doi:10.1080/13557858.2014.921891PubMedGoogle ScholarCrossref
26.
All of Us Research Hub. Data browser: COVID-19 Participant Experience (COPE). Accessed April 1, 2022. https://databrowser.researchallofus.org/survey/covid-19-participant-experience
27.
Denny  JC , Rutter  JL , Goldstein  DB ,  et al; All of Us Research Program Investigators.  The “All of Us” Research Program.   N Engl J Med. 2019;381(7):668-676. doi:10.1056/NEJMsr1809937PubMedGoogle ScholarCrossref
28.
Kroenke  K , Spitzer  RL , Williams  JB .  The PHQ-9: validity of a brief depression severity measure.   J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.xPubMedGoogle ScholarCrossref
29.
Manea  L , Gilbody  S , McMillan  D .  A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression.   Gen Hosp Psychiatry. 2015;37(1):67-75. doi:10.1016/j.genhosppsych.2014.09.009PubMedGoogle ScholarCrossref
30.
Verbeke  G . Linear mixed models for longitudinal data. In: Verbeke  G , Molenberghs  G , eds.  Linear Mixed Models in Practice: A SAS-Oriented Approach. Springer New York; 1997:63-153. doi:10.1007/978-1-4612-2294-1_3
31.
Bates  D , Sarkar  D , Bates  MD , Matrix  L . The lme4 package: linear mixed-effects models. R project for statistical computing. 2007;2(1):74.
32.
Lüdecke  D .  Ggeffects: tidy data frames of marginal effects from regression models.   J Open Source Softw. 2018;3(26):772-776. doi:10.21105/joss.00772Google ScholarCrossref
33.
Delgado-Rodríguez  M , Llorca  J .  Bias.   J Epidemiol Community Health. 2004;58(8):635-641. doi:10.1136/jech.2003.008466PubMedGoogle ScholarCrossref
34.
All of Us Research Program. All of Us Researcher Workbench. National Institute of Health. Accessed August 13, 2021. https://workbench.researchallofus.org/
35.
Lee  S , Waters  SF .  Asians and Asian Americans’ experiences of racial discrimination during the COVID-19 pandemic: impacts on health outcomes and the buffering role of social support.   Stigma Health. 2020;6(1):70-78. doi:10.1037/sah0000275Google ScholarCrossref
36.
Chae  DH , Yip  T , Martz  CD ,  et al.  Vicarious racism and vigilance during the COVID-19 pandemic: mental health implications among Asian and Black Americans.   Public Health Rep. 2021;136(4):508-517. doi:10.1177/00333549211018675PubMedGoogle ScholarCrossref
37.
Wu  C , Qian  Y , Wilkes  R .  Anti-Asian discrimination and the Asian-white mental health gap during COVID-19.   Ethn Racial Stud. 2021;44(5):819-835. doi:10.1080/01419870.2020.1851739Google ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close