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Depressive Disorders

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

JAMA Psychiatry

Published Online: July 27, 2022

Original Investigation

Article Information and Disclosures

Younga H. Lee, PhD^1,2,3;

Zhaowen Liu, PhD^1,2,3;

Daniel Fatori, PhD⁴;

Joshua R. Bauermeister, BSc⁵;

Rebecca A. Luh, BA¹;

Cheryl R. Clark, MD, ScD⁶;

Sarah Bauermeister, PhD, MSc, CPsychol⁵;

André R. Brunoni, MD, PhD⁴;

Jordan W. Smoller, MD, ScD^1,2,3,7

Author Affiliations

¹Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
²Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Boston, Massachusetts
³Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
⁴Departamento de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
⁵Department of Psychiatry, University of Oxford, Oxford, United Kingdom
⁶Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
⁷Center for Precision Psychiatry, Massachusetts General Hospital, Boston

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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.

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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.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.