Abstract
BackgroundResearch on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination. Objectives: (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization.MethodsWe used baseline data from the Toronto site of the At Home/Chez Soi randomized controlled trial of Housing First for homeless adults with mental illness (n = 550). Bivariate statistics and multivariable logistic regression models were used for the analysis.ResultsPerceived discrimination related to homelessness/poverty (30.4%) and mental illness/alcohol/substance use (32.5%) is prevalent among ethnically diverse homeless adults with mental illness in healthcare settings. Only 15% of the total participants reported discrimination due to race/ethnicity/skin color. After controlling for relevant confounders and presence of psychosis, all types of discrimination in healthcare settings were associated with more frequent ED use, a greater - 3 - severity of lifetime substance abuse, and mental health problems. Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination.ConclusionsUnderstanding the experience of discrimination in healthcare settings and associated healthcare utilization is the first step towards designing policies and interventions to address health disparities among vulnerable populations. This study contributes to the knowledge base in this important area.Trial registration numberThis study has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.
Highlights
Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups
We explored the prevalence of perceived discrimination in the previous 12 months and its association with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department (ED) utilization
Our findings suggest that among ethnically diverse homeless adults with mental illness in a large urban center in Canada, perceived discrimination in healthcare settings is common
Summary
Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Discrimination can be defined as the prejudicial and/or distinguishing treatment of an individual based on their actual or perceived membership or certain characteristics, such as race, ethnic origin, gender, sexual orientation, age, immigration status, income, medical condition or mental or physical disability. It can be conveyed through opinions, attitudes, and behaviours, and can be measured by documenting objective events or relying on subjective perceptions of events [1]. Perceived discrimination is shown to have a negative impact on help seeking, access to care, poverty, and social marginalization [7]. A recent Canadian review of discrimination in healthcare noted that negative health outcomes were evident “even under conditions of equal access to medical care” [12] p.19
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