Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States.

Henna Budhwani,Prabal De

doi:10.1089/heq.2018.0079

Abstract

Purpose: Addressing perceived and enacted stigma in clinical settings is critical to ensuring delivery of high-quality patient-centered care, reducing health disparities, and improving population health outcomes.Methods: Data from the Behavioral Risk Factor Surveillance System's (2012–2014) Reaction to Race module were analyzed to test the hypothesis that perceived stigma in health care settings would be associated with poorer physical and mental health. Poor health was measured by (1) the number of days the respondent was physically or mentally ill over the past month and (2) depressive disorder diagnosis. Multivariate linear and logistic regression models were employed.Results: Effects of stigma on physical and mental health were significant. Perceived stigma was associated with additional 2.79 poor physical health days (β=2.79, confidence interval [CI]=1.84–3.75) and 2.92 more days of poor mental health (β=2.92, CI=1.97–3.86). Moreover, perceived stigma in health care settings was associated with 61% higher odds of reporting a depressive disorder (adjusted odds ratio=1.61, CI=1.29–2.00). Among other findings, individuals who were married, younger, had higher income, had college degrees, and were employed reported significantly fewer poor physical and mental health days and had lower odds of self-reported depressive disorder.Conclusions: Reducing stigma against people of color in health care settings (environments that should be pro-patient) must be a top priority for population health scholars and clinicians. Reducing perceived stigma in clinical settings may produce better mental and physical health outcomes in minority patients thereby reducing health disparities. In addition, fewer days lost to poor health could positively influence the health care system by decreasing utilization and may improve economic productivity through increasing days of good health.

Highlights

The survey has been unique in implementing its Reactions to Race module that was designed by the Centers for Disease Control and Prevention (CDC) Measures of Racism Working Group
African Americans report the highest levels of stigma in health care settings, and the average numbers of reported bad physical and mental health
The results suggest that the effect of stigma is large—individuals reporting stigma in health care setting are likely to have 2.79 additional poor health days during the 30 days before the interview

Summary

Introduction

The United States is undergoing a rapid demographic transition with about a third of the American population currently identifying as a racial or ethnic minority or person/people of color.[1,2] This is a significant consideration when selecting evidence-based techniques to promote culturally appropriate patient centered care,[3,4,5,6,7] because these groups often have unique health care needs and may interact with the health care system in ways that are unfamiliar to clinical providers, providers who are not people of color themselves.[3,4,5,6,7] Since these patients are physically identifiable as ‘‘different,’’ they are susceptible to race-based stigma and discrimination both in and out of the health care system.[7,8,9]. Ample studies have been conducted examining health care-based stigma and physical health status,[17,18,19,20,21,22,23,24] with far fewer health disparity studies considering effects on both physical and mental health

Methods

Results

Discussion

Conclusion