Self-perceived Discrimination Research Articles

M60. Examining the Role of Cultural Distance and Psychosocial Disempowerment in Higher Rates of Psychotic Disorders in Ethnic Minority Groups: A Multi-National Case-Control Study

Background: Ethnic minorities have an increased risk of developing psychotic disorders, but the causes remain largely unknown. Theories such as social defeat have been suggested as possible explanatory frameworks, but empirical evidence is lacking. Here, we investigated whether psychosocial disempowerment (a perceived lack of control over one’s life), and cultural distance from the majority ethnic group accounted for the excess psychosis risk in ethnic minority groups. Methods: We used case-control data from the EU-GEI study, a 16-centre case-control study in 6 countries (England, France, the Netherlands, Italy, Spain and Brazil). Within defined epidemiological catchment areas, incidence cases with an OPCRIT-confirmed first episode of ICD-10 psychotic disorder (F10-33) were invited to participate. Population-based controls were sampled via primary care. We created a binary measure of psychosocial disempowerment, using a self-perceived discrimination questionnaire, where participants were asked if they had ever felt unfairly treated in 12 situations. We approximated cultural distance using the linguistic distance of a participant’s primary language from the majority language in each setting, informed by linguistic decision trees. Age and sex were included as confounders. Following multiple imputation to account for missing data we used logistic regression to investigate whether our exposures explained any increased psychosis risk in ethnic minority groups. Results: We recruited 1168 cases and 1498 controls, who were representative of the population at-risk. Ethnic minority status was associated with increased odds of psychotic disorder after controlling for age and sex (OR: 1.66; 95% CI: 1.59–1.73). Inclusion of psychosocial disempowerment and cultural distance in the model did not attenuate risk in ethnic minority groups (OR: 1.63; 95% CI: 1.54–1.72), despite greater exposure to psychosocial disempowerment (OR: 1.54; 95% CI: 1.47–1.62) and cultural distance (OR: 3.99; 95% CI: 3.83–4.17). Both psychosocial disempowerment (OR: 1.16; 95% CI: 1.13–1.19) and cultural distance (OR: 1.17; 95% CI: 1.14–1.22) independently predicted psychosis risk, after control for age, sex and minority status. Conclusion: Ethnic minorities had a higher risk of developing a psychotic disorder. Psychosocial disempowerment and cultural distance did not explain this risk, but had independent additional effects which appeared to follow dose-response relationships. These preliminary analyses suggest the social environment of ethnic minorities might be a significant predictor of psychosis risk, independent of ethnic minority status.

Self-Perceived Discrimination in LGBT Population in Oral Health Services. Medellin, Colombia: A Qualitative Approach

<p><strong>INTRODUCTION: </strong>We aim to understand the perception about discrimination within the LGBT population when accessing oral health services, from their perspective as well as that of the oral health professional.</p><p><strong>METHODS: </strong>A qualitative study from a phenomenological perspective was conducted by means of 37 in-depth interwiews (19 in health service providers and 18 in LGBT members). The script used in the interview included questions related to discrimination in social spaces, quality of life and its relationship with health, access to general and oral health care and proposals and strategies. Verbatim was transcripted and narrative content analysis was carried out for identifying meaning codes and after grouped through emergent categories. Atlas.Ti 6.0 software was used.</p><p><strong>RESULTS: </strong>Five categories within the participants’ discourses were identified: (1) Characteristics of LGBT population: This is a heterogeneous group (physical‚ social and cultural); (2) Quality of life (QOL), health related quality of life (HRQOL) and oral health related quality of life (OHRQOL): QOL is defined as the ability to enjoy opportunities in the human life process under equity conditions; HRQOL is related to an adequate access to health services‚ and OHRQOL as the appropriate state of the structures of the stomatognathic system; (3) Discrimination as a concept and experiences: People conceived discrimination as the act pejorative to someone because of a particular situation. Participants identified some types of discrimination in social spaces; (4) Accessibility to health services: Participants related individual and structural barriers when accessing to public health services; (5) Proposals and strategies: Interviewers suggested some educative strategies and social policies to reduce the endogenous and exogenous discrimination.</p><p><strong>CONCLUSIONS: </strong>The LGBT population is vulnerable to perceive experiences of discrimination and this situation causes a negative impact on their quality of life.</p>

The deterioration of Canadian immigrants' oral health: analysis of the Longitudinal Survey of Immigrants to Canada.

To examine the effect of immigration on the self-reported oral health of immigrants to Canada over a 4-year period. The study used Statistics Canada's Longitudinal Survey of Immigrants to Canada (LSIC 2001-2005). The target population comprised 3976 non-refugee immigrants to Canada. The dependent variable was self-reported dental problems. The independent variables were as follows: age, sex, ethnicity, income, education, perceived discrimination, history of social assistance, social support, and official language proficiency. A generalized estimation equation approach was used to assess the association between dependent and independent variables. After 2 years, the proportion of immigrants reporting dental problems more than tripled (32.6%) and remained approximately the same at 4 years after immigrating (33.3%). Over time, immigrants were more likely to report dental problems (OR = 2.77; 95% CI 2.55-3.02). An increase in self-reported dental problems over time was associated with sex, history of social assistance, total household income, and self-perceived discrimination. An increased likelihood of reporting dental problems occurred over time. Immigrants should arguably constitute an important focus of public policy and programmes aimed at improving their oral health and access to dental care in Canada.

Social determinants of self-perceived discrimination in Spain

To analyse the association between self-perceived discrimination and social determinants (social class, gender, country of origin) in Spain, and further to describe contextual factors which contribute to self-perceived discrimination. Cross-sectional design using data from the Spanish National Health Survey (2006). The dependent variable was self-perceived discrimination, and independent and stratifying variables were sociodemographic characteristics (e.g. sex, social class, country of origin, educational level). Logistic regression was used. The prevalence of self-perceived discrimination was 4.2% for men and 6.3% for women. The likelihood of self-perceived discrimination was higher in people who originated from low-income countries: men, odds ratio (OR) 5.59 [95% confidence interval (CI) 4.55-6.87]; women, OR 4.06 (95% CI 3.42-4.83). Women were more likely to report self-perceived discrimination by their partner at home than men [OR 8.35 (95% CI 4.70-14.84)]. The likelihood of self-perceived discrimination when seeking work was higher among people who originated from low-income countries than their Spanish counterparts: men, OR 13.65 (95% CI 9.62-19.35); women, OR 10.64 (95% CI 8.31-13.62). In comparison with Spaniards, male white-collar workers who originated from low-income countries [OR 11.93 (95% CI 8.26-17.23)] and female blue-collar workers who originated from low-income countries (OR 1.6 (95% CI 1.08-2.39)] reported higher levels of self-perceived discrimination. Self-perceived discrimination is distributed unevenly in Spain and interacts with social inequalities. This particularly affects women and immigrants.

Absence of protective ethnic density effect on Ecuadorian migrants’ mental health in a recent migration setting: a multilevel analysis

We aimed to study the association between the Ecuadorians' ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain. Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians' ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI). Prevalence of PPC, 24 % (95 %CI 20-28 %), varied by area of residence. Ecuadorians' ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians' ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01-2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87-2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78-2.40). No protective association between the Ecuadorians' ethnic density of the Area of residence and Ecuadorian migrants' mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.

MEASURING SELF-PERCEIVED RACIAL AND ETHNIC DISCRIMINATION IN SOCIAL SURVEYS

The aim of this article is to encourage a research agenda that attends to methodological considerations regarding measuring self-perceived racial and ethnic discrimination in social surveys. Toward this end, the author compared validity of alternative measures of discrimination. The first measure asks whether something unfair or bad has happened because of race and ethnicity, whereas the second measure asks about generic unfair events independent of attribution to race or ethnicity. In a probability sample of 586 Black respondents living in the Detroit metropolitan area interviewed in 1995, it was found that the prevalence of self-perceived racial and ethnic discrimination depended on question framing. Moreover, different respondents were likely to respond affirmatively to explicit versus generic measures of discrimination; importantly, the mental health consequences of self-perceived racial and ethnic discrimination varied by question framing. The results confirmed that the prevalence, correlates, and psychological impact of self-perceived discrimination should be evaluated on the basis of measurement sensitivity.