J Immigrant Minority Health DOI 10.1007/s10903-013-9969-3
ORIGINAL PAPER
Ethnic and Gender Differences in the Association Between Discrimination and Depressive Symptoms Among Five Immigrant Groups Il-Ho Kim • Samuel Noh
Ó Springer Science+Business Media New York 2013
Abstract This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8 % men, 49.2 % women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender. Keywords Immigrant health Ethnicity Gender Discrimination Depressive symptoms
I.-H. Kim (&) S. Noh Social and Epidemiological Research, Centre for Addiction and Mental Health, 33 Russell Street, Suite T-306, Toronto, ON M5S 2S1, Canada e-mail: [email protected] S. Noh Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Background In North America, race and ethnicity are pivotal determinants of social status and resources, as well as health [1]. Racism is among the social processes through which health inequalities are constructed [2–5]. A significant volume of research suggests that discrimination negatively affects mental health [2, 3, 6–8], but the experience of discrimination and its adverse health impacts may show complex variations across ethnic groups and genders [9, 10]. Despite this postulation, little empirical research gives a comprehensive picture of the ways discrimination influences minority and immigrant health [1, 2, 4]. Except for a few national or review studies [6, 7, 11], most studies on the social experience of racism or discrimination and its health consequences focus on single racial or ethnic samples, such as Africans [1, 3, 8, 12, 13], Hispanics [14–16], or Asian immigrants or refugees [17–21]. This study examines racial/ethnic differences and similarities in exposure to perceived discrimination, focusing on five selected ethnic communities of immigrants and refugees (Korean, Vietnamese, Ethiopian, Iranian, and Irish) in a metropolitan area of Canada. Discrimination is the behavioral expression of negative social emotion by dominant-group members toward outgroup minority victims and, racial/ethnic group identity is likely to influence the nature and extent of such adverse social experiences [9, 10]. According to the ‘‘ethnic preference’’ explanation [11, 22, 23], negative social emotions are directed toward selected racial or ethnic minorities who are excluded from fully sharing in equal opportunities and power. Members of the targeted minority groups are more likely to experience and report incidents of racial or ethnic discrimination. In the same vein, the theory of ‘‘skin-tone effect’’ purports that minorities are discriminated against
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based on skin color as a visible marker of racial status [4, 12, 24]. Existing empirical evidence from North America shows that white or European immigrants experience uniformly low levels of discrimination, whereas immigrants or refugees from African and Asian countries are more likely to face various forms of discrimination, including racial, language, income, or employment discrimination [1, 14, 25–27]. Furthermore, according to Hersch, ‘‘the skin-tone effect’’ victimizing racial minorities persists regardless of the length of residence in the host country [26]. With respect to health impacts of discrimination, recent research has shown that health risk is driven not simply by exposure to discrimination, but by diverse subjective experiences of, or vulnerabilities to, discrimination across ethnicities [19, 20, 28]. White immigrants may be even more susceptible to the negative effects of racial prejudice and discrimination than visible-minority immigrants, since they define themselves as part of the dominant group in hosting countries [6, 29]. In contrast, members of ethnic minorities who are repeatedly exposed to discrimination are likely to accept unfair treatment as a ‘fact of life’ [30– 33] and consequently develop resilience in coping with discrimination’s emotional toll [21, 27]. Kessler and his colleagues argue that non-Hispanic whites are more vulnerable to the health effects of discrimination than ethnic minorities [6]. However, other studies document significantly stronger correlations between discrimination and psychological distress among Black than White Americans [3]. It is unclear whether there are ethnic variations in the discrimination-depression link since few empirical studies have investigated the health effects of discrimination across diverse ethnic groups. The experience of discrimination may also radically differ between men and women. Immigrant research suggests that women’s vulnerability to discrimination leads to their encountering a greater risk of mental health problems [17, 34]. Compared to male immigrants, females, even those who are highly educated and skilled, are more likely to confront discrimination in the labor market where they face more unemployment or confinement to certain occupations [17, 35]. Okazaki [36] argues that ethnic minority women, in particular, encounter the double burden of ethnic and gender discrimination. To date, however, research on this issue has produced inconsistent findings. While some studies have found that discrimination influences women’s mental health more significantly than men’s [15– 17], others have reported the opposite, though with greater gender variations among Asian, African, and Hispanic American minorities than white Americans [4, 6, 13, 17]. Moreover, studies using US general population data (combining whites, blacks, and Asians) have found no differences between men and women [6, 18]. We assume these divergent findings stem from discrimination’s
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differing gender effect across ethnic groups. Thus, this present study uses a cross-sectional sample of five ethnic immigrant groups to investigate (1) whether ethnic minority groups report more discrimination than the European group; (2) whether more male than female immigrants experience exposure to discrimination; (3) whether the effect of discrimination on depression is lower for ethnic minority groups than for the European group; and (4) whether ethnic variations in the health effects of discrimination differ between men and women.
Methods Data Collection and Study Population Data were taken from the Toronto Study of Settlement and Health (TSSH), a cross-sectional study of first-generation immigrants residing in Toronto, Canada. The sample was drawn from five ethnic communities—Vietnamese, Ethiopian, Iranian, Korean, and Irish. For theoretical consideration, the five communities were selected in an effort to have representation of diverse regions (Africa, Europe, Middle East and Asia) and races (Black, White or Caucasian, Arab or Middle Eastern, and Asian and Southeast Asian). It should be noted that some communities (Iranian, Irish, and Korean) encompassed mostly voluntary immigrants, while large proportions of Ethiopian and Vietnamese community members landed in Canada as refugee claimants. Among European Canadians, Irish immigrants were chosen as a reference group; as Caucasians, they are closely identified with Canada’s ‘‘charter groups’’, yet have a long history of struggle as an ethnic minority. Accessibility was another consideration in selecting the five groups. That is, the investigation team had trained staff members who had access to the communities. Considering the difficulty in developing sampling frames in minority communities, quota sampling was applied; within each community, efforts were made to ensure a balanced representation of men and women, younger (18–44 years) and older (45–80 years) subjects, and newer immigrants (in Canada 10 years or less) and long-time immigrants (over 10 years). To complete the target of 200 interviews in each ethnic group, we approached 1,250 households (250 each) and were able to conduct interviews with one foreign-born adult (18 years or older) in each of 920 households (73.6 %). First-generation immigrants younger than 17 years were eliminated because their perceived discrimination may have significantly differed from that of older immigrants. Of the total 920 participants, 20 were removed in the final analyses due to incomplete responses. Sampling Ethiopian participants (N = 112) was challenged by a number of factors, including competing research
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projects in the community. Interviews were conducted in either English or the respondent’s native language according to his or her preference. Health Outcome This study utilized the Center for Epidemiologic Studies Depression Scale (CES-D), a widely used scale assessing depressive symptoms experienced during the 4 weeks prior to the interview. The original scale taps four symptom domains including depressive mood, somatic symptoms, social withdrawal, and positive or negative affect. It may be recalled that the original 20-item CES-D was developed for the purpose of screening for ‘‘potential cases’’ of major depression (CES-D [16) to pass on for further testing. Over the past decades, the instrument has been used for mostly research purposes (i.e., hypothesis testing), and rarely for clinical practice. As some studies have suggested a potential bias on the four positive affect items (happy, hopeful, high selfesteem, and joy in life) among certain immigrant groups, including Asian Americans [37] and Asian Canadians [38], we eliminated the 4 items. Total scale scores were computed with the remaining 16 items based on a four-point Likert scale, ranging from 0 for ‘‘rarely or none of the time (\1 day)’’ to 3 for ‘‘most or all of the time (5–7 days a week).’’ Scores spanned from 0 to 48, with a higher score indicating greater depressive symptoms. In this study, internal reliability (Cronbach’s alpha) of the 16-item CESD scale was 0.918. Despite uncertain clinical validity, this 16-item CES-D scale appears valid when conducting comparative investigations among several ethnic groups, including certain Asians [3, 38, 39]. If the 16-item scale were to be used for screening of ‘‘at risk’’ cases, the score range of 0–48 (of the 16 items) may be re-estimated on a range of 0–60, with the cut-off score of 16 [3, 40]. Everyday Discrimination The everyday discrimination scale was used to identify unfair treatment toward first-generation immigrants. We used the 10-item expanded version of the everyday discrimination scale to measure respondents’ experience of chronic racial discrimination in their day-to-day lives in Canada [41]. The original scale consisted of nine items, which asked how often subjects received less courtesy, less respect, and poorer service than others; were regarded as not smart, dishonest, inferior to others, and as someone to fear; were called names or insulted, and were threatened or harassed. An extra item (being followed around in stores or shopping malls) was included to reflect experiences often reported by young Black adults in focus groups. Responses to each item were scored on a 6-point scale ranging from 0
for ‘‘never’’ to 5 for ‘‘almost every day’’. The total summed scores ranged from 0 to 50. The internal reliability of the 10-item scale (Cronbach’s alpha) was 0.897. Social Determinants of Depressive Symptoms Potential covariates for determining immigrants’ depressive symptoms included demographic factors (age, sex, marital status), socioeconomic variables (pre- and postmigration education, employment status, household income), and financial difficulties. Chronological age and years in Canada were used as continuous variables. Marital status was coded as ‘‘currently married’’, ‘‘never married’’, and ‘‘previously married’’ (divorced, separated, or widowed). Pre-migration educational levels were divided into ‘‘high school or less’’ and ‘‘college or more.’’ Post-migration educational status was classified into ‘‘no’’ and ‘‘yes’’. Employment status was categorized into ‘‘employed’’ and ‘‘not employed’’. To reduce the potential for missing data, respondents were asked to indicate the range of their total annual household incomes, earned from all sources. Considering the small number of cases available for analysis in the ethnic subsamples, household income was recoded into three levels: under $30,000, $30,000–$59,999, and $60,000 or more. The responses of financial difficulties were coded in two groups: ‘‘occasionally or more’’ or ‘‘rarely or never’’. Statistical Analysis Chi square tests were applied to estimate the percentages of ethnicities and demographic variables. Means and standard deviations were calculated for age, years in Canada, and discrimination. The general linear model (GLM) procedure was used to estimate the effect of discrimination on depression across ethnicity and gender. To examine the role of ethnicity and gender in moderating the association between discrimination and depression, we used two multiplicative interactions—ethnicity by discrimination and gender by discrimination. First, the interaction term of discrimination*gender (female) and four interaction terms of discrimination*ethnicity (four groups contrasted on the reference group of Irish) were tested in separate models using the total sample (Table 3, models 2 and 3). Second, to examine gender differences in ethnic variation in vulnerability, we examined the three-way interaction of gender*ethnicity*discrimination. To ease the presentation of the results, we report slopes (b) separately for male and female samples (last two columns of Table 3) and include a graphic presentation (Fig. 1). PROC GLM enables us to test the degree of interaction (crossed effects) and nested effects. To compute discrimination scale scores, individual
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Fig. 1 Regression lines for the relationship between discrimination, ethnicity, and depression after controlling for all covariates, by gender
scores were centered with a mean of 0 and a standard deviation of 1.
Results Table 1 shows the descriptive characteristics of the study sample by gender. The sample consisted of a similar proportion of men (50.8 %) and women (49.2 %), as well as similar proportions of each ethnic group (ranging from 19.6 to 22.6 %), the exception being the Ethiopian group, which comprised 12.4 % of the sample. In comparison, more men (69.4 %) than women (62.3 %) were married, whereas a larger proportion of women (21.7 %) than men (11.4 %) were previously married. In pre-migration education, approximately 53.4 % of men and 59.7 % of women had a college or higher degree. The proportion of Canadian educational attainment was similar between men (46.6 %) and women (44.5 %). Men were more likely than women to be employed (68.5, 55.8 %, respectively). Approximately 46 % of women reported annual household earnings of \$30,000, and 44.2 % experienced financial difficulties each month. For men, about 38 % were in the lowest income group, and 28 % reported having financial difficulties. The mean age was 48.7 years among men and 45.7 years among women. The mean number of years of residence in Canada was 16 years. Table 2 shows gender and ethnic variations in the experience of discrimination. After controlling for all potential covariates, women were significantly less likely than men to experience discrimination (-1.623, p B .0001). Regarding ethnic variations, Ethiopians (mean = 7.4) were most likely to face discrimination (p B .0001);
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Koreans, Iranians, and Vietnamese reported lower levels of discrimination than Ethiopians, but higher levels than Irish immigrants. Both Irish immigrant men and women related an extremely low degree of exposure to discrimination (mean = 1.2 vs. 0.6). The ethnic differences in discrimination were similar between men and women. Data presented in Table 3 summarize GLMs (PROC GLM) of depressive symptoms. As shown in model 1, there was a curvilinear association between age and depression. Increased levels of depressive symptoms were associated with being female, single or previously married, not employed, living with a lower income (under $30,000 per year) and the experience of financial difficulties (occasionally or more). Compared to Irish immigrants, depressive symptom level was significantly lower for Ethiopians (p \ .0001) and Vietnamese (p \ .0001) and significantly higher for Iranians (p \ .01). Also shown in model 1, controlling for the influence of these factors, an increase in discrimination was significantly associated with increased depressive symptoms (b = 0.322, p \ .0001). Shown in model 2, the result of an interaction test between gender and discrimination showed that the effect of discrimination on depression was greater among women (b = .254 ? 1.195) than men (b = .254). In model 3, the association between discrimination and depression was not significant (b = 0.114, p [ 0.05) among Irish immigrants, but was significantly greater among Vietnamese (b = 0.389, p \ 0.01) and Iranian immigrants (b = 0.354, p \ 0.05). In subsample data (each male and female group), Iranian and Korean men were more likely than Irish men to experience an increase in depression with an increase in discrimination. Within female immigrants, however, ethnic variations in this association were not apparent when compared to the Irish female group.
J Immigrant Minority Health Table 1 Demographic characteristics of respondents by gender Total N (%) Total
Men N (%)
Women N (%)
900 (100)
457 (50.8)
443 (49.2)
Vietnamese
200 (22.2)
93 (46.5)
107 (53.5)
Ethiopian
112 (12.4)
64 (57.1)
48 (42.9)
Iranian
203 (22.6)
96 (47.3)
107 (52.7)
Korean
209 (23.2)
105 (50.2)
104 (49.8)
176 (19.6)
99 (56.3)
77 (43.8)
Married
593 (65.9)
317 (69.4)
276 (62.3)
Never married
159 (17.7)
88 (19.3)
71 (16.0)
Previously married
148 (16.4)
52 (11.4)
96 (21.7)
Ethnic group
Irish Marital status
within each ethnic group confirmed a gender variation in the strength of the discrimination-depression association in the Vietnamese sample (p \ .0001 for Vietnamese).
Discussion
Pre-migration education BHigh school
436 (48.4)
213 (46.6)
223 (50.3)
College or more
464 (51.6)
244 (53.4)
220 (49.7)
No
490 (54.4)
244 (53.4)
246 (55.5)
Yes
410 (45.6)
213 (46.6)
197 (44.5)
Employed
560 (62.2)
313 (68.5)
247 (55.8)
Not employed
340 (37.8)
144 (31.5)
196 (44.2)
Under $ 30,000 $30,000–$59,999
376 (41.8) 322 (35.8)
173 (37.9) 172 (37.6)
203 (45.8) 150 (33.9)
$60,000 or more
202 (22.4)
112 (24.5)
90 (20.3)
Post-migration education
Occupation
Income
Financial difficulties Occasionally or more
324 (36.0)
128 (28.0)
196 (44.2)
Rarely-Never
576 (64.0)
329 (72.0)
247 (55.8)
Mean (SD)
Mean (SD)
Mean (SD)
Age
47.2 (12.5)
48.7 (13.0)
45.7 (11.9)
Years in Canada
16.0 (11.7)
17.2 (12.5)
14.8 (10.7)
Discrimination
4.1 (6.2)
4.6 (7.0)
3.5 (5.2)
Depression
7.3 (8.4)
6.2 (7.5)
8.5 (9.1)
The last columns of Table 3 present the results from the two-way interaction of ethnicity*discrimination by gender. For a more heuristic presentation, results are displayed graphically in Fig. 1. Among male immigrants, the Iranian and Korean groups had a steeper increase in depression as discrimination increased in comparison with the Irish, Vietnamese, or Ethiopian groups. In contrast, a steep increase was found among Irish and Vietnamese female immigrants. Whereas both Ethiopian women and men were less likely to experience an increase in depression as discrimination increased, Vietnamese women seemed to have a significant increase in depression with greater levels of discrimination, compared to Vietnamese men (Fig. 1). Further analyses of interaction tests (gender*discrimination)
Our findings from the TSSH survey sample of five immigrant/refugee groups fully agreed with previous research findings, in which an increase in discrimination was significantly associated with an increased risk of depressive symptoms [3, 6, 13, 42]. Our analyses, however, revealed considerable ethnic and gender variations in exposure to discrimination and its association with depressive symptoms. Across the five ethnic groups, female immigrants were less likely than male immigrants to report discrimination, which was consistent with previous findings [6, 13]. A possible explanation for this finding is that women, who are more likely to work inside the home, are less likely to encounter discrimination than men, who traditionally work outside the home. Crosby [43] proposed, on the other hand, that women have a tendency to respond to discriminatory experiences with denial or little awareness. Regardless of gender, however, Ethiopians experienced the highest level of discrimination, followed by Koreans, Iranians and Vietnamese, whereas Irish immigrants had the lowest level. This finding implies that darker-skinned Africans were exposed to the highest level of discrimination, possibly due to ‘‘ethnic preference’’ from cultural distance or segregation. Light-skinned White immigrants may have social and economic privileges that lead to less discriminatory experiences [14, 44]. The ethnicity-discrimination interactions by gender show gender-specific similarities and differences in ethnic variations in the discrimination-depression link. First, our analysis, using a combined sample of all five ethnic groups (Table 3, model 2), found that women more than men were significantly correlated with the harmful effects of discrimination on depressive symptoms. This observation was identified by earlier studies using samples that combined several ethnic groups [15–17]. Previous evidence suggests women have a lower threshold and show higher tension and stress when experiencing discrimination, since it stimulates internal attention or ruminative tendencies [17, 27, 34]. Contrarily, men seem to reduce discrimination’s impact on depression through external distractions from stressful events [13, 45]. In our analysis, a significant increase in discrimination-related depressive symptoms among women, compared to their male counterparts, was found only in the Vietnamese sample. This result may be connected to the women’s experience of gender discrimination in employment opportunities, occupational downgrading, traditional gender roles, and/or the lack of social
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J Immigrant Minority Health Table 2 Estimated means, coefficients and p values for testing gender and ethnic variations in experiencing perceived discrimination Everyday Discrimination
Total (n = 900)
Men (n = 457) a
Women (n = 443) Mean (SD)
ba
0.712
3.6 (5.7)
2.817**
5.578***
5.2 (5.5)
4.261***
5.1 (6.2) 5.1 (5.7)
2.325 2.991*
3.7 (5.4) 4.7 (5.1)
2.675* 4.092***
1.2 (5.5)
0
0.6 (1.4)
0
Mean (SD)
b
1.838*
3.9 (5.7)
5.030***
9.1 (10.4)
4.3 (5.9) 4.9 (5.4)
2.472** 3.471***
0.7 (2.0)
0
Mean (SD)
b
Women
3.5 (9.1)
-1.623***
Men
4.6 (6.7)
0
Vietnamese
3.8 (5.7)
Ethiopian
7.4 (8.8)
Iranian Korean Irish
a
Sex
Ethnicity
* p B 0.05; ** p B 0.01; *** p B 0.001 a
Coefficients and p values were calculated after controlling for all potential covariates
supports [5, 35, 46]. Exposure theory proposes that women, encountering a greater number of stressors linked to their multiple roles, are more likely than men to develop psychological distress [47]. For Vietnamese women, kin and social ties, which are strongly attached to gender roles or value orientations, tend to exacerbate discrimination-related psychological problems [48]. Second, the ethnic variations were noticeably different between male and female immigrants. Within the male sample, the association between discrimination and depressive symptoms was significantly stronger among Iranian and Korean men, but relatively weaker among Vietnamese, Ethiopian, and Irish men. Cultural differentials in ways of socially and psychologically coping with discrimination across ethnicities may contribute to the ethnic variations [5, 6]. Korean immigrants respond to negative racial relations with emotional arousal or distress such as feeling sad, depressed, angry, frustrated, or discouraged [21]. It seems that Korean men, along with Iranian men, were the most emotionally reactive to discrimination. In contrast, within the female sample, Irish and Vietnamese women experienced the strongest relationship between discrimination and depressive symptoms, but such an association was weaker among Iranian, Korean, and Ethiopian women. Vulnerability theory explains that women are more vulnerable to stressful life events than men [17, 34]; the Irish women in this case may be more sensitive than Irish men to the unanticipated discrimination, leading to the higher risk of depressive symptoms [6, 29]. Finally, our study found that Ethiopian men and women showed an unexpected minimal health impact from discrimination even though they encountered the highest level. The resilience of Ethiopian immigrants to repeated discriminatory exposure may be related to their acceptance
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of unfair treatment as a common life event [32, 44, 49]. For example, the majority of men (91.9 %) and women (66.6 %) from Ethiopia—one of Canada’s primary sources of African immigrants and refugees—have suffered major social adversities such as pre-migration trauma, refugee camp internment, and/or post-migration stressful events [50]. Fenta et al. [50] found that, among Ethiopian immigrants, social and economic hardships such as unemployment, lack of education, pre-migration trauma, and postmigration stressful events were more influential determinants of depression than discriminatory experiences. Furthermore, Ethiopian women appear to be more tolerant toward downward social mobility or discriminatory social attitudes, believing that the new environment provides better opportunities for re-establishing their lives, in comparison to the harshness of their homeland [51]. This study’s findings indicate the significance of each ethnic group’s historical and cultural background in the discrimination-depression link. This study has some limitations. First, conceptual definitions of discrimination in our self-reported data are a potential source of measurement errors. This study also fails to investigate health effects related to different intensities of exposure to discrimination across ethnic groups, since the everyday discrimination scale only measures frequency of discrimination, not intensity. However, the risk of errors can be mitigated with the use of a 10-item discrimination measure that has proven strong reliability and validity. Second, given that Ethiopians were under-sampled, caution should be exercised in interpreting the absence of a discrimination-health association among Ethiopians. However, this study’s finding was consistent with those of previous studies of Ethiopian immigrants, including Canadian research [1, 50]. Finally, since this analysis was based on 2001 data, the ethnic variations may
J Immigrant Minority Health Table 3 Association between perceived discrimination and depression according to ethnic groups Parameter
Intercept
Total Model 1 b
Model 2 B
Model 3 b
-3.732
4.144
-3.869
Men
Women
b
b 3.218
2.893
0.175 -0.003**
0.582* -0.006*
Age Age Age*age
0.368** -0.004**
0.324* -0.004**
0.349* -0.004**
1.358**
1.279*
1.296*
Previously married
2.559***
2.598***
2.702***
2.674*
2.348*
Single
2.521**
2.633***
2.501**
1.989*
2.831*
Sex Female (ref = male) Marital status (ref = married)
Pre-migration education BHigh school (ref = college or more)
-0.071
-0.241
0.180
0.129
-0.054
0.704
-0.506
0.676
-0.072
1.027
Post-migration education No (ref = yes) Occupation No (ref = yes)
1.993***
1.934***
2.011***
1.956*
1.570
Income (ref = C$60,000) Under $30,000
2.032*
2.058**
2.094**
3.086**
1.255
0.619
0.695
0.769
1.545
0.014
Occasionally or more (ref = rarely-never)
2.262***
2.164***
2.230***
1.206*
Years in Canada
0.014
0.012
0.002
0.004
$30,000–$59,999 Financial difficulties
3.143*** -0.014
Ethnicity (ref = Irish) Vietnamese
-4.493***
-4.578***
-3.999***
-6.329***
-4.353
Ethiopian
-4.983***
-5.085***
-3.909***
-6.521***
-3.529
Iranian Korean Discrimination
2.875** -0.040 0.322***
2.908** -0.194 0.254***
0.616
3.202
0.506
3.324**
-1.835
0.274
0.114
0.027
0.918
Discrimination* gender Female (ref = male)
1.195*
Discrimination*ethnicity (ref = Irish) Vietnamese
0.389**
0.152
-0.150
Ethiopian
0.037
0.130
-0.893
Iranian
0.354*
0.605***
-0.631
Korean R2
0.310* 0.327
-0.604 0.309
10.12***
F
0.281
0.284
0.198 0.294
19.30***
19.63***
16.48***
8.91***
* p B 0.05; ** p B 0.01; *** p B 0.001
not reflect the current situation for recent immigrant populations. During the past decade, the changing distribution of ethnicity in Canada may have influenced changes in each ethnic group’s experience of discrimination and depression [52]. Nonetheless, the findings in this study will contribute to a better understanding of the dynamic relationship between discrimination and depression across genders and ethnicities.
Conclusion This study revealed ethnic and gender differences in the exposure to discrimination and its mental health effect across five ethnic groups. Generally, male immigrants were more likely than female immigrants to experience discrimination. Regardless of gender, Ethiopians experienced the highest level of discrimination, followed by Koreans,
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Iranians, and Vietnamese, whereas Irish immigrants confronted the lowest level. Furthermore, Iranian and Korean men had greater psychological vulnerability to discrimination than Irish men. Despite experiencing the highest level of discrimination, Ethiopian men and women were more likely to be resilient to discrimination-based depression. Contrarily, Irish and Vietnamese female immigrants, who reported the lowest exposure to discrimination, seemed to be the most vulnerable to an increase in depression. It is important to note that researching discrimination and its association with depression without systematic gender- and ethnic-specific assessments may lead to erroneous results. Mental health care providers in diverse populations should be attuned to potential adverse effect of racial tensions. Acknowledgments This research project was supported by the Medical Research Council of Canada and approved by the Office of Research Ethics at the University of Toronto (Protocol #3242).
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symptoms of psychological distress. Community Ment Health J. 2006;42(6):555–70. Arau´jo BY, Borrell LN. Understanding the link between discrimination, mental health outcomes, and life changes among Latinos. Hispanic J Behav Sci. 2006;28:246–66. Flores E, Tschann JM, Dimas JM, et al. Perceived discrimination, perceived stress, and mental and physical health among Mexicanorigin adults. Hispanic J Behav Sci. 2008;30(4):401–24. Finch BK, Kolody B, Vega WA. Perceived discrimination and depression among Mexican-origin adults in California. J Health Soc Behav. 2000;41(3):295–313. Hahm HC, Ozonoff A, Gaumond J, Sue S. Perceived discrimination and health outcomes: a gender comparison among Asian-Americans nationwide. Women’s Health Issues. 2010;20(5):350–8. Gee G, Spencer M, Chen J, et al. The association between selfreported racial discrimination and 12-month DSM-IV mental disorders among Asian Americans nationwide. Soc Sci Med. 2007;64(10):1984–96. Noh S, Beiser M, Kaspar V, et al. Perceived racial discrimination, depression, and coping: a study of Southeast Asian refugees in Canada. J Health Soc Behav. 1999;40:193–207. Noh S, Kaspar V. Diversity and immigrant health. In: Anisef P, Lanphier M, editors. The world in a city. Toronto: University of Toronto Press; 2003. p. 316–53. Noh S, Kaspar V. Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health. 2003;93(2):232–8. Breton R. The structure of relationships between ethnic collectivities. In: Driedger L, editor. The Canadian ethnic mosaic: a quest for identity. Toronto: McClelland and Stewart; 1978. p. 55–73. Wortley S. Justice for all? Race and perceptions of bias in the Ontario criminal justice system—a Toronto survey. Can J Criminol. 1996;38(4):439–67. Caselli F, Coleman WJ: On the theory of ethnic conflict. London, England: Centre for Economic Performance CEP Discussion Paper No. 732; 2006. Allen W, Telles E, Hunter M. Skin color, income and education: a comparison of African Americans and Mexican Americans. Natl J Sociol. 2000;12(1):129–80. Hersch J. The persistence of skin color discrimination for immigrants. Soc Sci Res. 2011;40(5):1337–49. Turner RJ, Avison WR. Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender. J Health Soc Behav. 2003;44(4): 488–505. Satterfield T, Mertz CK, Slovic P. Discrimination, vulnerability, and justice in the face of risk. Risk Anal. 2004;24(1):115–29. Byrd DR. Race/ethnicity and self-reported levels of discrimination and psychological distress, California, 2005. Prev Chronic Dis. 2012;9:E156. Craig MA, Richeson JA. Coalition or derogation? How perceived discrimination influences intraminority intergroup relations. J Pers Soc Psychol. 2012;102(4):759–77. Krieger N, Rowley DL, Herman AA, et al. Racism, sexism and social class: implications for studies of health, disease and wellbeing? Am J Prev Med. 1993;9(6 Suppl):82–122. Taylor DM, Wright SC, Moghaddam FM, Lalonde RN. The personal/group discrimination discrepancy: perceiving my group, but not myself, to be a target for discrimination. Pers Soc Psychol Bull. 1990;16(2):254–62. Krieger N, Sidney S, Coakley E. Racial discrimination and skin color in the CARDIA study: implications for public health research. Am J Public Health. 1998;88(9):1308–13. Kessler RC, McLeod JD. Sex differences in vulnerability to undesirable life events. Am Sociol Rev. 1984;49(5):620–31.
J Immigrant Minority Health 35. Pedraza S. Women and migration: the social consequences of gender. Annu Rev Sociol. 1991;17:303–25. 36. Okazaki S. Teaching gender issues in Asian American psychology. Psychol Women Q. 1998;22(1):33–52. 37. Li Z. Hicks MH: the CES-D in Chinese American women: construct validity, diagnostic validity for major depression, and cultural response bias. Psychiatry Res. 2010;175:227–32. 38. Noh S, Avison WR, Kaspar V. Depressive symptoms among Korean immigrants: assessment of a translation of the centre for epidemiologic studies—depression scale. Psychol Assess. 1992; 4(1):84–91. 39. Lin N. Measuring depressive symptomatology in China. J Nerv Ment Dis. 1989;177(3):121–31. 40. Noh S, Kaspar V, Chen X. Measuring depression in Asian populations: assessing validity of the translated version of CES-D Scale. Cross-Cult Res. 1998;32(4):358–77. 41. Williams DR, Gonzalez HM, Williams S, et al. Perceived discrimination, race and health in South Africa. Soc Sci Med. 2008;67:441–52. 42. Harris R, Tobias M, Jeffreys M, et al. Racism and health: the relationship between experience of racial discrimination and health in New Zealand. Soc Sci Med. 2006;63(6):1428–41. 43. Crosby F. The denial of personal discrimination. Am Behav Sci. 1984;27(3):371–86.
44. Dion K, Kawakami K. Ethnicity and perceived discrimination in Toronto: another look at the personal/group discrimination discrepancy. Can J Behav Sci. 1996;28(3):203–13. 45. Sethi S, Nolen-Hoeksema S. Gender differences in internal and external focusing among adolescents. Sex Roles. 1997;37(9/10):687–700. 46. Boyd M. At a disadvantage: the occupational attainments of foreign born women in Canada. Int Migr Rev. 1984;18(4):1091–119. 47. Rosenfield S. Sex differences in depression: do women always have higher rates? J Health Soc Behav. 1980;21(1):33–42. 48. Gellis ZD. Kin and nonkin social supports in a community sample of Vietnamese immigrants. Soc Work. 2003;48(2):248–58. 49. Krieger N, Smith K, Naishadham D, et al. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61(7):1576–96. 50. Fenta H, Hyman I, Noh S. Determinants of depression among Ethiopian immigrants and refugees in Toronto. J Nerv Ment Dis. 2004;192(5):363–72. 51. McSpadden LA, Moussa H. I have a name: the gender dynamics in asylum and in resettlement of Ethiopian and Eritrean refugees in North America. J Refug Stud. 1993;6(3):203–25. 52. Be´cares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and health. Health Place. 2009;15(3):670–8.
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ORIGINAL PAPER
Ethnic and Gender Differences in the Association Between Discrimination and Depressive Symptoms Among Five Immigrant Groups Il-Ho Kim • Samuel Noh
Ó Springer Science+Business Media New York 2013
Abstract This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8 % men, 49.2 % women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender. Keywords Immigrant health Ethnicity Gender Discrimination Depressive symptoms
I.-H. Kim (&) S. Noh Social and Epidemiological Research, Centre for Addiction and Mental Health, 33 Russell Street, Suite T-306, Toronto, ON M5S 2S1, Canada e-mail: [email protected] S. Noh Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Background In North America, race and ethnicity are pivotal determinants of social status and resources, as well as health [1]. Racism is among the social processes through which health inequalities are constructed [2–5]. A significant volume of research suggests that discrimination negatively affects mental health [2, 3, 6–8], but the experience of discrimination and its adverse health impacts may show complex variations across ethnic groups and genders [9, 10]. Despite this postulation, little empirical research gives a comprehensive picture of the ways discrimination influences minority and immigrant health [1, 2, 4]. Except for a few national or review studies [6, 7, 11], most studies on the social experience of racism or discrimination and its health consequences focus on single racial or ethnic samples, such as Africans [1, 3, 8, 12, 13], Hispanics [14–16], or Asian immigrants or refugees [17–21]. This study examines racial/ethnic differences and similarities in exposure to perceived discrimination, focusing on five selected ethnic communities of immigrants and refugees (Korean, Vietnamese, Ethiopian, Iranian, and Irish) in a metropolitan area of Canada. Discrimination is the behavioral expression of negative social emotion by dominant-group members toward outgroup minority victims and, racial/ethnic group identity is likely to influence the nature and extent of such adverse social experiences [9, 10]. According to the ‘‘ethnic preference’’ explanation [11, 22, 23], negative social emotions are directed toward selected racial or ethnic minorities who are excluded from fully sharing in equal opportunities and power. Members of the targeted minority groups are more likely to experience and report incidents of racial or ethnic discrimination. In the same vein, the theory of ‘‘skin-tone effect’’ purports that minorities are discriminated against
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based on skin color as a visible marker of racial status [4, 12, 24]. Existing empirical evidence from North America shows that white or European immigrants experience uniformly low levels of discrimination, whereas immigrants or refugees from African and Asian countries are more likely to face various forms of discrimination, including racial, language, income, or employment discrimination [1, 14, 25–27]. Furthermore, according to Hersch, ‘‘the skin-tone effect’’ victimizing racial minorities persists regardless of the length of residence in the host country [26]. With respect to health impacts of discrimination, recent research has shown that health risk is driven not simply by exposure to discrimination, but by diverse subjective experiences of, or vulnerabilities to, discrimination across ethnicities [19, 20, 28]. White immigrants may be even more susceptible to the negative effects of racial prejudice and discrimination than visible-minority immigrants, since they define themselves as part of the dominant group in hosting countries [6, 29]. In contrast, members of ethnic minorities who are repeatedly exposed to discrimination are likely to accept unfair treatment as a ‘fact of life’ [30– 33] and consequently develop resilience in coping with discrimination’s emotional toll [21, 27]. Kessler and his colleagues argue that non-Hispanic whites are more vulnerable to the health effects of discrimination than ethnic minorities [6]. However, other studies document significantly stronger correlations between discrimination and psychological distress among Black than White Americans [3]. It is unclear whether there are ethnic variations in the discrimination-depression link since few empirical studies have investigated the health effects of discrimination across diverse ethnic groups. The experience of discrimination may also radically differ between men and women. Immigrant research suggests that women’s vulnerability to discrimination leads to their encountering a greater risk of mental health problems [17, 34]. Compared to male immigrants, females, even those who are highly educated and skilled, are more likely to confront discrimination in the labor market where they face more unemployment or confinement to certain occupations [17, 35]. Okazaki [36] argues that ethnic minority women, in particular, encounter the double burden of ethnic and gender discrimination. To date, however, research on this issue has produced inconsistent findings. While some studies have found that discrimination influences women’s mental health more significantly than men’s [15– 17], others have reported the opposite, though with greater gender variations among Asian, African, and Hispanic American minorities than white Americans [4, 6, 13, 17]. Moreover, studies using US general population data (combining whites, blacks, and Asians) have found no differences between men and women [6, 18]. We assume these divergent findings stem from discrimination’s
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differing gender effect across ethnic groups. Thus, this present study uses a cross-sectional sample of five ethnic immigrant groups to investigate (1) whether ethnic minority groups report more discrimination than the European group; (2) whether more male than female immigrants experience exposure to discrimination; (3) whether the effect of discrimination on depression is lower for ethnic minority groups than for the European group; and (4) whether ethnic variations in the health effects of discrimination differ between men and women.
Methods Data Collection and Study Population Data were taken from the Toronto Study of Settlement and Health (TSSH), a cross-sectional study of first-generation immigrants residing in Toronto, Canada. The sample was drawn from five ethnic communities—Vietnamese, Ethiopian, Iranian, Korean, and Irish. For theoretical consideration, the five communities were selected in an effort to have representation of diverse regions (Africa, Europe, Middle East and Asia) and races (Black, White or Caucasian, Arab or Middle Eastern, and Asian and Southeast Asian). It should be noted that some communities (Iranian, Irish, and Korean) encompassed mostly voluntary immigrants, while large proportions of Ethiopian and Vietnamese community members landed in Canada as refugee claimants. Among European Canadians, Irish immigrants were chosen as a reference group; as Caucasians, they are closely identified with Canada’s ‘‘charter groups’’, yet have a long history of struggle as an ethnic minority. Accessibility was another consideration in selecting the five groups. That is, the investigation team had trained staff members who had access to the communities. Considering the difficulty in developing sampling frames in minority communities, quota sampling was applied; within each community, efforts were made to ensure a balanced representation of men and women, younger (18–44 years) and older (45–80 years) subjects, and newer immigrants (in Canada 10 years or less) and long-time immigrants (over 10 years). To complete the target of 200 interviews in each ethnic group, we approached 1,250 households (250 each) and were able to conduct interviews with one foreign-born adult (18 years or older) in each of 920 households (73.6 %). First-generation immigrants younger than 17 years were eliminated because their perceived discrimination may have significantly differed from that of older immigrants. Of the total 920 participants, 20 were removed in the final analyses due to incomplete responses. Sampling Ethiopian participants (N = 112) was challenged by a number of factors, including competing research
J Immigrant Minority Health
projects in the community. Interviews were conducted in either English or the respondent’s native language according to his or her preference. Health Outcome This study utilized the Center for Epidemiologic Studies Depression Scale (CES-D), a widely used scale assessing depressive symptoms experienced during the 4 weeks prior to the interview. The original scale taps four symptom domains including depressive mood, somatic symptoms, social withdrawal, and positive or negative affect. It may be recalled that the original 20-item CES-D was developed for the purpose of screening for ‘‘potential cases’’ of major depression (CES-D [16) to pass on for further testing. Over the past decades, the instrument has been used for mostly research purposes (i.e., hypothesis testing), and rarely for clinical practice. As some studies have suggested a potential bias on the four positive affect items (happy, hopeful, high selfesteem, and joy in life) among certain immigrant groups, including Asian Americans [37] and Asian Canadians [38], we eliminated the 4 items. Total scale scores were computed with the remaining 16 items based on a four-point Likert scale, ranging from 0 for ‘‘rarely or none of the time (\1 day)’’ to 3 for ‘‘most or all of the time (5–7 days a week).’’ Scores spanned from 0 to 48, with a higher score indicating greater depressive symptoms. In this study, internal reliability (Cronbach’s alpha) of the 16-item CESD scale was 0.918. Despite uncertain clinical validity, this 16-item CES-D scale appears valid when conducting comparative investigations among several ethnic groups, including certain Asians [3, 38, 39]. If the 16-item scale were to be used for screening of ‘‘at risk’’ cases, the score range of 0–48 (of the 16 items) may be re-estimated on a range of 0–60, with the cut-off score of 16 [3, 40]. Everyday Discrimination The everyday discrimination scale was used to identify unfair treatment toward first-generation immigrants. We used the 10-item expanded version of the everyday discrimination scale to measure respondents’ experience of chronic racial discrimination in their day-to-day lives in Canada [41]. The original scale consisted of nine items, which asked how often subjects received less courtesy, less respect, and poorer service than others; were regarded as not smart, dishonest, inferior to others, and as someone to fear; were called names or insulted, and were threatened or harassed. An extra item (being followed around in stores or shopping malls) was included to reflect experiences often reported by young Black adults in focus groups. Responses to each item were scored on a 6-point scale ranging from 0
for ‘‘never’’ to 5 for ‘‘almost every day’’. The total summed scores ranged from 0 to 50. The internal reliability of the 10-item scale (Cronbach’s alpha) was 0.897. Social Determinants of Depressive Symptoms Potential covariates for determining immigrants’ depressive symptoms included demographic factors (age, sex, marital status), socioeconomic variables (pre- and postmigration education, employment status, household income), and financial difficulties. Chronological age and years in Canada were used as continuous variables. Marital status was coded as ‘‘currently married’’, ‘‘never married’’, and ‘‘previously married’’ (divorced, separated, or widowed). Pre-migration educational levels were divided into ‘‘high school or less’’ and ‘‘college or more.’’ Post-migration educational status was classified into ‘‘no’’ and ‘‘yes’’. Employment status was categorized into ‘‘employed’’ and ‘‘not employed’’. To reduce the potential for missing data, respondents were asked to indicate the range of their total annual household incomes, earned from all sources. Considering the small number of cases available for analysis in the ethnic subsamples, household income was recoded into three levels: under $30,000, $30,000–$59,999, and $60,000 or more. The responses of financial difficulties were coded in two groups: ‘‘occasionally or more’’ or ‘‘rarely or never’’. Statistical Analysis Chi square tests were applied to estimate the percentages of ethnicities and demographic variables. Means and standard deviations were calculated for age, years in Canada, and discrimination. The general linear model (GLM) procedure was used to estimate the effect of discrimination on depression across ethnicity and gender. To examine the role of ethnicity and gender in moderating the association between discrimination and depression, we used two multiplicative interactions—ethnicity by discrimination and gender by discrimination. First, the interaction term of discrimination*gender (female) and four interaction terms of discrimination*ethnicity (four groups contrasted on the reference group of Irish) were tested in separate models using the total sample (Table 3, models 2 and 3). Second, to examine gender differences in ethnic variation in vulnerability, we examined the three-way interaction of gender*ethnicity*discrimination. To ease the presentation of the results, we report slopes (b) separately for male and female samples (last two columns of Table 3) and include a graphic presentation (Fig. 1). PROC GLM enables us to test the degree of interaction (crossed effects) and nested effects. To compute discrimination scale scores, individual
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Fig. 1 Regression lines for the relationship between discrimination, ethnicity, and depression after controlling for all covariates, by gender
scores were centered with a mean of 0 and a standard deviation of 1.
Results Table 1 shows the descriptive characteristics of the study sample by gender. The sample consisted of a similar proportion of men (50.8 %) and women (49.2 %), as well as similar proportions of each ethnic group (ranging from 19.6 to 22.6 %), the exception being the Ethiopian group, which comprised 12.4 % of the sample. In comparison, more men (69.4 %) than women (62.3 %) were married, whereas a larger proportion of women (21.7 %) than men (11.4 %) were previously married. In pre-migration education, approximately 53.4 % of men and 59.7 % of women had a college or higher degree. The proportion of Canadian educational attainment was similar between men (46.6 %) and women (44.5 %). Men were more likely than women to be employed (68.5, 55.8 %, respectively). Approximately 46 % of women reported annual household earnings of \$30,000, and 44.2 % experienced financial difficulties each month. For men, about 38 % were in the lowest income group, and 28 % reported having financial difficulties. The mean age was 48.7 years among men and 45.7 years among women. The mean number of years of residence in Canada was 16 years. Table 2 shows gender and ethnic variations in the experience of discrimination. After controlling for all potential covariates, women were significantly less likely than men to experience discrimination (-1.623, p B .0001). Regarding ethnic variations, Ethiopians (mean = 7.4) were most likely to face discrimination (p B .0001);
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Koreans, Iranians, and Vietnamese reported lower levels of discrimination than Ethiopians, but higher levels than Irish immigrants. Both Irish immigrant men and women related an extremely low degree of exposure to discrimination (mean = 1.2 vs. 0.6). The ethnic differences in discrimination were similar between men and women. Data presented in Table 3 summarize GLMs (PROC GLM) of depressive symptoms. As shown in model 1, there was a curvilinear association between age and depression. Increased levels of depressive symptoms were associated with being female, single or previously married, not employed, living with a lower income (under $30,000 per year) and the experience of financial difficulties (occasionally or more). Compared to Irish immigrants, depressive symptom level was significantly lower for Ethiopians (p \ .0001) and Vietnamese (p \ .0001) and significantly higher for Iranians (p \ .01). Also shown in model 1, controlling for the influence of these factors, an increase in discrimination was significantly associated with increased depressive symptoms (b = 0.322, p \ .0001). Shown in model 2, the result of an interaction test between gender and discrimination showed that the effect of discrimination on depression was greater among women (b = .254 ? 1.195) than men (b = .254). In model 3, the association between discrimination and depression was not significant (b = 0.114, p [ 0.05) among Irish immigrants, but was significantly greater among Vietnamese (b = 0.389, p \ 0.01) and Iranian immigrants (b = 0.354, p \ 0.05). In subsample data (each male and female group), Iranian and Korean men were more likely than Irish men to experience an increase in depression with an increase in discrimination. Within female immigrants, however, ethnic variations in this association were not apparent when compared to the Irish female group.
J Immigrant Minority Health Table 1 Demographic characteristics of respondents by gender Total N (%) Total
Men N (%)
Women N (%)
900 (100)
457 (50.8)
443 (49.2)
Vietnamese
200 (22.2)
93 (46.5)
107 (53.5)
Ethiopian
112 (12.4)
64 (57.1)
48 (42.9)
Iranian
203 (22.6)
96 (47.3)
107 (52.7)
Korean
209 (23.2)
105 (50.2)
104 (49.8)
176 (19.6)
99 (56.3)
77 (43.8)
Married
593 (65.9)
317 (69.4)
276 (62.3)
Never married
159 (17.7)
88 (19.3)
71 (16.0)
Previously married
148 (16.4)
52 (11.4)
96 (21.7)
Ethnic group
Irish Marital status
within each ethnic group confirmed a gender variation in the strength of the discrimination-depression association in the Vietnamese sample (p \ .0001 for Vietnamese).
Discussion
Pre-migration education BHigh school
436 (48.4)
213 (46.6)
223 (50.3)
College or more
464 (51.6)
244 (53.4)
220 (49.7)
No
490 (54.4)
244 (53.4)
246 (55.5)
Yes
410 (45.6)
213 (46.6)
197 (44.5)
Employed
560 (62.2)
313 (68.5)
247 (55.8)
Not employed
340 (37.8)
144 (31.5)
196 (44.2)
Under $ 30,000 $30,000–$59,999
376 (41.8) 322 (35.8)
173 (37.9) 172 (37.6)
203 (45.8) 150 (33.9)
$60,000 or more
202 (22.4)
112 (24.5)
90 (20.3)
Post-migration education
Occupation
Income
Financial difficulties Occasionally or more
324 (36.0)
128 (28.0)
196 (44.2)
Rarely-Never
576 (64.0)
329 (72.0)
247 (55.8)
Mean (SD)
Mean (SD)
Mean (SD)
Age
47.2 (12.5)
48.7 (13.0)
45.7 (11.9)
Years in Canada
16.0 (11.7)
17.2 (12.5)
14.8 (10.7)
Discrimination
4.1 (6.2)
4.6 (7.0)
3.5 (5.2)
Depression
7.3 (8.4)
6.2 (7.5)
8.5 (9.1)
The last columns of Table 3 present the results from the two-way interaction of ethnicity*discrimination by gender. For a more heuristic presentation, results are displayed graphically in Fig. 1. Among male immigrants, the Iranian and Korean groups had a steeper increase in depression as discrimination increased in comparison with the Irish, Vietnamese, or Ethiopian groups. In contrast, a steep increase was found among Irish and Vietnamese female immigrants. Whereas both Ethiopian women and men were less likely to experience an increase in depression as discrimination increased, Vietnamese women seemed to have a significant increase in depression with greater levels of discrimination, compared to Vietnamese men (Fig. 1). Further analyses of interaction tests (gender*discrimination)
Our findings from the TSSH survey sample of five immigrant/refugee groups fully agreed with previous research findings, in which an increase in discrimination was significantly associated with an increased risk of depressive symptoms [3, 6, 13, 42]. Our analyses, however, revealed considerable ethnic and gender variations in exposure to discrimination and its association with depressive symptoms. Across the five ethnic groups, female immigrants were less likely than male immigrants to report discrimination, which was consistent with previous findings [6, 13]. A possible explanation for this finding is that women, who are more likely to work inside the home, are less likely to encounter discrimination than men, who traditionally work outside the home. Crosby [43] proposed, on the other hand, that women have a tendency to respond to discriminatory experiences with denial or little awareness. Regardless of gender, however, Ethiopians experienced the highest level of discrimination, followed by Koreans, Iranians and Vietnamese, whereas Irish immigrants had the lowest level. This finding implies that darker-skinned Africans were exposed to the highest level of discrimination, possibly due to ‘‘ethnic preference’’ from cultural distance or segregation. Light-skinned White immigrants may have social and economic privileges that lead to less discriminatory experiences [14, 44]. The ethnicity-discrimination interactions by gender show gender-specific similarities and differences in ethnic variations in the discrimination-depression link. First, our analysis, using a combined sample of all five ethnic groups (Table 3, model 2), found that women more than men were significantly correlated with the harmful effects of discrimination on depressive symptoms. This observation was identified by earlier studies using samples that combined several ethnic groups [15–17]. Previous evidence suggests women have a lower threshold and show higher tension and stress when experiencing discrimination, since it stimulates internal attention or ruminative tendencies [17, 27, 34]. Contrarily, men seem to reduce discrimination’s impact on depression through external distractions from stressful events [13, 45]. In our analysis, a significant increase in discrimination-related depressive symptoms among women, compared to their male counterparts, was found only in the Vietnamese sample. This result may be connected to the women’s experience of gender discrimination in employment opportunities, occupational downgrading, traditional gender roles, and/or the lack of social
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J Immigrant Minority Health Table 2 Estimated means, coefficients and p values for testing gender and ethnic variations in experiencing perceived discrimination Everyday Discrimination
Total (n = 900)
Men (n = 457) a
Women (n = 443) Mean (SD)
ba
0.712
3.6 (5.7)
2.817**
5.578***
5.2 (5.5)
4.261***
5.1 (6.2) 5.1 (5.7)
2.325 2.991*
3.7 (5.4) 4.7 (5.1)
2.675* 4.092***
1.2 (5.5)
0
0.6 (1.4)
0
Mean (SD)
b
1.838*
3.9 (5.7)
5.030***
9.1 (10.4)
4.3 (5.9) 4.9 (5.4)
2.472** 3.471***
0.7 (2.0)
0
Mean (SD)
b
Women
3.5 (9.1)
-1.623***
Men
4.6 (6.7)
0
Vietnamese
3.8 (5.7)
Ethiopian
7.4 (8.8)
Iranian Korean Irish
a
Sex
Ethnicity
* p B 0.05; ** p B 0.01; *** p B 0.001 a
Coefficients and p values were calculated after controlling for all potential covariates
supports [5, 35, 46]. Exposure theory proposes that women, encountering a greater number of stressors linked to their multiple roles, are more likely than men to develop psychological distress [47]. For Vietnamese women, kin and social ties, which are strongly attached to gender roles or value orientations, tend to exacerbate discrimination-related psychological problems [48]. Second, the ethnic variations were noticeably different between male and female immigrants. Within the male sample, the association between discrimination and depressive symptoms was significantly stronger among Iranian and Korean men, but relatively weaker among Vietnamese, Ethiopian, and Irish men. Cultural differentials in ways of socially and psychologically coping with discrimination across ethnicities may contribute to the ethnic variations [5, 6]. Korean immigrants respond to negative racial relations with emotional arousal or distress such as feeling sad, depressed, angry, frustrated, or discouraged [21]. It seems that Korean men, along with Iranian men, were the most emotionally reactive to discrimination. In contrast, within the female sample, Irish and Vietnamese women experienced the strongest relationship between discrimination and depressive symptoms, but such an association was weaker among Iranian, Korean, and Ethiopian women. Vulnerability theory explains that women are more vulnerable to stressful life events than men [17, 34]; the Irish women in this case may be more sensitive than Irish men to the unanticipated discrimination, leading to the higher risk of depressive symptoms [6, 29]. Finally, our study found that Ethiopian men and women showed an unexpected minimal health impact from discrimination even though they encountered the highest level. The resilience of Ethiopian immigrants to repeated discriminatory exposure may be related to their acceptance
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of unfair treatment as a common life event [32, 44, 49]. For example, the majority of men (91.9 %) and women (66.6 %) from Ethiopia—one of Canada’s primary sources of African immigrants and refugees—have suffered major social adversities such as pre-migration trauma, refugee camp internment, and/or post-migration stressful events [50]. Fenta et al. [50] found that, among Ethiopian immigrants, social and economic hardships such as unemployment, lack of education, pre-migration trauma, and postmigration stressful events were more influential determinants of depression than discriminatory experiences. Furthermore, Ethiopian women appear to be more tolerant toward downward social mobility or discriminatory social attitudes, believing that the new environment provides better opportunities for re-establishing their lives, in comparison to the harshness of their homeland [51]. This study’s findings indicate the significance of each ethnic group’s historical and cultural background in the discrimination-depression link. This study has some limitations. First, conceptual definitions of discrimination in our self-reported data are a potential source of measurement errors. This study also fails to investigate health effects related to different intensities of exposure to discrimination across ethnic groups, since the everyday discrimination scale only measures frequency of discrimination, not intensity. However, the risk of errors can be mitigated with the use of a 10-item discrimination measure that has proven strong reliability and validity. Second, given that Ethiopians were under-sampled, caution should be exercised in interpreting the absence of a discrimination-health association among Ethiopians. However, this study’s finding was consistent with those of previous studies of Ethiopian immigrants, including Canadian research [1, 50]. Finally, since this analysis was based on 2001 data, the ethnic variations may
J Immigrant Minority Health Table 3 Association between perceived discrimination and depression according to ethnic groups Parameter
Intercept
Total Model 1 b
Model 2 B
Model 3 b
-3.732
4.144
-3.869
Men
Women
b
b 3.218
2.893
0.175 -0.003**
0.582* -0.006*
Age Age Age*age
0.368** -0.004**
0.324* -0.004**
0.349* -0.004**
1.358**
1.279*
1.296*
Previously married
2.559***
2.598***
2.702***
2.674*
2.348*
Single
2.521**
2.633***
2.501**
1.989*
2.831*
Sex Female (ref = male) Marital status (ref = married)
Pre-migration education BHigh school (ref = college or more)
-0.071
-0.241
0.180
0.129
-0.054
0.704
-0.506
0.676
-0.072
1.027
Post-migration education No (ref = yes) Occupation No (ref = yes)
1.993***
1.934***
2.011***
1.956*
1.570
Income (ref = C$60,000) Under $30,000
2.032*
2.058**
2.094**
3.086**
1.255
0.619
0.695
0.769
1.545
0.014
Occasionally or more (ref = rarely-never)
2.262***
2.164***
2.230***
1.206*
Years in Canada
0.014
0.012
0.002
0.004
$30,000–$59,999 Financial difficulties
3.143*** -0.014
Ethnicity (ref = Irish) Vietnamese
-4.493***
-4.578***
-3.999***
-6.329***
-4.353
Ethiopian
-4.983***
-5.085***
-3.909***
-6.521***
-3.529
Iranian Korean Discrimination
2.875** -0.040 0.322***
2.908** -0.194 0.254***
0.616
3.202
0.506
3.324**
-1.835
0.274
0.114
0.027
0.918
Discrimination* gender Female (ref = male)
1.195*
Discrimination*ethnicity (ref = Irish) Vietnamese
0.389**
0.152
-0.150
Ethiopian
0.037
0.130
-0.893
Iranian
0.354*
0.605***
-0.631
Korean R2
0.310* 0.327
-0.604 0.309
10.12***
F
0.281
0.284
0.198 0.294
19.30***
19.63***
16.48***
8.91***
* p B 0.05; ** p B 0.01; *** p B 0.001
not reflect the current situation for recent immigrant populations. During the past decade, the changing distribution of ethnicity in Canada may have influenced changes in each ethnic group’s experience of discrimination and depression [52]. Nonetheless, the findings in this study will contribute to a better understanding of the dynamic relationship between discrimination and depression across genders and ethnicities.
Conclusion This study revealed ethnic and gender differences in the exposure to discrimination and its mental health effect across five ethnic groups. Generally, male immigrants were more likely than female immigrants to experience discrimination. Regardless of gender, Ethiopians experienced the highest level of discrimination, followed by Koreans,
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Iranians, and Vietnamese, whereas Irish immigrants confronted the lowest level. Furthermore, Iranian and Korean men had greater psychological vulnerability to discrimination than Irish men. Despite experiencing the highest level of discrimination, Ethiopian men and women were more likely to be resilient to discrimination-based depression. Contrarily, Irish and Vietnamese female immigrants, who reported the lowest exposure to discrimination, seemed to be the most vulnerable to an increase in depression. It is important to note that researching discrimination and its association with depression without systematic gender- and ethnic-specific assessments may lead to erroneous results. Mental health care providers in diverse populations should be attuned to potential adverse effect of racial tensions. Acknowledgments This research project was supported by the Medical Research Council of Canada and approved by the Office of Research Ethics at the University of Toronto (Protocol #3242).
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