By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://empathymh.org/our-team/
Staff Research and Content Writer

© Copyright –Empathy Mental Health Inc., Milwaukee, Wisconsin – May 2025 – All rights reserved.

In an increasingly divided world, experiences of discrimination are commonplace both online and in-person. Unsurprisingly, discrimination has negative impacts on physical and mental health. Chronic exposure to discrimination increases a person’s risk of psychological distress, depression, and anxiety. 

Discrimination can occur as a result of many factors, such as race, gender, sexual orientation, religion, and socioeconomic status. So far, US research has not closely examined the relationship between racial discrimination and mental health on a nationally representative scale. 

Previous research has compared rates of discrimination and depression and anxiety between two racial groups but not across the spectrum of racial and ethnic identities present in the US. A new study published in March 2025 in the Journal of the American Medical Association is the first to examine the association between discrimination and mental health among a broad spectrum of racial and ethnic groups and using nationally-representative data.

What is discrimination?

Discrimination refers to routine, often subtle forms of mistreatment that individuals or groups experience. It is driven by negative stereotypes others hold about their background or identity. Examples of discrimination include being treated with less respect than those around them, experiencing microaggressions, or receiving inferior service.

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Discrimination is unfortunately a common experience among marginalized groups such as women, people of color, gender and sexual minorities, and those with disabilities. Experiences of discrimination are often personal but are upheld by structural or systemic factors.

What did this study do?

This cross-sectional study used data from the 2023 National Health Interview Survey (NHIS) to assess the association between people’s experiences of discrimination and their screening scores for depression and anxiety. The 2023 NHIS included 29,522 respondents, weighted to represent 258 million Americans.

The researchers examined the association between exposure to discrimination and depression and anxiety while controlling for covariates that could influence mental health. Covariates included things like the respondent’s age, socioeconomic status, health status, and place of residence. The researchers hypothesized that experiencing discrimination would be associated with scoring positively for depression and/or anxiety on screening questionnaires.

How did the study measure discrimination?

This study measured exposure to discrimination using the 5-item Everyday Discrimination Scale. The 5 items are as follows:

1. “How often are you treated with less courtesy or respect than others?” 
2. “How often do you receive poorer service at restaurants or stores compared to others?”
3. “How often do people act as if they think you are not smart?”
4. “How often do people act as if they are afraid of you?” 
5. “How often are you threatened or harassed?”

Scores for these items were totaled to give an overall discrimination score. The researchers categorized discrimination scores as none (0), low (1-10), and high (11-20)

The primary outcome measures, depression and anxiety, were measured using the Patient Health Questionnaire-2 scale and the Generalized Anxiety Disorder-2 scale.

What did the study find?

This study’s findings provide a deeper understanding of the relationship between discrimination and mental health, particularly among different racial and ethnic groups.

Over half of US adults (55.8%) reported experiencing discrimination. Most (52%) reported low discrimination scores while only 3.2% reported high discrimination scores.

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 Discrimination was highest among Black adults (8.6%), followed by multiracial adults (6.4%).

As the researchers predicted, high levels of exposure to discrimination were strongly associated with experiencing depression, anxiety, or both. The researchers identified a ‘dose-response relationship’ between discrimination scores and depression/anxiety screening. This means that for each unit increase in discrimination score, the odds of screening positively for depression and anxiety increased by 15% and 14%, respectively. 

Those who experienced lower levels of discrimination (discrimination scores between 1- 10)had twice the odds of screening positively for depression and/or anxiety. Those with high discrimination scores (11-20) had 5 times the odds of scoring positively for depression or anxiety. Those with high discrimination scores also had 9 times the odds of scoring positively for both depression and anxiety.

The association between discrimination and depression and/or anxiety was not affected by sex, but it was affected by race.

What was the association between race, discrimination, and depression/anxiety?

The association between discrimination and scoring positively for depression alone and depression and anxiety varied based on race/ethnicity. However, the relationship between discrimination and anxiety alone remained consistent regardless of race/ethnicity.

As exposure to discrimination increased, the probability of positive screening results for depression increased more sharply among White and multiracial or other race adults. For both depression and anxiety, the most pronounced increases were seen among Asian adults.

The sharp increases were surprising to the researchers, who posited several theories as to why White and Asian adults would experience sharper increases in depression and anxiety relative to discrimination than Black adults, who reported experiencing higher overall levels of discrimination. The sections below outline some factors that may have contributed to sharper increases in depression alone and depression and anxiety scores among White, Asian, and multiracial adults.

Multiracial adults

Adults who identify as multiracial face unique challenges in navigating multiple racial identities. They may struggle to find a sense of belonging within any one racial group, which can intensify feelings of isolation. Understanding these challenges is crucial for providing effective support to multiracial individuals affected by discrimination.

Asian adults

The researchers explain that stereotypes such as the ‘model minority’ stereotype of Asian people as being successful and high achieving can lead to unrealistically high intrinsic and extrinsic pressure and thus poor mental health outcomes. The ‘model minority’ stereotype often leads to the expectation of academic and professional success, which can create significant pressure and contribute to mental health issues. It is also well-known that anti-Asian racism increased during the COVID-19 pandemic, and this ongoing minority stress may have resulted in poorer mental health outcomes.

White adults

Finally, the researchers emphasize that more research is needed to understand the association between different forms of discrimination and mental health. There are likely other forms of discrimination at play contributing to poorer mental health outcomes among White adults, since they experience lower levels of racial discrimination than adults of other races. 

Understanding discrimination and mental health in Black populations

Black adults reported experiencing the highest levels of discrimination of all racial/ethnic groups in this study. However, their odds of positive screening for depression/anxiety did not increase as sharply with higher discrimination scores compared to White and multiracial adults. The researchers emphasize that this finding does not mean that exposure to discrimination is less significant or less impactful for Black populations or other racial and ethnic groups. They theorize that Black adults may have developed a form of resignation or passive acceptance of these experiences or maladaptive coping mechanisms that do not translate to positive scores for depression or anxiety.

Photo by Mikhail Nilov on Pexels

Additionally, because the survey depended on self-reported data, there may be a disconnect between the screening tests used and how Black adults perceive themselves and their symptoms. For example, individuals might think, “It’s not that bad for me,” leading them to rate their symptoms lower than a healthcare provider would. This reflects potential issues with self-reporting in the survey.

What are the recommendations from this study?

The findings from this study underscore the need for more research into the relationship between discrimination and mental health among racial and ethnic populations. For example, research can enhance our understanding of which forms of discrimination impact which populations, and what forms of mental health support and treatment can most effectively mitigate the mental health impacts of chronic discrimination.

By developing a clearer understanding of how discrimination impacts mental health and identifying those most at risk for depression and anxiety, we can better direct mental health supports to those in greatest need. More robust mental health support involves increasing the availability of services and training providers in areas such as anti-racism and trauma-informed care. Moreover, mental health support programs could be designed to acknowledge the unique experiences, stressors, and cultural factors that different racial and ethnic groups encounter.

Ultimately, though, an anti-racist approach to mental health care, inclusive public health campaigns, equitable and inclusive public policies, and a zero tolerance stance on hate based on racial identity or any other identity are essential for moving towards a world free from discrimination.

Key Takeaways

• Discrimination impacts physical and mental health and is correlated with higher rates of depression and anxiety.
• Certain racial groups experience higher levels of discrimination than others. This study found that Black and multiracial adults reported experiencing the highest levels of discrimination.
• People who experience higher levels of discrimination are 5 times more likely to score positively for depression and/or anxiety.
• As the discrimination score increases, so does the risk of depression alone or depression and anxiety.
• Sharper increases in rates of depression and/or anxiety were seen among White, Asian, and multiracial adults. More research is needed to understand this trend.
• This research can help tailor mental health supports for those who experience higher rates of discrimination-induced mental health struggles.

References

Wang ML, Narcisse M. Discrimination, Depression, and Anxiety Among US Adults. JAMA Netw Open. 2025;8(3):e252404. doi:10.1001/jamanetworkopen.2025.2404