High socioeconomic status (SES) may make young African American patients more likely to experience perceived discrimination when seeking medical treatment, which in turn may contribute to their risk for major depressive disorder (MDD), according to a new study.
“In most settings and for most populations, high socioeconomic status (SES) is protective,” lead author, Shervin Assari, MD, MPH, told MD Magazine. “For example, high SES protects populations against the risk of depression. However, this seems not to be the case for African Americans, particularly African American men, in whom high SES is found to increase the risk for depression. Researchers have been trying to find the underlying mechanisms behind this counterintuitive phenomenon.”
“Previously, this pattern was attributed to the increased exposure of high-SES African Americans to discrimination,” Assari, an assistant professor of psychiatry at the University of Michigan, in Ann Arbor, added.
In a cross-sectional study, he and his research team examined the effects of discrimination on patients with MDD in relation to SES in a sample of 810 young African Americans from the National Survey of American Life-Adolescent supplement. They looked at perceived discrimination along with MDD over the course of 30 days, then at 12 months, and then over the course of their lifetime. They also factored in age and gender, as well as subjective and objective indicators, such as income and poverty index. They analyzed their results using logistic regressions.
Perceived discrimination in everyday life was reported using the Everyday Discrimination Scale (EDS) over the course of 1 year. According to the authors, “the EDS is a subtle measure of experience of discrimination, well-validated and widely used.”
The EDS measured 13 items often considered to be indicators of institutional and interpersonal discrimination based on race. Some examples of the items on the EDS included: “You are followed around in stores” or “People act as if they think you are not smart.” It asked respondents to rate the frequency of their experiences on a scale of 1 to 6—a score of 1 indicating that they have never had that particular experience, while a 6 meaning it happened almost daily.
The authors wrote that the youths’ perception of discrimination was related to a higher risk of MDD over the course of all 3 timeframes. Their results indicated that objective factors in SES, including income and poverty index, were not associated with perceived discrimination. Although, they found that subjective SES—that is, self-reported indications of having either less than enough, enough, or more than enough money to live—interacted with their perceptions of discrimination.
“For the first time, our study showed that high SES also increases the vulnerability of African American youth to the effect of discrimination and racism,” said Assari. “That is, African Americans who have high SES, and do not expect discrimination and are less prepared to handle it, are hit harder when they get discriminated against. Thus, it is not just exposure, but also vulnerability, that explains high risk of depression in high SES African Americans.”