Associations of Perceived Discrimination With Impaired Functioning in a Population Sample With Psychological Distress

Abstract

Objective: To test associations between perceived discrimination based on mental health status and impaired functioning in a population sample with psychological distress. Methods: Interviews were conducted with a sample of respondents to the California Health Interview Survey with mild, moderate, or severe psychological distress. Perceived discrimination was assessed using 14 items covering four domains in which discrimination is reported: social, partner, institutional, and work. Associations of perceived discrimination scores (total score and domain scores) with impaired functioning, measured by the likelihood and number of days out of role, were estimated with statistical adjustment for demographic characteristics and serious psychological distress. Results: Discrimination domain scores are significantly correlated (r ranging from .34 to .65).Total discrimination score is associated with having days out of role (OR = 1.20, 95% CI = 1.10–1.30) and with number of days out of role (5.5 days) after adjustment for demographics and psychological distress. The high correlation among the domain scores makes the attribution of association to particular domains uncertain. Removal of the effect of discrimination using model-based simulation reduces past-year days out of role by 39.4 (SE 11.3) days. Conclusions: This observational study supports the suggestion that discrimination against people with mental illness contributes to their impaired functioning in a diverse range of social roles. The results provide preliminary evidence that reduction in discrimination against people with mental illness could improve social functioning and work productivity. Correlations among domain scores make it difficult to draw conclusions about domain-specific associations.

Funding

This research was supported by grants from the National Institute of Minority Health and Health Disparities (R01 MD010274, PI: Breslau) and the National Institute of Mental Health (R01 MH104381, PI: Collins).

Additional information

Funding

This research was supported by grants from the National Institute of Minority Health and Health Disparities (R01 MD010274, PI: Breslau) and the National Institute of Mental Health (R01 MH104381, PI: Collins).

Notes on contributors

J. Breslau

J. Breslau, PhD, ScD, is affiliated with the RAND Corporation, Pittsburgh, Pennsylvania.

E.C. Wong

 E.C. Wong, PhD, M.A. Burnam, PhD, M. Cefalu, PhD, E.A. Roth, PhD, and R.C. Collins, PhD, are affiliated with the RAND Corporation, Santa Monica, California.

M.A. Burnam

 E.C. Wong, PhD, M.A. Burnam, PhD, M. Cefalu, PhD, E.A. Roth, PhD, and R.C. Collins, PhD, are affiliated with the RAND Corporation, Santa Monica, California.

M. Cefalu

 E.C. Wong, PhD, M.A. Burnam, PhD, M. Cefalu, PhD, E.A. Roth, PhD, and R.C. Collins, PhD, are affiliated with the RAND Corporation, Santa Monica, California.

E.A. Roth

 E.C. Wong, PhD, M.A. Burnam, PhD, M. Cefalu, PhD, E.A. Roth, PhD, and R.C. Collins, PhD, are affiliated with the RAND Corporation, Santa Monica, California.

R.L. Collins

 E.C. Wong, PhD, M.A. Burnam, PhD, M. Cefalu, PhD, E.A. Roth, PhD, and R.C. Collins, PhD, are affiliated with the RAND Corporation, Santa Monica, California.