The influence of perceived discrimination in healthcare settings on psychological distress among a diverse sample of older Asian Americans

Abstract

Objectives

The purpose of this study was to determine the relationship between discrimination in healthcare settings and psychological distress.

Method

This study utilized a retrospective cross-sectional study design. The dataset was obtained from 2015-2017 California Health Interview Survey (CHIS). Healthcare discrimination experience (yes, no) was measured using the following question “Over your entire lifetime, how often have you been treated unfairly when getting medical care (never, rarely, sometimes, often)?”. Psychological distress was the study outcome and was measured using the Kessler Psychological Distress Scale. A composite score (0-24) was created for psychological distress for the prior 30 days and for the worse most in the past 12 months. A hierarchical multivariate linear regression was conducted to examine the influence of healthcare discrimination experience on psychological distress after adjusting for other covariates.

Results

Study participants (weighted N = 1,360,487) had a mean age of 64.35 years (SD = 0.61), were primarily female (54.93%), heterosexual (96.61%), and married or living with a partner (73.37%). About 10.00% of older Asian Americans ever perceived healthcare discrimination over their entire lifetime. Perceived discrimination was associated with higher levels of psychological distress for the past 30 days (beta= 2.107, SE = 0.662, p < 0.05) and for the worst month in the past year (beta= 2.099, SE = 0.697, p < 0.05) after controlling for covariates.

Conclusion

Self-reported discrimination was relatively low in this sample of older Asian American adults. However, consistent with prior research, perceived discrimination in the healthcare setting was associated with increased psychological distress. The findings have implications for improving the quality of health care services received.

Keywords:

• Psychological distress
• healthcare discrimination
• Asian Americans
• older adult

Acknowledgements

We would also like to thank the Rutgers Asian Resource Center for Minority Aging Research, UIC Center for Clinical Translational Science (National Institutes of Health, UL1TR002003) and UCLA Center for Health Policy Research for their support with this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The contributions of Dr. Li were supported by the Asian Resource Center for Minority Aging Research at Rutgers University (National Institutes of Aging, 1P30AG059304-01) Pilot Grant. Dr. Matthews’ efforts in the development of this manuscript were support by funds from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (National Institutes of Health, 1U54MD012523-01). The content is solely the authors’ responsibility and does not necessarily represent the official views of the National Institutes of Health.