Experienced Racism and Discrimination and Psychological Distress amid Different Phases of the COVID-19 Pandemic: Evidence from Wisconsin

Abstract

The SARS-COV-2 pandemic created an unprecedented crisis and raised concerns about racial discrimination and psychological distress. We assessed trends in COVID-19-related racism and discrimination irrespective of infection status and changes in emotional health and mental well-being outcomes due to experienced racism and discrimination. Using three waves of the Wisconsin COVID-19 Community Impact Survey (2020-2021), we compared demographics of respondents categorized by two mutually exclusive groups: reporting vs. not reporting COVID-19-related racism and discrimination. Using longitudinal logistic-multivariable regressions, we modeled changes in racism and discrimination-induced stress and 4-item patient health questionnaire screening for anxiety and depression (PHQ-4) associated with experiencing racism and discrimination. Prevalence of reported experiencing COVID-19-related racism and discrimination increased among adult Wisconsinites between 2020 and 2021: 6.28% in Wave 1, 11.13% in Wave 2 (Pearson's chi-square Wave 1 vs 2=16.96, p<.001) vs. 10.87% in Wave 3 (chi-square, Wave 1 vs 3=14.99, p<.001). Experiencing COVID-19-related racism and discrimination was associated with a higher likelihood stress (OR=3.15, 95% CI 2.32-4.29) and a higher PHQ-4 score (coeff=0.63, 95% CI 0.32-0.94). Relative to White respondents, racial/ethnic minorities had a higher likelihood of feeling stress: Black OR=7.13, 95% CI 4.68-10.85; Hispanics OR=3.81, 95% CI 2.11-6.89; and other races OR=2.61, 95% CI 1.51-4.53. Estimated associations varied across racial/ethnic groups, age groups, and survey waves. Our study showed that experienced COVID-19-related racism and discrimination increased during the first 2 years of the pandemic and was associated with greater psychological distress among Wisconsinites of all racial/ethnic groups. Public health policies promoting inclusiveness should be implemented to reduce (COVID-19-related) racism and discrimination and its long-term effects on mental health and well-being.

Keywords: COVID-19 discrimination; PHQ-4; Psychological distress; Racial discrimination; Stress.

Figure 1:

Report of experienced racism & discrimination by SHOW COVID-19 Community Impact Survey wave

Figure 2:

Stress due to COVID-19-related racism and discrimination and PHQ-4 composite scale by experienced racism and discrimination and race/ethnicity across COVID-19 community impact survey waves Acronym: PHQ-4: 4-item patient health questionnaire for anxiety and depression screening Notes: Hispanic was combined with other race/ethnicity due to small sample sizes were distinguishing between respondents reporting COVID-19-related racism and discrimination and those not reporting such experiences. The correlation between stress due to COVID-19-related racism and discrimination and PHQ-4 composite scale is 0.1548, p<0.05.

Figure 3:

Estimates of the association between reporting having experienced COVID-19-related racism and discrimination and psychological health outcomes Acronym: PHQ-4: 4-item patient health questionnaire for anxiety and depression screening Notes: Plots of results from regressions identical to those in Table A4. Estimates shown as dots and 95% confidence intervals as bars. Longitudinal logistic regressions with population averages were estimated, and odds ratios are reported on a log scale for binary outcomes (stress since start of COVID-19 due to COVID-19-related racism and discrimination, PHQ-4 anxiety and depression subscales). Longitudinal ordinary least squares regression was estimated, and coefficients are reported for the PHQ-4 composite scale ranging from 0 to 12. Heteroskedasticity robust standard errors were estimated. Regressions controlled for indicators for age category, race/ethnicity, sex, educational attainment, annual household income, self-reported anxiety or depression unrelated to COVID-19, and survey waves. Inference: * p < 0.05, ** p < 0.01, *** p < 0.001