Perceived Discrimination and Mental Health Disorders: The South African Stress and Health Study (Original Articles) (Survey‪)‬

Discrimination includes actions (subtle or overt, direct or indirect) that limit the social, political or economic opportunities of particular groups (1) and may have short- and long-term consequences. (2) Considering that perceived discrimination by victimised groups captures a sense of oppression by members of the dominant group, it can have profound psychological effects on its victims. (3) There is evidence of a strong association between perceived discrimination and objective indicators of inequality, and with psychiatric disorder. (4) Empirical research has examined the association between perceived discrimination and health. (5,6) Most early research utilised samples of black persons in North America. Research documents an inverse association between self-reported discrimination and health for multiple racial groups in the USA, immigrant populations in European countries, and non-dominant racial groups in Australia and New Zealand. (6) Mental health outcomes have been the most widely used measure of health status in these studies, but there has been little research on the psychological impact of discrimination in South Africa and its mental health consequences. Researchers have suggested that the subjective experience of South African racial discrimination, which was supported by law and custom, could have had extremely negative psychological consequences. (7,8) National data from South Africa found that perceived racial discrimination was unrelated to self-rated ill health, but positively associated with psychological distress. (9) Research on perceived discrimination and health also suggests that the generic perception of unfair treatment tends to be adversely related to health, regardless of whether the discriminatory behaviour is attributed to race or other factors. (6) Because of attributional ambiguity in many interpersonal encounters and a growing reluctance to explicitly discuss racism in South Africa, it is important to examine the health correlates of racial and non-racial discrimination. (9) We examined the relationship between perceived discrimination and psychiatric disorders using a national probability sample of adult South Africans, looking at the extent to which perceived discrimination is associated with the report of mood, anxiety or substance use disorders within a 12-month period and over a lifetime, taking into account socio-demographic characteristics. Previous research is inconsistent with regard to whether discrimination is related to ill health independent of other measures of stress. (6,9) In addition, psychological predispositions can affect the perception of discriminatory behaviour and the likelihood of reporting it. Accordingly, we examined the extent to which the association between self-reports of discrimination and mental disorders are independent of other sources of stress and psychological factors.