The Mental Health Impact of Racial Discrimination Against Asian American Pacific Islanders

BACKGROUND AND PURPOSE: Racism against Asian American/Pacific Islanders (AAPI) is not a new phenomenon in the United States, but reports of racial discrimination and hate crimes have surged during the COVID-19 pandemic. According to the Pew Research Center, about 40% of Asian American adults reported that other people were visibly uncomfortable around them since the start of the pandemic. This racialization of COVID-19 has the potential to produce long-lasting effects on attitudes towards AAPIs, which is alarming since a substantial body of research has linked racial discrimination to adverse mental health outcomes as well as lower use of formal treatment.

METHODS: We analyzed data from the Healthy Minds Study (September 2020 – December 2020), which was conducted during the pandemic among a large sample of students attending one of 28 universities in the US (N=15,949). Using multivariable logistic regression, we examined the association between experiencing racial/ethnic discrimination in the context of COVID-19 and several mental health outcomes.

RESULTS: Among the AAPI students (N=1697), over a quarter reported experiencing discriminatory or hostile behavior due to their race/ethnicity as a result of the COVID-19 pandemic. Over two-thirds of respondents who endorsed this item met the criteria for clinically significant mental health conditions. We found that COVID-19 related racial discrimination was associated with greater odds of having moderately severe or severe depression [aOR: 2.02; 95% CI: 1.55-2.62; p=0.000], moderate to severe anxiety [aOR: 1.97; 95% CI: 1.58-2.44; p=0.000], binge drinking [aOR: 1.46; 95% CI: 1.17-1.83; p=0.001], self-injurious behaviors [aOR: 1.78; 95% CI: 1.40-2.27; p=0.000], and suicidal ideation [aOR: 2.02; 95% CI: 1.43-2.85; p=0.000], adjusting for age and gender. Among students with clinically significant mental health symptoms, less than a third of AAPI students reported seeking any current mental health treatment, which is the lowest of all racial groups.

CONCLUSIONS AND IMPLICATIONS: These findings should be interpreted bearing in mind that the response rate was 14%, which is low but common for these types of surveys. Also, racial/ethnic discrimination was self-reported, which is prone to both under- and over-reporting. And while the sample is of university students, it is possible that the associations between discrimination and mental health may be even stronger outside of this context, especially among Asian American immigrants with limited English proficiency. Even a year into the COVID-19 pandemic, hate crimes against AAPIs are still making headlines, with harrowing reports of physical injuries and deaths. As AAPI researchers and scholars, we urge our colleagues and institutions to speak out publicly against these acts of racism, and we call for the removal of barriers that prevent AAPI’s from accessing appropriate mental health treatment. Finally, studies are showing that other racial and ethnic minority groups have also experienced racial discrimination throughout the pandemic, and so we underscore the need to address the racial disparities that have devastated Black and Latinx communities, and mitigate the pernicious effects of racism on population health.