Discrimination in Health Care Settings and Depression Among Older Black Adults during Covid-19 Pandemic

Background and Purpose: We propose a study to examine the association between discrimination in health care settings and depressive symptoms among older Black adults during the Covid-19 pandemic. While the adverse effects of discrimination on Black individuals’ mental health are widely documented, evidence is lacking on how discrimination specifically in health care setting may be related to mental health among older Black adults. The study will use a within-group approach that specifically centers on older Black adults’ mental health during the Covid-19 pandemic. The central research question is: to what extent are experiences of discrimination in healthcare settings associated with past-week depressive symptoms and 12-month major depressive among older Black Adults during Covid-19?

Methods: Data for the study came from the Health and Retirement Study, a national survey study that is representative of older adults aged 51 or older. Non-Hispanic Black adults aged 51 or older were selected for analysis (N = 659). Covid-related measures were collected from March 2020 to June 2021. Discrimination in health care settings was measured with one item assessing how often respondents received poorer service or treatment than others from doctors or hospitals. Past-week depressive symptoms were measured by an 8-item Center for Epidemiologic Studies Depression (CESD) scale. The 12-month major depression was measured by the Composite International Diagnostic Interview Short Form (CIDI-SF). Control variables included socio-demographic variables. Covid-related controls included receiving stimulus check (yes/no), levels of concerns over the pandemic (ranging 1-10), and delayed care (yes/no). Weighted logistic regression models adjusting for complex sampling design were conducted to test the study aims and generate weighted estimates.

Results: The study sample had an average age of 67.1. The majority were women (65.2%) and lived in the south (63.0%). Findings suggested that more frequent discrimination in healthcare settings is related to higher risk of both past-week depressive symptoms and 12-month major depression. Specifically, one-unit increase in discrimination in healthcare settings was associated with 1.30 times higher odds of past-week depressive symptoms (p=0.013). Similarly, one-unit increase in healthcare discrimination was associated with 1.55 time higher odds of 12-month major depressive episodes (p=0.009).

Conclusions and Implications: First, this study expands evidence on older Black adults’ experiences of discrimination in day-to-day life to health care settings. The original Everyday Discrimination Scale did not capture discriminatory experiences that specifically occur in healthcare settings. Healthcare discrimination during the pandemic may affect older Black individuals’ willingness to seek timely medical care for Covid-related symptoms. Second, the Covid-19 pandemic disproportionately affected older adults and Black individuals. Existing literature on discrimination has overlooked older Black individuals. Using a within-group approach, we focus specifically on experiences of older Black adults. The findings will help social workers in healthcare settings identify distinct social stressors to mental health among older Black adults. The relationship between older Black adults and the healthcare system is fraught with mistrust and social workers who practice in medical settings are well positioned to lead anti-racist efforts in these areas.