摘要：Objectives. Our understanding of the relationships between perceived discrimination and health was limited by the cross-sectional design of most previous studies. We examined the longitudinal association of self-reported everyday discrimination with depressive symptoms and self-rated general health. Methods. Data came from 2 waves (1996 and 2001) of the Eastside Village Health Worker Partnership survey, a community-based participatory survey of African American women living on Detroit’s east side (n=343). We use longitudinal models to test the hypothesis that a change in everyday discrimination over time is associated with a change in self-reported symptoms of depression (positive) and on self-reported general health status (negative). Results. We found that a change over time in discrimination was significantly associated with a change over time in depressive symptoms (positive) (b=0.125; P <.001) and self-rated general health (negative) (b=−0.163; P <.05) independent of age, education, or income. Conclusions. The results reported here are consistent with the hypothesis that everyday encounters with discrimination are causally associated with poor mental and physical health outcomes. In this sample of African American women, this association holds above and beyond the effects of income and education. A growing body of evidence from population-based studies indicates that the experience of everyday discrimination is associated with multiple indicators of poorer physical and mental health status. 1 – 10 This evidence is especially clear for mental health status, as self-reported everyday discrimination is consistently associated with poorer mental health across multiple racial or ethnic groups (Whites, Latinos, African Americans) and for both women and men. Evidence for the relationship between discrimination and physical health is more complex. Some studies find a negative effect of discrimination on physical health, some find an effect only under certain conditions, and some find no effect. 1 There is evidence suggesting that everyday experiences of discrimination may contribute to persistent racial inequalities in health, above and beyond that associated with institutional forms of racism such as race-based segregation. 7 , 10 Yet the understanding of the relationship between perceived discrimination and health remains limited by shortcomings of research design and measurement. In their recent literature review, Williams et al. noted that “we do not know the extent to which exposure to perceived discrimination leads to increased risk of disease, the conditions under which this might occur, or the mechanisms and processes that might be involved.” 1 (p202) In part, this uncertainty stems from the fact that previous studies of discrimination and health are overwhelmingly cross-sectional in design. In this article, we address this limitation by examining longitudinal relationships between self-reported everyday discrimination and health among African American women in Detroit, Mich. Previous studies provided limited but suggestive evidence that perceived discrimination may be associated with poorer health status over time. Brown and colleagues analyzed 2 waves of data from the National Survey of Black Americans (NSBA) and found that baseline racial discrimination was associated with subsequent poor mental health. 3 They also reported that baseline mental health status was not associated with subsequent reports of racial discrimination. This finding suggests that the cross-sectional association between discrimination and health reflects more than a tendency for people with poorer mental health to perceive themselves as having been treated unfairly. A separate analysis of NSBA data found that perceived discrimination was associated with poorer mental health and, weakly and surprisingly, with better physical health over a 13-year period. Significantly, these patterns varied with both the measure of health and the measure of discrimination that was used. 4 Both NSBA studies used a single-item measure of perceived discrimination that assessed whether individuals or their families had been treated badly in the past month. Jackson et al. 4 also used a second single-item measure that asked respondents to select from 3 choices: “Whites want to keep Blacks down.”; “Whites want to see Blacks get a better break.”; or “Whites just don’t care one way or the other about Blacks.” We used longitudinal data from a survey of African American women residing in Detroit to examine the relationships between a change over time in experiences of perceived discrimination and change over time in symptoms of depression and general self-reported health. Our measure of perceived discrimination was a 5-item scale assessing everyday discrimination. 9 Our health outcome measures were the short-form Center for Epidemiologic Studies Depression Scale (CES-D) to assess symptoms of depression, 11 and a single-item indicator assessing general self-reported health status. 12 Previous analyses from the first wave of this study demonstrated that perceived discrimination is associated with poorer health cross-sectionally in this sample. 7 , 13 We used change or conditional models to test the hypothesis that a change over time in discrimination is associated with a change over time in self-reported symptoms of depression (positive) and in self-reported general health status (negative).
