Racial Discrimination and Mental Health among Asian Americans during the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has had devastating health, economic, and social effects on people throughout American society. At the same time, racism spread alongside the virus. As China was blamed for COVID-19, Asian Americans became targets of prejudice and discrimination. In this study we document the racism experienced by Asian Americans during the pandemic and explore its link to mental health. Using the National Couples’ Health and Time Study’s Asian American oversample, we investigate the relationship between discrimination and COVID stress and mental health outcomes during the pandemic (anxiety, depression, and life satisfaction). We consider potential moderating variables (racial/ethnic identity centrality, community support, relationship satisfaction, and social support). We find among Asian American respondents, higher levels of reported discrimination and COVID-19 stress were associated with more depressive symptoms, anxiety and lower life satisfaction. Higher social support and relationship satisfaction were associated with better well-being, but we found little evidence of moderation. As we move beyond the pandemic, researchers should continue to document the persistence and variability of anti-Asian discrimination, its impacts on Asian American mental health and well-being, and potential protections and interventions.

The COVID-19 pandemic has upended the lives of Americans, profoundly affecting their health, security, and well-being, as it has for people around the globe. U.S. unemployment reached 14.8%, more than one-third of Americans were food insecure, and many experienced mental health declines (Congressional Research Service 2021; Reading Turchioe et al. 2021; Wolfson and Leung 2020). Political rhetoric racializing COVID-19 as the “China Virus” reinforced and escalated anti-Asian sentiment and violence. While anti-Asian racism has a long history in the United States, Asian Americans reported increasing discrimination since the pandemic. Between March 2020 and December 2021, over 10,000 anti-Asian incidents were reported in the U.S. (Yellow Horse et al. 2021). High profile incidents including the Atlanta Spa shootings and attacks on Asian elders and others across the age spectrum contributed to racial trauma among Asian Americans. The rise in anti-Asian discrimination is concerning for many reasons, including that racism is a known social determinant of health (Lee and Ahn 2011). Extant research suggests that Asian Americans, like Black and Latinx Americans, report fewer mental health problems than white Americans despite experiencing racism (Erving, Thomas and Frazier 2019; Keyes 2009), and further research is needed to better understand the relationship between discrimination and well-being in racially minoritized groups. Further, the “model minority” stereotype perpetuates a view that Asian Americans are devoid of serious problems and not in need of social science or policy attention (Shih, Chang and Chen 2019). Racism experienced by Asian Americans has been largely hidden or ignored even though it has long been a defining feature of American life (Tessler, Choi and Kao 2020). This paper documents the experiences of Asian Americans during the COVID-19 pandemic, examines the association between discrimination and pandemic-related stress and mental health, and examines Asian American subgroup differences.

Despite the perception of Asian Americans as fully integrated and successful, some research has found significant mental health issues and high rates of suicidal ideation and behaviors among this population (Shih, Chang and Chen 2019). These are not only hidden due to social science inattention to Asian Americans, but also because when Asian Americans are included in analyses, they are often treated as a homogeneous group, disregarding important differences in socioeconomic status, nativity, education, ethnic and regional origins, language, and racialized experiences. Indeed, a major shortcoming of research on Asian Americans is it often fails to disaggregate data, and thus obscures critical differences within the pan-ethnic group (Lee and Waters 2021; Wu, Qian and Wilkes 2021). By focusing primarily on within group differences among Asian Americans, we aim to begin to parse out the ways in which the pandemic and racism were experienced by different subgroups of Asian Americans.

We draw on the social stress framework in conceptualizing our research questions and analysis. Social stress theory argues that systemic social stressors can harm health and well-being (Aneshensel 1992). According to this model, stigma and discriminatory treatment contribute to the greater stressors that marginalized groups experience that negatively impact their mental health (Carter 2007; Pearlin 1989; Pearlin and Bierman 2013; Wu, Qian, and Wilkes 2021). Psychosocial resources like social support can protect against these detrimental effects (Mossakowski and Zhang 2014; Thoits 2011).

Using population representative data from Asian Americans collected during the pandemic as part of the National Couples’ Health and Time Study (Kamp Dush et al. 2023), we ask four key questions. First, to what extent have Asian Americans experienced discrimination and COVID-19 stress during the pandemic? Second, how are experiences with discrimination and COVID-19 stress among Asian Americans associated with depression, anxiety, and life satisfaction? Third, do psychosocial resources moderate the negative associations between discrimination and COVID-19 stress and mental health for Asian Americans? Finally, how did Asian Americans fare compared to other racial groups? This research will advance our understanding of the experiences and mental well-being of Asian Americans during the pandemic.

Anti-Asian Racism and the COVID-19 Pandemic

The COVID-19 pandemic in the United States unleashed racism and discrimination against Asian and Asian Americans. A Pew Research Center poll taken during 2020 found that 39% of Asian adult respondents said it was more common for people to express racism against Asians during the pandemic than before, 40% reported that others acted uncomfortable around them, 31% reported being subjected to racial slurs or jokes, and 26% reported being fearful that they would be threatened or physically attacked (Ruiz, Menasce Horowitz and Tamir 2020). Lee and Waters (2021) found that approximately one-third of their Asian respondents reported being discriminated against during the early months of the pandemic. Comparing Asian Americans and white Americans during the early pandemic, Wu et al. (2021) found that Asian Americans were more likely to encounter discrimination that exacerbated COVID related stress. This widespread anti-Asian racism was fueled by political and racialized rhetoric that blamed China, and more broadly Asians, for spreading the virus. Racialized scapegoating and blame are not new, and mirrors the ways in which Arab Americans were portrayed as terrorists following 9/11 (Cheng et al. 2021). The COVID-19 pandemic appears to be an important context in which anti-Asian racism has intensified. In their experimental study, Lu, Kaushal, et al. (2021) found that priming COVID-19 increased prejudice and discriminatory intent against Asians through the perception that they were culturally incompatible and irresponsible.

Racism and xenophobia against Asians have a long history in the United States. Since large-scale migration in the 19^th century, Asians have been cast as perpetual foreigners and a yellow peril, viewed as carrying virulent infectious disease and posing economic and political threats (Lee 2015; Tessler et al. 2020; Wu et al. 2021). These long-held and persistent stereotypes led to perceptions of Asian and Asian Americans as suspicious, dangerous, and untrustworthy. Such characterizations have contributed to structural racism and discriminatory treatment as exemplified by Japanese American World War II incarceration, the Chinese Exclusion Act, discriminatory alien land laws, exclusion from naturalized citizenship, and anti-Asian violence, bigotry, and mistreatment. During the pandemic, these harmful views of Asian Americans have been inflamed, further fueling COVID-related anti-Asian racism and violence.

Often viewed as a homogeneous racial group, Asian Americans are comprised of people with ancestry from more than 20 ethnic groups, with diverse cultural, language, and religious backgrounds, distinct immigrant histories, and with different social structural locations (Budiman and Ruiz 2021; Lee 2019; Okamoto 2007). Despite being the nation’s fastest growing racial group (Budiman and Ruiz 2021), Asian Americans are largely invisible in social science research, policy, and public concern. Perceived as outsiders or “alien in one’s own land” and not as “real” Americans, Asian American concerns have not been viewed as worthy of attention (Sue et al. 2007; Tuan 1999). Further, contemporary stereotypes cast Asian Americans as “model minorities” immune to serious problems or disparities. Often citing high average educational, occupational, and income attainment, this stereotype conceals the vast inequities within Asian America. In fact, income inequality within Asian America is greater than it is for any other racial group, with some Asian ethnic groups such as Indians having very high incomes while others, such as Burmese have very low incomes (Kochhar and Cilluffo 2018). These disparities are rendered invisible by characterizations that portray Asian Americans as widely successful, well-resourced, and well-adjusted.

The model minority stereotype suggests that unlike other racial minoritized groups, Asian Americans do not encounter racism—even as many Asian Americans report personally having experienced discrimination and almost all report having experienced “vicarious racism” or witnessing other Asians being targets of racism (Chen et al. 2020; Ong et al. 2013). Difficult living conditions, workplace and housing barriers, inadequate access to linguistically and culturally resonant health and other services, and indignities of racial stigma and mistreatment remain largely unnoticed when Asian Americans are viewed through the lens of the success myth. Given this, it is not surprising that relatively few research dollars have been allocated to research on Asian Americans. For example, only .17% of National Institute of Health funding since 1992 focused on studying Asian Americans (Chen et al. 2020; Đoàn et al. 2019).

Recognizing the heterogeneity among Asian Americans in various domains, including the domains of health and mental health, is important. Given different histories, status, structural positions, and racialization, there are group differences in self-reported everyday discrimination and reported chronic health conditions between Asian ethnic and regional groups (Gee et al. 2007). For instance, Southeast Asians have higher rates of psychiatric disorders, anxiety, and PTSD compared to other Asian groups and are more likely to be refugees with pre-migration trauma (Hsu et al. 2004; Kinzie et al. 1990; Lee, Martin, Lee 2015). Cho and colleagues (2022) found higher rates of mental distress among Korean and Vietnamese ethnic subsamples compared to the Chinese subgroup, and negative effects of discrimination were more profound for the Vietnamese subsample in a regional Asian American survey. South Asians have been found to have less mood and anxiety disorders compared with other Asian Americans, although with gender differences (Masood, Okazaki, and Takeuchi 2009). For this reason, our study considers potential subgroup differences. Given the politicalization of the pandemic, widespread blame on China, and by extension Chinese people, and the amplified anti-Asian sentiment that followed, we anticipated that those Asian subgroups more likely to be perceived as Chinese due to phenotype and assumptions of cross-ethnic homogeneity (East Asians and possibly Southeast Asians) might have heightened experiences with discrimination and stress during the pandemic compared to Asian subgroups racialized in other ways (South Asians). Thus, we examined East Asian, Southeast Asian, and South Asian for possible subgroup variation.

Social Stress Theory

The social stress process model theorizes the potential harmful effects of social stressors on health and well-being (Aneshensel 1992). Stigma, prejudice, and discrimination can act as significant stressors that contribute to mental health difficulties among minoritized populations (Harrell 2000; Meyer 2003; Pearlin 1989; Pearlin and Bierman 2013). Climates where racism proliferates can trigger “race-based traumatic stress” in which racial discrimination generates acute stress causing psychological harm (Carter 2007).

Although less studied than other marginalized groups, racial discrimination negatively impacts Asian American mental health contributing to such problems as anxiety, depression, psychological stress, sleep disruption, negative affect, and somatic symptoms (Gee et al. 2009; Hwang and Goto 2008; Lee and Ahn 2011; Lee and Waters 2021; Lewis, Cogburn and Williams 2015; Ong et al. 2013). Asian Americans’ experiences with discrimination can produce race-related stress negatively affecting mental health above and beyond general stress (Cheng et al. 2021; Wu et al. 2021). Cho and colleagues (2022) found perceived discrimination was associated with 1.9 times higher odds of mental distress controlling for other background factors, and varied by ethnic group. Furthermore, scholars found that even those who have not reported direct racism may be negatively affected by racism targeted at loved ones or other Asian Americans through vicarious racism which also causes harm (Cheng et al. 2021; Lewis et al. 2015).

Treatment as perpetual foreigners and not as full members of American society has been at the root of frequent microaggressions experienced by Asian Americans (Sue et al. 2007). Microaggressions are experienced by Asian Americans more frequently than other racial groups, and although sometimes viewed as trivial, they are associated with lower levels of social belonging and life satisfaction (Huynh, Devos and Smalarz 2011; Lee and Waters 2021), increased anxiety and depressive symptoms, and somatic symptoms (Hwang and Goto 2008; Sue et al. 2007; Wong et al. 2014).

COVID 19 brought frequent and severe incidents of animosity towards Asian Americans, and this hostile context may have intensified race-related stress (Cheng et al. 2021). Research conducted during the initial months of the pandemic found Asian Americans encountered more COVID related discrimination than whites and this discrimination was associated with elevated anxiety, depression, physical symptoms, and sleep difficulties (Lee and Waters 2021, Wu et al. 2021). Our study examines beyond these early months of the pandemic, as associated discrimination and stress continued.

Furthermore, the COVID pandemic brought uncertainty and stress about the health consequences of the virus. Research found anticipatory stress about a person or their loved ones becoming ill with the virus had negative impacts on mental well-being. These worries were compounded by other concerns such as racial discrimination in health care settings (Cobb, Erving, and Byrd 2021), and varied by age and gender (Niño et al. 2020). In this study we examine COVID stress related to the respondent or their family members contracting the virus and its relation to mental health among Asian Americans.

Social Support and Racial Identity and Community as Protective Factors

Social stress theory also attends to psychosocial resources that can buffer against the damaging effects of social stressors (Thoits 1995, Thoits 2011) including those that mitigate the detrimental effects of racial discrimination on mental health (Cho et al. 2022; Thomas Tobin, Erving and Barve 2021; Williams 2018). Although social support has been found to buffer the negative effects of discrimination on health, extant research yields mixed results on the types of social support that attenuate the impacts of racial discrimination on mental distress for Asian Americans. In some instances, family, spouse, or friend support has buffering effects, and in other instances, it does not (Kim and Epstein 2021, Mossakowski and Zhang 2014). Mossakowski and Zhang (2014) found that among Asian Americans, family support buffered stress from discrimination that caused a serious problem, but not stress from everyday discrimination, and support from friends was not stress buffering. Kim and Epstein (2021) found neither family nor friend social support reduced the negative effects of racism on Asian American physical or mental health. Woo and Jun (2022) found social support from spouses (but not friends) buffered the detrimental impact of COVID-related discrimination on depression for Asian Americans during the early pandemic. Given prior research, we examine the potential moderating effects of social support from family and friends for Asian Americans during COVID.

Relationship quality may also buffer the negative impacts of stress and discrimination. Hatzenbuehler (2009) argued that stigma-related stress can create problems in intimate relationships, undermining mental health. There is evidence of stress spillover for Asian American parents such that COVID-19 stress was associated with poorer relationship quality (Huang and Tsai 2023). Yet having a strong relationship in the context of high stress may attenuate the negative effects of that stress for mental health (Edwards, Nazroo and Brown 1998), thus we test the moderating role of relationship quality.

Both individual and collective psychosocial resources may be beneficial in navigating discriminatory contexts (Cheng et al. 2021). Some research suggests a strong racial-ethnic identity can buffer the harmful effects of racism because feeling confident and rooted in one’s racial-ethnic group may serve as a resource when encountering discrimination (Umaña-Taylor et al. 2014; Yip et al. 2019). While having the potential to garner strength in the face of racial hostility, other research suggests racial identity centrality can heighten perceptions of discrimination or contribute to internalized stigma with negative consequences for mental health (Cheng et al. 2021). Calling for greater attention to “linked fate” in mental health research, Monk argues that ethnoracial identity can act as a collective threat within a context of stigmatization, structural inequality, and group vulnerability (2020). Monk found that a perception of linked fate, or the view that what happens to others in one’s group affects one’s life, was associated with lower mental health outcomes in a nationally representative sample of African Americans (2020). For Asian Americans in the COVID pandemic context, it may be that heightened stigmatization and collective threat intensified with anti-Asian rhetoric and acts which may have weakened potential protective effects of racial-ethnic identity. Location may matter as well. Living in a community of persons who share one’s ethnoracial identity or is perceived to support one’s ethnic/racial group may counter marginalization. However, social distancing in the pandemic context may have intensified isolation from one’s racial-ethnic community during a time of increasing media reports documenting anti-Asian bias. We examine the potential buffering effects of racial/ethnic identity centrality and racial climate in one’s community for Asian Americans during the COVID pandemic.

Current Study

There are challenges to studying Asian American experiences with discrimination and mental health. Although the Asian American population is rapidly growing, comprising approximately 7% of the U.S. population (Budiman and Ruiz 2021), its relatively small size has made it challenging to conduct fully powered studies on Asian American samples. Partially due to the model minority tropes, most quantitative research that examines racial discrimination’s effects on health compare white, Black, and sometimes Latine samples, and Asian Americans have been excluded or have been grouped in an “other” category, limiting our understanding of their unique experiences with racism and stress. In addition, the heterogeneity of Asian Americans with regards to socioeconomic status, ethnicity, and immigration history, makes it problematic to categorize them into a single racial group without obscuring important differences. Despite the wide diversity within the umbrella category “Asian,” they share similarities in how they have been racialized, discriminated against, and viewed as interchangeable racial objects (Cheng et al. 2021). During the COVID 19 pandemic, individuals from varied Asian ethnic groups, particularly those of East and Southeast Asian descent, reported racist incidents, were blamed for the virus, and were targeted with anti-Chinese rhetoric (Borja et al. 2020). For these reasons the National Couples’ Health and Time Study team collected an oversample of Asian American respondents. We focus our analysis within the Asian American group to identify important factors that may contribute to experiences with discrimination, discrimination’s relationship to mental health, and sources of resilience that may mitigate the impact of discrimination on well-being.

It is important to note that our data come from the National Couples’ Health and Time Study, which focused on married and cohabiting persons. Previous research suggests that marriage is associated with greater wellbeing likely due to various forms of partner support and social integration (Idler et al. 2012; Reczek et al. 2018; Waite and Gallagher 2001). This marital advantage may have extended into the pandemic (Thomeer et al. 2023). Further, extant research shows that Asian American adults are more likely to be partnered than other racial groups (Juteau 2023). Results should be interpreted with this in mind.

Our work addresses four research questions. First, to what extent have Asian Americans experienced discrimination and COVID stress during the pandemic? Second, how are experiences with discrimination and COVID stress among Asian Americans associated with mental health and well-being? Based on the stress process models we expected COVID-19 stress to be positively associated with anxiety and depression, and negatively associated with life satisfaction. Third, do, and if so what, resources among Asian Americans buffer discrimination and COVID stress effects on mental health? We anticipated that racial/ethnic identity centrality, perceptions of a supportive ethnoracial community, relationship satisfaction, and social support would moderate associations between discrimination and COVID-19 stress on mental health. Finally, we compare Asian Americans to other racial groups to identify if Asian Americans had elevated experiences with discrimination, COVID stress, and mental health problems compared to non-Asian respondents.

Methods

This analysis primarily focuses on the Asian American subsample of the National Couples’ Health and Time Study (NCHAT). NCHAT is a study of same- and different-gender couples collected from September 2020 to April 2021 (Kamp Dush et al. 2023). NCHAT respondents were primarily recruited from the Gallup Panel, a probability-based nationally representative panel of approximately 110,000 individuals. To be included in, respondents had to be between the ages of 20 to 60, living with a spouse/partner, and able to read English or Spanish. Given the uptick in racial violence against Asian Americans, NCHAT purposively collected an oversample of Asian Americans to meaningfully examine discrimination, stress, and health during the pandemic from a population-representative sample of Asian Americans. The main dataset includes survey data from 3,642 main respondents. The Asian American sample includes 301 main respondents who self-identified as at least one of the seven listed Asian ethnicities in the survey: Asian Indian, Chinese, Filipino/a/x, Japanese, Korean, Vietnamese, Other Asian and were not missing any data on any study variables.

Measures

Discrimination and COVID stress.

Discrimination.

Respondents were asked, “In your day-to-day life over the past month, how often did any of the following things happen to you?” and included nine domains, including “You were treated with less respect than other people” and “You were threatened or harassed” on a scale of 1 (never) to 5 (very often) (Meyer et al. 2016; Williams et al. 1997). A sum of the 9-items was taken (α = .86 for the full sample and .89 for the subsample of Asian respondents), with a higher value indicating more frequent experiences of discrimination. COVID-19 Stress was measured by summing 3-items (α = .86 for the full sample and .88 for the subsample of Asian respondents), assessing stress about 1) yourself getting coronavirus, 2) your partner getting coronavirus, and 3) your parents, siblings, or other family members getting coronavirus on a 5-point scale from not at all stress to very stressed.

Mental Health.

Depression was measured using the 10-item Center for Epidemiological Studies-Depression (CES-D) Short Form (Andresen et al. 1994). Respondents were asked how often they felt certain ways (e.g., lonely, depressed) in the past seven days on a 3-point scale from Rarely or none of the time (less than 1 day) to Most or all of the time (5–7 days). The items were summed (α = .87 for the full sample and .87 for the subsample of Asian respondents). Anxiety was measured using the 7-item Generalized Anxiety Disorder measure (Spitzer et al. 2006; Tiirikainen et al. 2019). Respondents were asked how often they were bothered by seven different problems in the past seven days (e.g., not being able to stop or control your worrying) on a 4-point scale from not at all to nearly every day. The items were summed (α = .92 for the full sample and .92 for the subsample of Asian respondents). Respondents reported their current Life Satisfaction on 11-point scales from the worst possible life (0) to the best possible life (10) (Cantril 1965).

Moderators.

Community racial climate was measured by respondents reporting whether the city or area where they live was a good place (5) or not a good place (1) to live for individuals who are racial and ethnic minorities (Meyer et al. 2016). Social Support was measured separately for three domains, including partner, family, and friends (Procidano and Heller 1983). For each domain, respondents were asked “How much do you rely on each of the following people for emotional support … I rely on my partner/spouse for emotional support, I rely on my family for emotional support, I rely on my friends for emotional support.” Responses ranged from 1 ‘Not at all’ to 5 ‘A great deal.’ Relationship Satisfaction (Funk and Rogge 2007) was measured as the sum of four items (α = .89 for the full sample and .91 for the subsample of Asian respondents), including “Please indicate the level of happiness, all things considered, in your relationship” on a scale from 1 (extremely unhappy) to 7 (perfect); “I have a warm and comfortable relationship with my spouse/partner I have a warm and comfortable relationship with my spouse/partner” on a scale from 1 (not at all true) to 6 (completely true); “How rewarding is your relationship with your spouse/partner?” on a scale from 1 (not at all rewarding) to 6 (completely rewarding); and “In general, how satisfied are you with your relationship?” on a scale from 1 (not at all satisfied) to 6 (completely satisfied). Racial/ethnic identity centrality was measured as “My racial or ethnic identity is a central part of my identity” on a 1 (strongly disagree) to 5 (strongly agree) scale.

Sociodemographic Variables.

Asian Region is a 4-category variable constructed from respondent’s reports of Asian ethnicities. Respondents identified as either “Chinese,” “Japanese,” or “Korean” were coded as “East Asian,” “Asian Indian” as “South Asian,” and “Filipino” and “Vietnamese” as “Southeast Asian.” Those who identified with multiple Asian ethnicities across these three regions and those who selected “Other Asian” were coded in the fourth category, “Other Asian and multiregion.” A dichotomous indicator for foreign born was constructed if the main respondent was born outside the United States. Education was divided into three categories: high school degree or less, some college or post-high school education, and a Bachelor’s degree or more. Employment was a categorical indicator of whether the respondent was employed full or part-time. Age was constructed using the respondent’s birth month and year and the month and year they completed the survey. Respondents reported if they were legally married to their spouse/partner. Respondents completed a household roster and reported demographic characteristics of all members of their household. Respondents reported their gender from five options, including Woman, Man, Trans Woman, Trans Man, and some other gender identity. For these analyses, we created a three-category variable: cis-Woman, cis-Man, and Transgender/Non-binary. Household children was a dichotomous variable indicating the presence of persons under the age of 18 living in their household, including grandchildren. In supplemental analyses that compared the Asian sample to the full NCHAT sample, race/ethnicity was coded as Asian, Non-Hispanic White, Non-Hispanic Black, and Hispanic (not Asian). We use the term Hispanic to include those who identify as Latina/o/e/x and Hispanic.

Analytic Plan

Analyses were conducted in STATA 16.0. Descriptive statistics for all study variables, including the weighted means or percents, standard deviations, minimum, and maximum values, are reported in Table 1. Table 2 shows the weighted percentages of Asian respondents who have experienced any form of discrimination in the past month or are currently experiencing COVID-19 stress. Table 3 shows bivariate regression analyses for the three mental health outcomes on key independent variables for the full sample and separately by Asian American subgroup. We then present nested ordinary least square regression models for the three measures of mental health outcomes in Tables 4 through 6 with the final two models in each table testing for moderation. All analyses were weighted, and we used the subpopulation command to accurately estimate standard errors of the estimates. All models were checked for multicollinearity prior to performing the analyses by checking variance inflation factors. All variance inflation factors were under 10, indicating that concerns for multicollinearity within models are low (Salmerón, García and García 2018).

Table 1.

Descriptive Statistics for All Study Variables, by Asian Subgroups

Variable	Weighted Mean/Percent
	Total Asian Sample	East Asia	South Asia	Southeast Asia	Other or Multiregion
N	301	139	63	52	47
Mental Health Outcomes
Depression	8.66	8.40	8.70	8.86	9.12
Anxiety	11.95	11.27	11.21	13.92*	12.66
Life Satisfaction	7.12	7.26	6.76	7.54	6.78
Key Independent Variables
Discrimination	13.91	13.98	13.45	14.04	14.24
COVID-19 Stress	8.41	8.17	8.42	8.04	9.49
Social Support: Partner	3.87	3.78	3.77	3.96	4.18
Social Support: Family	3.27	3.25	3.35	3.20	3.30
Social Support: Friends	3.1	3.23	3.08	2.77*	3.12
Couple Satisfaction Index	14.53	13.90	13.42	16.85***	15.24
Community Support Race	3.84	3.86	3.79	3.71	3.98
Racial/Ethnic Identity Centrality	3.65	3.71	3.42	3.61	3.91
Key Controls
Asian Regions
East Asia	43.63%	-	-	-	-
South Asia	23.05%	-	-	-	-
Southeast Asia	17.95%	-	-	-	-
Other Asian or Multiregion	15.37%	-	-	-	-
Foreign Born	41.42%	31.10%	70.03%***	33.54%	37.02%
Education
High school or less	1.82%	2.43%	0%**	2.01%	2.62%
Some College	12.54%	13.37%	2.4%**	19.95%	16.75%
College +	85.63%	84.20%	97.6%**	78.03%	80.63%
Employment Status
Not Employed	16.82%	10.80%	20.75%	16.25%	28.65%
Employed	83.18%	89.20%	79.25%	83.75%	71.35%
Age	40.01	40.22	40.64	39.34	39.29
Married	83.42%	77.45%	90.06%	88.59%	84.37%
Gender
Cis Men	54.26%	58.28%	63.69%	42.16%	42.84%
Cis Women	45.13%	41.63%	33.96%	57.71%	57.16%
Transgender/Non-Binary	0.61%	0.10%	2.34%	0.13%	0.00%
Having Children under 18
No	43.36%	46.15%	31.73%	53.53%	40.98%
Yes	56.64%	53.85%	68.27%	46.47%	59.02%

Note: 1.

^*p<0.05

^**p<0.01

^***p<0.001, indicating that values for the corresponding Asian subgroups are statistically different from those for East Asians (reference group).

Source: National Couples’ Health and Time Study

Table 2.

Detailed Descriptive Statistics of Discrimination and COVID-19 Stress by Item (N=301; weighted)

Survey Item	% Ever Experienced	N	Weighted %	Unweighted Mean (Range 1–5)	SD	Weighted Mean
Discrimination (in the past month)
You were treated with less respect than other people.	66.00	198	67.27	1.97	0.88	2.00
You received poorer service than other people at restaurants or stores.	50.33	151	51.80	1.72	0.86	1.72
People acted as if they were afraid of you.	31.00	93	31.80	1.43	0.74	1.46
People acted as if they thought you were dishonest.	31.00	93	32.80	1.43	0.73	1.42
People acted as if they were better than you.	62.00	186	65.25	2.11	1.10	2.17
You were called names or insulted.	30.67	92	31.14	1.44	0.78	1.45
You were threatened or harassed.	24.33	73	25.20	1.35	0.69	1.35
You were hit, beaten, physically attacked, or assaulted.	7.00	21	7.42	1.08	0.32	1.08
You were robbed, or your property was stolen, vandalized, or purposely damaged.	6.00	18	6.89	1.09	0.40	1.10
COVID-19 Stress (currently)
Stress about yourself getting coronavirus	77.33	232	72.91	2.66	1.27	2.48
Stress about your partner getting coronavirus	79.00	237	73.44	2.86	1.36	2.68
Stress about your parents, siblings, or other family members getting coronavirus	89.67	269	88.69	3.31	1.27	3.21

Source: National Couples’ Health and Time Study

Table 3.

Bivariate Regression Coefficients of Each Key Independent Variable for Each Mental Health Outcomes, by Asian Subgroups

	Total Asian Sample		East Asia		South Asia		Southeast Asia		Other or Multiregion
Independent Variable	B	SE	B	SE	B	SE	B	SE	B	SE
Bivariate Regression of Depression on Key Factors
Discrimination	0.55***	0.07	0.57***	0.08	0.41*	0.21	0.63***	0.15	0.53*	0.26
COVID-19 Stress	0.48***	0.13	0.44*	0.21	0.22	0.28	0.55*	0.24	0.83**	0.30
Community Racial Climate	-1.48***	0.44	-2.55***	0.47	0.09	1.00	-2.15*	1.03	0.33	1.22
Social Support: Partner	-1.19**	0.43	-0.76	0.50	-1.98***	0.66	-1.09	1.18	-1.74	1.81
Social Support: Family	-1.28***	0.35	-1.25*	0.50	-0.74	0.75	-1.13	0.91	-2.28**	0.83
Social Support: Friends	0.06	0.38	-0.35	0.54	0.56	0.64	-0.45	0.90	1.09	1.30
Relationship Satisfaction	-0.47***	0.10	-0.47***	0.11	-0.54***	0.16	-0.83***	0.21	-0.35	0.44
Centrality of Racial/Ethnic Identity	0.57	0.42	-0.16	0.68	1.05	0.67	1.72*	0.79	1.03	1.08
Bivariate Regression of Anxiety on Key Factors
Discrimination	0.46***	0.07	0.54***	0.09	0.10	0.16	0.67***	0.13	0.29*	0.14
COVID-19 Stress	0.51***	0.11	0.60**	0.20	0.09	0.21	0.54*	0.25	0.83	0.19
Community Racial Climate	-1.38***	0.43	-2.32***	0.59	0.55	0.67	-1.89	0.96	-0.67	1.22
Social Support: Partner	-0.32	0.34	0.05	0.42	-1.04*	0.52	-0.95	0.96	-0.28	1.19
Social Support: Family	-0.57	0.33	-0.33	0.50	-0.77	0.59	-0.68	0.81	-0.71	0.90
Social Support: Friends	-0.13	0.32	-0.24	0.45	0.05	0.47	-0.64	0.84	1.13	0.92
Relationship Satisfaction	-0.13	0.07	-0.14	0.08	-0.21	0.12	-0.60***	0.19	-0.03	0.29
Centrality of Racial/Ethnic Identity	0.24	0.37	-0.05	0.65	0.14	0.59	1.22	0.66	-0.06	0.80
Bivariate Regression of Life Satisfaction on Key Factors
Discrimination	-0.10***	0.02	-0.10***	0.03	-0.04	0.06	-0.03	0.05	-0.20*	0.10
COVID-19 Stress	-0.13***	0.04	-0.14***	0.04	-0.09	0.08	-0.07	0.07	-0.20	0.10
Community Racial Climate	0.41***	0.12	0.63***	0.12	0.19	0.27	0.26	0.22	0.23	0.50
Social Support: Partner	0.35**	0.12	0.23	0.13	0.78***	0.21	0.39	0.31	0.03	0.43
Social Support: Family	0.29**	0.11	0.28*	0.11	0.25	0.26	0.28	0.32	0.50	0.26
Social Support: Friends	0.11	0.10	-0.03	0.13	0.21	0.20	0.26	0.22	0.27	0.30
Relationship Satisfaction	0.13***	0.02	0.13***	0.03	0.18***	0.05	0.19**	0.06	0.04	0.09
Centrality of Racial/Ethnic Identity	-0.12	0.12	-0.13	0.16	0.04	0.23	-0.42	0.22	0.04	0.45
N	301		139		63		52		47

Notes: 1.

^*p<0.05

^**p<0.01

^***p<0.001;

2. Source: National Couples’ Health and Time Study, 2020–21.

Table 4.

Ordinary Least Squares Regression Results for Depression (among the full Asian sample N = 301; weighted)

Independent Variable	Model 1		Model 2		Model 3		Model 4		Model 5
	B	SE	B	SE	B	SE	B	SE	B	SE
Discrimination			0.48***	(0.07)	0.41***	(0.06)	0.42**	(0.16)	0.57***	(0.14)
COVID-19 Stress			0.28**	(0.11)	0.27**	(0.10)	-0.25	(0.26)	-0.07	(0.29)
Community Support Race					0.02	(0.40)	0.09	(0.38)	0.06	(0.41)
Social Support: Partner					0.47	(0.35)	0.48	(0.36)	0.53	(0.36)
Social Support: Family					-1.19***	(0.30)	-2.47**	(0.78)	-1.17***	(0.30)
Family Support × Discrimination							-0.00	(0.05)
Family Support × COVID-19 Stress							0.16*	(0.07)
Social Support: Friends					0.25	(0.28)	0.23	(0.28)	0.30	(0.28)
Couple Satisfaction Index					-0.52***	(0.09)	-0.52***	(0.09)	-0.56**	(0.20)
Couple Satisfaction Index × Discrimination									-0.01	(0.01)
Couple Satisfaction Index × COVID-19 Stress									0.02	(0.02)
Centrality of Racial/Ethnic Identity					0.21	(0.29)	0.25	(0.29)	0.22	(0.28)
Asian Regions (ref: East Asia)
South Asia	0.48	(1.15)	0.97	(0.97)	1.21	(0.89)	1.20	(0.89)	1.23	(0.89)
Southeast Asia	-0.09	(1.25)	-0.16	(1.01)	1.32	(0.92)	1.42	(0.89)	1.42	(0.94)
Other Asian or multiregion	0.05	(1.23)	-0.28	(1.10)	0.40	(0.98)	0.65	(0.94)	0.30	(0.98)
Foreign Born	-0.49	(0.97)	-1.33	(0.72)	-1.44*	(0.67)	-1.34*	(0.66)	-1.45*	(0.68)
Education (ref: High School or less)
Some College	0.00	(3.76)	2.11	(2.44)	2.55	(1.55)	2.71*	(1.29)	2.90*	(1.31)
College+	0.86	(3.61)	1.62	(2.26)	1.23	(1.43)	1.37	(1.16)	1.63	(1.13)
Employment (ref: Not employed)
Employed	-2.73	(1.45)	-2.12	(1.17)	-1.04	(1.03)	-0.80	(1.08)	-1.15	(1.09)
Age	-0.07	(0.04)	-0.06	(0.04)	-0.10**	(0.04)	-0.11**	(0.04)	-0.10**	(0.04)
Married	-0.16	(1.27)	1.47	(1.01)	1.72	(0.93)	1.62	(0.90)	1.81	(0.93)
Gender (ref: Cis Man)
Cis Woman	1.79*	(0.87)	0.88	(0.75)	0.96	(0.65)	1.06	(0.63)	0.86	(0.65)
Transgender/Non-Binary	2.62	(1.51)	0.72	(1.33)	-2.64	(1.49)	-2.68	(1.48)	-2.88	(1.52)
Household Children <18 (ref: No)
Yes	-1.74	(0.91)	-1.89*	(0.78)	-1.78**	(0.68)	-1.80**	(0.67)	-1.69*	(0.67)
Constant	13.49**	(4.23)	2.15	(3.07)	11.49**	(3.60)	15.01**	(4.56)	11.09**	(3.75)
N	301		301		301		301		301
F	2.82***		8.11***		14.63***		13.19***		15.52***
R-squared	0.10		0.30		0.48		0.49		0.48

Note:

^*p<0.05

^**p<0.01

^***p<0.001

Source: National Couples’ Health and Time Study

Table 6.

Ordinary Least Squares Regression Results for Life Satisfaction (among the full Asian sample N = 301; weighted)

	Model 1		Model 2		Model 3		Model 4		Model 5
Independent Variable	B	SE	B	SE	B	SE	B	SE	B	SE
Discrimination			-0.07***	(0.02)	-0.05*	(0.02)	-0.03	(0.05)	-0.09	(0.05)
COVID-19 Stress			-0.09**	(0.03)	-0.08*	(0.03)	-0.01	(0.09)	-0.00	(0.10)
Community Support Race					0.14	(0.12)	0.13	(0.12)	0.14	(0.12)
Social Support: Partner					0.01	(0.12)	0.01	(0.12)	-0.00	(0.12)
Social Support: Family					0.23*	(0.10)	0.48	(0.25)	0.22*	(0.10)
Family Support × Discrimination							-0.01	(0.01)
Family Support × COVID-19 Stress							-0.02	(0.02)
Social Support: Friends					0.04	(0.08)	0.04	(0.08)	0.03	(0.07)
Couple Satisfaction Index					0.11***	(0.02)	0.11***	(0.02)	0.11	(0.06)
Couple Satisfaction Index × Discrimination									0.00	(0.00)
Couple Satisfaction Index × COVID-19 Stress									-0.01	(0.01)
Centrality of Racial/Ethnic Identity					-0.08	(0.10)	-0.09	(0.10)	-0.09	(0.09)
Asian Regions (ref: East Asia)
South Asia	-0.58	(0.31)	-0.66*	(0.28)	-0.72**	(0.26)	-0.72**	(0.26)	-0.73**	(0.26)
Southeast Asia	0.35	(0.32)	0.35	(0.31)	0.10	(0.30)	0.08	(0.30)	0.08	(0.30)
Other Asian or multiregion	-0.31	(0.41)	-0.20	(0.36)	-0.41	(0.36)	-0.45	(0.36)	-0.39	(0.37)
Foreign Born	-0.03	(0.25)	0.16	(0.23)	0.20	(0.22)	0.19	(0.23)	0.20	(0.23)
Education (ref: High School or less)
Some College	0.47	(0.86)	0.16	(0.66)	-0.00	(0.47)	0.03	(0.48)	-0.09	(0.44)
College+	0.65	(0.78)	0.60	(0.58)	0.67	(0.39)	0.70	(0.40)	0.57	(0.36)
Employment (ref: Not employed)
Employed	0.87*	(0.40)	0.80*	(0.37)	0.45	(0.36)	0.41	(0.36)	0.47	(0.38)
Age	-0.02	(0.01)	-0.02	(0.01)	-0.01	(0.01)	-0.01	(0.01)	-0.01	(0.01)
Married	0.65	(0.43)	0.36	(0.40)	0.29	(0.37)	0.32	(0.37)	0.27	(0.36)
Gender (ref: Cis Man)
Cis Woman	-0.48	(0.25)	-0.28	(0.23)	-0.34	(0.24)	-0.36	(0.23)	-0.31	(0.24)
Transgender/Non-Binary	-0.64	(0.48)	-0.34	(0.47)	0.24	(0.44)	0.24	(0.43)	0.30	(0.45)
Household Children <18 (ref: No)
Yes	0.31	(0.27)	0.32	(0.25)	0.33	(0.24)	0.34	(0.24)	0.30	(0.24)
Constant	6.09***	(0.96)	8.05***	(0.88)	4.91***	(1.02)	4.08**	(1.41)	5.12***	(1.17)
N	301		301		301		301		301
F	2.73**		4.69***		9.25***		8.76***		9.42***
R-squared	0.13		0.22		0.36		0.36		0.36

Note:

^*p<0.05

^**p<0.01

^***p<0.001

Source: National Couples’ Health and Time Study

Results

The description of the sample is provided in Table 1, discrimination was below the midpoint, but COVID-19 stress was above the midpoint. The mental health measures of depression and anxiety were below their midpoints on average. Life satisfaction was above the midpoint. Just under half of the Asian sample identified as East Asian (43%), followed by South Asian (23%), Southeast Asian (18%), and Other Asian or Multiregion (16%). Forty-two percent of the sample was born outside of the U.S. Fifty-four percent of the sample identified as cis-men, 45% identified as cis-women, and less than 1% identified as transgender or gender non-binary. About 84% were married and the average age was 40. Approximately 43% of the sample had no children. A majority had a college education and were employed. Community racial climate, social support, racial/ethnic identity centrality, and relationship satisfaction were above the midpoint.

Table 2 focuses in detail on the discrimination and stress indicators and shows that approximately 2 in 3 Asian respondents reported that they were treated with less respect than other people (67.27%) and that people acted as if they were better than them (65.25%). Just over half of Asian respondents reported that they received poorer service than other people at restaurants or stores (51.80%). Approximately 30% of Asian respondents reported that people acted as if they were afraid of them (31.80%), people acted as if they thought they were dishonest (32.80%), and people called them names or insulted them (31.14%). One in four Asian respondents reported that they were threatened or harassed (25.20%). Less than ten percent reported that they were hit, beaten, physically attacked, or assaulted (7.24%) and robbed, or had property stolen, vandalized, or purposely damaged (6.89%). The majority of Asian respondents reported experiencing stress about themselves (72.91%), their partner (73.44%), or their parents, siblings, or other family members getting coronavirus (88.69%). In supplemental analysis we looked at differences in reports of our measures of discrimination and COVID stress by Asian subgroup (see Online Appendix Table 4). We found that results were similar across all groups for all items with one exception. Those identifying as “Other or multiregion” reported significantly higher stress about their partner getting coronavirus. There were no other significant differences across Asian subgroups.

Table 3 shows bivariate regression analyses for key independent variables on depression, anxiety, and life satisfaction for the full Asian sample and by Asian subgroup. In the full Asian sample, higher discrimination and COVID-19 stress were associated with elevated depression and anxiety and lower life satisfaction. A supportive community racial climate was associated with lower levels of depression and anxiety and higher life satisfaction. Social support from the respondent’s partner/spouse and family were associated with lower levels of depression and anxiety and higher life satisfaction. Higher relationship satisfaction was associated with lower levels of depression and higher levels of life satisfaction. Higher centrality of racial/ethnic identity was associated with higher levels of depression but not the other outcomes.

Given the number of bivariate regression results among the Asian subgroups, we discuss a few key findings. First among the East Asian sample, higher discrimination and COVID-19 stress, and lower community racial climate was associated with poorer mental health in the bivariate analyses. In contrast, higher discrimination was only associated with elevated depression for the South Asian subgroup. Partner support was associated at the bivariate level with better mental health for South Asians. For our Southeast Asian subgroup, elevated discrimination and COVID-19 stress was associated with higher depression and anxiety. Relationship satisfaction was associated at the bivariate level with better mental health for the Southeast Asian subgroup. For those with other or multiregion Asian identities, discrimination was consistently associated with poorer mental health.

Multivariate Analyses: The Role of Discrimination and COVID-19 Stress on Mental Health Outcomes

Nested ordinary least square regression results for depression, anxiety, and life satisfaction are reported in Tables 4, 5, and 6. The first model includes sociodemographic indicators. Southeast Asian respondents reported more anxiety than East Asian respondents. Cis-women reported more anxiety and depression than cis-men, and transgender/non-binary respondents reported higher anxiety than cis-men. Employed respondents had significantly higher life satisfaction. Model 2 added discrimination and COVID-19 stress to the models. Across all three outcomes, higher levels of discrimination as well as COVID-19 stress were associated with significantly higher depressive symptoms and anxiety and lower life satisfaction net of sociodemographic controls.

Table 5.

Ordinary Least Squares Regression Results for Anxiety (among the full Asian sample N = 301; weighted)

Independent Variable	Model 1		Model 2		Model 3		Model 4		Model 5
	B	SE	B	SE	B	SE	B	SE	B	SE
Discrimination			0.38***	(0.07)	0.35***	(0.07)	0.50*	(0.20)	0.49***	(0.12)
COVID-19 Stress			0.36***	(0.10)	0.34***	(0.10)	0.10	(0.32)	-0.08	(0.25)
Community Support Race					-0.24	(0.37)	-0.21	(0.35)	-0.18	(0.35)
Social Support: Partner					0.18	(0.35)	0.19	(0.35)	0.25	(0.34)
Social Support: Family					-0.49	(0.30)	-0.47	(0.88)	-0.47	(0.29)
Family Support × Discrimination							-0.05	(0.06)
Family Support × COVID-19 Stress							0.07	(0.09)
Social Support: Friends					-0.12	(0.26)	-0.11	(0.27)	-0.04	(0.28)
Couple Satisfaction Index					-0.17*	(0.08)	-0.16*	(0.08)	-0.28	(0.16)
Couple Satisfaction Index × Discrimination									-0.01	(0.01)
Couple Satisfaction Index × COVID-19 Stress									0.03	(0.02)
Centrality of Racial/Ethnic Identity					-0.07	(0.26)	-0.04	(0.26)	-0.07	(0.26)
Asian Regions (ref: East Asia)
South Asia	0.25	(0.90)	0.65	(0.77)	0.63	(0.79)	0.64	(0.81)	0.65	(0.79)
Southeast Asia	2.17*	(0.99)	2.14**	(0.78)	2.45**	(0.79)	2.46**	(0.78)	2.61**	(0.80)
Other Asian or multiregion	0.95	(0.99)	0.52	(0.84)	0.79	(0.85)	0.89	(0.84)	0.71	(0.83)
Foreign Born	-0.17	(0.84)	-1.01	(0.64)	-0.99	(0.62)	-0.94	(0.62)	-1.00	(0.62)
Education (ref: High School or less)
Some College	-0.64	(2.82)	1.06	(2.01)	1.27	(1.84)	1.74	(1.63)	1.64	(1.61)
College+	-0.78	(2.70)	-0.31	(1.89)	-0.30	(1.74)	0.11	(1.46)	0.10	(1.43)
Employment (ref: Not employed)
Employed	-0.52	(0.89)	-0.08	(0.72)	0.44	(0.73)	0.47	(0.74)	0.26	(0.73)
Age	-0.06	(0.03)	-0.06	(0.03)	-0.07*	(0.03)	-0.07*	(0.03)	-0.08*	(0.03)
Married	-0.15	(1.12)	1.28	(0.78)	1.38	(0.77)	1.46*	(0.74)	1.50	(0.77)
Gender (ref: Cis Man)
Cis Woman	2.17**	(0.73)	1.24*	(0.59)	1.43**	(0.55)	1.39*	(0.55)	1.31*	(0.55)
Transgender/Non-Binary	2.69*	(1.14)	1.11	(1.02)	0.44	(1.14)	0.30	(1.14)	0.14	(1.12)
Household Children <18 (ref: No)
Yes	-0.76	(0.69)	-0.85	(0.56)	-0.76	(0.61)	-0.71	(0.60)	-0.67	(0.59)
Constant	14.71***	(3.16)	4.89*	(2.46)	10.06**	(3.30)	9.01*	(4.35)	10.52**	(3.24)
N	301		301		301		301		301
F	4.41***		9.97***		12.29***		11.98***		12.56***
R-squared	0.12		0.36		0.40		0.40		0.41

Note:

^*p<0.05

^**p<0.01

^***p<0.001

Source: National Couples’ Health and Time Study

Model 3 included the main effects for the key moderators of community racial climate, social support from their spouse/partner, family, and friends, couple relationship satisfaction, and race/ethnicity identity centrality. More discrimination and COVID-19 stress remained significantly associated with more depressive and anxious symptoms and less life satisfaction. Greater levels of social support from family and higher relationship satisfaction were protective and associated with less depressive symptomology and higher life satisfaction. For anxiety, only higher relationship satisfaction was associated with lower anxiety.

We only tested moderation with the key moderators that were significantly associated with our outcomes – family social support and relationship satisfaction. In Tables 4 through 6, Model 4 included the interaction term for family social support by discrimination, and family social support by COVID-19 stress. In models predicting depressive symptoms, anxious symptoms, and life satisfaction, there was no evidence of any moderation of the negative association between discrimination and mental health except for one significant interaction. The interaction term between COVID-19 stress and family social support was significant for depressive symptoms. Contrary to our expectations, respondents with higher family social support reported higher depressive symptoms in the context of higher COVID-19 stress.

In an analysis for the fourth research question, we compared non-Hispanic Black, Hispanic (non-Asian), and non-Hispanic white mental health to Asian American mental health in the full NCHAT sample. In weighted ordinary least squares regression models predicting discrimination and COVID-19 stress (see Online Appendix Table 1), we find in bivariate models that non-Hispanic white respondents report significantly less discrimination and COVID-19 stress than Asian American respondents. Further, we find that non-Hispanic Black respondents reported significantly more discrimination, while Hispanic respondents report less discrimination as compared to Asian American respondents. There were no bivariate differences in COVID-19 stress between Asian Americans and Black and Hispanic respondents. Following the addition of control variables, the pattern of results was the same with two exceptions - non-Hispanic Black respondent reported more COVID-19 stress than Asian American respondents, and the previously significant difference in COVID-19 stress between non-Hispanic white and Asian respondents was no longer statistically significant.

In weighted ordinary least squares regression models examining depression, anxiety, and life satisfaction, we found few between-race differences (see Online Appendix Table 2). In no models were there any significant differences between non-Hispanic white and Asian respondents. Non- Hispanic Black respondents reported significantly lower depression and anxiety than Asian respondents, even after accounting for discrimination and COVID-19 stress. Hispanic respondents reported significantly lower depression than Asian respondents across all models. For life satisfaction, Hispanic respondents reported higher life satisfaction, but the association was no longer statistically significant following the addition of discrimination and COVID-19 stress.

Finally, we examined separate weighted ordinary least squares regression models for each racial/ethnic group of the association between COVID-19 stress and discrimination and our mental health outcomes of depression, anxiety, and life satisfaction (see Online Appendix Table 3). Overall, we found that discrimination and COVID-19 stress was associated with significantly higher depression and anxiety, and lower life satisfaction for every race and ethnic group, even after controls were added to the model.

Discussion

The COVID-19 pandemic was a source of both stress and discrimination for Asian Americans. Over 70% of Asian Americans in the NCHAT Study reported being stressed about getting COVID themselves or their partner getting COVID, and over 85% were stressed about their parents, siblings, or other family members getting coronavirus. While dealing with this stress, experiences of discrimination were common. In our study, over 65% of Asian Americans felt that they were treated with less respect than other people and that individuals acted better than them, over 50% reported they received poorer service than other people at restaurants or stores, over 30% felt that others acted as if they were afraid of them, felt that others acted as if they were dishonest, called them names, and insulted them, and 25% were threatened or harassed in the past month. Although there is a long history of racism and xenophobia against Asians in the US, the pandemic was uniquely stressful. The New York Police Department reported that bias incidents against Asians were 43 times higher from 2019 to 2021 (Park 2022).

According to the social stress framework, stigma, prejudice, and discrimination undermines mental health among marginalized populations. Our results support this assertion. More discrimination was significantly associated with higher levels of depression and anxiety, and lower life satisfaction, net of sociodemographic controls. COVID-19 stress was also associated with higher levels of depression and anxiety, and lower life satisfaction. These results suggest that those Asian Americans who faced double jeopardy in terms of stress during the pandemic – the stress of whether or not they or loved ones would get coronavirus, and the stress of discrimination due xenophobia and racism intensified by the politicization of the pandemic as the “China Virus” and “Kung-Flu” (Walker and Daniel Anders 2022) experienced poorer mental health. Because mental health is associated with a whole host of critical life course factors, such as parenting, work performance, and even longevity (Brown et al. 2020; Diener and Chan 2011; Wright, Bonett and Sweeney 1993), the detrimental association between discrimination and mental health has wide-ranging negative consequences for those who experienced discrimination.

Though we expected to see differences across Asian American region groups in reports of discrimination and COVID stress given the heterogeneity of the population, we found no differences across the Asian regional subgroups. It may be that during the COVID pandemic, anti-Asian sentiment and discrimination were felt similarly across Asian American subgroups, and that respondents across ethnic and regional groups experienced similar racialization during this time. We did find that Southeast Asians reported higher levels of anxiety, and South Asians reported lower life satisfaction compared with East Asians. The elevated anxiety in Southeast Asians during the COVID pandemic is consistent with pre-pandemic research, and may be attributable, in part, to the greater likelihood of being refugees who have experienced premigration trauma associated with war and ethnic, religious, or political persecution (Hsu et al. 2004; Kinzie et al. 1990; Lee, Martin, Lee 2015). Lower life satisfaction among South Asians may be related to the specific COVID context. We note that COVID-19 mortality was higher in South Asia compared to the other Asian regions (Panda et al. 2023). Life satisfaction may have suffered among South Asians due to the potentially higher burden of grief and stress related to extended family. Further exploration of the variability of experiences within Asian American communities during the pandemic is warranted.

We also examined several factors that could buffer the association between discrimination and COVID-19 stress and mental health. Social stress theory (Aneshensel 1992; Thoits 1995; Thoits 2011) suggests that psychosocial resources can protect individuals against some of the negative consequences of social stressors. We included indicators of social support, intimate relationships, community climate, and racial identity centrality. In the multivariate models only family social support and relationship satisfaction remained significantly associated with well-being. Yet tests for moderation, including interaction terms between family social support and relationship satisfaction and both discrimination and COVID-19 stress, were not significant with one exception that we discuss below. In most of these models, discrimination and COVID-19 stress remained positively associated with depressive and anxious symptoms and negatively associated with life satisfaction. These findings align with the social stress theory in those psychosocial resources, in this case, from family members, were positively associated with mental health, but even after accounting for psychosocial resources, discrimination and COVID-19 stress remained predictive of lower well-being. These results are consistent with prior studies; Mossakowski and Zhang (2014) and Kim and Epstein (2021) reported that the stress of everyday discrimination was not buffered by social support.

We found the interaction term between COVID-19 stress and family social support to be statistically significant. An increase in COVID-19 stress attenuated the protective effect of family social support on depressive symptoms. However, our measure of COVID-19 stress included stress about family members getting COVID. It may be that individuals who had more social support from family were in greater contact with their family due to family members being concerned about COVID-19, or at higher risk of serious complications of getting COVID-19. This combination of higher family social support but higher COVID-19 stress, then may have put individuals at greater risk of depression. Indeed, individuals who received higher family social support may have been providing more family social support as well. Future research should consider both the receipt and provision of social support in the context of health-related stress.

We also examined the role of centrality of racial-ethnic identity. Some research suggests that feeling confident and rooted in one’s racial-ethnic group may support positive mental health (Yip et al. 2019), but other research suggests that if anti-Asian rhetoric and racism is internalized, it can undermine racial-ethnic identity and not serve as a source of support (Cheng et al. 2021). Further, perceptions of “linked fate” that may accompany a strong sense of racial/ethnic identity in a context of heightened racism and stigmatization may intensify a sense of collective threat and weaken potential protective effects of racial-ethnic identity (Monk 2020). At the bivariate level, higher centrality of racial/ethnic identity was associated with significantly more depressive symptoms. In the full models, centrality of racial/ethnic identity was not significantly associated with mental health. Additional research to understand the role of racial/ethnic identity centrality and whether, and through what mechanisms, it is tied to mental health in the Asian American community is warranted.

At the bivariate level, living in a community favorable for racial and ethnic minorities was associated with fewer depressive symptoms, lower anxiety, and higher life satisfaction. In the full models the association was no longer significant. It may be that due to pandemic social distancing, Asian Americans were less connected to co-ethnic community in a time of heightened and harsh anti-Asian rhetoric and discrimination, dulling the positive effects of a supportive community as a psychosocial resource for mental well-being. Unpacking the characteristics of communities with positive racial climates for Asian Americans in particular is understudied; much of the research is focused on campus climates for Asian American college students (Tausen et al. 2020). Additional research on community racial climate for Asian Americans is needed.

In our supplementary analyses, we did not find evidence that Asian Americans were stressed by COVID more than non-Hispanic white or other non-white respondents. We also found that Asian Americans reported more discrimination than white and Hispanic respondents but less than Black respondents. Further, in predicting mental health, there were no significant differences between Asian American and non-Hispanic white respondents for depression, anxiety, and life satisfaction. Black respondents had less depression and anxiety than Asian American, and Hispanic respondents had significantly lower depression compared to Asian respondents. It is perhaps unsurprising that Asian Americans did not report more COVID stress or mental health problems than white respondents. White respondents may have been particularly affected by the structural stress of the pandemic given that white respondents are not as used to structural stressors as individuals with marginalized racial identities. We found that Asian Americans reported less COVID stress than Black Americans. Given that Black Americans died at higher rates than Asian Americans, it is unsurprising that Black Americans experienced elevated COVID stress (Wrigley-Field et al. 2020)

While this study contributes to our understanding of the experiences of Asian Americans in couples during the pandemic, there are limitations. First, we did not have pre-pandemic data, and unable to document how the pandemic causally impacted experiences of discrimination and mental health among Asian Americans. Asian Americans were experiencing discrimination before the pandemic (Sue et al. 2007). Our results suggest that this discrimination is associated with poor mental health outcomes, and future research should explore recovery and deterioration in Asian American mental health following the pandemic. Reverse causality – poor mental health influencing perceptions of discrimination and/or COVID-19 stress – is possible, and longitudinal data is needed to tease apart causal pathways. This study only examined cohabiting and married Asian Americans and focused exclusively on one member of the couple. Future research should explore its impact on singles and those living alone, as well as investigate couple-level minority stress (LeBlanc, Frost and Wight 2015) or how one partner’s experience of discrimination or stress may be associated with the other partner’s well-being. Understanding the effects of vicarious racism, particularly targeted at loved ones, in the mental health of Asian Americans is a key next step.

This work offers new insights into Asian American experiences during the pandemic. The heightened discrimination targeted at Asian Americans coupled with the stress of the pandemic itself influenced the psychological wellbeing of Asian Americans who felt that discrimination and stress. While the intensity of these negative experiences may be a temporary phenomenon as the pandemic recedes, these experiences have left a mark that may take a long time to overcome. They may also have wide ranging effects on different domains of life such as family, work, health, and feelings of social belonging. Furthermore, as adults confronted discrimination and the stress of the pandemic there were likely spillover effects with costs for their children’s development. Even though family appeared to be an important resource, family social support and relationship quality did not buffer the negative associations between discrimination and stress and mental health. It will be important to identify forces that might foster Asian American resilience and acknowledge that these forces are operating at the societal level in terms of policies and social climate as well as at the individual level. Further attention to how Asian American families move forward and cope with the negative repercussions of their pandemic experiences is critical.

Biographies

Teresa Toguchi Swartz is a Professor of Sociology and Asian American Studies at the University of Minnesota Twin Cities. Her research interests focus on families, social support, race and racism, Asian Americans, and well-being. Her work has appeared in journals such as Annual Review of Sociology, Ethnic and Racial Studies, Social Science & Medicine, and Journal of Marriage and Family.

Claire M. Kamp Dush is Professor of Sociology and the director of the Development Core at the Minnesota Population Center at the University of Minnesota Twin Cities. She is a family demographer who studies intimate relationships and their intersection with human development, with a particular focus on mental health. She is the lead or co-lead investigator of two population representative studies focused on intimate relationships and health – the National Couples’ Health and Time Study and the Work and Family Life Study.

Xiaowen Han is a PhD candidate in Sociology at the University of Minnesota, also affiliated with the Minnesota Population Center and the Life Course Center as an alumni predoctoral trainee in Population Studies. Her research focuses on diverse forms of labor market inequality over the life course and their health consequences, particularly the interplay between non-monetary intrinsic rewards and economic outcomes.

Miranda Berrigan is a Research Development Professional at the University of Minnesota. Her research focuses on work and family and well-being.

Wendy D. Manning is the Dr. Howard E. Aldrich and Penny Daum Aldrich Distinguished Professor of Sociology and codirector of the National Center for Family and Marriage Research at Bowling Green State University. She is a family demographer focusing on trends in family formation, dissolution and well-being for individuals with sexually diverse identities as well as same-gender and different-gender couples. Her research examines social relationships and the health and well-being of children, parents, and adults in the United States. She has contributed to major data collections including the Toledo Adolescent Relationships Study and the National Couples’ Health and Time Use Study.

Katie Nguyen graduated from the University of Minnesota with majors in Sociology and Applied Economics and a minor in Asian American Studies, and is a former McNair Scholar.