Table 1.

Reviews of the research literature linking discrimination and health

Discrimination study	Focus	No. papers included	Study design	Health outcomes	Findings
Mental health
Britt‐Spells, AM., et al (2018)	Depressive symptoms	12	Cross‐sectional: 100%	Depressive symptoms, psychological distress, psychiatric symptoms	Positive (r = .290; 95% CI: 0.235, 0.343)
Carter, RT., et al (2019)	Mental and physical health	242 Mental: 200 Physical: 48 Cultural: 88 Substance use: 23	Cross‐sectional Longitudinal*	Adverse mental health (eg, anxiety, depression, hostility, anger, stress, psychological distress), physical health (eg, blood pressure, BMI, self‐reported health), and substance use (eg, alcohol, smoking, polysubstance use) outcomes	Overall: positive (r = .16, P < .01) Mental: positive (r = .21, P < .01) Substance use: positive (r = .16, P < .01) Physical: positive (r = .07, P < .01)
Carter, RT., et al (2017)	Mental and physical health	105	Cross‐sectional Longitudinal*	Adverse mental health, physical health, and substance use	Overall: positive (r = .17; 95% CI: 0.15, 0.20) Mental: positive (r = .20; 95% CI: 0.17, 0.24) Physical: positive (r = .09; 95% CI: 0.03, 0.14) Substance use: null (r = .12; 95% CI: −0.02, 0.25)
de Freitas, DF., et al (2018)	Mental health	51	Cross‐sectional Longitudinal*	Psychological disturbance, depression, anxiety, psychosis, perceived stress, externalizing behavior, self‐esteem, positive evaluation of life, self‐efficacy, well‐being psychological adaptation	Overall: positive (r = .17; 95% CI: 0.15, 0.20) Mental: positive (r = .20; 95% CI: 0.17, 0.24) Physical: positive (r = .09; 95% CI: 0.03, 0.14) Substance use: null (r = .12; 95% CI: −0.02, 0.25)
Hopkins, PD., Shook, NJ. (2017)	Anxiety	24	Cross‐sectional	General anxiety disorder or social anxiety disorder	Positive: 100% (n = 3) One study found a positive association with general anxiety disorder among a sample of only African Americans
Jones, KP., et al (2016)	Mental and physical health	90	Of the 44 primary samples obtained, 4/44 were from experimental studies	Psychological health, physical health	Positive: physical health (r = .19; 95% CI: 0.07‐0.21); psychological health (r = .30; 95% CI: 0.15‐0.36)
Kirkinis, K., et al (2018)	Trauma	28 papers 44 associations	Cross‐sectional: 93% (n = 26) Longitudinal: 7% (n = 2)	PTSD, dissociation, other measures of trauma, and race‐based traumatic stress symptoms	Positive: 70% (31/44 associations)
Lewis et al (2015)	Mental disorders	12	Cross‐sectional	DSM‐IV disorders (depression, anxiety, eating, psychotic)	Positive association with disorders Inverse association with depression, anxiety for Asian immigrants
Paradies, Y., et al (2015)	Mental and physical health	293	Cross‐sectional: 89.8% Longitudinal: 9.0% Other: 1.2%	Negative mental health (ie, depression, distress, stress, anxiety, internalizing, negative affect, PTSD, somatization, suicide ideation/ attempts, other mental health symptoms, general mental health, overall negative mental health); positive mental health (ie, self‐esteem, control, life satisfaction, positive affect, well‐being, overall positive mental health); physical health (ie, BP, heart conditions, overweight, diabetes, misc.); general health	Negative: negative mental health (r = −.23; 95% CI: −0.24, −0.21); positive mental health (r = −.13; 95% CI: −0.16, −0.10); general health (r = −.13; 95% CI: −0.18, −0.09); physical health (r = −.09; 95% CI: −0.12, −0.06)
Potter, LN., et al (2019)	Daily mental health	25	Longitudinal (daily diary studies)	Poor mental health in daily life (eg, depressive symptoms, negative affect, somatic symptoms, active coping)	Positive: poor mental health (10/11; 91%)
Schmitt, MT., et al (2014)	Psychological well‐being	328 for the first research question and 54 for the second	Cross‐sectional and longitudinal for the first meta‐analysis and experimental studies only for the second meta‐analysis	Psychological well being, broadly constructed (ie, mood, self‐esteem, anxiety, depression, life satisfaction, affect, other measures of mental health)	Negative: psychological well‐being (r = −.21; 95% CI: −0.22, −0.19)
Triana, MC., et al (2015)	Mental and physical health	79	Cross‐sectional Longitudinal*	Psychological health (ie, stress, mental health, anxiety, negative affect, self‐esteem, life satisfaction, and depression); physical health (ie, blood pressure, bodily pain, general physical health, illness, drug or alcohol use)	Negative: psychological health (r = −.12, ρ = −0.14); physical health (r = −.06, ρ = −0.07) Positive: coping behavior (r = .17, ρ = 0.20)
Vines, AI., et al (2017)	Mental health	85	Cross‐sectional Longitudinal*	Mental health was not specified, but includes PTSD, depression. mediators/ confounders: aggression, coping & personality, internalized psych response (eg, self‐esteem), external supportive buffers	Conditional/mixed: no percentage breakdown of trends
Physical health
Bernardo, CD., et al (2017)	Adiposity	10	Longitudinal: 100%	Weight change; waist circumference change; BMI change; become obese; remain obese	Weight change: positive Waist circumference change: 1 positive, 3 null BMI change: 2 positive, 2 null Become obese: positive Remain obese: null
Black, LL., et al (2015)	Physical health	19	Cross‐sectional Longitudinal*	Heart disease risk factors (ie, CRP (C‐reactive protein); coronary calcium positive status; IMT (carotid intima‐media thickness); arterial plaque; coronary artery calcification); blood pressure (and incidence of hypertension); adverse birth outcomes; cancer/tumor incidence; weight change (and body fat distribution); other outcomes (ie, all‐cause mortality (ACM); Epstein‐Barr virus reactivation (EBV); frequency of common colds/physical illnesses (cold))	Heart disease risk factors: null (3/3) Blood pressure: null (3/3) Adverse birth outcomes: null (1/6); positive (5/6) Cancer/tumor incidence: conditional on context of discrimination (1/2); positive (1/2) Weight change: positive (1/2); negative (1/2) Other health outcomes: ACM: null (1/1); EBV: positive (1/1); Cold: positive (1/1)
Busse, D., et al (2017)	Stress	27	Experimental: 37% (n = 10) Longitudinal: 7% (n = 2) Cross‐sectional: 56% (n = 15)	Hypothalamic‐pituitary‐adrenal (HPA) axis: salivary and awakening cortisol; dehydroepiandrosterone (DHEA); corticotropin‐releasing hormone	Salivary cortisol: 1/2 positive; 1/2 negative Cortisol awakening response: 1/1 positive Null: corticotropin‐releasing hormone; afternoon DHEA
Dolezsar, CM., et al (2014)	Hypertension	44	Cross‐sectional, longitudinal, experimental designs*	Hypertensive status; blood pressure	Positive: hypertensive status (z = 0.05; 95% CI: 0.01, 0.09), nighttime ambulatory blood pressure (z = 0.15; 95% CI: 0.04, 0.19) Null: blood pressure (systolic: z = 0.01; 95% CI: −0.01, 0.03) (diastolic: z = 0.2; 95% CI: −0.01, 0.03)
Korous, KM., et al (2017)	Cortisol	16	Experimental: 25% (n = 4) Nonexperimental: 75% (n = 12)	Current cortisol, diurnal cortisol, cortisol reactivity, average cortisol	Positive (r = .040; 95% CI: 0.038‐0.117)
Lewis, TT., et al (2014)	Cardiovascular health	38	26 cross‐sectional 12 longitudinal/cohort or unspecified	Lifestyle factors (eg, smoking, physical activity, alcohol intake); hypertension and blood pressure; biomeasures (eg, obesity, C‐reactive protein, coronary artery occlusion)	Conditional: lifestyle factors; resting blood pressure/hypertension; biomeasures Positive: ambulatory blood pressure
Lockwood, KG., et al (2018)	Cardiovascular health	21	Cross‐sectional, longitudinal, experimental designs*	Cardiovascular reactivity (ie, blood pressure, heart rate, heart rate variability, total peripheral resistance, preejection period, cardiac output); HPA axis (ie, diurnal cortisol slope); immune (ie, C‐reactive protein, interleukin, monocyte chemoattractant protein, tumor necrosis factor, interferon), neural activity	Generally positive associations for CVD reactivity, flatter diurnal cortisol slopes, systemic inflammation, and neural activity in the brain regions consistent with exposure to psychosocial stress
Health behaviors
Desalu, JM., et al (2019)	Alcohol use	27	Cross‐sectional: 85% Longitudinal: 15%	Consumption; binge/heavy drinking; at‐risk drinking; alcohol use disorders (AUD); negative drinking consequences	Positive: consumption (r = .12; 95% CI: 0.08, 0.17); binge drinking (r = .06; 95% CI: 0.02, 0.10); at‐risk drinking (r = .14; 95% CI: 0.06, 0.23); negative drinking consequences (r = .25; 95% CI: 0.09, 0.42) Null: AUD (r = .10; 95% CI: −0.01, 0.20)
Gilbert, PA., et al (2016)	Alcohol use	97	Cross‐sectional: 80% Longitudinal: 18% Experimental: 2%	Alcohol‐related outcomes (number of drinks per month, past 2 weeks of binge drinking, past week/ 30 days/ year of alcohol use, past 2 months of weekend drinking, drinking‐related problems, past‐year alcohol use, past 30/90 days of binge drinking, drinking debut, alcohol use disorder, lifetime alcohol use, hazardous drinking, current alcohol use, alcohol use disorder)	Positive: 45% (n = 14) Null: 32% (n = 10) Conditional: 23% (n = 7)
Slopen, N., et al (2016)	Sleep	17	Longitudinal: 29% (n = 5 [1 daily diary]) Cross‐sectional: 71% (n = 12)	Poor sleep outcomes (ie, duration, efficiency, sleep latency, wake after sleep onset, REM sleep, light sleep, stage 3 and 4 sleep)	Positive: sleep difficulties or insomnia (16/16; 100%); poor sleep quality (7/7; 100%)
Health care utilization
Ben, J., et al (2017)	Health care utilization	Review: 83 Meta‐analysis: 59	Cross‐sectional: 96.4% Longitudinal: 3.6%	Health service experiences [HSE] (ie, communication; satisfaction/perceived quality of care; trust; some combination of these) Health service utilization [HSU] (ie, having examinations, screenings, checks, etc; uptake of treatments, medications, vaccinations; hospital visits and admissions to ERs; delaying health care; insurance coverage; some combination of these)	HSE: negative HSU: conditional on outcome, negatively associated with uptake of treatments and seeking health care; no association for the other measures
Gaston, GB., et al (2013)	HIV treatment adherence	16	Qualitative	Antiretroviral medication or medical self‐care adherence	Discrimination serves as a barrier to medical care, poorer self‐rated health, lower self‐care adherence, less satisfaction with care, greater depressive symptoms
Children and adolescents
Alhusen, JL., et al (2016)	Maternal and child health	15	Qualitative: 27% (n = 4) Quantitative: 73% (n = 11)	Preterm birth; low birth weight; small‐for‐gestational‐age newborn; access to and quality of prenatal care	Preterm birth (quant studies: 5): 3/5 null; 2/5 positive Low birth weight (quant studies: 3): 2/3 positive; 1/3 null Small‐for‐gestational‐age: positive Initiation of prenatal care (quant studies:1): null
Benner AD. et al (2018)	Socioemotional, academic, and behavioral health	214	Cross‐sectional Longitudinal*	Socioemotional well‐being (depression, internalizing symptoms, positive well‐being, self‐esteem); academic (achievement, school engagement, motivation); behavioral (externalizing behaviors, risky sex behaviors, substance use, deviant peer affiliations)	Racial discrimination was positively associated with depression, internalizing symptoms, externalizing behaviors, risky sex behaviors, substance use, deviant peer affiliations and negatively associated with self‐esteem, academic achievement, school engagement, academic motivation
Heard Garris NJ et al (2018)	Child health (infant health outcomes, mental health, socioemotional health, health care utilization, physical health, cognitive development, and youth health)	30	Case‐control (10%), cross‐sectional (27%), and longitudinal (53%)	Infant health outcomes (preterm birth, cortisol reactivity, birthweight); mental health (depressive symptoms, anxiety, substance use, well‐being, anxiety); socioemotional health (externalizing and internalizing behavior, socioemotional difficulties, self‐esteem, positive behavior); health care utilization (frequency of sick child visits); physical health (BMI, general child illness, weight for age); cognitive development (spatial ability); youth health outcomes (depressive)	Caregiver racial discrimination is associated with preterm birth in 4/7 studies, cortisol reactivity in 1/1 study, and birthweight in 6/9 studies observing child outcomes. Within postbirth, caregiver pathway: caregiver racial discrimination is associated with depressive symptoms in 1/7 studies, anxiety in 1/3, substance use in 1/2, well‐being in 1/1, depressive symptoms in 1/7, externalizing in 7/10, internalizing behavior in 4/7, socioemotional difficulties in 2/2, self‐esteem in 1/1, positive behavior in 1/4, frequency of sick child visits in 1/2, BMI in 1/1, general child illness in 1/2, weight for age in 1/1, and spatial cognitive ability in 1/1 in child outcomes; within postbirth, other pathway: caregiver racial discrimination was associated with depressive symptoms in 1/2 studies in child outcomes
Priest N. et al (2013)	Mental and physical health (negative and positive mental health, negative and positive general health, physical health, negative and positive pregnancy, behavior problems, well‐being, health‐related behaviors, health care utilization)	121	2% Case‐control, 78% Cross‐sectional, and 20% longitudinal	Negative mental health (anxiety, depression, distress, hopelessness, loneliness, negative self‐esteem, posttraumatic stress, psychological distress, social and emotional difficulties, somatic symptoms, stress, suicide, mental health problems); positive mental health (emotional adjustment, psychological adjustment, psychological adaption, resilience, self‐esteem, self‐worth, social and adaptive functioning); physical health (blood pressure, childhood illnesses, common childhood illnesses, insulin resistance, obesity, physical symptoms); general health; negative general health (feeling unhappy, feeling unhealthy, health problems); positive general health (self‐rated health); well‐being (general health, HrQoL, life satisfaction, well‐being); negative pregnancy (LBW, preterm birth, VLBW); positive pregnancy (birth weight, gestational age); behavior problems (ADHD, aggression, behavior problems, conduct problems, delinquent behavior, deviance, emotional and behavioral problems, externalizing, internalizing, problem behavior; health‐related behavior (alcohol, drug use, smoking); health care utilization (access and cost)	Of the 121 studies and 461 associations, 46% of associations were negatively associated with reported racial discrimination, 18% were positive and 3% were conditional. 76% of the associations between racial discrimination and negative mental health outcomes were positive. 62% of the associations between racial discrimination and negative mental health outcomes were negative. 69% of the associations between racial discrimination and behavior problems/delinquent behaviors were positive. 51% of the associations between racial discrimination and health‐related behaviors were positive. 45% of the associations between racial discrimination and well‐being/life satisfaction/quality of life outcomes were negative and 50% was unrelated. 79% of the associations between racial discrimination and negative pregnancy/birth outcomes were positive. 67% of the associations between racial discrimination and physical health had no significant associations. Additionally, mental health was the most studied association among the 121 studies and 461 relationships (51% of associations were mental health‐related)

^*Study type breakdown was not specified.