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. Author manuscript; available in PMC: 2022 May 31.
Published in final edited form as: Int J Geriatr Psychiatry. 2022 May;37(5):10.1002/gps.5717. doi: 10.1002/gps.5717

Perceived discrimination and cognitive function among older Puerto Ricans in Boston: The mediating role of depression

Kaipeng Wang 1, Dale Dagar Maglalang 2, Bongki Woo 3, Carson M De Fries 4, Leslie K Hasche 4, Luis M Falcón 5
PMCID: PMC9153945  NIHMSID: NIHMS1805211  PMID: 35460286

Abstract

Objectives:

To examine (1) the association between perceived discrimination, including everyday perceived discrimination and major lifetime perceived discrimination, and cognitive function and (2) the mediating role of depression between discrimination and cognitive function among older Puerto Ricans.

Methods:

Data came from the Boston Puerto Rican Health Study, collected from 562 Puerto Ricans aged 60+. Structural Equation Modelling was used to examine the association between discrimination and cognitive function and the mediating effect of depression.

Results:

Everyday perceived discrimination was negatively associated with cognitive function, which was fully mediated by depression. Major Lifetime perceived discrimination was not associated with cognitive function.

Conclusions:

The findings contribute new information regarding the impact of perceived discrimination on cognitive function among older Puerto Ricans and underscore the importance of assessing experiences of discrimination to prevent depression and cognitive decline in this population.

Keywords: cognitive function, depression, discrimination, minority aging, Puerto Ricans

1 |. INTRODUCTION

Perceived discrimination is defined as unfair experiences related to one’s identities (e.g., race, gender, age, ability, etc.) that occur intra/interpersonally and structurally in institutions and systems.1,2 Such experiences deter or make it more difficult for marginalized individuals and populations to access critical services, spaces, and institutions.3,4 Within the context of the United States (U.S.), people of color, women, LGBTQ+, immigrants, and low-income individuals, among many others, are often on the receiving end of discrimination.5,6

A common target of discrimination in the U.S. is the Latinx population. Latinx communities have been associated with stereotypes concerning legal authorization, educational attainment, socioeconomic status, and gang affiliation.7 These discriminating experiences have been found to influence harmful health behaviors (e.g., substance use, prenatal smoking, cancer screening adherence, etc.) and adverse health outcomes (e.g., increased allostatic load, poor physical health, poor sleep, low quality of life, depression, etc.) in the Latinx population.1,8,9 Nevertheless, Latinx communities have resisted discriminating experiences through their cultural wealth – strength-based factors such as their native language, strategies navigating institutions, and community history and memory – that counteract discriminatory experiences.10 Despite the many known outcomes of discrimination, an understudied facet is its relationship with cognitive function.

Research has consistently shown disparities in cognitive function between non-Hispanic whites and Hispanics. For example, the mean Mini-Mental State Exam (MMSE) score (possible score range: 0–30) for Hispanics is 25.7, significantly lower than that for non-Hispanic whites (27.5).11 The mean of the modified Telephone Interview for Cognitive Status (TICS-M) score (possible score range: 0–27) for Hispanics is 13.7, significantly lower than that for non-Hispanic whites (15.7).12 In addition, although the prevalence of cognitive decline does not differ significantly between non-Hispanic whites (10.9%) and Hispanics (11.0%)13, cognitive decline is more likely to interfere with work or social activities for Hispanics than for non-Hispanic whites.14

Experiences of discrimination may contribute to cognitive impairment through its potential connection to mental health. This link can be explained by the minority stress model, which suggests that certain social structures yield hostile stressors, like experiences of discrimination, which are encountered at a higher rate by marginalized groups and that, in turn, contributes to poor mental health outcomes.15 Numerous studies have established the relationship between experiences of discrimination and its association with depressive symptoms.16 Individuals who live with depression have been found to experience memory lapses, cognitive inhibition, and limited attention span.17,18 Thus, symptoms of depression may mediate how individuals respond to experiences of perceived discrimination and how this impacts cognitive impairment. The prevalence of depression by race and ethnicity in the U.S. show that 8.2% of Hispanics experience depression compared to 7.9% of non-Hispanic white.19 Puerto Ricans have significantly higher risk of depression than not only non-Hispanic white Americans20 but also people from other Hispanic/Latino heritages.21 Therefore, addressing experiences of perceived discrimination can be a preventative measure by buffering the effects of discrimination on the mental health of older adults, which could potentially influence the likelihood of chronic cognitive impairment.22

With the continued growth of the Latinx population in the U.S.,23 it is crucial to assess how experiences of perceived discrimination can further impact essential aspects of the overall health and well-being of the Latinx population. Moreover, the Hispanic population is often viewed as a monolith, obscuring health and mental health disparities that differ based on national origin and concealing the disproportionate mental health burden experienced by groups like Puerto Ricans living in the U.S. Indeed, studies have shown that Puerto Ricans share a higher burden of various mental health conditions than other Hispanics, including a higher prevalence of psychological distress, depression, anxiety, and cognitive decline.12,24,25 To better understand the root causes of these disparities, it is urgent to identify the psychological and social determinants of older Puerto Ricans’ physical and mental health.

The purpose of this article is to examine 1) the association between perceived discrimination, including everyday and lifetime perceived discrimination, and cognitive function and 2) assess the mediating role of depression in the relationship of perceived discrimination and cognitive function. Findings from this study can help identify interventions to manage experiences of perceived discrimination and potentially mitigate the effects of cognitive impairment.

2 |. METHODS

2.1 |. Participants

We used data from the Boston Puerto Rican Health Study (BRPHS), a longitudinal study centered on a cohort of 1,500 Puerto Ricans that examines the relationships between social determinants of stress, health behaviors, and health outcomes among Puerto Rican adults aged 45 or above living in the Boston, MA metro area. Using the 2000 U.S. Census data, participants were recruited from neighborhood areas where at least 25 Puerto Ricans lived.26 Puerto Ricans living in blocks with at least ten self-identified Puerto Ricans were randomly selected and enumerated door-to-door. For each household, only one individual was invited to participate in the study. Additional participants were recruited randomly at community events and festivals through flyers, radio announcements, T.V. spots, and referrals. Eligibility criteria included individuals who (1) self-identified as being of Puerto Rican descent, (2) could answer interview questions in English or Spanish, (3) were 45 or older, and (4) lived in the Greater Boston metropolitan area. Interviews were scheduled after the initial screening. Participants who were eligible and interested called the study site office after receiving information about the study. Trained bilingual interviewers administered the structured questionnaires and tests in the participants’ homes. The response rate was approximately 83.7%. All participants were provided with written informed consent. This study was approved by the institutional review board at [Blinded for review] (IRB: 10–04–12).

We used the data from Wave 3 of the BPRHS, collected from June 2011 to July 2015, because this wave was the first and only wave to include full measures of both everyday perceived discrimination and major lifetime perceived discrimination. The Wave 3 of the Boston Puerto Rican Health Study included 828 participants. We deleted observations for participants below the age of 60 (N = 320), leaving 562 participants aged 60 or older in the sample for analysis. We also included the cognitive function measure collected during Wave 1 (May 2004 – October 2009) and Wave 2 (June 2006 – June 2011) to control for the stability of cognitive function over time. Data collection overlapped between Wave 1 and Wave 2. We started collecting Wave 2 data in 2006 for participants enrolled in 2004 for Wave 1. We continued to enroll new participants for Wave 1 until 2009—the project aimed to conduct interviews with participants with a two-year gap between Wave 1 and 2—the resulting span between interviews was closer to 2.7 years. The final analytic sample included 562 Puerto Ricans aged 60 or above living in the Boston metro area.

2.2 |. Measures

2.2.1 |. Cognitive function

We used the Mini-Mental State Examination (MMSE) to ascertain participants’ general cognitive function. The MMSE is a screening cognitive test that consists of 16 questions and ranges from 0 to 30, aiming to assess the severity of cognitive impairment, especially for attention, recall, language, and orientation.27 It should be noted that about 44.0% of participants refused to respond to the question that asked participants to subtract seven from 100 and then keep subtracting seven from the answer until they were asked to stop. Given that the MMSE score based on the other 15 questions did not differ between those who completed this question and those who did not (t = 1.91, p = 0.06), we removed this item from this scale, making the possible range for cognitive function 0–25 for this study. The Spanish version of MMSE has been validated.28

2.2.2 |. Everyday perceived discrimination

We measured everyday perceived discrimination using a modified version of the Everyday Experiences of Discrimination Scale.29 Participants were asked how often they have experienced discriminatory events in their day-to-day lives within the past 12 months. The scale had a total of nine items, examples of which were “how often have you been treated with less respect than other people?”, “how often have people criticized your accent or the way you speak?” and “how often have you been threatened or harassed?” Responses included 0 = never, 1 = rarely, 2 = sometimes, and 3 = often. We used the mean of all responses to assess everyday perceived discrimination, with a higher score indicating a higher level of everyday perceived discrimination. The scale had a possible range of 0–3 (Cronbach’s α = 0.848).

2.2.3 |. Major lifetime perceived discrimination

We measured major lifetime perceived discrimination using a modified version of the Major Experiences of Discrimination Scale,29 which was designed to capture acute and observable discriminatory experiences during their lifetime. This scale had a total of five items, which asked how often participants have been treated unfairly or been discriminated against (1) at school, (2) at work, (3) when getting medical care, (4) by the police and the courts, and (5) in other situations. Responses included 0 = never, 1 = rarely, 2 = sometimes, and 3 = often. We used the mean of all responses to assess major life perceived discrimination, with the higher score indicating the higher level of every perceived discrimination. The scale had a possible range of 0–3 (Cronbach’s α = 0.626).

2.2.4 |. Depression

We measured depression using the Center for Epidemiologic Studies of Depression Scale (CESD).30 Participants were asked how often they had experienced 20 items in the past week. Examples included how often the respondent “was bothered by things that usually do not bother me”, “felt [their] life had been a failure”, and “felt fearful”. The responses for each item were 0 = rarely or never, 1 = some or a few times, 2 = occasionally or a moderate amount, and 3 = most or all of the time. Some of those items were reversely coded so that a higher score represented a higher level of depression symptoms. The CES-D score was calculated by the sum of responses for each item and had a possible range from 0 to 60, with higher scores indicating higher depressive symptoms (Cronbach’s α = 0.950).

2.2.5 |. Covariates

This study adjusted for participants’ sociodemographic characteristics, health, acculturation factors, and cognitive function measures in Wave 1 and 2. Sociodemographic factors included age, sex (0 = male; 1 = female), marital status (married with a spouse in the household was coded as the reference group), education (No schooling or less than 5th grade was coded as the reference group), employment status (0 = not working; 1 = working), and the ratio of household income to the household size-adjusted federal poverty level. Health status was measured using the self-rated health question (excellent was coded as the reference category). Two indicators measured acculturation—the Psychological Acculturation Scale (PAS) and a measure of the number of years in the mainland United States. The PAS was developed for Puerto Ricans on the mainland to assess an individual’s sense of psychological attachment to and belonging within the Anglo-American or Hispanic culture.31 Examples of these items include “With which group of people do you feel you share most of your beliefs and values?”, “With which group of people do you feel most comfortable?” and “Which culture do you feel proud to be a part of?”. Responses included 1 = only with Puerto Ricans, 2 = more with Puerto Ricans than Americans, 3 = same among Puerto Ricans and Americans, 4 = more with Americans than Puerto Ricans, and 5 = only with Americans. Psychological acculturation was quantified as the sum of responses for each item and had a possible range of 10 to 50. A higher score indicated a higher level of psychological acculturation (Cronbach’s α = 0.950).

2.3 |. Statistical analysis

We used structural equation modeling (SEM) to examine the relationships proposed in this study. More specifically, paths were constructed (1) from the two perceived discrimination measures and each covariate simultaneously to depression and (2) from the two perceived discrimination measures, depression, and each covariate simultaneously to cognitive function in Wave 3. The Little’s MCAR tests (χ2 = 529.237, p < 0.001) rejected the assumption of missing completely at random. Thus, we applied full information maximum likelihood (FIML) to reduce bias caused by missing values in estimating parameters and standard errors. The Doornik-Hansen multivariate normality test (χ2 = 10600.000, p < 0.001) indicated that the multivariate normality assumption was violated. Thus, we applied a robust standard errors correction to the SEM model and used the delta method. We obtained the nonlinear combination of structural coefficients to estimate the total effect of each perceived discrimination measure on cognitive function for Wave 3 and the indirect effect of each perceived discrimination measure on cognitive function through depression.32 We performed all data analyses in STATA SE 15.

3 |. RESULTS

3.1 |. Sample characteristics

Table 1 displays descriptive statistics of the sample. It is worth noting that the mean end-point cognitive function was 21.821 (SD = 2.258). The means of everyday perceived discrimination and major lifetime perceived discrimination were respectively 0.236 (SD = 0.438) and 0.174 (SD = 0.386). The means of perceived discrimination seemed low because (1) most participants reported zero for all items of each scale (65.16% for everyday perceived discrimination and 77.36% for major lifetime perceived discrimination) and (2) the percentages generally decreased for participants reporting higher levels of perceived discrimination. Depression symptoms were high for the group (Mean = 18.195; SD = 9.310). A quarter of the participants lived with a spouse in the household. The majority did not live with a spouse (4.3%) or were divorced or separated (32.2%)—and about a quarter was widowed (24.9%) or had never married (13.6%). The level of education for the group was low, with more than half of the participants (56.9%) having an education below 9th grade. The percentage of participants who were still employed was also low (7.1%). It is also important to highlight the low percentages of participants who rated their health as excellent (5.2%) and very good (5.9%).

TABLE 1.

Characteristics of older Puerto Ricans (N = 562)

Variables Mean (SD) Percentage N(missing)
Age 67.758 (5.500) 0
Sex 0
 Male 25.8%
 Female 74.2%
Marital status 3
 Married, spouse in household 25.0%
 Married, spouse not in household 4.3%
 Divorced/separated 32.2%
 Widowed 24.9%
 Never married 13.6%
Education 1
 No schooling or less than 5th grade 29.1%
 5th - 8th grade 27.8%
 9th - 12th grade or GED 31.5%
 Some college or bachelor’s degree 9.5%
 At least some graduate school 2.1%
Working 7.1% 0
Household income in federal poverty ratio 1.200 (2.199) 71
Self‐rated health 1
 Excellent 5.2%
 Very good 5.9%
 Good 20.5%
 Fair 54.9%
 Poor 13.5%
Psychological acculturation 15.296 (7.515) 5
Years lived in the U.S. 42.382 (11.762) 16
Depression 18.195 (9.310) 9
Everyday perceived discrimination 0.236 (0.438) 8
Major lifetime perceived discrimination 0.174 (0.386) 10
Cognitive function (Wave 1) 21.274 (2.462) 0
Cognitive function (Wave 2) 21.527 (2.286) 26
Cognitive function (Wave 3) 21.821 (2.258) 9
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3.2 |. Structural equation model

Table 2 shows completely standardized coefficients and their 95% confidence intervals (CI) for the SEM model. Notably, after adjusting for all covariates, one standard deviation increase in everyday perceived discrimination was significantly associated with a 0.318 standard deviation increase in depression (p < 0.001). In contrast, major lifetime perceived discrimination was not significantly associated with depression. After adjusting for depression and all covariates, neither everyday perceived discrimination nor major lifetime perceived discrimination was significantly associated with cognitive function in Wave 3. However, one standard deviation increase in depression was significantly associated with a 0.130 standard deviation decrease in cognitive function in Wave 3 (p < 0.001). Figure 1 displays the relationship between perceived discrimination measures, depression, and cognitive function in Wave 3 and the key direct effect coefficients.

TABLE 2.

Results of Structural Equation Modelling (N = 562)

Endogenous Variables Predictors β 95% CI
Depression Everyday perceived discrimination 0.318*** (0.214, 0.422)
Major lifetime perceived discrimination 0.064 (−0.036, 0.164)
Age −0.044 (−0.125, 0.038)
Female (ref: male) 0.124** (0.053, 0.196)
Marital status (ref: Married, spouse in household)
 Married, spouse not in household −0.000 (−0.058, 0.058)
 Divorced/separated 0.076 (−0.002, 0.154)
 Widowed 0.154** (0.056, 0.251)
 Never married 0.005 (−0.078, 0.088)
Education (ref: less than 5th grade)
 5th - 8th grade 0.133** (0.039, 0.228)
 9th - 12th grade or GED 0.044 (−0.051, 0.139)
 Some college or bachelor’s degree −0.008 (−0.094, 0.079)
 At least some graduate school 0.034 (−0.044, 0.112)
Working −0.067* (−0.130, −0.004)
Household income in federal poverty ratio −0.037 (−0.075, 0.002)
Self‐rated health (ref: excellent)
 Very good −0.018 (−0.125, 0.089)
 Good −0.032 (−0.152, 0.089)
 Fair 0.042 (−0.099, 0.183)
 Poor 0.152* (0.032, 0.272)
Psychological acculturation 0.070 (−0.005, 0.145)
Years lived in the U.S. 0.020 (−0.059, 0.099)
Cognitive function (Wave 1) −0.074 (−0.174, 0.026)
Cognitive function (Wave 2) −0.025 (−0.124, 0.074)
Cognitive function (Wave 3) Depression −0.130*** (−0.204, −0.056)
Everyday perceived discrimination −0.088 (−0.190, 0.013)
Major lifetime perceived discrimination 0.069 (−0.017, 0.149)
Age −0.138*** (−0.212, −0.064)
Female (ref: male) 0.080* (0.008, 0.151)
Marital status (ref: Married, spouse in household)
 Married, spouse not in household 0.089** (0.031, 0.146)
 Divorced/separated 0.056 (−0.023, 0.134)
 Widowed 0.000 (−0.090, 0.090)
 Never married 0.042 (−0.031, 0.114)
Education (ref: less than 5th grade)
 5th - 8th grade 0.097* (0.005, 0.189)
 9th - 12th grade or GED 0.244*** (0.154, 0.333)
 Some college or bachelor’s degree 0.193*** (0.123, 0.263)
 At least some graduate school 0.052 (−0.016, 0.120)
Working 0.077** (0.022, 0.133)
Household income in federal poverty ratio −0.075*** (−0.115, −0.034)
Self‐rated health (ref: excellent)
 Very good 0.108* (0.021, 0.195)
 Good 0.106 (−0.043, 0.255)
 Fair 0.220* (0.048, 0.393)
 Poor 0.050 (−0.087, 0.187)
Psychological acculturation −0.064 (−0.137, 0.009)
Years lived in the U.S. 0.036 (−0.038, 0.111)
Cognitive function (Wave 1) 0.205*** (0.104, 0.306)
Cognitive function (Wave 2) 0.184*** (0.080, 0.287)
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Note: All coefficients (β) were completely standardized; AIC = 33575.16, BIC = 34956.91; Given the model is just identified (i.e., the number of free parameters is equal to the number of known values, i.e., a model with zero degrees of freedom), CFI = 1, TLI = 1, RMSEA = 0.

*

p < 0.05,

**

p < 0.01,

***

p < 0.001.

FIGURE 1.

FIGURE 1

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Relationship between perceived discrimination, depression, and cognitive function.

Applying the delta method to the SEM model, we obtained the nonlinear combination of structural coefficients for the total effect of each of the perceived discrimination measures on cognitive function for Wave 3 and the indirect effect of each of the perceived discrimination measures on cognitive function through depression after adjusting for all covariates (see Table 3). We found that the total effect of everyday perceived discrimination on cognitive function was statistically significant (β = −0.129, p < 0.01), indicating everyday perceived discrimination was negatively associated with cognitive function. The indirect effect of everyday perceived discrimination on cognitive function through depression was statistically significant (β = −0.041, p < 0.01), which accounts for 34.1% of the total effect. However, as shown in Figure 1, the direct effect of everyday perceived discrimination on cognitive function was not statistically significant. Those results indicate that depression fully mediated the association between everyday perceived discrimination and cognitive function. Neither the total effect of major lifetime perceived discrimination on cognitive function (β = 0.058, p = 0.175) nor the indirect effect of major lifetime perceived discrimination on cognitive function through depression (β = −0.008, p = 0.206) was statistically significant.

TABLE 3.

Standardized Structural Coefficients of Key Direct Effects, Indirect Effects, and Total Effect (N = 562)

Major Paths β 95% CI
Direct effects
 Everyday perceived discrimination → Depression 0.318*** (0.214, 0.422)
 Everyday perceived discrimination → Cognitive function (Wave 3) −0.088 (−0.190, 0.013)
Major lifetime perceived discrimination → Depression 0.064 (−0.036, 0.164)
Major lifetime perceived discrimination → Cognitive function (Wave 3) 0.069 (−0.017, 0.149)
Depression → Cognitive function −0.130*** (−0.204, −0.056)
Indirect effects
 Everyday perceived discrimination → Depression → Cognitive function (Wave 3) −0.041** (−0.069, −0.013)
Major lifetime perceived discrimination → Depression → Cognitive function (Wave 3) −0.008 (−0.021, 0.005)
Total effect
 Everyday perceived discrimination → Cognitive function (Wave 3) −0.129** (−0.213, −0.046)
Major lifetime perceived discrimination → Cognitive function (Wave 3) 0.058 (−0.026, 0.141)
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Note: All parameters were estimated after adjusting for covariates. All parameters were completely standardized.

**

p < 0.01,

***

p < 0.001.

4 |. DISCUSSION

Using a sample of older Puerto Ricans in Boston, the present study examined the mediating effect of depression on the association between discrimination and cognitive function. Overall, results indicated that older Puerto Ricans with higher everyday perceived discrimination had lower levels of cognitive function. In contrast, major lifetime perceived discrimination was not associated with cognitive function. In addition, the relationship between everyday perceived discrimination and cognitive function was fully mediated by depression.

Our finding suggests that perceived everyday discrimination is a significant risk factor for the decline in cognitive function. This result is consistent with previous studies among African Americans33–35 and older adults in general.36 Unlike everyday discrimination, we did not find a significant effect of major lifetime discrimination. One potential explanation is that, compared to major life discrimination incidents, everyday discrimination (e.g., “people acted as if they think you are not smart”; “people acted as if they are better than you are”) may deliver messages that induce a threatening stereotype, which is related to worse memory functioning among older adults.37 The internalization of daily discriminatory messages about one’s ability may lead to disengagement from cognitive challenges and compromise cognitive health.38

Our findings also show that individuals who perceived more everyday discrimination events are more likely to have severe symptoms of depression, which in turn leads to worse cognitive function. This finding is consistent with the framework developed by Glymour and Manly,38 which explains multiple pathways, including race and discrimination, to cognitive health. This framework purports that discrimination triggers various psychological responses related to stress or anger. Direct psychological experiences, such as depression, have a cumulative effect across the life course and lead to cognitive impairment later. Previous literature has conceptualized discrimination as a chronic social stressor and associated with depression among Puerto Ricans and, broadly, the Latinx American population.9,39,40

Further, previous research has documented that depression severity is associated with reduced cognitive performance.41 Though there is no definitive explanation for the relationship between depression and cognitive function, one possibility is that depressive symptoms decrease healthy behaviors (e.g., exercise and physical activity) and social connections, shown to protect against cognitive impairment.42–44 Another potential explanation is that depression is related to hippocampus shrinkage or white matter changes, which can also be related to cognitive impairment.45 Overall, the present study is one of a few studies that provide empirical evidence that depression is a critical mechanism that clarifies the linkage between experiences of discrimination and cognitive function. Given that both depression and cognitive decline are prevalent and often co-occur among the older adult population,46 addressing their day-to-day experiences of discrimination could play a significant role in reducing this linkage.

Similar findings that depression partially mediates the relationship between discrimination and cognition have been documented by research on older African American adults33,35; however, unlike those studies that did not find the significant pathway from discrimination to cognition among their Latinx sample, the present study found the full mediation effect among Puerto Ricans. One potential reason for the inconsistent results may lie in the ethnic differences within Latinxs. For example, according to a previous national study, 40% of Puerto Ricans reported experiencing unfair treatment, higher than the average rate of 30% among the Latinxs,47 suggesting that discrimination may be an especially salient stressor for Puerto Ricans. Moreover, previous studies reported that Puerto Ricans had a higher prevalence of psychiatric disorders, including depressive symptoms than other Latinx subgroups.48,49 The high prevalence of perceived discrimination and depressive symptoms among Puerto Ricans suggests that these experiences may be especially critical risk factors for their cognitive function in old age. Findings from this study highlight the importance of investigating ethnicity-specific mechanisms related to cognitive function at the group level rather than using ethnicity-based aggregations.

Several limitations should be noted. We omitted one item of the MMSE scale due to its high non-response rate, which possibly influenced the internal validity of results; however, the high non-response rate for the item highlights the importance of developing more feasible and culturally responsive measures to assess cognitive function for this population. Although we included cognitive function measures for Wave 1 and Wave 2 to control for stability, data on the perceived discrimination measures were only collected at one point. This prevented us from examining the longitudinal relationship between perceived discrimination, depression, and cognitive function and limited our ability to assess potential causal relationships among those variables. Furthermore, the age range for participants in this study was between 60 and 81 years old, limiting the findings’ generalizability to Puerto Ricans outside of that age range. In addition, participants were only recruited from the Greater Boston Area, limiting the external validity of conclusions to other older Puerto Ricans in the U.S. Finally, the high rate of refusal to answer (44%) for one question on the MMSE measure was concerning. Finally, the present study only focuses on the association between the degree of perceived discrimination and cognitive function; however, we do recognize that even within a single ethnic group there exist differences in how individuals perceive as making them a target of discrimination. This more nuanced analysis should be the topic of further research with this population.

5 |. CONCLUSION

Despite these limitations, findings from this study have important implications for future research and practice. This paper, to our knowledge, is among the first to examine the relationship between everyday perceived discrimination, major lifetime perceived discrimination and cognitive function among older Puerto Ricans using a probabilistic sample. Further, we controlled for cognitive function measures earlier, which strengthened the causal relationship of the findings relative to traditional cross-sectional designs. Additional longitudinal studies are needed to examine how a change in everyday perceived discrimination is related to depression and cognitive function changes for this population. The present study highlights the importance of assessing everyday perceived discrimination to prevent depression and cognitive decline and develop culturally appropriate psychosocial interventions for older Puerto Ricans.

Key points.

  • Everyday perceived discrimination was negatively associated with cognitive function, which was fully mediated by depression

  • Major Lifetime perceived discrimination was not associated with cognitive function

ACKNOWLEDGMENTS

This work was supported by the National Institutes of Health [Grant Numbers: P01-AG023394, P50-HL105185, and R01-AG055948].

Footnotes

CONFLICT OF INTEREST

There is no conflict of interest for this study.

DATA AVAILABILITY STATEMENT

Data will be available upon reasonable request.

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