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. 2022 Dec 15;318:115620. doi: 10.1016/j.socscimed.2022.115620

The associations of everyday and major discrimination exposure with violence and poor mental health outcomes during the COVID-19 pandemic

Anita Raj a,b,∗, Sangeeta Chatterji d, Nicole E Johns a, Jennifer Yore a, Arnab K Dey a, David R Williams c
PMCID: PMC9750505  PMID: 36587480

Abstract

Research on discrimination and risks for violence and mental health issues under the pandemic is notably absent. We examined the relative effects of perceived everyday discrimination (e.g., poorer service, disrespectful treatment in a typical week) and major experiences of race-based discrimination (e.g., racial/ethnic discrimination in housing or employment at any point in the lifetime) on experiences of violence and the PHQ-4 assessment of symptoms of depression and anxiety under the pandemic. We analyzed state-representative cross-sectional survey data from California adults (<I>N</I> = 2114) collected in March 2021. We conducted multivariate regression models adjusting for age, race/ethnicity, gender, sexual identity, income, and disability. One in four Californians (26.1%) experienced everyday discrimination in public spaces, due most often to race/ethnicity and gender. We found that everyday discrimination was significantly associated with past year physical violence (single form Adjusted Odds Ratio [AOR] 5.0, 95% CI 2.5–10.3; multiple forms AOR 2.6, 95% CI 1.1–5.8), past year sexual violence (multiple forms AOR 2.5, 95% CI 1.4–4.4), and mental health symptoms (e.g., severe symptoms, multiple forms AOR 3.3, 95% CI 1.6–6.7). Major experiences of race-based discrimination (reported by 10.0% of Californians) were associated with past year sexual violence (AOR 2.0, 95% CI 1.1–3.8) and severe mental health symptoms (AOR 2.7, 95% CI 1.2–6.2). Non-race-based major discrimination (reported by 23.9% of Californians) was also associated with violence and mental health outcomes Everyday discrimination, more than major experiences of discrimination, was associated with higher risk for violence and poor mental health outcomes during the pandemic. Non-race-based forms of major discrimination independently were also associated with these negative outcomes. Findings indicate that efforts to reduce and ultimately eliminate discrimination should be a focus of public health and COVID-19 rebuilding efforts.

Keywords: Sexual violence, Sexual harassment, Gender-based violence, COVID-19, Economic deprivation, Poverty

The authors report no conflicts of interest.

1. Introduction

Global evidence documents a 25% increase in depression and anxiety disorders as a consequence of the social isolation and economic and health stressors of the COVID-19 pandemic (WHO, 2022). In the United States (U.S.), these mental health consequences are occurring in tandem with an increase in violence, with some indication that these disproportionately affected women and racial/ethnic minorities (Connor et al., 2020; FBI, 2021, June, 2021; GEH, May 13, 2021). Racially motivated hate crimes and racial discrimination also increased in this same timeframe, as did those based on sexual identity, religion and gender (FBI. and August 30, 2021; Strassle et al., 2022). Racial discrimination is a driver of major health inequities including experiences of violence and poor mental health (Marmot, 2017; McCartney et al., 2019; Williams and Cooper, 2019). However, research has not examined the associations between discrimination and these outcomes in the pandemic.

The American Psychological Association describes discrimination as “the unfair or prejudicial treatment of people and groups based on social characteristics or identities such as race, gender, age or sexual orientation.” (APA, October 31, 2019). Such discrimination can be in the form of “everyday discrimination,” which can include being treated with lesser courtesy and respect in everyday interactions (Williams et al., 1997) or “‘microaggressions’ such as snubs, slights and misguided comments that suggest a person doesn't belong or invalidates his or her experiences” (APA, October 31, 2019). In contrast, major episodes of discrimination are those that are similar to major life events and instrumental in adversely affecting opportunities for advancement or triggering retrogression/harm (Williams et al., 2008). These include discrimination occurring at the institutional level, with resultant disadvantage based on a social attribute by the system (e.g., refusal of a loan from a bank) or within the institution (e.g., denial of promotion or salary inequity in one's place of employment) (Lincoln and Stanley, 2021), as well as institutional violence such as discriminatory policing (Williams et al., 2008). Limited research has examined the relative effects of these forms of discrimination, though both forms are associated with poorer health, particularly mental health (Gee, 2002, 2008; Williams et al., 2019a).

Discrimination may also be associated with the exacerbation of poorer mental health outcomes resulting from the pandemic (Hossain et al., 2020), particularly given evidence of elevation in racial/ethnic discriminatory attacks over the past few years in the U.S. (Laster Pirtle and Wright, 2021). Prior research indicates that experiences of violence are associated with COVID-19 related mental health effects (A. Raj et al., 2020a, Raj et al., 2020b), but discrimination has not been examined in this regard. This is a notable absence given that discrimination itself can be considered a form of violence (Lombardi et al., 2002; Sanders-Phillips, 2009; SteelFisher et al., 2019). Further, similar to community and family violence (Bacchus et al., 2018; Baranyi et al., 2021; Norman et al., 2012), discrimination has been implicated in creating chronic stress and poorer mental health outcomes among socially marginalized populations (APA, October 31, 2019; Bailey et al., 2017; Berger and Sarnyai, 2015; Ruth A. Hackett et al., 2020; Paradies et al., 2015; Williams et al., 2019b). Racial/ethnic discrimination experiences may have increased under the pandemic (Laster Pirtle and Wright, 2021) and may be linked with both violence and poorer mental health outcomes. Other forms of social discrimination also may have increased under the pandemic, but consideration of both racial and non-racial discrimination simultaneously is not typically done in the literature, despite calls for more intersectional analysis (Fagrell Trygg et al., 2019).

Research that has examined associations between discrimination and victimization from violence has mostly focused on self-reported perceptions of gender discrimination and experiences of violence against women and lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual (LGBTQIA+) individuals (Gordon and Meyer, 2007; Jackson et al., 2019a; Lombardi et al., 2002; Rafferty, 2013; SteelFisher et al., 2019). Similarly, there is extensive evidence regarding gender and mental health. There has long been evidence regarding higher levels of depression for women relative to men, but research also documents associations between gender discrimination and poor mental health outcomes (Hackett et al., 2019). Studies also show that experiences of discrimination against LGBTQIA + individuals areassociated with poorer mental health outcomes, and further, that minority stress contributes to this increased risk in ways similar to that seen for racial/ethnic minority communities (Hatzenbuehler and Pachankis, 2016; Meyer, 2003; Tan et al., 2020). Intersectional minority stresses, such as being gay and Black, likely compound stress responses and increase risk for consequent mental health concerns (Parra and Hastings, 2018). Certainly, other characteristics could contribute to experiences of discrimination as well, such as disability; research shows that disability-based discrimination is also linked to both violence, including hate crime violence, and poorer mental health outcomes (Clement et al., 2011; R. A. Hackett et al., 2020a, Hackett et al., 2020b). Age discrimination, based mostly on older age, is also correlated with worse physical and mental health outcomes (Jackson et al., 2019b). So here, too, we see the potential harms of discrimination across attributes, and the aggregate and intersectional risks that can occur for those who are, for example, older and living with disability.

Racial discrimination and victimization from violence has received less attention, despite extensive research documenting the association between this form of discrimination and other negative social and health outcomes, including mental health trauma (Bailey et al., 2017; Lewis et al., 2015; Williams and Cooper, 2019; Williams et al., 2019a). Mental health trauma is highly correlated with violence in racial/ethnic minority communities (Williams, 2018). Lack of focus on this issue is particularly of concern given the availability of research on race/ethnicity and violent crime (Burt et al., 2012) and the demonstrated interconnections of violence victimization, violence perpetration, and mental health (Choe et al., 2008; Hong et al., 2015; Russell et al., 2010). Further, while there is an increasing recognition of intersectional discrimination – i.e., discrimination based on multiple social factors in combination, such as race/ethnicity and gender (Fagrell Trygg et al., 2019), and differential effects of everyday compared with major experiences of discrimination, as noted above, little research has examined multiple forms of discrimination simultaneously. A study that did assess the independent and intersectional associations of self-reported perceptions of racial/ethnic and gender discrimination with experiences of victimization from violence found that both were associated with increased risk for victimization from dating violence among adolescents (Roberts et al., 2018).

The literature connecting violence and mental health outcomes shows that violence can be causal or resultant of poor mental health and is often embedded in social contexts of vulnerability and social and economic alienation (Chatterji and Heise, 2021). Meta-analyses using empirical research with youth and adults show a causal association between violence, experiences most often occurring for the first time in youth, and outcomes of depression and anxiety symptoms and diagnosis (Bellis et al., 2019; LeMoult et al., 2020). Studies also show that perpetrators are more likely to hold an anxiety attachment style, indicating that poor mental health outcomes may precede or follow violence experiences (Velotti et al., 2022). Additional review studies highlight that contexts of social alienation and economic marginalization increase risk for both perpetration and victimization from violence, and exacerbate harmful effects of violence on mental health (Gao et al., 2017, 2021). Taken together, these findings highlight that violence and its negative health effects occur in and are affected by social and economic marginalization. Discrimination can be a mechanism through which marginalization occurs.

This study examines the associations between everyday and major experiences of discrimination [measured by self-perception reports] and outcomes of victimization from violence [past year physical and sexual violence] and negative mental health symptoms [past two-week depression and anxiety symptoms] during the pandemic among a state-representative sample of California adults. This work can provide insight into the relative effects of everyday versus major discrimination on violence and mental health, and the relative effects of race-based and non-race based major experiences of discrimination on these outcomes. Such findings can offer greater insight into the ways in which multiple aspects of systemic racism can affect health disparities related to trauma and mental health (Boynton-Jarrett et al., 2021). We examine these issues in the context of a study from California, a state that showed both a significant increase in violence from 2020 to 2022 and early in the pandemic adverse mental health consequences (GEH, May 13, 2021; Anita Raj et al., 2020; A. Raj et al., 2020a, Raj et al., 2020b; Raj et al. September 2022). Findings can help guide how to address pandemic impacts with considerations of social inequalities and health disparities.

2. Methods

2.1. Data source

We analyzed cross-sectional data from a state-representative online survey of California residents aged 18 and older (N = 2203) conducted in March 2021 as part of the California Study on Violence Experiences Across the Lifespan 2021 (Cal-VEX 2021) (GEH, May 13, 2021).

The Cal-VEX 2021 survey built upon prior annual surveys with an additional focus on impacts of the COVID-19 pandemic (Anita Raj et al., 2020). NORC at the University of Chicago obtained the survey sample from a general population sample of California adults age 18 and older selected from their probability-based AmeriSpeak Panel and supplemented by non-probability panels to reach desired sample size. NORC funds and operates the AmeriSpeak Panel of randomly selected US households, inviting selected households into the study using US mail, telephone, and field interviewers (face to face). This panel provides sample coverage of approximately 97% of the U.S. household population. Households with P.O. Box only addresses, addresses not listed in the USPS Delivery Sequence File, and some newly constructed dwellings are excluded from this sample. Most AmeriSpeak households participate in online surveys, but non-internet households can participate by telephone or smartphone. For this study, NORC sampled from the California portion of the AmeriSpeak panel sample and supplemented it with respondents from nonprobability online opt-in panels to achieve the sample size of approximately 2000 participants. NORC conducted a statistical calibration to combine these samples and create a survey-weighted final sample that is representative of the California adults with regard to gender, age, race/ethnicity, income, education, employment status and region of the state. The recruitment rate for this study was 20%, and the response rate was 28%. These are standard for online panel surveys, which hover around 20–25% (Callegaro and DiSogra, 2009; Nulty, 2008).

The NORC team contacted participants to invite them into the 15-min online survey. Respondents were offered the cash equivalent of USD$2 for completion of this survey. All participation was voluntary, and the participant was allowed to decline questions or stop the survey at any time. Participants in the survey panels provided written informed consent at the time of enrolment in the panel, and agreed to privacy policies provided by NORC. Due to the sensitive nature of topics covered in the survey, the survey included a prompt on all pages with the following text, “If you are experiencing distress or discomfort, see this website for services in the state https://victims.ca.gov/resources.aspx.” To ensure confidentiality, our team only had access to completely anonymized data. Both NORC/University of Chicago and the University of California San Diego (Project #201780) Institutional Review Boards approved these study procedures.

2.2. Measures

Our dependent variables were past year experience of physical violence, past year experience of sexual violence, and past two-week mental health symptom severity.

We assessed participants’ past year experiences regarding three types of <i>physical violence</i> (physical abuse, threat or violence with a knife, threat or violence with a gun) and six types of <i>sexual violence</i> (verbal sexual harassment, homophobic or transphobic comments, cyber sexual harassment, physically aggressive sexual harassment, <i>quid pro quo</i> or coercive sexual harassment, and forced sex) (Anita Raj et al., 2020). We categorized the physical violence and sexual violence outcomes as yes/no based on whether they said yes to any of the specific subtypes of violence assessed or no to all items assessed.

We assessed depression and anxiety symptoms, and severity of symptoms, using the Patient Health Questionnaire-4 (PHQ-4), which assesses number of days in the past two weeks they experienced specific symptoms (e.g., “not being able to stop or control worrying” (Kroenke et al., 2009).

Response options ranged from “Not at all” = 0 to “Nearly every day” = 3, allowing for a range of 0–12 for the summated score. The Cronbach alpha for these four symptom items was 0.90. The severity of mental health symptom score as stipulated by the PHQ-4 tool is the sum of the four items, categorized as normal (0–2), mild (3–5), moderate (6–8), and severe (9–12) (Kroenke et al., 2009).

Our independent variables of interest were perceived experiences of everyday discrimination and perceived major experiences of racial/ethnic discrimination.

We assessed <i>everyday discrimination</i> using a modified five-item version of the Everyday Discrimination scale. The original scale has been previously validated in the US. (Williams et al., 1997) We asked if the participants experienced any of the following specific forms of everyday discrimination in a typical week, yes/no. Example items included: “People treat me as if I am not intelligent.” And “People treat me like I am dishonest.”

The Cronbach alpha for these five types of everyday discrimination was 0.62. We categorized responses as experiencing no forms of everyday discrimination, one form, or multiple forms. The perceived reason for the discrimination was not assessed.

We assessed <i>major experiences of discrimination</i> using the six-item Major Experiences of Discrimination Scale (abbreviated) (Sternthal et al., 2011). Example items included: “unfairly fired or denied a promotion” and “unfairly prevented from moving into a neighborhood because the landlord/realtor refused to rent/sell a house/apartment.”

We did not conduct a Cronbach's alpha for this measure, because the measure was not designed to assess a unitary construct. Hence, there is no expectation of these items to show good inter-correlation.

If respondents indicated experience of one or more forms of major discrimination, we then asked what the primary reason for this discrimination was, with answer choices: race/ethnicity, age, gender, religion, immigration situation (or assumption thereof), physical appearance, sexual orientation or gender identity, income level/social class, or other. Respondents could only select one primary reason; we categorized those who selected race/ethnicity as experiencing <i>race-based major discrimination</i>. We ultimately used a binary measure of race-based major discrimination, any experience vs none. We categorized participants who experienced at least one of the six forms of major discrimination but reported a primary reason other than race/ethnicity as having experienced <i>non-race-based major discrimination</i>. A binary measure was used for this predictor, any experience vs none. Because the primary reason for discrimination follow-up question allowed for a single response on the social factor most associated with these major experiences of discrimination, race-based major discrimination and non-race-based major discrimination were mutually exclusive.

We also included past year experience of policing as a separate form of major discrimination, based on the extensive data indicating that police are more likely to track males and racial/ethnic minorities (PPI, May 14, 2019) and its alignment with the definition of major discrimination (Williams et al., 2008). This measure was tied to past year experience. Using a single item measure, we asked participants whether they had been stopped or approached by the police: in the past six months, in the past year but not past six months, ever but not in the past year, or had never been stopped by the police. We dichotomized responses as stopped in the past year or not, i.e., <i>policing</i> or no policing exposure. For those who had policing exposure in the past year, we also asked, “On the last occasion you were approached by the police, how do you think you were treated?” Response options were ‘very badly,’ ‘somewhat badly,’ ‘neither well nor badly,’ ‘reasonably well,’ or ‘very well.’ We provide these data descriptively for the 27 participants reporting it.

We included socio-demographic covariates for the social factors that could be the basis of discrimination experiences in adjusted models: self-defined gender, race/ethnicity, age, income, sexual identity, and disability status. Details on questions and variable constructions for these covariates are outlined in prior reports (GEH, May 13, 2021; Raj et al. September 2022). We categorized race/ethnicity as White, Black, Asian, Hispanic, and Other/multiple races due to small cell sizes for other racial/ethnic groups.

2.3. Data analysis

We present frequency data on all key variables for the total sample, overall and by each outcome. We also present correlation between the measures of discrimination. We then conducted unadjusted and adjusted logistic regressions to assess associations between experiences of discrimination and past year physical and sexual violence. We conducted unadjusted and adjusted multinomial logistic regressions to assess associations between experiences of discrimination and mental health symptom severity. Adjusted models included all measures of discrimination, as well as gender, race/ethnicity, age, income, sexual identity, and disability. All analyses accounted for survey design and weighting to produce state-representative findings, and were conducted using STATA 15.1. Statistical significance was set at p < 0.05 for all odds ratios (ORs), adjusted odds ratios (AORs), relative risk ratios (RRRs), and adjusted relative risk ratios (aRRRs); 95% confidence intervals (CIs) are reported throughout.

3. Results

3.1. Sample and characteristics

The total number of Cal-VEX 2021survey participants was 2203, but the analytic sample was restricted to participants providing responses to all discrimination, outcome, and demographic items, resulting in a final analytic sample of N = 2114 individuals. (Note: Non-binary participants were too small in number (n = 13) for inclusion in gender-stratified analyses.)

One quarter of participants (26.1%) regularly experienced everyday discrimination in public spaces in an average week (See Table 1 .). One in ten respondents (10.0%) reported major experiences of race-based discrimination. Of these, 38% attributed this discrimination primarily to race/ethnicity, 18% to physical appearance, 10% age, and 9% gender. One in four respondents (23.9%) reported major experiences of discrimination for reasons other than race/ethnicity; of these, the most common reasons for discrimination were age (22%), income level/socioeconomic status (15%), physical appearance (14%), and gender (14%). One in eight (13.6%) were approached or stopped by police in the prior year; of those who were approached, 65.7% reported that they were treated reasonably or very well, 23.0% reported neutral treatment, and 11.3% reported that they were treated somewhat or very badly (result not shown). Though theoretically related, our measures of discrimination were very weakly correlated in the study sample; everyday discrimination and major experiences of race-based discrimination: rho = 0.26; everyday discrimination and policing: rho = 0.30; and major experiences of race-based discrimination and policing: rho = 0.12. Nonetheless, they were significantly associated, suggesting inter-relationships across forms of discrimination.

Table 1.

Experiences of discrimination, past year victimization from violence, recent depression/anxiety symptoms, and socio-demographic characteristics among a state representative sample of California adults in March 2021 (N = 2114).

 Unweighted N
 Weighted %
Total 2114 100%
Experiences of discrimination
Everyday discrimination
 None 1603 73.9%
 Single Form 298 14.2%
 Multiple Forms 213 11.9%
Major experiences of race-based discrimination
 No 1931 90.0%
 Yes 183 10.0%
Major experience of non-race-based discrimination
 No 1537 76.1%
 Yes 577 23.9%
Policing in past year
 No 1766 86.4%
 Yes 348 13.6%
Outcomes
Physical violence, past year
 No 1943 93.0%
 Yes 171 7.0%
Sexual harassment or violence, past year
 No 1840 86.6%
 Yes 274 13.4%
Depression/anxiety symptoms, past 2 weeks
 Normal 1229 56.1%
 Mild 523 25.4%
 Moderate 223 10.7%
 Severe 139 7.8%
Socio-demographics
Gender
 Female 989 51.0%
 Male 1125 49.0%
Race
 White 1436 44.5%
 Black 85 5.6%
 Asian 151 12.5%
 Hispanic 339 31.4%
 Other/multiple races 103 6.1%
Age (continuous; mean SD) 48.5 17.2
Income Quintile
 Lowest 375 25.5%
 Second Lowest 369 19.9%
 Middle 351 17.0%
 Second Highest 472 18.6%
 Highest 547 19.1%
Sexual identity
 Heterosexual 1891 90.2%
 Gay/Lesbian/Bisexual/Other 223 9.8%
Disability
 No 1465 71.3%
 Yes 649 28.8%
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We also assessed each form of discrimination reported by racial/ethnic group and found white participants least likely and Black participants most likely to report everyday discrimination (16.5% and 43.7%, respectively) and race-based major discrimination (3.2% and 45.2%, respectively). Hispanic participants were most likely to report past-year policing across racial/ethnic groups (20.8% vs. 9.1–13.3% for the other racial/ethnic groups categorized in this study).

Past year physical violence was reported by 7% of respondents, and 13.4% had experienced past year sexual violence (See Table 1.). More than half of participants (56.1%) reported normal levels of depression and/or anxiety symptoms in the prior two weeks, 25.4% reported mild levels, 10.7% reported moderate levels, and 7.8% reported severe levels of depression and/or anxiety symptoms in the past two weeks (See Table 1.).

3.2. Associations between discrimination and outcomes

In unadjusted regression models, everyday discrimination, non-race-based major discrimination, and policing experience were associated with significantly greater odds of past-year physical violence experience (ps < 0.001) (See Table 2 .). In fully adjusted models, experiences of everyday discrimination (single form AOR 5.0, 95% CI 2.5–10.3, p < 0.001; multiple forms AOR 2.6, 95% CI 1.1–5.8, p = 0.02) remained significantly associated with increased odds of physical violence, but major experiences of race-based and non-race-based discrimination were not significantly associated with the outcome. Policing exposure remained associated with greater odds of past-year physical violence in fully adjusted models (AOR 3.8, 95% CI 2.0–7.1, p < 0.001).

Table 2.

Frequencies, unadjusted and adjusted logistic regression analyses to assess associations between experiences of discrimination and past year physical violence among a state representative sample of California adults in March 2021 (N = 2114).

Tabulations by outcome
 Unadjusted regression
 Adjusted regression
Physical Violence Subsample
 No Physical Violence Subsample
 OR
 p-value
 95% CI
 AOR
 p-value
 95% CI
Unwt N Wt % Unwt N Wt % Lower Upper Lower Upper
Everyday Discrimination
 None 44 26.8% 1559 77.4% Ref Ref Ref Ref Ref Ref Ref Ref
 Single Form 72 47.4% 226 11.7% 11.67 <0.001 6.39 21.31 5.03 <0.001 2.46 10.31
 Multiple Forms 55 25.7% 158 10.8% 6.85 <0.001 3.49 13.44 2.57 0.02 1.14 5.79
Major experiences of race-based discrimination
 No 137 84.7% 1794 90.4% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 34 15.3% 149 8.6% 1.70 0.16 0.82 3.53 0.94 0.90 0.34 2.57
Major experience of non-race-based discrimination
 No 87 51.9% 1450 77.9% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 84 48.1% 493 22.1% 3.27 <0.001 1.95 5.48 1.95 0.054 0.99 3.83
Policing in Past Year
 No 53 46.8% 1713 89.4% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 118 53.3% 230 10.7% 9.56 <0.001 5.57 16.41 3.82 <0.001 2.04 7.14
Gender
 Male 126 57.3% 999 48.4% Ref Ref Ref Ref Ref Ref Ref Ref
 Female 45 42.7% 944 51.6% 0.70 0.18 0.41 1.18 0.69 0.21 0.39 1.24
Race
 White 113 29.1% 1323 45.6% Ref Ref Ref Ref Ref Ref Ref Ref
 Black 4 5.3% 81 5.6% 1.47 0.54 0.43 4.99 1.23 0.74 0.35 4.31
 Asian 5 4.3% 146 13.1% 0.52 0.24 0.17 1.56 0.39 0.20 0.09 1.63
 Hispanic 44 59.2% 295 29.3% 3.17 <0.001 1.88 5.35 1.76 0.11 0.88 3.50
 Other/multiple races 5 2.1% 98 6.4% 0.52 0.23 0.18 1.52 0.32 0.051 0.10 1.00
Age
 Continuous - mean (SD) 34.7 (11.2) 49.5 (17.0) 0.94 <0.001 0.92 0.95 0.96 <0.001 0.94 0.98
Income Quintile
 Lowest 27 37.0% 348 24.6% Ref Ref Ref Ref Ref Ref Ref Ref
 Second Lowest 17 14.2% 352 20.3% 0.46 0.07 0.20 1.07 0.39 0.03 0.17 0.93
 Middle 14 10.7% 337 17.5% 0.41 0.04 0.17 0.98 0.54 0.20 0.21 1.38
 Second Highest 42 19.8% 430 18.5% 0.71 0.36 0.35 1.47 1.02 0.97 0.47 2.21
 Highest 71 18.3% 476 19.2% 0.64 0.19 0.32 1.25 1.14 0.76 0.49 2.65
Sexual identity
 Heterosexual 132 71.8% 1759 91.6% Ref Ref Ref Ref Ref Ref Ref Ref
 Gay/Lesbian/Bisexual/Other 39 28.2% 184 8.4% 4.28 <0.001 2.33 7.85 2.43 0.01 1.19 4.96
Disability
 No 50 32.1% 1415 74.2% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 121 67.9% 528 67.9% 6.09 <0.001 3.54 10.47 2.57 0.004 1.36 4.84
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In unadjusted regression models, everyday discrimination, non-race-based major discrimination, and policing experience were associated with significantly greater odds of past-year sexual violence experience (ps < 0.001) (See Table 3 .). Experience of race-based major discrimination was also associated with greater likelihood of sexual violence in unadjusted comparisons (OR 2.1, 95% CI 1.2–3.5, p = 0.01). In fully adjusted models, experiences of everyday discrimination (single form AOR 1.7, 95% CI 1.0–2.9, p = 0.047, multiple form AOR 2.5, 95% CI 1.4–4.4, p = 0.002) and experiences of race-based major discrimination (AOR 2.0, 95% CI 1.1–3.8, p = 0.03) remained significantly associated with increased odds of sexual violence. Experience of non-race-based major discrimination (AOR 2.4, 95% CI 1.5–3.9, p = 0.001) and policing (AOR 2.6, 95% CI 1.6–4.2, p < 0.001) were also associated with greater odds of past-year sexual violence.

Table 3.

Frequencies, unadjusted and adjusted logistic regression analyses to assess associations between experiences of discrimination and past year sexual harassment and violence among a state representative sample California adults in March 2021 (N = 2114).

Tabulations by outcome
 Unadjusted regression
 Adjusted regression
Sexual Violence Subsample
 No Sexual Violence Subsample
 OR
 p-value
 95% CI
 AOR
 p-value
 95% CI
Unwt N Wt % Unwt N Wt % Lower Upper Lower Upper
Everyday Discrimination
 None 110 43.9% 1493 78.5% Ref Ref Ref Ref Ref Ref Ref Ref
 Single Form 87 27.6% 211 12.2% 4.06 <0.001 2.49 6.60 1.70 0.047 1.01 2.87
 Multiple Forms 77 28.5% 136 9.3% 5.49 <0.001 3.36 8.96 2.48 0.002 1.41 4.36
Major experiences of race-based discrimination
 No 224 83.2% 1707 91.0% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 50 16.8% 133 9.0% 2.05 0.01 1.19 3.53 2.03 0.03 1.08 3.81
Major experience of non-race-based discrimination
 No 157 59.2% 1380 78.7% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 117 40.8% 460 21.3% 2.54 <0.001 1.71 3.78 2.36 0.001 1.45 3.85
Policing in Past Year
 No 142 64.3% 1624 89.8% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 132 35.7% 216 10.2% 4.87 <0.001 3.16 7.51 2.60 <0.001 1.61 4.19
Gender
 Male 141 31.8% 984 51.6% Ref Ref Ref Ref Ref Ref Ref Ref
 Female 133 68.2% 856 48.4% 2.29 <0.001 1.55 3.37 3.19 <0.001 2.09 4.86
Race
 White 167 32.3% 1269 46.3% Ref Ref Ref Ref Ref Ref Ref Ref
 Black 13 6.3% 72 5.5% 1.65 0.22 0.74 3.67 0.92 0.84 0.38 2.19
 Asian 14 8.3% 137 13.1% 0.91 0.79 0.43 1.91 0.72 0.42 0.32 1.60
 Hispanic 62 44.1% 277 29.4% 2.15 <0.001 1.40 3.30 1.12 0.67 0.67 1.88
 Other/multiple races 18 8.9% 85 5.7% 2.25 0.02 1.13 4.50 1.57 0.34 0.62 3.96
Age
 Continuous - mean (SD) 37.3 (13.0) 50.2 (17.1) 0.95 <0.001 0.94 0.96 0.96 <0.001 0.94 0.97
Income Quintile
 Lowest 46 29.7% 329 24.8% Ref Ref Ref Ref Ref Ref Ref Ref
 Second Lowest 37 20.5% 332 19.8% 0.86 0.62 0.49 1.53 0.98 0.96 0.53 1.82
 Middle 33 13.7% 318 17.5% 0.65 0.19 0.34 1.23 1.05 0.90 0.51 2.17
 Second Highest 70 18.6% 402 18.6% 0.84 0.54 0.48 1.48 1.41 0.30 0.73 2.71
 Highest 88 17.6% 459 19.3% 0.76 0.33 0.44 1.32 1.58 0.12 0.88 2.85
Sexual Identity
 Heterosexual 213 78.5% 1678 92.0% Ref Ref Ref Ref Ref Ref Ref Ref
 Gay/Lesbian/Bisexual/Other 61 21.6% 162 8.0% 3.17 <0.001 1.95 5.16 2.16 0.003 1.30 3.60
Disability
 No 128 48.9% 1337 74.7% Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 146 51.1% 503 25.3% 3.08 <0.001 2.09 4.54 1.76 0.01 1.14 2.72
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Individuals who experienced severe depression and/or anxiety symptoms in the past two weeks more frequently reported experiences of everyday discrimination than those who reported normal symptom levels (48.3% vs 16.2%) and more frequently reported race-based major discrimination (19.2% vs 9.0%) (See Table 4 a.). Those who experienced severe symptoms also more frequently reported non-race-based major discrimination (31.3% vs 17.7%) and being approached or stopped by the police in the past year (23.6% vs 8.6%). In unadjusted multinomial regression models, everyday discrimination, non-race-based major discrimination, and policing experience were associated with significantly greater risk of mild, moderate, and severe mental health symptoms (ps < 0.05) (See Table 4 b.). Experience of race-based major discrimination was also associated with greater risk of severe mental health symptoms in unadjusted comparisons (RRR 2.4, 95% CI 1.2–4.9, p = 0.02). In fully adjusted models, experience of multiple forms of everyday discrimination (aRRR 3.3 95% CI 1.6–6.7, p = 0.001) and experience of race-based major discrimination (aRRR 2.7, 95% CI 1.2–6.2, p = 0.02) remained significantly associated with increased risk of severe depression and/or anxiety symptoms (See Table 4 c.). Experience of a single form of everyday discrimination was also associated with greater risk of moderate mental health symptoms (aRRR 2.0, 95% CI 1.1–3.6, p = 0.02), and experience of multiple forms of everyday discrimination was associated with greater risk of mild mental health symptoms (aRRR 2.0, 95% CI 1.1–3.6, p = 0.02). Experience of non-race-based major discrimination was significantly associated with mild (aRRR 1.7, 95% CI 1.2–2.5, p = 0.005) and moderate (aRRR 1.9, 95% CI 1.2–2.9, p = 0.007) mental health symptom severity. Past year policing experience was not associated with any level of mental health symptom severity.

Table 4a.

Distributions of discrimination experiences and demographics by recent depression/anxiety symptoms among a state representative sample of California adults in March 2021 (N = 2114).

Normal Symptoms
 Mild Symptoms
 Moderate Symptoms
 Severe Symptoms
Unwt N Wt % Unwt N Wt % Unwt N Wt % Unwt N Wt %
Everyday Discrimination
 None 1063 83.8% 357 64.8% 121 59.8% 62 51.7%
 Single Form 111 9.9% 100 18.2% 58 26.9% 29 14.9%
 Multiple Forms 55 6.3% 66 16.9% 44 13.3% 48 33.4%
Major experiences of race-based discrimination
 No 1144 91.0% 469 88.9% 204 93.8% 114 80.8%
 Yes 85 9.0% 54 11.1% 19 6.2% 25 19.2%
Major experience of non-race-based discrimination
 No 980 82.4% 340 69.7% 128 63.9% 89 68.7%
 Yes 249 17.7% 183 30.4% 95 36.1% 50 31.3%
Policing in Past Year
 No 1110 91.4% 414 81.6% 158 78.8% 84 76.4%
Yes 119 8.6% 109 18.4% 65 21.2% 55 23.6%
Gender
 Male 675 53.0% 266 46.8% 118 45.5% 66 32.5%
 Female 554 47.0% 257 53.3% 105 54.5% 73 67.5%
Race
 White 867 48.8% 340 39.8% 139 36.2% 90 39.4%
 Black 51 5.6% 21 5.4% 6 5.3% 7 6.2%
 Asian 86 12.3% 43 15.2% 18 11.8% 4 5.5%
 Hispanic 168 27.9% 90 30.7% 47 41.0% 34 45.0%
 Other/multiple races 57 5.3% 29 8.8% 13 5.7% 4 4.0%
Age
 Continuous - mean (SD) 52.6 (17.4) 45.6 (15.4) 44.0 (16.2) 34.9 (11.6)
Income Quintile
 Lowest 183 20.3% 98 25.0% 56 36.9% 38 47.9%
 Second Lowest 218 21.0% 80 17.1% 42 18.2% 29 23.5%
 Middle 212 17.9% 88 17.3% 37 17.9% 14 8.4%
 Second Highest 290 19.7% 124 20.8% 35 12.7% 23 11.5%
 Highest 326 21.1% 133 19.8% 53 14.3% 35 8.7%
Sexual Identity
 Heterosexual 1137 94.2% 451 86.1% 194 90.9% 109 73.9%
 Gay/Lesbian/Bisexual/Other 92 5.8% 72 13.9% 29 9.1% 30 26.1%
Disability
 No 1015 85.3% 312 61.5% 101 50.0% 37 31.4%
 Yes 214 14.7% 211 38.5% 122 50.0% 102 68.6%
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Table 4b.

Unadjusted multinomial logistic regression analysis to assess associations between experiences of discrimination and recent depression/anxiety symptoms among a state representative sample of California adults in March 2021 (N = 2114).*

Mild
 Moderate
 Severe
RRR
 p-value
 95% CI
 RRR
 p-value
 95% CI
 RRR
 p-value
 95% CI
Lower Upper Lower Upper Lower Upper
Everyday Discrimination
None Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Single Form 2.39 <0.001 1.55 3.69 3.82 <0.001 2.23 6.53 2.44 0.02 1.15 5.16
Multiple Forms 3.47 <0.001 2.11 5.71 2.96 0.001 1.59 5.48 8.58 <0.001 4.49 16.39
Major experiences of race-based discrimination
No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Yes 1.27 0.31 0.80 2.03 0.67 0.32 0.30 1.48 2.41 0.02 1.18 4.90
Major experience of non-race-based discrimination
No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Yes 2.03 <0.001 1.46 2.82 2.64 <0.001 1.71 4.07 2.13 0.007 1.23 3.68
Policing in Past Year
No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Yes 2.38 <0.001 1.54 3.69 2.85 <0.001 1.67 4.86 3.28 <0.001 1.78 6.04
Gender
Male Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Female 1.28 0.19 0.96 1.71 1.35 0.15 0.90 2.02 2.34 0.001 1.39 3.95
Race
White Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Black 1.19 0.62 0.61 2.32 1.27 0.64 0.46 3.49 1.36 0.57 0.47 3.91
Asian 1.52 0.07 0.97 2.38 1.29 0.46 0.66 2.51 0.55 0.34 0.17 1.86
Hispanic 1.35 0.10 0.95 1.92 1.98 0.004 1.25 3.14 1.99 0.01 1.15 3.47
Other/multiple races 2.05 0.01 1.16 3.64 1.45 0.37 0.65 3.22 0.93 0.91 0.25 3.38
Age
Continuous 0.98 <0.001 0.97 0.98 0.97 <0.001 0.96 0.98 0.93 <0.001 0.91 0.95
Income Quintile
Lowest Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Second Lowest 0.66 0.09 0.41 1.06 0.48 0.02 0.26 0.87 0.47 0.03 0.24 0.94
Middle 0.79 0.33 0.49 1.27 0.55 0.06 0.30 1.03 0.20 0.001 0.08 0.50
Second Highest 0.86 0.50 0.55 1.34 0.36 0.001 0.19 0.67 0.25 <0.001 0.12 0.52
Highest 0.77 0.22 0.50 1.17 0.38 0.002 0.20 0.69 0.18 <0.001 0.08 0.37
Sexual Identity
Heterosexual Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Gay/Lesbian/Bisexual/Other 2.62 <0.001 1.64 4.20 1.63 0.11 0.89 2.96 5.73 <0.001 3.04 10.80
Disability
No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Yes 3.63 <0.001 2.62 5.02 5.80 <0.001 3.77 8.91 12.68 <0.001 7.19 22.34
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*Reference is normal symptoms.

Table 4c.

Adjusted multinomial logistic regression analysis to assess associations between experiences of discrimination and recent depression/anxiety symptoms among a state representative sample of California adults in March 2021 (N = 2114).

Mild Moderate Severe
aRRR p-value 95% CI aRRR p-value 95% CI aRRR p-value 95% CI
Lower Upper Lower Upper Lower Upper
Everyday Discrimination
 None Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Single Form 1.38 0.19 0.85 2.23 2.02 0.02 1.13 3.60 0.74 0.55 0.27 2.00
 Multiple Forms 2.01 0.02 1.14 3.55 1.57 0.24 0.74 3.33 3.29 0.001 1.62 6.68
Major experiences of race-based discrimination
 No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 1.19 0.55 0.67 2.13 0.61 0.33 0.23 1.63 2.71 0.02 1.19 6.19
Major experience of non-race-based discrimination
 No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 1.71 0.005 1.17 2.48 1.87 0.01 1.19 2.94 1.79 0.11 0.88 3.64
Policing in Past Year
 No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 1.51 0.10 0.92 2.47 1.63 0.14 0.85 3.14 1.27 0.51 0.62 2.61
Gender
 Male Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Female 1.44 0.02 1.05 1.98 1.34 0.21 0.85 2.10 2.40 0.005 1.29 4.46
Race
 White Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Black 0.77 0.48 0.38 1.57 1.02 0.97 0.38 2.75 0.39 0.08 0.13 1.13
 Asian 1.54 0.08 0.95 2.51 1.50 0.29 0.71 3.15 0.65 0.58 0.14 2.99
 Hispanic 0.92 0.69 0.61 1.39 1.15 0.62 0.66 2.02 0.69 0.29 0.35 1.37
 Other/multiple races 1.54 0.18 0.82 2.90 1.20 0.69 0.49 2.93 0.49 0.34 0.11 2.13
Age
 Continuous 0.98 <0.001 0.97 0.99 0.97 <0.001 0.96 0.99 0.93 <0.001 0.91 0.95
Income Quintile
 Lowest Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Second Lowest 0.75 0.27 0.45 1.26 0.55 0.08 0.29 1.06 0.57 0.14 0.27 1.20
 Middle 0.99 0.96 0.60 1.64 0.73 0.37 0.37 1.45 0.36 0.07 0.12 1.10
 Second Highest 1.08 0.75 0.68 1.72 0.47 0.03 0.24 0.91 0.45 0.07 0.19 1.06
 Highest 0.99 0.97 0.62 1.59 0.54 0.07 0.28 1.04 0.33 0.02 0.13 0.81
Sexual Identity
 Heterosexual Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Gay/Lesbian/Bisexual/Other 1.88 0.008 1.18 3.01 0.92 0.81 0.45 1.86 2.84 0.01 1.34 6.00
Disability
 No Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
 Yes 3.45 <0.001 2.44 4.88 5.25 <0.001 3.27 8.42 11.40 <0.001 5.98 21.73
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*Reference is normal symptoms.

4. Discussion

Findings from this study demonstrate that experiences of everyday discrimination, major experiences of racial discrimination, and heavy policing are associated with higher odds of experiencing physical violence, sexual violence, and severe symptoms of depression and anxiety. These findings are consistent with prior research implicating discrimination as a key risk factor for chronic stress and poor mental health outcomes among racial/ethnic minority populations (APA, October 31, 2019). Our analyses extend this work by documenting the associations between discrimination and victimization from violence during the pandemic. Prior research suggests that both violence victimization and mental health issues have increased during the pandemic (Connor et al., 2020; de Figueiredo et al., 2021; A. Raj et al., 2020a, Raj et al., 2020b), and this study suggests that previously documented increases in experiences of race/ethnicity related discrimination during the pandemic (Strassle et al., 2022) may have exacerbated violence and mental health risks. Additionally, results indicate that experiences of non-race/ethnicity-based discrimination – most commonly tied to age, income/class, and gender or sexual identity-also contribute to victimization and adverse health outcomes. Findings support the use of an intersectional analysis in our understanding of discrimination and its impacts (Fagrell Trygg et al., 2019).

An important finding is that everyday experiences of discrimination tend to have a larger association with all our outcomes as compared with major race-based discrimination. This difference could be attributed, at least partially, to the different timeframes for both measures. Everyday discrimination assesses current experiences of discrimination, whereas the measure for major discrimination assesses lifetime experiences of discrimination. Because such experiences could have occurred months, years, or decades prior to the survey, they may be less significant relative to more immediate and chronic experiences of everyday discrimination. These findings are consistent with prior research showing stronger associations between everyday discrimination and mental health outcomes as compared to major discrimination (Ayalon and Gum, 2011). Nevertheless, it is important to note that race-based major discrimination was significantly associated with increased risk for sexual violence and severe mental health symptoms. Major race-based discrimination remains a key risk factor, as it can affect the socioeconomic stability and well-being of individuals and perceptions of options to help ensure safety.

We found that policing exposure is also associated with greater risk for violence, though not with mental health concerns. It may be that policing is more likely to happen in contexts where violence occurs. Environments with heavy policing and police surveillance may also be places where victimization from violence is more likely. Racial residential segregation is linked with abuses from police for Black and Latinx residents (Johnson et al., 2019). As a result, policing in these neighborhoods may be an everyday reality for these residents and may not be associated with mental health outcomes but are associated with an increased risk of victimization (Lodge et al., 2021). Regardless, given the history of racial discrimination in policing, and growing concerns regarding abusive police during the pandemic (Sewell, 2020), more research is needed on this.

We also need more research on the exact mechanisms underlying the association between discrimination and victimization. Our study results may be indicative of the dual risk of discrimination and victimization among racial/ethnic minority populations. Discrimination may increase the risk for violence, or may co-occur with violence. More research is needed to understand whether experiences of discrimination are directly associated with specific forms of victimization. For example, instances of verbal discrimination may escalate into instances of physical aggression, increasing the risk for physical and sexual violence. These results also highlight the importance of employing an intersectional lens when assessing the risk for victimization and poor mental health outcomes. Prior research documents that violence often occurs in multiple forms against those who experience victimization. Multiple forms of everyday racism can take an even bigger toll on mental health.

5. Limitations

We must consider the findings in light of certain study limitations. As noted, the study is cross-sectional, so we cannot assume temporal ordering or causality. Our data relied on self-report and are thus subject to recall and social desirability biases. Recall for violence is likely high given the salience of the issue, and recall of mental health symptoms is likely high due to the recall time being the past two weeks. However, participants may under-report both outcomes given the stigma attached to both victimization and mental health concerns. We used previously validated discrimination scales, but these too may not fully reflect all experiences of discrimination for participants. The Everyday Discrimination scale used in this study did not allow for clarity on what characteristics resulted in discrimination, and there is some indication of variability in the scale by demographic characteristics (Harnois et al., 2019). We also only have measures of perception of discrimination and not objective measures of discrimination. Meta-analysis of subjective (perception) versus more objective measures of discrimination show stronger effects of objective measures on well-being including mental health outcomes (Schmitt et al., 2014). Hence, our findings are likely yielding conservative estimates.

The study used an online probability panel that facilitates engagement of a state representative sample, but the participation rate is low (32%), which is typical of online studies (Callegaro and DiSogra, 2009; Nulty, 2008). At the same time, random sampling approaches would be better to reduce potential biases inevitable in on-line rapid surveys, because standard approaches likely under-represent those affected by violence and mental health issues (Pierce et al., 2020). Additionally, while this study is weighted to yield a state representative sample, it is also a convenience sample of online panel participants, though efforts were made to reduce some of the biases from typical online surveys as much as possible, including area probability and address-based recruitment and inclusion of non-internet and non-cell phone households. A non-response follow-up campaign was also used to increase participation and representation. Additionally, generalizability of findings may be limited to adults in California and may not reflect younger populations or populations in other states.

6. Conclusion

In summary, this cross-sectional study of discrimination, violence, and mental health of California adults, undertaken during the COVID-19 pandemic in 2021, demonstrates that experiences of discrimination, particularly everyday discrimination, are associated with increased risk for physical and sexual violence as well as depression and anxiety symptoms during the pandemic. Further, we see that everyday discrimination, which can manifest as regularly occurring microaggressions, more than major racial discrimination experiences (e.g., discrimination resulting in non-hiring or denial of bank loans from financial institutions), may be driving these vulnerabilities. Experiences with different types of discrimination, including policing, are also associated with an increased risk for violence victimization. This work provides greater insight into some aspects of systemic racism and health disparities related to trauma and mental health (Boynton-Jarrett et al., 2021) and documents the need to focus on anti-racist care and service provision as part of COVID-19 rebuilding efforts. Importantly, given the other attributes linked to discrimination, in particular age and sex/gender, more work is needed to recognize that these forms of discrimination also persist and yield harm. We also need further methodological work to disentangle the impacts of everyday versus major experiences of discrimination in addition to identifying mechanisms underlying the discrimination-victimization link. Nonetheless, the findings emphasize the need to address social determinants of health with an intersectional lens and as part of strengthening community health for both pandemic management and post-pandemic rebuilding (Bleser et al., 2022). Further, these findings support the growing body of evidence that shows that we cannot achieve health equity and human dignity without ending all forms of discrimination, including racial/ethnic discrimination (Bleser et al., 2022).

Sources of funding

Blue Shield of California Foundation Grants RP-1907-13755 & P-2006-14747; Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation Grants 20202903 & 118910; Bill and Melinda Gates Foundation INV018007.

Credit author statement

Anita Raj: Conceptualization, Writing – original draft, Review and Editing. Sangeeta Chatterji: Writing – original draft, Review and Editing, Validation. Nicole E Johns: Formal analysis, Writing – original draft, Review and Editing. Jennifer Yore: Project administration. Arnab Dey: Writing – review & editing. David R Williams: Methodology, Writing – review & editing.

Acknowledgements

We would like to thank our CalVEX Advisory Board, NORC, Lilibeth Ramirez, and our participants for helping create this study.

Data availability

Data will be made available on request.

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