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South African Medical Journal

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Perceived discrimination and mental health disorders: The South African Stress and Health study

H Moomal, PB Jackson, DJ Stein, A Herman, L Myer, S Seedat, E Madela-Mntla

Abstract


Objectives. To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders.

Design. A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables.
Setting. A nationally representative sample of adults in South
Africa.
Subjects. 4 351 individuals aged 18 years and older.
Outcomes. 12-month and lifetime mood, anxiety and substance
use disorders.
Results. In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acute
racial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic nonracial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder was
evident across mood, anxiety, and substance use disorders in
the fully adjusted models.

Conclusion. The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders.




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