Analyzing the mediating effects between discrimination and depression: A cross-sectional study

Abstract

Background Depression is pervasive and influences health. There is, however, a lack of understanding regarding the nuanced way racial discrimination influences depression within medical settings. Objective To increase understanding regarding the relationship between discrimination and depression, we analyzed the relationships between experiencing discrimination and depressive symptoms, whether anxiety and stress were mediators of this relationship, and whether self-esteem and racial identity moderated these relationships. Design: Stratified random sampling was used to identify 383 participants (228 White and 155 Black). Hayes’ PROCESS macro was utilized to analyze both the mediating and moderating influences of discrimination on depression. Results The overall model showed that discrimination, self-esteem, racial identity, anxiety, and perceived stress accounted for 57% of the variance in depressive symptoms. There was a significant direct association between experiences of discrimination with depressive symptoms (B = .21, p > .01). Both anxiety (B = .24, p < .01) and perceived stress (B = .53, P < .01) were also associated with depressive symptoms. Self- Esteem appeared to moderate the relationship between discrimination and both anxiety (B = − .60, P < .01) and perceived stress (B = − .55, p < .01). Conclusions These data suggest that, in the presence of depressive symptoms, clinicians should consider screening for discrimination, stress, and anxiety. In addition, interventions emphasizing self-esteem may mitigate the influence of discrimination, stress, and anxiety.