Association of everyday discrimination with health outcomes among Asian and non-Asian US older adults before and during the COVID-19 pandemic

Abstract

Increases in anti-Asian COVID-19 related discriminatory behaviors have been observed, many of which targeted older adults. Studies demonstrate that racial discrimination is associated with worse health outcomes, including anxiety, depression, and sleep difficulties. No previous studies have examined the impact of day-to-day experiences of discrimination before and during COVID-19 on both Asian and non-Asian older adults within the same sample. We examined whether everyday discrimination was associated with increased anxiety and depression symptoms, decreased levels of functioning, and increased sleep difficulties among Asian and non-Asian US older adults before and during the pandemic. Data came from the Positive Minds-Strong Bodies randomized clinical trial, an evidence-based mental health and disability prevention intervention for racially and ethnically diverse older adults with elevated depression or anxiety symptoms and minor to moderate disability. We conducted secondary data analyses in a cohort of 165 older adults (56 Asian and 109 non-Asian) assessed before COVID-19 (May 2015-May 2018) and during COVID-19 (March 2021-July 2022). Regression models examined whether everyday discrimination impacted health outcomes differently before and during COVID-19, and whether this effect was stronger among Asian compared to non-Asian older adults. Non-Asian older adults reported the same levels of everyday discrimination before and during COVID-19. Consistent with literature suggesting that social distancing has inadvertently kept US Asian populations from experiencing discrimination, Asian older adults reported marginally lower levels of everyday discrimination during the pandemic compared with pre-pandemic. We found that everyday discrimination was not associated with health outcomes before COVID-19. In contrast, during the pandemic, everyday discrimination was associated with worse anxiety and depression symptoms and worse levels of functioning, although only the impact on depression was significantly stronger compared with before the pandemic. This negative impact of everyday discrimination on health outcomes during the pandemic appeared to affect both Asian and non-Asian older adults similarly. Social support and social cohesion buffered against the negative effect of everyday discrimination on depression and level of functioning during the pandemic. Results suggest that public health interventions aimed at reducing everyday discrimination and emphasizing social support and cohesion can potentially improve health outcomes for all US older adult populations.Clinical trial registrationwww.ClinicalTrials.gov; identifier: NCT02317432.

Coping with the post-COVID-19 pandemic: perceived changes of older adults in their life satisfaction, depression, and quality of life

“…A study by Levkovich et al (2021) reported that life satisfaction among older adults is not directly related to depression but rather to mediators that increase depression levels. A study conducted in China reported that during a 2-week lockdown period, older adults with increased depression experienced a poor QoL (Tavares, 2022; Zhang et al , 2022b), but they did not report the impact on life satisfaction. While QoL refers to general well-being, but life satisfaction refers to life evaluations.…”

“…The required samples were based on the repeated measures design by measuring each subject four times. Based on a recent study in the USA, a moderate effect size (¼ 0.20) on the change in depression levels in older adults before and after COVID-19 was adopted (Zhang et al, 2022a(Zhang et al, , 2022b. Using the G Ã Power software v3.1.9.7, this study required at least 36 samples that can achieve 80% power and 5% type I error.…”

“…The COVID-19 outbreak has adversely affected older adults’ well-being and mental health (Gigantesco et al , 2019; Zhang et al , 2022b). The literature reported that older adults were experiencing an increased level of fear and distress during the pandemic (Hansen et al , 2022).…”

“…Moreover, subsequently suffer from stress, anxiety and depression (Varma et al , 2021). In a study conducted in China at the beginning of the pandemic, the depression and QoL of older adults were evaluated before and after the two-week lockdown due to the whole city implementing an isolated period (Zhang et al , 2022b). It was found that there was an increase in depression and poor QoL levels in older adults after the two-week isolation period.…”