Whether on the basis of race, ethnicity, gender, or other factor, discrimination is sadly common. Much has been published about the short-term harms of discrimination, but what about long-term effects?
To answer that question Lei et al (10.1542/peds.2021-051378) looked at the relationship of discrimination and mental health, substance abuse, and overall wellbeing. The authors analyzed data from over 1,800 youth starting at 18 years of age from 2007-2017 who were part of families engaged in the “Transition to Adulthood” supplement of a national longitudinal national survey (the Panel Study of Income Dynamics). The central finding is that no matter what the nature of the discrimination, it was associated in a dose-dependent manner with mental illness, substance use, and psychological distress up to 6 years after report of the initial discrimination exposure. In addition, no particular type of discrimination was more likely to lead to poor outcomes.
So, what can we do as pediatric clinicians to address these disturbing and eye-opening findings? To answer that question, we asked Drs. Jennifer Walton from Nationwide Children’s Hospital and Dr. Adiaha Spinks-Franklin from Texas Children’s Hospital (10.1542/peds.2021-053619) to share their thoughts in an accompanying commentary. They point out three areas of discrimination and provide us with suggestions as to how to counter against them—i.e., the impact of interpersonal discrimination (as this study demonstrates); how implicit bias can perpetuate episodes of discrimination; and how current medical education curriculum needs to evolve to include core competency training in areas such as bias, equity, and discrimination.
This brief blog cannot do justice to how much you will learn about the short- and long-term consequences of discrimination in our patients by linking to both articles.