Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework

Abstract

BackgroundIntersectionality theory focuses on how one’s human experiences are constituted by mutually reinforcing interactions between different aspects of one’s identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination.MethodsMultivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use.ResultsIntersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22–5.03]), alcohol use (B = 1.65, CI = [0.56–2.73]), tobacco use (OR = 3.45, CI = [1.97–6.05]), and marijuana use (OR = 3.38, CI = [1.80–6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03–4.29] for depressive symptoms, B = 1.45 and CI = [0.58–2.32] for alcohol use, OR = 2.21 and CI = [1.32–3.70] for tobacco use, and OR = 3.01 and CI = [1.77–5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39–5.02]) and marijuana use (OR = 2.81, CI = [1.33–5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52–3.28]) and marijuana use (OR = 2.37, CI = [1.24–4.49]).ConclusionsOur results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression).

Racial and Gender Discrimination Predict Mental Health Outcomes among Healthcare Workers Beyond Pandemic-Related Stressors: Findings from a Cross-Sectional Survey

“…We also included a single item asking respondents how often they were treated unfairly based on their gender in the previous year (i.e., from January 2020-2021), which was scored using the same 6-point scale as the racial discrimination measure. This item has been used to assess gender discrimination among both men and women [17].…”

The role of social mechanisms of change in women’s addiction recovery trajectories

“…This is perhaps in contrast to Hall's (2019) research on male's recovery/desistance identities in which recovery often becomes the primary social component with which they guide their recovery journeys and structure their lifestyles. The intersections of disadvantage women often experience (Vu et al, 2019) and the social expectations women must juggle with regards to their social identity (Gunn & Canada, 2015) perhaps mean women experience structural limitations which may restrict the development of a primarily recovery-focused identity. It could however be argued that in fact this balance is a healthy approach to the adoption of a recovery identity, due to the multitude of meaningful activities women became engaged in.…”

The Effects of Coronavirus Victimization Distress and Coronavirus Racial Bias on Mental Health Among AIAN, Asian, Black, and Latinx Young Adults

“…Since racial/ethnic minorities are more likely to be employed in health care or low-wage jobs that are considered essential during the pandemic (31,46), emerging reports indicate they are experiencing higher levels of depression and anxiety (47). Finally, although in general gender and sexual minority status among young adults is associated with increases in depression and anxiety (48,49), intersecting ethnic and sexual minority identities have been identified as an increased risk factor for depression and suicidal ideation among Latinx and Black sexual minority men and women (50)(51)(52)(53)(54) and across people of color identified as transgender females (55,56).…”

“…Our study suggests this is due not only to the infection risks associated with work outside the home during this period, but to victimization by others based on social perceptions that people of color are more likely to be infected with the virus. Past research has also shown that sexual and gender minority status, medical conditions and financial insecurity have direct impact on depression and anxiety among Black, Indigenous and Latinx young adults (26,27,(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(48)(49)(50)(51)(52)(53)(54)(55)(56).…”