Background

International and population-specific evidence identifies elevated psychological distress prevalence among those experiencing interpersonal discrimination. We aim to quantify the potential whole-of-population contribution of interpersonal discrimination to psychological distress prevalence and Indigenous–non-Indigenous gaps in Australia.

Methods

We did a cross-sectional analysis of data from Mayi Kuwayu: the National Study of Aboriginal and Torres Strait Islander Wellbeing. Baseline surveys were completed between June 8, 2018, and Sept 28, 2022. We analysed responses from participants who were aged 18 years or older at survey completion, whose surveys were processed between Oct 1, 2018, and May 1, 2021. Sample weights were developed on the basis of national population benchmarks. We measured everyday discrimination using an eight-item measure modified from the Everyday Discrimination Scale and classified experiences as racial discrimination if participants attributed these experiences to their Indigeneity. Psychological distress was measured using a validated, modified Kessler-5 scale. Applying logistic regression, we calculated unadjusted odds ratios (ORs), to approximate incident rate ratios (IRRs), for high or very high psychological distress in relation to everyday discrimination and everyday racial discrimination across age-gender strata. Population attributable fractions (PAFs), under the hypothetical assumption that ORs represent causal relationships, were calculated using these ORs and population-level exposure prevalence. These PAFs were used to quantify the contribution of everyday racial discrimination to psychological distress gaps between Indigenous and non-Indigenous adults.

Findings

9963 survey responses were eligible for inclusion in our study, of which we analysed 9951 (99·9%); 12 were excluded due to responders identifying as a gender other than man or woman (there were too few responses from this demographic to be included as a category in stratified tables or adjusted analyses). The overall prevalence of psychological distress was 48·3% (95% CI 47·0–49·6) in those experiencing everyday discrimination compared with 25·2% (23·8–26·6) in those experiencing no everyday discrimination (OR 2·77 [95% CI 2·52–3·04]) and psychological distress prevalence was 49·0% (95% CI 47·3–50·6) in those experiencing everyday racial discrimination and 31·8% (30·6–33·1) in those experiencing no everyday racial discrimination (OR 2·06 [95% CI 1·88–2·25]. Overall, 49·3% of the total psychological distress burden among Aboriginal and Torres Strait Islander adults could be attributable to everyday discrimination (39·4–58·8% across strata) and 27·1% to everyday racial discrimination. Everyday racial discrimination could explain 47·4% of the overall gap in psychological distress between Indigenous and non-Indigenous people (40·0–60·3% across strata).

Interpretation

Our findings show that interpersonal discrimination might contribute substantially to psychological distress among Aboriginal and Torres Strait Islander adults, and to inequities compared with non-Indigenous adults. Estimated PAFs include contributions from social and health disadvantage, reflecting contributions from structural racism. Although not providing strictly conclusive evidence of causality, this evidence is sufficient to indicate the psychological harm of interpersonal discrimination. Findings add weight to imperatives to combat discrimination and structural racism at its core. Urgent individual and policy action is required of non-Indigenous people and colonial structures, directed by Aboriginal and Torres Strait Islander peoples.

Funding

National Health and Medical Research Council of Australia, Ian Potter Foundation, Australian Research Council, US National Institutes of Health, and Sierra Foundation.

中文翻译：

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人际歧视对澳大利亚原住民和托雷斯海峡岛民成年人心理困扰以及原住民与非原住民不平等的人口层面贡献：社区控制的原住民队列研究的横断面分析

 背景

国际和特定人群的证据表明，遭受人际歧视的人心理困扰的患病率较高。我们的目标是量化人际歧视对澳大利亚心理困扰患病率和土著与非土著差距的潜在整体影响。

 方法

我们对 Mayi Kuwayu 的数据进行了横断面分析：原住民和托雷斯海峡岛民福祉国家研究。基线调查于2018年6月8日至2022年9月28日期间完成。我们分析了调查完成时年龄在18岁或以上的参与者的回复，他们的调查是在2018年10月1日至2021年5月1日期间处理的。样本权重是根据国家人口基准制定的。我们使用从日常歧视量表修改而来的八项衡量标准来衡量日常歧视，如果参与者将这些经历归因于他们的原住民，则将这些经历归类为种族歧视。使用经过验证的、改良的 Kessler-5 量表来测量心理困扰。应用逻辑回归，我们计算了与跨年龄性别阶层的日常歧视和日常种族歧视相关的高或极高心理困扰的未调整比值比（OR），以近似事件发生率（IRR）。在 OR 代表因果关系的假设下，使用这些 OR 和人群水平暴露率计算人口归因分数 (PAF)。这些 PAF 用于量化日常种族歧视对土著和非土著成年人之间心理困扰差距的影响。

 发现

9963 份调查回复符合纳入我们研究的条件，我们分析了其中 9951 份 (99·9%)； 12 名受访者被排除在外，因为受访者的性别不是男性或女性（该人群的受访者太少，无法作为一个类别纳入分层表或调整分析中）。在那些遭受日常歧视的人中，心理困扰的总体患病率为 48·3% (95% CI 47·0–49·6)，而在那些没有遭受日常歧视的人中，心理困扰的总体患病率为 25·2% (23·8–26·6)。 OR 2·77 [95% CI 2·52–3·04]），在日常遭受种族歧视的人群中，心理困扰患病率为 49·0% (95% CI 47·3–50·6)，而心理困扰患病率为 31·8% (95% CI 47·3–50·6)。 30·6–33·1）在那些没有日常种族歧视的人中（OR 2·06 [95% CI 1·88–2·25]。总体而言，原住民和托雷斯海峡的总心理困扰负担为 49·3%岛民成年人可能会受到日常歧视（各阶层的 39·4–58·8%），27·1% 可能会受到日常种族歧视的影响。日常种族歧视可以解释原住民与非原住民之间心理困扰总体差距的 47·4%。 - 原住民（各阶层 40·0–60·3%）。

 解释

我们的研究结果表明，人际歧视可能会在很大程度上导致原住民和托雷斯海峡岛民成年人的心理困扰，以及与非原住民成年人相比的不平等。估计的 PAF 包括社会和健康劣势的贡献，反映了结构性种族主义的贡献。虽然没有提供严格确凿的因果关系证据，但这一证据足以表明人际歧视的心理危害。调查结果更加强调了打击歧视和结构性种族主义的必要性。非原住民和殖民结构需要在原住民和托雷斯海峡岛民的指导下采取紧急的个人和政策行动。

 资金

澳大利亚国家健康和医学研究委员会、伊恩·波特基金会、澳大利亚研究委员会、美国国立卫生研究院和塞拉基金会。