POPULATION-LEVEL CONTRIBUTION OF INTERPERSONAL DISCRIMINATION TO PSYCHOLOGICAL DISTRESS AMONG ABORIGINAL AND TORRES STRAIT ISLANDER AUSTRALIAN ADULTS, AND TO INDIGENOUS-NON-INDIGENOUS INEQUITIES: CROSS-SECTIONAL ANALYSIS OF A COMMUNITY-CONTROLLED FIRST NATIONS COHORT STUDY

• Published in: The Lancet
• Main Authors: Thurber, Katherine A., Brinckley, Makayla-May, Jones, Roxanne, Evans, Olivia, Nichols, Kirsty, Priest, Naomi, Guo, Shuaijun, Williams, David R, Gee, Gilbert C, Joshy, Grace, Banks, Emily, Thandrayen, Joanne, Baffour, Bernard, Mohamed, Janine, Calma, Tom, Lovett, Raymond
• Format: Text
• Language: English
• Published: 2022
• Subjects: Article; First Nations
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807286/; http://www.ncbi.nlm.nih.gov/pubmed/36502846; https://doi.org/10.1016/S0140-6736(22)01639-7

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’. METHODS: Applying logistic regression to cross-sectional data from 9,951 Mayi Kuwayu Study adult participants, we calculate unadjusted Odds Ratios (ORs, to approximate Incident Rate Ratios) and 95%CI for high/very high psychological distress in relation to any versus no everyday discrimination and everyday racial (attributed to Indigeneity) 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, and used to quantify everyday racial discrimination’s contribution to ‘gaps’. FINDINGS: Across strata, ORs for psychological distress were 2·36(95%CI:1·62,3·44; 45·7% versus 26·3%) to 3·12(2·44–3·99; 47·8% versus 22·7%) for everyday discrimination and 1·50(1·09,2·06; 45·0% versus 35·3%) to 2·42(1·89–3·11; 43·1% versus 23·8%) for everyday racial discrimination. 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). Everyday racial discrimination could explain 47·4% of the ‘gap’ overall (40·0–60·3% across strata). INTERPRETATIONS: Findings demonstrate interpersonal discrimination may contribute substantially to psychological distress among Aboriginal and Torres Strait Islander adults, and to inequities. 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 harm. Findings add weight to imperatives to combat ...