Mental health and well-being in different levels of perceived discrimination.

BACKGROUND: To compare mental health and well-being in different levels of the perceived discrimination among Iranian people living in Tehran.
METHOD: Using multi-stage sampling, 1255 subjects with the average age of 45 years and 9 months (including 672 women and 583 men) were selected and they completed all items of the general health questionnaire (GHQ), the social well-being inventory (SWI), personal well-being inventory (PWI), and a question to assess the perceived discrimination.
RESULTS: Data analysis by Kruskal-Wallis test revealed that there were significant differences between physical symptoms (χ(2)=5.93, P<0.05) and depression (χ (2)=15.70, P<0.05), the subscales of mental health in different levels of the perceived discrimination. Furthermore, comparing personal well-being scores and its subscales in different levels of the perceived discrimination showed significant differences in personal hygiene (χ(2)=7.20, P<0.05), and security in future (χ(2)=7.60, P<0.05). Emotional well-being (χ(2)=12.25, P<0.05), self-rule (χ(2)=7.45, P<0.05), personal growth (χ(2)=19.87, P<0.05), and psychological well-being (χ(2)= 9.09, P<0.05) were significantly different in different levels of the perceived discrimination, too. Moreover, comparing social well-being in different levels of the perceived discrimination indicated significant differences between social acceptance (χ (2)=14.91, P<0.05), and social participation (χ (2)= 10.91, P<0.05).
CONCLUSION: Therefore, people are more active in society, increases the possibility of encountering with discrimination and consequently the perception of that.

Introduction

Perceived discrimination means individual’s belief about others selective behavior regardless of his/her competence. Perhaps this is the result of individual’s feeling due to different behaviors toward him/her in public places or not having access to appropriate information resources and social networks (1).

The main attitude in understanding the phenomenon of perceived discrimination is social identity attitude according to which individuals classify others and they based on major characteristics such as demographic features in separate groups and because of membership in those groups anticipate certain behavior (2).

According to Essed (3, 4), two kinds of discrimination can be known, first one is daily discrimination that is repeatable and seems nearly normal and the second one is major discriminatory events which are lifelong and rarely happen. Sever discrimination or experienced discriminatory behavior can be more harmful to individual’s mental health in daily life than lifelong discriminatory behavior (5).

Studies have shown that people are more interested in reporting daily discrimination than discrimination, which rarely occur (6, 7).

Williams & Williams-Morris (reported in 8) believe internalized discrimination can involve serious psychological and negative emotional consequences. Dion & Earn (9) and Liebkind (10) know perceived discrimination as one of the factors related to disorder in mental health and Mesch, Turjeman, Fishman (11) believe that is related to the reduction of well-being.

In addition, Dion & Earn (9) believe perceived discrimination accompanies the increase of aggression, Sorrow, anxiety and self-centered. Moreover, Liebkind (10) considers the experience of discrimination as one of the best predictors of anxiety and stress symptoms.

Williams and Williams-Morris (reported in 8) also believe that perceived discrimination has as unpleasant effect on individual’s mental health because he/she may internalize negative beliefs and stereotypes about him/herself and the group to which he/she belongs. They also analyze that internalizing discrimination can harmfully affect social and mental performance of individual and consequently makes negative mental and emotional results. This idea is in consistent with the model of “being under stress process” that indicates stressful events and severe tension, due to the weariness of self-concept which is the factor of health enhancement, harm individual’s well-being (12).

Researches conducted on Iranian refugees in the Netherlands show that discrimination feeling is a really common and ordinary experience among them (13).

Many studies have also shown that perceived discrimination is one of the most secondary stressful factors, which are connected to the main stressful events such as losing job and/or aggression (14). According to the definition, well-being feeling can be known as security feeling and general satisfaction of life that involve oneself and others in different areas including family, occupation, etc (15). Mental well-being or happiness and lack of mental distress are the main dimensions of well-being (16, 17). Therefore, people who own high levels of well-being mainly experience positive emotions while those who have low levels of well-being evaluate the events and their lives unpleasantly and more experience negative emotions such as anxiety, depression and anger (15).

Studies have shown that facing repeatedly to the behavioral discrimination causes sadness to rise and the individual’s control on life to decrease, and also daily negative interaction have a harmful effect on well-being (11). As it is observed in stress-disease model presented by Lazarus & Folkman (18), discrimination has been introduced as one of stressful factors. Because stressful factors as the negative events of life have capability of harming the mental and physical well-being, it may be concluded that discrimination can have a negative effect on well-being feeling (18–20).

Comprehensive well-being has four components including psychological, personal, social, and emotional well-being. Many focused studies have shown that discrimination has severe varying effects on emotional well-being (21–25).

Many studies have also shown a positive relationship between the degree of perceived social support and emotional well-being (26, 27). Perceived discrimination can act as a direct or internalized stressful factor and because of its negative effect on physical (28) and mental health decline the use of hygienic care which is one of the components of personal well-being (7, 29).

Internalizing unfair behavior may indirectly affect the use of hygienic care through increasing other social-mental, financial and/or attitude stressors (25). Sociopsychological stressors such as depression have been connected to the decline of regular medical care over time (30). Financial stress, shortage of social support and other stressors of life are also connected to the decline of hygienic care usage (31–34). According to above information and the important role of health (physical, mental and social) in personal life, and based on the harmful role of perceived discrimination as a stressful factor, this research is going to compare mental health and well-being in different classes of perceived discrimination.

Materials and Methods

This study was a kind of causal-comparative research. The sample of research includes 1200 participants (672 women, 583 men) with the average age of 45 years and 9 months, and Iranian citizenship. They are living in Tehran and own diploma and/or higher degree and were selected by multi-steps random sampling. Then each subject answered to the items of general health questionnaire, personal and comprehensive well-being questionnaire, and researcher-made scale.

Introducing the tools of gathering data:

General health questionnaire (GHQ) (35). This questionnaire was used as a tool of studying individuals’ mental health. 28-Question form scales including: physical symptoms, anxiety and sleep disorder, social functioning disorder and depression subscales. Noorbala, Bagher Yazdi and Yasami (36) administered SCL-90-R test with GHQ to 90 subjects, in order to examine concurrent validity of GHQ. The degree of correct diagnostic consistency of both tests shows that GHQ-28 has high accuracy and sensitivity to diagnose mental health. By using test-retest method with one week interval after the first administration, the correlation was significant (r= 0.85, P<0.05).

Personal well-being inventory (37): personal well-being Index includes 7 items consisting of: life standards and conditions, health, whatever attained in life, relationship with others, relief (peace 0 and security feeling, togetherness and membership among others and security in future. Reliability and validity of this index has been obtained among the spouses of injured combatant of Ghom Province by Sharif (38) and its reliability was obtained through Cronbakh Alpha as 0.84.

Comprehensive well-being Questionnaire (39, 40): comprehensive well-being Questionnaire which has been presented by Keyes involves 13 subscales of pleasurable (eg emotional well-being) and virtuous (eg social and psychological well-being) aspects. In Iran Joshan Loo, Rostami & Nosrat Abadi (41) reported Cronbakh Alpha for social well-being Subscale as 0.76, for psychological well-being. Subscale as 0.6, and for emotional well-being as 0.8.

A multiple-choice question was designed by the researcher to assess perceived discrimination. The question was “In your opinion, In current society how much is the degree of discrimination, generally? “ Which involved three choices: nothing, to some extent, so much?

Results

In this research mental health and its components, comprehensive well-being and its components, and personal well-being with its components in different classes of perceived discrimination have been compared through nonparametric test of Kruskal-Wallis (because of non-homogeneity of groups variance).

As the results of Table 1 shows, only physical symptoms and depression subscales of mental health are significantly different in different levels of perceived discrimination. It means that people who have less perception of social discrimination gained higher scores in these subscales.

Table 1:

Mental health and its subscales in different levels of perceived discrimination

	Mean Rank			Kruskal-Wallis test
	L	M	H	X2	df	P
Mental health	678.21	641.91	616.90	2.867	2	0.238
Physical symptoms	707.81	643.01	613.45	5.937	2	0.050
Anxiety	606.73	617.90	634.54	0.828	2	0.661
Depression	691.07	680.98	598.59	15.703	2	0.001
Social functioning disorder	615.89	595.91	643.20	4.334	2	0.115

The results of Table 2 reflects that only personal hygiene and mental security subscales of personal well-being have significant difference in different levels of perceived discrimination, so that people who have less perception of social discrimination, enjoy more security of future, however, they care less about their personal hygiene.

Table 2:

Comparing personal well-being and its subscales in different levels of perceived discrimination

	Mean Rank			Kruskal-Wallis test
	L	M	H	X2	df	P
Personal Well-Being	642.76	641.84	620.49	1.007	2	0.604
Life Standards	687.62	644.24	614.94	4.064	2	0.131
Personal Hygiene	526.24	630.92	636.94	7.208	2	0.027
Personal Target	627.30	641.47	622.20	0.714	2	0.70
Personal Security	687.59	630.18	621.07	2.567	2	0.277
Interpersonal Satisfaction	594.12	608.35	639.96	2.723	2	0.256
Personal communication in society	540.43	638.69	632.13	5.310	2	0.070
Security In Future	716.90	645.73	611.35	7.609	2	0.022
Life Satisfaction	608.70	633.06	627.73	0.308	2	0.857

The results of Table 3 indicates that total scores of emotional well-being and psychological well-being and also the scores of self-rule, personal growth and meaningfulness in life (i.e. subscales of psychological well-being) have significant difference in different levels of perceived discrimination. Therefore, those who gained higher scores in emotional well-being perceived less social discrimination. In addition, those who gained higher scores in psychological well-being, personal growth, and meaningfulness in life perceived discrimination that is more social. However, those who gained higher scores in self-rule subscales had average perception of social discrimination.

Table 3:

Comparing emotional well-being, life satisfaction, psychological well-being and its subscales in different levels of perceived discrimination

	Mean Rank			Kruskal-Wallis test
	L	M		L	M	P
Positive Affect	763.04	620.83	617.57	12.252	2	0.002
Life Satisfaction	609.03	629.68	629.17	0.264	2	0.884
Self-Acceptance	645.51	604.13	636.64	2.217	2	0.330
Self – Rule	524.56	641.71	632.41	7.455	2	0.024
Control Over Environment	579.95	625.87	633.75	1.678	2	0.432
Personal Growth	561.57	601.45	646.24	6.80	2	0.033
Positive Relationship	568.79	603.99	644.40	5.470	2	0.065
Meaningfulness In Life	493.89	592.88	656.76	19.878	2	0.001
Psychological Well-Being	538.46	603.27	647.76	9.098	2	0.011

In Table 4 can be observed that only social acceptance and social participation subscales of social well-being have significant difference in different levels of perceived discrimination, so that those who have higher scores of social acceptance perceived less social discrimination. Also those who had higher scores of social participation, perceived higher social discrimination.

Table 4:

Emotional well-being, life satisfaction, psychological well-being and its subscales in different levels of perceived discrimination

	Mean Rank			Kruskal-Wallis test
	L	M		L	M	P
Social well-being	635.78	626.34	927.94	0.045	2	0.978
Social togetherness	622.77	616.81	633.40	0.544	2	0.762
Social acceptance	721.87	663.97	602.91	14.091	2	0.001
Social participation	539.63	596.22	650.72	10.918	2	0.004
Social flourishing	622.37	658.07	615.46	3.523	2	0.172
Social perceptiveness	629.40	616.68	632.79	0.50	2	0.779

Discussion

As mentioned before, the findings of this research revealed that the scores of physical symptoms and depression have significant difference in different levels of perceived discrimination. Therefore, those who fall in less perception of social discrimination class, gained higher scores in depression subscale. This finding is contrary to Rumbaut (42), some researchers (e.g. 9, 10) findings that showed the experience of discrimination is a predictor of psychological disorder and opposed to mental health and well-being. This finding is also contrary to other (28, 43) findings which found out the negative effect of perceived discrimination on physical health. To explain this finding we should point to emotional symptoms of depression. These kinds of people are generally bored, unhappy, isolated, and uninterested in interacting with others (44). They are preoccupied with themselves and mainly focus on past and their pain and sorrow (45). Therefore, people with depression are ignorant and insensitive to stimuli such as the existent discrimination is society and do not respond to them. Therefore, they perceive less discrimination.

In explaining another finding, which claims people with higher scores in physical symptoms subscale, have less perception of social discrimination, it can be said that these people, because of concerning about their physical problems, often pay little attention to the environment and so report less perception of discrimination.

Based on the findings of table 2, another finding of the research shows a significant difference between personal hygiene and mental security subscales of personal well-being in different levels of perceived discrimination. Therefore, those who have less perception of social discrimination, enjoy more security of future. In explaining these differences in different levels of perceived discrimination, and security in future, we can pin to the role of social support. There is a positive relationship between the degree of perceived social support and emotional well-being (26, 27). In addition, there is a relationship between perceived discrimination and lower levels of positive affect or emotional well-being (46, 47). Therefore, those who have support that is more social perceive less discrimination.

Perceived social support is a piece of information which makes the person believe that he/she is loved, confirmed and valued and belongs to the network of communications and mutual duties (48).

The existence of supportive resources makes people feel that they are cared, loved, esteemed, and valued (49, 50). According to what has been said, people who enjoy high levels of social support, have more security feeling towards their future.

To explain another finding that indicates those who have less perception of social discrimination care less about their personal hygiene, we can rely on some findings (e.g. 7, 28, 29) who believe that perceived discrimination can act as a direct or internalized stressful factor and because of its negative effect on physical and mental health makes the use of hygienic care decrease.

Based on the results of Table 3, total scores of emotional and psychological well-being and also the scores of self-rule, personal growth and meaningfulness in life, subscales of psychological well-being, have significant difference in different levels of perceived discrimination, so that those with higher scores of emotional well-being, perceive less social discrimination.

According to the studies conducted by others (21–25) discrimination has a severe unpleasant effect on emotional well-being. Other researches (46, 47) have also shown that perceived discrimination accompanies lower levels of positive affection (emotional well-being) and lower levels of life satisfaction. Therefore, the finding of this research is consistent with those of previous studies. In explaining this finding indicating the relationship between perceived discrimination and emotional well-being, we have to mention that emotional well-being is one of specific elements of well-being construct (51) and involved some of signs of having or lack of positive feelings towards life (52).

Based on above definition of emotional well-being, it seems that those having high emotional well-being are happy and comfortable, as much as possible. They are also more satisfied with their lives and so are less likely to encounter discrimination.

As it was mentioned, the findings of this research indicate that those with higher psychological well-being scores perceive more social discrimination. These findings are inconsistent with those (e.g. 18–20) indicated stressful factors (such as perceived discrimination) as negative events of life, are capable of harming physical and mental well-being.

In addition, this finding is in contrary to other findings (8) believed internalizing discrimination can harmfully affect individual’s social and mental functioning and consequently cause negative mental and emotional outcomes.

In explaining this finding, it seems that those having psychological well-being are completely sensitive to the surrounding stimuli and perceive the least discrimination easily. Those who obtained higher scores in self-rule subscale had average perception of social discrimination. The relationship between perceived discrimination and self-rule subscale can be explained so that concerning Ryan & Grolnick (53), those having high self-rule, enjoy higher levels of deserts and worthiness. In addition, they have more positive emotional state (54, 55). These people have stronger intrinsic motivation and pay little attention to extrinsic ones. Therefore, because of having such moral characteristics, they will not have high perception of discrimination.

The findings of this research indicate that those with higher scores of personal growth perceive discrimination that is more social. In explaining this finding, the definition of personal growth (having the feeling of continuous growth and its capability; receptiveness to new experiences; increasing efficiency and wisdom) should be considered (40). Those who own high level of personal growth, have more chance to encounter with discrimination and recognize it easily because of their wisdom.

Another finding indicates that those with higher scores of meaningfulness perceive discrimination that is more social. In explaining this finding, according to the definition of meaningfulness in life which reflects having goals and orientation in life and believe in ideas that direct life (40), it seems that those who try to achieve a goal in their lives have more interaction with others and consequently encounter with more discrimination.

Based on the observed results, only social acceptance and participation subscales of social well-being have significant difference in different levels of perceived discrimination, so that those who have higher scores of social acceptance perceived less social discrimination. In explaining this finding, as social acceptance shows individual’s perception of society feature as the unity, those who have optimum levels of this component of social well-being, enjoy positive attitude towards humanity, trust others and believe in people goodness (56). Therefore, those who have high levels of social acceptance because of their optimistic beliefs towards others’ life and behavior perceive less discrimination. In addition, the findings show that those with higher scores of social participation perceive more social discrimination concerning social participation subscale, while those with optimum levels of social participation feel that they are important member of their society and can present valuable things to the world (56). Therefore, these people are more active in society and their interactions with others increase too, and this increases the possibility of encountering with discrimination and consequently the perception of that.

Ethical considerations

Ethical issues (Including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc) have been completely observed by the authors. The consent from were completed out prior to applying tests.