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Hispanic Journal of Behavioral
http://hjb.sagepub.com/content/30/4/401
The online version of this article can be found at:
DOI: 10.1177/0739986308323056
7 August 2008
2008 30: 401 originally published onlineHispanic Journal of Behavioral Sciences
A. Pasch and Cynthia L. de Groat
Elena Flores, Jeanne M. Tschann, Juanita M. Dimas, Elizabeth A. Bachen, Lauri
Health Among Mexican-Origin Adults
Perceived Discrimination, Perceived Stress, and Mental and Physical
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Perceived Discrimination,
Perceived Stress, and Mental
and Physical Health Among
Mexican-Origin Adults
Elena Flores
University of San Francisco
Jeanne M. Tschann
University of California, San Francisco
Juanita M. Dimas
Private Practice
Elizabeth A. Bachen
Mills College
Lauri A. Pasch
Cynthia L. de Groat
University of California, San Francisco
This study provided a test of the minority status stress model by examining
whether perceived discrimination would directly affect health outcomes even
when perceived stress was taken into account among 215 Mexican-origin adults.
Perceived discrimination predicted depression and poorer general health, and mar-
ginally predicted health symptoms, when perceived stress was taken into account.
Perceived stress predicted depression and poorer general health while controlling
for the effects of perceived discrimination. The influence of perceived discrimina-
tion on general health was greater for men than women, and the effect of perceived
stress on depression was greater for women than men. Results provide evidence
that discrimination is a source of chronic stress above and beyond perceived stress,
and the accumulation of these two sources of stress is detrimental to mental and
physical health. Findings suggest that mental health and health practitioners need
to assess for the effects of discrimination as a stressor along with perceived stress.
Keywords: perceived discrimination; perceived stress; depression; physi-
cal health; Mexican-origin adults
Scholars have argued that racial disparities in health can be attributed to
the larger structure of social, economic, and racial/ethnic inequality in
the United States (Spalter-Roth, Lowenthal, & Rubio, 2005; Williams,
Hispanic Journal of
Behavioral Sciences
Volume 30 Number 4
November 2008 401-424
© 2008 Sage Publications
10.1177/0739986308323056
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Lavizzo-Mourey, & Warren, 1994). Specifically, researchers have noted
that people who are exposed to multiple adverse conditions such as poverty,
crowded housing, unsafe neighborhoods, unequal health care treatment,
and racial discrimination tend to suffer from poorer mental and physical
health (Spalter-Roth et al., 2005; Williams, Yu, Jackson, & Anderson,
1997). Sociological and psychological researchers have promoted the con-
ceptualization that groups occupying multiple disadvantaged social cate-
gories (e.g., race, ethnicity, gender, socioeconomic status [SES]),
particularly stigmatized minority groups, are exposed to multiple risk fac-
tors and stressful social environments that may increase their vulnerability
to the effects of stress and compromise their health (Allison, 1998; Meyer,
2003; Williams et al., 1994). Investigators have argued that ethnic minori-
ties experience stressors associated with their minority status, in addition to
the daily life stressors that nonminorities face, and that this heightened
stress places them at increased risk for health and mental health problems
(Allison, 1998; Harrell, 2000; Turner & Avison, 2003; Williams et al.,
1997). The minority status stress model describes the unique or excess
stress, as compared to general stress, to which individuals in oppressed
groups are exposed as a result of their minority status in society (Allison,
1998; Meyer, 2003). A central contributor to the minority status stress expe-
rience is racial/ethnic discrimination. There is growing evidence that the
subjective experience of racial/ethnic discrimination is a major stressor that
directly and indirectly affects the mental and physical health status of eth-
nic minority populations (Jackson et al., 1996; Ren, Amick, & Williams,
1999; Williams, Neighbors, & Jackson, 2003).
In particular, perceived discrimination, which is the subjective experience
of being treated unfairly relative to others in everyday experience, has been
linked to health (Dion, Dion, & Pak, 1992; Williams et al., 2003). In studies
of African Americans, perceived discrimination has been associated with
physical health outcomes such as hypertension (Krieger & Sidney, 1996;
402 Hispanic Journal of Behavioral Sciences
Authors’ Note: This research was supported by Grant R40MC00118 from the Maternal and
Child Health Bureau, Health Resources and Services Administration, Department of Health
and Human Services, awarded to Jeanne M. Tschann. We would like to thank the families who
participated in the Adolescent Health Research Project and the Kaiser Foundation Research
Institute, which provided access to members of Kaiser Permanente. We are grateful to Lilia
Cardenas, Martha Castrillo, Jorge Palacios, Philip Pantoja, Carlos Penilla, and Stephanie
Whitzell for assistance in data collection and to Philip Pantoja and Seth Duncan for data man-
agement. Address correspondence to Elena Flores, Counseling Psychology Department,
School of Education, University of San Francisco, 2130 Fulton St., San Francisco, CA 94118;
e-mail: florese@usfca.edu.
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Williams & Neighbors, 2001), cardiovascular function (Anderson, 1989;
Troxel, Matthews, Bromberger, & Sutton-Tyrrell, 2003), and negative physi-
ological reactions (Jones, Harrell, Morris-Prather, Thomas, & Omowale,
1996). Mental health status has been the most common outcome examined in
studies of the effects of perceived discrimination on health. Among African
Americans, perceived discrimination has been associated with higher levels
of psychological distress (Broman, Mavaddat, & Hsu, 2000; Jackson et al.,
1996), depression and anxiety (Kessler, Mickelson, & Williams, 1999), and
problem drinking (Martin, Tuch, & Roman, 2003). In addition, perceived dis-
crimination has been associated with increased depression among Asian
Americans (Lee, 2005; Mossakowski, 2003) and Southeast Asian refugees in
Canada (Noh, Beiser, Kaspar, Hou, & Rummens, 1999).
There are few empirical studies investigating the influence of perceived
discrimination on mental and physical health among Latinos, as described
below. This study contributes to the limited literature on Latinos by testing
the notion set forth in the minority status stress model that perceived dis-
crimination is additive to the general stress experienced by Mexican immi-
grants and Mexican Americans. While perceived discrimination may have
an indirect impact on the general stressors experienced by those of Mexican
origin, we expected that perceived discrimination would directly affect
health outcomes even when general stress was taken into account. The cur-
rent study used an expanded measure of chronic discrimination stress in
everyday life to examine the effects of perceived discrimination on mental
and physical health among Mexican-origin men and women. In addition,
we examined whether there were gender differences in the effects of per-
ceived discrimination on health.
Background
Minority Status Stress
The minority status stress model, which is based on an expansion of gen-
eral stress theory, provides an important conceptual framework for under-
standing the stress process and the impact of discrimination as a stressor for
Mexican-origin adults. Although general stress theory has been utilized to
examine the psychological and health functioning of racial/ethnic minority
groups, the mainstream models of the stress process have been criticized for
not including stressors experienced by minority cultural groups (Cervantes
& Castro, 1985; Slavin, Rainer, McCreary, & Gowda, 1991). In particular,
Flores et al. / Perceived Discrimination and Health 403
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Slavin et al. (1991) have expanded the stress model of Lazarus and
Folkman (1984) to integrate cultural factors salient to the stress process for
ethnic minorities. These researchers contend that membership in a visible
minority group, experiences of discrimination, lower SES, and unique cul-
tural customs all contribute to affect the nature and frequency of stressful
life events that individuals experience, the appraisal process, and the per-
ceptions about the available options and resources for successful coping. A
major contention of the model is that ethnic minorities experience unique
stressors due to their disadvantaged social position and membership in sev-
eral social categories—that is, lower SES, ethnic minority, and gender—
and therefore may encounter more stressful life events than nonminorities
(Allison, 1998; Meyer, 2003). In turn, the multiple stressors experienced
among members of oppressed groups may enhance vulnerability to stress,
such that individuals live in a state of heightened vigilance or high levels of
stress that affect health.
There is some evidence to support the notion that Mexican-origin adults
experience more stress in their lives than nonminorities due to exposure to
more stressful life events and chronic stressors, which can adversely impact
their mental and physical health. For example, Golding and Burnam (1990)
reported greater exposure to stress, measured as financial, employment, and
household strain, among Mexican Americans than non-Hispanic Whites,
which predicted higher mean depression levels. A recent major survey
(American Psychological Association [APA], 2006) found Latinos are
more likely than non-Latino Whites to report concerns with the level of
stress in their lives, yet they are among the least likely to do anything about
it. Latinos were more likely than other ethnic groups to report multiple
symptoms of stress. Money, work related to lower income occupations, and
family members’ health are bigger sources of stress for Latinos than for
non-Latino Whites. Two thirds of Latinos in the survey fell into lower
income households, and they were more likely to report stress than those
with higher incomes. Both men and women reported low wages and hous-
ing, family, and health expenses as major stressors as well as unsafe work
conditions for men and problems with supervisors for women. In addition,
racial/ethnic discrimination was reported as a source of stress more for
Latinos than non-Latino Whites, especially contributing to workplace
stress. Latinos concerned about stress were more likely to be diagnosed
with anxiety, depression, and obesity, and less likely to report good physi-
cal health, than those with no concerns about stress. Similarly, perceived
stress has been associated with high numbers of chronic health problems
among Mexican immigrants and Mexican Americans (Farley, Galves,
404 Hispanic Journal of Behavioral Sciences
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Dickinson, & Perez, 2005). Latinos in general, especially those of Mexican
origin, are less likely to have employer-provided health coverage due to
their concentration in service sector jobs (Spalter-Roth et al., 2005). Thus,
it can be argued that Mexican-origin adults experience higher levels of gen-
eral stress due to being members of a disadvantaged group. They experi-
ence multiple sources of stress over which they may have little control, and
this enhanced vulnerability to stressors contributes to mental and physical
health conditions.
Important aspects of minority status stress for Mexican-origin adults that
can further explain poor health outcomes involve experiences of discrimi-
nation and unique cultural stressors such as immigration, legal status,
acculturation, and language differences (Cervantes & Castro, 1985;
Miranda, 2000). In general, research on discrimination and stress among
Mexican-origin adults has been embedded within the concept of accultura-
tive stress, defined as strains due to the immigrant experience and the accul-
turation process. In fact, acculturative stress is the most common stressor
studied among the Mexican-origin population and has been associated with
poorer mental health (Dimas, Snowden, Lopez-Kinney, & Vega, 1999;
Hovey, 2000; Hovey & Magana, 2000) and general health (Finch & Vega,
2003). While discrimination may be intertwined with acculturative stress,
we argue that discrimination needs to be examined as a conceptually dis-
tinct and important stressor impacting health. Research indicates that accul-
turative stress among Mexican-origin adults and adolescents decreases with
years in the United States, whereas discrimination remains a stressor across
generations (Finch, Kolody, & Vega, 2000; Gil, Vega, & Dimas, 1994).
Williams et al. (1994) argue that racism has a significant impact because it
can transform social status, affecting the degree of risk factors one is
exposed to and directly affecting health through its effects on psychologi-
cal and physiological reactions. Thus, racial/ethnic discrimination may be
salient for Mexican-origin adults because it influences their social positions
and the conditions they experience on a daily basis and may be experienced
directly as a frequent, chronic stressor in their lives.
Discrimination and Health
There is growing evidence that exposure to discriminatory experiences
is an ongoing aspect of life for Latinos in general, and the Mexican-origin
population in particular, within the United States (Araujo & Borrell, 2006).
The National Survey of Latinos (2002) reported that perceived discrimina-
tion was a major problem that kept them from succeeding in general (82%)
Flores et al. / Perceived Discrimination and Health 405
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and was a problem in the workplace (78%) and at schools (75%). In the sur-
vey, one in three Latinos reported that they or someone close to them had
suffered discrimination in the past 5 years because of their racial or ethnic
background, particularly due to their physical appearance and/or the lan-
guage they speak. In addition, Latinos reported more subtle forms of dis-
crimination (i.e., treated with disrespect, insulted, or called names) than
non-Latino Whites. A few studies have shown that darker skinned Latinos
experience more racial discrimination than lighter skinned Latinos (Araujo
& Borrell, 2006). There is considerable evidence that perceived discrimi-
nation is widespread in the workplace for Latinos; such discrimination
affects hiring, wages, and class mobility (DeFrietas, 1991; Gutierres, Delia,
& Green, 1994; Telles & Murguia, 1990; Yen, Ragland, Greiner, & Fisher,
1999). Thus, perceived discrimination appears to be a common stressful life
event and chronic stressor for Latinos.
A few studies have examined the influence of perceived discrimination
on mental and physical health among Mexican-origin adults. One study
found perceived discrimination to have an independent effect on physical
health after taking into account SES, national heritage, acculturative stress,
and social support among Mexican-origin adults (Finch, Hummer, Kolody,
& Vega, 2001). Dimas et al. (1999) reported that perceived discrimination
predicted psychiatric disorders above and beyond the effects of accultura-
tion and acculturative stress. In several studies of Mexican American adults,
and Mexican and Latino immigrants, perceived discrimination has been
directly and indirectly related to depressive symptoms or depression
(Alderete, Vega, Kolody, & Aguilar-Gaxiola, 1999; Finch et al., 2000;
Salgado de Snyder, 1987; Steffen & Bowden, 2006) as well as psychologi-
cal distress (Amaro, Russo, & Johnson, 1987; Moradi & Risco, 2006) and
lower levels of psychological well being (Ryff, Keyes, & Hughes, 2003).
However, the notion that perceived discrimination is an additional stressor
that affects health above and beyond general stress has not been examined
among the Mexican-origin population. The current study provides a test of
this aspect of the minority status stress model by examining whether per-
ceived discrimination is related to depression and physical health while
considering the effects of general stress among Mexican-origin adults.
Gender Differences in Discrimination and Health
The possibility that there are gender differences in the effects of perceived
discrimination on health has received little attention. There is some evidence
that men and women differ in their reports of experiencing discrimination;
406 Hispanic Journal of Behavioral Sciences
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however, the few studies that have examined gender have not found signifi-
cant gender differences in the effects of perceived discrimination on mental
and physical health (Borrell, Kiefe, Williams, Diez-Roux, & Gordon-Larsen,
2006; Kessler et al., 1999; Turner & Avison, 2003). One exception is a study
of Mexican Americans by Finch et al. (2000), which found that the influence
of perceived discrimination on depression was greater for women than men.
In addition, research indicates that men and women differ in the types of
stress experienced and in exposure to and appraisal of stressful events (APA,
2006; Davis, Matthews, & Twamley, 1999; Matud, 2004). For example,
women have been found to have more chronic stress and minor daily stres-
sors than men. Some studies have found that women report more tension, dis-
tress, and fear during stress while men report elevated blood pressure
(Matthews, Gump, & Owens, 2001; Morris-Prather et al., 1996). To our
knowledge, this is the first study to investigate gender differences in the
effects of perceived discrimination on physical health or in the effects of per-
ceived stress on mental and physical health among Mexican-origin adults.
Research Questions
We examined the following research questions: Does perceived discrim-
ination predict depression, general health, and health symptoms, and do
these effects remain even when perceived stress is taken into account?
Second, does perceived stress predict depression, general health, and health
symptoms even after taking perceived discrimination into account? Third,
are there gender differences in the effects of perceived discrimination and
perceived stress on depression, general health, and health symptoms?
Method
Procedure and Participants
Parents and adolescents who had participated in a previous study (Study
1), examining marital conflict and adolescent health-related functioning
among Mexican Americans and European Americans (Flores, Tschann,
Marin, & Pantoja, 2004; Tschann et al., 2002), were recontacted to partic-
ipate in the current study (Study 2). For Study 1, potential participants were
randomly selected from the membership lists of a large health maintenance
organization (HMO) in Northern California, using a computer program.
Eligible families were intact (parents still living together), parents were the
biological parents or had adopted the adolescent before the age of 1 year,
Flores et al. / Perceived Discrimination and Health 407
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all three family members were of Mexican-origin or were U.S.-born
European American, the adolescent was between 12 and 15 years of age
and had no severe learning disability, and all three family members agreed
to participate. Seventy three percent of eligible families participated in the
research. Of these, 153 (50%) were of Mexican origin.
Four years after their initial participation in Study 1, families were
recontacted to participate in Study 2, a follow-up study examining family
functioning and violence among adolescents (Tschann et al., in press). For
Study 2, parents were sent letters introducing the new research, then were
telephoned and asked to participate in the study. A total of 215 Mexican-
origin parents, including 96 fathers and 119 mothers, participated in Study
2, representing 64% (fathers) and 78% (mothers) of the participants in the
original research. Of these, 91 couples were married to each other. Both
Study 1 and Study 2 protocols were approved by the Institutional Review
Board of the university and the HMO.
The current report is based on a 1-hour telephone interview with the
Mexican-origin parents, conducted during Study 2. Participants were inter-
viewed by bilingual, bicultural interviewers in the language of their choice;
83% chose to be interviewed in Spanish. Demographic characteristics for
the sample are shown in Table 1.
Measures
Translation. Bilingual, bicultural translators translated all measures into
Spanish, other translators translated them back into English, and items were
decentered as needed. Decentering is a process in which both languages are
considered equally important, and the original-language version of an item
may be altered to obtain conceptual equivalence for both languages (Marin
& Marin, 1991). In the final step, five bilingual members of the research
team reviewed the entire interview in both languages together and resolved
discrepancies by consensus.
Perceived discrimination. We developed a 14-item Discrimination Stress
Scale (see Appendixes A and B) to measure discrimination in everyday life
due to minority status by adapting items from existing scales that assessed
perceived discrimination in everyday life (Dimas et al., 1999; Finch et al.,
2001; Williams et al., 1997). Only items that appeared to be applicable to
people of Mexican or other Latino origin were retained. Sample items are
408 Hispanic Journal of Behavioral Sciences
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“How often are you discriminated against because of your race or ethnicity?”
“How often do others lack respect for you because of your race or ethnic-
ity?” and “How often do you find it difficult to find work you want because
of your race or ethnicity?” Response options range from 1 (never) to 4 (very
often). The original version of the scale contained 17 items. Exploratory
factor analysis revealed that 14 of the 17 items loaded on the first unrotated
factor (eigenvalue =7.2; 43% of the variance). The mean value of items was
calculated to obtain the scale score (α=.92). Most (88%) participants
reported at least one experience of discrimination.
Perceived stress. The Perceived Stress Scale (Cohen, Kamarack, &
Mermelstein, 1983) was used to measure general stress. This widely used
10-item scale measures how unpredictable, uncontrollable, and overloaded
participants find their lives. The scale assesses the frequency of perceived
stress over the past month, with responses ranging from 0 (never) to 3 (very
often); for example, “How often have you felt nervous and stressed?” and
“How often have you found that you could not cope with all the things that
Flores et al. / Perceived Discrimination and Health 409
Table 1
Demographic Characteristics of Participants
Males Females
(n=96) (n=119)
Variable M(SD) or % M(SD) or % t or χ2
Age 47.82 (7.06) 44.63 (5.94) 3.59***
Born in Mexico 88% 82% 1.14
Age when moved to U.S. 19.82 (10.39) 17.78 (11.31) 1.36
Education (years) 8.43 (4.73) 8.29 (4.63) 0.22
Employed 100% 80% 21.79***
Occupational levela3.52 (1.88) 3.55 (2.14) –0.91
Married 93% 92% 0.20
Socioeconomic status –0.63 (0.67) –0.65 (0.68) 0.27
Acculturation 2.03 (1.00) 1.92 (1.04) 0.79
Perceived discrimination 1.77 (.56) 1.60 (0.51) 2.44*
Perceived stress 0.86 (0.39) 1.12 (0.54) –3.87***
Depression 30.17 (7.50) 34.65 (12.73) –3.05**
General health 3.03 (1.05) 2.92 (1.02) 0.81
Health symptoms 5.04 (8.98) 7.99 (13.97) –1.66
a. Based on the Hollingshead (1975) scale, ranging from 1 (lowest) to 9 (highest).
*p<.05. **p<.01. ***p<.001. All tests are two-tailed.
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you had to do?” The scale score was calculated by obtaining the mean value
of items (αfor our sample =.77).
Depression. The 20-item Center for Epidemiological Studies Depression
Scale was used to assess frequency of depressive symptoms during the past
week. Responses can range from 1 (less than 1 day) to 4 (5-7 days). This
measure is widely used in studies examining depression among Latinos,
including Mexican Americans. The scale score was calculated by totaling
items (αfor our sample =.89).
General health. General health was measured using a single item: “In
general, would you say your health is . . .” with response options ranging
from poor (1) to excellent (5) (Idler & Benjamini, 1997). Similar global
self-rated health items are commonly used as indicators of physical health
(Williams et al., 2003).
Health symptoms. A list of seven common health symptoms was adapted
from the Health Review (Jenkins, Kreger, Rose, & Hurst, 1980), a self-
report measure of physical symptoms. Participants were asked how many
episodes of symptoms they had experienced during the past 3 months; for
example, “During the last 3 months, how many stomachaches did you
have?” The score is the sum of all episodes for each symptom of fever,
nausea, sore throat, stomachache, diarrhea, constipation, and headache.
Self-report measures of health symptoms are often used to assess physical
health status (Williams et al., 2003).
Acculturation. The five-item Language subscale of the Marin Acculturation
Scale (Marin, Sabogal, Marin, Sabogal, & Perez-Stable, 1987) was used to
assess acculturation. Scores can range from 1 (Spanish only) to 5 (English
only). Mean scores were calculated, so a score of 3 represents equal use of
each language (αin our sample =.90).
Demographic variables. In the initial study, participants reported their
age, years of education, and current occupational status, coded as lowest (1)
to highest (9) (Hollingshead, 1975). Couples’ education and occupational
status were standardized and combined to create a family-level index of
SES (α=.92). Thus, for the current report, each participant had a family-
level SES score.
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Results
Descriptive Statistics
Descriptive statistics for demographic characteristics and study vari-
ables, presented separately for men and women, are shown in Table 1. Men
were significantly older than women, t(213) =3.59, p<.001, and more
often employed, χ2=21.79, p<.0001. Men reported greater discrimination,
t(213) =2.44, p<.02, and women reported greater stress, t(213) =−3.87,
p<.0001, and depression, t(213) =−3.05, p<.003.
Table 2 shows the correlations between study variables. Age, gender,
SES, and acculturation were all significantly related to at least one health
outcome. In addition, perceived discrimination and perceived stress were
significantly related to depression, general health, and health symptoms.
Statistical Models
To examine whether perceived discrimination was related to depression,
general health, and health symptoms, we fit a series of linear regression
equations, using generalized estimating equations, which allowed for clus-
tering within couples. In each equation, we included demographic variables
Flores et al. / Perceived Discrimination and Health 411
Table 2
Correlations and Descriptive Statistics for Study
Variables (n==185-215)
Variable 1 2 3 4 5 6 7 8 9
1. Age —
2. Gender –.24** —
3. Socioeconomic status –.05 –.02 —
4. Acculturation –.11 –.05 .61** —
5. Perceived discrimination –.02 –.17*–.03 .01 —
6. Perceived stress –.07 .26** –.21** –.16*.15*—
7. Depression –.03 .20** –.20** –.19** .23** .70** —
8. General health –.20** –.06 .36** .35** .24** –.36** –.37** —
9. Health symptoms –.09 .12 .05 .24** –.25** .20** .30** –.14 —
M46.06 1.55 –0.64 1.97 1.67 1.01 32.65 2.97 6.70
SD 6.65 0.50 0.67 1.02 0.53 0.49 10.92 1.03 12.12
*p<.05. **p<.01. All tests are two-tailed.
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(age, gender, SES, and acculturation) as covariates in Step 1. Perceived dis-
crimination was entered in Step 2, and perceived stress was added in Step
3. To assess whether there were gender differences in the effects of per-
ceived discrimination on health outcomes, the interaction between gender
and perceived discrimination was entered in Step 4. Parallel regression
models were calculated to examine the effects of perceived stress, in which
perceived stress was entered in Step 2, perceived discrimination was
entered in Step 3, and the interaction term in Step 4 was between gender
and perceived stress.
Perceived Discrimination and Health
As shown in Table 3, greater perceived discrimination was significantly
related to elevated depression (b=5.20, p <.0001), poorer general health
(b=−.52, p<.0001), and more health symptoms (b=5.69, p<.02), after
taking age, gender, SES, and acculturation into account (Step 2). When
perceived stress was included in the equation (Step 3), greater perceived
412 Hispanic Journal of Behavioral Sciences
Table 3
Regression Predicting Health Outcomes Showing Unstandardized
Regression Coefficients and Standard Error
Depression General Health Health Symptoms
b (SE)b (SE)b (SE)
Step and Predictor Variable (n =214) (n =213) (n =185)
Step 1
Age –0.03 (0.09) –0.03 (0.01)*** –0.11 (0.10)
Gender 3.91 (1.24)** –0.18 (0.13) 2.86 (1.78)
Socioeconomic status –2.58 (1.30)*0.36 (0.12)** 0.43 (1.23)
Acculturation –0.97 (0.81) 0.19 (0.08)*0.56 (0.89)
Step 2
Perceived discrimination 5.20 (1.41)*** –0.52 (0.12)*** 5.69 (2.43)*
or
Perceived stress 14.66 (1.00)*** –0.68 (0.14)*** 5.36 (2.70)*
Step 3
Perceived discrimination 2.97 (0.97)** –0.41 (0.13)*** 5.04 (2.65)
Perceived stress 14.04 (1.03)*** –0.59 (0.14)*** 4.25 (2.78)
Step 4
Perceived Discrimination × –0.21 (1.82) 0.55 (0.24)*–3.24 (4.75)
Gender
Perceived Stress × Gender 4.31 (2.08)*0.12 (0.27) 8.07 (4.17)
*p<.05. **p<.01. ***p<.001. All tests are two-tailed.
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discrimination remained a significant predictor of heightened depression
(b=2.97, p<.002) and poorer general health (b=−.41, p<.0001).
However, in the equation predicting health symptoms, when perceived
stress was included in Step 3, the effect of perceived discrimination was
reduced to marginal significance (b=5.04, p<.06).
Perceived Stress and Health
Higher perceived stress was significantly related to increased depression
(b=14.04, p<.0001) and worse general health (b=−.59, p <.0001), even
when controlling for the effects of demographic factors and perceived
discrimination (Step 3, Table 3). Higher perceived stress was significantly
related to greater health symptoms before perceived discrimination was
entered into the equation (Step 2; b=5.36, p<.05). However, when per-
ceived discrimination was also included in the equation (Step 3), perceived
stress was no longer a significant predictor of health symptoms (b=4.25,
p>.10).
Gender Differences in Effects of Perceived
Discrimination and Stress on Health
There was a significant interaction between gender and perceived discrimi-
nation for general health (b=.55, p <.02; Table 3). As shown in Figure 1,
men who reported lower levels of discrimination had better general health
compared to men reporting greater discrimination and women regardless
of discrimination level. There was also a significant interaction between
gender and perceived stress in the prediction of depression (b=4.31, p<.04).
Women who reported higher levels of stress were more depressed than
women and men who had lower levels of stress, while men who reported
higher levels of stress had moderate levels of depression (Figure 2).
Demographics and Health Outcomes
As shown in Table 3, the effect of each demographic variable on health
outcomes was considered while taking into account the remaining demo-
graphic variables. Younger participants reported better general health than
older participants (b=−.03, p<.001). Women reported greater depression
compared to men (b=3.91, p<.002). Participants of higher SES were less
depressed (b=−2.58, p<.05) and reported better general health (b=.36,
p<.003) compared to those of lower SES. Finally, those who were more
Flores et al. / Perceived Discrimination and Health 413
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acculturated reported better general health (b=.19, p<.02) than those who
were less acculturated.
Discussion
The current study provides support for the minority status stress model
among Mexican-origin adults; specifically, experiencing discrimination
stress as an ethnic minority, in addition to general stress, places them at
increased risk for health and mental health problems. We tested one aspect
of the model that has not been examined before in this population. This
aspect of the model contends that perceived discrimination is a source of
chronic stress above and beyond general stress. We found that perceived
discrimination predicted depression, general health, and health symptoms
among Mexican-origin men and women and continued to have a significant
effect on depression and general health even when general stress was taken
into account. Our results regarding depression are consistent with the findings
of previous studies: Experiences of discrimination affected psychological
414 Hispanic Journal of Behavioral Sciences
20
25
30
35
40
45
Low High
Perceived Stress
Depression
men
women
Figure 1
Interaction Between Perceived Discrimination
and Gender for General Health
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well-being in other populations after general stressors were taken into
account (Dion et al., 1992; Williams et al., 1997). Further, this study pro-
vides new evidence in this population that perceived discrimination has an
independent effect on general health above and beyond general stress. A
central contribution of our findings supports the argument that for ethnic
minorities, psychological well-being and physical health are compromised
partially due to cumulative exposure to a combination of discrimination-
related stress and general stress (Cervantes & Castro, 1985; Harrell, 2000;
Williams et al., 1997). To contribute to the understanding of health dispar-
ities among this population, future research should focus on the impact of
perceived discrimination on specific physical health conditions (e.g., hyper-
tension) and especially on possible moderators, such as coping strategies
and social support, in reducing the impact of discrimination on mental and
physical health.
This study examined the experience of chronic everyday discriminatory
stressors, which are considered better predictors of the onset and course of
illness than brief acute life event stressors (Cohen, Kessler, & Gordon, 1995;
Williams et al., 2003). Our findings provide evidence that discrimination-
related chronic stress in the form of daily hassles or microstressors—such as
being treated unfairly, disliked, disrespected, rejected, or stereotyped—is
harmful to the mental and physical health of Mexican-origin men and
Flores et al. / Perceived Discrimination and Health 415
2
2.5
3
3.5
Low High
Perceived Discrimination
General Health
men
women
Figure 2
Interaction Between Perceived Stress and Gender for Depression
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women. These findings suggest that to understand the contribution of dis-
crimination to health conditions, it is important to assess those ongoing
experiences of discrimination that may accumulate over long periods of
time and lead to serious stress reactions. This issue is especially relevant to
the study of discrimination and health for Mexican-origin adults, since
few studies of this population have used multiple-item measures of chronic
discriminatory stress (for a review, see Araujo & Borrell, 2006). In this
research, we used a 14-item measure that assessed perceived discrimination
as chronic unfair treatment that can be experienced on a daily basis. Future
studies should use multiple-item measures to investigate chronic everyday
discriminatory experiences among Mexican immigrants, Mexican Americans,
and other Latinos.
This is the first study to examine the relationship between perceived
stress, mental health, and general health among Mexican-origin adults.
We found that perceived stress predicted depression, general health, and
health symptoms for Mexican American men and women. When perceived
discrimination was taken into account, perceived stress continued to have
an effect on depression and general health. Similar to literature on stress
and health in other populations (Cohen et al., 1995), our findings provide
further evidence that perceived stress can lead to negative emotional states
and poor health. In addition, the fact that perceived stress and discrimina-
tion had independent effects on depression and general health indicates that
individuals with more sources of stress are more susceptible to poorer health.
This finding is consistent with research by Cohen, Tyrrell, and Smith
(1993), who found independent effects of stressful life events and perceived
stress on different aspects of risks for colds. The results support the impor-
tance of the role of perceived stress in the lives of Mexican-origin adults
and the need for health providers to address concerns about chronic stress.
Future research is needed to examine the impact of perceived stress on
specific mental and physical health outcomes as well as to identify which
coping strategies are most effective in reducing the effects of perceived
stress on psychological distress and physical health.
Little attention has been given to studying gender differences in the
effects of perceived discrimination and perceived stress on health. In this
study, we found that the influence of perceived discrimination on general
health was greater for men than women. One possible explanation for the
greater effect of discrimination as a stressor is that men may employ dif-
ferent coping strategies in dealing with discrimination than women, and the
strategies they use may not help to alleviate physiological symptoms,
resulting in poorer health. In addition, there is some evidence that women
416 Hispanic Journal of Behavioral Sciences
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are more likely to deny or discount the discrimination they experience
(Kessler et al., 1999). Thus, there may be different processes going on for
women than for men. For example, women may be more likely to seek
social support in the face of discrimination. Future research is needed that
examines the processes that may explain the differential effects of discrim-
ination on men and women.
We also found that the influence of perceived stress on depression was
greater for women than men. This finding is consistent with previous
research reporting that women experience more stress than men and report
more psychological distress as a result of stress than men (Davis et al.,
1999; Matud, 2004; Morris-Prather et al., 1996). Consistent with previous
research, women in our study reported greater stress than men. A major
explanation for such findings has focused on gendered social roles and the
“cost of caring” hypothesis. Namely, women typically feel obligated to
meet the needs of the family, even if they work outside the home; therefore,
they are likely to experience more stress due to concerns about problems
experienced by a wide range of persons in their family and social networks
(Davis et al., 1999; Turner & Avison, 2003). In turn, women may feel less
control over their circumstances, leading to more depressive symptoms.
Another important consideration is the possibility that the disclosure of
depression is more socially sanctioned for women than men. More research
is needed to examine the moderating effects of gendered social roles and
coping on general perceived stress and health outcomes among Mexican-
origin men and women.
It is important to consider our findings within certain limitations. First,
the sample had limited variation in terms of acculturation because a major-
ity of the study sample was born in Mexico and came to the United States
as young adults. Second, participants were married and recruited from an
HMO in Northern California. Therefore, results may not generalize to
Mexican-origin adults who have no health insurance, are separated or divorced,
or who live in other regions of the United States. Third, the research was
cross-sectional, and we could not draw causal inferences regarding the
results. While not a limitation, the finding that those who were more accul-
turated reported better general health goes against previous research that
health declines with acculturation. However, Finch et al. (2001) found that
self-ratings of health improved with higher level of English usage. It may
be that the group in our sample was able to maintain health insurance and
access more frequent health care, resulting in a higher self-rating of general
health. Despite the limitations noted, these findings represent an important
contribution to understanding the effects of perceived discrimination and
perceived stress on health outcomes for Mexican-origin men and women.
Flores et al. / Perceived Discrimination and Health 417
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In conclusion, these research findings suggest that mental health inter-
ventions with Mexican-origin men and women need to include assessments
for the effects of discrimination stress along with other sources of chronic
stress relevant to this population. Mental health providers need to ask
clients about discrimination in their lives along with other well-known
stressors such as immigration and acculturation experiences. Since dis-
crimination is a major stressor in the lives of ethnic minorities in this
country, it is critical that mental health and health providers receive train-
ing on discrimination as a chronic stressor, the impact it has on mental and
physical health, and ways to assist clients to adapt and cope to reduce the
negative impact of discrimination on their overall health.
Appendix A
Discrimination Stress Scale
These questions are about experiences that people of Mexican or other
Latino origin sometimes have in this country (response options: never,
sometimes,often,very often).
1. How often are you treated rudely or unfairly because of your race or
ethnicity?
2. How often are you discriminated against because of your race or ethnicity?
3. How often do others lack respect for you because of your race or ethnicity?
4. How often do you have to prove your abilities to others because of your
race or ethnicity?
5. How often is racism a problem in your life?
6. How often do you find it difficult to find work you want because of your
race or ethnicity?
7. How often do people dislike you because of your race or ethnicity?
8. How often have you seen friends treated badly because of their race or
ethnicity?
9. How often do you feel that you have more barriers to overcome than
most people because of your race or ethnicity?
10. How often do you feel rejected by others due to your race or ethnicity?
11. How often is your race or ethnicity a limitation when looking for a job?
12. How often do people seem to have stereotypes about your racial or
ethnic group?
13. How often do people try to stop you from succeeding because of your
race or ethnicity?
14. How often do you not get as much recognition as you deserve for the
work you do, just because of your race or ethnicity?
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Appendix B
Discrimination Stress Scale–Spanish version
Las siguientes preguntas se tratan de experiencias que personas de origen
Mexicano o de otro grupo Latinoamericano tienen algunas veces en este
país (response options: nunca,algunas veces,seguido,muy seguido).
1. ¿Con qué frecuencia a Ud. le tratan ruda o injustamente debido a su raza
o etnicidad?
2. ¿Con qué frecuencia le discriminan debido a su raza o etnicidad?
3. ¿Con qué frecuencia otras personas le faltan el respeto debido a su raza
o etnicidad?
4. ¿Con qué frecuencia tiene que “probar” sus habilidades a otros debido a
su raza o etnicidad?
5. ¿Con qué frecuencia el racismo es un problema en su vida?
6. ¿Con qué frecuencia le es difícil encontrar el trabajo que quiere debido a
su raza o etnicidad?
7. ¿Con qué frecuencia usted no le cae bien a la gente debido a su raza o
etnicidad?
8. ¿Con qué frecuencia ha visto que tratan mal a sus amistades debido a su
raza o etnicidad?
9. ¿Con qué frecuencia siente que tiene más barreras que vencer que la
mayoría de la gente debido a su raza o etnicidad?
10. ¿Con qué frecuencia se siente rechazado(a) por otros debido a su raza o
etnicidad?
11. ¿Con qué frecuencia es su raza o etnicidad una limitación al buscar un
buen trabajo?
12. ¿Con qué frecuencia la gente parece tener estereotipos o ideas equivocadas
sobre su grupo racial o étnico?
13. ¿Con qué frecuencia la gente trata de impedirle que avance debido a su
raza o etnicidad?
14. ¿Con qué frecuencia no recibe el reconocimiento que se merece por su
trabajo debido a su raza o etnicidad?
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Elena Flores received her PhD in clinical psychology from the Wright Institute in Berkeley,
California. She is an associate professor in the Counseling Psychology Department, School of
Education, at the University of San Francisco. She teaches multicultural psychology and coun-
seling courses in the Marriage and Family Therapy and School Counseling/PPS Credential
Programs. She is a research associate in the Department of Psychiatry at the University of
California, San Francisco, where she is currently a coinvestigator of a National Institutes of
Health–funded study examining parental influences on obesity among Mexican American
children. Her research has focused on Mexican American family functioning and adolescent
health risk behaviors.
Jeanne M. Tschann obtained her PhD in social psychology from the University of California,
Santa Cruz. She is a professor in the Department of Psychiatry at the University of California,
San Francisco. She has been conducting research on personal relationships and health-related
behaviors in Latino populations since 1992. She is currently funded by the National Institutes
of Health to examine parental influences on obesity among Mexican American children; she
is collaborating with Dr. Flores, Dr. Pasch, Ms. de Groat, and other colleagues on this project.
Juanita M. Dimas earned her PhD in clinical psychology from the University of California,
Berkeley, and completed a postdoctoral clinical internship at the University of California, San
Francisco. She is a licensed psychologist in California since 1999. She has worked the full
spectrum from research to implementation, including teaching, consulting, and practice, at the
individual, family, academic, organizational, and community levels. She currently dedicates
her professional efforts full-time to private practice with adults and adolescents. Her profes-
sional presentations and publications have focused on culture and health/mental health, health
disparities, minority status stress, and multiracial issues.
Flores et al. / Perceived Discrimination and Health 423
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Elizabeth A. Bachen earned her PhD in clinical psychology from the University of Pittsburgh.
She is an associate professor of psychology at Mills College. Her research examines underly-
ing mechanisms linking stress, depression, and anxiety to health outcomes. Her current
research focus is on understanding the effect of stress on neuroendocrine and immune alter-
ations and disease activity in women with autoimmune illnesses and identifying genetic and
psychosocial factors associated with increased risk for anxiety and mood disorders in autoimmune
diseases.
Lauri A. Pasch received her PhD in clinical psychology from the University of California,
Los Angeles, and completed a postdoctoral fellowship in health psychology at the University
of California, San Francisco. She conducts research aimed at improving the health of Mexican
American families. She is involved in teaching medical students, residents, and fellows about
social and cultural issues in medicine. She is an assistant professor in the Department of
Psychiatry.
Cynthia L. de Groat obtained her MA in research psychology from San Francisco State
University. She is currently a statistician in the Department of Psychiatry at the University of
California, San Francisco.
424 Hispanic Journal of Behavioral Sciences
at UNIV OF SAN FRANCISCO on October 9, 2010hjb.sagepub.comDownloaded from
