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Blood Pressure and Psychological Distress among North Africans in France: The Role of Perceived Personal/Group Discrimination and Gender.

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Objectives: To examine the associations between perceived ethnic discrimination and (physical and mental) health indicators among North African women and men living in France. Methods: This study included 82 North Africans, aged 18–64 years. Perceived discrimination was measured at both group level (PGD ) and personal level (PPD). The physical health indicator was blood pressure. The mental health indicator was self-reported psychological distress. Results: Multiple regression analyses showed that higher levels of PGD predicted higher blood pressure. PPD was not related to blood pressure. PPD was positively related to psychological distress among women, but not among men. Conclusion: PPD and PGD are associated with physical and mental health indicators in different ways among North African women and men in France.
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SHORT REPORT
Blood pressure and psychological distress among North Africans
in France: The role of perceived personal/group discrimination
and gender
Florence Loose
1
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Marie Tiboulet
2
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Christelle Maisonneuve
3
|
Anne Taillandier-Schmitt
4
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Michael Dambrun
5
1
University of Montpellier, MRM,
Montpellier, 34296, France
2
Universit
e Clermont Auvergne,
LAPSCO UMR 6024,
Clermont-Ferrand, 63037, France
3
University of Rennes, CRPCC/
LAUREPS, Rennes, 35043, France
4
University of Tours, PAV/CRPCC,
Tours, 37020, France
5
Universit
e Clermont Auvergne,
LAPSCO UMR 6024, Clermont-Ferrand,
63037, France
Correspondence
Michael Dambrun, Universit
e Clermont
Auvergne, 34 avenue Carnot, 63037
France.
Email: michael.dambrun@uca.fr
Abstract
Objectives: The purpose of this study was to examine the associations between per-
ceived ethnic discrimination and (physical and mental) health indicators among
North African women and men living in France.
Methods: This study included 82 North Africans, aged 1864 years. Perceived dis-
crimination was measured at both group level (PGD) and personal level (PPD). The
physical health indicator was blood pressure. The mental health indicator was self-
reported psychological distress.
Results: Multiple regression analyses showed that higher levels of PGD predicted
higher blood pressure. PPD was not related to blood pressure. PPD was positively
related to psychological distress among women, but not among men.
Conclusion: PPD and PGD are associated with physical and mental health indicators
in different ways among North African women and men in France.
1
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INTRODUCTION
Psychological stressors can contribute to adverse health out-
comes and lead to health disparities. Compared to native
people, immigrants are exposed to additional risks that can
threaten their physical and mental health. Among these risks,
perceived ethnic discrimination (i.e., the subjective experi-
ence of being treated unfairly relative to others, due to ethnic
origin) has been clearly established as an important chronic
life stressor (Williams & Mohammed, 2009). As such, it has
been found to be linked to biological and mental health indi-
cators among minorities, such as blood pressure (McClure
et al., 2010) and psychological distress (Tummala-Narra,
Alegria, & Chen, 2012).
However, there are several limitations of past work. First,
the bulk of research has usually focused on African and Lat-
ino American minorities. European studies on migrant health
are still scarce. France is the country with the longest history
of immigration in Europe, and North Africans represent the
first immigrant population (Borrel, 2006). Stigmatization and
feelings of exclusion from the host society can frequently be
noticed; North African migrants are often seen as un-
assimilablein nature, mainly because of the claim that their
Islamic cultural background obstructs their integration in
France (Fellag, 2014). We expect to find a positive relation,
among this population, between perceived discrimination
and mental and physical health indicators (i.e., psychological
distress and blood pressure).
Second, little attention has been given to the role of gen-
der in the relationship between discrimination and health. If
female immigrants are less likely than their male counterparts
to report discrimination (Kim & Noh, 2014), research sug-
gests that womens stronger vulnerability to discrimination
could lead them to encounter a greater risk of health
Am J Hum Biol. 2017;e23026.
https://doi.org/10.1002/ajhb.23026
wileyonlinelibrary.com/journal/ajhb V
C2017 Wiley Periodicals, Inc.
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1of5
Received: 14 November 2016
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Revised: 19 May 2017
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Accepted: 29 May 2017
DOI: 10.1002/ajhb.23026
American Journal of Human Biology
problems (Hahm, Ozonoff, Gaumond, & Sue, 2010). Conse-
quently, a stronger positive association between perceived
discrimination and heath indicators (psychological distress
and blood pressure) can be expected among North African
women compared to men.
Third, in the literature on ethnic discrimination, an
important distinction has been made between perceived per-
sonal discrimination (PPD; perceived unfair treatment
against oneself because of ones ethnic origin) and perceived
group discrimination (PGD; perceived unfair treatment
against ones ethnic group as a whole). These two facets of
discrimination often have different or even opposite effects
on psychosocial variables (i.e., on self-esteem; Bourguignon,
Seron, Yzerbyt, & Herman, 2006) and on behavioral prob-
lems (Brody et al., 2006). However, in the health domain,
most studies have only assessed PPD (Pascoe & Smart Rich-
man, 2009), while others have used measures in which PPD
and PGD were not clearly separated (see Brown et al.,
2000). Are the perception of oneself as a victim of discrimi-
nation and the perception of ones group as a victim of dis-
crimination related to physical and mental health in the same
way, or do they represent two different ways by which dis-
crimination affects health disorders? To answer this question,
we focus on both kinds of discrimination.
In sum, this pilot study examined the relationships
between PPD, PGD, and physical and mental health indica-
tors (i.e., blood pressure and psychological distress), among
a population rarely covered in this literature: North African
men and women in France.
2
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METHODS
A sample of 82 North African immigrants (38 females and
44 males; 1864 years of age; M531.5 years old;
SD 510.9) living in France was recruited to participate in
this study via local contacts and associations.
All of them received a questionnaire including self-
reported indicators and instructions on how to complete it.
The survey was presented as a study on North Africans
well-being in France. They were assured that their responses
would be anonymous.
Age, sex, income level, educational level, and country of
birth were the sociodemographic variables.
Perceived Personal Discrimination (PPD) was assessed
with four items, modeled after those from a previously used
PPD scale (Dambrun, 2007). They measured the perceived
degree of being personally treated unfairly due to ones eth-
nic background, and were rated on a 7-point Likert scale
(1 5totally disagree, 7 5totally agree) (a5.74).
Perceived Group Discrimination (PGD) was assessed with
four items, modeled after those from a previously used PGD
scale (Dambrun, 2007). They measured on a 7-point Likert
scale the perceived degree with which ones ethnic group is
treated unfairly due to their ethnic background (a5.80).
The Psychological Distress scale (Dambrun, 2007)
assessed the mental component of health with eight items
(a5.88). Participants were asked to rate on a 7-point scale
(15not at all; 75very much) the extent to which they often
feel happy (reversed coded), stressed, discouraged,
depressed, nervous, anxious, unable to relax, and tense.
Blood Pressure measurements (Systolic and Diastolic
BP) were collected using an oscillometric blood pressure
monitor (Digitensio, BP 3 BEO-2), at two separate times, in
a quiet room, before and after the questionnaire was filled
out, and following standard practice (the two scores were
averaged).
All analyses were conducted using SPSS 22. The level of
significance was set at P<.05.
Multiple regression analyses were performed to test the
respective effects of PPD and PGD, as well as their interac-
tion effect and their interaction with gender, on health meas-
ures (blood pressure and psychological distress). Age,
income, education level, and country of birth were entered as
covariates.
3
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RESULTS
Descriptive analyses are reported in Table 1 as means and
standard deviations for all variables included in the analyses.
North African men and women significantly differed in sys-
tolic blood pressure (P<.01) and diastolic blood pressure
(P<.05), with higher levels for men. Women had a signifi-
cantly higher level of psychological distress than men
(P<.001) and they perceived significantly less personal dis-
crimination than men (P<.05).
Men and women perceived a higher level of ethnic dis-
crimination directed at their group as a whole than at them-
selves as individual members (t(81) 511.28, P<.001).
This result replicated a robust phenomenon: the personal/
group discrimination discrepancy (Taylor, Ruggiero, &
Louis, 1996). This refers to the tendency of minority group
members to report higher levels of discrimination against
their group in general than against themselves personally as
members of that group.
Table 2 presents the estimates (and SE) of the effects of
PPD, PGD, and gender separately for each health dependent
variable (blood pressure, psychological distress).
Multiple regression analyses indicated that higher levels
of PGD predicted higher systolic and diastolic blood pressure
(P<0.05). PPD was not related to blood pressure, and gen-
der did not emerge as a significant moderator of the level of
perceived discrimination.
Psychological distress was marginally related to the inter-
action between PPD and gender (P5.07). While PPD was
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American Journal of Human Biology LOOSE ET AL.
positively and significantly related to psychological distress
among women (b5.43, SE 5.16, P<.05), this was not the
case among men (b5.09, SE 5.13, P>.49). The PPD x
PGD x Gender interaction on the scores of psychological dis-
tress was also marginally significant (P<.08). However,
decomposition of this interaction did not reveal any signifi-
cant effect.
4
|
DISCUSSION
This pilot study revealed that, among North Africans in
France, perceived personal discrimination and perceived
group discrimination represent two different ways in which
discrimination affects biological and mental health disorders.
PGD is positively related to blood pressure but unrelated to
psychological distress. In contrast, PPD is not associated
with blood pressure, but is positively linked to the mental
health measure (only among women). As such, assessing
these two subjective forms of unfair treatment is required so
as to understand the relationships between perceived discrim-
ination and health.
Perceptions of unfair treatment toward ones ethnic
group, but not those toward oneself, may instigate a stress
response that could be reflected in blood pressure. Future
research should determine the underlying mechanisms that
could explain such a difference in this biological indicator of
health. As a suggestion, we can mention the personal/group
discrimination discrepancy found here: participants reported
higher PGD than PPD. An explanation of this phenomenon
is that being a target of discrimination decreases feelings of
control over ones environment. Consequently, even if ethnic
minorities acknowledge and report discrimination toward
their group, they often minimize the personal prejudice that
they experience in order to preserve some feelings of control
(Ruggiero & Taylor, 1997). It is known that stressors that are
uncontrollable are particularly pathogenic (Carter, 2007).
This could partly explain why PGD, as a more uncontrol-
lable stressor than PPD, is linked to increased blood pressure.
In addition, perceived unfair collective treatment (PGD) can
elicit group-based emotions like anger (e.g. Smith, 1993).
This emotion is positively associated with both blood pres-
sure (Gerin, Davidson, Christenfeld, Goyal, & Schwartz,
TABLE 2 Estimate and standard error (SE) of the effects of per-
ceived personal discrimination, perceived group discrimination and
gender on health measures
SBP
(mm Hg)
DBP
(mm Hg)
Psychological
Distress
Estimate
(SE)
Estimate
(SE)
Estimate
(SE)
Constant 117.1*** (4.8) 76.2*** (2.9) 3.5*** (0.4)
PPD 25.28 (4.6) 23.34 (2.8) .51 (0.4)
PGD 3.43* (1.6) 2.52* (1.0) .02 (0.1)
Gender 10.59 (10.8)21.82 (6.7) 2.09* (1.0)
PPD 3Gender .29 (4.6) 2.53 (2.8) .791(0.4)
PGD 3Gender 21.22 (1.5) .59 (0.9) .08 (0.1)
PPD 3PGD .52 (0.8) .36 (0.5) .06 (0.1)
PPD 3PGD 3
Gender
.21 (0.9) .51 (0.5) .151(0.1)
Controlling for
Age .29 (0.2) .14 (0.1) .00 (0.0)
Income
Evaluation
.46 (0.9) .18 (0.6) .01 (0.1)
Education level .19 (1.3) .55 (0.8) .14 (0.1)
Country of birth .99 (1.8) 1.17 (1.1) .07 (0.2)
R
2
0.28 0.24 0.31
Adjusted R
2
0.16 0.11 0.20
Note: DBP, diastolic blood pressure; PPD, perceived personal discrimination;
PGD, perceived group discrimination; SBP, systolic blood pressure. All inde-
pendent variables were centered at the grand mean.
1P<.10; * P<.05; ** P<.01; *** P<.001.
TABLE 1 Anthropometric, health measures and perceived
discrimination
a
Measures
General Mean
(n582)
Females
(n538)
Males
(n544)
Age (years) 31.36 (11.1) 31.57 31.19
Income evaluation 4.51 (1.7) 4.41 4.53
Education level 3.38 (1.3) 3.08 3.67*
Country of birth: France 43% 54% 34%1
SBP (mm Hg) 116.23 (13.5) 111.51 120.48**
DBP (mm Hg) 74.60 (8.1) 72.42 76.52*
Psychological
distress scale
2.83 (1.3) 3.36 2.38***
Perceived personal
discrimination
scale (PPD)
3.07 (1.4) 2.68 3.41*
Perceived group
discrimination
scale (PGD)
4.65 (1.4) 4.43 4.81
Note: DBP, diastolic blood pressure; SBP, systolic blood pressure.
a
Differences between females and males are statistically different at: 1P<.10;
*P<.05; ** P<.01; *** P<.001.
LOOSE ET AL.American Journal of Human Biology
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2006) and coronary heart disease outcomes (Chida & Step-
toe, 2009).
PGD was not associated with psychological distress
among North African participants. PPD was positively
related to it, but only among women (despite their perceiving
less personal discrimination than men). Few studies have
examined gender differences in the harmful effects of ethnic
discrimination on mental health, but these effects have usu-
ally been found to be stronger among women than men
(Kim & Noh, 2014). Previous evidence also suggests that
women have a lower threshold and show higher stress when
experiencing ethnic discrimination against themselves
(Hahm et al., 2010). This could partly explain this gender
difference in the relationship between PPD and mental
health. Thus, the association between perceived discrimina-
tion and psychological distress is very complex. Recent
research showed that acculturation orientation and accultura-
tive stress can mediate this relation (Tonsing, Tse, & Tons-
ing, 2016). These kinds of mediating sociocultural factors
should, thus, be the subject of more in-depth investigation.
Several limitations must be considered from these pre-
liminary findings. Since our design is correlational, it is diffi-
cult to provide strong claims about causality. Future studies
using experimental designs would increase our confidence in
the causal direction between both types of perceived discrim-
ination and mental/physical health. Our modest sample size
represents a second limitation. Further research should
include a larger sample that prevents type II error.
Despite these limitations, these pilot data respond to the
need to collect more detailed information on health in vari-
ous ethnic groups (Toselli, Gualdi-Russo, Marzouk, Sund-
quist, & Sundquist, 2014; Toselli, Rinaldo, Caccialupi, &
Gualdi-Russo, in press). Moreover, it supports the need for
further investigation, so as to provide a deeper understanding
of the biological and mental health risks among minorities.
ACKNOWLEDGMENTS
We would like to thank all the participants who kindly
took part in this study.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
AUTHORS CONTRIBUTIONS
MD and MT designed the study and conducted the statistical
analyses. MT collected the data.
FL wrote the first draft of the manuscript. All authors
(FL, MD, MT, CM, ATS) edited for intellectual content and
provided critical comments on the manuscript.
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How to cite this article: Loose F, Tiboulet M, Maison-
neuve C, Taillandier-Schmitt A, Dambrun M. Blood
pressure and psychological distress among North Afri-
cans in France: The role of perceived personal/group
discrimination and gender. Am J Hum Biol. 2017;
e23026. https://doi.org/10.1002/ajhb.23026
LOOSE ET AL.American Journal of Human Biology
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... 5,17,[19][20][21][22][23][24][29][30][31]33,[35][36][37][38]41,42,46,49,[52][53][54][55][56][57][58][59][60][61]63,67 The remaining studies were from Australia, Canada, Denmark, France, Scotland, Sweden, the Netherlands, and the United Kingdom (n = 22, 42%). [25][26][27][28]32,34,39,40,[43][44][45]47,48,50,51,62,[64][65][66]68,69 Ten studies used samples from Michigan and Chicago, Illinois. 17,21,23,24,29,41,[57][58][59]67 Several studies had samples of between 100 and 1000 people. ...
... 44 For North Africans in France, perceived ethnic discrimination was associated with more psychological distress among women but not men. 48 A few studies examined discrimination and mental health among refugees. Among Middle Eastern refugees to Sweden, experiencing discrimination or status loss was correlated with symptoms of common mental disorders and posttraumatic stress disorder (PTSD). ...
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The present study focused on experiences of discrimination and acculturative stress and their potential role in depression among South Asians. Drawing from the National Latino and Asian American Study (NLAAS), we examined differences in perceived discrimination and depression among South Asians, other Asian subgroups (e.g., Chinese, Vietnamese, Filipino), and non-Hispanic Whites, and differences in acculturative stress between South Asians and other Asian subgroups. We further examined the relationship between perceived discrimination and depression, the relationship between acculturative stress and depression among the various ethnic groups, and the moderating role of family support and peer support in the relationship between perceived discrimination and depression in the South Asian sample (N = 169). There were mixed findings with respect to differences on perceived discrimination and acculturative stress across different Asian subgroups. Multiple regression analyses revealed that perceived discrimination was positively associated with depression for South Asians. Family support was found to moderate the relationship between perceived discrimination and depression in the South Asian sample. Implications of the findings for research and practice with South Asians are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
argue in this chapter that the common social-psychological conceptualization of stereotyping, prejudice, and discrimination in terms of beliefs, attitudes, and attitude-driven behavior, though it offers many important insights, is inadequate in basic respects / [stereotyping, prejudice and discrimination] can best be understood as appraisals, emotions, and emotion action tendencies, based in the perceiver's social identity / explicate some of the problems in the traditional conceptualization and some of the theoretical strengths and novel hypotheses implicit in the new one / sketch some directions for research that could provide further empirical support for this new viewpoint on prejudice and related phenomena (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Why is women's mental health inferior to that of men? This study hypothesized that women's mental health is not as good as men's because women perceive more personal discrimination. It was confirmed that women obtained higher scores than did men on a subjective scale of psychological distress. Additionally, women perceived greater personal and group discrimination than did men. Perceived personal discrimination proved to be the more robust predictor of psychological distress. This was evident when results of a mediation analysis revealed that gender differences in subjective distress were mediated by the measure of perceived personal discrimination, but not by the measure of group discrimination.