Perceived Discrimination

To be included in the research synthesis, an article needed to meet a variety of criteria. Most important, the article had to contain data relating discrimination to a health outcome. Specifically, because the focus of this analysis was the relationship between the actual perception of discrimination and health outcomes, articles needed to contain a measure of discrimination or an unfair treatment score based on the individual’s perception of being discriminated against. Studies that examined group differences in health outcomes without measuring perceived level of discrimination, such as a comparison study of cardiovascular disease rates for Blacks and Whites, were excluded from the analysis. This exclusion extended to studies in which the main determinant of discrimination was assessed by the researcher and not the participant, such as reports of pollution levels, percentage of a certain ethnic group living in segregated area, and differential clinical diagnoses (mental and/or physical) based solely on race or gender of the respondents.
Statistical criteria for inclusion were that each article needed to report sufficient data for us to calculate a correlation coefficient. Correlation coefficients were found in the literature in one of four ways. First, authors could provide an actual correlation coefficient in the article. Authors could also provide standardized betas in a univariate regression model, which are equal to correlation coefficients in this form. Third, authors could provide unadjusted odds ratios that could be converted to a correlation coefficient with the formula suggested by Digby (1983) : (OR^3/4 −1)/(OR^3/4 + 1), where OR = odds ratio. Finally, authors could provide sufficient data for us to calculate standardized mean differences, which we could convert to correlation coefficients using the Comprehensive Meta-Analysis software (Borenstein, Hedges, Higgins, & Roth-stein, 2005 ). For us to calculate a standardized mean difference, articles needed to provide the following: means, standard deviations, and sample sizes for both high-discrimination and low-discrimination groups; means for each group, along with a total sample size and paired-groups t value; means and sample sizes for the high-discrimination and low-discrimination groups, along with an independent-groups t value; or the standardized mean difference itself, along with the lower limit, upper limit, confidence level, and effect direction. All effects used within the meta-analytic portion of this review are zero-order.
Articles that met all other criteria but did not provide sufficient data for us to calculate a zero-order correlation coefficient were included in the review portion of this research only. A total of 78 articles did not contain appropriate data or did not present sufficient data for meta-analysis.

The literature search procedure for this analysis was designed to locate both published and unpublished research. The primary method of retrieval was through major electronic databases, including PsycINFO, Sociological Abstracts, and MEDLINE. Because there has not been a major quantitative analysis encompassing all aspects of perceived discrimination and health in the field, publication date was not restricted. Discrimination-related keywords used in database searching included discrimination, prejudice, racism, sexism, and unfair treatment. Each of these keywords was included with each of the following health keywords in turn: health, cardio*, blood pressure, smok*, alcohol*, depress*, anxiety, self-esteem, life satisfaction, psychological distress, well being, anger, mental, psychological stress, and perceived stress. The computer database search located approximately 769 articles, dissertations, and book chapters. If the titles and abstracts of the above documents indicated the article might contain data relevant to this analysis (see Criteria for Including Studies below), the full document was retrieved. This process ultimately identified approximately 192 studies relevant for further study, which spanned 1986–2007.
In addition, we mined the citations of several articles highly relevant to the analysis topic, including the review articles described above, for important articles the database search may have missed. This method of retrieval revealed 18 potentially relevant articles. Finally, to locate articles that may be unpublished or in press and therefore undetectable by the previous methods, we sent a call for unpublished and in-press papers to the Society for Personality and Social Psychology e-mail listserv. The Society for Personality and Social Psychology is a professional association with over 4,500 members that represents the largest organization of social and personality psychologists in the world. The listserv request was informally passed on by society recipients to researchers in behavioral medicine, health psychology, and public health who may not have received the original request and who also sent material to us. A number of prominent researchers outside social psychology were also contacted directly by Laura Smart Richman. A total of 18 manuscripts, posters, and papers in progress or under review were received and were eligible for inclusion in the analysis.

The EDS (Williams et al., 1997 (link)) measures chronic and routine unfair treatment in everyday life. Adopted from the Detroit Area Study, respondents were asked to report how often they experience unfair treatment in their day-to-day life on a 6-point Likert-type response format. Response categories ranged from 1 (never) to 6 (experience discrimination almost every day), with higher scores indicating greater perceived discrimination. Nine items included in the EDS are: “You are treated with less courtesy than other people are (Item 1),” “You are treated with less respect than other people are (Item 2),” “You receive poorer service than other people at restaurants or stores (Item 3),” “People act as if they think you are not smart (Item 4),” “People act as if they are afraid of you (Item 5),” “People act as if they think you are dishonest (Item 6),” “People act as if they’re better than you are (Item 7),” “You are called names or insulted (Item 8),” and “You are threatened or harassed (Item 9).” The internal consistency for the EDS was acceptable; Cronbach’s α was .88 and McDonald’s ω was .85. Distribution statistics (i.e., skewness and kurtosis) indicated univariate normality (skewness < 2; kurtosis < 7; see Curran, West, & Finch, 1996 ) for Items 1–7, but minor violations for Items 8 (skewness = 2.05) and 9 (skewness = 2.49, kurtosis = 8.67).