歧視感如何影響健康的長期分析：性別和種族的差異

A Longitudinal Analysis of How Perceived Discrimination Gets Under the Skin: Investigating Gender and Racial/Ethnic Differences

現有對歧視感和健康的關係研究中，歧視感對健康的長期影響、影響路徑以及性別和種族差異受到的關注較少。本研究採取一種近期發展出的中介效應分析方法，來對「美國人民生活變遷追蹤調查」數據進行分析，討論歧視感是否會通過自尊心和社會支持，而對美國人民的自評健康狀況有負面影響。研究發現：（1）一個人感受到的歧視會顯著降低個人十年後的自評健康。（2）在歧視感與自評健康的關聯中，自尊感的中介效應（70%）比社會支持（30%）更為重要。（3）雖然總體來看沒有發現明顯的性別和種族差異，我們發現自尊感的中介效應對於白人相較於非白人更為重要。基於這些發現，我們認為歧視感會長期影響健康水平，並建議相關干預治療需關注受歧視者的心理路徑建設。

There are three gaps in our understanding of the relationship between perceived discrimination and health: (1) the long-term direct effect of perceived discrimination on health is little known, (2) the pathways linking these two concepts are under-explored, and (3) it remains unclear if there is any gender or race/ethnicity difference in these relationships. To fill these gaps, this study applies a recently developed mediation analysis technique to the Americans’ Changing Lives longitudinal data (N=1,163) and investigates whether self-esteem and social support mediate the adverse impact of perceived discrimination on self-rated health. Three major findings are obtained. First, an individual’s experience of discrimination, even a decade ago, has a significant and negative effect on self-rated health via relationship that cannot be fully explained by variations in individual characteristics. Second, the self-esteem pathway plays a more important role than the social support pathway in mediating the relationship between perceived discrimination and selfrated health, with the former accounting for 70% of the effect, whereas the latter accounts for only 30%. Finally, though there is little evidence for gender or racial/ethnic difference, the self-esteem pathway is more critical for whites than non-whites. These findings suggest that perceived discrimination has a long-lasting effect on health and potential intervention should focus on the psychological pathway to prevent perceived discrimination from being a chronic stressor.