Skip to main content
SpringerLink
Log in

Depression Mediates Association Between Perceived Ethnic Discrimination and Elevated Blood Glucose Levels Among Sub-Saharan African Migrants in Australia

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Depression and perceived ethnic discrimination (PED) are both implicated in type 2 diabetes mellitus (T2DM) risk in some migrant populations. The role of these factors remains understudied in sub-Saharan African migrants, who comprise a significant at-risk group for T2DM in Australia. To assess interactions between PED, depression scores and elevated blood glucose levels among sub-Sahara African immigrants in North-Eastern Australia. Face to face surveys were used to assess PED and depressive tendencies in a purposive sample of 170 adults (aged ≥18 year). Fasting blood glucose levels (FBGL) were measured at the time of interviews. Prevalence of elevated FBGL (≥6.1 mmol/L), PED and severe depression (SD) were: 17.6% (n = 30), 14.7% (n = 25) and 18.8% (n = 32), respectively. Prevalence of elevated FBGL, PED and SD were all higher in males than females. The highest prevalence of elevated BGL, PED and SD each occurred in the 40–50 year age group. Strong positive correlations of both high level PED and SD with elevated FBGL were observed. There was also a strong positive association between PED and SD. Depression score was found to mediate partially the strong association between PED and elevated FBGL (β-value for PED dropped from β = 0.452 to β = 0.246, p < 0.01 and the associated between FBGL and SD remained strong β = 0.554, p < 0.01). The strong association between elevated FBGL and PED seems to be moderated by SD, indicating that interventions to attenuate depression and PED may be a useful adjunct to diabetes prevention programs in this population. Interventions targeted to specific age groups may also be warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carballo M, Nerukar A. Migration, refugees, and health risks. Emerg Infect Dis [Internet]. 2001 [cited 2018 Mar 5];7(3 Suppl):556–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11485671

  2. WHO. International migration, health and human rights [Internet]. 2013 [cited 2018 Mar 5]. Available from: www.iom.int

  3. WHO Regional Office for Europe. Migration and health: key issues. 2017 Mar 4 [cited 2018 Mar 5];1–15. Available from: http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/migrant-health-in-the-european-region/migration-and-health-key-issues#292115

  4. Carta M; Bernal M; Hardoy M; Haro-Abad J; Kovess V; Brugha T; Lehtinen V; Angermeyer M; Xavier M; Kittel F; Fryers T; Aongusa B; Stefansson C; Poulsen H; Pull C; Abad J; Katschnig H; Madianos M; Dalgard O; Bijl R; Rutz W; Henderson J; Lafortune G; Mateos RB. Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clin Pract Epidemiol Ment Heal [Internet]. 2018 [cited 2018 Jan 12]; Available from: https://cpementalhealth.biomedcentral.com/articles/10.1186/1745-0179-1-13

  5. Gushulak B; MacPherson D. The basic principles of migration health: population mobility and gaps in disease prevalence. Emerg Themes Epidemiol [Internet]. 2006 [cited 2018 Jan 12]; Available from: https://ete-online.biomedcentral.com/articles/10.1186/1742-7622-3-3

  6. Buja A, Gini R, Visca M, Damiani G, Federico B, Francesconi P, et al. Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study, Valore Project. BMC Public Health [Internet]. 2013 Dec 24 [cited 2018 Jan 12];13(1):504. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-504

  7. Castañeda H, Holmes SM, Madrigal DS, Young M-ED, Beyeler N, Quesada J. Immigration as a Social Determinant of Health. Annu Rev Public Health [Internet]. 2015 Mar 18 [cited 2018 Jan 12];36(1):375–92. Available from: http://www.annualreviews.org/doi/10.1146/annurev-publhealth-032013-182419

  8. Ikram UZ, Snijder MB, de Wit MAS, Schene AH, Stronks K, Kunst AE. Perceived ethnic discrimination and depressive symptoms: the buffering effects of ethnic identity, religion and ethnic social network. Soc Psychiatry Psychiatr Epidemiol [Internet]. 2016 May 12 [cited 2018 Jun 15];51(5):679–88. Available from: http://link.springer.com/10.1007/s00127-016-1186-7

  9. Aroian KJ, Norris A. Assessing risk for depression among immigrants at two-year follow-up. Arch Psychiatr Nurs [Internet]. 2002 Dec 1 [cited 2018 Jun 12];16(6):245–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12567372

  10. Ikram UZ, Snijder MB, Fassaert TJL, Schene AH, Kunst AE, Stronks K. The contribution of perceived ethnic discrimination to the prevalence of depression. Eur J Public Health. 2015 Apr 1 [cited 2018 Jun 12];25(2):243–8. Available from: https://academic.oup.com/eurpub/article-lookup/doi/10.1093/eurpub/cku180

  11. Fenta H, Hyman I, Noh S. Determinants of Depression Among Ethiopian Immigrants and Refugees in Toronto. J Nerv Ment Dis. 2004 May [cited 2018 Jun 12];192(5):363–72. Available from: https://insights.ovid.com/crossref?an=00005053-200405000-00005

  12. Schweitzer R, Melville F, Steel Z, Lacherez P. Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust N Z J Psychiatry [Internet]. 2006 Feb 1 [cited 2018 Jan 12];40(2):179–88. Available from: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-1614.2006.01766.x

  13. Markus A. Australians today mapping social cohesion [Internet]. 2016 [cited 2018 Jan 12]. Available from: https://www.monash.edu/__data/assets/pdf_file/0009/585918/australians-today.pdf

  14. Ikram UZ, Snijder MB, Agyemang C, Schene AH, Peters RJG, Stronks K, et al. Perceived ethnic discrimination and the metabolic syndrome in ethnic minority groups. Psychosom Med [Internet]. 2017 Jan [cited 2018 Jan 12];79(1):101–11. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006842-201701000-00012

  15. Rodríguez-Álvarez E, González-Rábago Y, Borrell LN, Lanborena N. Perceived discrimination and self-rated health in the immigrant population of the Basque Country, Spain. Gac Sanit [Internet]. 2017 Sep 1 [cited 2018 Jan 12];31(5):390–5. Available from: http://www.sciencedirect.com/science/article/pii/S0213911117300432

  16. Whitaker KM, Everson-Rose SA, Pankow JS, Rodriguez CJ, Lewis TT, Kershaw KN, et al. Experiences of discrimination and incident Type 2 diabetes mellitus: The multi-ethnic study of atherosclerosis (MESA). Am J Epidemiol [Internet]. 2017 Aug 15 [cited 2018 Jan 12];186(4):445–55. Available from: http://academic.oup.com/aje/article/186/4/445/3603583/Experiences-of-Discrimination-and-Incident-Type-2

  17. S HHoAgJs. Perceived discrimination and health outcomes: A gender comparison among Asian-Americans nationwide. Women’s Heal Issues [Internet]. 2010 [cited 2018 Jan 15];20(5):350–8. Available from: http://www.sciencedirect.com/science/article/pii/S1049386710000599

  18. Borrell C, Palència L, Bartoll X, Ikram U, Malmusi D. Perceived discrimination and health among immigrants in Europe according to national integration policies. Int J Environ Res Public Health [Internet]. 2015 Aug 31 [cited 2018 Jan 12];12(9):10687–99. Available from: http://www.mdpi.com/1660-4601/12/9/10687/

  19. Park G, Son I, Public SK-J of PM and, 2016 U. Hahm HC, ozonoff A, Gaumond J, Sue S. ncbi.nlm.nih.gov [Internet]. 2016 [cited 2018 Jan 15]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066421/

  20. Park G, Son I, Public SK-J of PM and, 2016 U. Perceived Ethnic Discrimination and Depressive Symptoms Among Biethnic Adolescents in South Korea. J Prev Med Public Heal [Internet]. 2016 [cited 2018 Jan 15];49(5):301–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066421/

  21. Todorova ILG, Falcón LM, Lincoln AK, Price LL. Perceived discrimination, psychological distress and health. Sociol Health Illn [Internet]. 2010 Jul 23 [cited 2018 Jan 12];32(6):843–61. Available from: http://doi.wiley.com/10.1111/j.1467-9566.2010.01257.x

  22. Juang L, Prevention JC-TJ of P, 2009 U. Acculturation, discrimination, and depressive symptoms among Chinese American adolescents: A longitudinal study. J Prim Prev [Internet]. 2009 [cited 2018 Jan 15];30(3–4):475–96. Available from: https://idp.springer.com/authorize/casa?redirect_uri=http://link.springer.com/article/10.1007/s10935-009-0177-9&casa_token=P2yk1Cu0sesAAAAA:L-Zt4rNC2AHgEgXBwlK1fCK4LknEYmePW86GBOVeiNUcvQSTw7azy8TbCUBa5oFhV5TVNJYnZhO4CXGZ2g

  23. Knol MJ, Twisk JWR, Beekman ATF, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia [Internet]. 2006 May 7 [cited 2018 Jan 12];49(5):837–45. Available from: http://link.springer.com/10.1007/s00125-006-0159-x

  24. Brondolo E, Hausmann L, … JJ-A of behavioral, 2011 U. Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators. Brondolo EHausmann LJhalani JPencille MAtencio-Bacayon JKumar AKwok JUllah JRoth AChen DCrupi RSchwartz J [Internet]. 2011 [cited 2018 Jan 12];42(1):14–28. Available from: https://idp.springer.com/authorize/casa?redirect_uri=http://link.springer.com/article/10.1007/s12160-011-9265-1&casa_token=2dNycCRawH4AAAAA:QO1kTgb8Bq-bPQVqJe8bWp4bMghNIrBRna-A3R6pBXzdy_S3fWxvVwOMhY9GtY5s-eXL2GdxRqSuWj3jUQ

  25. Engum A. The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res [Internet]. 2007 [cited 2018 Jan 16];62(1):31–8. Available from: http://www.sciencedirect.com/science/article/pii/S002239990600331X

  26. Psychosomatic AE-J of, 2007 U. The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res [Internet]. 2007 [cited 2018 Jan 12];62(1):31–8. Available from: http://www.sciencedirect.com/science/article/pii/S002239990600331X

  27. Perez S, Junod A. [Depression in Sub-Saharan Africa]. Med Trop (Mars) [Internet]. 1998 [cited 2018 Jun 12];58(2):168–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9791599

  28. Mossie TB, Berhe GH, Kahsay GH, Tareke M. Prevalence of depression and associated factors among diabetic patients at Mekelle City, North Ethiopia. Indian J Psychol Med [Internet]. 2017 [cited 2018 Jun 12];39(1):52–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28250559

  29. Tomlinson M, Swartz L, Kruger L-M, Gureje O. Manifestations of affective disturbance in sub-Saharan Africa: key themes. J Affect Disord [Internet]. 2007 Sep 1 [cited 2018 Jun 12];102(1–3):191–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17126409

  30. Patel V. Explanatory models of mental illness in sub-Saharan Africa. Soc Sci Med [Internet]. 1995 May 1 [cited 2018 Jun 12];40(9):1291–8. Available from: https://www.sciencedirect.com/science/article/pii/027795369400231H

  31. Gill G V., Mbanya J-C, Ramaiya KL, Tesfaye S. A sub-Saharan African perspective of diabetes. Diabetologia [Internet]. 2009 Jan 10 [cited 2018 Jun 23];52(1):8–16. Available from: http://link.springer.com/10.1007/s00125-008-1167-9

  32. Hall V, Thomsen RW, Henriksen O, Lohse N. Diabetes in Sub Saharan Africa 1999–2011: Epidemiology and public health implications. a systematic review. BMC Public Health [Internet]. 2011 Dec 14 [cited 2017 Dec 21];11(1):564. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-564

  33. Wagner JA, Tennen H, Feinn R, Osborn CY. Self-reported discrimination, diabetes distress, and continuous blood glucose in women with type 2 diabetes. J Immigr Minor Heal [Internet]. 2015 Apr [cited 2019 Jul 25];17(2):566–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24469589

  34. Bilal PI, Chan CKY, Somerset SM. Acculturation and perceived ethnic discrimination predict elevated blood glucose level in sub-Saharan African immigrants in Australia. J Immigr Minor Health. 2019;

  35. Brondolo E, Kelly KP, Coakley V, Gordon T, Thompson S, Levy E, et al. The perceived ethnic discrimination Questionnaire: Development and preliminary validation of a community version1. J Appl Soc Psychol [Internet]. 2005 Feb [cited 2018 Jan 15];35(2):335–65. Available from: http://doi.wiley.com/10.1111/j.1559-1816.2005.tb02124.x

  36. Lovibond P, therapy SL-B research and, 1995 undefined. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Elsevier [Internet]. [cited 2018 Jan 16]; Available from: http://www.sciencedirect.com/science/article/pii/000579679400075U

  37. Larson A, Gillies M, Howard PJ, Coffin J. It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Aust N Z J Public Health [Internet]. 2007 Aug [cited 2018 Jun 14];31(4):322–9. Available from: http://doi.wiley.com/10.1111/j.1753-6405.2007.00079.x

  38. Paradies Y. Anti-racism and indigenous Australians. Anal Soc Issues Public Policy [Internet]. 2005 Dec [cited 2018 Jun 14];5(1):1–28. Available from: http://doi.wiley.com/10.1111/j.1530-2415.2005.00053.x

  39. Gushulak B, Weekers J, MacPherson D. Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework. Emerg Health Threats J [Internet]. 2009 Jun 1 [cited 2018 Jan 12];2(0). Available from: http://journals.co-action.net/index.php/ehtj/article/view/7091

  40. Hahm HC, Ozonoff A, Gaumond J, Sue S. Perceived discrimination and health outcomes: a gender comparison among Asian-Americans Nationwide. Women’s Heal Issues [Internet]. 2010 Sep 1 [cited 2018 Jan 12];20(5):350–8. Available from: http://www.sciencedirect.com/science/article/pii/S1049386710000599

  41. Molina KM, James D. Discrimination, internalized racism, and depression: A comparative study of African American and Afro-Caribbean adults in the US. Gr Process Intergr Relations [Internet]. 2016 Jul 3 [cited 2018 Jan 12];19(4):439–61. Available from: http://journals.sagepub.com/doi/10.1177/1368430216641304

  42. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. Hills RK, editor. PLoS One [Internet]. 2015 Sep 23 [cited 2018 Jan 12];10(9):e0138511. Available from: http://dx.plos.org/10.1371/journal.pone.0138511

  43. Viruell-Fuentes EA, Miranda PY, Abdulrahim S. More than culture: Structural racism, intersectionality theory, and immigrant health. Soc Sci Med [Internet]. 2012 Dec 1 [cited 2018 Jan 12];75(12):2099–106. Available from: http://www.sciencedirect.com/science/article/pii/S0277953612000822

  44. Misra R, Hunte H. Perceived discrimination and health outcomes among Asian Indians in the United States. BMC Health Serv Res [Internet]. 2016 Dec 12 [cited 2018 Jan 12];16(1):567. Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1821-8

  45. Mays VM, Cochran SD, Barnes NW. Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol [Internet]. 2007 Jan [cited 2018 Jan 15];58(1):201–25. Available from: http://www.annualreviews.org/doi/10.1146/annurev.psych.57.102904.190212

  46. Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev [Internet]. 2016 Dec 3 [cited 2018 Jan 12];37(1):12. Available from: http://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4

  47. Mergia A. Black African Immigrants in Australia: An exploratory analysis of the impacts of race and class on their lived experiences and adaptation processes [Internet]. 2006 [cited 2018 Jan 12]. Available from: https://minerva-access.unimelb.edu.au/bitstream/handle/11343/37582/286313_mergia_ayalew_2005.pdf?sequence=1

  48. Williams D, Williams-Morris R. Racism and Mental Health: The African American experience. Ethn Health [Internet]. 2000 Aug [cited 2018 Jan 15];5(3–4):243–68. Available from: http://www.tandfonline.com/doi/abs/10.1080/713667453

  49. Abramson CM, Hashemi M, Sánchez-Jankowski M. Perceived discrimination in U.S. healthcare: Charting the effects of key social characteristics within and across racial groups. Prev Med Reports [Internet]. 2015 Jan 1 [cited 2018 Jan 15];2:615–21. Available from: http://www.sciencedirect.com/science/article/pii/S2211335515000972

  50. Pereira CAN, Larder N, Somerset S. Food acquisition habits in a group of African refugees recently settled in Australia. Health Place [Internet]. 2010 Sep [cited 2019 May 8];16(5):934–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20570547

  51. Gichunge C, Harris N, Tubei S, Somerset S, Lee P. Relationship between food insecurity, social support, and vegetable intake among resettled African refugees in Queensland, Australia. J Hunger Environ Nutr [Internet]. 2015 Jul 3 [cited 2017 Dec 20];10(3):379–89. Available from: http://www.tandfonline.com/doi/full/10.1080/19320248.2014.929544

Download references

Acknowledgement

Our great appreciation goes to all participants for this study and the African community councils of Queensland and Northern Australia for making it possible for the researcher to meet various African communities in Brisbane and Darwin.

Funding

This study received no external funding.

Author information

Authors and Affiliations

  1. School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia

    P. I. Bilal

  2. School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia

    C. K. Y. Chan

  3. Faculty of Health, University of Canberra, Bruce, ACT, Australia

    S. M. Somerset

Authors
  1. P. I. Bilal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. K. Y. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. M. Somerset
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. M. Somerset.

Ethics declarations

Conflict of interest

Authors PB, CC, and SS declares that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. The University ethics clearance ID is 2013 66Q.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bilal, P.I., Chan, C.K.Y. & Somerset, S.M. Depression Mediates Association Between Perceived Ethnic Discrimination and Elevated Blood Glucose Levels Among Sub-Saharan African Migrants in Australia. J Immigrant Minority Health 23, 199–206 (2021). https://doi.org/10.1007/s10903-020-01131-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-020-01131-1

Keywords

Search

Navigation