Perceived Discrimination and Mental Distress Amid the COVID-19 Pandemic: Evidence From the Understanding America Study

Am J Prev Med. 2020 Oct;59(4):481-492. doi: 10.1016/j.amepre.2020.06.007. Epub 2020 Jul 6.


Introduction: This study examines COVID-19-associated discrimination regardless of infection status. It evaluates the contribution of various risk factors (e.g., race/ethnicity and wearing a face mask) and the relationship with mental distress among U.S. adults in March and April 2020, when the pandemic escalated across the country.

Methods: Participants consisted of a probability-based, nationally representative sample of U.S. residents aged ≥18 years who completed COVID-19-related surveys online in March and April (n=3,665). Multivariable logistic regression was used to predict the probability of a person perceiving COVID-19-associated discrimination. Linear regression was used to analyze the association between discrimination and mental distress. Analyses were conducted in May 2020.

Results: Perception of COVID-19-associated discrimination increased from March (4%) to April (10%). Non-Hispanic Black (absolute risk from 0.09 to 0.15 across months) and Asians (absolute risk from 0.11 to 0.17) were more likely to perceive discrimination than other racial/ethnic groups (absolute risk from 0.03 to 0.11). Individuals who wore face masks (absolute risk from 0.11 to 0.14) also perceived more discrimination than those who did not (absolute risk from 0.04 to 0.11). Perceiving discrimination was subsequently associated with increased mental distress (from 0.77 to 1.01 points on the 4-item Patient Health Questionnaire score).

Conclusions: Perception of COVID-19-associated discrimination was relatively low but increased with time. Perceived discrimination was associated with race/ethnicity and wearing face masks and may contribute to greater mental distress during early stages of the pandemic. The long-term implications of this novel form of discrimination should be monitored.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Asian People* / psychology
  • Asian People* / statistics & numerical data
  • Betacoronavirus / isolation & purification
  • Black or African American* / psychology
  • Black or African American* / statistics & numerical data
  • COVID-19
  • Coronavirus Infections* / ethnology
  • Coronavirus Infections* / psychology
  • Female
  • Humans
  • Male
  • Masks*
  • Mental Health / trends
  • Pandemics*
  • Pneumonia, Viral* / ethnology
  • Pneumonia, Viral* / psychology
  • Psychological Distress
  • Public Health / methods
  • Public Health / statistics & numerical data
  • SARS-CoV-2
  • Social Discrimination* / prevention & control
  • Social Discrimination* / psychology
  • Social Discrimination* / statistics & numerical data
  • Social Perception*
  • Surveys and Questionnaires