Skin colour, perception of racism and depression among adolescents in urban Brazil

Abstract

Background: The relation between race, ethnicity and health has been recognised as having an important role in the understanding of social inequalities in health. In Brazil, miscegenation (the mixing of different ethnicities or races, especially in marriage) is recognised as a sign of racial tolerance, but individuals with black skin colour have poorer social and health indicators than whites. The hypothesis that perceived racial discrimination is associated with depression and depressive symptoms among adolescents living in a Brazilian urban area is analysed, taking into consideration sociodemographic variables, socioeconomic status and skin colour. Method: This paper presents results from a cross-sectional study carried out with a random one-stage cluster sampling of households in the city of Salvador, Bahia, Brazil. The study population comprises 973 individuals from 10 to 21 years of age who answered questionnaires about racial discrimination, socio-demographic and health-related variables. Major depression according to DSM-IV criteria was assessed using a validated Portuguese version of the Patient Health Questionnaire (PHQ). The overall prevalence of major depression was estimated as 10.4%. Results: No statistically significant differences were found for prevalence of major depression or any depressive symptom according to skin colour (Black versus non-Black). However, adolescents who reported racial discrimination were more likely to have major depression, even after adjustment for age, sex, socioeconomic status, skin colour and self-esteem (Adjusted Prevalence ratio = 2.00, 95% Confidence Interval: 1.37–2.97). Low self-esteem was not associated with racial discrimination. Conclusion: Depression among adolescents is a common disorder. Skin colour, a biological component of ethnic differences, was not a factor associated with depression or depressive symptoms. Instead, the perception of racial discrimination was a strong potential risk factor for major depression in this population group, which needs to be addressed in further studies and considered in preventive and mental health care programs.