Psychological distress, racism, sexism, cissexism, heterosexism, ageism, and sizeism: analyzing patterns of association using explicit and implicit measures of discrimination

Abstract Background: Research on discrimination and health has predominantly relied on explicit self-report data for single types of discrimination; use of implicit measures is scant. Methods: Our exploratory cross-sectional study investigated associations between psychological distress (Kessler-6 K6 score) and implicit and explicit measures for 6 types of discrimination: racism, sexism, heterosexism, cissexism, ageism, and sizeism. The 699 participants were recruited (May 28, 2020 to August 4, 2022) from rosters of three Boston, MA community health centers. Covariate-adjusted linear regression models estimated associations between K6 scores and the discrimination measures. Results: Participants’ mean K6 score was 7.47 (SD=5.15); 17.0% experienced “severe psychological distress” (K6 ≥13). Target vs. dominant groups experienced higher discrimination for both the implicit and explicit measures (p 0.01). Participants who both self-reported and implicitly recognized 4-6 vs. 0-3 types of discrimination had elevated K6 (adjusted model β: 0.29, 95% CI 0.07 to 0.51). In crude models, K6 scores were positively associated with self-reported discrimination for all 6 types, and with implicit measures for sexism, heterosexism, cissexism, and ageism. In adjusted models, K6 was positively associated with both explicit and implicit metrics only for sexism, e.g., for self-reported experiences of sexism among women (β: 0.25; 95% CI 0.13 to 0.36) and non-binary/genderqueer participants (β: 0.26; 95% CI 0.13 to 0.39), and for implicit recognition of sexism toward women among women (β: 0.12; 95% CI -0.01 to 0.24). Conclusion: Using both implicit and explicit measures for multiple discrimination types, with attention to differences between target vs. dominant groups, is warranted.