What you need to know
There is little known about the types of discrimination reported by older adults with mental health conditions. However, there is strong evidence that stigma and discrimination associated with mental health conditions also intersect with other prejudices, such as ageism and sexism. Therefore, people living with mental health conditions are less likely to achieve social and economic participation due to stigma and discrimination.
Researchers in Australia used the national representative General Social Survey (GSS) conducted in 2014 to examine discrimination and health care barriers faced by older adults aged 55 years and over. From the national cross-sectional data, the researchers found that older adults with mental health conditions were experiencing discrimination more than twice as much as those without mental health conditions. Furthermore, the researchers found that discrimination was associated with preventing or delaying health care access.
What is this research about?
There is little known about the types of discrimination reported by older adults aged 55 years and over with mental health conditions. However, there is strong evidence that stigma and discrimination associated with mental health conditions also intersect with other prejudices, such as ageism and sexism. Stigma and discrimination greatly affect those living with mental health conditions and their family members. Furthermore, both ageism and discrimination based on mental health status are forms of stigma that impact older adults living with mental health conditions.
In this study, the researchers looked at national cross-sectional data to answer questions regarding the experiences of discrimination reported by older adults in Australia living with mental health conditions.
The study aimed to answer the following three questions:
- What is the prevalence of older Australians with mental health conditions reporting any form of discrimination?
- Does the type (e.g., ageism) or context (e.g., in a health care setting) of discrimination differ by presence of a mental health condition?
- Is exposure to discrimination associated with experiencing a barrier to health care?
What did the researchers do?
The researchers looked at the cross-sectional data captured from the 2014 GSS to examine discrimination and health care barriers. The GSS was first conducted in 2002, with additional surveys conducted in 2006, 2010 and 2014.
The 2014 survey was conducted across urban and rural areas of Australia. However, individuals living in very remote locations and in discrete Aboriginal and Torres Strait Islander communities were excluded from the survey.
The GSS included questions about:
- health
- family relationships
- social and community involvement
- education
- employment
- income and financial stress
- assets and liabilities
- housing and mobility
- crime and safety
- transport
- attendance at culture and leisure venues
- sports attendance and participation.
The researchers looked at data on the following factors:
- age (55–64, 65–74, 75+)
- region of residence (major cities, inner regional areas, other areas)
- household financial well-being
- health conditions
- measures of discrimination.
What did the researchers find?
The researchers analyzed data from 4,967 respondents aged 55 years and older.
The researchers found the following based on the three questions:
What is the prevalence of older Australians with mental health conditions reporting any form of discrimination?
- 22 per cent to 25 per cent of older adults with mental health conditions reported an instance of discrimination in the last 12 months, compared to 10 per cent of older adults without a mental illness.
Does the type or context of discrimination differ by presence of a mental health condition?
- Approximately 20 per cent of those with mental health conditions attributed discrimination to their health conditions and other characteristics, including age.
- One in three of those experiencing discrimination indicated the workplace as a key point of exposure to discrimination.
- Among those living with a mental health condition, almost one third of those with a psychological (28.1 per cent) or head injury, stroke or brain damage (26.6 per cent) reported discrimination.
- 20 per cent of those with a mental health condition were considerably more likely to attribute discrimination to a disability or health condition compared to 10.4 per cent of those without a mental health condition.
Is exposure to discrimination associated with experiencing a barrier to health care?
- For people with mental health conditions, everyday discrimination, discrimination in health care and discrimination attributed to the person’s health condition all increased the odds of experiencing a barrier to care by two to three times.
- For each type of discrimination reported (e.g., racism, ageism, etc.), the odds of experiencing a barrier to care increased 1.3 times.
Overall, the data showed that older adults with mental health conditions were experiencing discrimination more than twice as much as those without mental health conditions. Furthermore, the GSS showed that discrimination was associated with preventing or delaying health care access, and that barriers to care declined with increasing age.
Limitations of the research
The researchers note that their study had several limitations. First, because the data from the national survey was cross-sectional, the researchers could not determine a cause-and-effect relationship between discrimination and experiencing difficulties accessing health care. Secondly, the data was self-reported and therefore might have resulted in underreporting and recall bias. Thirdly, the survey was limited to those living in private households and did not include those living in high-care nursing homes, hospitals or other non-private households. Similarly, the analysis did not include the role discrimination plays in describing barriers to health care for older Aboriginal and Torres Strait Islander people living with mental health conditions. Lastly, there were limitations in measuring specific mental health conditions in later life.
How can you use this research?
The researchers note that the study will help Australian policy-makers inform strategies to promote mental health care in older people and begin to address the health care utilization in underserved groups. They highlight how important it is to understand the diverse pathways and strategies to mitigate the harmful effects of stigma in particular settings, rather than adopting a one-size-fits-all approach. Finally, they also recommend conducting more research to examine how reports of discrimination differ by demographic characteristics such as gender, country of birth, marital status and measures of socio-economic status.
About the researchers
Jeromey B. Temple1, Bianca Brijnath2, Joanne Enticott3,4, Ariane Utomo5, Ruth Williams6, Margaret Kelaher6
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Social Gerontology, National Ageing Research Institute (NARI), Parkville, Australia
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, Australia
- School of Geography, Faculty of Science, University of Melbourne, Melbourne, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia