Perceived Discrimination is Related to Emotional/Psychological and Physical Symptoms in Sickle Cell Disease

Purpose: Perceived discrimination is a psychological stressor that has been linked to negative health outcomes in both healthy and patient populations.^1-3 Yet little is known about the relationship between perceived discrimination and emotional/psychological and physical symptoms in adult patients with sickle cell disease (SCD). Americans with SCD are vulnerable to the negative influence of perceived discrimination because of historical and contemporary exposure to discriminatory practices, since the majority of patients with SCD are people of African or Hispanic descent. Guided by the model of perceived unfairness (MPU), the purpose of this descriptive comparative study was to determine the relationship between perceived discrimination, and emotional/psychological (perceived stress, anger, anxiety, and depression) and physical (pain and fatigue) symptoms in patients with SCD. The MPU states that the perception of unfairness, such as perceived discrimination, could initiate stress responses, which may accumulate to negatively affect health.⁴We hypothesize that compared to patients with SCD who did not report the experience of perceived discrimination, those who did would be more likely to report greater emotional/psychological (perceived stress, anger, anxiety, and depression) and physical (pain, and fatigue) symptoms. 

Methods: Patients (N=54, mean age 36.3±10.9 years [ranged from 22-74 years], 96% African-American, 57% female) recruited between March-December 2015 completed PAINReportIt, a computerized pain measure, demographic questions, the Perceived Discrimination Questionnaire, the Perceived Stress Questionnaire, and the PROMIS measures (anger, anxiety, and depression). We analyzed the data using the statistical software R.

1.5, n=26) p Value Perceived Stress (0-1) 0.30 (0.18) 0.45 (0.15) .001 Anger (10-90) 46.4 (13.2) 56.1 (9.3) .003 Anxiety (10-90) 49.1 (10.3) 57.0 (5.5) <.001 Depression (10-90) 47.4 (10.0) 56.2 (8.0) <.001 Pain Intensity (0-10) 3.6 (2.3) 4.4 (2.3) .24 Fatigue (10-90) 53.8 (11.2) 59.4 (6.0) .03 " align="left" height="146" hspace="12" vspace="5" width="512">Results: We found the mean scores for the study variables to be: Perceived discrimination (1.8±0.7); perceived stress (0.37±0.18); anger (51.1±12.4); anxiety (52.9±9.1); depression (51.6±10.0); average pain intensity (4.5±2.4); and fatigue (56.5±9.4). As shown in the Table, our comparative analysis results indicated that there were statistically significant differences between Low Perceived Discrimination (<=1.5, n=28) and High Perceived Discrimination (>1.5, n=26) groups on study variables, except for the average pain intensity.

Study Variables Low Discrimination (discrim<=1.5, n=28) High Discrimination (discrim>1.5, n=26) p Value Perceived Stress (0-1) 0.30 (0.18) 0.45 (0.15) .001 Anger (10-90) 46.4 (13.2) 56.1 (9.3) .003 Anxiety (10-90) 49.1 (10.3) 57.0 (5.5) <.001 Depression (10-90) 47.4 (10.0) 56.2 (8.0) <.001 Pain Intensity (0-10) 3.6 (2.3) 4.4 (2.3) .24 Fatigue (10-90) 53.8 (11.2) 59.4 (6.0) .03

Conclusions: Findings provide preliminary evidence of the relationship between perceived discrimination, and perceived stress, anger, anxiety, depression, and fatigue in patients with SCD. Findings are consistent with the MPU and suggest that perceived stress related to the experience of perceived discrimination could be the mechanism through which perceived discrimination affects emotional/psychological and physical symptoms in patients with SCD. Results from future studies in this population will provide additional evidence to better understand the influence of perceived discrimination on emotional/psychological and physical symptoms in patients with SCD, and would likely inform future psychoeducational intervention studies to decrease perceived stress, anger, anxiety, depression, and fatigue in patients with SCD who experience perceived discrimination related to their disease or minority status.