Background
Globally across contexts and populations racism and racial discrimination are recognized as critical determinants of health and health inequalities [
41,
65]. The added burden of racism is arguably the most critical distinctive social exposure influencing health experienced by racially stigmatized groups globally, including indigenous peoples, ethnic minorities and in some cases migrants [
66]. Interpersonal racism, that is racism that is personally mediated via the expression of prejudicial attitudes and discriminatory behavior, is a psychosocial stressor that adversely affects a broad range of health outcomes and health risk behaviors as documented in several recent meta-analyses [
33,
38,
40,
52]. However, this evidence is largely focused on adult populations, with knowledge of patterns and health impacts of racial discrimination among children and adolescents far less understood [
37,
45,
52].
Moreover, children and young people are considered particularly vulnerable to the harmful effects of racial discrimination as a psychosocial stressor [
37,
45]. There is growing scientific consensus that childhood adversity and stress influence health profoundly both in childhood and later in life, including physical and mental health and cardiovascular, metabolic and immune function [
54]. Two key ways in which early experiences can influence adult health are proposed - by repeated exposure to stress that accumulates damage over time or by the biological embedding of stress and adversities during sensitive developmental periods [
28,
30,
54]. However, increased understanding of potentially malleable childhood risk factors is needed, including patterns of different forms of childhood stressors such as racial discrimination, and how they influence health over time [
54].
Existing racial discrimination research among children and adolescents has concentrated mostly on direct discrimination experiences where children and adolescents themselves are the targets [
42,
45,
46]. Vicarious (or indirect) forms of racial discrimination, that is hearing about or seeing another person’s experience of racism ([
34]; Harrell
25) as well as carers or close family members experiencing discrimination that may or may not be witnessed by children and adolescents [
44] are now also starting to be documented in relation to negative child and adolescent outcomes. This is consistent with considerable evidence demonstrating harmful effects for children and youth of vicarious, indirect experiences of violence such as hearing reports of violence against people they know or witnessing violence [
63]. Witnessing bullying and harassment has also been shown to impact negatively on mental health for children and adolescents [
36,
51]. However, key knowledge remains nascent regarding the impacts of vicarious racial discrimination for children and adolescents. Current work on vicarious racism and health and development outcomes for children [
6,
9,
20,
22,
29,
44,
57] and adolescents [
8,
15,
19] almost exclusively focuses on carer reports of racism rather than child and adolescent reports of vicarious experiences (although, see [
42,
46]). Moreover, the co-occurrence and impacts of direct and vicarious racial discrimination experiences reported by children and adolescents over time have, so far, not been investigated empirically [
42,
46].
Most studies of racial discrimination and child and youth health have examined negative mental health outcomes, particularly reporting significant associations with childhood depression [
45]. Within this body of work, loneliness is examined as a particular depressive symptom [
10] as well as a separate outcome [
26,
35], with experiences of racial discrimination associated with both depressive symptoms and loneliness among young populations [
35,
67]. However, more work is needed using longitudinal designs to understand the specific effects of racial discrimination, both direct and vicarious, on these two closely related mental health outcomes over time [
42,
45,
46].
Increased understanding of the patterns and impacts of different types of experiences of racial discrimination on children and adolescents within the key settings of their lives is thus an important research priority. One such critical setting is school, where children and adolescents spend much of their time interacting with peers [
24]. Schools are complex multi-level institutions that impact children’s development in a variety of ways, including teacher, peer and physical environmental influences [
14]. As such, they are central settings for interpersonal relationships, including racism as expressed through racial discrimination, racial bullying and racial victimization [
7].
While empirical research on racism and child and adolescent health has been growing in recent years, a recent systematic review of the field revealed most studies have been conducted in the United States [
45] with work emerging in countries where ethnic diversity is largely driven by recent migration, such as the United Kingdom [
3], Canada [
21], Australia [
44] and New Zealand [
11] as well as nations with longer histories of cultural diversity such as the Netherlands [
2,
60].
Australia has a high level of racial/ethnic diversity among its primary and secondary school student population with one third of students either immigrants themselves or born in Australia to at least one immigrant parent [
27]. Another 4.9% are Indigenous [
4]. More than 230 countries of origin and over 200 languages and dialects are represented; from 2006 to 2010, 17.5% of permanent additions to the Australian population aged 0–17 years were from Southeast Asia, 17.4% from Southern Asia, 12.0% from Southern and East Africa, 12.0% from Northeast Asia and 5.2% from the Middle East (Department of Immigration and Border Protection 2010). In this context of high and increasing levels of racial ethnic diversity, racism and racial discrimination are substantial concerns for many Australian students. Yet research on the prevalence and impact of racist experiences among these students is limited. A 2009 survey of 698 secondary students across four states found 70% of those from non-Anglo backgrounds reporting experiences of racism during their lifetime, with 67% of these experiences occurring in school [
34]. More recently, a survey of 263 primary and secondary students from diverse racial/ethnic backgrounds in Victoria, Australia, found high levels of perceived racial discrimination with at least one form of racism experienced directly by 32.2% of the sample monthly or more, and by 22.1% every day [
42,
46].
Previously we have reported direct experiences of racial discrimination as robustly associated with higher loneliness and depressive symptoms among Australian students cross-sectionally, and that the association with depressive systems was attenuated to marginal significance for students with low motivated fairness, that is low levels of motivation to respond without prejudice [
42,
46]. However, whether these patterns of association are maintained over time, or the direction of association between perceived discrimination and loneliness and depressive symptoms is unidirectional, is as yet unknown. As noted, previous cross-sectional studies assume a direction of effects in which discrimination precedes poor mental health but have not examined the simultaneous effects of direct and vicarious racism on mental health over time in a full cross-lagged model. Furthermore, previous research has not distinguished between discrete mental health dimensions of loneliness and depressive symptoms over time in this age group.
Depressive symptoms and loneliness are related dimensions of mental health and psychosocial functioning, and are conceptualised and measured using various means among children and adolescents as well as adults [
32,
47]. For example, several depression scales for children include ‘feeling lonely’ as a domain [
12,
16]. However, more recent work identifies that loneliness and depressive symptoms, are conceptually distinct forms, though partly overlapping constructs [
55,
61]. Loneliness and depressive symptoms have been shown to have different relations with other constructs, including various aspects of adjustment, different developmental trajectories, and different patterns by gender implying further distinction between them and highlighting the need to assess both loneliness and depressive symptoms [
55]. Loneliness and depressive symptoms as reciprocally associated, and potentially reinforcing one another over time, has also been empirically shown among adolescents [
61].
As recommended [
55,
61], in this study we consider depressive symptoms and loneliness as two separate constructs among students, and examine the effects of racial discrimination on each construct over time, as well as stability of, and associations between, each construct modelled simultaneously over time in a full cross-lagged model. The present study aims to examine the auto-regressive and cross-lagged associations between perceived racial discrimination and loneliness and depressive symptoms over time among Australian primary and secondary school students. Using a longitudinal model, the study will be able to determine over time (a) the extent to which mental health symptoms (i.e., depressive symptoms and loneliness) are determined by their pre-existing levels, versus (b) the independent effect of racial discrimination (direct and vicarious) on each of these symptoms.
We hypothesize that racial discrimination (direct and vicarious) independently predict both depressive symptoms and loneliness, even after accounting for pre-existing levels of depressive symptoms and loneliness.
These aims were investigated using one component of data collected for the evaluation of the Localities Embracing and Accepting Diversity (LEAD) program. LEAD was a community-based intervention to counter racial discrimination and promote racial/ethnic diversity across multiple settings in two local government areas (LGAs) in Victoria, Australia; primary and secondary schools being one site of intervention [
17,
42,
46]. This provided a unique opportunity to examine the effects of discrimination on mental wellbeing across both primary and secondary school students over time within a diverse community setting.
Discussion
Perceived experiences of racial discrimination are prevalent and highly salient for children and youth from minority backgrounds [
18] with deleterious impacts on numerous concurrent and later outcomes [
1,
45]. This study adds to the growing literature investigating the impact of discrimination among children and adolescents outside of the U.S. and from Indigenous and migrant backgrounds. This study extends previous work by showing that perceived direct racial discrimination had significant, negative effects on later depressive symptoms and on later loneliness but that vicarious racial discrimination had no effect on either depressive symptoms or loneliness beyond the effect of direct racial discrimination.
Consistent with existing research citing the direct effects of discrimination on depressive symptoms among adolescents over time [
23,
58], the current study found racial discrimination fully explained an increased likelihood of experiencing depressive symptoms over time among Australian students, with no (auto-regressive) effect of T1 depressive symptoms remaining. Also consistent with cross-sectional research [
26,
35], racial discrimination exerted a longitudinal effect on loneliness, although the effect size was smaller than for that of racial discrimination on depressive symptoms. Mediation analysis indicated that racism only partially mediated loneliness, which was also directly predicted by existing loneliness 12 months prior. These dimensions of mental health may thus be distinct constructs, at least in terms of how they relate to experiences of racial discrimination [
26] in middle childhood and adolescence.
Another distinction between these mental health dimensions in our findings was the cross-lagged (and unidirectional) effect of depressive symptoms on loneliness. Although this effect was not predicted, it may indicate that depressive symptoms are psychologically prior and can lead to loneliness, although other evidence suggests loneliness predicts depression, and that depressive symptoms and loneliness are reciprocally related over time [
61]. Our findings are consistent with understandings of depression as an underlying condition, of which loneliness is a more narrow-bandwidth symptom, as operationalized in childhood depression scales that include ‘feeling lonely’ as a symptom [
12,
16]. Nevertheless, direct racism was still the most powerful cross-lagged predictor of loneliness in our study, consistent with our expectations.
A recent meta-analysis [
50] and empirical evidence [
59] indicated reciprocal relationships between peer victimization and psychosocial problems. We found, however, no evidence of reciprocal cross-lagged effects on racial discrimination by either depressive symptoms or loneliness. It is plausible that depressive symptoms and loneliness are differently related to general peer victimization than to racial discrimination as a form of identity-based or bias-based victimization [
48], with previous research suggesting general and racial victimization experiences are only moderately correlated among school students [
31]. However, the difference in effect sizes for racial discrimination with loneliness and with depressive symptoms in our study are consistent with the findings from the general peer victimization literature that also show victimization is differentially related to specific dimensions of mental health and psychosocial symptoms [
59].
Vicarious discrimination was not found to be associated with either depressive symptoms or loneliness over time in this study after accounting for direct racism, suggesting that direct racism is a better predictor of loneliness and depressive symptoms over time than vicarious racism. However, it is also plausible that this finding may be related to methodological issues, and that vicarious experiences of discrimination may be hard to capture or may not have been captured by the measure used in the study. Bivariate correlations between vicarious racism and later loneliness and depressive symptoms are however consistent with studies that show witnessing generalised bullying and harassment impacts negatively on mental health for children and adolescents [
36,
51]. More investigation of the experiences and impacts of vicarious discrimination reported by children and adolescents is needed in future studies, both in isolation and in combination with direct experiences of discrimination.
Limitations
While single-item measures of self-rated health are predictive of objective health outcomes and are widely utilised [
13], there is a need to replicate our findings using more robust psychometrically validated instruments of both depressive symptoms and loneliness. Short-form measures were required by the intervention evaluation study from which these data were drawn. However, the current study findings are consistent with other research using multi-item measures of these dimensions of mental health.
Further psychometric validation studies of the racial discrimination measures developed for this study are also required across samples of children from a range of ethnic, migration and language of origin backgrounds. The appropriate conceptualization and measurement of racial discrimination among children, and indeed among adults, and across population groups and contexts, remains under-developed in the field globally, [
5,
45].
Other limitations include the need for more detailed measurement of racial/ethnic background, both self-report and socially ascribed, within future research. However, our approach is consistent with the broad analytic categories of ‘immigrant’ or ‘visible minority’ i.e. non-Indigenous non-White/Anglo frequently used in other national settings including Canada [
56,
64]. Larger sample size would likely be required for such subgroup analyses, particularly longitudinally. As a community-based study, participants were not randomly selected and it is not a representative population sample. However, the internal validity of the study remains high and many findings are consistent with other research in the field as described earlier. In addition, as noted above, our findings form part of a broader intervention study, elements of which may have influenced variations in prevalence of outcomes over time. Although, separate analyses show a lack of intervention effect over time on student reports of either discrimination or social attitudes [
42].