Effect of everyday discrimination on depression and suicidal ideation during the COVID-19 pandemic: a large-scale, repeated-measures study in the All of Us Research Program

Objective The COVID-19 pandemic has coincided with an increase in depressive symptoms as well as a growing awareness of health inequities and structural racism in the United States. Here, we examine the mental health impact of everyday discrimination during the pandemic in a large and diverse cohort of the All of Us Research Program. Methods Using repeated assessments of 62,651 participants in May to July of 2020, we fitted mixed-effects models to assess the effect of everyday discrimination on moderate to severe depression (Patient Health Questionnaire (PHQ)-9 ≥ 10) and suicidal ideation (PHQ-9 item 9 > 0), and applied inverse probability weights to account for non-random probabilities of completing the voluntary survey. Results Everyday discrimination was associated with increased odds of depression (adjusted odds ratio (aOR) [95% CI]: 1.21 [1.20 -1.22]) and suicidal ideation (1.17 [1.16-1.18]). For depression, the effects were larger in earlier phases of the pandemic (interaction p=8.2×10−5), which varied by main reason for discrimination and self-reported race and ethnicity. Among those who identified race or ancestry/national origin(s) as a primary reason for discrimination, Asian and Black or African American participants had 24% and 17% increase in the odds of depression in May of 2020 (1.24 [1.17-1.31] and 1.17 [1.12-1.22]), respectively, versus a 3% and 7% increase in July (1.03 [0.96-1.10] and 1.07 [1.02-1.12]). Conclusion In this large and diverse sample, increased levels of everyday discrimination were associated with higher odds of depression, particularly during the early phase of the pandemic among participants self-identifying as Asian or Black. ### Competing Interest Statement J.W.S. is a member of the Leon Levy Foundation Neuroscience Advisory Board, the Scientific Advisory Board of Sensorium Therapeutics, and has received honoraria for internal seminars at Biogen, Inc and Tempus Labs. He is PI of a collaborative study of the genetics of depression and bipolar disorder sponsored by 23andMe for which 23andMe provides analysis time as in-kind support but no payments. ### Funding Statement The All of Us Research Program is supported by grants through the National Institutes of Health, Office of the Director: Regional Medical Centers: 1 OT2 OD026549; 1 OT2 OD026554; 1 OT2 OD026557; 1 OT2 OD026556; 1 OT2 OD026550; 1 OT2 OD 026552; 1 OT2 OD026553; 1 OT2 OD026548; 1 OT2 OD026551; 1 OT2 OD026555; IAA#: AOD 16037; Federally Qualified Health Centers: HHSN 263201600085U; Data and Research Center: 5 U2C OD023196; Biobank: 1 U24 OD023121; The Participant Center: U24 OD023176; Participant Technology Systems Center: 1 U24 OD023163; Communications and Engagement: 3 OT2 OD023205; 3 OT2 OD023206; and Community Partners: 1 OT2 OD025277; 3 OT2 OD025315; 1 OT2 OD025337; 1 OT2 OD025276 In addition to the funded partners, the All of Us Research Program would not be possible without the contributions made by its participants. All authors are supported by the International HundredK+ Cohorts Consortium (IHCC), which has been created in collaboration with the Global Alliance for Genomics and Health (GA4GH) and the Global Genomics Medicine Collaborative (G2MC) with support from the National Institute of Health and the Wellcome Trust. In addition, J.R.B. and S.B. are supported by: Dementias Platform UK (DPUK) funded by the Medical Research Council (MRC) MR/T0333771. J.W.S. is supported in part by a gift from the Demarest Lloyd, Jr. Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Boards of the All of Us Research Program approved all study procedures, and all participants provided informed consent to share electronic health records (EHRs), surveys, and other study data with qualified investigators for broad-based research. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes De-identified data are available on the Researcher Workbench of the All of Us Research Program located at .