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

Research on discrimination and health has predominantly relied on explicit self-report data for single types of discrimination; use of implicit measures is scant. 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 3 Boston, MA, community health centers. Covariate-adjusted linear regression models estimated associations between K6 scores and the discrimination measures. 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 < .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, 0.07-0.51]). 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, for example, for self-reported experiences of sexism among women (β: 0.25 [95% CI, 0.13-0.36]) and nonbinary/genderqueer participants (β: 0.26 [95% CI, 0.13-0.39]), and for implicit recognition of sexism toward women among women (β: 0.12 [95% CI, –0.01 to 0.24]). Using both implicit and explicit measures for multiple discrimination types, with attention to differences between target vs dominant groups, is warranted.