The RCPsych Article of the Month for February is ‘Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada)’ Diana Miconi, Zhi Yin Li, Rochelle L. Frounfelker, Tara Santavicca, Jude Mary Cénat, Vivek Venkatesh and Cécile Rousseau published in BJPsych Open.

The COVID-19 pandemic highlighted pre-existing social, economic and political fractures and injustices within communities and societies, fueling fear and xenophobic discourses in the general population. Many countries, including Canada, are not systematically collecting information on socio-cultural aspects (e.g., ethnicity/race, immigrant status) related to COVID-19 infections, but reports in Quebec as well as the US and UK highlight pandemic health disparities and denounce COVID-19-related discriminatory actions against minorities and marginalized groups.

Research on prior epidemics such as Ebola and HIV indicate that exposure to the virus, disease-related stigma and discrimination are risk factors for both physical and mental health. To date, empirical evidence on the relationship between exposure to COVID-19 and experiences of discrimination and mental health during the COVID-19 pandemic is scarce, and even more so when it comes to visible minority groups.

Our study aimed to investigate the association of exposure to the virus, COVID-19-related discrimination and stigma with mental health during the COVID-19 pandemic in a culturally diverse sample of adults in Quebec (Canada).

A total of 3273 residents of the province of Quebec (49% aged 18–39 years, 57% women, 51% belonging to a minority ethnocultural group) completed an online survey during the first wave of the COVID-19 pandemic in the late spring/early summer of 2020. Participants who self-identified as members of a visible minority reported more COVID-related discrimination than White participants. Exposure to the virus, COVID-19-related discrimination, and stigma were associated with poorer mental health. Associations with mental health varied across ethno-cultural groups, with exposed and discriminated Black participants reporting higher mental distress.

These results tell us that there are sociocultural inequalities related to COVID-19 not just in physical health but also mental health outcomes in the Canadian context. COVID-19-related risk factors, including exposure, discrimination and stigma, jeopardize mental health. This burden is most noteworthy for the Black community. There is an urgent need for public health authorities and health professionals to advocate against the discrimination of racialized minorities and ensure that anti-oppressive mental health services are accessible and culturally sensitive during and in the aftermath of the pandemic.

Future research should monitor longitudinally the mental health of racialized minorities to find ways to better support these groups’ well-being as to prevent the widening of social and health inequalities in the short and long-term.

Why I chose this article:

Ethnic and cultural themes impact mental health status with reported disparities in treatment and outcome.  Under the lens of COVID-19, these issues have been magnified; for not only is it an issue of psychiatric morbidity but also increased mortality from COVID-19.  This month we celebrate as “Article of the Month” an important, preliminary (First Wave) study by Dr. Diana Miconi and colleagues entitled “Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada)” [BJPsych Open 2021; 7(1):e14].  The authors analyzed data from 3273 residents in Quebec addressing mental health symptoms (depression and anxiety), perception of COVID-19 on mental health, COVID-19 exposure, COVID-related discrimination, COVID-related stigma, and socio-cultural variables. The diverse sample permitted comparisons among multiple race/ethnicities, religions and other sociodemographic variables.  The findings support the need for policy makers to consider the role of ethno-cultural themes when addressing mental health during the COVID-19 pandemic (and beyond) with emphasis on anti-discrimination programs and accessible mental health services which are culturally sensitive for racial minorities.  The authors are commended on this article and are encouraged to conduct a further longitudinal study. 

Kenneth Kaufman, BJPsych Open Editor in Chief