Multiple and intersectional discrimination and mental health of migrant populations in Portugal after the COVID-19 pandemic

• Date: 30 July 2024
• Pages: 504-522
• DOI: https://doi.org/10.1108/IJMHSC-01-2024-0003
• Published date: 30 July 2024
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements
• Author: Violeta Alarcão,Pedro Candeias,Miodraga Stefanovska-Petkovska,Sónia Pintassilgo,Fernando Luís Machado

Multiple and intersectional discrimination

and mental health of migrant populations

in Portugal after the COVID-19 pandemic

Violeta Alarcão, Pedro Candeias, Miodraga Stefanovska-Petkovska, S

onia Pintassilgo and

Fernando Luís Machado

Abstract

Purpose –A growing body of evidencesuggests that experiences of discriminationmay affect physical

and mental health through multiple pathways. This paper aims to characterize the extent of everyday

perceived discriminationamong Brazilian and Cape Verdean immigrantadults in Portugal, to identify its

forms and analyzeits association with mental health.

Design/methodology/approach –This study draws on data from the EQUALS4COVID19 (Equity in

health in times of pandemic) project that implemented a cross-sectional survey combining online and

face-to-facequestionnaires for data collectionbetween February and November 2022.

Findings –Women were less likelythan men to report no discrimination experiencesand more likely to

report combined bases of discrimination. While Brazilian women were more likely than Cape Verdean

counterpartsto report gender and nationality-baseddiscrimination, Cape Verdeanwomen and men were

more likely to report experiencingrace-based discrimination. Gender(being identified as a woman) and

length of stay in Portugal were the main predictorsof depression, while resilienceand perceived social

support were protective factors. Participants with higher levels of resilience showed a significantly

diminishedassociation between perceiveddiscrimination and depressivesymptoms.

Practical implications –This study highlights the need for further research on the interl ocking influences of

gender, race, nationality and otherstructures of power, on health and illness to increase our understanding of

what would help meetthe specific needs of migrants’ mental health and improve equitablehealth care.

Originality/value –The findings on the multiple and intersectional discrimination perceived by the

Brazilianand Cape Verdean populations in Portugalillustrated the ways mental health canbe affected by

social structures, such as gender and ethnic hierarchies, and can be used to inform the relevance to

design and implement programson combating individual and institutional discriminationand improving

the rightsof all people.

Keywords Mental health, Gender discrimination, Health equity, Minority health,

Racial and ethnic discrimination

Paper type Research paper

Introduction

Evidence is mounting that migrant groups are disproportionally affected by everyday

discrimination related to COVID-19 pandemic and that these experiences can worsen

mental health (Le et al.,2023). Everyday discrimination refers to acts of interpersonal

discrimination that can happen repeatedly over the life course in different contexts and

includes events such as being treated with disrespect and being given poor service

(Essed, 1991). Even before the pandemic, there was a growing scientific interest in

examining the extent to which perceptions of racial/ethnic discrimination are a type of

stressful life experience that can adversely affect physical and mental health (Everett et al.,

2016;Williams et al., 2008). A growing number of comprehensive literature reviews found

VioletaAlarca

˜oand

Pedro Candeiasare both

based atthe Centro de

Investigac¸a

˜o e Estudosde

Sociologia,ISCTE-Instituto

Universit

ario de Lisboa,

Lisboa,Portugal and

Institutode Sa

ude

Ambiental,Faculdade de

Medicina, Universidade d e

Lisboa,Lisboa, Portugal.

MiodragaStefanovska-

Petkovskais based at the

Institutode Sa

ude

Ambiental,Faculdade de

Medicina, Universidade d e

Lisboa,Lisboa, Portugal.

S

onia Pintassilgo and

Fernando Luı

´s Machado

are both based at the

Centro de Investigac¸a

˜oe

Estudos de Sociologia,

ISCTE-Instituto

Universit

ario de Lisboa,

Lisboa, Portugal.

Received 3 January 2024

Revised 1 June 2024

Accepted 1 July 2024

PAGE 504 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 20 NO. 3 2024, pp. 504-522, ©Emerald Publishing Limited, ISSN 1747-9894 DOI 10.1108/IJMHSC-01-2024-0003

substantial evidence for the negative effects of perceived discrimination on mental health

outcomes (including depression, psychological distress, anxiety and well-being) (Schmitt

et al., 2014), although the underlying mechanisms are still poorly understood. Increasing

rates of mental health disorders, more specifically schizophrenia, mood and anxiety

disorders and psychological distress, have been found in various ethnic minority groups

across the world (Anglin et al.,2021;Karlsen et al.,2005;Selten and Sijben, 1994;Veling

et al.,2007

;Veling and Susser, 2011). The very limited number of studies that investigate

the impact of the COVID-19 pandemic on the mental health of migrant populations find an

increased prevalence of post-traumatic stress disorder (PTSD), depressive and anxiety

disorders (such as feelings of fear, panic and helplessness) and deficits in working memory

and inhibitory control during the COVID-19 pandemic compared to the pre-COVID-19

period (Kira et al., 2021;Logie et al.,2021;Sevinc et al., 2021). A study conducted with

Chinese Americans in the USA reported higher discrimination which was related to higher

depressive symptoms and lower life satisfaction (Litam and Oh, 2022). Although this

negative discrimination against Chinese immigrants has been heavily documented, it is

plausible that other immigrant groups have also been discriminated against. Studies have

shown that in situations of instability, racist manifestations and discrimination against

immigrants increase (e.g. Andersonet al.,2020;Bray et al., 2022).

Despite the existing agreement that many of these challenges may be exacerbated for

racial-, ethnic-minority and migrant communities, research aimed at identifying protective

factors that improve the well-being of the migrant population is rather scarce (Henrı

´quez

et al.,2022

;IOM, 2020;Urz

ua and Cabieses, 2018).

One potential buffering factor is psychological resilience, which encompasses the ability to

recover from or adapt successfully to adversity and use coping strategies, such as positive

reappraisal of adverse events (Mylord et al., 2023); however, it is not a static characteristic

(Ong et al.,2009). Resilience is a dynamic phenomenon that can change over time in

response to internal and external life events, including discrimination and other minority

stressors (Emlet et al.,2017) that can vary across cultures, age groups and gender

(Siriwardhana et al.,2017). The role of resilience in contributing to mental health has been

extensively researched among forced migrant groups, leading to its recognition as a

relevant protective factor for psychosocial health among this type of migrant. Research

findings indicate that it varies according to individual characteristics, such as older age,

prolonged displacement and hardship acting to decrease resilience. Improved living and

working conditions, young age and highlevels of support can enhance resilience and, thus,

improve mental health (Davydovet al., 2010;Miller et al., 2023;Min et al.,2015).

Another protective factor that plays a role in the relationship between perceived

discrimination and mental health is social support. Social support has been recognized as

one of the buffering factors against theeffect of perceived discrimination on subjective well-

being (Hashemi et al., 2021) and it is found to be associated with lower levels of

psychological distress and a better assessment of life satisfaction (Khatiwada et al.,2021).

A systematic review study indicated that social support was an important protective factor

against psychological distress. It was associated with increased resilience and lower

symptoms of PTSD, depression and anxiety among conflict-driven adult forced migrants

(Siriwardhana et al.,2014). A more recent study among Venezuelan migrants living in Chile

showed that perceived social support is a mechanism by which identity fusion with the

country of origin is related to psychological well-being (Henrı

´quez et al.,2022).

Perceived discrimination, mental health and intersectionality

Everyday discrimination of different groups remains a complex and insufficiently

understood phenomenon and currently it is widely assessed by the everyday discrimination

scale (EDS) developed by Williams et al. (1997). The EDS was developed more than two

decades ago to address an important gap in the research on the health effects of racial

VOL. 20 NO. 3 2024 jINTERNA TIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 505