Data from “Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases” were analyzed. This was a 116-item web-based survey that was nationally distributed in the United States from May 2021 to January 2022. Qualtrics, LLC conducted recruitment and survey distribution using a national survey panel. The survey was in English only. For more details, see the study by Montiel Ishino et al [33]. Analysis was restricted to Hispanic or Latino (ie, Mexican or Mexican American; Puerto Rican, Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults, which included both foreign-born and US-born groups. The final sample size was 1181.

Depressive symptoms were assessed using the Patient Health Questionnaire-2 [34]. Two items were used to assess whether “Over the last 2-week period how often were you bothered by the following problems?”: (1) “Little interest or pleasure in doing things”; and (2) Feeling down, depressed or hopeless.” Responses to these items included (1) “not at all” for a score of 0; (2) “several days” for a score of 1; (3) “more than half the days” for a score of 2; and (4) “nearly every day” for a score of 3. Scores were summed for a range of 0-6, where a score of 0-2 (reference category) indicates no depressive symptoms and a score of 3 or more indicates present depressive symptoms [34]. The Patient Health Questionnaire-2 has been validated by both Spanish- and English-speaking Hispanic and Latino adults [34-37].

The short version of the Everyday Discrimination Scale was used [38]. Items of the short version assessed whether “In your day-to-day life how often have any of the following things happened to you?”: (1) You are treated with less courtesy or respect than other people. (2) You receive poorer service than other people at restaurants or stores. (3) People act as if they think you are not smart. (4) People act as if they are afraid of you. (5) You are threatened or harassed. Responses to the 5 items were (1) never; (2) monthly to weekly; and (3) multiple times a week to daily. A composite score was created to compare participants who had never experienced any discrimination with those with experiences of discrimination.

All items were self-reported. Acculturation factors included years in the United States (ie, less than 10 years and 10 or more years) and English-speaking proficiency level (ie, none or poor, fairly well, well, or very well). Self-reported sociodemographic factors included the following: age group (ie, 18-35 years, 36-55 years, and 56 years of age and older); gender (ie, man, woman, and another gender category that included responses for nonbinary, transgender, or responses provided through fill in the blank); marital status (ie, divorced or separated, married or living with a partner, never been married, or widowed); educational attainment (ie, categorized by self-reported highest schooling that included less than high school, did not attend school, elementary level education, more than elementary to junior high school, or some high school; high school diploma or GED; some college or vocational or technical schooling; bachelor’s degree; and master’s degree or above that includes doctoral, professional, or postgraduate degree); and annual household income (ie, US <$25,000, US $25,000 to US $34,999, US $35,000 to US $49,999, US $50,000 to US $74,999, and US ≥$75,000).

We used a multinomial logistic regression with a block entry model to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as to examine how controls and covariates affected the relationship of interest. All findings are reported in odds ratios (ORs) or adjusted odds ratios (AORs) using 95% CI and P value at ≤.05 statistical level of significance. All analyses were conducted using Stata/MP (version 16.1; StataCorp).

The NIH Intramural Research Program institutional review board, Human Research Protection Program, and Office of Human Subjects Research Protections reviewed this study’s research protocol, determined that our protocol did not involve human participants and granted an exemption on December 23, 2020 (IRB#000308). For full information on ethical considerations for this study, see the study by Ishino et al [33]. Qualtrics recruited participants, and web-based informed consent was obtained from each participant prior to filling out the survey. Participants were assured that responses were confidential and were reminded that the study was voluntary, and they could opt out of the survey or skip any questions without repercussions. All answers were kept confidential, and no personal identifiers were shared with the National Institute on Minority Health and Health Disparities research team, which participants were also made aware of. A US $10 gift card was given to each participant after the completion of their survey, which took approximately 30 minutes to complete.

The largest subpopulation among the sample was Mexican or Mexican American (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%; Table 1). Depressive symptoms were reported in 31.26% (367/1181) of the sample and 54.56% (634/1181) reported experiencing some form of discrimination. Most of the participants reported living in the United States for 10 years or more (900/1181, 76.53%), spoke English very well (832/1181, 70.63%), were 18-35 years of age (541/1181, 49.54%), and were women (728/1181, 61.75%). About a quarter of participants (290/1181, 24.83%) reported having a household income of less than US $25,000 (Table 1).

Model 1 (the unadjusted model) found that there was a significant relationship between discrimination and the likelihood of depressive symptoms. In model 2, we then included acculturation factors, where years in the United States were found to be significant. In model 3, the comprehensive model that was selected for interpretation included the variables from the aforementioned models in addition to sociodemographic variables. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (AOR 3.31, 95% CI 2.42-4.54). In addition, we observed that sociodemographic factors such as age and gender were significant. Participants aged 18-35 years of age and 36-55 years of age had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively) when compared with participants 56 years of age and older. Regarding gender, women compared with men had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30). Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000 (Table 2).

We found a significant association between discrimination and depressive symptoms that persisted after adjusting for acculturation and sociodemographic factors, indicating that discrimination cannot be overlooked among Hispanic and Latino communities during the pandemic. This relationship is particularly important given discrimination’s role in perpetuating systemic inequities and socioeconomic disparities [39]. For instance, research predating the pandemic reported that discrimination toward Latino communities significantly limits job opportunities, income, housing, and education [40,41]. Discrimination has also been shown to increase substance use disorders, chronic disease, and blood pressure [42]. All these discrimination-related adverse life and health outcomes were risk factors for poor physical and mental health during the pandemic [43]. Thus, when placing our findings in the context of a pandemic that has caused greater financial and social instability for racial and ethnic minoritized communities, the need to address the deleterious effects of discrimination on the mental health of Hispanic and Latino communities is urgently salient. Ultimately, our findings mirror research showing that discrimination is associated with depressive symptoms and other adverse psychological outcomes both predating [26,40,42,44] and during the COVID-19 pandemic [45-47].

Contrary to our hypothesis, we did not find differences in the odds of depressive symptoms by Hispanic or Latino subgroup. This may be because we adjusted for sociodemographic and migration factors, which have been shown to attenuate differences in anxiety and psychiatric disorders by Hispanic or Latino subgroup [48,49]. Furthermore, our findings may be an indication that the pandemic was detrimental to mental health irrespective of subgroup given the prevalence of discrimination and depressive symptoms was exceedingly high and similar across all subgroups. Thus, future research should examine whether discrimination impacts depression symptoms differently by Hispanic or Latino subgroup during the pandemic and beyond. For instance, Held and Lee’s [49] study about discrimination and mental health among Latino adults reported that discrimination was more likely to have an effect on the odds of having a psychiatric disorder among Mexican adults than among Puerto Rican adults, and there was no difference between Cubans and Puerto Ricans. However, no further investigation or comparison regarding other Hispanic or Latino subgroups was performed.

This study also found that younger respondents (18-35 and 36-55 years of age) were more likely to report depression symptoms than older respondents (56 years of age and older). This finding is discordant with prepandemic literature, which has typically reported a higher risk of depression and levels of distress among older Latino adults [50]. Explanations for these trends lie within the longer time spent in the United States being linked with loss of cultural values that may be protective against depression and distress, and longer exposure to discrimination and acculturative stress [50,51]. Our findings align with previous research conducted during the pandemic, which has shown a consistent pattern in the United States of an inverse relationship between age and mental health symptoms, including psychological distress and depressive disorder [52,53]. Furthermore, a web-based study using a national sample of 124 Hispanic and Latino adults found that younger age was associated with poorer overall mental health during the COVID-19 pandemic [54]. These findings may be explained by younger Latino individuals (younger than 50 years) being more likely to report experiencing discrimination during the pandemic, according to a March 2021 report from the Pew Research Center, which may translate to greater odds of mental health symptoms [55].

In our study, women had higher odds of depressive symptoms than men, which is consistent with prior studies [53,56-59]. Multiple explanations for this association exist, including Latina women having greater internalizing behaviors (ie, anxiety and mood disorders), psychological distress, depressive responses to discrimination and family conflict, and experiencing greater levels of acculturative stress than Latino men [56-58,60]. Furthermore, traditional Latino cultural values such as machismo and marianismo may increase the odds of depressive symptoms among Latina women compared with men [59]. In addition, discrimination is linked to greater family conflict among Latino adults, although whether gender modifies this association is unclear and requires further study [61]. These pathways for distress and depression may be exacerbated during the pandemic, especially given that Hispanic and Latino families have faced significantly more economic and health-related hardships than Asian and White families across the income spectrum [62]. Also, among Hispanic and Latina parents, women more than men report childcare during the pandemic as being very or somewhat difficult, suggesting that the burden of family responsibilities and childcare may be higher among Latina women [63]. Furthermore, Latina women are overrepresented in unemployment and layoffs during the pandemic, which is likely to worsen financial instability and inequities [22,64]. The disproportionate burdens of stressors and risk factors may manifest into worse depressive symptoms among Latina women as seen in our study. Finally, this study found that individuals with lower income had increased odds of depressive symptoms, which is consistent with prior research showing that lower-income groups are more affected by national financial and public health crises [65-67]. Low-income Latino individuals also face numerous structural and systemic barriers to well-being, such as segregation, food deserts, limited job opportunities, and overcrowded housing—all of which can contribute to worse mental health [68-70]. Moreover, low-income and Latino communities have a heightened risk of COVID-19 incidence and severe symptoms [21,68,71]. Thus, this constellation of factors may also contribute to their higher odds of depressive symptoms.

Given this study is cross-sectional, directionality and causality cannot be established. Also, Dominicans and individuals who indicate “Another Hispanic, Latino, or Spanish origin” were combined due to small sample sizes. Thus, the association between discrimination and depressive symptoms among Dominicans could not be elucidated and may be obscured. In addition, the survey was conducted in English and web-based only, meaning individuals with limited English proficiency or who do not have access to the internet may not be captured and are underrepresented. Another limitation is the survey was administered over a 6-month period when vaccines became more available and some restrictions were lifted, meaning answer choices may differ depending on when the survey was completed. It should also be noted that the 5-item Everyday Discrimination Scale has not been previously validated among Hispanic and Latino adults, which may affect our results.

Using a national sample of Hispanic and Latino adults, we found that discrimination was associated with depressive symptoms during the COVID-19 pandemic. We further found elevated odds of depressive symptoms among women, individuals younger than 56 years, and lower-income adults—highlighting potentially at-risk groups. Our results hold significant relevance due to the numerous pandemic-related socioeconomic crises that disproportionately impact Latino communities, increased xenophobia and tension toward immigrants, inadequate resources to address mental health care demands among Hispanic and Latino communities, and existing hesitancy in accessing mental health services in these communities. The findings of this study serve as compelling evidence of the poor depression outcomes experienced by Hispanic and Latino communities. This study can serve as an important foundational step in promoting health equity for these at-risk groups.