Perceived discrimination, humiliation, and mental health: a mixed-methods study among Haitian migrants in the Dominican Republic.
OBJECTIVE
Many Haitian migrants live and work as undocumented laborers in the Dominican Republic. This study examines the legacy of anti-Haitian discrimination in the Dominican Republic and association of discrimination with mental health among Haitian migrants.


METHODS
This study used mixed methods to generate hypotheses for associations between discrimination and mental health of Haitian migrants in the Dominican Republic. In-depth interviews were conducted with 21 Haitian and 18 Dominican community members and clinicians. One hundred and twenty-seven Haitian migrants participated in a pilot cross-sectional community survey. Instruments included culturally adapted Kreyòl versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) and a locally developed function impairment scale.


RESULTS
Haitian migrants described humiliation (imilyasyon) as a reason for mental distress and barrier to health care. Dominicans reported that discrimination (discriminación) was not a current social problem and attributed negative social interactions to sociocultural, behavioral, and biological differences between Dominicans and Haitians. These qualitative findings were supported in the quantitative analyses. Perceived discrimination was significantly associated with depression severity and functional impairment. Perceived mistreatment by Dominicans was associated with a 6.6-point increase in BDI score (90% confidence interval [CI]: 3.29, 9.9). Knowing someone who was interrogated or deported was associated with a 3.4-point increase in BAI score (90% CI: 0.22, 6.64).


CONCLUSIONS
Both qualitative and quantitative methods suggest that perceived discrimination and the experience of humiliation contribute to Haitian migrant mental ill-health and limit access to health care. Future research should evaluate these associations and identify intervention pathways for both improved treatment access and reduction of discrimination-related health risk factors.
a Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health , Emory University , Atlanta , GA , USA.
Hunter M
HM
Keys
Bonnie N
BN
Kaiser
Jennifer W
JW
Foster
Rosa Y
RY
Burgos Minaya
Brandon A
BA
Kohrt
D000328:Adult; D004293:Dominican Republic; D005260:Female; D006205:Haiti / Q000208:ethnology; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010865:Pilot Projects; D011287:Prejudice; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D014171:Transients and Migrants / Q000523:psychology*
Dominican Republic; Haiti; Haití; República Dominicana; discriminación; discrimination; indocumentado; mental health; migración; migration; salud mental; undocumented