Health-related quality of life, ethnicity and perceived discrimination among immigrants and natives in Spain

Objectives The current study compares subjective mental and physical health among native Spaniards and immigrant groups, and examines the effects of ethnicity and perceived discrimination (PD) on subjective health in immigrants. Design Two random samples of 1250 immigrants to Spain from Colombia, Bolivia, Romania, Morocco, and Sub-Saharan Africa and 500 native Spaniards, aged between 18 and 65, were recruited for this cross-sectional study. Several hierarchical regression analyses of ethnicity and PD on subjective mental and physical health (assessed using the health-related quality of life items, HRQLSF-12) were carried out separately for men and women. Results Male immigrants from Colombia and Sub-Saharan Africa showed better physical health than natives, controlling for age and socioeconomic and marital status. The immigrants - except for the Colombians - had poorer mental health than natives, especially African men and Bolivian women. Socioeconomic status had no impact on these differences. Among immigrants, PD was the best predictor of physical and mental health (controlling for socio-demographic variables). African men, Bolivian women and women without legal status exhibited the poorest self-rated mental health. Conclusion Clear differences in health status among natives and immigrants were recorded. The self-selection hypothesis was plausible for physical health of Colombians and Sub-Saharan African men. Acculturation stress could explain poorer mental health in immigrants compared with natives. The association between ethnicity and poor self-reported mental health appears to be partially mediated by discrimination.