Addressing an Overlooked Population: The Role of Discrimination and Violence in Depression Among South Asian Female College Students

South Asian women represent a key population of focus because they experience barriers rooted in the intersection of multiple marginalized identities. Perceived discrimination, or the perception of unfair treatment based on factors such as a person’s race, ethnicity, age, gender or sexual orientation, is a critical determinant of health in this group.³ Most college students who identify as a racial or ethnic minority report experiencing racial discrimination in academic and social spaces, with this experience being heightened at majority White universities.⁴ One in five Black college students and one in four Hispanic college students reported feeling discriminated against in their academic programs compared to 15% of all other students.^{5, 6}

Intersectionality theory highlights how overlapping forms of oppression, such as racism and sexism, can result in additional experiences of discrimination and marginalization faced by a demographic group like South Asian women.⁷ For example, one study found that one in two Indian Americans reported being discriminated against within the past year.⁸ Research among South Asian American medical students revealed that women were more likely to face discrimination than men, indicating that differences in discrimination are highly gender-based.⁹ Unfortunately, South Asian women are also underrepresented in clinical research and are more likely to be misdiagnosed, emphasizing the urgency to address health disparities among this population.¹⁰

Violence is an increasingly prevalent health issue on college campuses, encapsulating intentional or unintentional acts of physical, verbal, or sexual harm against a person or group that result in a higher likelihood of psychological harm, injury or death.¹¹ Among undergraduate students, over a quarter (26.4%) of females and 6.8% of males experience some form of physical or sexual violence, while 9.7% of females and 2.5% of males experience this at the graduate level.¹² College increases the risk of being exposed to violence, with one study finding that women who attend college are three times more likely to experience sexual violence than the average woman, demonstrating a need to reform campus policies and combat this issue.¹²

Women of color experience significantly higher rates of campus violence compared to White women, with Black women reporting rates of intimate partner violence that are 35% higher than their White counterparts. Hispanic and Asian/Pacific Islander women report lower rates than Black women, but still face higher risks compared to White women.¹³ An additional study, which measured fear of discriminatory violence, found that Black students experienced the highest level of fear followed by Hispanic, Middle Eastern and Asian students.¹⁴ Campus violence statistics specifically among South Asian women are limited, however, South Asian women are still disproportionately impacted by violence across their lifetime, with 48% of participants reporting physical violence and 11% reporting sexual abuse in a nationwide study.¹⁵ The prevalence of violence among minority women demonstrates an urgency to create culturally mindful interventions to support female college students during and after college.

Discrimination and violence are critical factors because of their well-documented associations with adverse mental health outcomes, including depression, anxiety, and disordered eating.¹⁶ A survey conducted in the United States found that 44% of college students reported symptoms of depression.¹⁷ In regard to racial/ethnic differences in depression, one study found that Arab-American female students had the highest proportion of depression (23.4%), followed by multiracial (20.8%) and Black (20.6%) students.¹⁸ Depression similarly impacts South Asian students, with one in five in the U.S. experiencing a mood disorder in their lifetime and South Asian women being prone to higher levels of distress than South Asian men.¹⁹

The Minority Stress Model suggests that cumulative exposure to stressors faced by minority populations within dominant social structures worsens physical and mental health outcomes.²⁰ However, the “Model Minority” myth, which perpetuates the false belief that Asian Americans are largely immune to social problems due to high levels of education and income, has obscured the unique mental health challenges of South Asians, leading to underinvestment in culturally responsive care.²¹ Depression is important to address because evidence indicates that people who have depression are at higher risk of developing other chronic health issues such as heart disease, diabetes, stroke, and Alzheimer’s disease.²²

Despite widespread acknowledgement of discrimination and violence as mental health determinants, little research has focused on South Asian female college students in the U.S., a group located at the intersection of race, gender, culture, and higher education. This study addresses the gap by examining how perceived discrimination and campus-based violence independently and jointly contribute to depression in this underserved population. Discrimination, violence, and depression are important measures to analyze in this study because evidence indicates that they can be linked to other chronic health issues during adulthood such as asthma, heart disease, diabetes, stroke, and Alzheimer’s disease.^{23, 22} Findings from this study will be among the first to: (1) provide disaggregated insights into South Asian women’s experiences; (2) inform culturally tailored mental health interventions; and (3) support evidence-based policy development on college campuses to promote health equity among South Asian women.

A quantitative cross-sectional anonymous survey was administered through Qualtrics across the United States. As an incentive, participants were offered entry into a raffle for a chance to win $50 Amazon gift cards. The survey gathered sociodemographic data, experiences of perceived discrimination, gender-based violence on college campuses, and depression. Participant confidentiality was protected by ensuring the survey would be entirely anonymous and responses would not be linked to personally identifiable information. Participants provided written consent prior to completing the survey to conduct and publish findings from this study. Furthermore, participants experiencing distress were provided with mental health resources, including university counseling services and culturally appropriate support organizations. Participants were eligible to take the survey if they self-identified as female, self-identified as South Asian, were at least 18 years old, and were attending a college or university in the United States.

Data collection began on February 19, 2025, and concluded on March 31, 2025. To achieve an adequate sample size, the South Asian Americans Leading Together (SAALT) database was used to identify the top five cities in the U.S. with the largest South Asian populations: New York City, Chicago, Washington, DC, Los Angeles, and San Francisco. The two universities with the highest enrollment were selected within each city for the initial survey sample. The survey was distributed by George Washington University Maternal and Child Health Graduate Students to South Asian student organizations via email, listservs, and social media platforms (Instagram, GroupMe, LinkedIn, Facebook). Following this, a snowball sampling technique was used to extend the participant pool across other institutions. Additionally, personal networks were also contacted to increase participation. The survey took approximately 15-20 minutes to complete.

The initial data sample consisted of 955 responses. The data was cleaned by removing participants who did not meet all of the eligibility criteria, completed less than 50% of the survey, or completed the survey in under five minutes. Bots and duplicates were also removed. After data cleaning was completed, there were a total of 673 responses in the analytical sample. The survey received Institutional Review Board (IRB) approval from The George Washington University. (IRB Number: NCR256361)

Demographic questions were asked at the beginning of the survey to understand important characteristics of the study sample, identify trends among demographic groups, and compare responses across various demographic categories. Demographic questions included age group, whether or not participants were born in the United States, length of residency for those not born in the United States, sexual orientation, relationship status, college location, and year in college.

Perceived discrimination was assessed in two different ways: day-to-day discrimination and college discrimination. Items for day-to-day discrimination were adapted directly from the 9-item Daily Discrimination scale.²⁴ Examples of day-to-day discrimination questions included: “In your day-to-day life, how often do any of the following things happen to you; you are treated with less courtesy than other people by classmates and professors; you receive poorer service than other people at restaurants and stores; and people act as if they are afraid of you.” Responses were recorded using a Likert Scale response (1=never, 2=rarely, 3= sometimes, 4= often), with higher scores indicating greater perceived discrimination. The 9 daily discrimination items were averaged using the compute function in SPSS. As shown in Table 3, the mean day-to-day discrimination score was 2.048 (SD=0.688). The Cronbach’s alpha for the scale was 0.923, indicating an excellent reliability.

College discrimination was assessed by asking participants if they had ever encountered specific discriminatory experiences during college, with responses being “yes,” “no,” or “not sure.” Items were adapted from the 11-item Lifetime Discrimination scale, but questions were modified to reflect scenarios that were relevant to college students.²⁴ Example survey items included: “You were denied a scholarship;” “You were unfairly discouraged by a teacher or advisor from continuing your education;” and “Your teachers, classmates, or advisors made you feel like you were not smart or capable enough.” Answer responses of “yes” were coded as 1 and both “no” or “not sure” were coded as 0. A composite binary score was created by summing the number of discriminatory experiences reported. This sum was then categorized into four groups: no discrimination, one form of discrimination, two forms of discrimination and 3+ forms of discrimination. These groups examined the dose-response relationship between discriminatory experiences and depression.

Questions about experiences of violence on college campuses included verbal, physical and sexual abuse scenarios. Items were adapted from the World Health Organization’s Violence Against Women (VAW) Study Instrument, a validated 13-item survey used to assess different forms of gender-based violence perpetrated by intimate partners.²⁵ The questions were modified to capture experiences of violence occurring during participants’ college years. Example questions included: “Since you began at your school, has someone ever: insulted you or made you feel bad about yourself? Slapped you or thrown something at you that could hurt you? Physically forced you to have sexual intercourse when you didn’t want to?”. Participants responded with either “yes” or “no” to each item. Responses were dichotomized, with individuals reporting one or more instances of violence coded as 1, and those reporting no instances coded as 0. College violence scores were then combined into a composite binary score for the independent-samples t-test.

Participants were screened for Major Depressive Disorder (MDD) using Patient Health Questionnaire 9 (PHQ-9), a validated instrument by the American Psychological Association (APA), incorporating the DSM-V criteria for depression using self-report.²⁶ Example questions included: “Over the last 2 weeks, how often have you been bothered by the following problems: little interest or pleasure in doing things, trouble falling or staying asleep, or sleeping too much,” with answers ranging from 0 to 3 (0 = not at all, 1= several days, 2 = more than half the days, 3= nearly every day). The compute function was used to create both total and mean depression scores. The prevalence of depression in the study sample was determined using APA guidelines for depression severity, where a total score of 0-4 indicated no depression, 5-9 indicated mild depression, 10-14 indicated moderate depression, 15-19 indicated moderately severe depression, and 20-27 indicated severe depression. Participants with a score of 10 or more meet the criteria for depression, as outlined by the APA.²⁷ The Cronbach’s alpha for the scale was 0.902, indicating an excellent reliability.

Bivariate analyses on differences in depression scores among participants who experienced day-to-day discrimination, discrimination during college, or violence during college were explored using Pearson’s correlation, a one-way ANOVA, and an independent-samples t-test. Pearson’s correlation was utilized to determine whether higher levels of perceived day-to-day discrimination were associated with increased levels of depressive symptoms, a one-way ANOVA was utilized to compare depression scores across different levels of college discrimination, and an independent-samples t-test was utilized to compare mean depression scores among those who did and did not experience violence in college. Multivariate linear regression adjusting for statistically significant sociodemographic characteristics was conducted to provide further analysis on the data. SPSS was used to conduct all bivariate and linear regression analyses.

Table 6 illustrates the regression model, where depression scores were measured against each of the independent variables while adjusting for covariates. The adjusted R² value was 0.242, indicating that 24.2% of variation in depression could be explained by day-to-day discrimination, college discrimination, college violence and the sociodemographic covariates in the model. For every 1-unit increase in day-to-day discrimination scores, depression scores increased by approximately 0.261 points, holding all other variables constant, indicating a strong, positive and statistically significant relationship (p<0.001). On average, students who experienced college violence had depression scores that were 0.207 points higher than those who did not, controlling for all other variables (p< 0.001). Although college discrimination was not statistically significant in this adjusted model, participants who experienced college discrimination had 0.039 higher mean depression scores than those who did not.

Heterosexual participants served as the reference group for sexual orientation. Compared to their heterosexual counterparts, bisexual individuals had depression scores that were 0.132 points higher (p<0.001), while those who identified as questioning/unsure had depression scores that were 0.093 points higher (p<0.05). No significant differences in depression scores were observed among those participants who identified as gay, lesbian, queer and other identities.

HHS Region 1 served as the reference group for college location. Findings from the linear regression indicate that participants in HHS Region 5 had mean depression scores that were 0.096 points higher than participants in HHS Region 1 while holding all other variables constant in the model (p<0.05).

Universities should develop and integrate culturally responsive, gender-sensitive mental health services that reflect the cultural realities of South Asian students. Peer-led programs embedded within the South Asian student associations, multilingual counseling services, and partnerships with community-based South Asian organizations could increase access to care. Anti-discrimination and bystander intervention training for faculty, staff, and students should explicitly address subtle forms of bias, microaggressions, and identity-based violence. Additionally, campus climate surveys and institutional data collection should disaggregate Asian American subgroups to ensure South Asian students’ needs are visible in policy and programming.

At the public health level, the findings underscore the need to expand culturally competent care models and challenge the persistence of the ‘model minority’ myth, which continues to mask mental health inequities within Asian American communities. Recognizing and addressing the unique stressors faced by South Asian women can contribute to reducing disparities across the life course.

This study’s strengths include a large, diverse national sample, use of validated scales with high internal consistency (Cronbach’s α > 0.9), and the integration of intersectional frameworks to interpret findings. However, the cross-sectional design limits causal inference, and reliance on self-reported data may introduce recall or social desirability bias. Recruitment through South Asian campus organizations may also limit generalizability to less-connected students or those attending smaller institutions. Future research should use longitudinal or mixed-methods approaches to explore the temporal and contextual dynamics of discrimination, violence, and mental health in this population.

However, there are various limitations to this study. The reliance on self-reported data introduces the possibility of recall bias or social desirability bias, particularly given the sensitive nature of mental health, violence, and discrimination experiences. Cultural stigma may have further contributed to underreporting. The cross-sectional design of this study precludes causal inferences between discrimination, violence and depression. While the study focused on South Asian students, it did not capture important subgroup differences, such as country of origin or religious affiliation, which may influence the observed associations. Finally, because the survey was distributed primarily through South Asian campus organizations, the sample may not fully represent the broader population of South Asian college students in the United States, particularly those at rural institutions or those less connected to cultural organizations on campus.

This study received Institutional Review board (IRB) approval from the Ethics Review Committee at the George Washington University (IRB: NCR256361). All procedures performed in this study involving human participants were in accordance.

Informed consent was obtained from all participants involved in this research.

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by The George Washington University Center of Excellence in Maternal and Child Health under Grant Number T76MC35370 from the Health Resources & Services Administration (HRSA) Maternal and Child Health Bureau. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau.