ORIGINAL PAPER The DRUID study: exploring mediating pathways between racism and depressive symptoms among Indigenous Australians Yin C. Paradies • Joan Cunningham Received: 7 June 2010 / Accepted: 3 December 2010 Ó Springer-Verlag 2010 Abstract Purpose Racism is an important determinant of mental and physical health for minority populations. However, to date little is known about the relationship between racism and ill-health outside of the U.S. or the causal pathways between racism and poor health. This paper focuses on the relationship between racism and depression in a non-U.S. indigenous population, including examination of novel mediators and moderators. Methods One hundred and eighty-five adults in the Dar- win Region Urban Indigenous Diabetes study responded to a validated instrument assessing multiple facets of racism. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were consid- ered as possible mediators and moderators in linear regression models. Results Interpersonal racism was significantly associated with depression after adjusting for socio-demographic factors (b = 0.08, p \ 0.001). Lack of control, stress, negative social connections and feeling ashamed, amused or powerless as reactions to racism were each identified as significant mediators of the relationship between racism and depressive symptoms. All examined mediators together accounted for 66% of the association between interpersonal racism and depressive symptoms. Conclusions This study demonstrates that racism is associated with depressive symptoms in an indigenous population. The mediating factors between racism and depressive symptoms identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health. Keywords Indigenous Á Racism Á Mental health Á Depression Á Australia Introduction Racism can be defined as avoidable and unfair phenomena that result in inequality of resources, opportunity or benefit among racial/ethnic groups. Racism can be expressed through stereotypes, prejudice or discrimination and can occur at the internalised (i.e. within an individual’s worldview), interpersonal (i.e. between individuals) and/or systemic level (i.e. policies and practices of institutions and organisations) [1]. In recent years, the study of racism and health has emerged as an area of public health research. To the end of 2007, reviews identified over 250 publications examining racism as a determinant of health and/or health behaviours, revealing strong associations between self- reported racism and ill-health among minority groups in developed countries [2–4]. These associations remained after adjusting for a range of confounders and occur in longitudinal as well as cross-sectional studies, suggesting that racism precedes ill-health rather than vice versa. The most consistent finding is the association between racism and mental ill-health, particularly psychological distress, depression and anxiety [2–4]. J. Cunningham Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, Australia Y. C. Paradies (&) Á J. Cunningham Onemda Unit and McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Level 5, 207 Bouverie St, Melbourne, VIC 3010, Australia e-mail: yinp@unimelb.edu.au 123 Soc Psychiat Epidemiol DOI 10.1007/s00127-010-0332-x