Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues

Experiences of Discrimination and Depression Trajectories over Pregnancy

INTRODUCTION

Research on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy.

METHOD

Participants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy.

RESULTS

Participants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms.

CONCLUSIONS

These findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.

Embracing Race, Resisting Oppression: African American Parents as Experienced Guides for Navigating Racial Oppression: Dismantling Systems of Racism and Oppression during Adolescence

This study examined how discrimination experiences, beliefs, and coping in middle adolescence contributed to heterogeneity in African American parent-adolescent relationship (PAR) profiles three years later. Data were from the Maryland Adolescent Development in Context Study in which 589 African American caregivers (92% female; M_age  = 39.15, SD = 6.72; range = 27-74 years old) were interviewed when youth were in 8th and 11th grades. We used previously identified profiles of ethnic-racial socialization, general parenting practices, and relationship quality: No-nonsense High Socializers, Indulgent Average Socializers, Unengaged Silent Socializers, and Authoritative Cultural Socializers. Results indicated that parents' discrimination experiences, racial coping self-efficacy, and racial coping socialization when youth were in the 8th grade predicted membership in PAR profiles three years later controlling for youth gender, parent marital status, and family socioeconomic status.

Allostatic Load, Income, and Race Among Black and White Men in the United States

Research indicates that income is significantly associated with allostatic load (AL) and that this association may differ between White and Black Americans. Most existing income–AL link work focuses on women and less is known about this association among men. Using data from the National Health and Nutrition Examination Survey (NHANES), we examined whether race moderates the association between income and AL among Black and White men in the United States (n = 5,685). We find that, regardless of income levels, Black men have significantly higher prevalence of being in the high-AL group compared with high-income White men. Our findings suggest that Black men do not receive the same health benefits for increased income relative to their White counterparts.

Association of active coping to unfair treatment with perceived stress and depressive symptoms in African Americans: mh-grid study

BACKGROUND

Unfair treatment such as discrimination and racism contribute to depression and perceived stress in African Americans. Although studies have examined how responding to such treatment is associated with ameliorating depressive symptoms and levels of perceived stress, most do not focus on African Americans. The purpose of this study is to assess how talking to others in response to unfair treatment is associated with self-reported depressive symptoms and perceived stress levels in African Americans.

METHODS

A sample from the 2010-2013 Minority Health Genomics and Translational Research Bio-Repository Database was used and consisted of 376 African American adults aged 30-55 years old residing in the southern region of the United States. Linear regression models were used to assess the association between talking to others following unfair treatment, compared to keeping it to oneself, on self-reported depressive symptoms and perceived stress. The predictor variable was based on the question "If you have been treated unfairly, do you usually talk to people about it or keep it to yourself?".

RESULTS

Talking to someone after being treated unfairly was inversely associated with perceived stress ([Formula: see text]: -3.62, SE: 1.14, p ≤ 0.05) and depressive symptoms ([Formula: see text]: -3.62, SE: 1.14, p ≤ 0.05).

CONCLUSIONS

African Americans who talked to others in response to unfair treatment had lower depressive symptoms and perceived stress than those who kept it to themselves. More outreach to African Americans regarding the importance of talk in response to exposure to unfair treatment is needed as a potential coping mechanism.

Invited Commentary: The Need for Repeated Measures and Other Methodological Considerations When Investigating Discrimination as a Contributor to Health

To determine potential measurement error related to the assessment of lifetime discrimination, Van Dyke et al. (Am J Epidemiol. 2022;191(3):370-378) investigated inconsistencies in reporting of racial, socioeconomic status, and sex discrimination over time among Black and White adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors found that "ever" reports of discrimination (as assessed by the Experiences of Discrimination Scale) decreased over time and that populations who most experience discrimination (i.e., Black/African-American people, younger persons, persons of low socioeconomic status, and women) were often also the most likely to inconsistently report discrimination over the course of the study period (from 1992 to 2010). The authors have raised an important issue related to the potential underestimation of lifetime discrimination that may depend on when discrimination is assessed, as well as the social identity of individuals surveyed. With implications for health inequities, these findings highlight study design and methodological issues that should be addressed to accurately estimate the true burden discrimination places on health. In this commentary, we further illuminate potential methodological challenges and opportunities to consider when investigating the impact of discrimination on health.

Suicide typologies among Medicaid beneficiaries, North Carolina 2014-2017

BACKGROUND

There is a well-established need for population-based screening strategies to identify people at risk of suicide. Because only about half of suicide decedents are ever diagnosed with a behavioral health condition, it may be necessary for providers to consider life circumstances that may also put individuals at risk. This study described the alignment of medical diagnoses with life circumstances by identifying suicide typologies among decedents. Demographics, stressful life events, suicidal behavior, perceived and diagnosed health problems, and suicide method contributed to the typologies.

METHODS

This study linked North Carolina Medicaid and North Carolina Violent Death Reporting System (NC-VDRS) data for analysis in 2020. For suicide decedents from 2014 to 2017 aged 25-54 years, we analyzed 12 indicators of life circumstances from NC-VDRS and 6 indicators from Medicaid claims, using a latent class model. Separate models were developed for men and women.

RESULTS

Most decedents were White (88.3%), with a median age of 41, and over 70% had a health care visit in the 90 days prior to suicide. Two typologies were identified in both males (n = 175) and females (n = 153). Both typologies had similar profiles of life circumstances, but one had high probabilities of diagnosed behavioral health conditions (45% of men, 71% of women), compared to low probabilities in the other (55% of men, 29% of women). Black beneficiaries and men who died by firearm were over-represented in the less-diagnosed class, though estimates were imprecise (odds ratio for Black men: 3.1, 95% confidence interval: 0.8, 12.4; odds ratio for Black women: 5.0, 95% confidence interval: 0.9, 31.2; odds ratio for male firearm decedents: 1.6, 95% confidence interval: 0.7, 3.4).

CONCLUSIONS

Nearly half of suicide decedents have a typology characterized by low probability of diagnosis of behavioral health conditions. Suicide screening could likely be enhanced using improved indicators of lived experience and behavioral health.

Multiple Reasons for Perceived Everyday Discrimination and All-Cause Mortality Risk Among Older Black Adults

BACKGROUND

This study assessed whether reporting multiple reasons for perceived everyday discrimination was associated with an increased risk for all-cause mortality risk among older Black adults.

METHODS

This study utilized data from a subsample of older Black adults from the Health and Retirement Study (HRS), a nationally representative panel study of older adults in the United States. Our measure of multiple reasons for perceived everyday discrimination was based on self-reports from the 2006/2008 HRS waves. Respondents' vital status was obtained from the National Death Index and reports from key household informants (spanning 2006-2019). Cox proportional hazard models, which accounted for covariates linked to mortality, were used to estimate the risk of all-cause mortality.

RESULTS

During the observation period, 563 deaths occurred. Twenty percent of Black adults attributed perceived everyday discrimination to 3 or more sources. In demographic adjusted models, attributing perceived everyday discrimination to 3 or more sources was a statistically significant predictor of all-cause mortality risk (hazard ratio = 1.45; 95% confidence interval = 1.12-1.87). The association remained significant (hazard ratio = 1.49; 95% confidence interval = 1.15-1.93) after further adjustments for health, behavioral, and economic characteristics.

CONCLUSIONS

Examining how multiple reasons for perceived everyday discrimination relate to all-cause mortality risk has considerable utility in clarifying the unique contributions of perceived discrimination to mortality risk among older Black adults. Our findings suggest that multiple reasons for perceived everyday discrimination are a particularly salient risk factor for mortality among older Black adults.

Relationship Between Decreased Cortisol and Development of Chronic Pain in Traumatically Injured

BACKGROUND

The relationship between pain and stress is widely accepted, yet the underlying neuroendocrine mechanisms are poorly understood. Cortisol secretion during a stress response, may distract attention from a painful stimulus, inhibiting pain. However, when pain is the stressor, cortisol secretion may intensify the pain experience and condition a fear-based memory of pain. This study attempts to determine the relationship between acute pain, chronic pain, and cortisol in the traumatically injured population.

METHODS

Secondary analyses of a prospective observational study with participants from a Midwestern Adult Level I Trauma Center post traumatic injury, with interview and serum cortisol taken at hospitalization (baseline) and 6 mo after discharge, was completed using Ward's Method hierarchical cluster analysis, Pearson's correlations, and linear regressions.

RESULTS

Two major clusters were identified. The Chronic Pain group were those who had severe pain at discharge and continued to have severe pain as defined by Numeric Pain Score. The Resolved Pain group were those who had moderate pain at discharge and their pain improved or resolved. Pain score at discharge significantly, negatively correlated with baseline cortisol levels (r = -0.142, P = 0.02). Minority status, single individuals, low cortisol at baseline, and greater psychological distress at baseline significantly increased the likelihood of developing chronic pain.

CONCLUSIONS

Low cortisol and greater psychological stress, which are also associated with minority status and single individuals, contribute to chronic pain in the traumatically injured population. Trauma victims without an adequate cortisol response to acute injury and pain are at risk for development of chronic pain after injury.

Improving The Measurement Of Structural Racism To Achieve Antiracist Health Policy

Antiracist health policy research requires methodological innovation that creates equity-centered and antiracist solutions to health inequities by centering the complexities and insidiousness of structural racism. The development of effective health policy and health equity interventions requires sound empirical characterization of the nature of structural racism and its impact on public health. However, there is a disconnect between the conceptualization and measurement of structural racism in the public health literature. Given that structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy, how can anyone accurately measure its insidiousness? This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity. We identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.

The relations between discrimination, stressful life events, and substance use among adults experiencing homelessness

The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.

Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years (SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years (b = -2.62, 95% confidence interval [CI] = [-5.01, -0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations (b = -2.51, 95% CI = [-4.91, -0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

Associations between discrimination and substance use among college students in the United States from 2015 to 2019

Discrimination has been associated with adverse health behaviors and outcomes, including substance use. Higher rates of substance use are reported among some marginalized groups, such as lesbian, gay, and bisexual populations, and have been partially attributed to discrimination. This study uses 2015-2019 National College Health Assessment data to determine whether college students reporting discrimination due to sexual orientation, race/ethnicity, gender, or age report greater substance use than their peers who do not report such experiences. Additionally, we assess exploratory questions regarding whether substance choices differ among students who reported facing discrimination. Over time, about 8.0% of students reported experiencing discrimination in the past year. After applying inverse probability treatment weights (IPTWs), exposure to discrimination was associated with an excess of 44 cases of marijuana use per 1000 students, an excess of 39 cases of alcohol use per 1000 students, and an excess of 11 cases of prescription painkiller use per 1000 students. Multivariable logistic regression models with IPTW demonstrated that students who experienced discrimination were more than twice as likely to use inhalants and methamphetamine. These students were also significantly more likely to use other drugs, including opiates, non-prescribed painkillers, marijuana, alcohol, hallucinogens, cocaine, and cigarettes; however, the differences with peers were smaller in magnitude. Students who experienced discrimination did not differ from peers who reported non-prescribed antidepressants use and were significantly less likely to use e-cigarettes and smokeless tobacco. Associations between discrimination and substance use vary by race, gender, sexual orientation, and age. These findings indicate that discrimination has significant associations with many kinds of substance use; however, the magnitude varies by substance type. More institutional efforts to address sources of discrimination affecting college students are needed.

Early life stress and substance use disorders: The critical role of adolescent substance use

Early life stress (ELS) is a well-established risk factor for many psychiatric and medical disorders, including substance use disorders (SUDs). The relationship between ELS and SUDs is complex and there are likely multiple pathways from ELS to adverse substance use outcomes. The association between ELS and substance use emerges in adolescence. Adolescence is a critical period in development during which substance exposure markedly increases risk for SUDs. Therefore, this review focuses on the literature supporting the hypothesis that ELS increases risk for the development of SUDs through its influence on adolescent substance use. We discuss studies substantiating the role of ELS in adolescent substance use and explore how internalizing and externalizing psychopathology may be antecedents of substance use in adolescence. We examine clinical work suggesting ELS sculpts the Hypothalamic-Pituitary-Adrenal (HPA) Axis and developing brain-particularly subcortical brain regions that underlie stress response, mesocorticolimbic brain systems associated with reward sensitivity, and prefrontal regions that underlie executive control-in a way that increases risk for adolescent substance use and SUDs. We further explore how substance use during adolescence alters structure and function of these same systems, and how brain changes following ELS and adolescent substance use may independently, additively, or interactively contribute to risk for addiction. We conclude by discussing how the current literature can inform interventions aimed at reducing risk for SUDs in individuals with a history of ELS.

The Association between Racial Discrimination, Posttraumatic Stress Disorder, and Cardiovascular-Related Conditions Among Non-Hispanic Blacks: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

OBJECTIVES

To test the association between racial discrimination and cardiovascular-related conditions and whether PTSD mediates this relationship in a nationally representative sample of non-Hispanic Blacks.

METHODS

We used data from the 2013 National Epidemiologic Survey on Alcohol and Related Conditions to conduct logistic regression analyses to examine the association between racial discrimination, PTSD, and cardiovascular-related conditions. We also performed mediation analyses to assess whether the association between racial discrimination and cardiovascular conditions was partly explained by PTSD.

RESULTS

Racial discrimination was positively associated with both PTSD and cardiovascular-related conditions. Additionally, PTSD was positively associated with cardiovascular conditions. Results from the fully adjusted mediation models suggest that PTSD significantly mediated the association between racial discrimination and cardiovascular conditions.

CONCLUSIONS

Our results demonstrate an association between racial discrimination and cardiovascular-related conditions that is significantly mediated by PTSD. To improve cardiovascular functioning among non-Hispanic Blacks, health care professionals in conjunction with Black communities must adopt culturally competent screening for and treatment for PTSD. To address racial differences in cardiovascular conditions, public health efforts must address institutional policies that negatively alter health opportunities among the Black population.

The Intersecting Consequences of Race-Gender Health Disparities on Workforce Engagement for Older Workers: An Examination of Physical and Mental Health

The dramatic growth of older adults' labor participation over the past 25 years, including women and people of color, is reshaping the American labor force. The current study contributes new knowledge concerning why individuals over age 50 years may be working longer despite negative impacts of deteriorating physical and mental health associated with aging. Inquiries regarding who continues to work and why can be answered, in part, by addressing how workforce engagement and health are shaped by notable social inequities along the dimensions of age, race, and gender. Guided by cumulative advantage/disadvantage and intersectionality frameworks, we examine whether having multiple chronic conditions (MCC)-two or more physical conditions-and depression affect workforce participation. Using multinomial logistic regression models, we analyze the 2014-2016 waves of the Health and Retirement Study (N = 4250). Findings reveal that having multiple chronic illnesses increase the likelihood of labor force exit, especially among workers who also have depression. We also discover intersectional nuances which illuminate complex race-gender dynamics related to health and work processes in later life. We conclude with recommendations for workplace policy that promote the retention of older workers with chronic illness and depression and aim to decrease disparities in older workers' work engagement.

Ideology shapes how workers perceive and react to workplace discrimination: An experimental study on parenthood discrimination

Employers use ideologically-tinged rhetoric to justify workplace discrimination. We argue that workers will be less likely to label biased treatment against them as discriminatory when they subscribe to those ideologies as well. We tested this prediction and the consequences of labeling for work attitudes and performance using an experiment that assigned parents to a low-status position in a work group, varying whether the decision invoked biased, ideological assumptions about parenthood. As expected, ideology drove mothers' (but not fathers') labeling. Mothers were less likely to label biased treatment against them as discriminatory when they were conservative and when they subscribed to separate spheres and ideal worker ideologies. Mothers who labeled their treatment as discriminatory had more negative work attitudes than those who did not, but also tended to appeal the decision. Ideology thus shapes whether people label discrimination when it occurs as well as their subsequent work attitudes and justice-seeking behaviors.

The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population

A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.

Place Is Power: Investing in Communities as a Systemic Leverage Point to Reduce Breast Cancer Disparities by Race

Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.

Social Epidemiology: Past, Present, and Future

In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research.

Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Stress-Related Mental Health Disorders and Inflammation in Pregnancy: The Current Landscape and the Need for Further Investigation

Many studies have focused on psychoimmunological mechanisms of risk for stress-related mental health disorders. However, significantly fewer studies have focused on understanding mechanisms of risk for stress-related disorders during pregnancy, a period characterized by dramatic changes in both the innate and adaptive immune systems. The current review summarizes and synthesizes the extant literature on the immune system during pregnancy, as well as the sparse existing evidence highlighting the associations between inflammation and mood, anxiety, and fear-related disorders in pregnancy. In general, pregnant persons demonstrate lower baseline levels of systemic inflammation, but respond strongly when presented with an immune challenge. Stress and trauma exposure may therefore result in strong inflammatory responses in pregnant persons that increases risk for adverse behavioral health outcomes. Overall, the existing literature suggests that stress, trauma exposure, and stress-related psychopathology are associated with higher levels of systemic inflammation in pregnant persons, but highlight the need for further investigation as the existing data are equivocal and vary based on which specific immune markers are impacted. Better understanding of the psychoimmunology of pregnancy is necessary to reduce burden of prenatal mental illness, increase the likelihood of a successful pregnancy, and reduce the intergenerational impacts of prenatal stress-related mental health disorders.

Social Determinants of the Mental Health of Young Migrants

Abstract. Background: Young migrants face particular risks to develop mental health problems. Discrimination and social support impact mental health, yet little is known about the differential impact thereof on mental health in newcomers, non-newcomer migrants, and non-migrants. Aim: This study sheds light on mental health (posttraumatic stress, behavioral problems, hyperactivity, emotional distress, peer relationship problems, prosocial behavior) and the overall well-being of newcomers, non-newcomer migrants, and non-migrants. Furthermore, the impact of social support and discrimination on mental health is investigated. Method: Descriptive analysis and Structural Equation Modelling (SEM) were applied to analyze responses of 2,320 adolescents through self-report questionnaires in Finland, Sweden, and the UK. Results: Newcomers, non-newcomer migrants, and non-migrants have different psychological profiles. While newcomers suffer more from posttraumatic stress disorder (PTSD) and peer problems, non-newcomers and non-migrants report more hyperactivity. Discrimination strongly threatens all mental health dimensions, while support from family serves as a protective factor. Support from friends has a positive impact on PTSD among newcomers. Limitations: As this study has a cross-sectional design, conclusions about causality cannot be drawn. In addition, history of traumatic life events or migration trajectory was lacking, while it may impact mental health. Conclusion: Different mental health profiles of newcomers, non-newcomer migrants, and non-migrants point to the need for a tailored and diversified approach. Discrimination remains a risk factor for mental health, while family support is a protective factor for adolescents. Interventions that foster social support from friends would be especially beneficial for newcomers.

Etapas iniciais da adaptação transcultural do Intersectional Discrimination Index para o português do Brasil

RESUMO Objetivo: O presente estudo realizou a adaptação transcultural do Intersectional Discrimination Index (InDI) para o português do Brasil. Trata-se de um instrumento composto de 31 itens, que visa mensurar os impactos para a saúde de experiências interseccionais com discriminação antecipada (InDI-A), cotidiana (InDI-D) e maior (InDI-M). Métodos: Foram percorridas as seguintes etapas: (1) traduções independentes; (2) síntese das traduções; (3) avaliação por comitê de especialistas; (4) análise por membros da população-alvo; (5) tradução reversa; e (6) pré-teste. Calculou-se igualmente o coeficiente de validade de conteúdo (CVC) de cada um dos itens e de todo o instrumento. O CVC foi empregado por permitir identificar quais itens necessitavam de ajustes de acordo com os critérios de clareza de linguagem, relevância teórica e pertinência prática. Resultados: Dos 31 itens do instrumento, 24 foram considerados adequados e sete necessitaram de ajustes de linguagem. Os valores dos CVC foram satisfatórios para os critérios de clareza de linguagem (CVCt=0,86), pertinência prática (CVCt=0,87) e relevância teórica (CVCt=0,87), e o público-alvo considerou satisfatória a compreensão do instrumento (média=4,44; desvio padrão=1,36). O tempo médio de resposta foi de 15,5 minutos e não foram registradas dúvidas adicionais. A tradução reversa foi aprovada pelos autores originais do instrumento. Conclusão: As etapas iniciais do processo de adaptação transcultural mostraram que o InDI parece promissor para uso no Brasil. Estudos futuros ainda precisam examinar as propriedades psicométricas do instrumento para confirmar os resultados positivos do presente trabalho, bem como sua utilidade para a avaliação dos impactos para a saúde de experiências interseccionais com discriminação.

Racial Stress and Trauma and the Development of Adolescent Depression: A Review of the Role of Vigilance Evoked by Racism-Related Threat

There are known disparities in the burden of illness and access/quality of care for African, Latino/a, Asian, and Native American (ALANA) patients diagnosed with depressive disorders, which may occur because of health inequities. Racial stress and trauma (RST), or the significant fear and distress that can be imparted from exposure to racism, is one such inequity linked to the development of depression. The current review summarizes past research examining the association between racism, RST, and depression, as well as avenues in which RST becomes biologically embedded in ALANA individuals. We describe multimodal research that supports vigilance as a potential mediator of the association between RST and depression and consider the nuanced role that vigilance plays during experiences with racism. Finally, we describe methodological advances in the assessment of vigilance evoked by RST and the clinical implications that may be generated by future improvements. In each of these areas, we present examples of how ongoing and future research can be leveraged to provide support for psychosocial programs that facilitate autonomous community healing and resilience, increase calls for public policy changes, and support clinical interventions that lessen the burden of racism on ALANA communities.

Do Discrimination and Negative Interactions with Family Explain the Relationship between Interracial Relationship Status and Mental Disorder?

Using the stress process model, the authors investigate whether individuals in interracial relationships experience greater risk for past-year mood and anxiety disorder compared with their same-race relationship counterparts. The authors also assess interracial relationship status differences in external stressors (i.e., discrimination and negative interactions with family) and whether stress exposure explains mental disorder differences between individuals in interracial versus same-race romantic partnerships. Data are from the National Survey of American Life (2001–2003). Results show that individuals in interracial relationships are at greater risk for anxiety disorder (but not mood disorder) relative to those in same-race relationships. Interracially partnered individuals also report more discrimination from the public and greater negative interactions with family. External stressors partially explain the higher risk for anxiety disorder among individuals in interracial partnerships. This study addresses a void in the literature on discrimination, family relationships, and health for the growing population of individuals in interracial unions.

The unique contribution of gendered racial stress to depressive symptoms among pregnant Black women

Introduction:

Pregnant Black women are at disproportionate risk for adverse birth outcomes, in part associated with higher prevalence of stress. Stress increases risk of depression, a known risk factor for preterm birth. In addition, multiple dimensions of stress, including perceived stress and stressful life events, are associated with adverse birth outcomes, independent of their association with prenatal depression. We use an intersectional and contextualized measure of gendered racial stress to assess whether gendered racial stress constitutes an additional dimension to prenatal depression, independent of stressful life events and perceived stress.

Methods:

In this cross-sectional study of 428 Black women, we assessed gendered racial stress (using the 39-item Jackson Hogue Phillips Reduced Common Contextualized Stress Measure), perceived stress (using the Perceived Stress Scale), and stressful life events (using a Stressful Life Event Index) as psychosocial predictors of depressive symptoms (measured by the Edinburgh Depression Scale). We used bivariate analyses and multivariable regression to assess the association between the measures of stress and prenatal depression.

Results:

Results revealed significant bivariate associations between participant scores on the full Jackson Hogue Phillips Reduced Common Contextualized Stress Measure and its 5 subscales, and the Edinburgh Depression Scale. In multivariable models that included participant Perceived Stress Scale and/or Stressful Life Event Index scores, the Jackson Hogue Phillips Reduced Common Contextualized Stress Measure contributed uniquely and significantly to Edinburgh Depression Scale score, with the burden subscale being the strongest contributor among all variables. No sociodemographic characteristics were found to be significant in multivariable models.

Conclusion:

For Black women in early pregnancy, gendered racial stress is a distinct dimension of stress associated with increased depressive symptoms. Intersectional stress measures may best uncover nuances within Black women’s complex social environment.

Prevalence of functional limitations among foreign and US-born Black older adults: 2010-2016 National Health Interview Surveys

OBJECTIVE

To determine whether the prevalence of functional limitations in United States (US) born differs from that of foreign-born Black older adults.

DESIGN

We performed a cross-sectional analysis of data from 14,438 US-born and 1583 foreign-born Black older adults (≥50 years) in the 2010-2016 National Health Interview Surveys (NHIS). Functional limitations were defined by upper and lower extremity limitations, and global functional limitations. Generalized linear modeling using a Poisson distribution and logarithmic link function was used to compare the predicted probabilities of functional limitations in both groups.

RESULTS

The mean age (SE) of US-born Blacks was 63.56 (0.12) years and foreign-born Blacks was 62.06 (0.32). The majority (92%) of foreign-born Blacks had resided in the US for ≥10 years. US-born older adults were more likely to have upper (46% vs. 29%, p < .001) and lower (61% vs. 40%, p < .001) extremity limitations than foreign-born Blacks. The prevalence of lower extremity limitations was 22% less in foreign-born Blacks compared to US-born Blacks after adjusting for sociodemographic and health profiles (Prevalence Ratio [PR]: 0.78, 95% CI:0.73-0.84). The adjusted prevalence of upper extremity limitations in foreign-born Blacks was 27% (PR: 0.73, 95% CI: [0.68-0.79]), compared to US-born Black older adults. And that of global functional limitations was 22% less (PR: 0.78, 95% CI [0.73-0.83]) in foreign-born compared to US-born Blacks.

CONCLUSION

Compared to their US-born counterparts, foreign-born Black older adults had a markedly lower prevalence of upper and lower extremity functional limitations. Future comparative studies should examine reasons for this apparent health advantage among foreign-born adults to inform social and medical interventions to prevent functional decline in Black older adults in the US.

Advantages of a Developmental Psychopathology Approach to Studying the Antecedents of Physical Health

Although the field of developmental psychopathology has traditionally focused on mental health, there has been increasing interest in exploring how psychological and developmental factors are associated with physical health. I argue that the principles of developmental psychopathology may be particularly useful for understanding physical health across development. I discuss how researchers can apply the following developmental psychopathology principles to the study of physical health: 1) dimensional measurement of stress exposure, 2) the multifaceted nature of risk and resilience, 3) focus on processes and pathways, and 4) lifespan development and intergenerational effects. I provide several future directions and considerations for work in this area, many of which are consistent with the new goals of Infant and Child Development.

Perceived Racial/Ethnic Discrimination, Physical and Mental Health Conditions in Childhood, and the Relative Role of Other Adverse Experiences

Adverse childhood experiences (ACEs) are associated with poor health. Childhood experiences of racial/ethnic discrimination and other forms of racism may underlie or exacerbate other ACEs. We explored health-related associations with perceived racial/ethnic discrimination relative to other ACEs, using data from 2016-2019 National Survey of Children's Health, an annual cross-sectional, nationally representative survey. Parent responses for 88,183 children ages 6-17 years with complete data for ACEs (including racial/ethnic discrimination) were analyzed for associations between racial/ethnic discrimination, other ACEs, demographics, and physical and mental health conditions with weighted prevalence estimates and Wald chi-square tests. To assess associations between racial/ethnic discrimination and health conditions relative to other ACEs, we used weighted Poisson regressions, adjusted for exposure to other ACEs, age, and sex. We assessed effect modification by race/ethnicity. Prevalence of other ACEs was highest among children with racial/ethnic discrimination, and both racial/ethnic discrimination and other ACEs were associated with having one or more health conditions. Adjusted associations between racial/ethnic discrimination and health conditions differed by race/ethnicity (interaction P-values < 0.001) and were strongest for mental health conditions among Hispanic/Latino (adjusted prevalence ratio (aPR)=1.62, 95% confidence interval (CI): 1.24-2.10) and non-Hispanic/Latino Asian American (aPR=2.25, 95% CI: 1.37-3.71) children. Results suggest racial/ethnic discrimination and other ACEs are associated with child health conditions, with differences in relative associations by race/ethnicity. Public health efforts to prevent childhood adversity, including racial/ethnic discrimination and other forms of racism could be associated with improvements in child health.

Examining the Relationship between Discrimination and Prescription Drug Misuse: Findings from a National Survey of Black Americans

Background: Research shows that substance use may be a way individuals cope with psychosocial stressors. Less is known about whether discrimination contributes to prescription drug misuse. Methods: Using a national sample of Black Americans, we examined whether two psychosocial stressors (i.e., everyday and lifetime major discrimination) were associated with lifetime prescription drug misuse (i.e., opioids, tranquilizers, sedatives, or stimulants). Results: Our logistic regression models separately examining the influence of everyday and major discrimination controlling for relevant demographic, health, and other drug use variables showed that only everyday discrimination was associated with higher odds of prescription drug misuse. In the model simultaneously considering both types of discrimination, only unit increases in everyday discrimination were associated with higher odds of prescription drug misuse. Conclusions: Encounters with everyday discrimination may be an important psychosocial stressor linked to prescription drug misuse in Black adults and possibly other racial-ethnic minorities. Intervention strategies aiming to reduce prescription drug misuse should consider developing ways to curb the negative health-related consequences of discriminatory experiences. Strategies to combat discrimination-related prescription drug misuse and limitations of this study are discussed.

Racial Discrimination and Trajectories of Problematic Alcohol Use Among African American Emerging Adults: The Role of Organizational Religious Involvement

Racial discrimination jeopardizes a wide range of health behaviors for African Americans. Numerous studies demonstrate significant negative associations between racial discrimination and problematic alcohol use among African Americans. Culturally specific contexts (e.g., organized religious involvement) often function protectively against racial discrimination's adverse effects for many African Americans. Yet organized religious involvement may affect the degree to which racial discrimination increases problematic alcohol use resulting in various alcohol use trajectories. These links remain understudied in emerging adulthood marked by when individuals transition from adolescence to early adult roles and responsibilities. We use data from 496 African American emerging adults from the Flint Adolescent Study (FAS) to (a) identify multiple and distinct alcohol use trajectories and (b) examine organizational religious involvement's protective role. Three trajectory classes were identified: the high/stable, (20.76% of sample; n = 103); moderate/stable, (39.52% of sample; n = 196); and low/rising, (39.72% of the sample; n = 197). After controlling for sex, educational attainment, and general stress, the interaction between racial discrimination and organized religious involvement did not influence the likelihood of classifying into the moderate/stable class or the low/rising class, compared with the high/stable class. These results suggest organized religious involvement counteracts, but does not buffer racial discrimination's effects on problematic alcohol use. Findings emphasize the critical need for culturally sensitive prevention efforts incorporating organized religious involvement for African American emerging adults exposed to racial discrimination. These prevention efforts may lessen the role of racial discrimination on health disparities related to alcohol use.

Intersectional Discrimination Attributions and Health Outcomes Among American Older Adults: A Latent Class Analysis

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged ≥50) from the Health and Retirement Study in 2014-2015 were included (N = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life.

Discrimination and Subsequent Mental Health, Substance Use, and Well-being in Young Adults

OBJECTIVES

Discrimination has been shown to have profound negative effects on mental and behavioral health and may influence these outcomes early in adulthood. We aimed to examine short-term, long-term, and cumulative associations between different types of interpersonal discrimination (eg, racism, sexism, ageism, and physical appearance discrimination) and mental health, substance use, and well-being for young adults in a longitudinal nationally representative US sample.

METHODS

We used data from 6 waves of the Transition to Adulthood Supplement (2007-2017, 1834 participants) of the Panel Study of Income Dynamics. Outcome variables included self-reported health, drug use, binge drinking, mental illness diagnosis, Languishing and Flourishing score, and Kessler Psychological Distress Scale score. We used logistic regression with cluster-robust variance estimation to test cross-sectional and longitudinal associations between discrimination frequency (overall, cumulative, and by different reason) and outcomes, controlling for sociodemographics.

RESULTS

Increased discrimination frequency was associated with higher prevalence of languishing (relative risk [RR] 1.34 [95% CI 1.2-1.4]), psychological distress (RR 2.03 [95% CI 1.7-2.4]), mental illness diagnosis (RR 1.26 [95% CI 1.1-1.4]), drug use (RR 1.24 [95% CI 1.2-1.3]), and poor self-reported health (RR 1.26 [95% CI 1.1-1.4]) in the same wave. Associations persisted 2 to 6 years after exposure to discrimination. Similar associations were found with cumulative high-frequency discrimination and with each discrimination subcategory in cross-sectional and longitudinal analyses.

CONCLUSIONS

In this nationally representative longitudinal sample, current and past discrimination had pervasive adverse associations with mental health, substance use, and well-being in young adults.

Measuring the Biological Embedding of Racial Trauma Among Black Americans Utilizing the RDoC Approach

The NIMH Research Domain Criteria (RDoC) initiative aims to understand the mechanisms influencing psychopathology through a dimensional approach. Limited research thus far has considered potential racial/ethnic differences in RDoC constructs that are influenced by developmental and contextual processes. A growing body of research has demonstrated that racial trauma is a pervasive chronic stressor that impacts the health of Black Americans across the life course. In this review article, we examine the ways that an RDOC framework could allow us to better understand the biological embedding of racial trauma among Black Americans. We also specifically examine the Negative Valence System domain of RDoC to explore how racial trauma is informed by and can help expand our understanding of this domain. We end the review by providing some additional research considerations and future research directives in the area of racial trauma that build on the RDoC initiative.

The role of perceived discrimination in predicting changes in health behaviours among African Americans in the Jackson Heart Study

BACKGROUND

This study examined whether perceived discrimination was associated with health behaviours over time and whether associations of discrimination with behaviours varied by attribution of discrimination.

METHODS

Multinomial logistic regression was used to estimate ORs and CIs for the associations of discrimination (everyday, lifetime, stress from lifetime discrimination) with health behaviours (cigarette smoking, alcohol use) over time among 3050 African Americans in the Jackson Heart Study from visit 1 (2000-2004) to visit 3 (2009-2013). Smoking status was classified as persistent current, persistent former, persistent never, current to former and former/never to current smokers. Alcohol use status was classified as persistent heavy, persistent moderate/none, heavy to moderate/none and moderate/none to heavy alcohol users.

RESULTS

Higher everyday discrimination was associated with persistent current smoking (OR per SD higher discrimination 1.26, 95% CI 1.11,1.43) and with persistent former smoking (high vs low OR 1.32, 95% CI 1.02,1.70) relative to persistent never smoking. Similar findings were observed for lifetime discrimination and persistent current smoking (high vs low OR 1.85, 95% CI 1.15,2.95) and with persistent former smoking (high vs low OR 1.45, 95% CI 1.06,1.98). Participants reporting lifetime discrimination as very stressful compared with not stressful were more likely to be persistent former smokers (OR 1.44, 95% CI 1.04,1.99). Associations did not vary by discrimination attribution.

CONCLUSION

Discrimination did not predict changes in smoking status or alcohol use. Discrimination was associated with persistent current smoking status, which may provide a plausible mechanism through which discrimination impacts the health of African Americans.

Tip of the iceberg: Measuring racial discrimination in studies of health

There is compelling evidence that racial discrimination is a risk factor for illness and disease. But what are health scientists measuring-and what do they think they are measuring-when they include measures of racial discrimination in health research? We synthesize theoretical conceptualizations of racial discrimination in health research and critically assess whether and how these concepts correspond (or not) to widely used measures of racial discrimination. In doing so, we show that while researchers often use terms such as 'self-reported discrimination', 'perceptions of discrimination', and 'exposure to discrimination' interchangeably, these concepts are indeed unique, with each holding a distinct epistemological position and theoretical and methodological capacity to uncover the impact of racial discrimination on health and health disparities. Importantly, we argue that commonly used measures of self-reported or perceived racial discrimination are just the 'tip of the iceberg' in terms of revealing the ways in which discrimination shapes health inequities. Scientists and practitioners must be cognizant of and intentional in their measurement choices and language, as the framing of these processes will inform policy and intervention efforts aimed at eliminating discrimination.

Experiences With Everyday and Major Forms of Racial/Ethnic Discrimination and Type 2 Diabetes Risk Among White, Black, and Hispanic/Latina Women: Findings From the Sister Study

Racial/ethnic discrimination may contribute to the risk of type 2 diabetes mellitus (T2DM), but few studies have prospectively examined this relationship among racially/ethnically diverse populations. We analyzed prospective data from 33,833 eligible Sister Study participants enrolled from 2003 to 2009. In a follow-up questionnaire (2008-2012), participants reported their lifetime experiences of everyday and major forms of racial/ethnic discrimination. Self-reported physician diagnoses of T2DM were ascertained through September 2017. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, overall and by race/ethnicity. Mean age at enrollment was 54.9 (standard deviation, 8.8) years; 90% of participants self-identified as non-Hispanic (NH) White, 7% as NH Black, and 3% as Hispanic/Latina. Over an average of 7 years of follow-up, there were 1,167 incident cases of T2DM. NH Black women most frequently reported everyday (75%) and major (51%) racial/ethnic discrimination (vs. 4% and 2% of NH White women, respectively, and 32% and 16% of Hispanic/Latina women, respectively). While everyday discrimination was not associated with T2DM risk, experiencing major discrimination was marginally associated with higher T2DM risk overall (hazard ratio = 1.26, 95% confidence interval: 0.99, 1.61) after adjustment for sociodemographic characteristics and body mass index. Associations were similar across racial/ethnic groups; however, racial/ethnic discrimination was more frequently reported among racial/ethnic minority women. Antidiscrimination efforts may help mitigate racial/ethnic disparities in T2DM risk.

Structural Barriers Associated with the Intersection of Traumatic Stress and Gun Violence: A Case Example of New Orleans

Gun violence drastically increased in urban cities following the ease of shutdown restrictions associated with the Coronavirus Pandemic. The association of gun violence and COVID-19 has highlighted the importance of taking a public health perspective, particularly as it relates to impacts on the Black community. In this article we discuss macro-level factors and community traumas in the city of New Orleans, an area that has had longstanding issues related to gun violence. Community structural issues, traumatic stress from disasters, and recommendations to address disparities in social determinants of health are discussed.

COVID-19 and Systemic Racism Pandemics Impact Daily Life for Immigrant/Refugees, Minneapolis, USA

Background:

The pandemics of COVID-19 and systemic racism have a deleterious impact on the daily life experiences and health for populations of color. The experiences are compounded for immigrant/refugee communities that may have other barriers such as English language literacy or trauma. Cumulative stress due to everyday racism is harmful for health.

Objectives:

This study describes the impact of day-to-day lived experiences of Karen, Somali, and Latinx communities during the COVID-19 pandemic and aftermath of the police murder of George Floyd in the Minneapolis/St. Paul metro area.

Methods:

In-depth interviews were conducted over three weeks in September and October 2020 to understand the daily life experiences of Karen, Somali and Latinx adults drawn from community contacts during the COVID-19 pandemic and the aftermath of the police murder of George Floyd. Interviewers were bilingual and from the communities they interviewed. Nine questions were asked, ranging from their knowledge of COVID-19, prevention practices, experiences during shelter-in-place, and the perceptions of the police murder of George Floyd. Qualitative analysis included transcript review, coding facilitated by Atlas.ti Cloud software, summaries, and validation by interviewers.

Findings:

Thirty-two adults were interviewed (Latinx = 10, Karen = 10, Somali = 12). One-third were in person per participant request and complying with COVID-19 precautions, and the remainder were remote. The average age recorded was 37 years (range 20–66 years), 43.8% males and 56.3% females. Respondents reported experiences of discrimination and systemic racism while engaging in daily life activities, including accessing foods and common goods, school, work, transportation, and healthcare, all of which were exacerbated by COVID-19 and the police murder of George Floyd.

Conclusions:

Immigrant/refugee communities of color in Minneapolis/St. Paul face daily experiences of racism that were compounded by the events of 2020. Discrimination and systemic racism contribute to the persistent health inequities among populations of color.

Discrimination and Hypertension Among Older African Americans and Caribbean Blacks: The Moderating Effects of John Henryism

OBJECTIVES

Discrimination is a major contributor to health disparities between Black and White older adults. Although the health effects of discrimination are well established, less is known about factors that may intervene in the discrimination-health connection, such as coping strategies. The study aim was to determine whether John Henryism (JH; high-effort coping) moderates the association between racial discrimination and hypertension in nationally representative samples of older African Americans and Caribbean Blacks.

METHODS

The analytic sample was drawn from the National Survey of American Life-Reinterview, which was conducted 2001-2003, and included African Americans (N = 546) and Caribbean Blacks (N = 141) aged 55 and older. Study variables included racial discrimination, JH, and hypertension. Logistic regressions, which controlled key sociodemographic differences, were used to test the study aim.

RESULTS

Among both Black ethnic groups, discrimination and JH were not associated with hypertension. For African Americans low and moderate in JH, discrimination was unrelated to hypertension; discrimination was positively associated with hypertension for African Americans high in JH. For Caribbean Blacks, discrimination was positively associated with hypertension among respondents low in JH. Among Caribbean Blacks moderate and high in JH, discrimination was not associated with hypertension.

DISCUSSION

The findings indicate that JH, in the face of discrimination, is associated with hypertension of older African Americans but may be an effective coping strategy for older Caribbean Blacks due to cultural and sociodemographic differences between the 2 ethnic groups. Future research should investigate the differing mechanisms by which JH influences health in heterogeneous older Black populations.

Tooth Loss Condition and Social Discrimination in Brazilian Healthcare Services

Objective: To explore factors associated with social discrimination against users of health services regarding dental aesthetic conditions.

Methods: Based on a Brazilian National Survey, multivariate Poisson regressions with robust variance were used to explore the association of outcome discrimination related to different motivations in health services and exposure to sociodemographic and dental variables. Effect modification by complete prosthesis wearing was assessed.

Results: Among the 60,200 people interviewed, 11.5% reported being discriminated against in health services. For women, a higher prevalence of discrimination was found among those in the age group of 30–44 years. For both sexes, discrimination was associated with black and brown skin color. Regarding dental characteristics, the higher the tooth loss was, the higher the prevalence of discrimination; however, complete prosthesis wearing presented as a protective factor. Social discrimination was the major motivation for reported discrimination and presented higher prevalence in edentulous individuals who did not wear prosthesis.

Conclusion: Dental loss may lead to self-reported discrimination in health care services. The prevalence of discrimination increases when tooth loss increases, and the major reason associated is social discrimination.

Lifetime Major Discrimination Experiences Moderate the Impact of Depressive Symptoms on Chronic Conditions among Black Americans

To clarify the ways in which Black Americans' experiences of structural racism may influence their mental and physical health in distinct ways, the present study evaluated whether major discrimination moderates the association between depressive symptoms and chronic physical health conditions among this population. t-tests and chi-squared tests of significance were used to determine significant differences between women and men. The association between major discrimination and depressive symptoms was examined by assessing mean depressive symptoms scores across levels of major discrimination. ANOVA tests indicated whether there were significant differences in symptom scores across each discrimination category. Additional t-tests determined significant gender differences within each level of discrimination. Gender-stratified negative binomial models were used, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the relationship between depressive symptoms, major discrimination, and chronic conditions. Our findings indicated that the association between depressive symptoms and chronic conditions depends on lifetime experiences of major discrimination among Black Americans and varies significantly between women and men. Considering that major discrimination conditioned the depressive symptom-chronic conditions association among our sample, this provides insight into potential pathways for intervention in efforts to offset the detrimental mental and physical consequences of experiencing racism.

Staying "One Step Ahead of a Racist": Expanding Understandings of the Experiences of the Covid-19 Pandemic Among People From Minoritized Ethnic Groups Living in Britain

Covid-19 has had a disproportionate impact on those in minoritized ethnic groups. Considerable attention has been given to evidence of ethnic inequalities in rates of infection, hospitalisation, and death. But other ways in which the pandemic experience has been affected by ethnicity have received less consideration. This paper explores the lived experiences of people in different minoritized ethnic groups living in South West England, during the United Kingdom's first pandemic lockdown, using qualitative data collected from interviews and comments provided on a survey. Perceived positive opportunities for growth were offset by anxiety and stress, which were themselves compounded by an awareness of the additional risks they experienced as members of racialised groups, and a sense that this was being ignored-or intentionally exacerbated-by the British authorities. Frustration with an incompetent and corrupt national Government was intensified by concerns regarding their racist motives. Racism in wider society undermined confidence in key public institutions, such as the NHS and the police, while also producing barriers to informal local-community pandemic responses. Only through recognition of the particular ways in which the pandemic affected those in minoritized ethnic groups, including the multiple and compounding effects of current and historical racism, will it be possible to identify avenues for transformative systemic policy change and opportunities to rebuild trust and a better post-pandemic society for all.

Assessing the Real-time Influence of Racism-Related Stress and Suicidality Among Black Men: Protocol for an Ecological Momentary Assessment Study

BACKGROUND

Suicide is the third leading cause of death among Black adults aged 18-35 years. Although men represent a majority of suicide deaths among Black adults, less is known regarding the extent to which unique cultural stressors, such as racism-related stress (eg, racial discrimination), are salient in exacerbating suicide risk among Black men. Moreover, few studies examine the daily influence of racism-related stressors on suicide outcomes using real-time smartphone-based approaches. Smartphone-based mobile health approaches using ecological momentary assessments (EMA) provide an opportunity to assess and characterize racism-related stressors as a culturally sensitive suicide risk factor among Black young adult men.

OBJECTIVE

The goal of this study is to describe a protocol development process that aims to capture real-time racism-related stressors and suicide outcomes using a smartphone-based EMA platform (MetricWire).

METHODS

Guided by the Interpersonal Theory of Suicide (ITS), we developed a brief EMA protocol using a multiphased approach. First, we conducted a literature review to identify brief measures previously used in EMA studies, with special emphasis on studies including Black participants. The identified measures were then shortened to items with the highest construct validity (eg, factor loadings) and revised to reflect momentary or daily frequency. Feasibility and acceptability of the study protocol will be assessed using self-report survey and qualitative responses. To protect participants from harm, a three-tier safety protocol was developed to identify participants with moderate, elevated, and acute risk based on EMA survey response to trigger outreach by the study coordinator.

RESULTS

The final EMA protocol, which will be completed over a 7-day period, is comprised of 15 questions administered 4 times per day and a daily questionnaire of 22 items related to sleep-related impairment and disruption, as well as racism-related stress. Study recruitment is currently underway. We anticipate the study will be completed in February 2023. Dissemination will be conducted through peer-reviewed publications and conference presentations.

CONCLUSIONS

This protocol will address gaps in our understanding of Black men's suicide outcomes in the social contexts that they regularly navigate and will clarify the temporal role of racism-related stressors that influence suicidal outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/31241.

Effects of chronic ethnic discrimination in the daily life of Turkish immigrants living in Austria: study protocol of a 30-day ambulatory assessment study

INTRODUCTION

Chronic ethnic discrimination is associated with negative mental and physical health outcomes in ethnic minority groups. It is assumed that suffering from repeated discriminatory events leads, over time, to psychological consequences such as higher perceived stress, higher negative affect and lower positive affect. Higher stress reactivity to non-discriminatory stressors, such as daily hassles, as well as anticipation and avoidance behaviour regarding discriminatory events, may further contribute to the overall burden for affected individuals. Studies investigating chronic ethnic discrimination and its psychological consequences in the daily lives of affected persons are lacking. Here, we present a study protocol to investigate the impact of chronic ethnic discrimination and acute discriminatory events in the daily lives of Turkish immigrants living in Austria, using an ambulatory assessment design. The feasibility of our study design was tested and confirmed in a pilot study (n=10).

METHODS AND ANALYSIS

Ninety male Turkish immigrants will complete daily questionnaires for 30 days. Participants will indicate stress, perceived discrimination, negative and positive affect, daily hassles, anticipation and avoidance behaviour, as well as rumination with regard to discriminatory events on a daily basis. Furthermore, they will use preprogrammed iPods to assess acute discriminatory events in real time. Our hypotheses will be tested using multilevel analyses.

ETHICS AND DISSEMINATION

This study has been approved by the institutional review board of the University of Vienna (reference number 00358). Results will be presented at conferences and submitted for publication in a peer-reviewed journal.