Measuring the biological embedding of racial trauma among Black Americans utilizing the RDoC approach

The neurophysiological consequences of racism-related stressors in Black Americans

Racism-related stressors, from experiences of both implicit and explicit racial discrimination to systemic socioeconomic disadvantage, have a cumulative impact on Black Americans' health. The present narrative review synthesizes peripheral (neuroendocrine and inflammation markers), psychophysiological (heart-rate variability, skin conductance), and neuroimaging (structural and functional) findings that demonstrate unique associations with racism-related stress. Emerging evidence reveals how racism-related stressors contribute to differential physiological and neural responses and may have distinct impacts on regions involved with threat and social processing. Ultimately, the neurophysiological effects of racism-related stress may confer biological susceptibility to stress and trauma-related disorders. We note critical gaps in the literature on the neurophysiological impact of racism-related stress and outline additional research that is needed on the multifactorial interactions between racism and mental health. A clearer understanding of the interactions between racism-related stress, neurophysiology, and stress- and trauma-related disorders is critical for preventative efforts, biomarker discovery, and selection of effective clinical treatments for Black Americans.

Caste and Black intergenerational racial trauma in the United States of America

The United States (U.S.) racial caste system and White dominance began in slavery, culminating in Black intergenerational racial trauma. Until recently, Black intergenerational racial trauma largely was ignored by family scholars and therapists. Given that Black intergenerational racial trauma is inseparable from racial caste in the United States, it should be regarded as a wider, systemic problem, requiring intervention at the micro (e.g., family) and macro (e.g., society) levels. The U.S. dominant White society's investment in conserving racial caste furthers the ideological (e.g., political) and sentimental (e.g., democratic ideals) nullification of Black intergenerational racial trauma. Therefore, Black intergenerational racial trauma is often disenfranchised and can hamper Black people's experience of racial trauma as a collective. As passive bystanders, family scholars and therapists are co-conspirators in the long, enduring suffering of Black people. As advocates, family scholars and therapists are called upon to name the racial hierarchy in the United States as a caste system and to advance Black humanization. Specifically, Wilkerson's (Caste: The origins of our discontents. Random House, 2020) notion of the U.S. racial hierarchy as a functioning caste system frames the discussion of Black intergenerational racial trauma and includes the following topics: Black racial trauma, disenfranchised Black intergenerational racial trauma, collective Black intergenerational racial trauma, Black intergenerational racial trauma and the U.S. academy (traditionally White institutions of higher learning), history and its impact on Black intergenerational racial trauma, the Black body and racial trauma, intersectionality and the U.S. caste system, and collective hope and resilience.

A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms

The present 21-day daily diary study (conducted 2021-2022) tested anger and racism-related vigilance as potential transdiagnostic mediators linking exposure to racial and ethnic discrimination (RED) to distress (negative affect and stress, respectively). The data analytic sample included N = 317 Mexican-origin adolescents (Mage = 13.5 years; 50.8% male, 46.7% female; 2.5% non-binary) from the Midwestern United States. Results from longitudinal mediation models revealed significant mediation effects through anger and racism-related vigilance, respectively, in the association between daily RED and daily distress, both within and across adolescents. Implications for theory, research, and practice are discussed so that future work can leverage these novel findings toward promoting the well-being of Mexican-origin adolescents, especially those who live in contexts of ethnoracial adversity.

Where I'm Livin' and How I'm Feelin': Associations among community stress, gender, and mental-emotional health among Black Americans

RATIONALE

Structural racism is a primary avenue for the perpetuation of racial health disparities. For Black Americans, both historically and contemporarily, the neighborhood context serves as one of the most striking examples of structural racism, with stressful neighborhood contexts contributing to the well-documented inequalities in psychological functioning among this population.

OBJECTIVE

Thus, in this study, we adapted an intersectional-ecological framework to investigate the links between community stress and multiple dimensions of mental-emotional health for Black men and women.

METHODS

Drawing on cross-sectional data from 842 Black Americans from the Milwaukee area, we tested both objective (Area Deprivation Index; ADI) and subjective (perceived neighborhood disadvantage; PND) indicators of community stress as simultaneous predictors of negative and positive affect and the odds of psychological disorder (depression, anxiety) in multilevel models, examining gender differences in these linkages.

RESULTS

Results showed greater objective community stress was related to lower levels of negative affect for both men and women and lower odds of psychological disorder for women specifically. Greater subjective community stress was related to higher levels of negative affect and lower levels of positive affect for both men and women and to higher odds of psychological disorder for women specifically.

CONCLUSIONS

Findings highlight the complex intersectional nature of the links between community stress and Black Americans' mental-emotional health. Specifically, findings demonstrate the pernicious psychological effects of perceived community stress and allude to Black Americans', particularly women's, active resistance and resilience to objective disadvantage, potentially through investing in social relationships in their neighborhoods.

Whose Signals Are Being Amplified? Toward a More Equitable Clinical Psychophysiology

Research using psychophysiological methods holds great promise for refining clinical assessment, identifying risk factors, and informing treatment. Unfortunately, unique methodological features of existing approaches limit inclusive research participation and, consequently, generalizability. This brief overview and commentary provides a snapshot of the current state of representation in clinical psychophysiology, with a focus on the forms and consequences of ongoing exclusion of Black participants. We illustrate issues of inequity and exclusion that are unique to clinical psychophysiology, considering intersections among social constructions of Blackness and biased design of current technology used to measure electroencephalography, skin conductance, and other signals. We then highlight work by groups dedicated to quantifying and addressing these limitations. We discuss the need for reflection and input from a wider variety of stakeholders to develop and refine new technologies, given the risk of further widening disparities. Finally, we provide broad recommendations for clinical psychophysiology research.

Experiences of racial discrimination and adverse gene expression among black individuals in a level 1 trauma center sample

Up to 40 % of individuals who sustain traumatic injuries are at risk for posttraumatic stress disorder (PTSD) and the conditional risk for developing PTSD is even higher for Black individuals. Exposure to racial discrimination, including at both interpersonal and structural levels, helps explain this health inequity. Yet, the relationship between racial discrimination and biological processes in the context of traumatic injury has yet to be fully explored. The current study examined whether racial discrimination is associated with a cumulative measure of biological stress, the gene expression profile conserved transcriptional response to adversity (CTRA), in Black trauma survivors. Two-weeks (T1) and six-months (T2) post-injury, Black participants (N = 94) provided a blood specimen and completed assessments of lifetime racial discrimination and PTSD symptoms. Mixed effect linear models evaluated the relationship between change in CTRA gene expression and racial discrimination while adjusting for age, gender, body mass index (BMI), smoking history, heavy alcohol use history, and trauma-related variables (mechanism of injury, lifetime trauma). Results revealed that for individuals exposed to higher levels of lifetime racial discrimination, CTRA significantly increased between T1 and T2. Conversely, CTRA did not increase significantly over time in individuals exposed to lower levels of lifetime racial discrimination. Thus, racial discrimination appeared to lead to a more sensitized biological profile which was further amplified by the effects of a recent traumatic injury. These findings replicate and extend previous research elucidating the processes by which racial discrimination targets biological systems.

Pre-COVID respiratory sinus arrhythmia moderates associations between COVID-19 stress and child externalizing behaviors: Testing neurobiological stress theories

Exposure to stress related to the COVID-19 pandemic contributes to psychopathology risk, yet not all children are negatively impacted. The current study examined a parasympathetic biomarker of stress sensitivity, respiratory sinus arrhythmia (RSA), as a moderator of the effects of exposure to pandemic stress on child internalizing and externalizing behaviors in a sample of children experiencing economic marginalization. Three to five years pre-pandemic, when children were preschool-aged, RSA during baseline and a challenging parent-child interaction were collected. Mid-pandemic, between November 2020 and March 2021, children's exposure to pandemic stress and internalizing and externalizing behaviors were collected. Results demonstrated that children who, pre-pandemic, demonstrated blunted parasympathetic reactivity (i.e., no change in RSA relative to baseline) during the dyadic challenge exhibited elevated risk for externalizing behaviors mid-pandemic. Further, this risk was greatest for children exposed to high and moderate levels of pandemic stress. Consistent with diathesis stress and polyvagal frameworks, these conditional effects suggest that blunted parasympathetic reactivity in response to stress in early childhood may escalate the development of externalizing behaviors following stress exposure at school age.

Negative emotional reactivity to minority stress: measure development and testing

The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.

Post-traumatic stress disorder symptoms and PrEP intentions among Black American young adults at high-risk for HIV

OBJECTIVES

Black Americans bear the greatest burden of HIV, accounting for 43% of new diagnoses. Yet Black Americans also evidence the lowest utilization rates of Pre-Exposure Prophylaxis (PrEP), a highly effective biomedical strategy for preventing HIV infection. Predictors of PrEP acceptance vary; however, little is known about psychological distress, such as post-traumatic stress disorder (PTSD) symptoms, as a predictor.

DESIGN

In this cross-sectional study, n = 195 Black Americans, evidencing behaviors found in the research literature to heighten risk for contracting HIV (e.g. sex work, injection drug use) ages 18-29, 55% cisgender women, 39.5% cisgender men, 3% transgender/non-binary, completed audio-computer-assisted self-interviews.

RESULTS

Bivariate analyses indicated significant positive associations between PTSD symptoms and PrEP acceptance and self-confidence. In multinomial logistic regression analyses, after controlling for Perceived HIV Risk, participants had a higher likelihood of responding they 'probably would' take PrEP (as opposed to 'definitely would not' take PrEP) if they reported higher levels of PTSD symptoms. Post-hoc analyses revealed a curvilinear relationship between PTSD symptoms and PrEP acceptance with those reporting the highest level of PTSD in the sample having slightly lower PrEP acceptance than those reporting moderately high levels of PTSD.

CONCLUSION

Findings are discussed in the context of the negative impacts of high levels of PTSD and potential positive adaptations subsequent to moderate levels of PTSD that could be relevant to advances in HIV prevention efforts.

Associations Between Direct and Indirect Forms of Racism Exposure and Stress-Induced Inflammatory Response and Health in Pregnancy

Theory and research suggest chronic direct and indirect exposures to racism impact health, and stress-responsive inflammation may play a role in these paths. This study examines links between forms of racism-related stress, salivary markers of inflammation during acute psychosocial stress, and perinatal mental and physical health in a racially heterogenous sample. Pregnant people (n = 108, 27% non-white) self-reported personal and vicarious exposure to racism (racial microaggressions, online racism, overt racial/ethnic discrimination) and racial collective self-esteem, as well as affective symptoms and general physical health. Five saliva samples collected before and after the Trier Social Stress Test were assayed for pro-inflammatory cytokines and C-reactive protein. Results revealed associations between racism-related stress and greater inflammatory reactivity/delayed recovery to acute stress, between racial collective self-esteem and lower levels of inflammation, and between profiles of inflammatory responses to stress and mental and physical symptoms. We discuss implications for understanding perinatal health disparities.

Love, health, and the 'hood: An examination of romantic relationship adjustment and perceived neighborhood quality as predictors of partnered Black Americans' long-term psychological health

Existing disparities regarding Black Americans' psychological health warrant further investigation of socioecological factors that may be associated with negative and positive dimensions of psychological health in this population. Romantic relationship functioning and neighborhood context are two domains relevant to Black Americans' mental health. However, less is known about how they may serve as independent and interactive prospective predictors of Black Americans' psychological health and potentially in distinctive ways for Black men and women. Using data from 333 partnered Black Americans who participated in the Midlife in the United States study, we investigated relationship adjustment and neighborhood quality as independent and interactive predictors of negative and positive affect 10 years later and examined gender differences in these linkages. Higher neighborhood quality predicted lower levels of negative affect and higher levels of positive affect for both men and women a decade later. Additionally, for Black men, the longitudinal association between relationship adjustment and negative affect differed by neighborhood quality such that better relationship adjustment predicted higher subsequent negative affect only for men in lower quality neighborhoods. Findings demonstrate the connections among romantic relationship functioning, ecological resources, and gender in this population and highlight the importance of incorporating socioecological and intersectional perspectives for predicting Black Americans' long-term psychological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Restoring the missing person to personalized medicine and precision psychiatry

Precision psychiatry has emerged as part of the shift to personalized medicine and builds on frameworks such as the U.S. National Institute of Mental Health Research Domain Criteria (RDoC), multilevel biological "omics" data and, most recently, computational psychiatry. The shift is prompted by the realization that a one-size-fits all approach is inadequate to guide clinical care because people differ in ways that are not captured by broad diagnostic categories. One of the first steps in developing this personalized approach to treatment was the use of genetic markers to guide pharmacotherapeutics based on predictions of pharmacological response or non-response, and the potential risk of adverse drug reactions. Advances in technology have made a greater degree of specificity or precision potentially more attainable. To date, however, the search for precision has largely focused on biological parameters. Psychiatric disorders involve multi-level dynamics that require measures of phenomenological, psychological, behavioral, social structural, and cultural dimensions. This points to the need to develop more fine-grained analyses of experience, self-construal, illness narratives, interpersonal interactional dynamics, and social contexts and determinants of health. In this paper, we review the limitations of precision psychiatry arguing that it cannot reach its goal if it does not include core elements of the processes that give rise to psychopathological states, which include the agency and experience of the person. Drawing from contemporary systems biology, social epidemiology, developmental psychology, and cognitive science, we propose a cultural-ecosocial approach to integrating precision psychiatry with person-centered care.

Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation

Background: Racial discrimination is a traumatic stressor that increases the risk for posttraumatic stress disorder (PTSD), but mechanisms to explain this relationship remain unclear. Peritraumatic dissociation, the complex process of disorientation, depersonalization, and derealization during a trauma, has been a consistent predictor of PTSD. Experiences of frequent racial discrimination may increase the propensity for peritraumatic dissociation in the context of new traumatic experiences and contribute to PTSD symptoms. However, the role of peritraumatic dissociation in the relationship between experiences of discrimination and PTSD has not been specifically explored.Objective: The current study investigated the role of peritraumatic dissociation in the impact of racial discrimination on PTSD symptoms after a traumatic injury, and the moderating role of gender.Method: One hundred and thirteen Black/African American individuals were recruited from the Emergency Department at a Level I Trauma Center. Two weeks after the trauma, participants self-reported their experiences with racial discrimination and peritraumatic dissociation. At the six-month follow-up appointment, individuals underwent a clinical assessment of their PTSD symptoms.Results: Results of longitudinal mediation analyses showed that peritraumatic dissociation significantly mediated the effect of racial discrimination on PTSD symptoms, after controlling for age and lifetime trauma exposure. A secondary analysis was conducted to examine the moderating role of gender. Gender was not a significant moderator in the model.Conclusions: Findings show that racial discrimination functions as a stressor that impacts how individuals respond to other traumatic events. The novel results suggest a mechanism that explains the relationship between racial discrimination and PTSD symptoms. These findings highlight the need for community spaces where Black Americans can process racial trauma and reduce the propensity to detach from daily, painful realities. Results also show that clinical intervention post-trauma must consider Black Americans' experiences with racial discrimination.

An integrative framework and recommendations for the study of DNA methylation in the context of race and ethnicity

Human social epigenomics research is critical to elucidate the intersection of social and genetic influences underlying racial and ethnic differences in health and development. However, this field faces major challenges in both methodology and interpretation with regard to disentangling confounded social and biological aspects of race and ethnicity. To address these challenges, we discuss how these constructs have been approached in the past and how to move forward in studying DNA methylation (DNAm), one of the best-characterized epigenetic marks in humans, in a responsible and appropriately nuanced manner. We highlight self-reported racial and ethnic identity as the primary measure in this field, and discuss its implications in DNAm research. Racial and ethnic identity reflects the biological embedding of an individual's sociocultural experience and environmental exposures in combination with the underlying genetic architecture of the human population (i.e., genetic ancestry). Our integrative framework demonstrates how to examine DNAm in the context of race and ethnicity, while considering both intrinsic factors-including genetic ancestry-and extrinsic factors-including structural and sociocultural environment and developmental niches-when focusing on early-life experience. We reviewed DNAm research in relation to health disparities given its relevance to race and ethnicity as social constructs. Here, we provide recommendations for the study of DNAm addressing racial and ethnic differences, such as explicitly acknowledging the self-reported nature of racial and ethnic identity, empirically examining the effects of genetic variants and accounting for genetic ancestry, and investigating race-related and culturally regulated environmental exposures and experiences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44155-023-00039-z.

Approaching Mental Health Equity in Neuroscience for Black Women Across the Lifespan: Biological Embedding of Racism From Black Feminist Conceptual Frameworks

Black women in the United States are faced with unrelenting chronic stressors that are often driven by racism and oppression and that result in mental health inequities. Similar to common U.S. societal views of Black women, ideological values about Black women's lives also permeate psychiatry and neuroscience research to prevent likely impactful research that fully examines the role of social power structures in the biological embedding of racism. This article's overall aim is to highlight the most urgent areas to address in mental health inequities utilizing a Black feminist lens that include 1) culturally grounded and contextually relevant considerations for the biological embedding of racism on mental health outcomes for Black women across the lifespan and 2) intersectional frameworks that address mental health inequities ingrained in multiple marginalization. We conclude with a call to action informed by Black feminist thought for the field of neuroscience to make a concerted effort to address mental health inequities among Black women and other disenfranchised groups from a frame of compassion, cultural humility, and a continuous pursuit of social justice.

Neural Impacts of Stigma, Racism, and Discrimination

Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life and have long-term consequences. In this review, we sought to use neuroscience research to describe how stigma, racism, and discrimination can impact brain and mental health. Societal stigmas may be encoded by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecologic systems to build resilience and foster posttraumatic growth.

Associations of maternal emotion regulation with child white matter connectivity in Black American mother-child dyads

Parental emotion regulation plays a major role in parent-child interactions, and in turn, neural plasticity in children, particularly during sensitive developmental periods. However, little is known about how parental emotion dysregulation is associated with variation in children's brain structure, which was the goal of this study. Forty-five Black American mother-child dyads were recruited from an intergenerational trauma study; emotion regulation in mothers and their children (age 8-13 years) was assessed. Diffusion-weighted images were collected in children; deterministic tractography was used to reconstruct pathways of relevance to emotion regulation. Metrics of white matter connectivity [fractional anisotropy (FA), mean diffusivity (MD)] were extracted for pathways. Socio-economic variables were also included in statistical models. Maternal emotion dysregulation was the strongest predictor of child fornix MD (r = .35, p = .001), indicating that more severe emotion dysregulation in mothers corresponded with lower fornix connectivity in children. Maternal impulsivity was a strong predictor of child fornix MD (r = .51, p < .001). Maternal emotion dysregulation may adversely influence connectivity of the child.s fornix, a hippocampal-striatal pathway implicated in reward processes; these associations remained even after accounting for other socio-environmental factors. Dysregulated maternal emotions may uniquely impact children's adaptation to trauma/stress by affecting networks that support appetitive processing.

Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment

Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims’ life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is no way to identify racial trauma other than through a life-course approach that captures the complex nature of individual, collective, historical, and intergenerational experiences of racism experienced by BIPOC communities in Western society. This article presents evidence for complex racial trauma (CoRT), a theoretical framework of CoRT, and guidelines for its assessment and treatment. Avenues for future research, intervention, and training are also presented.

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.