Effort-reward imbalance and well-being among psychiatric nurses: the mediating role of burnout and decent work

BACKGROUND

Psychiatric nurses face additional challenges due to negative perceptions, workplace violence, and a lack of respect, impacting their well-being and job satisfaction, which are crucial for improving psychiatric care and patient outcomes.

OBJECTIVES

This study aims to examine the relationship between effort-reward imbalance, well-being, burnout, and decent work among psychiatric nurses.

METHODS

This study used a cross-sectional design. Data were collected using a convenience sampling method in February 2024 from 397 psychiatric nurses at two psychiatric hospitals in Hangzhou and Huzhou, Zhejiang Province. The Effort-Reward Imbalance Scale, Decent Work Perception Scale, Maslach Burnout Inventory-General Survey, and General Well-Being Schedule Scale were used for data collection. Data analysis was conducted using SPSS 26.0 and the PROCESS macro.

RESULTS

The study found that effort-reward imbalance among psychiatric nurses was negatively correlated with decent work (r = -0.564, p < 0.001) and well-being (r = -0.541, p < 0.001), and positively correlated with burnout (r = 0.603, p < 0.001). Burnout mediated the relationship between effort-reward imbalance and well-being (95% CI [-0.386, -0.257]), while decent work also served as a mediator (95% CI [-0.100, -0.012]). Additionally, burnout and decent work were found to mediate the relationship between effort-reward imbalance and well-being (95% CI [-0.050, -0.006]).

CONCLUSION

This study highlights the impact of effort-reward imbalance on well-being, confirming that burnout and decent work serve as mediators. Enhancing support, fair compensation, reasonable work schedules, and professional development can promote psychiatric nurses' perception of decent work and improve their well-being.

Health Care Discrimination Affects Patient Activation, Communication Self-Efficacy, and Pain for Black Americans

This study examines whether a key psychosocial factor-perceiving racial discrimination in health care-is associated with worse patient activation, communication self-efficacy, and physical health outcomes for Black veterans with chronic pain. Moreover, we explore the role of physician-patient working alliance as a moderator that may alleviate the potential consequences of perceiving racial discrimination. This work is a secondary analysis of baseline data from a clinical trial with 250 U.S. Black veterans with chronic musculoskeletal pain. Participants were recruited from primary care clinics at a Midwestern VA hospital between 2018 and 2021. Perceiving racial discrimination in health care was associated with lower patient activation, lower self-efficacy in communicating with one's physician, higher pain intensity, and lower pain management self-efficacy (ps < .049) but was unrelated to reports of pain interference or use of pain coping strategies (ps > .157). Although the relationship between perceived discrimination and patient activation was moderated by working alliance (P = .014), having a stronger working alliance improved patient activation to varying degrees across levels of perceived discrimination (rather than buffering against negative outcomes when perceiving higher levels of discrimination). Moderation was not significant on any other measures. This study deepens our understanding of the broad range of health outcomes that are (not) associated with perceiving racial discrimination in health care. Contrary to prior theorizing, this work also indicates that having a strong working alliance does not attenuate the consequences of perceiving discrimination among Black individuals living with pain. These results highlight the need for system-level interventions to address perceptions of racial mistreatment in health care. PERSPECTIVE: This work has important public health implications by identifying the broad range of outcomes associated with perceived discrimination in health care among Black Americans. Importantly, a strong physician-patient relationship did not buffer Black individuals from the consequences of perceiving discrimination. These findings inform intervention targets to mitigate racial health disparities.

Justice beliefs for self and others: Associations with positive and negative affectivity in African Americans and White Americans

Prior research has shown that a belief in personal justice (i.e., justice for self) is associated with better health and well-being, whereas a belief in justice more generally (i.e., justice for others) is unrelated. However, an emerging perspective is that racial differences may overlay the relationships between multidimensional beliefs about justice and indices of well-being. This includes that well-being among African Americans may be additionally supported by rejecting rather than endorsing some forms of believing in justice. In the present study, we consider racial similarities and differences in the links between beliefs about justice for self and others and emotional well-being. African Americans (N = 117) and White Americans (N = 188) completed measures of beliefs about justice for self and others, and also measures of dispositional tendencies towards experiencing positive and negative emotion (i.e., positive and negative affectivity). In both groups, beliefs about justice for the self were associated with greater positive affect and reduced negative affect. However, beliefs about justice for others were additionally associated with greater negative affect only among African Americans. The link between justice for others and negative affect among African Americans was not attributable to measurement or mean differences in justice beliefs across racial groups, or to socioeconomic differences. Results align with an emerging perspective that simultaneously endorsing and rejecting justice beliefs may be vital to preserving well-being for some racial minorities.

Racial Slurs by Police and Posttraumatic Stress Symptoms: Intrusive Policing and Perceived Injustice

Using the Future of Families and Child Wellbeing Study (N = 785), this article considers the ramifications of police use of racial slurs, a type of intrusive behavior, toward minority youth for posttraumatic stress (PTS). We also examine whether other intrusive police behaviors exacerbate this relationship and test whether perceptions of injustice mediate it. Results indicated that hearing a police officer use a racial slur was positively associated with PTS after controlling for intrusive police behaviors and other covariates. Intrusive policing tended to co-occur with the use of racial slurs and was positively associated with PTS. The association between hearing a racial slur and PTS did not vary by the number of intrusive behaviors exhibited by police. The association between hearing a slur and PTS was partially mediated by perceived procedural injustice. Overall, the use of racial slurs by police may do harm to minority adolescents by putting them at risk for posttraumatic stress disorder. Our results are consistent with prior research that racial slurs may contribute to PTS by eroding the bounds of what is considered just and fair. Interestingly, the association between racial slurs and PTS was independent of other intrusive policing behaviors. Mental health screeners should ask not only about being stopped by police but the characteristics of that encounter as well - including those imbued with racial animus.

Writing about justice and injustice: Complex effects on affect, performance, threat, and biological responses to acute social stress among african American women and men

OBJECTIVE

Brief, culturally-tailored, and scalable stress coping interventions are needed to address a broad range of stress-related health disparities, including among African Americans. In this study, we develop two brief justice writing interventions and demonstrate a methodological approach for evaluating how prompting African Americans to think about justice and injustice can alter responses to acute social stress.

METHODS

African American women and men were randomized to a neutral writing condition or one of two justice-based writing interventions, which prompted them to recall past experiences of personal justice - with (adjunctive injustice) or without (personal justice-only) recalling and writing about injustice. Participants then completed a modified Trier Social Stress Test, during which they received feedback on poor performance. We measured cognitive performance, affect, and perceived threat in response to task feedback. We also measured blood pressure and salivary cortisol stress responses.

RESULTS

Men experienced more positive emotion, performed better on the stressor task, and were less threatened by poor performance feedback in the personal justice-only condition. Men also had lower systolic blood pressure reactivity in the justice writing conditions compared to control. Women experienced less positive emotion, performed worse on the stressor task, and were more threatened by feedback in the personal justice-only condition. Women also had lower cortisol recovery after the stressor task in the adjunctive injustice condition.

CONCLUSION

Thinking about justice and injustice may alter performance, affect, threat, and biological responses to acute social stress. Still, gender differences highlight that justice thinking is likely to produce heterogeneous and complex stress coping responses among African Americans.

Perceived discrimination, health, and well-being among adults with and without pain: a prospective study

ABSTRACT

Discrimination negatively influences health and well-being in the general population, but its impact on people with pain is unclear. This study assessed discrimination, health, and well-being in people with and without pain. Data were from 5871 participants from the English Longitudinal Study of Ageing. Experiences of discrimination were reported in 2010 to 2011. Pain, self-rated health, depressive symptoms, quality of life, life satisfaction, and loneliness were assessed in 2010 to 2011 and 2016 to 2017. A quarter (26%, n = 1524) of the sample reported pain at baseline. Participants with pain were more likely to report discrimination than those without pain (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.13-1.46). Cross-sectionally, those with pain who perceived discrimination had poorer self-rated health (OR = 1.28, 95% CI 1.02-1.61), greater depressive symptoms (OR = 1.90, 95% CI 1.48-2.45), were more likely to be lonely (β = 0.21, 95% CI 0.15-0.26), and had lower quality of life (β = -4.01, 95% CI -4.88 to -3.14), and life satisfaction (β = -1.75, 95% CI -2.45 to -1.06) than those with pain who did not perceive discrimination. Prospectively, discrimination in those with pain was associated with greater depression (OR = 1.67, 95% CI 1.19-2.34) and loneliness (β = 0.11, 95% CI 0.05-0.17), adjusting for baseline values. In those without pain in 2010 to 2011, discrimination predicted pain in 2016 to 2017, controlling for covariates (OR = 1.29, 95% CI 1.06-1.56). People with pain are more likely to report discrimination than those without pain, and this experience is associated with increased depression and loneliness. Discrimination was predictive of incident pain in pain-free adults. These findings highlight the need to tackle discrimination to improve well-being in those with pain and to potentially reduce the risk of pain onset.

Organizational Justice and Cognitive Failures in Japanese Employees: A Cross-Sectional Study

OBJECTIVE

We examined the association of organizational justice (ie, procedural justice and interactional justice) with cognitive failures, and the mediation effect of psychological distress on this association in Japanese employees.

METHODS

A total of 189 men and 35 women from two sites of a manufacturing company in Japan were surveyed using a self-administered web-based questionnaire. A multiple mediation analysis was conducted.

RESULTS

A significant negative total effect of procedural justice on cognitive failures was observed (c = -0.180 [95% confidence interval: -0.315 to -0.044]). Furthermore, the mediation effect of psychological distress was significant (c-c' = -0.213 [95% confidence interval: -0.323 to -0.115]). Similar patterns were observed for interactional justice.

CONCLUSIONS

Employees may be more likely to experience cognitive failures in daily activities in work settings where organizational justice is lower, which seems to be explained by psychological distress.

Race, social pain minimization, and mental health

People often believe Black individuals experience less social pain and require less social support to cope with distress than White individuals (e.g., Deska, Kunstman, Lloyd, et al., 2020). However, researchers have not tested whether biases in third-person pain judgments translate to first-person experiences with social pain minimization. For example, do Black individuals feel their social pain is underrecognized to a greater extent than White individuals? The current work tested whether Black individuals felt their social pain was minimized more than White individuals and if the experience of social pain minimization was related to worse mental health and greater life stress. Data from two cross-sectional, correlational studies provide initial support for these predictions ( Ntotal = 1,501). Black participants felt their social pain was minimized more than White participants and this race difference in social pain minimization was associated with worse mental health and greater life stress. These results suggest that Black individuals feel their pain is underrecognized and this experience of social pain minimization is related to worse mental health outcomes.

Older Latino Mental Health: A Complicated Picture

The aggregation of Latino subgroups in national studies creates an overly simplistic narrative that Latinos are at lower risk of mental illness and that foreign nativity seems protective against mental illness (i.e., immigrant paradox). This broad generalization does not hold up as the Latino population ages. Given that social inequalities for risk appear to widen with age, the social disadvantages of being Latino in the United States increase the risk for mental illness across the life span. This review focuses on the mental health of older Latinos, specifically the 3 subgroups with the longest residential history in the United States—Mexicans, Puerto Ricans, and Cubans. We examine relevant epidemiological and clinical psychopathology studies on aging in these Latino populations and present evidence of the heterogeneity of the older Latino population living in the United States, thus illustrating a limitation in this field—combining Latino subgroups despite their diversity because of small sample sizes. We address the migration experience—how intraethnic differences and age of migration affect mental health—and discuss social support and discrimination as key risk and protective factors. We conclude with a discussion on meeting the mental health needs of older Latinos with a focus on prevention, a promising approach to addressing mental illness in older Latinos, and future directions for mental health research in this population. Success in this endeavor would yield a substantial reduction in the burden of late-life depression and anxiety and a positive public health impact.

Investigating the Health Consequences for White Americans Who Believe White Americans Are Wealthy

Poor White Americans report feeling “worse off” than poor Black Americans despite the persistent negative effects of racism on Black Americans. Additionally, some health issues are rising among White but not Black Americans. Across two representative samples, we test whether White = wealthy stereotypes lead White Americans to feel relatively worse off than their racial group and whether these perceptions have health consequences. Across both samples, White Americans perceived their own status to be significantly lower than the status of the majority of White Americans. In contrast, Black Americans perceived their own status to be significantly higher than the majority of Black Americans. Critically, status comparisons between the self and one’s racial group predicted the experience of fewer positive emotions among White, but not Black, Americans, which mediated reduced mental and physical health. We conclude that race/class stereotypes may shape how poverty subjectively feels.

Can Hostile Attitudes and Hostile Affections Lead to Depressive Symptoms Under Stress? A Study Based on Racial/Ethnic and Gender Differences

BACKGROUND

Stress has a significant influence on the development of depressive symptoms. An individual's coping style and resilience may moderate the symptoms of depression. This study is aimed to investigate the role of coping styles and resilience to depressive symptoms when individuals are facing stress in life based on racial/ethnic and gender differences.

METHODS

Enrolled individuals were assessed using the Unfairness Scale, City Stress Inventory, Cook-Medley Hostility Scale, Conner-Davidson Resilience Scale, and Beck Depression Inventory (BDI).

RESULTS

Three hundred ninety-six individuals completed the rating scales. There were significant interactions between race and unfairness, city stress (P = 0.006, P < 0.001), and between gender and city stress (P = 0.016). AAs and males suffer more stress than EAs and females. Hostile attitudes and affects act as mediators and significantly affect the relationship between stress and depressive symptoms (indirect effect: B = 0.812, P < 0.001; direct effect: B = 1.015, P < 0.001). Individuals with high resilience reported lower BDI scores. AAs with high stress and medium resilience had a buffer effect on depressive symptoms, while EAs did not.

CONCLUSION

The racial and gender effects of stress on depressive symptoms were significant. Individuals who have frequently experienced stress exhibited a more hostile attitude/affect compared to those who have experienced less stress. Furthermore, individuals who had a more hostile attitude/affect were more likely to be affected by depressive symptoms. Resilience has a protective factor for all participants, and medium resilience had a better buffer effect for AAs compared to EAs. There should be training for boosting resilience in schools and in vulnerable communities.

The Detrimental Influence of Racial Discrimination on Child Health in the United States

BACKGROUND

The current literature describing the largely damaging effect of racial discrimination on child health is weakened by several confounding factors. We aimed to: 1) describe the relation between racial discrimination and child health and 2) evaluate the potential mediating role of mental health relating racial discrimination to child health, using methods that mitigate confounding.

METHODS

Using the 2011-2012 National Survey of Children's Health (N = 95,677), we performed: 1) propensity score analysis, matching and comparing discrimination-exposed to non-exposed children and 2) structural equation modeling, examining mental health as a mediator of the pathway between discrimination and child health.

RESULTS

In the first approach, the proportion of children with excellent health was 5.4% (95% Confidence Interval (CI), 3.6,7.2%) lower with exposure to racial discrimination. Among minority children, those with low income had the greatest decrements in general health associated with racial discrimination. Among white children, those with high income had the greatest decrements. In the structural equation model, minority children had higher odds of experiencing racial discrimination (Odds ratios (ORs) ≥ 5.47, [95% CIs, 4.92,10.6]); meanwhile, children who experienced discrimination were more likely to have anxiety and depression (ORs ≥ 3.58, [95% CIs, 2.87,4.58]), which were linked to lower odds of excellent health (ORs ≤ 0.44, [95% CIs, 0.41.52]).

CONCLUSION

The negative health association of racial discrimination may be mediated by mental health and vary by racial, ethnic, or socioeconomic group. This work may stimulate the formation of targeted interventions to address these disparities.

Perceived Injustice Mediates the Relationship Between Perceived Childhood Neglect and Current Function in Patients with Chronic Pain: A Preliminary Pilot Study

Cumulative evidence supports the association between perceived childhood neglect and adulthood psychological and physical health. To date, pathways mediating this association remain largely unknown, though other evidence suggests that negative patterns of appraisal, including injustice perception related to pain, may be shaped by prior adverse social experiences. Consequently, the current study examined perceived injustice about chronic pain as a possible factor connecting childhood neglect and pain-related outcomes, given its relevance for both adaptation to chronic pain and to prior adverse life experiences. Patients (n = 742) visiting a tertiary pain clinic completed a survey administered via the Collaborative Health Outcomes Information Registry. Path modeling analyses were used to examine perceived injustice as a mediator of the relationships between childhood neglect and affective distress and physical function, after controlling for pain intensity and pain catastrophizing. Patients endorsing childhood neglect reported higher levels of perceived injustice and worse affective distress and physical function. Further, inclusion of perceived injustice as a mediator fully accounted for the relationship between neglect and current levels of physical function, and accounted for a significant proportion of the relationship between neglect and current levels of affective distress. These preliminary findings suggest that perceived injustice appears to be a more proximal factor by which prior experiences of neglect may adversely affect adaptation to chronic pain. Given the single-item assessment of childhood neglect and cross-sectional nature of the current findings, further research may focus on replicating these findings in longitudinal studies with validated measures and examining other adverse social experiences (e.g., abuse, social disparities) that may contribute to injustice perception and poor pain-related outcomes.

Describing Perceived Racial Bias Among Youth With Sickle Cell Disease

Objectives

Sickle cell disease (SCD) predominately affects Black Americans. This is the first study of its kind to describe the racial bias experiences of youth with SCD and their reactions to these experiences.

Methods

Participants were 20 youth with SCD (ages 13-21 years) who were asked to describe any racial bias events they experienced, as recorded on the Perception of Racism in Children and Youth measure (PRaCY). Interviews were recorded, transcribed, and analyzed by two independent raters using a conventional content analysis approach.

Results

All participants reported at least one incident of racial bias. Content analysis of racial bias events (n = 104) yielded 4 categories and 12 subcategories as follows: Perpetrator (Peers, Authority Figures, and General Public), Type of Racial Bias (Explicit, Implicit), Behavioral Reaction (Approach, Avoidant), and Emotional Response (Dysphoria, Anger, Unconcerned, Inferior, Anxious).

Discussion

This study provides a description of racial bias experiences within community and medical settings and highlights the need for further evaluation of the impact of racial bias among youth with SCD.

Injustice Appraisal, but not Pain Catastrophizing, Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain

Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.

The Pernicious Effects of Malicious versus Benign Envy: Perceived Injustice, Emotional Hostility and Counterproductive Behaviors in the Workplace

Despite the fact that literature regarding the implications of envy in the work environment has generated growing interest in recent years, the role of malicious and benign envy in the workplace has scarcely been studied. Therefore, the present study, using an experimental design, N = 213 (140 female and 73 male; Mage = 31.05, SD = 10.01; range from 18 to 68), aims to examine the effects of malicious (vs. benign) envy on perceived injustice, negative emotions, and the individual tendency to express counterproductive work behaviors. The results obtained showed that the mere activation of malicious envy (vs. benign envy) leads to an increased perceived injustice (p < .001, ηp2= .15), and to higher levels of negative emotions (p < .001, ηp2= .18) and counterproductive (harmful) behaviors toward the envied co-worker (p < .001, ηp2= .16). Additionally, we found that perceptions of injustice and negative emotions mediated the effect of malicious (vs. benign) envy on the inclination to express counterproductive work behaviors (Indirect Effect (IE) = .227, SE = .064, 95% CI [.127, .386]. Finally, these findings and their possible implications are discussed.

Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain

Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP), no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on white/Caucasian participant samples. The current study examined the associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N = 137) -51 (37.2%) white, 43 (31.4%) Hispanic, 43 (31.4%) black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated the association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared with white and Hispanic participants, black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression and pain-related disability. Black participants also reported higher pain intensity than white participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially informed antecedents of injustice appraisals. Perspective: Perceived injustice predicted worse outcomes in CLBP, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than their white or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.

Coping with Pain in the Face of Healthcare Injustice in Patients with Sickle Cell Disease

To evaluate the pain coping strategies of patients with sickle cell disease (SCD) who experience healthcare injustice from either physicians or nurses during medical visits for pain management. It is unknown how patients' coping with pain relates to their experiences of healthcare injustice from physicians or nurses. This descriptive comparative study included adult outpatients with SCD who completed the PAINReportIt^®, Healthcare Justice Questionnaire^©, and Coping Strategies Questionnaire-SCD. Data were analyzed using independent t tests. Frequent coping strategies of patients who experienced healthcare justice from physicians were praying-hoping and from nurses were praying-hoping, calming self-statements, diverting attention, and increasing behavioral activity. In contrast, frequent coping strategies of patients who experienced healthcare injustice from physicians were catastrophizing and isolation and from nurses were isolation. Patients who experienced healthcare justice used different sets of pain coping strategies than those who experienced healthcare injustice during medical visits for pain management.

Telomere length and procedural justice predict stress reactivity responses to unfair outcomes in African Americans

This experiment demonstrates that chromosomal telomere length (TL) moderates response to injustice among African Americans. Based on worldview verification theory - an emerging psychosocial framework for understanding stress - we predicted that acute stress responses would be most pronounced when individual-level expectancies for justice were discordant with justice experiences. Healthy African Americans (N=118; 30% male; M age=31.63years) provided dried blood spot samples that were assayed for TL, and completed a social-evaluative stressor task during which high versus low levels of distributive (outcome) and procedural (decision process) justice were simultaneously manipulated. African Americans with longer telomeres appeared more resilient (in emotional and neuroendocrine response-higher DHEAs:cortisol) to receiving an unfair outcome when a fair decision process was used, whereas African Americans with shorter telomeres appeared more resilient when an unfair decision process was used. TL may indicate personal histories of adversity and associated stress-related expectancies that influence responses to injustice.

Socioeconomic status discrimination and C-reactive protein in African-American and White adults

OBJECTIVES

We examined the association between socioeconomic status (SES) discrimination and C-reactive protein (CRP) in a biracial cohort of middle-aged adults using an intersectionality framework.

METHODS

Participants were 401 African-American and White adults from a population-based cohort in the Southeastern United States. SES discrimination was self-reported with a modified Experiences of Discrimination Scale, and CRP levels were assayed from blood samples. Linear regression analyses were used to examine the associations among SES discrimination, race, education, and CRP after controlling for age, gender, racial and gender discrimination, financial and general stress, body mass index, smoking, sleep quality, and depressive symptoms. Intersectional effects were tested using race×SES discrimination, education×SES discrimination and race×education×SES discrimination interactions.

RESULTS

Adjusting for sociodemographics, racial discrimination, gender discrimination, and all relevant two-way interaction terms, we observed a significant race×education×SES discrimination interaction (p=0.019). In adjusted models stratified by race and education, SES discrimination was associated with elevated CRP among higher educated African-Americans (β=0.29, p=0.018), but not lower educated African-Americans (β=-0.13, p=0.32); or lower educated (β=-0.02, p=0.92) or higher educated (β=-0.01, p=0.90) Whites.

CONCLUSIONS

Findings support the relevance of SES discrimination as an important discriminatory stressor for CRP specifically among higher educated African-Americans.

Discrimination, Racial/Ethnic Identity, and Substance Use Among Latina/os: Are They Gendered?

BACKGROUND

Prior research suggests that stronger racial/ethnic identification offsets negative effects of discrimination on substance use. Yet research in this area and on whether gender modifies this association is limited for Latina/os.

PURPOSE

The purpose of the present study is to examine whether different sources of discrimination (everyday and racial/ethnic) are associated with substance use (alcohol use disorder, smoking), if racial/ethnic identity buffers this association, and the potential moderating role of gender among these variables.

METHODS

We present cross-sectional, US population-based data from the Latina/o adult sample (1427 females and 1127 males) of the National Latino and Asian American Study. Respondents completed self-reported measures of everyday and racial/ethnic discrimination, racial/ethnic identity, smoking status, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) lifetime alcohol use disorder.

RESULTS

Weighted logistic regression analyses showed that before inclusion of three-way interactions and adjusting for covariates, everyday discrimination predicted increased risk for any DSM-IV lifetime alcohol use disorders. Moderation analyses revealed that the effect of everyday discrimination on the risk of being a current smoker was strongest for Latino men with high levels of racial/ethnic identity compared to those with low racial/ethnic identity. No differences were noted among Latino women. There were no main or interaction effects of racial/ethnic discrimination for any substance use outcome.

CONCLUSIONS

Findings suggest differential associations for type of discrimination and outcome and that the role of racial/ethnic identity is gender-specific for smoking, appearing particularly detrimental for Latino men reporting high levels of racial/ethnic identity.

Healthcare injustice in patients with sickle cell disease

Purpose

– The purpose of this paper is to detail experiences that sickle cell disease (SCD) patients associate with healthcare justice and injustice in pain control.

Design/methodology/approach

– A content analysis study of open-ended comments written by 31 participants who completed a 20-item healthcare injustice questionnaire-revised twice: once in reference to experiences with doctors and once in reference to experiences with nurses.

Findings

– Participants’ mean age was 33±10 years; most were African-Americans and women. Themes showed: the four domains of healthcare justice were represented in patients’ comments; examples of justice and injustice were provided; specific incidents and interactions with healthcare providers were memorable to patients; and setting was a factor important to healthcare experiences because expectations about services vary by setting.

Research limitations/implications

– Patients were self-selected. Future work will include qualitative interviews and focus groups to uncover more details about how patients experience healthcare injustice.

Practical implications

– Additional training is needed for SCD providers and about proper management of sickle cell pain; educational modules are also needed that address areas of healthcare injustice by patients.

Originality/value

– The authors are the first to report how patients define healthcare justice and injustice. Specific details about memorable SCD patient-provider interactions and pain control are described.

Perceived discrimination and poor health: Accounting for self-blame complicates a well-established relationship

Past research has reliably demonstrated that both perceiving oneself as a target of discrimination and a tendency to blame negative events on oneself undermine psychological and physical health. These two literatures, however, have evolved largely independently of one another. The present research sought to develop a deeper understanding of the health effects of perceived discrimination by taking into account the relationship between perceived discrimination and self-blame. In two correlational studies, we examined perceived ethnic-based discrimination, self-blame, and psychological and physical health among White and ethnic minority adults residing in the United States. Contrary to the hypothesis that attributing negative events to discrimination leads to the discounting of self-blame, perceived discrimination and self-blame were positively related. Replicating past research, perceived discrimination was negatively related to health when examined as an independent predictor. When perceived discrimination and self-blame were examined as simultaneous predictors of health, however, the negative health effects of perceived discrimination were weakened. Furthermore, an alternative model revealed that perceived discrimination indirectly predicted decreased health through increased self-blame. The present findings highlight the importance of taking self-blame into account when assessing and interpreting the negative health effects of perceived discrimination.

Neighborhood racial composition, racial discrimination, and depressive symptoms in African Americans

While evidence indicates that experienced racial discrimination is associated with increased depressive symptoms for African Americans, there is little research investigating predictors of experienced racial discrimination. This paper examines neighborhood racial composition and sociodemographic factors as antecedents to experienced racial discrimination and resultant levels of depressive symptoms among African American adults. The sample included 505 socioeconomically-diverse African American adults from Baltimore, MD. Study data were obtained via self-report and geocoding of participant addresses based on 2010 census data. Study hypotheses were tested using multiple pathways within a longitudinal Structural Equation Model. Experienced racial discrimination was positively associated with age and sex such that older individuals and males experienced increased levels of racial discrimination. In addition, the percentage of White individuals residing in a neighborhood was positively associated with levels of experienced racial discrimination for African American neighborhood residents. Experienced racial discrimination was positively associated with later depressive symptoms. Neighborhood-level contextual factors such as neighborhood racial composition and individual differences in sociodemographic characteristics appear to play an important role in the experience of racial discrimination and the etiology of depression in African American adults.

Perceived injustice predicts stress and pain in adults with sickle cell disease

Research evidence shows that perceived injustice is a context-based unfair treatment that has negative influence on health outcomes. We examined the contribution of patients' perceived injustice regarding interactions with health care providers to stress and pain in adults with sickle cell disease (SCD). This study was a cross-sectional correlational pilot study. Included in the study were adults with SCD who received their care from a university-affiliated comprehensive sickle cell clinic. Participants were 52 adults whose mean age was 34 ± 11 years (minimum [min] 20 years, maximum [max] 70 years). Most of the patients were African American (n = 48, 92%) and female (n = 41, 79%). Forty-eight patients (92%) reported having a high school diploma or higher. Participants completed the perceived injustice questionnaire, perceived stress questionnaire, and the PAINReportIt, which includes questions to measure pain and demographics. We analyzed the data using the linear regression analyses. Perceived injustice from doctors was a significant predictor of perceived stress (p < .001) and pain (p = .002). Perceived injustice from nurses also was a significant predictor of perceived stress (p < .001) and pain (p = .02). The procedural, distributive, and informational domains of perceived injustice attributed to both doctors and nurses consistently predicted patients' perceived stress, but only the procedural and distributive domains of perceived injustice consistently predicted patients' pain. Findings suggest that perceived injustice was negatively associated with stress and pain in adults with SCD and warrant further investigation in a larger sample.

Perceived Teacher Unfairness, Instrumental Goals, and Bullying Behavior in Early Adolescence

The present study examined links between perceived teacher unfairness and bullying behavior in early adolescence, and the potential mediating role of instrumental social goals (specifically, agentic and separate goals). Based on social information processing theory, our model of proactive aggression was evaluated using path analysis in a sample of 662 Italian students aged between 11 and 13 years old (mean age = 12.55, SD = 0.99; 50.6% males). Results showed that perceived teacher unfairness positively relates to bullying, and that this relationship is partially mediated by the endorsement of instrumental goals. Our findings offer promising implications for future research and for intervention programs that aim to prevent school bullying through modifying the classroom context.

Stereotypes Can "Get Under the Skin": Testing a Self-Stereotyping and Psychological Resource Model of Overweight and Obesity

The authors draw upon social, personality, and health psychology to propose and test a self-stereotyping and psychological resource model of overweight and obesity. The model contends that self-stereotyping depletes psychological resources, namely self-esteem, that help to prevent overweight and obesity. In support of the model, mediation analysis demonstrates that adult Hispanics who highly self-stereotype had lower levels of self-esteem than those who self-stereotype less, which in turn predicted higher levels of body mass index (overweight and obesity levels). Furthermore, the model did not hold for the referent sample, White participants, and an alternative mediation model was not supported. These data are the first to theoretically and empirically link self-stereotyping and self-esteem (a psychological resource) with a strong physiological risk factor for morbidity and short life expectancy in stigmatized individuals. Thus, this research contributes to understanding ethnic-racial health disparities in the United States and beyond.

A multiple-group path analysis of the role of everyday discrimination on self-rated physical health among Latina/os in the USA

BACKGROUND

Few studies have examined the psychosocial mechanisms through which self-reported discrimination may influence the health status of Latinos.

PURPOSE

This study examined the mediating role of subjective social status in the USA and psychological distress on the relation between everyday discrimination and self-rated physical health, and the moderating role of gender and ethnicity.

METHODS

A US population-based sample of Latinos (N = 2,554) was drawn from the National Latino and Asian American Study. Respondents completed measures of everyday discrimination, subjective social status, psychological distress, and self-rated physical health.

RESULTS

Path analysis revealed that among the total sample, subjective social status and psychological distress sequentially mediated the effect of everyday discrimination on self-rated physical health. Psychological distress was a more consistent mediator across Latino subgroups. Gender and ethnicity moderated the mediation model.

CONCLUSIONS

This study provides a systematic examination of how psychosocial mechanisms may operate differently or similarly across Latino subgroups.

“It’s Not Fair”

Social justice appraisals refer to evaluations about fairness. These judgments are particularly pertinent in the experience of an undeserved fate, such as the suffering caused by a chronic health complaint. Published research examining the implications of these appraisals for adjustment to long-term painful conditions has emerged only recently, focused in two areas of investigation. One area shows that perceived injustice for pain may be a vulnerability factor that can block adjustment. The second area shows that maintaining some sense of justice in life, despite personal adversity, might protect psychological health when people are in pain. The review discusses this research and identifies key reactions to perceived injustice in the context of chronic pain. We call for investigations to synthesize this research, specifically to establish mediators and moderators of varied justice appraisals, to examine the relationships between core justice beliefs and injustice appraisals, and to identify drivers of responses to injustice. Finally, we consider interventions for those pain sufferers struggling to cope with perceived injustice.

Further validation of a measure of injury-related injustice perceptions to identify risk for occupational disability: a prospective study of individuals with whiplash injury

PURPOSE

Emerging evidence suggests that perceptions of injustice negatively impact return to work following whiplash injury. The Injustice Experiences Questionnaire (IEQ) is a recently developed measurement tool that may be used to assess injury-related perceptions of injustice following injury. To date, although research has supported the predictive validity of the IEQ, a clinical cut off for interpreting this measure has not been established. Increased support for the validity and clinical interpretation of the IEQ represents a first step towards identifying patients that might benefit from targeted intervention to mitigate the impact of perceived injustice.

METHODS

The IEQ was completed by 103 whiplash-injured patients upon commencement and completion of a standardized multidisciplinary rehabilitation program. One year later, individuals reported on their employment activity, pain severity, and use of narcotics. A receiver operating characteristic (ROC) curve analysis was conducted to identify the post-treatment IEQ score that was optimally associated with unemployment status at the follow-up. Secondary ROC curve analyses examined IEQ scores best associated with high pain severity and narcotic use 1 year following treatment.

RESULTS

Results indicated that IEQ scores significantly discriminated individuals who returned and did not return to work at the follow-up. An IEQ score of 19 optimally identified participants in terms of follow-up employment status. IEQ scores at the end of treatment also discriminated individuals with high and low pain severity ratings and narcotic use status at the follow-up. Post-treatment IEQ scores of 18 and 20 optimally identified participants who had high pain severity ratings and who were using narcotics at the follow-up, respectively.

CONCLUSIONS

These results further support the validity of the IEQ and provide a guideline for its clinical interpretation in patients with persistent pain and disability following musculoskeletal injury. IEQ scores above the identified cut off may represent a barrier to work return and may warrant targeted intervention.

Perceived injustice in fibromyalgia: psychometric characteristics of the Injustice Experience Questionnaire and relationship with pain catastrophising and pain acceptance

OBJECTIVE

To validate a Spanish version of the Injustice Experience Questionnaire (IEQ), a measure of perceived injustice, in a fibromyalgia sample and to examine its relationship with pain catastrophising and pain acceptance.

METHODS

The IEQ was administered along with the Pain Visual Analogue Scale, the Fibromyalgia Impact Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale (PCS) and the Chronic Pain Acceptance Questionnaire (CPAQ) to 250 primary care patients with fibromyalgia.

RESULTS

The IEQ had good test-retest reliability (intraclass correlation coefficient=0.98) and internal consistency (Cronbach's α=0.92). The factor structure obtained was similar to the original validation study. The multiple regression analyses showed that perceived injustice (PI) accounted for significant pain-related outcomes after controlling pain intensity, PCS and CPAQ. Principal component analysis of both the IEQ and the CPAQ taken together showed that the two constructs do not represent opposite extremes of the same dimension.

CONCLUSION

The IEQ is a reliable assessment tool for measuring PI among patients with fibromyalgia. PI seems to be distinct from catastrophising, although the two constructs are very similar. The factor analysis showed that PI and acceptance represent related constructs, and this entails relevant implications for therapy, as acceptance-based interventions would be appropriate.

A Longitudinal Study of Social Status, Perceived Discrimination, and Physical and Emotional Health Among Older Adults

This study examines the relationships between social status, perceived discrimination, and physical and emotional health using a nationally representative sample of 6,377 older adults from the 2006 and 2008 waves of the Health and Retirement Study. About 63% of older adults reported at least one type of everyday discrimination and 31% reported at least one major discriminatory event during lifetime. Blacks, those separated, divorced, or widowed, and those with lower household assets have higher levels of perceived discrimination than Whites, the married or partnered, and those with more assets. Perceived discrimination is negatively associated with changes in health over 2 years, and everyday discrimination has stronger effects than major discriminatory events, especially on emotional health. The effects of perceived everyday discrimination on changes in depressive symptoms and self-rated health are independent of general stress. Efforts to reduce discrimination, including perceptions of discrimination, can be beneficial for health in old age.

An investigation of constructions of justice and injustice in chronic pain: A Q-methodology approach

This study used Q-methodology to explore justice-related accounts of chronic pain. Eighty participants completed the Q-sorting procedure (33 chronic pain sufferers and 47 non-pain sufferers). Analysis revealed five main factors. Three factors blame: society for poor medical and interpersonal treatment; the chronic pain sufferer for indulging in self-pity and unempathic healthcare workers for ignoring patients. A fourth factor acknowledges the unfairness of pain and encourages self-reliance. The fifth factor rejects injustice in the chronic pain discourse. Overall, there is a shared view that chronic pain brings unfair treatment, disrespect and a de-legitimization of pain. Future research ideas are suggested.