1
|
Liu J, Feaster DJ, Shahid N, Lazarus K, Boga DJ, Willie P, Juste RS, Silva MF, Adeojo L, Wright M, Reid R, Gonzalez S, Madhu A, Warman C, Bolden R, Pan Y, Nelson CM, Hlaing W, Rodriguez A, Alcaide ML, Ironson G, Safren S, Wright I, Dale SK. Testing for Measurement Invariance (MI): Do the Structures of Microaggression, Discrimination, and Resilience Among Black Women Living with HIV Remain the Same Across Time? J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02087-w. [PMID: 39102174 DOI: 10.1007/s40615-024-02087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Assessing measurement invariance and the interplay of discrimination, microaggressions, and resilience among Black women living with HIV (BWLWH) across time utilizing latent class and repeated measure analysis may provide novel insights. A total of 151 BWLWH in a southeastern U.S. city completed surveys focused on multiple forms of microaggressions and discrimination (race, gender, sexual orientation, or HIV-related) and resilience factors (social support, self-efficacy, post-traumatic growth) at baseline, 3 months, and 6 months. To capture the psychosocial domains of discrimination, microaggressions, and resilience, three latent factors were developed and measured across three time points. Latent class analysis was also conducted to identify and compare meaningful subgroups based on varying levels of discrimination, microaggressions, and resilience reported. Three latent classes were created. MI testing suggested that measurement invariance was partially met (established metric invariance and scalar invariance), and it is possible to compare factor means of discrimination, microaggressions, and resilience across time. Latent factor mean scores of microaggressions and discrimination decreased after 3 and 6 months and increased for resilience after 6 months and varied over time across the three latent classes identified. The subgroup with the lowest level of discrimination and microaggressions and the highest level of resilience reported at baseline, experienced increases in resilience after months 3 and 6. Clinical interventions, research, and policies aimed at promoting resilience and reducing structural and social barriers linked to racism, sexism, HIV stigma, and classism are needed to improve the health and well-being of BWLWH.
Collapse
Affiliation(s)
- Jingxin Liu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Naysha Shahid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Devina J Boga
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Peyton Willie
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Reyanna St Juste
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Layomi Adeojo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mya Wright
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Aarti Madhu
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Chelsie Warman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Roxana Bolden
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - WayWay Hlaing
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan Rodriguez
- Department of Medicine (Infectious Diseases), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Ian Wright
- Department of Economics, University of Miami School of Business, Coral Gables, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| |
Collapse
|
2
|
Dale SK, Wright IA, Madhu A, Reid R, Shahid NN, Wright M, Sanders J, Phillips A, Rodriguez A, Safren SA. A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV. AIDS Behav 2024:10.1007/s10461-024-04408-w. [PMID: 39012452 DOI: 10.1007/s10461-024-04408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = - 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.
Collapse
Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Ian A Wright
- Department of Economics, Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Aarti Madhu
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Naysha N Shahid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Mya Wright
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Jasmyn Sanders
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Arnetta Phillips
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Allan Rodriguez
- Clinical Immunology, Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| |
Collapse
|
3
|
Jeon ME, Robison M, Robertson L, Udupa NS, Potter MR, Joiner TE. From identity-based distress to thinking "I am better off being dead:" Minority stress, posttraumatic cognitions, and suicidal ideation. J Affect Disord 2024; 354:143-151. [PMID: 38490586 DOI: 10.1016/j.jad.2024.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/18/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress - i.e., traumatic, insidious distress that results from acts of discrimination - may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI. METHODS Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337). RESULTS Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions. LIMITATIONS Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used. CONCLUSIONS Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality.
Collapse
Affiliation(s)
- Min Eun Jeon
- Department of Psychology, Florida State University, United States of America.
| | - Morgan Robison
- Department of Psychology, Florida State University, United States of America
| | - Lee Robertson
- Department of Psychology, Florida State University, United States of America
| | - Nikhila S Udupa
- Department of Psychology, Florida State University, United States of America
| | - Miracle R Potter
- Department of Psychology, Florida State University, United States of America
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States of America
| |
Collapse
|
4
|
Shahid NN, Dale SK. Gendered Racial Microaggressions, Self-silencing, Substance Use, and HIV Outcomes Among Black Women Living with HIV: A Structural Equation Modeling Approach. AIDS Behav 2024; 28:1276-1290. [PMID: 37642823 DOI: 10.1007/s10461-023-04157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
To better understand factors that may contribute to HIV outcomes experienced by Black women living with HIV (BWLWH), the present study examined the relationships among gendered racial microaggressions (GRM; subtle daily insults due to racism and sexism), self-silencing, substance use, antiretroviral therapy (ART) medication adherence, and viral suppression using structural equation modeling and path analysis. Self-silencing and substance use were examined as potential mediators. Participants were 119 BWLWH residing in South Florida. Results of this study showed that GRM was directly and positively associated with self-silencing and indirectly and negatively associated with medication adherence via self-silencing. GRM was directly related to higher alcohol use disorder severity. Self-silencing was directly and negatively associated with medication adherence. Medication adherence was directly and negatively related to viral suppression. The model fit the data well. Identifying the negative consequences of GRM in conjunction with self-silencing and substance use may help inform prevention and intervention strategies to improve mental health and HIV-related outcomes among BWLWH.
Collapse
Affiliation(s)
- Naysha N Shahid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| |
Collapse
|
5
|
Dawson D, Goodman SH, Granger DA, Laurent H. Associations Between Direct and Indirect Forms of Racism Exposure and Stress-Induced Inflammatory Response and Health in Pregnancy. J Racial Ethn Health Disparities 2023; 10:2641-2652. [PMID: 36344746 PMCID: PMC9640889 DOI: 10.1007/s40615-022-01442-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
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.
Collapse
Affiliation(s)
- Danyelle Dawson
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, USA
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA
| | - Sherryl H Goodman
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA
- Department of Psychology, Emory University, Atlanta, USA
| | - Douglas A Granger
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA
- Interdisciplinary Institute for Salivary Bioscience Research, University of California Irvine, Irvine, USA
- Science and Technology Center, Salimetrics, Carlsbad, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA
| | - Heidemarie Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, USA.
- Department of Human Development and Family Studies, Pennsylvania State University, State College, USA.
| |
Collapse
|
6
|
Marks LR, Hayes LR, Amos ATM, Moore KL, Dark T. 'Don't judge me 'til you walk through my shoes': A qualitative investigation of the experiences of women living with HIV. ETHNICITY & HEALTH 2023; 28:1128-1144. [PMID: 37439581 DOI: 10.1080/13557858.2023.2231667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Women living with the human immunodeficiency virus (HIV) are less of a focus in the HIV literature, which tends to focus on the HIV experiences of men who have sex with men (MSMs). Hence, we conducted a qualitative study that examined: (a) the type of stigma and discrimination that women living with HIV experience related to their HIV status, (b) the source of this stigma and discrimination, (c) their responses related to this stigma and discrimination, and (d) the ways in which women living with HIV cope with these experiences of stigma and discrimination. DESIGN Participants consisted of 14 self-identified women living with HIV that were recruited at a community organization in the Southern United States that provides services to individuals living with HIV. The participants ranged in age from 27 to 65 (M = 47.92, SD = 13.08). The sample primarily identified as Black (N = 12), followed by White (N = 1) and Multiracial (N = 1). Most women were cisgender (N = 13) with one woman identifying as transgender (N = 1). RESULTS Fourteen women participated in one of two focus groups (seven in each focus group), which were audio recorded and transcribed. We identified 24 categories across five domains (Stigma and Discrimination, Source of Stigma and Discrimination, Response to Stigma and Discrimination, Coping with Stigma and Discrimination, and Support). CONCLUSIONS This study identified that women living with HIV experience stigma and discrimination in a multitude of ways from different sources. Moreover, women with HIV responded to and coped in negative and positive ways. Multidimensional approaches including personal and community education may help alleviate the stigma and discrimination faced by women living with HIV.
Collapse
Affiliation(s)
- Laura Reid Marks
- Department of Educational Psychology and Leaning Systems, College of Education, Florida State University, Tallahassee, FL, USA
| | - Lauren R Hayes
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Asia T M Amos
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Kanesha L Moore
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Tyra Dark
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
7
|
Nillni YI, Horenstein A, McClendon J, Duke CC, Sawdy M, Galovski TE. The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans. PLoS One 2023; 18:e0291965. [PMID: 37751447 PMCID: PMC10521990 DOI: 10.1371/journal.pone.0291965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Black and Hispanic/Latinx individuals experience a greater burden of mental health symptoms as compared to White individuals in the general population. Examination of ethnoracial disparities and mechanisms explaining these disparities among veterans is still in its nascence. The current study examined perceived everyday discrimination and income as parallel mediators of the association between race/ethnicity and PTSD, depression, and general anxiety symptoms in a sample of White, Black, and Hispanic/Latinx veterans stratified by gender. METHODS A random sample of 3,060 veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey. Veterans completed self-report measures of perceived discrimination via the Everyday Discrimination Scale, PTSD symptoms via the Posttraumatic Stress Disorder Checklist-5, depressive symptoms via the Patient Health Questionnaire, and anxiety symptoms via the Generalized Anxiety Disorder Questionnaire. RESULTS Models comparing Black vs. White veterans found that the significant effect of race on PTSD, depression, and anxiety symptoms was mediated by both perceived discrimination and income for both male and female veterans. Results were less consistent in models comparing Hispanic/Latinx vs. White veterans. Income, but not perceived discrimination, mediated the relationship between ethnicity/race and depression and anxiety symptoms, but only among women. CONCLUSIONS Results suggest that discrimination and socioeconomic status are important mechanisms through which marginalized social status negatively impacts mental health.
Collapse
Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Juliette McClendon
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Molly Sawdy
- Suffolk University, Boston, MA, United States of America
| | - Tara E. Galovski
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| |
Collapse
|
8
|
Erving CL, Zajdel R, McKinnon II, Van Dyke ME, Murden RJ, Johnson DA, Moore RH, Lewis TT. Gendered Racial Microaggressions and Black Women's Sleep Health. SOCIAL PSYCHOLOGY QUARTERLY 2023; 86:107-129. [PMID: 38371316 PMCID: PMC10869115 DOI: 10.1177/01902725221136139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Gendered racial microaggressions reflect historical and contemporary gendered racism that Black women encounter. Although gendered racial microaggressions are related to psychological outcomes, it is unclear if such experiences are related to sleep health. Moreover, the health effects of gendered racial microaggressions dimensions are rarely investigated. Using a cohort of Black women (N = 400), this study employs an intracategorical intersectional approach to (1) investigate the association between gendered racial microaggressions and sleep health, (2) assess whether gendered racial microaggressions dimensions are related to sleep health, and (3) examine whether the gendered racial microaggressions-sleep health association persists after accounting for depressive symptoms and worry. Gendered racial microaggressions were associated with poor sleep quality overall and four specific domains: subjective sleep quality, latency, disturbance, and daytime sleepiness. Two gendered racial microaggressions dimensions were especially detrimental for sleep: assumptions of beauty/sexual objectification and feeling silenced and marginalized. After accounting for mental health, the effect of gendered racial microaggressions on sleep was reduced by 47 percent. Future research implications are discussed.
Collapse
Affiliation(s)
| | - Rachel Zajdel
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Dale SK, Nelson CM, Wright IA, Etienne K, Lazarus K, Gardner N, Bolden R, Adeojo L, Patrick J, Wallen C, Liu J, Ironson G, Alcaide ML, Safren S, Feaster D. Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol 2023; 42:299-313. [PMID: 37141016 PMCID: PMC10167554 DOI: 10.1037/hea0001275] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Compared to non-Black women, Black women in the United States are more likely to be diagnosed with HIV, living with HIV, and have suboptimal HIV outcomes, disparities largely linked to structural and psychosocial factors that may impact mental health. METHOD 151 Black women living with HIV (BWLWH) enrolled in a longitudinal cohort study completed baseline assessments between October 2019 and January 2020 in the Southeastern United States. Measures captured microaggressions (gendered-racial, HIV, and Lesbian/Gay/Bisexual/Transgender/Queer), "macro" discrimination acts (gender, race, HIV, sexual orientation), resilience factors (self-efficacy, trait resilience, posttraumatic growth, positive religious coping, and social support), and mental health (depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic cognitions). Four structural equation models were estimated with latent discrimination (LD), latent microaggression (LM), and latent resilience (LR) as predictors and depressive symptoms, PTSD symptoms, posttraumatic cognitions, and latent mental health (LH) as outcomes. Indirect pathways from LD and LM via LR and LR as a moderator were estimated. RESULTS Models fit well based on indices. There were significant direct pathways from LM and LR to depressive symptoms, posttraumatic cognitions, and LH and a significant direct pathway from LM to PTSD symptoms, but not from LD to any mental health outcome. Indirect pathways were not significant. However, LR moderated the relationships between both LM and LD with PTSD symptoms. CONCLUSION Intersectional microaggressions and resilience factors may play key roles in BWLWH's mental health. Research is needed to examine these pathways overtime and provide opportunities to improve mental health and HIV outcomes among BWLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - C. Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Ian A. Wright
- Department of Economics, University of Miami School of Business
| | | | | | | | | | | | | | | | | | | | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), OB/GYN and Public Health, University of Miami Miller School of Medicine
| | | | - Daniel Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
10
|
Haeny AM, Holmes SC, Woerner J, Hicks TA, Ahuja M, Overstreet C, Amstadter A, Sartor CE. The Associations of Racial Discrimination and Neighborhood Disadvantage With World Assumptions Among Black, Latine, and Asian Young Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6798-6818. [PMID: 36433838 PMCID: PMC10211824 DOI: 10.1177/08862605221137701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The theory of shattered assumptions proposes that experiencing traumatic events can change how people view themselves and the world. Most adults experience a traumatic event during their lifetime, and some subsequently develop post-traumatic stress disorder (PTSD). However, the current conceptualization of trauma (i.e., Criterion A PTSD) may be too narrow to adequately capture the range of potentially traumatizing events that People of Color experience, including racial discrimination and neighborhood disadvantage. This study investigated the association of racial discrimination and neighborhood disadvantage with core beliefs about the world being safe and predictable (i.e., world assumptions) among a sample of Black, Latine, and Asian young adults. Multi-step analyses of covariance tested associations between racial discrimination and neighborhood disadvantage with world assumptions and whether these held in the context of other traumatic exposures. Results indicated that racial discrimination negatively impacted world assumptions among Asian young adults only and this effect remained in the context of trauma. In addition, low neighborhood support negatively impacted world assumptions across all racial groups and neighborhood violence negatively impacted world assumptions among Latine young adults only; however, this effect did not remain in the context of trauma. This study indicates it is worthwhile to consider other adverse events in the conceptualization of trauma, such as racial discrimination and neighborhood disadvantage, that may impact world assumptions and contribute to subsequent post-trauma psychopathology.
Collapse
Affiliation(s)
| | | | | | | | - Manik Ahuja
- East Tennessee State University, Johnson City, USA
| | | | | | | |
Collapse
|
11
|
Sharma R, Dale SK. Using Network Analysis to Assess the Effects of Trauma, Psychosocial, and Socioeconomic Factors on Health Outcomes Among Black Women Living with HIV. AIDS Behav 2023; 27:400-415. [PMID: 35927538 PMCID: PMC10712664 DOI: 10.1007/s10461-022-03774-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Black women living with HIV (BWLWH) face intersectional adversities impacting their wellbeing. This study utilized network analysis to assess the associations among adversities linked to racism, sexism, HIV stigma, and socioeconomic status (income, housing, education) and determine which adversities predict mental health outcomes, HIV viral load, and medication adherence more consistently among BWLWH. 119 BWLWH aged 18 years or older completed self-report measures on sociodemographics, adversity factors, and mental health outcomes. Viral load count was obtained through blood draws, and medication adherence was measured via Wisepill adherence monitoring device. Multiple regression analysis was used to assess if the more central factors in the network also predicted health outcomes more consistently than the less central factors. The four most central factors in the network were income, housing, gendered racial microaggression (GRM) frequency, and GRM appraisal. Multiple regression analysis revealed that GRM frequency, GRM appraisal, and the number of traumas contributed uniquely and were positively associated with both depressive symptoms and posttraumatic stress disorder symptoms. HIV-related discrimination contributed uniquely and was positively associated with HIV viral load.
Collapse
Affiliation(s)
- Ratanpriya Sharma
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| |
Collapse
|
12
|
Harb F, Bird CM, Webb EK, Torres L, deRoon-Cassini TA, Larson CL. Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation. Eur J Psychotraumatol 2023; 14:2211486. [PMID: 37229524 DOI: 10.1080/20008066.2023.2211486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/27/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Farah Harb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Claire M Bird
- Trauma Research Consortium, Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - E Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| |
Collapse
|
13
|
Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2023; 39:1-12. [PMID: 36322713 PMCID: PMC9889016 DOI: 10.1089/aid.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.
Collapse
Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Darren J. Baker
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
| | - George A. Kuchel
- UConn Center on Aging, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kathryn E. Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Bruce Brew
- Department of Neurology and HIV Medicine, St. Vincent's Hospital, Sydney, Australia
- Department of Neurology, Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, Department of Neurology, University of New South Wales Sydney, Sydney, Australia
- University of Notre Dame Australia, Sydney, Australia
| | - Lucette A. Cysique
- Faculty of Science, Department of Psychology, School of Psychology, University of New South Wales Sydney, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Neuroscience Unit, St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Chelsie Wallen
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joseph B. Margolick
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Divisions of Infectious Diseases, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
- Divisions of Geriatric Medicine, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
14
|
Moody AT, Lewis JA, Owens GP. Gendered Racism, Coping, and Traumatic Stress Among Black Women: The Moderating Roles of the Strong Black Woman Schema and Womanist Attitudes. PSYCHOLOGY OF WOMEN QUARTERLY 2022. [DOI: 10.1177/03616843221143752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to investigate the associations between gendered racism, coping strategies, the Strong Black Woman (SBW) schema, womanist attitudes, and traumatic stress symptoms among Black women. Specifically, this study utilized an intersectionality framework to test the link between gendered racism and traumatic stress as mediated by coping strategies (detachment, internalization, drug/alcohol use, education/advocacy, and resistance), and moderated by two aspects of Black women’s identity (SBW schema and womanist attitudes). Participants were 185 Black women from across the United States who completed an online survey. Results from a mediation analysis indicated that disengagement coping (detachment and drug/alcohol use) significantly mediated the gendered racism-traumatic stress link. In addition, the SBW schema moderated the gendered racism-detachment coping link, such that this association was stronger at high levels of SBW schema. Results from the moderated mediation analyses were not significant, though SBW schema was associated with greater disengagement coping (internalization and detachment) and womanist attitudes was associated with greater engagement coping (education/advocacy and resistance). These findings highlight the importance of understanding how Black women cope with gendered racism as well as internalized beliefs that may be beneficial or harmful.
Collapse
Affiliation(s)
- Anahvia T. Moody
- Department of Psychology, University of Tennessee, Knoxville, USA
| | - Jioni A. Lewis
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, USA
| | - Gina P. Owens
- Department of Psychology, University of Tennessee, Knoxville, USA
| |
Collapse
|
15
|
Sissoko DRG, Lewis JA, Nadal KL. It’s More Than Skin-Deep: Gendered Racial Microaggressions, Skin Tone Satisfaction, and Traumatic Stress Symptoms Among Black Women. JOURNAL OF BLACK PSYCHOLOGY 2022. [DOI: 10.1177/00957984221137957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examined the moderating effects of skin tone and skin tone satisfaction on the relations between gendered racial microaggressions and traumatic stress symptoms ( N = 237) among self-identified Black women between 18 and 50 years old. It was hypothesized that skin tone and skin tone satisfaction would moderate the relation between gendered racial microaggressions and traumatic stress, such that having a darker skin tone and lower levels of skin tone satisfaction would exacerbate the association between gendered racial microaggressions and traumatic stress symptoms. Results from two hierarchical multiple linear regression analyses indicated skin tone satisfaction significantly moderated the association between gendered racial microaggressions and traumatic stress symptoms, whereas skin tone did not. Findings suggest that skin tone satisfaction may play a bigger role in buffering or exacerbating the link between gendered racial microaggressions and mental health among Black women than skin tone alone. The results can inform future research and clinical practice on the important role of skin tone satisfaction in the link between gendered racial microaggressions and traumatic stress among Black women.
Collapse
Affiliation(s)
- D. R. Gina Sissoko
- The Graduate Center, City University of New York, New York, NY, USA
- John Jay College of Criminal Justice, New York, NY, USA
| | | | - Kevin L. Nadal
- The Graduate Center, City University of New York, New York, NY, USA
- John Jay College of Criminal Justice, New York, NY, USA
| |
Collapse
|
16
|
Boga DJ, Dale SK. Black Women Living with HIV: A Latent Profile Analysis of Intersectional Adversities, Resilience, and Mental Health. AIDS Patient Care STDS 2022; 36:364-374. [PMID: 36040393 PMCID: PMC9514596 DOI: 10.1089/apc.2022.0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black women living with HIV (BWLWH) face adversities, including discrimination (race, HIV, and gender related) and trauma. This study examines which latent profiles of resilience (R) and adversity (A) are most prevalent and their relationships to mental health among 119 BWLWH [age = 44.1 (standard deviation = 10.9)]. Questionnaires measured resilience (post-traumatic growth, trait/coping resilience, religious coping, social support), adversity (discrimination, trauma, microaggressions), and mental health [post-traumatic stress disorder (PTSD) symptoms, post-traumatic cognitions (PTC), and depressive symptoms]. Four salient profiles emerged through latent profile analysis and mental health differences were evaluated. Profile 1 (19.8%) reported lowest scores on 4 resilience measures, lowest traumas, and second lowest on discrimination (low resilience/low adversity-LR/LA). Profile 2 (13.8%) had second lowest on 3 resilience measures but second highest social support, highest/second highest on traumas and discrimination and microaggressions (low resilience/high adversity-LR/HA). Profile 3 (59.5%) exhibited higher scores on resilience and lowest scores on 3 of 4 adversity measures (high resilience/low adversity-HR/LA). Profile 4 (6.9%) reported high on 3 resilience measures, but third lowest on social support, and second highest/highest traumas, discrimination, and microaggressions (high resilience/high adversity-HR/HA). For PTC, the HR/LA group had significantly lower scores compared with the LR/LA and LR/HA groups; and LR/HA had higher PTC scores than the HR/HA group. PTSD scores were significantly lower for HR/LA than all profiles. Depression scores were significantly higher for LR/LA and LR/HA groups than HR/LA. Findings indicate that lower adversity alongside higher resilience leads to better mental health. Policies must address intersectional discrimination and prevent trauma impacting BWLWH; interventions are needed to improve social support and healing. Clinical Trial Registration number NCT02764853.
Collapse
Affiliation(s)
- Devina J. Boga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sannisha K. Dale
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida, USA
| |
Collapse
|
17
|
Alessi EJ, Kahn S. Toward a trauma-informed qualitative research approach: Guidelines for ensuring the safety and promoting the resilience of research participants. QUALITATIVE RESEARCH IN PSYCHOLOGY 2022. [DOI: 10.1080/14780887.2022.2107967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Edward J. Alessi
- The State University of New Jersey, School of Social Work, Rutgers, New Brunswick, New Jersey, USA
| | - Sarilee Kahn
- McGill University, School of School Social Work, Montreal, Québec, Canada
| |
Collapse
|
18
|
Banks BM, Landau S. Take a Deep Breath: Coping and the Cognitive Consequences of Racial Microaggression among Black College Women. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2022. [DOI: 10.1080/87568225.2022.2100855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Brea M. Banks
- Department of Psychology, Illinois State University, Normal, Illinois, USA
| | - Steven Landau
- Department of Psychology, Illinois State University, Normal, Illinois, USA
| |
Collapse
|
19
|
Yalch MM, Watters KN, Gallagher AR. Influence of Personality Traits on Post-Traumatic Cognitions of Sexual Assault. J Trauma Dissociation 2022; 23:416-431. [PMID: 34641762 DOI: 10.1080/15299732.2021.1989121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sexual assault is a common form of trauma that is associated with psychological distress for many people who experience it. One factor that influences the degree to which sexual assault survivors exhibit distress is the cognitions they form related to the assault in its aftermath. The more times the assault happens, the more disruptive are the post-traumatic cognitions, although both the frequency of sexual assault and nature of post-traumatic cognitions differ by gender. Another factor that may influence post-traumatic cognitions is personality, which emerging research suggests has an influence on post-traumatic response in general and post-traumatic cognitions in particular. However, there is little research on the influence of personality on post-traumatic cognitions related to sexual assault specifically. In this study, we examine the association between personality traits (Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness) and post-traumatic cognitions of sexual assault in a sample of sexual assault survivors recruited from Amazon's Mechanical Turk (N = 303) using a Bayesian approach to multiple regression. Results suggest that although the influence of traits varied depending on the post-traumatic cognition under analysis and the sex of the sexual assault survivor, Neuroticism was the primary predictor of post-traumatic cognitions over and above sexual assault frequency, although this applied more for men than for women. Study findings clarify previous research on the role of personality traits in post-traumatic response and suggest directions for future research and clinical intervention.
Collapse
Affiliation(s)
- Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California
| | | | - Alana R Gallagher
- Department of Psychology, Palo Alto University, Palo Alto, California
| |
Collapse
|
20
|
Wright IA, Reid R, Shahid N, Ponce A, Nelson CM, Sanders J, Gardner N, Liu J, Simmons E, Phillips A, Pan Y, Alcaide ML, Rodriguez A, Ironson G, Feaster DJ, Safren SA, Dale SK. Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020. Am J Public Health 2022; 112:S433-S443. [PMID: 35763751 PMCID: PMC9241469 DOI: 10.2105/ajph.2021.306675] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).
Collapse
Affiliation(s)
- Ian A Wright
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Rachelle Reid
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Naysha Shahid
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Amanda Ponce
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - C Mindy Nelson
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Jasmyn Sanders
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Nadine Gardner
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Jingxin Liu
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Ervin Simmons
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Arnetta Phillips
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Yue Pan
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Maria L Alcaide
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Allan Rodriguez
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Gail Ironson
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Daniel J Feaster
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Steven A Safren
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Sannisha K Dale
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| |
Collapse
|
21
|
Karver TS, Atkins K, Fonner VA, Rodriguez-Diaz CE, Sweat MD, Taggart T, Yeh PT, Kennedy CE, Kerrigan D. HIV-Related Intersectional Stigma and Discrimination Measurement: State of the Science. Am J Public Health 2022; 112:S420-S432. [PMID: 35763725 PMCID: PMC9241460 DOI: 10.2105/ajph.2021.306639] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/18/2023]
Abstract
Background. Across settings, individuals from populations that are multiply stigmatized are at increased risk of HIV and experience worse HIV treatment outcomes. As evidence expands on how intersecting stigmatized identities and conditions influence HIV outcomes, researchers have used diverse quantitative approaches to measure HIV-related intersectional stigma and discrimination. To date, no clear consensus exists regarding how to best quantitatively measure and analyze intersectional stigma and discrimination. Objectives. To review and document existing quantitative measures of HIV-related intersectional stigma and discrimination to inform research, programmatic, and policy efforts. Search Methods. We searched 5 electronic databases for relevant studies. References of included articles were screened for possible inclusion. Additional articles were screened on the basis of consultations with experts in the field. Selection Criteria. We included peer-reviewed studies published between January 1, 2010, and May 12, 2021, that were HIV related and presented 1 or more quantitative measures of stigma and discrimination using an intersectional lens in measure design or analysis. Data Collection and Analysis. Systematic methods were used to screen citations and abstract data via a standardized coding form. Data were analyzed by coding categories stratified according to 2 subgroups: (1) studies incorporating a single intersectional measure and (2) studies that examined intersectional stigma through analytical approaches combining multiple measures. Main Results. Sixteen articles met the inclusion criteria, 7 of which explicitly referenced intersectionality. Ten studies were from the United States. All of the studies included participants living with HIV. Among the 4 studies incorporating a single intersectional stigma measure, 3 explored race and gender stigma and 1 explored gender and HIV stigma. Studies involving analytic approaches (n = 12) mostly examined intersectional stigma via interaction terms in multivariate regression models. Three studies employed structural equation modeling to examine interactive effects or latent constructs of intersectional stigma. Conclusions. Research on the measurement of HIV-related intersectional stigma and discrimination is currently concentrated in high-income settings and generally focuses on the intersection of 2 identities (e.g., race and gender). Efforts are needed to expand appropriate application of intersectionality in the development, adaptation, and use of measures of HIV-related intersectional stigma and discrimination. The use of context-, identity-, or condition-adaptable measures should be considered. Researchers should also carefully consider how to meaningfully engage communities in the process of measurement development. Public Health Implications. The measures and analytic approaches presented could significantly enhance public health efforts in assessing the impact of HIV-related intersectional stigma and discrimination on critical health outcomes. (Am J Public Health. 2022;112(S4):S420-S432. https://doi.org/10.2105/AJPH.2021.306639).
Collapse
Affiliation(s)
- Tahilin Sanchez Karver
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Kaitlyn Atkins
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Virginia A Fonner
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Carlos E Rodriguez-Diaz
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michael D Sweat
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Tamara Taggart
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Ping Teresa Yeh
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Caitlin E Kennedy
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Deanna Kerrigan
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| |
Collapse
|
22
|
The Negative Effect of Social Discrimination on Pain Tolerance and the Moderating Role of Pain Catastrophizing. J Clin Psychol Med Settings 2022; 30:169-181. [PMID: 35244822 DOI: 10.1007/s10880-022-09860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
This study examined the negative impact of social discrimination on the time to pain tolerance during experimentally induced cold pressor pain among healthy individuals. It was hypothesized that the degree to which one catastrophized about pain would exacerbate the negative impact of a history discriminatory experiences on pain tolerance, and that this interaction would be different between individuals of a racial and ethnic minority and non-Hispanic white individuals (thus testing catastrophizing as a moderated moderator). Higher levels of discrimination were positively related to catastrophic thinking about pain, and there was a significant negative relationship between the level of experienced discrimination and time to pain tolerance. Pain catastrophizing emerged as a significant moderator in that when pain catastrophizing levels were high, there was no association between social discrimination and pain tolerance. A history of social discrimination was significantly associated with reduced pain tolerance at low and moderate levels of pain catastrophizing. Racial minority status did not significantly alter this moderating relationship. Implications for the importance of assessing sociocultural variables, such as experiencing social discrimination in the clinical assessment of the individual with pain are outlined.
Collapse
|
23
|
Nicholson AA, Siegel M, Wolf J, Narikuzhy S, Roth SL, Hatchard T, Lanius RA, Schneider M, Lloyd CS, McKinnon MC, Heber A, Smith P, Lueger-Schuster B. A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda. Eur J Psychotraumatol 2022; 13:2002572. [PMID: 35251527 PMCID: PMC8890555 DOI: 10.1080/20008198.2021.2002572] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Systemic oppression, particularly towards sexual minorities, continues to be deeply rooted in the bedrock of many societies globally. Experiences with minority stressors (e.g. discrimination, hate-crimes, internalized homonegativity, rejection sensitivity, and microaggressions or everyday indignities) have been consistently linked to adverse mental health outcomes. Elucidating the neural adaptations associated with minority stress exposure will be critical for furthering our understanding of how sexual minorities become disproportionately affected by mental health burdens. UNLABELLED Following PRISMA-guidelines, we systematically reviewed published neuroimaging studies that compared neural dynamics among sexual minority and heterosexual populations, aggregating information pertaining to any measurement of minority stress and relevant clinical phenomena. RESULTS Only 1 of 13 studies eligible for inclusion examined minority stress directly, where all other studies focused on investigating the neurobiological basis of sexual orientation. In our narrative synthesis, we highlight important themes that suggest minority stress exposure may be associated with decreased activation and functional connectivity within the default-mode network (related to the sense-of-self and social cognition), and summarize preliminary evidence related to aberrant neural dynamics within the salience network (involved in threat detection and fear processing) and the central executive network (involved in executive functioning and emotion regulation). Importantly, this parallels neural adaptations commonly observed among individuals with posttraumatic stress disorder (PTSD) in the aftermath of trauma and supports the inclusion of insidious forms of trauma related to minority stress within models of PTSD. CONCLUSIONS Taken together, minority stress may have several shared neuropsychological pathways with PTSD and stress-related disorders. Here, we outline a detailed research agenda that provides an overview of literature linking sexual minority stress to PTSD and insidious trauma, moral affect (including shame and guilt), and mental health risk/resiliency, in addition to racial, ethnic, and gender related minority stress. Finally, we propose a novel minority mosaic framework designed to inform future directions of minority stress neuroimaging research from an intersectional lens.
Collapse
Affiliation(s)
- Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Department of Medical Biophysics, Western University, London, Canada.,Homewood Research Institute, Guelph, Canada
| | - Magdalena Siegel
- Department of Developmental and Educational Psychology, University of Vienna, Vienna, Austria.,Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Jakub Wolf
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Sandhya Narikuzhy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Sophia L Roth
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Taylor Hatchard
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Canada
| | - Maiko Schneider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | | | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada
| | | | - Patrick Smith
- The Centre of Excellence for PTSD, Royal Ottawa Hospital, Ottawa, Canada
| | | |
Collapse
|
24
|
Levy ME, Waters A, Sen S, Castel AD, Plankey M, Molock S, Asch F, Goparaju L, Kassaye S. Psychosocial stress and neuroendocrine biomarker concentrations among women living with or without HIV. PLoS One 2021; 16:e0261746. [PMID: 34941922 PMCID: PMC8699620 DOI: 10.1371/journal.pone.0261746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Women living with HIV (WLWH) experience psychosocial stress related to social-structural vulnerabilities. To investigate neuroendocrine pathways linking stress and increased cardiovascular disease risk among WLWH, we evaluated associations between psychosocial stress (i.e., perceived stress, posttraumatic stress, and experiences of race- and gender-based harassment) and a composite neuroendocrine biomarker index among WLWH and women without HIV. METHODS In 2019-2020, Women's Interagency HIV Study participants in Washington, DC completed a questionnaire and provided blood and 12-hour overnight urine samples for testing of serum dehydroepiandrosterone sulfate (DHEA-S) and urinary free cortisol, epinephrine, and norepinephrine. Psychosocial stress was measured using the Perceived Stress Scale, PTSD Checklist-Civilian Version, and Racialized Sexual Harassment Scale. Latent profile analysis was used to classify participants into low (38%), moderate (44%), and high (18%) stress groups. Composite biomarker index scores between 0-4 were assigned based on participants' number of neuroendocrine biomarkers in high-risk quartiles (≥75th percentile for cortisol, epinephrine, and norepinephrine and ≤25th percentile for DHEA-S). We evaluated associations between latent profile and composite biomarker index values using multivariable linear regression, adjusting for socio-demographic, behavioral, metabolic, and HIV-related factors. RESULTS Among 90 women, 62% were WLWH, 53% were non-Hispanic Black, and median age was 55 years. In full multivariable models, there was no statistically significant association between psychosocial stress and composite biomarker index values among all women independent of HIV status. High (vs. low) psychosocial stress was positively associated with higher mean composite biomarker index values among all monoracial Black women (adjusted β = 1.32; 95% CI: 0.20-2.43), Black WLWH (adjusted β = 1.93; 95% CI: 0.02-3.83) and Black HIV-negative women (adjusted β = 2.54; 95% CI: 0.41-4.67). CONCLUSIONS Despite a null association in the overall sample, greater psychosocial stress was positively associated with higher neuroendocrine biomarker concentrations among Black women, highlighting a plausible mechanism by which psychosocial stress could contribute to cardiovascular disease risk.
Collapse
Affiliation(s)
- Matthew E. Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Westat, Rockville, Maryland, United States of America
- * E-mail:
| | - Ansley Waters
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Division of Clinical Epidemiology, Office of Epidemiology, Virginia Department of Health, Richmond, Virginia, United States of America
| | - Sabyasachi Sen
- Division of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC, United States of America
| | - Federico Asch
- Cardiovascular Core Laboratories and Cardiac Imaging Research, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Washington, DC, United States of America
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| |
Collapse
|
25
|
Dale SK, Pan Y, Gardner N, Saunders S, Wright IA, Nelson CM, Liu J, Phillips A, Ironson GH, Rodriguez AE, Alcaide ML, Safren SA, Feaster DJ. Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests. AIDS Behav 2021; 25:4000-4007. [PMID: 34046762 PMCID: PMC8158077 DOI: 10.1007/s10461-021-03321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
Black women living with HIV (BWLWH) in the U.S. face microaggressions based on race, gender, HIV-status, and sexual orientation. We examined changes in daily microaggressions and related distress among 143 BWLWH in Miami, FL. Microaggression-related distress increased from 52% at baseline/October, peaked at 70% during the holidays (November/December), declined to 55% in March when COVID-19 social distancing began, and peaked to 83% in June/July 2020 during widespread Black Lives Matters protests. Baseline viral suppression was associated with lower microaggressions across the 9-months. Microaggression-related distress may change due to social context and research is needed on microaggressions and viral load overtime.
Collapse
Affiliation(s)
- Sannisha K Dale
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nadine Gardner
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sherence Saunders
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Ian A Wright
- Department of Economics, Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Cheri M Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jingxin Liu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arnetta Phillips
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Gail H Ironson
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, College of Arts and Sciences, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
26
|
Spanierman LB, Clark DA, Kim Y. Reviewing Racial Microaggressions Research: Documenting Targets' Experiences, Harmful Sequelae, and Resistance Strategies. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 16:1037-1059. [PMID: 34498519 DOI: 10.1177/17456916211019944] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article, we review the theoretical and empirical literature on racial microaggressions from 2007 to 2020 (N = 138 articles). First, we refine racial microaggressions theory and update the definition to address mischaracterizations in the literature and clarify the term (i.e., "micro" refers to microlevel interactions rather than degree of harm). Next, we used four superordinate categories (i.e., pathologizing differences, denigrating and pigeonholing, excluding or rendering invisible, and perpetuating color-blind racial attitudes) in which to situate racial microaggression themes from the extant literature. Moreover, we consolidated and renamed existing themes to privilege targets' perspectives (e.g., facing assumptions of inferior status and enduring exoticization). We then synthesized qualitative and quantitative research that shows harmful sequelae of racial microaggressions (i.e., psychological and physiological symptoms). Extending prior research on coping with gendered racial microaggressions, we describe empirical findings on collective, resistance, and self-protective strategies to mitigate the harmful impact of racial microaggressions. We conclude with directions for future research.
Collapse
Affiliation(s)
| | - D Anthony Clark
- Interdisciplinary Humanities and Communication, Arizona State University
| | - Yeeun Kim
- Counseling and Counseling Psychology, Arizona State University
| |
Collapse
|
27
|
Thompson M, Dale SK. Gendered Racial Microaggressions and Self-Silencing Associated with Suicidality Among Black Women Living with HIV. J Racial Ethn Health Disparities 2021; 9:748-755. [PMID: 33783758 DOI: 10.1007/s40615-021-01009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
Black women represent the majority of women living with HIV in the USA and their risk for suicide may be linked to the impact of psychosocial stressors experienced at the intersection of race and gender such as gendered racial microaggressions (GRMS) and silencing the self (to maintain harmony). However, little research has been done on the relationship between microaggressions, self-silencing, and suicidality among BWLWH. As part of an intervention development study, 119 BWLWH in the Southeastern USA completed a baseline assessment consisting of a clinical interview (e.g., Mini-International Neuropsychiatric Interview) to assess suicidality, the gendered-racial microaggressions scale (GRMS), and the Silencing the Self-Scale. Multivariate linear regression analyses controlling for age and education indicated that higher microaggression appraisal scores on the GRMS scale (β = 2.80, p < .01) was associated with current suicidality and higher self-silencing was associated with current suicidality (β = 1.05, p < .01) and lifetime suicidality (β = 1.03, p < .01). Additional analyses that included major depression indicated that self-silencing uniquely contributed to suicidality above and beyond depression. Our findings support the importance of understanding how gender and race specific factors may relate to suicidality. Future research is needed to examine potential moderating factors (e.g., coping strategies) that may be enhanced through interventions and structural changes are needed to decrease acts of microaggressions.
Collapse
Affiliation(s)
- Monai Thompson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| |
Collapse
|
28
|
Berman M, Eaton LA, Watson RJ, Maksut JL, Rucinski KB, Earnshaw VA. Perpetuated HIV Microaggressions: A Novel Scale to Measure Subtle Discrimination Against People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:1-15. [PMID: 33617319 DOI: 10.1521/aeap.2021.33.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
HIV discrimination has served as a barrier to addressing the HIV epidemic and providing effective HIV treatment and care. Measuring HIV discrimination, particularly covert HIV discrimination, has proven to be complex. Adapted from a previous scale, we developed a perpetuated HIV micro-aggressions scale to assess covert forms of discriminatory beliefs among HIV-negative/unknown HIV status individuals. Factor analysis resulted in three subscales, explaining 73.58% of the scale's variance. The new scale demonstrated both convergent validity (HIV prejudice, HIV stereotypes) and discriminant validity (alcohol use, depressive symptomology). Perpetuated HIV microaggressions were significantly associated with HIV conspiracy beliefs, HIV prejudice, and HIV stereotypes. This new scale can serve as an important tool in evaluating perpetuated HIV microaggressions among HIV-negative individuals.
Collapse
Affiliation(s)
- Marcie Berman
- Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, Connecticut
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, Connecticut
| | - Ryan J Watson
- Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut, Storrs, Connecticut
| | - Jessica L Maksut
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine B Rucinski
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| |
Collapse
|
29
|
Dale SK, Safren SA. Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV. J Urban Health 2020; 97:377-386. [PMID: 32291580 PMCID: PMC7305274 DOI: 10.1007/s11524-020-00432-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Black women are disproportionately impacted by HIV and depression has been linked to negative HIV outcomes. Little attention has been given to social/structural factors that may drive depression among Black women living with HIV (BWLWH), including discrimination and gendered racial microaggressions (GRM). One hundred BWLWH completed measures on GRM, race- and HIV-related discrimination, and depressive symptoms, as well as a clinical interview for major depressive episode (MDE). GRM and race- and HIV-related discrimination were significantly associated with depressive symptoms and increased likelihood of MDE, but only GRM contributed uniquely in associations with both. Interventions targeting depression among BWLWH should address GRM and race- and HIV-related discrimination.
Collapse
Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| |
Collapse
|