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Rastogi R, Woolverton GA, Lee RM, Yip T, Stevens C, Chen JA, Liu CH. Microaggression and discrimination exposure on young adult anxiety, depression, and sleep. J Affect Disord 2024; 363:141-151. [PMID: 39029681 PMCID: PMC11343644 DOI: 10.1016/j.jad.2024.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Increasing research examines social determinants of health, including structural oppression and discrimination. Microaggression - subtle/ambiguous slights against one's marginalized identity - is distinct from discrimination, which typically presents as overt and hostile. The current study investigated the comparative effects of each exposure on young adult anxiety, depression, and sleep. Race-stratified analyses investigated patterns across groups. METHODS Young adults (N = 48,606) completed the Spring 2022 American College Health Association-National College Health Assessment III. Logistic regressions tested odds of anxiety symptoms, depressive symptoms, and sleep disturbance in association with microaggression and discrimination exposure. RESULTS Microaggression and discrimination equally predicted increased likelihood of anxiety symptoms (ORMicro = 1.42, ORDiscrim = 1.46). Discrimination more strongly predicted depressive symptoms (OR = 1.59) and sleep disturbance (OR = 1.54) than did microaggression (ORDepress = 1.24, ORSleep = 1.27). Race-stratified analyses indicated stronger associations between the each exposure and poor mental health in Whites than Asian American, Black/African American, and Hispanic or Latino/a/x respondents. LIMITATIONS Microaggression and discrimination exposure were each assessed using a single item. The outcome measures were not assessed using validated measures of anxiety, depression, and sleep (e.g., GAD-7, MOS-SS); thus results should be interpreted with caution. Analyses were cross-sectional hindering our ability to make causal inferences. CONCLUSIONS The findings provide preliminary evidence that microaggression and discrimination exposure operate on health in distinct ways. Racially marginalized individuals may demonstrate a blunted stress response relative to Whites. Treatment approaches must be tailored to the particular exposures facing affected individuals to maximize benefits.
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Affiliation(s)
- Ritika Rastogi
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Richard M Lee
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Tiffany Yip
- Department of Psychology, Fordham University, New York, NY, USA
| | - Courtney Stevens
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychology, Willamette University, Salem, OR, USA
| | - Justin A Chen
- Department of Psychiatry, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY, USA
| | - Cindy H Liu
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
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Williams TR, Davis BL, Jones P, Muwele C, Simpson I, Mashburn R. Controlling images and standards of beauty shapes body image: using a relational cultural approach to improve Black American women's well-being. ETHNICITY & HEALTH 2024:1-19. [PMID: 39048382 DOI: 10.1080/13557858.2024.2378320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES Controlling images and racialized stereotypical myths inform Eurocentric and cultural standards of beauty that shape Black American women's body image and well-being. Cultural responsiveness is crucial in understanding the lived experiences of Black American women, the systemic oppressive factors that subjugate them, and the impacts on their mental health. DESIGN An integrative review was conducted on controlling images and racialized stereotypes, standards of beauty, and body image to assess the contribution of these factors on Black American women's mental health, specifically, disordered eating, depression, and anxiety. Black Feminist and Intersectionality theories were used to conceptualize the role of controlling images and racialized stereotypes. RESULTS A conceptual model is offered, and a discussion is provided to explain the contribution of controlling images and racialized stereotypes on the manifestation of standards of beauty and Black American women's perceptions of body image which leads to poor mental health outcomes. CONCLUSIONS Cultural responsiveness in therapeutic settings is imperative, as providers must understand the intersecting effects of controlling images and racialized stereotypes on Black American Women's well-being. Relational Cultural Theory is offered as a therapeutic modality that invites practitioners to move beyond symptom reduction and basic 'helping' interventions and gives emphasis to a contextual and relational approach that aims to ameliorate the impacts of systemic oppression and gender and racial marginalization.
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Affiliation(s)
- Tiffany R Williams
- Psychological Sciences and Counseling, Tennessee State University, Nashville, TN, USA
| | - Brittan L Davis
- Counseling and Psychological Services, Brown University, Providence, RI, USA
| | - Paigean Jones
- School of Social Work, Howard University, Washington, DC, USA
| | - Chomba Muwele
- Psychological Sciences and Counseling, Tennessee State University, Nashville, TN, USA
| | - Ina Simpson
- Federal Correctional Complex, Yazoo City, MS, USA
| | - Reniece Mashburn
- Psychological Sciences and Counseling, Tennessee State University, Nashville, TN, USA
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Erving CL, Zajdel RA, Blevins KM, Fields ND, Martin ZT, McKinnon II, Parker R, Murden RJ, Udaipuria S, Swanson S, Booker B, Burey T, Vaccarino V, Moore RH, Johnson DA, Lewis TT. The association between Superwoman schema and subjective sleep quality among Black women. Sleep Health 2024; 10:302-307. [PMID: 38403559 PMCID: PMC11162945 DOI: 10.1016/j.sleh.2023.12.008] [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] [Received: 09/13/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Similar to women overall, Black women are socialized to be communal and "self-sacrificing," but unlike women from other racial/ethnic backgrounds, Black women are also socialized to be "strong" and "invulnerable." This phenomenon is labeled Superwoman schema. This study examined associations between Superwoman schema endorsement and subjective sleep quality. METHODS Participants included 405 Black women (ages 30-46). Superwoman schema was measured using a 35-item scale capturing five dimensions: obligation to present strength, suppress emotions, resistance to vulnerability, motivation to succeed, and obligation to help others. Superwoman schema overall and the five dimensions/subscales were analyzed. The Pittsburgh Sleep Quality Index (PSQI) was used to investigate overall subjective sleep quality (range: 0-19), poor sleep quality (PSQI >5), and specific sleep domains (eg, sleep duration, sleep disturbances). We fit linear and binary logistic regression models, adjusting for health-related and sociodemographic factors. RESULTS Superwoman schema dimension obligation to help others was associated with lower overall subjective sleep quality (β: .81, 95%CI=0.29, 1.32) and poor sleep quality (OR: 1.55, 95%CI=1.10, 2.19), as well as bad subjective sleep quality (OR: 1.76, 95%CI=1.18, 2.66), sleep disturbances (β: .73, 95%CI =0.07, 1.41), and daytime sleepiness (OR: 2.01, 95%CI=1.25, 3.26). Suppress emotions (OR: 1.41, 95%CI=1.01, 1.99) was associated with poor subjective sleep quality. Superwoman schema overall was associated with daytime sleepiness (OR: 2.01, 95%CI=1.06, 3.82). CONCLUSION Superwoman schema endorsement, especially obligation to help others and suppress emotions, may be important psychosocial risk factors for Black women's sleep health.
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Affiliation(s)
- Christy L Erving
- University of Texas at Austin, Department of Sociology & Population Research Center, Austin, Texas, USA.
| | - Rachel A Zajdel
- National Heart, Lung, and Blood Institute (NHLBI), Division of Intramural Research, Bethesda, Maryland, USA
| | - Kennedy M Blevins
- University of California, Irvine, School of Social Ecology, Department of Psychological Science, Irvine, California, USA
| | - Nicole D Fields
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Zachary T Martin
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Izraelle I McKinnon
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Rachel Parker
- Emory University, Rollins School of Public Health, Biostatistics and Bioinformatics Department, Atlanta, Georgia, USA
| | - Raphiel J Murden
- Emory University, Rollins School of Public Health, Biostatistics and Bioinformatics Department, Atlanta, Georgia, USA
| | - Shivika Udaipuria
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Seegar Swanson
- Emory University, Rollins School of Public Health, Biostatistics and Bioinformatics Department, Atlanta, Georgia, USA
| | - Bianca Booker
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Taylor Burey
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Reneé H Moore
- Drexel University, Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, Pennsylvania, USA
| | - Dayna A Johnson
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Tené T Lewis
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
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Wilson EJ, Primgaard AR, Hambrick EP, Marszalek JM, Berkley-Patton J, Nilsson JE, Bennett KK. Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors. J Behav Med 2024; 47:515-530. [PMID: 38281260 PMCID: PMC11031310 DOI: 10.1007/s10865-023-00464-0] [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] [Received: 05/22/2023] [Accepted: 12/08/2023] [Indexed: 01/30/2024]
Abstract
Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (β = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (β = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (β = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (β = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (β = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (β = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.
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Affiliation(s)
- Elizabeth J Wilson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA.
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Anahi R Primgaard
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Erin P Hambrick
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacob M Marszalek
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Johanna E Nilsson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kymberley K Bennett
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
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Abdallah K, Udaipuria S, Murden R, McKinnon II, Erving CL, Fields N, Moore R, Booker B, Burey T, Dunlop-Thomas C, Drenkard C, Johnson DA, Vaccarino V, Lim SS, Lewis TT. Financial Hardship and Sleep Quality Among Black American Women With and Without Systemic Lupus Erythematosus. Psychosom Med 2024; 86:315-323. [PMID: 38724039 PMCID: PMC11090455 DOI: 10.1097/psy.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To compare dimensions of financial hardship and self-reported sleep quality among Black women with versus without systemic lupus erythematosus (SLE). METHODS Participants were 402 Black women (50% with validated diagnosis of SLE) living in Georgia between 2017 and 2020. Black women with SLE were recruited from a population-based cohort established in Atlanta, and Black women without SLE were recruited to be of comparable age and from the same geographic areas as SLE women. Financial hardship was measured using three different scales: financial adjustments, financial setbacks, and financial strain. Sleep was assessed continuously using the Pittsburgh Sleep Quality Index (PSQI) scale. Each dimension of financial hardship was analyzed separately in SLE-stratified multivariable linear regression models and adjusted by sociodemographic and health status factors. RESULTS Dimensions of financial hardship were similarly distributed across the two groups. Sleep quality was worse in Black women with, versus without, SLE (p < .001). Among Black women with SLE, financial adjustment was positively associated with a 0.40-unit increase in poor sleep quality (95% CI = 0.12-0.67, p = .005). When accounting for cognitive depressive symptoms, financial setbacks and strain were somewhat attenuated for Black women with SLE. Overall, no associations between financial hardships and sleep quality were observed for the women without SLE. CONCLUSIONS Black women with SLE who experience financial hardships may be more at risk for poor sleep quality than Black women without SLE. Economic interventions targeting this population may help improve their overall health and quality of life.
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Affiliation(s)
- Khadijah Abdallah
- From the Department of Epidemiology (Abdallah, Udaipuria, Murden, McKinnon, Fields, Booker, Burey, Dunlop-Thomas, Drenkard, Johnson, Vaccarino, Lim, Lewis), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Sociology (Erving), Population Research Center, University of Texas, Austin, Texas; Dornsife School of Public Health (Moore), Drexel University, Philadelphia, Pennsylvania; Division of Rheumatology (Drenkard), Emory University; and Division of Rheumatology (Lim), Grady Health System, Atlanta, Georgia
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