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Cénat JM. Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience. Public Health 2024; 230:207-215. [PMID: 38574426 DOI: 10.1016/j.puhe.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms. STUDY DESIGN The study used a population-based cross-sectional design. METHODS Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables. RESULTS 32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009). CONCLUSIONS Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier, 4085, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
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Darius WP, Moshirian Farahi SMM, Kogan CS, Ndengeyingoma A, Cénat JM. Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02641-1. [PMID: 38429537 DOI: 10.1007/s00127-024-02641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Although suicidal ideation (SI) is a serious concern in Canada, its prevalence and related factors among Black individuals are poorly documented. Using data from the Mental Health of Black Communities in Canada project (BeCoMHeal), this study aimed to assess the prevalence of SI in Black individuals aged 15-40 years old in Canada, the mediating role of traumatic life events in the association between depression and SI, and the moderating role of racial microaggressions and internalized racism. METHODS Eight hundred and sixty participants aged between 15 and 40 years (Mage =24.96, SD = 6.29) completed the online questionnaire assessing sociodemographic data, depression symptoms, traumatic life events, racial microaggressions, internalized racism, and SI. RESULTS Findings showed that 25.7% of the participants reported having experienced SI (26.5% women, 22.7% men, 𝛘2 = 1.08, p = .299). The moderated-mediation model revealed that traumatic life events fully mediated the association between depression and SI (B = 0.12, p = .004; 95% CI, [0.04, 0.20]) and that racial microaggressions (B = - 0.03, p = .042; 95% CI [-0.07, - 0.00]) and internalized racism (B = 0.06, p = .006; 95% CI [0.02, 0.10]) moderated this relationship. CONCLUSION These findings underscore the importance of addressing racial microaggressions and internalized racism in therapy contexts among Black individuals to mitigate the potential negative impacts on their mental health. They also emphasize the need to develop effective, culturally sensitive, and racially adapted suicide prevention and intervention programs for Black communities in Canada.
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Affiliation(s)
- Wina Paul Darius
- School of Psychology (Clinical), University of Ottawa, 136 Jean-Jacques-Lussier, 4017, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | | | - Cary S Kogan
- School of Psychology (Clinical), University of Ottawa, 136 Jean-Jacques-Lussier, 4017, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON, Canada
| | - Assumpta Ndengeyingoma
- Department of Nursing, Université du Québec en Outaouais, Gatineau, QC, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON, Canada
| | - Jude Mary Cénat
- School of Psychology (Clinical), University of Ottawa, 136 Jean-Jacques-Lussier, 4017, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON, Canada.
- University of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, ON, Canada.
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Cénat JM, Broussard C, Jacob G, Kogan C, Corace K, Ukwu G, Onesi O, Furyk SE, Bekarkhanechi FM, Williams M, Chomienne MH, Grenier J, Labelle PR. Antiracist training programs for mental health professionals: A scoping review. Clin Psychol Rev 2024; 108:102373. [PMID: 38232574 DOI: 10.1016/j.cpr.2023.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
Racism has been shown to be directly deleterious to the mental health care received by minoritized peoples. In response, some mental health institutions have pledged to provide antiracist mental health care, which includes training mental health care professionals in this approach. This scoping review aimed to synthesize the existing published material on antiracist training programs among mental health care professionals. To identify studies, a comprehensive search strategy was developed and executed by a research librarian in October 2022 across seven databases (APA PsycInfo, Education Source, Embase, ERIC, MEDLINE, CINAHL, and Web of Science). Subject headings and keywords relating to antiracist training as well as to mental health professionals were used and combined. There were 7186 studies generated by the initial search and 377 by the update search, 30 were retained and included. Findings revealed four main antiracist competencies to develop in mental health professionals: importance of understanding the cultural, social, and historical context at the root of the mental health problems; developing awareness of individual biases, self-identity and privilege; recognizing oppressive and racism-sustaining behaviors in mental health care settings; and, employing antiracist competencies in therapy. Professionals who have taken trainings having the main components have developed skills on the interconnectedness between racialized groups' mental health and the cultural, religious, social, historical, economic, and political issues surrounding race, necessary for successful clinical practice and for providing anti-racist mental health care. This scoping review presents a summary of the essential antiracist competencies drawn from the literature which must be applied in a mental health care setting, to improve help seeking behaviors, and reduce distrust in mental health care professionals and settings.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Cathy Broussard
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Grace Jacob
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Cary Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Institute for Mental Health at The Royal, Ottawa, Ontario, Canada
| | - Kim Corace
- The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Institute for Mental Health at The Royal, Ottawa, Ontario, Canada
| | - Gloria Ukwu
- Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Onesi
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Monnica Williams
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Canada Research Chair on Mental Health Disparities, Ottawa, Ontario, Canada
| | - Marie-Hélène Chomienne
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on the Health Status of Black Immigrant Francophones, Ottawa, Ontario, Canada; Institut du Savoir Montfort, Ottawa, Ontario, Canada
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Hamilton A. Black therapists' experiences with their Black clients: A systematic review. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:150-174. [PMID: 37890044 DOI: 10.1111/jmft.12678] [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: 10/30/2022] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
This systematic review explores Black therapists' experiences with their Black clients. The search initially identified 459 possible articles. Through the study selection process, following the Cochrane Collaboration's guidelines, the 459 studies were narrowed down to 11 studies. A total of eight qualitative studies and three quantitative studies were identified. The analytic process of this review mirrored that of a thematic analysis due to the proportion of qualitative articles. Five themes emerged: Understanding the Black Experience, Connection to Clients, Working with Black Clients, Working While Black, and Training Black Therapists. Implications for training and supervision are discussed.
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Affiliation(s)
- Alexus Hamilton
- Psychological and Quantitative Foundations Department, University of Iowa, Iowa City, Iowa, USA
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Tulli-Shah M, Hilario C, Salami B, Pui-Hing Wong J. Caring in the Context of Systems: Service Provider Perspectives on the Mental Health Needs of Newcomer Young Men. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023:2752535X231217211. [PMID: 37991984 DOI: 10.1177/2752535x231217211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
In this study, we applied an intersectional framework to explore service providers' perspectives on the mental health needs of newcomer young men. We conducted focus groups and interviews with 26 service providers in Edmonton, Calgary, and Vancouver, Canada. Findings show that service providers made sense of young men's mental health needs and service access in the context of systems. We identified three interconnected themes: newcomer young men's senses of self in relation to macro-systems, including racism and economic marginalization; settling well as a determinant of mental health; and systems capacities and interdependent resilience. While service providers are engaged in cross-sectoral work in support of newcomer young men's mental health, this work is not being sufficiently supported. Further work is needed around cross-sector capacity bridging and advocacy, as well as the tailoring of services to young men without the assumption and reinforcement of gender stereotypes.
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Cénat JM, Dromer É, Darius WP, Dalexis RD, Furyk SE, Poisson H, Mansoub Bekarkhanech F, Diao DG, Gedeon AP, Shah MS, Labelle PR, Bernheim E, Kogan CS. Incidence, Racial Disparities and Factors Related to Psychosis among Black Individuals in Canada: A Scoping Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:713-731. [PMID: 37269120 PMCID: PMC10517652 DOI: 10.1177/07067437231178957] [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: 06/04/2023]
Abstract
OBJECTIVE Black communities are increasingly concerned about psychosis, a worry echoed by provincial health-care systems across Canada. Responding to the lack of evidence on psychosis in Black communities, this scoping review examined the incidence and prevalence of psychosis, access to care (pathways to care, coercive referrals, interventions, etc.), treatments received, and stigma faced by individuals with psychosis. METHOD To identify studies, a comprehensive search strategy was developed and executed in December 2021 across 10 databases, including APA PsycInfo, CINAHL, MEDLINE and Web of Science. Subject headings and keywords relating to Black communities, psychosis, health inequalities, Canada and its provinces and territories were used and combined. The scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping review (PRISMA-ScR) reporting standard. RESULTS A total of 15 studies met the inclusion criteria, all of them conducted in Ontario and Quebec. Results highlight different disparities in psychosis among Black communities. Compared to other Canadian ethnic groups, Black individuals are more likely to be diagnosed with psychosis. Black individuals with psychosis are more likely to have their first contact with health-care settings through emergency departments, to be referred by police and ambulance services, and to experience coercive referrals and interventions, and involuntary admission. Black individuals experience a lower quality of care and are the ethnic group most likely to disengage from treatment. CONCLUSION This scoping review reveals many gaps in research, prevention, promotion and intervention on psychosis in Black individuals in Canada. Future studies should explore factors related to age, gender, social and economic factors, interpersonal, institutional and systemic racism, and psychosis-related stigma. Efforts should be directed toward developing trainings for health-care professionals and promotion and prevention programs within Black communities. Culturally adapted interventions, racially disaggregated data, and increased research funding are needed.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Poisson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Muhammad S. Shah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Emmanuelle Bernheim
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Law, Civil Law Section, University of Ottawa, Ottawa, Ontario, Canada
- Canada Research Chair on Mental Health and Access to Justice, University of Ottawa, Ottawa, Ontario, Canada
| | - Cary S. Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
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Okoye H, Ojukwu E, Coronel Villalobos M, Saewyc E. Racism as a social determinant of health: Link to school-related psychosocial stressors in a population-based sample of African adolescents in Canada. J Adv Nurs 2023; 79:3498-3512. [PMID: 37070694 DOI: 10.1111/jan.15673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/01/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Racism is a social determinant of health that links to the health and well-being of racial/ethnic marginalized populations. However, perceived racism among African Canadian adolescents has not been adequately addressed, especially the link between racism and psychosocial stressors in school settings. AIM The aim of the current study was to assess racism and the link to school-related psychosocial stressors in a population-based sample of African Canadian adolescents. DESIGN Secondary analysis of the population-based 2018 British Columbia Adolescent Health Survey dataset. METHODS Logistic regression and generalized linear models tested the link between racism and psychosocial stressors among African Canadian adolescents (n = 942), adjusting for sociodemographic factors. RESULTS/FINDINGS More than 38% of the adolescents reported racism in the year preceding the survey. Regardless of gender and birthplace, and controlling for covariates, those who experienced racism were significantly more likely to report peer victimization, which includes teasing, social exclusion, cyberbullying and sexual harassment, and they felt less safe and connected to their schools compared to those who did not experience racism. With gender and birthplace differences, those who reported racism had higher odds of having been physically assaulted, stayed away from school, reported negative emotional responses and used avoidant behaviours to evade racism. CONCLUSION African Canadian adolescents are a visible racialized ethnic group in British Columbia, who are at heightened risk of racism and the associated psychosocial stressors. IMPACT These findings demonstrate the influences of racism on psychosocial stressors and related emotional responses among African Canadian adolescents. Nurses and other healthcare providers should be cognizant of racism and the psychological impacts when providing care to "at-risk" populations. Promoting positive and inclusive school climates and addressing racism at all levels of the society will foster better social integration, as well as improve the health and academic achievement of African Canadian adolescents. PATIENT OR PUBLIC CONTRIBUTION We presented the research and preliminary results of the data analysis to the African community (parents and adolescents who self-identify as African). The African community who attended the gathering corroborated the link between racism and health and reiterated that addressing these psychosocial stressors can promote adolescent health and well-being. The attendees accepted all the variables that we included in the analysis. However, they emphasized the need for more African representation among school staff and teachers to foster trust, feelings of safety and connectedness, and to promote African students' academic achievement and well-being. They stressed the need to train and build the capacities of the school staff and teachers so that they can assist students regardless of race. They emphasized the need to promote cultural awareness and cultural sensitivity among all healthcare providers. We included the recommendations in the appropriate sections of the manuscript.
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Affiliation(s)
- Helen Okoye
- Stigma and Resilience among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuela Ojukwu
- Stigma and Resilience among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mauricio Coronel Villalobos
- Stigma and Resilience among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Saewyc
- Stigma and Resilience among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Cénat JM, Farahi SMMM, Dalexis RD. Prevalence and determinants of depression, anxiety, and stress symptoms among Black individuals in Canada in the context of the COVID-19 pandemic. Psychiatry Res 2023; 326:115341. [PMID: 37482045 DOI: 10.1016/j.psychres.2023.115341] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
The COVID-19 pandemic has disproportionately affected Black communities in Canada in terms of infection, hospitalizations, and mortality rates. It exacerbated social, economic, and health disparities that can impact their mental health. We investigated the prevalence and predictors of symptoms of depression, anxiety, and stress in Black individuals in Canada. A community-representative weighted sample of 2002 Black individuals (51.66% women) aged 14 to 94 years old (Mean age 29.34; SD = 10.13). Overall, 40.94%, 44.50%, and 31.36% of participants were classified as having clinically meaningful anxiety, depression, and stress levels, respectively, based on DASS scores. Men (45.92%) reported a higher prevalence of anxiety than women (36.27%), χ2 (1) = 19.24, p<.001, but similar symptoms of depression and stress. The progression of the prevalence of anxiety, depression, and stress symptoms were consistent with the progression of the prevalence of everyday racial discrimination. After controlling for socio-demographic variables, regression models showed that everyday discrimination (B = 0.14, p=.001, B = 0.14, p= .006, B = 0.18, p< .001), major experiences of racial discrimination (B = 0.30, p=.046, B = 0.34, p= .033, B = 0.35, p=.024), and COVID-19 traumatic stressors (B = 0.43, p<.001, B = 0.43, p< .001, B = 0.44, p< .001) were positively associated with anxiety, while community resilience (B= -0.02, p= .039, B= -0.04, p= .001, B= -0.03, p= .014) was negatively associated with anxiety, depression, and stress, respectively. This study demonstrates the need to address racial discrimination in implementing prevention and intervention programs among Black individuals and to consider intersectional factors related to age, birthplace, language spoken, and province of residence.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, ON, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Cénat JM, Noorishad PG, Farahi Moshirian SMM, Darius WP, Flynn RJ. Reasons for admission to service and overrepresentation of Black youth in the child welfare system in Ontario, Canada: Does race matter? CHILD ABUSE & NEGLECT 2023; 140:106157. [PMID: 37002977 DOI: 10.1016/j.chiabu.2023.106157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND In studies exploring racial disparities in the Canadian child welfare systems, evidence is still lacking on the reasons for admission of children to service. OBJECTIVE This study investigates the reasons for admission to service in Ontario child welfare based on racial identities. METHODS We analyzed three-time points (2018, 2019, and 2020) of the Ontario Looking After Children (OnLAC) project. The sample included 4036 children (Mage = 14.30, SD = 2.21; 39.22 % girls). Univariate and multiple random-effects (REs) logistic regressions were performed to analyze the admission to service according to racial identities. RESULTS The results showed that the most frequent reason for admission to service was caregiver capacity in 2018 (56.02 %), 2019 (57.76 %), and 2020 (55.49 %). The results revealed few differences between racial groups on the reasons for their admission to service. There were more differences between racial groups in 2019 and 2020. The three-year cohort analyses showed that Black youth were less likely to have admission to service due to harm by omission (AOR = 0.41, 95%CI 0.18-0.93, z = -2.14, p < .05) and emotional harm (AOR = 0.40, 95%CI 0.17-0.92, z = -2.12, p < .05) than other racial groups. Results from the multiple random-effects logistic regression showed that in 2019 (AOR = 1.83, 95%CI 1.28-2.62, z = 3.32, p < .01) and 2020 (AOR = 2.13, 95%CI 1.41-3.21, z = 3.58, p < .01), youth were particularly at risk of having been admitted to service for caregiver capacity. CONCLUSIONS The present study reveals a comprehensive description of the reasons for admission in child welfare in Ontario according to racial identities. Implications for research, prevention, and intervention are discussed.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Canada; Universiity of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | | - Robert J Flynn
- School of Psychology, University of Ottawa, Ontario, Canada
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Cénat JM, Moshirian Farahi SMM, Bakombo SM, Dalexis RD, Pongou R, Caulley L, Yaya S, Etowa J, Venkatesh V. Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system. J Med Virol 2023; 95:e28738. [PMID: 37185858 DOI: 10.1002/jmv.28738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic disproportionately affected Black communities in Canada in terms of infection and mortality rates compared to the general population. Despite these facts, Black communities are among those with the highest level of COVID-19 vaccine mistrust (COVID-19 VM). We collected novel data to analyze the sociodemographic characteristics and factors associated with COVID-19 VM among Black communities in Canada. A survey was conducted among a representative sample of 2002 Black individuals (51.66% women) aged 14-94 years (M = 29.34; SD = 10.13) across Canada. Vaccine mistrust was assessed as the dependent variable and conspiracy theories, health literacy, major racial discrimination in healthcare settings, and sociodemographic characteristics of participants were assessed as independent variables. Those with a history of COVID-19 infection had higher COVID-19 VM score (M = 11.92, SD = 3.88) compared to those with no history of infection (M = 11.25, SD = 3.83), t (1999) = -3.85, p < 0.001. Participants who reported having experienced major racial discrimination in healthcare settings were more likely to report COVID-19 VM (M = 11.92, SD = 4.03) than those who were not (M = 11.36, SD = 3.77), t (1999) = -3.05, p = 0.002. Results also showed significant differences for age, education level, income, marital status, provinces, language, employment status, and religion. The final hierarchical linear regression showed that conspiracy beliefs (B = 0.69, p < 0.001) were positively associated with COVID-19 VM, while health literacy (B = -0.05, p = 0.002) was negatively associated with it. The mediated moderation model showed that conspiracy theories completely mediated the association between racial discrimination and vaccine mistrust (B = 1.71, p < 0.001). This association was also completely moderated by the interaction between racial discrimination and health literacy (B = 0.42, p = 0.008), indicating that despite having a high level of health literacy, those who experienced major racial discrimination in health services developed vaccine mistrust. This first study on COVID-19 VM exclusively among Black individuals in Canada provides data that can significantly impact the development of tools, trainings, strategies, and programs to make the health systems free of racism and increase their confidence in vaccination for COVID-19 and other infectious diseases.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada
| | | | - Schwab Mulopo Bakombo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Caulley
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Josephine Etowa
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ontario, Canada
| | - Vivek Venkatesh
- Department of Art Education, Concordia University, Quebec, Montreal, Canada
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Cénat JM, Kouamou LN, Moshirian Farahi SMM, Darius WP, Dalexis RD, Charles M, Kogan CS. Perceived racial discrimination, psychosomatic symptoms, and resilience among Black individuals in Canada: A moderated mediation model. J Psychosom Res 2022; 163:111053. [PMID: 36244137 DOI: 10.1016/j.jpsychores.2022.111053] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/02/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Although no study has explored psychosomatic symptoms in Black communities in Canada, several studies in the United States showed that psychological distress is often express as physical pain among African Americans. Using a cross-sectional design, the present study documents the frequency of psychosomatic symptoms and its association to racial discrimination, and resilience among Black individuals aged 15 to 40 in Canada. METHOD A total of 860 participants (Mage = 25.0 years, SD = 6.3), predominantly born in Canada (79.1%) and women (75.6%), completed the Symptom Checklist-90-Revised (somatization subscale), the Everyday Discrimination Scale, and the Resilience Scale-14. RESULTS Findings revealed that 81.7% of participants experienced psychosomatic symptoms, with higher prevalence among women (84.2%) compared to men (70.7%;), ꭓ2 = 21.5, p < .001; participants aged 25 to 40 years old (93.7%) compared to those aged 15-24 years old (75.2%) (ꭓ2 = 45.0, p < .001). Participants reporting greater racial discrimination had more psychosomatic symptoms (89.4%) compared to others (72.9%), ꭓ2 = 39.2, p < .001). A moderated mediation model showed that everyday racial discrimination was positively associated with psychosomatic symptoms (B = 0.1, SE = 0.01, p < .001). The model showed that the association between racial discrimination and psychosomatic symptoms was partially mediated by resilience (B = -0.01, SE = 0.0, p < .01), and negatively moderated by gender (B = -0.04, SE = 0.01, p < .01). In other words, being a woman is associated with higher levels of psychosomatic symptoms among those who have experienced racial discrimination. CONCLUSION By highlighting the association between racial discrimination and psychosomatic symptoms and the role of resilience and gender in this relation, this article reveals important factors to integrate to improve healthcare services, prevention, and interventions among Black individuals with psychosomatic symptoms.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Michée Charles
- Department of Sociology, Université Toulouse Jean Jaurès, Toulouse, France
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Canada
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Cénat JM, Noorishad PG, Bakombo SM, Onesi O, Mesbahi A, Darius WP, Caulley L, Yaya S, Chomienne MH, Etowa J, Venkatesh V, Dalexis RD, Pongou R, Labelle PR. A Systematic Review on Vaccine Hesitancy in Black Communities in Canada: Critical Issues and Research Failures. Vaccines (Basel) 2022; 10:1937. [PMID: 36423032 PMCID: PMC9695687 DOI: 10.3390/vaccines10111937] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 07/25/2023] Open
Abstract
Black communities have been disproportionately impacted by Coronavirus Disease 2019 (COVID-19) in Canada, in terms of both number of infections and mortality rates. Yet, according to early studies, vaccine hesitancy appears to be higher in Black communities. The purpose of this systematic review is to examine the prevalence and factors associated with vaccine hesitancy in Black communities in Canada. Peer-reviewed studies published from 11 March 2020 to 26 July 2022, were searched through eleven databases: APA PsycInfo (Ovid), Cairn.info, Canadian Business & Current Affairs (ProQuest), CPI.Q (Gale OneFile), Cochrane CENTRAL (Ovid), Embase (Ovid), Érudit, Global Health (EBSCOhost), MEDLINE (Ovid), and Web of Science (Clarivate). Eligible studies were published in French or English and had empirical data on the prevalence or factors associated with vaccine hesitancy in samples or subsamples of Black people. Only five studies contained empirical data on vaccine hesitancy in Black individuals and were eligible for inclusion in this systematic review. Black individuals represented 1.18% (n = 247) of all included study samples (n = 20,919). Two of the five studies found that Black individuals were more hesitant to be vaccinated against COVID-19 compared to White individuals, whereas the other three found no significant differences. The studies failed to provide any evidence of factors associated with vaccine hesitancy in Black communities. Despite national concerns about vaccine hesitancy in Black communities, a color-blind approach is still predominant in Canadian health research. Of about 40 studies containing empirical data on vaccine hesitancy in Canada, only five contained data on Black communities. None analyzed factors associated with vaccine hesitancy in Black communities. Policies and strategies to strengthen health research in Black communities and eliminate the color-blind approach are discussed.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Schwab Mulopo Bakombo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Olivia Onesi
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Aya Mesbahi
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Lisa Caulley
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Medicine, Family Medicine University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Ottawa, ON K1N 6N5, Canada
- The George Institute for Global Health, Imperial College London, London NW9 7PA, UK
| | - Marie-Hélène Chomienne
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Medicine, Family Medicine University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institut du Savoir Montfort, Ottawa, ON K1K 0T2, Canada
| | - Josephine Etowa
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Nursing, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Vivek Venkatesh
- Department of Art Education, Concordia University, Montreal, QC H3H 1M8, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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