Prevalence and Effects of Daily and Major Experiences of Racial Discrimination and Microaggressions among Black Individuals in Canada

Prevalence and moderators of depression symptoms among black individuals in Western Countries: a systematic review and meta-analysis among 1.3 million people in 421 studies

Background

Black people living in Western countries face a range of structural challenges and disparities (e.g. difficult socio-economic conditions, historical and intergenerational trauma, police brutality, racism) that adversely affect their mental health. This study assesses depression prevalence among Black individuals in minority contexts, examining sociodemographic factors, study type, evaluation period, publication year, and measures; and differences in depression rates between Black individuals and other racial groups (Asian, Indigenous, Latinx, White).

Methods

To identify studies, a comprehensive search strategy was developed and executed on September 30, 2022 across six databases (Allied and Complementary Medicine Database, APA PsycInfo, CINAHL. Cochrane CENTRAL, Embase, MEDLINE). The meta-analysis protocol was registered with PROSPERO (CRD42020155634). A random-effects meta-analysis estimated depression prevalence among Black individuals. Meta-regression tested differences by racial background, gender, sample type, evaluation method, age group, and publication year, reporting Odd ratios (ORs) with Confidence intervals (CIs).

Findings

From 21,215 citations, 421 studies were included with a sample of 1,305,366 Black individuals (411 studies were conducted in North America, 9 in Europe, and one in both Europe and North America). Pooled prevalence was 20.2% (95% CI: 18.7%-21.7%) among Black individuals, 13.4% (95% CI: 10.2-16.9) among Asians, 21.0% (95% CI: 18.7-23.5) among Latinx, and 17.8% (95% CI: 16.3-19.2) among Whites. It was significantly lower among White (OR = 0.98, p = 0.04, 95% CI: 0.95, 1.00) and Asian people (OR = 0.94, p = 0.004, 95% CI: 0.90, 0.98) compared to Black individuals. Pooled prevalence was 26.6% for the past week (95% CI: 24.6%-28.6%), 22.1% (95% CI: 19.2-23.1) for the past two weeks, 21.6% (95% CI: 11.6-33.5) for the past month, 9.1% (95% CI: 7.7%-10.7%) for the past year, and 16.6 (95% CI: 12.9-20.8) for lifetime. Depression prevalence was higher among Black women (24.3%; 95% CI: 21.3-27.4) and in North America (20.3%; 95% CI: 18.8-21.9). Depression prevalence was higher in 2000-2009 (23.5%; 95% CI: 20.9-26.2), decreased in 2010-2019 (17.7%; 95% CI: 15.6-19.9) and increased since 2020 (20.6%; 95% CI: 17.5-23.8).

Interpretation

As depression constitutes a burden among Black individuals in the West, it is urgent to mobilize public health agencies, research funding agencies and clinicians to develop and implement antiracist and culturally adapted prevention and intervention programs.

Funding

Public Health Agency of Canada, (grant number 1920-HQ-000053), the Social Sciences and Humanities Research Council (SSHRC) and Canadian Institutes of Health Research (CIHR) (grant number 469050).

Prevalence and risk factors of post-traumatic stress disorder and psychological distress symptoms in populations affected by Ebola in DR Congo before and during the COVID-19 pandemic

BACKGROUND

Ebola virus disease (May 19-September 16, 2020) and COVID-19 simultaneously affected the province of Equateur in DR Congo (DRC). To date, no longitudinal studies have explored symptoms of post-traumatic stress disorder (PTSD) and psychological distress (PD) related to COVID-19 or Ebola in DRC.

METHODS

A representative sample of 1669 participants aged ≥18 was recruited in March-April 2019 (Time 1) and August-September 2020 (Time 2). Questionnaires assessed PTSD (PCL-5) and PD (K-10) symptoms, social support, Ebola and COVID-19 exposure and related stigmatization.

RESULTS

Prevalence of PTSD (58.24 % in T1 to 43.74% at T2, x2(1) = 5.83, p < .001) and PD symptoms (49.44 % in T1 to 28.94 % at T2, x2 (1) = 5.83, p < .001) decreased from the Ebola outbreak to the COVID-19 pandemic. Populations living in rural areas consistently reported higher prevalence of PTSD and PD symptoms. Generalized estimating equation (GEE) models showed that stigmatization related to Ebola is the most important predictor of both PTSD (B = 0.90, p < .0001) and PD (B = 1.22, p < .001) symptoms, followed by exposure to Ebola (B = 0.41, p < .001 and B = 0.56, p < .001). COVID-19 related stigmatization only predicted PTSD symptoms (B = 0.21, p = .009). GEE models also confirmed that PTSD (B = -0.78, p < .001) and PD (B = -1.25, p < .001) decreased from Ebola outbreak to the COVID-19 pandemic. A significant interaction was found between Ebola stigmatization and time (B = -0.40, p = .021) for PTSD, and between exposure to Ebola and time (B = -0.36, p = .026) for PD.

CONCLUSIONS

This study confirms that Ebola related stigmatization is the most important predictor of mental health problems. Community-based strategies can address, reduce, and eliminate this issue.

Rates and Factors Related to COVID-19 Vaccine Uptake in Racialized and Indigenous Individuals in Canada: The Deleterious Effect of Experience of Racial Discrimination

Racialized and Indigenous communities have been disproportionately affected by COVID-19 infections and mortality, driven by systemic socioeconomic inequalities. However, how these factors specifically influence COVID-19 vaccine uptake is not documented among racialized individuals in Canada. The present study aims to examine COVID-19 vaccine uptake rates and related factors among racialized and Indigenous communities compared to White people in Canada. In total, 41,931 individuals aged 16 and older, consisting mainly of Arab, Asian, Black, Indigenous, and White individuals, were randomly invited to participate from a panel of 420,000 Canadian households. A total of 4220 participants completed this cross-sectional survey study in October 2023. In total, 89.60% of participants were vaccinated: 2.38% received one dose, 31.45% received two doses, 33.46% received three doses, 18.86% received four doses, and 13.86% received five doses and more. There were significant differences according to racial and ethnic background in vaccine uptake (χ2 = 57.45, p < 0.001), with Indigenous and Black individuals having lower vaccination rates (83.54%, OR = 1.98% and 84.76%, OR = 2.16, p < 0.01) compared to White individuals (91.66%). Confidence in health authorities was positively associated with vaccine uptake (B = 0.62, p < 0.001). Conspiracy beliefs partially mediated this association (B = -0.13, p < 0.001). Racial discrimination attenuated vaccine uptake, even if respondents had confidence in health authorities (B = -0.08, p < 0.001). Vaccine uptake was lowest amongst Indigenous and Black communities, placing them at higher risk of severe COVID-19 infection. In addition to mistrust of public health authorities due to racism, racialized communities are affected by conspiracy beliefs that hinder COVID-19 vaccine uptake. A whole-of-society approach to address barriers to vaccine uptake among racialized populations, including wage disparities, racial discrimination, is needed to eliminate racial health disparities and increase vaccination rates in racialized communities.

Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism

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.

Providing antiracist cognitive-behavioral therapy: Guidelines, tools, and tips

This article addresses gaps in cognitive-behavioral therapy (CBT) when it comes to integrating racial issues that affect racialized patients' mental health. Traditional adaptations of CBT focused on social, religious, and linguistic challenges but neglected the critical aspects of interpersonal, institutional and systemic racism, internalized racism and complex racial trauma. This oversight has resulted in less effective outcomes for racialized individuals. The article proposes clear, applicable guidelines for clinicians to provide anti-racist CBT interventions. They cover clinical self-development, re-design the CBT triangular (thoughts, feelings, behaviors) theoretical framework, provide practical tools and tips to facilitate antiracist CBT interventions. Clinicians are encouraged to engage in self-assessment to understand their own racial biases and develop competencies to address racial issues and dynamics in therapy. CBT theoretical framework is re-envisioned to include environmental factors that impact the lives of racialized people, acknowledging the pervasive effects of racism on mental and physical health. The article also highlights the importance of creating a culturally safe therapeutic environment for racialized children, adolescents, and families, and emphasizes the need for specialized training to effectively serve these groups. The proposed guidelines aim to transform CBT practice, increase confidence of racialized individuals in mental health care, and ultimately decolonize CBT interventions.

COVID-19 vaccine mistrust, health literacy, conspiracy theories, and racial discrimination among a representative ethnically diverse sample in Canada: The vulnerability of Arab, Asian, Black, and Indigenous peoples

Despite increased risk of severe acute respiratory syndrome coronavirus 2 infections and higher rates of COVID-19-related complications, racialized and Indigenous communities in Canada have lower immunization uptake compared to White individuals. However, there is woeful lack of data on predictors of COVID-19 vaccine mistrust (VM) that accounts for diverse social and cultural contexts within specific racialized and Indigenous communities. Therefore, we sought to characterize COVID-19 VM among Arab, Asian, Black, and Indigenous communities in Canada. An online survey was administered to a nationally representative, ethnically diverse panel of participants in October 2023. Arabic, Asian, Indigenous, and Black respondents were enriched in the sampling panel. Data were collected on demographics, COVID-19 VM, experience of racial discrimination, health literacy, and conspiracy beliefs. We used descriptive and regression analyses to determine the extent and predictors of COVID-19 VM among racialized and Indigenous individuals. All racialized respondents had higher VM score compared to White participants. Among 4220 respondents, we observed highest VM among Black individuals (12.18; ±4.24), followed by Arabic (12.12; ±4.60), Indigenous (11.84; ±5.18), Asian (10.61; ±4.28), and White (9.58; ±5.00) participants. In the hierarchical linear regression analyses, Black participants, women, everyday racial discrimination, and major experience of discrimination were positively associated with COVID-19 VM. Effects of racial discrimination were mediated by addition of conspiracy beliefs to the model. Racialized and Indigenous communities experience varying levels of COVID-19 VM and carry specific predictors and mediators to development of VM. This underscores the intricate interaction between race, gender, discrimination, and VM that need to be considered in future vaccination campaigns.

Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population

BACKGROUND

Race-related stress (RRS) is an unrecognized source of moral injury (MI)-or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined.

METHODS

Black Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity.

RESULTS

MIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (β = 0.10, p < 0.005).

CONCLUSIONS

All types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.

Harmonizing Assessments of Everyday Racial Discrimination Experiences: The Multigroup Everyday Racial Discrimination Scale (MERDS)

Reliable and valid assessment of direct racial discrimination experiences in everyday life is critical to understanding one key determinant of ethnoracial minority health and health disparities. To address psychometric limitations of existing instruments and to harmonize the assessment of everyday racial discrimination, the new Multigroup Everyday Racial Discrimination Scale (MERDS) was developed and validated. This investigation included 1,355 college and graduate students of color (Mage = 21.54, 56.0% women). Factor analyses were performed to provide evidence for structural validity of everyday racial discrimination scores. Item response theory modeling was used to investigate item difficulty relative to the level of everyday racial discrimination, and measurement error conditioned on the construct. MERDS scores were reliable, supported construct unidimensionality, and distinguished individuals who reported low to very high frequency of everyday racial discrimination. Results on the associations with racial identity and psychopathology symptoms, and utility of the scale are discussed.

The state of COVID-19 vaccine confidence and need in Black individuals in Canada: Understanding the role of sociodemographic factors, health literacy, conspiracy theories, traumatic stressors and racial discrimination

BACKGROUND

Black communities in Canada have been among the most affected by the COVID-19 pandemic, in terms of number of infections and deaths. They are also among those most hesitant about vaccination against COVID-19. However, while a few studies have documented the factors associated with COVID-19 vaccine hesitancy, those related to vaccine confidence remain unknown. To respond to this gap, this study aims to investigate factors associated to vaccine confidence in Black individuals in Canada.

METHODS

A total of 2002 participants (1034 women) aged 14 to 89 years old (Mean age = 29.34, SD = 10.13) completed questionnaires assessing sociodemographic information, COVID-19 vaccine confidence and need, health literacy, conspiracy beliefs, major racial discrimination, and traumatic stressors related to COVID-19.

RESULTS

Results showed an average score of COVID-19 vaccine confidence and need of 33.27 (SD = 7.24), with no significant difference between men (33.48; SD = 7.24) and women (33.08; SD = 7.91), t (1999) = 1.19, p = 0.234. However, there were significant differences according to employment status, migration status, age, inhabited province, spoken language, education, marital status, religion, and income. The linear regression model explained 25.8 % of the variance and showed that health literacy (B = 0.12, p < 0.001) and traumatic stressors related to COVID-19 (B = 0.21, p < .001) predicted COVID-19 vaccine confidence and need positively, while conspiracy beliefs (B = -1.14, p < 0.001) and major racial discrimination (B = -0.20, p = 0.044) predicted it negatively.

CONCLUSIONS

This study showed that building the confidence of Black communities in vaccines requires health education, elimination of racial discrimination in the Canadian society and a focus on certain groups (e.g., young people, those living in Quebec and Ontario). The results also argue in favor of involving community leaders and organizations in the development and implementation of vaccination-related tools, strategies and programs by city, provincial and federal public health agencies.

COVID-19 vaccine uptake, conspiracy theories, and health literacy among Black individuals in Canada: Racial discrimination, confidence in health, and COVID-19 stress as mediators

Factors influencing vaccine uptake in Black individuals remain insufficiently documented. Understanding the role of COVID-19 related stress, conspiracy theories, health literacy, racial discrimination experiences, and confidence in health authorities can inform programs to increase vaccination coverage. We sought to analyze these factors and vaccine uptake among Black individuals in Canada. A representative sample of 2002 Black individuals from Ontario, Quebec, Alberta, Nova Scotia, New Brunswick, British Columbia, and Manitoba, aged 14 years or older completed questionnaires assessing vaccine uptake, health literacy, conspiracy theories, racial discrimination experiences, COVID-19-related stress, and confidence in health authorities. Mediation analyses were conducted to assess (1) the effect of health literacy on COVID-19 vaccination uptake through confidence and need, COVID-19 related traumatic stress, and racial discrimination, and (2) the effect of conspiracy beliefs on COVID-19 vaccination uptake through the same factors. Overall, 69.57% (95% confidence interval, 67.55%-71.59%) of the participants were vaccinated and 83.48% of them received two or more doses. Those aged 55 years and older were less likely to be vaccinated, as well as those residing in British Columbia and Manitoba. Mediation models showed that the association between health literacy and COVID-19 vaccine uptake was mediated by confidence in health authorities (B = 0.02, p < 0.001), COVID-19-related stress (B = -0.02, p < 0.001), and racial discrimination (B = -0.01, p = 0.032), but both direct and total effects were nonsignificant. Lastly, conspiracy beliefs were found to have a partial mediation effect through the same mediators (B = 0.02, p < 0.001, B = -0.02, p < 0.001, B = -0.01, p = 0.011, respectively). These findings highlight the need for targeted interventions to address vaccine hesitancy and inform approaches to improve access to vaccinations among Black communities.

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

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

Caring in the Context of Systems: Service Provider Perspectives on the Mental Health Needs of Newcomer Young Men

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.

Incidence, Racial Disparities and Factors Related to Psychosis among Black Individuals in Canada: A Scoping Review

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.

The intersection of race and femininity in the classroom

This vignette told in eight graphic panels illustrates a story about how emotional responses associated with White femininity are used to derail a classroom discussion about racial injustice in a university setting. The panels show how this weaponization of femininity occurs and how it shields those who wield it from external criticism while centering themselves in conversations about race. Women of other races typically cannot access this psychological tactic, thus it constitutes a strategic intersectional use of race, psychology, and privilege to access a power position. In offering suggestions on how to respectfully engage in situations in which racial injustice is a topic of discussion, we unveil how failure of emotional regulation is part of the core psychological framework that leads to these kinds of power dynamics.

Gender differences in perceived racism threat and activism during the Black Lives Matter social justice movement for Black young adults

A longitudinal study involving 455 Black young adults living in Canada investigated whether gender and autonomous motivation influenced the relationship between perceived racism threat and Black Lives Matter (BLM) activism, and whether BLM activism influenced life satisfaction over time. A moderated mediation analysis using PROCESS Macro Model 58 tested the indirect effect of autonomous motivation on the relationship between perceived racism threat and BLM activism varying by gender. Multiple linear regression assessed how well BLM activism predicted life satisfaction. Black women perceived greater racism threat than Black men related to increases in BLM activism via the influence of autonomous motivation. BLM activism had a positive influence on life satisfaction over time, regardless of gender. This research suggests Black young women are playing pivotal roles in the BLM movement and helps us understand how motivation may be influencing involvement and well-being in social justice issues.

Prevalence and determinants of depression, anxiety, and stress symptoms among Black individuals in Canada in the context of the COVID-19 pandemic

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.

Reasons for admission to service and overrepresentation of Black youth in the child welfare system in Ontario, Canada: Does race matter?

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 (M_age = 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.

Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system

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.

A Systematic Review of Black People Coping With Racism: Approaches, Analysis, and Empowerment

This article reviews the current research literature concerning Black people in Western societies to better understand how they regulate their emotions when coping with racism, which coping strategies they use, and which strategies are functional for well-being. A systematic review of the literature was conducted, and 26 studies were identified on the basis of a comprehensive search of multiple databases and reference sections of relevant articles. Studies were quantitative and qualitative, and all articles located were from the United States or Canada. Findings demonstrate that Black people tend to cope with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly). Findings suggest gender differences in coping strategies. We also explore the relationship between coping with physical versus emotional pain and contrast functional versus dysfunctional coping approaches, underscoring the importance of encouraging personal empowerment to promote psychological well-being. Findings may help inform mental-health interventions. Limitations include the high number of American-based samples and exclusion of other Black ethnic and national groups, which is an important area for further exploration.

Prevalence of Current PTSD Symptoms Among a Sample of Black Individuals Aged 15 to 40 in Canada: The Major Role of Everyday Racial Discrimination, Racial Microaggresions, and Internalized Racism

OBJECTIVE

Most Black individuals in Canada report having experienced racial discrimination. Although previous studies have shown that there is a strong relationship between racial discrimination and posttraumatic stress disorder (PTSD), no studies in Canada have documented this association among Black individuals. The present study documents (1) the prevalence of PTSD among Black individuals using data from the Black Communities Mental Health project and (2) risk factors associated with PTSD, including racial microaggressions, everyday racial discrimination, and internalized racism.

METHOD

A total of 860 participants (75.6% of women) aged 15 to 40 years old (M = 24.96, SD = 6.29) completed questionnaires assessing PTSD, experience of traumatic events, racial microaggressions, everyday racial discrimination, and internalized racism.

RESULTS

Findings showed that 95.1% of participants reported exposure to at least one traumatic event during their lifetime. In total, 67.11% of participants reported probable PTSD with no significant difference between men and women (68.2% and 67.8%, χ² = 0.132, p = 0.72). Participants born in Canada were more likely to experience significant PTSD symptoms, compared to those born abroad (70.92% and 53.14%, χ² = 19.69, p < 0.001). A multivariable linear regression model of PTSD symptoms was computed using sociodemographic variables and exposure to traumatic events as independent variables, which explained 25.9% of the variance. In addition to these variables, a second model included racial microaggressions, everyday racial microaggressions, and internalized racism, which explained 51.8% of the variance. The model showed that traumatic events (b = 0.6; p = 0.02), racial microaggressions (b = 0.5; p < 0.001), everyday discrimination (b = 0.2; p = 0.03) and internalized racism (b = 0.5; p < 0.001) were positively associated with PTSD symptoms.

CONCLUSIONS

This article highlights the detrimental consequences of racial discrimination against Black people in Canada. Prevention and mental health programs aimed at mitigating its consequences on the lives of Black people and other racialized populations must be implemented.

Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review

BACKGROUND

In Canada, two of five individuals will be diagnosed with cancer in their lifetime and one in four will die from this disease. Given the disparities observed in health research among Black individuals, we conducted a scoping review to analyze the state of cancer research in Canadian Black communities regarding prevalence, incidence, screening, mortality, and related factors to observe advances and identify gaps and disparities.

METHODS

A comprehensive search strategy was developed and executed in December 2021 across 10 databases (e.g., Embase). Of 3451 studies generated by the search, 19 were retained for extraction and included in this study.

RESULTS

Studies were focused on a variety of cancer types among Black individuals including anal, breast, cervical, colorectal, gastric, lung, and prostate cancers. They included data on incidence, stage of cancer at diagnosis, type of care received, diagnostic interval length, and screening. A few studies also demonstrated racial disparities among Black individuals. This research reveals disparities in screening, incidence, and quality of care among Black individuals in Canada.

CONCLUSIONS

Given the gaps observed in cancer studies among Black individuals, federal and provincial governments and universities should consider creating special funds to generate research on this important health issue.

PLAIN LANGUAGE SUMMARY

Important gaps were observed on research on cancer among Black communities in Canada. Studies included in the scoping review highlights disparities in screening, incidence, and quality of care among Black individuals in Canada.

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

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

Black Canadians' Exposure to Everyday Racism: Implications for Health System Access and Health Promotion among Urban Black Communities

This study explores the social determinants of Black Canadians' exposure to everyday racism, its relationship to health system access, and implications for health promotion. We used data from the A/C Study survey on HIV transmission and prevention among Black Canadians. We implemented the survey (N = 1360) in 2018-2019 in Toronto and Ottawa-two large cities that together account for 42% of Canada's Black population-among self-identified Black residents aged 15-64 years, who were born in sub-Sahara Africa or the Caribbean or had a parent who was born in those regions. Participants reported racist encounters in the preceding 12 months using the Everyday Discrimination Scale. We assessed the socio-demographic correlates of racist experiences and the impact of racism on health system access using multivariable generalised linear models. Sixty percent of participants reported experiencing racism in the preceding 12 months. Based on the adjusted odds ratios, participants were more likely to experience racism if they were older, employed, Canadian-born, had higher levels of education, self-identified as LGBTQ + and reported generally moderate access to basic needs and adequate housing; and less likely to experience racism if they lived in Ottawa, self-identified as female or reported higher levels of social capital. Visiting a healthcare provider or facility, and difficulty accessing healthcare were associated with racist experiences. Racist experiences diminished the likelihood of being tested for HIV. Racist experiences were widespread, especially among those with higher levels of social wellbeing or greater exposure to Canadian institutions. Study participants also associated racist experiences with the healthcare system.

Beyond tokenism and objectivity: theoretical reflections on a transformative equity, diversity, and inclusion agenda for higher education in Canada

Universities, the sites for objective knowledge, apolitical and legitimized to contribute to human and intellectual capacity, find themselves in a tenuous position on issues of merit, equality, and fairness. On one hand, social forces have demonstrated how universities have been institutions for the production and reproduction of systemic inequality. On the other hand, universities maintain that they are well positioned, as part of their institutional renewal practices, to address contemporary calls for Equity, Diversity, and Inclusion (EDI). Since universities are now eager to embrace EDI principles, it is appropriate to demonstrate their historical failures and provide some recommendations towards institutional renewal. Drawing on critical pedagogy, the paper examines selected academic contributions and knowledge claims that have reproduced systemic inequality, specifically on the discourse on human classification. The broader question is whether universities are simply going through the motions and hope EDI is a fad or are serious about institutional renewal and transformative changes. The study offers some ideas on how universities can pursue transformative changes grounded on EDI principles.