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Kral TRA, Williams CY, Wylie AC, McLaughlin K, Stephens RL, Mills-Koonce WR, Birn RM, Propper CB, Short SJ. Intergenerational effects of racism on amygdala and hippocampus resting state functional connectivity. Sci Rep 2024; 14:17034. [PMID: 39043776 PMCID: PMC11266580 DOI: 10.1038/s41598-024-66830-3] [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: 03/25/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024] Open
Abstract
Racism is an insidious problem with far-reaching effects on the lives of Black, Indigenous, and People of Color (BIPOC). The pervasive negative impact of racism on mental health is well documented. However, less is known about the potential downstream impacts of maternal experiences of racism on offspring neurodevelopment. This study sought to examine evidence for a biological pathway of intergenerational transmission of racism-related trauma. This study examined the effects of self-reported maternal experiences of racism on resting state functional connectivity (rsFC) in n = 25 neonates (13 female, 12 male) birthed by BIPOC mothers. Amygdala and hippocampus are brain regions involved in fear, memory, and anxiety, and are central nodes in brain networks associated with trauma-related change. We used average scores on the Experiences of Racism Scale as a continuous, voxel-wise regressor in seed-based, whole-brain connectivity analysis of anatomically defined amygdala and hippocampus seed regions of interest. All analyses controlled for infant sex and gestational age at the 2-week scanning session. More maternal racism-related experiences were associated with (1) stronger right amygdala rsFC with visual cortex and thalamus; and (2) stronger hippocampus rsFC with visual cortex and a temporo-parietal network, in neonates. The results of this research have implications for understanding how maternal experiences of racism may alter neurodevelopment, and for related social policy.
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Affiliation(s)
- T R A Kral
- Center for Healthy Minds, University of Wisconsin -Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin -Madison, Madison, USA
| | - C Y Williams
- Center for Healthy Minds, University of Wisconsin -Madison, Madison, WI, USA
- Department of Counseling Psychology, University of Wisconsin -Madison, Madison, USA
| | - A C Wylie
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - K McLaughlin
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - R L Stephens
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - W R Mills-Koonce
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - R M Birn
- Department of Psychiatry, University of Wisconsin -Madison, Madison, USA
| | - C B Propper
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - S J Short
- Center for Healthy Minds, University of Wisconsin -Madison, Madison, WI, USA.
- Department of Educational Psychology, University of Wisconsin -Madison, Madison, USA.
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Datta BK, Chowdhury SK. Religious minority status and risk of hypertension in women: Evidence from Bangladesh. Heliyon 2024; 10:e33428. [PMID: 39035524 PMCID: PMC11259843 DOI: 10.1016/j.heliyon.2024.e33428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Discrimination based on religion and communal violence against religious minorities have been on the rise worldwide. Despite growing incidences of violence against religious minorities, little is known on the relationship between minority status and population health outcomes in the low-and-middle income countries (LMICs). This study intends to fill this gap by assessing the prevalence of hypertension among religious minority women in Bangladesh, a South Asian country with high levels of social hostilities involving religion. Using data from the Bangladesh Demographic and Health Survey (BDHS) 2017-18, we examined whether religious minority women had a differential risk of having hypertension. We estimated logistic regression models to obtain the odds in favor of being hypertensive among women aged 18-49 years and compared the odds for religious minority women with that of their non-minority counterparts. We then estimated linear regression models to examine how average systolic- and diastolic-blood pressure measures differ across minority and non-minority women. We found that the odds of being hypertensive for minority women were 1.43 (95 % CI: 1.14-1.79) times that of their non-minority counterparts. The adjusted odds ratio was very similar, 1.45 (95 % CI: 1.14-1.84), when various sociodemographic and other risk factors were accounted for. The conditional average SBP and DBP levels were respectively 3.42 mmHg (95 % CI: 1.64-5.20) and 1.44 mmHg (95 % CI: 0.37-2.51) higher among minority women. Thus, we found evidence that religious minority women in Bangladesh had a disproportionately higher risk of having hypertension compared to their non-minority peers. These results call for further research on psychological distress from systematic discrimination and collective trauma among religious minorities in Bangladesh.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
- Department of Health Management, Economics and Policy, School of Public Health, Augusta University, Augusta, GA, USA
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Chaudhary S, Hoffmann JA, Pulcini CD, Zamani M, Hall M, Jeffries KN, Myers R, Fein J, Zima BT, Ehrlich PF, Alpern ER, Hargarten S, Sheehan KM, Fleegler EW, Goyal MK. Youth Suicide and Preceding Mental Health Diagnosis. JAMA Netw Open 2024; 7:e2423996. [PMID: 39078631 PMCID: PMC11289695 DOI: 10.1001/jamanetworkopen.2024.23996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/28/2024] [Indexed: 07/31/2024] Open
Abstract
Importance Suicide is a leading cause of death among US youths, and mental health disorders are a known factor associated with increased suicide risk. Knowledge about potential sociodemographic differences in documented mental health diagnoses may guide prevention efforts. Objective To examine the association of documented mental health diagnosis with (1) sociodemographic and clinical characteristics, (2) precipitating circumstances, and (3) mechanism among youth suicide decedents. Design, Setting, and Participants This retrospective, cross-sectional study of youth suicide decedents aged 10 to 24 years used data from the Centers for Disease Control and Prevention National Violent Death Reporting System from 2010 to 2021. Data analysis was conducted from January to November 2023. Exposures Sociodemographic characteristics, clinical characteristics, precipitating circumstances, and suicide mechanism. Main Outcomes and Measures The primary outcome was previously documented presence of a mental health diagnosis. Associations were evaluated by multivariable logistic regression. Results Among 40 618 youth suicide decedents (23 602 aged 20 to 24 years [58.1%]; 32 167 male [79.2%]; 1190 American Indian or Alaska Native [2.9%]; 1680 Asian, Native Hawaiian, or Other Pacific Islander [4.2%]; 5118 Black [12.7%]; 5334 Hispanic [13.2%]; 35 034 non-Hispanic; 30 756 White [76.1%]), 16 426 (40.4%) had a documented mental health diagnosis and 19 027 (46.8%) died by firearms. The adjusted odds of having a mental health diagnosis were lower among youths who were American Indian or Alaska Native (adjusted odds ratio [aOR], 0.45; 95% CI, 0.39-0.51); Asian, Native Hawaiian, or Other Pacific Islander (aOR, 0.58; 95% CI, 0.52-0.64); and Black (aOR, 0.62; 95% CI, 0.58-0.66) compared with White youths; lower among Hispanic youths (aOR, 0.76; 95% CI, 0.72-0.82) compared with non-Hispanic youths; lower among youths aged 10 to 14 years (aOR, 0.70; 95% CI, 0.65-0.76) compared with youths aged 20 to 24 years; and higher for females (aOR, 1.64; 95% CI, 1.56-1.73) than males. A mental health diagnosis was documented for 6308 of 19 027 youths who died by firearms (33.2%); 1691 of 2743 youths who died by poisonings (61.6%); 7017 of 15 331 youths who died by hanging, strangulation, or suffocation (45.8%); and 1407 of 3181 youths who died by other mechanisms (44.2%). Compared with firearm suicides, the adjusted odds of having a documented mental health diagnosis were higher for suicides by poisoning (aOR, 1.70; 95% CI, 1.62-1.78); hanging, strangulation, and suffocation (aOR, 2.78; 95% CI, 2.55-3.03); and other mechanisms (aOR, 1.59; 95% CI, 1.47-1.72). Conclusions and Relevance In this cross-sectional study, 3 of 5 youth suicide decedents did not have a documented preceding mental health diagnosis; the odds of having a mental health diagnosis were lower among racially and ethnically minoritized youths than White youths and among firearm suicides compared with other mechanisms. These findings underscore the need for equitable identification of mental health needs and universal lethal means counseling as strategies to prevent youth suicide.
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Affiliation(s)
- Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christian D. Pulcini
- Department of Emergency Medicine and Pediatrics, University of Vermont Medical Center and Children’s Hospital, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Mark Zamani
- Children’s Hospital Association, Lenexa, Kansas
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Rachel Myers
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Joel Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Bonnie T. Zima
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan Ann Arbor
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee
| | - Karen M. Sheehan
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric W. Fleegler
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC
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Webb EK, Carter SE, Ressler KJ, Fani N, Harnett NG. The neurophysiological consequences of racism-related stressors in Black Americans. Neurosci Biobehav Rev 2024; 161:105638. [PMID: 38522814 PMCID: PMC11081835 DOI: 10.1016/j.neubiorev.2024.105638] [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: 01/03/2024] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Racism-related stressors, from experiences of both implicit and explicit racial discrimination to systemic socioeconomic disadvantage, have a cumulative impact on Black Americans' health. The present narrative review synthesizes peripheral (neuroendocrine and inflammation markers), psychophysiological (heart-rate variability, skin conductance), and neuroimaging (structural and functional) findings that demonstrate unique associations with racism-related stress. Emerging evidence reveals how racism-related stressors contribute to differential physiological and neural responses and may have distinct impacts on regions involved with threat and social processing. Ultimately, the neurophysiological effects of racism-related stress may confer biological susceptibility to stress and trauma-related disorders. We note critical gaps in the literature on the neurophysiological impact of racism-related stress and outline additional research that is needed on the multifactorial interactions between racism and mental health. A clearer understanding of the interactions between racism-related stress, neurophysiology, and stress- and trauma-related disorders is critical for preventative efforts, biomarker discovery, and selection of effective clinical treatments for Black Americans.
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Affiliation(s)
- E Kate Webb
- McLean Hospital, Division of Depression and Anxiety, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Sierra E Carter
- Georgia State University, Department of Psychology, Athens, GA, USA
| | - Kerry J Ressler
- McLean Hospital, Division of Depression and Anxiety, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Nathaniel G Harnett
- McLean Hospital, Division of Depression and Anxiety, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
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5
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Lui PP, Kamata A. Harmonizing Assessments of Everyday Racial Discrimination Experiences: The Multigroup Everyday Racial Discrimination Scale (MERDS). Assessment 2024; 31:397-417. [PMID: 37029544 DOI: 10.1177/10731911231162357] [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] [Indexed: 04/09/2023]
Abstract
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.
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Affiliation(s)
- P Priscilla Lui
- Southern Methodist University, Dallas, TX, USA
- University of Washington, Seattle, USA
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6
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Zhu Y, Deng W. Moderating the link between discrimination and adverse mental health outcomes: Examining the protective effects of cognitive flexibility and emotion regulation. PLoS One 2023; 18:e0282220. [PMID: 37815988 PMCID: PMC10564165 DOI: 10.1371/journal.pone.0282220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
Discrimination is associated with mental health problems. While prior research has demonstrated the significance of emotion regulation in explaining the onset and development of discrimination-related anxiety, few studies investigated this dynamic with cognitive flexibility among sexual and/or racial minority individuals. The current study incorporated cognitive flexibility to investigate its potential buffering effects on discrimination-related anxiety. 221 individuals, 37.6% of whom (n = 83) identified as sexual and/or racial minorities, responded to an online questionnaire about their levels of cognitive flexibility and emotion regulation, perceived discrimination, and anxiety. Moderated mediation analyses were conducted with these variables. Our findings indicated that emotion regulation difficulty (ERD) mediated the relationship between discrimination and anxiety, while cognitive flexibility had a strong moderating effect on the relationship between ERD and anxiety. These results suggested new research directions and implied the therapeutic potential of advancing cognitive flexibility skills with emotion regulation training in depression and anxiety intervention and treatments. Future research is needed to investigate cognitive flexibility as a transdiagnostic mechanism underlying the onset and development of anxiety, to potentially lead to novel prevention or intervention for marginalized people facing additional stressors like discrimination.
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Affiliation(s)
- Yutong Zhu
- Department of Psychology, Yale University, New Haven, Connecticut, United States of America
| | - Wisteria Deng
- Department of Psychology, Yale University, New Haven, Connecticut, United States of America
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7
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Obenauf C, Mekawi Y, Lathan EC, Hinojosa CA, Thomas JG, Stevens JS, Powers A, Michopoulos V, Carter S. Indirect effect of race-related stress on traumatic stress and depression symptoms via subjective social status in a Black community sample. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:116-126. [PMID: 37434412 DOI: 10.1002/ajcp.12693] [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: 08/05/2022] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
Experiencing racism is linked to lower subjective social status (SSS), defined as one's perception of their position in society. SSS is influenced by power, prestige, and objective socioeconomic status (SES). Previous findings suggest that race-related stress may be related to adverse mental health outcomes through SSS in Black Americans, a population that has been deeply affected by continuing legacies of oppression. The current study examines the indirect association between race-related stress and posttraumatic stress disorder (PTSD) and depression symptoms through SSS in a community sample of largely trauma-exposed Black Americans (N = 173). Hierarchical regression analyses indicated that overall race-related stress significantly predicted lower SSS, higher PTSD symptoms, and higher depression symptoms. Analyses also revealed indirect effects of cultural race-related stress on PTSD and depression symptoms through SSS after controlling for SES. Results suggest that the experience of race-related stress, particularly cultural race-related stress, which involves the degradation and disparagement of one's culture and worldview, is associated with more severe PTSD and depression symptoms potentially due to these experiences decreasing Black Americans' SSS. Findings support the need for systemic intervention strategies to disrupt the cultural oppression of Black Americans and improve the societal value and mental health of this population.
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Affiliation(s)
- Caterina Obenauf
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cecilia A Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joel G Thomas
- Department of Psychology, Agnes Scott College, Decatur, Georgia, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory National Primate Research Center, Atlanta, Georgia, USA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
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Ravi M, Mekawi Y, Blevins EJ, Michopoulos V, Stevens J, Carter S, Powers A. Intersections of oppression: Examining the interactive effect of racial discrimination and neighborhood poverty on PTSD symptoms in Black women. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:567-576. [PMID: 37079842 PMCID: PMC10293083 DOI: 10.1037/abn0000818] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Black Americans living in urban environments are disproportionately impacted by posttraumatic stress disorder (PTSD). Both racial discrimination and neighborhood poverty are factors that contribute to this health disparity. However, studies focused on the intersection of these two oppressive systems on PTSD symptoms are lacking. To address this gap in the literature, we assessed the interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms in an urban sample of trauma-exposed Black women (N = 300). Simple moderation analysis was used to assess the main and interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms. The overall model significantly predicted PTSD symptoms, with a main effect of racial discrimination (B = 1.87, p = .009) and neighborhood poverty rate (B = 0.29, p = .008), independent of prior trauma exposure and percentage of Black residents in the zip code. More frequent experiences of racial discrimination and higher rates of neighborhood poverty both predicted higher PTSD symptoms. There was also a trending interaction of racial discrimination and neighborhood poverty (B = -0.05, p = .054), where the effect of neighborhood poverty on PTSD symptoms was only present for those who reported fewer experiences of racial discrimination. Our results suggest that people who have experienced more instances of racial discrimination show high levels of PTSD symptoms regardless of neighborhood poverty rates and highlight the importance of considering multiple levels of oppression that Black individuals face while diagnosing and treating stress-related psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Meghna Ravi
- Emory University, Graduate Program in Neuroscience
| | - Yara Mekawi
- University of Louisville, Department of Psychological and Brain Sciences
| | - Emily J. Blevins
- University of Illinois at Urbana-Champaign, Department of Psychology
| | | | - Jennifer Stevens
- Emory University, Department of Psychiatry and Behavioral Sciences
| | | | - Abigail Powers
- Emory University, Department of Psychiatry and Behavioral Sciences
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Deckard FM, Messamore A, Goosby BJ, Cheadle JE. A Network Approach to Assessing the Relationship between Discrimination and Daily Emotion Dynamics. SOCIAL PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1177/01902725221123577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Discrimination-health research has been critiqued for neglecting the endogeneity of reports of discrimination to negative affect and the multidimensionality of mental health. To address these challenges, we model discrimination’s relationship to multiple psychological variables without directional constraints. Using time-dense data to identify associational network structures allows for joint testing of the social stress hypothesis, prominent in discrimination-health literature, and the negativity bias hypothesis, an endogeneity critique rooted in social psychology. Our results show discrimination predicts negative emotions from day-to-day but not vice versa, indicating that racial discrimination is a risk factor and not symptom of negative emotion. Furthermore, we identify sadness, guilt, hostility, and fear as a locus of interrelated emotions sensitive to racism-related stressors that emerges over time. Thus, we find support for what race scholars have argued for 120+ years in a model without a priori directional restrictions and then build on this work by empirically identifying cascading mental health consequences of discrimination.
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Neumann D, Juengst SB, Bombardier CH, Finn JA, Miles S, Zhang Y, Kennedy R, Rabinowitz AR, Thomas A, Dreer LE. Anxiety Trajectories the First 10 Years Following a Traumatic Brain Injury (TBI): A TBI Model Systems Study. Arch Phys Med Rehabil 2022; 103:2105-2113. [PMID: 35905772 DOI: 10.1016/j.apmr.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/27/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Determine anxiety trajectories and predictors up to 10 years post-traumatic brain injury (TBI). DESIGN Prospective longitudinal, observational study. SETTING Inpatient rehabilitation centers. PARTICIPANTS 2,836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points. MAIN OUTCOME MEASURE Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. RESULTS Linear mixed models showed higher GAD-7 scores were associated with Black race (p<.001), public insurance (p<.001), pre-injury mental health treatment (p<.001), 2 additional TBIs with loss of consciousness (LOC) (p=.003), violent injury (p=.047), and more years post-TBI (p=.023). An interaction between follow-up year and age was also related to GAD-7 scores (p=.006). A latent class mixed model identified three anxiety trajectories: low-stable (n=2,195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had ≥mild GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16). CONCLUSIONS A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years, but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and two prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.
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Affiliation(s)
- Dawn Neumann
- Associate Professor, Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Indianapolis, IN; Research Director, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254.
| | - Shannon B Juengst
- University of Texas Southwestern Medical Center, Department of Physical Medicine & Rehabilitation
| | | | - Jacob A Finn
- Rehabilitation & Extended Care, Minneapolis VA Health Care System, Department of Psychiatry & Behavioral Sciences, University of Minnesota
| | - Shannon Miles
- James A. Haley Veterans' Hospital, Tampa, FL and Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Yue Zhang
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care
| | - Richard Kennedy
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care
| | | | - Amber Thomas
- Spaulding Rehabilitation Hospital, Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, MA
| | - Laura E Dreer
- University of Alabama at Birmingham, Departments of Ophthalmology & Visual Sciences & Physical Medicine & Rehabilitation
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Webb EK, Bird CM, deRoon-Cassini TA, Weis CN, Huggins AA, Fitzgerald JM, Miskovich T, Bennett K, Krukowski J, Torres L, Larson CL. Racial Discrimination and Resting-State Functional Connectivity of Salience Network Nodes in Trauma-Exposed Black Adults in the United States. JAMA Netw Open 2022; 5:e2144759. [PMID: 35072718 PMCID: PMC8787596 DOI: 10.1001/jamanetworkopen.2021.44759] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 12/21/2022] Open
Abstract
Importance For Black US residents, experiences of racial discrimination are still pervasive and frequent. Recent empirical work has amplified the lived experiences and narratives of Black people and further documented the detrimental effects of racial discrimination on both mental and physical health; however, there is still a need for further research to uncover the mechanisms connecting experiences of racial discrimination with adverse health outcomes. Objective To examine neurobiological mechanisms that may offer novel insight into the association of racial discrimination with adverse health outcomes. Design, Setting, and Participants This cross-sectional study included 102 Black adults who had recently experienced a traumatic injury. In the acute aftermath of the trauma, participants underwent a resting-state functional magnetic resonance imaging scan. Individuals were recruited from the emergency department at a Midwestern level 1 trauma center in the United States between March 2016 and July 2020. Data were analyzed from February to May 2021. Exposures Self-reported lifetime exposure to racial discrimination, lifetime trauma exposure, annual household income, and current posttraumatic stress disorder (PTSD) symptoms were evaluated. Main Outcomes and Measures Seed-to-voxel analyses were conducted to examine the association of racial discrimination with connectivity of salience network nodes (ie, amygdala and anterior insula). Results A total of 102 individuals were included, with a mean (SD) age of 33 (10) years and 58 (57%) women. After adjusting for acute PTSD symptoms, annual household income, and lifetime trauma exposure, greater connectivity between the amygdala and thalamus was associated with greater exposure to discrimination (t(97) = 6.05; false discovery rate (FDR)-corrected P = .03). Similarly, racial discrimination was associated with greater connectivity between the insula and precuneus (t(97) = 4.32; FDR-corrected P = .02). Conclusions and Relevance These results add to the mounting literature that racial discrimination is associated with neural correlates of vigilance and hyperarousal. The study findings extend this theory by showing that this association is apparent even when accounting for socioeconomic position, lifetime trauma, and symptoms of psychological distress related to an acute trauma.
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Affiliation(s)
- E. Kate Webb
- Department of Psychology, University of Wisconsin–Milwaukee
| | - Claire M. Bird
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Terri A. deRoon-Cassini
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Carissa N. Weis
- Institute for Health and Equity, Department of Epidemiology, Medical College of Wisconsin, Milwaukee
| | - Ashley A. Huggins
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | | | | | | | - Jessica Krukowski
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
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Sandi C, Carey MR. COVID-19, stress, and inequities in (neuro)science. Neuron 2021; 109:3358-3360. [PMID: 34559981 PMCID: PMC8596192 DOI: 10.1016/j.neuron.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/05/2022]
Abstract
The COVID-19 pandemic has posed major challenges for diversity, equity, and inclusion (DEI) efforts in research and academia. As chairs of the ALBA Network, we reflect on how the pandemic has exacerbated, and also shone a spotlight on, inequalities in science and society.
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Affiliation(s)
- Carmen Sandi
- Brain Mind Institute, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland; ALBA Network, Brussels, Belgium.
| | - Megan R Carey
- Neuroscience Program, Champalimaud Center for the Unknown, Lisbon, Portugal; ALBA Network, Brussels, Belgium.
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