Racism, racial discrimination, and trauma: a systematic review of the social science literature

Heterogeneity in racist events and posttraumatic mental health among Black, Indigenous, People of Color (BIPOC) first responders

Background: Black, Indigenous, People of Color (BIPOC) first responders in Canada report experiencing racism and an increased risk of trauma-related mental health symptoms.Objective: Using a BIPOC first responder sample in Canada, the present study examined subgroups of BIPOC first responders based on the frequency of different types of racist events, and their relations with mental health symptoms (posttraumatic stress disorder [PTSD] symptom clusters of intrusion, avoidance, negative alterations in cognitions and mood [NACM], and alterations in arousal and reactivity [AAR]; depression severity; anxiety severity).Method: The sample included 196 BIPOC first responders who reported more than one traumatic experience (Mage = 35.30; 71.4% men).Results: Latent profile analyses indicated a best-fitting 3-profile solution: Low (Profile 1), Moderate (Profile 2), and High (Profile 3) Frequency of Racist Events. Multinomial logistic regression indicated that BIPOC first responders reporting more frequent racist events endorsed greater depression severity, anxiety severity, and PTSD's NACM symptom severity.Conclusions: Findings improve our understanding of subgroups of BIPOC first responders based on the frequency and types of racist events they experience. Results highlight the need to incorporate assessments of racism-related experiences into therapeutic work, and to target depression, anxiety, and NACM symptoms among those who encounter more racist events.

Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas

Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals-invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories rise to the level of being traumatic, are associated with PTSD symptoms, and are prevalent among minoritized individuals. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.

Exploring Approaches to Mental Health Treatment and the Critical Role of Partnerships Among Hospital-Based Violence Intervention Programs

Federal initiatives have invested considerable resources to end gun violence. Hospital-based violence intervention programs (HVIPs) are shown to reduce violent injury recidivism and address social needs of trauma-exposed clients. Mental health is a significant need among HVIP clients, yet little research on mental health and HVIPs exists. This community-initiated study utilized a triangulation-convergence mixed-methods design. HVIP programs were recruited for survey development aiming to explore aspects of mental health relevant for populations served by HVIPs, standards of care for mental health care among HVIPs, and the function and utility of community partners. Quantitative surveys (n = 16) of Health Alliance of Violence Intervention (HAVI) members and qualitative interviews (n = 4) were conducted with a sample of HAVI Mental Health Working Group members. Using descriptive statistics and thematic analysis, findings highlight the leading mental health needs of HVIP clients, inform best practices for multidisciplinary HVIP teams to effectively meet mental health needs, including the necessity of strong community partnerships, and address the critical intersection of mental health and social determinants of health.

Pathways of Intergenerational Risk: Examining the Association Between Maternal Adverse Childhood Experiences and Child Socio-Emotional and Behavioral Concerns at 8 Years of Age

Support has been found for the intergenerational transmission of risk from maternal adverse childhood experiences (ACEs) to child outcomes. Less research has focused on longitudinal psychosocial pathways that account for this transmission. In the current study, path analysis examined mediating pathways (i.e., maternal adult attachment insecurity, romantic relationship functioning, and maternal anxiety and depression symptoms) in the association between maternal ACEs and internalizing and externalizing concerns among their child at eight years of age. Participants included 1,994 mother-child dyads from a prospective longitudinal cohort sample. Maternal ACEs were significantly associated directly with child internalizing concerns (β = .06, p = .025) and indirectly via both maternal attachment anxiety and avoidance, lower romantic relationship functioning, and depression, (β = .002, p = .006; β = .003, p = .005, respectively). Maternal ACEs were directly associated with child externalizing concerns (β = .06, p = .018) and indirectly via both maternal attachment anxiety and avoidance, lower romantic relationship functioning, and depression, (β = .001, p = .008; β = .002, p = .010, respectively). This study identified several maternal risk factors that have implications for downstream internalizing and externalizing concerns among their children.

Social Safety and Health Outcomes in Emerging Adults: Interactions of Adverse Childhood Experiences and Discrimination

Social safety theory suggests that individuals from minoritized racial and ethnic groups or sexual and gender diverse (SGD) groups are exposed to multilevel and interacting stressors, which can set the stage for adverse health outcomes. Using a social safety framework, we examine interactions between discrimination and adverse childhood experiences (ACEs) on health outcomes and how these interactions may differ by race and ethnicity or SGD status among young adults. An online survey with 2287 young adults (mean age = 25.8 years; 55.5% female) assessed ACEs and interpersonal discrimination and sleep quality, problematic alcohol or cannabis use, and post-traumatic stress disorder (PTSD) symptoms. Linear regression analyses tested interactions between ACEs and discrimination in relation to the outcomes among the overall sample and stratified by race and ethnicity or SGD status. In the overall sample, there was one significant interaction between ACEs and discrimination, such that those experiencing both greater exposure to ACEs and greater discrimination reported higher PTSD scores. Race-stratified models showed that among people of color experiencing high levels of ACEs, greater discrimination was associated with greater PTSD scores. SGD-stratified models showed that for problematic alcohol use and PTSD there was a significant interaction between ACEs and discrimination only among non-SGD participants. Consistent with social safety theory, findings highlight the potential health consequences of experiencing both discrimination and childhood adverse experiences. Intervention efforts are needed to help young people increase coping skills and other strategies to promote resilience when experiencing major life stressors.

The Role of Discrimination, Childhood Maltreatment, and Social Determinants of Health in Adult BIPOC Pain Disparities

OBJECTIVES

Chronic pain disproportionately affects Black and Indigenous people and other people of color (BIPOC). Disparities may be related to increased chronic stress due to discrimination, trauma exposure, and social determinants of health (SDoH).

METHODS

Using data from families (n = 1307) in the family matters study (collected 2017-2019), a secondary data analysis explored SDoH of baseline pain severity and change in pain at 18 months, and the moderating effects of childhood maltreatment and discrimination on SDoH-pain relationships. General estimating equations (GEE) modeling was used.

RESULTS

Childhood maltreatment was associated with higher baseline pain severity, and discrimination was the strongest correlate of worse pain 18 months later. Childhood maltreatment exacerbated risk for higher pain severity for women, individuals under the federal poverty line, and individuals living in areas with low financial privilege. Discrimination increased risk for higher baseline pain for Black and Latinx individuals.

CONCLUSIONS

Discrimination and traumatic event exposure may be important contributors to BIPOC pain disparities. Pain interventions may benefit from additional attention to the toll of oppressive systems and chronic stressors on BIPOC health.

Reframing the Victim-Offender Overlap: Moral Injury and Adolescent Offending

It is well established within the literature that early childhood trauma and maltreatment increase risk for adolescent offending behaviors. However, the mechanisms underlying this association are not currently well understood. The construct of moral injury, or distress and psychopathology stemming from events that violate an individual's deeply held moral beliefs, has most frequently been studied in adult veterans. However, researchers have recently begun to apply the concept of moral injury to child and adolescent populations. From a developmental psychopathology perspective, moral injury offers a novel lens through which to view the victim-offender overlap in adolescents. The current paper reviews existing empirical evidence regarding the prevalence and sources of moral injury in justice-involved youth. It further synthesizes theory and research from diverse subfields of developmental and clinical psychology and criminology in order to describe how disruptions to cognitive, affective, and social development might link moral injury with juvenile offending and justice involvement. A novel, dynamic model of moral injury and juvenile offending is proposed, and implications for future research, clinical practice, and juvenile justice policy are discussed.

The relationship between racial discrimination in healthcare, loneliness, and mental health among Black Philadelphia residents

BACKGROUND

Black individuals in the U.S. report experiencing the highest levels of racial discrimination in healthcare. Racial discrimination in healthcare contributes to mental health issues and has been shown to be associated with loneliness. Despite this, there is limited research on the role loneliness plays in the relationship between racial discrimination in healthcare settings and mental health outcomes. This study explored the relationship between racial discrimination in healthcare, loneliness, and mental health outcomes (depression and anxiety) among Black individuals.

METHODS

This study was part of the PhillyCEAL (Community Engagement Alliance) initiative. Between February 2024 and April 2024, 327 Black Philadelphia residents completed online surveys. Multiple linear regression analyses examined the associations between racial discrimination in healthcare, loneliness, depression, and anxiety. Covariates included Hispanic ethnicity, age, insurance, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) status, sex assigned at birth, relationship status, employment, medical conditions, income, and education.

RESULTS

Racial discrimination in healthcare was positively associated with loneliness (b = 0.66, 95% CI: 0.29 to 1.04), depression (b = 0.52, 95% CI: 0.19 to 0.86), and anxiety (b = 0.85, 95% CI: 0.50 to 1.19). When controlling for loneliness, the association between racial discrimination in healthcare and depression became non-significant (b = 0.29, 95% CI: -0.03 to 0.61), while the association between racial discrimination in healthcare and anxiety remained significant (b = 0.62, 95% CI: 0.29 to 0.94).

CONCLUSION

Addressing racial discrimination within healthcare settings is crucial for improving mental health outcomes among Black populations. Given the significant role of loneliness in this relationship, interventions aimed at reducing loneliness may help mitigate the adverse mental health effects of racial discrimination in healthcare for Black populations.

Disclosing racial trauma in psychological therapy: Exploring the experiences of racially minoritised people in the UK

OBJECTIVES

Exposure to racism is repeatedly experienced by individuals from racially minoritised backgrounds, and has a range of negative emotional, physical and social consequences; however, its traumatising effects are under-recognised. Further, psychological therapists often lack sufficient knowledge, training and confidence to sensitively manage conversations about racism. As this has important implications for the standards of care this population receives, this study explored how racially minoritised clients experience disclosing, or attempting to disclose racial trauma in psychological therapy.

DESIGN

The study utilised an online qualitative survey design.

METHODS

Participants were 28 adults who identified as belonging to minoritised racial groups and had engaged in psychological therapy in the UK. Therapy spanned a range of modalities, and providers included the NHS, private therapists/organisations, charities and university services. Data were analysed using thematic analysis.

RESULTS

Three superordinate themes were constructed: The Dangers of Disclosure; Holding the Burden; and Feeling Heard and Held. These demonstrated both the range of potential harms and burdens associated with disclosures of racial trauma in therapy, and examples of meaningful, validating therapist responses to disclosure.

CONCLUSIONS

Therapists, regardless of racial heritage, have the potential to both perpetuate harm and provide meaningful support in response to disclosures of racial trauma. Racial reflexivity and education on racism and racial trauma are essential to ethical and antiracist therapeutic practice, and crucial to safeguarding racially minoritised clients from racial harm in therapy. These must be embedded in training, practice and policy for meaningful improvements in racially minoritised clients' experiences of therapy to occur.

Exploring attitudes towards seeking help for mental health problems among university students from racially minoritised backgrounds: a systematic review and thematic synthesis

BACKGROUND

University students from racially minoritised backgrounds are at an increased risk of experiencing mental health difficulties but are less likely to seek support compared to students from racial and ethnic majority backgrounds. To increase the accessibility and appropriateness of mental health support for university students, it is important to understand the attitudes towards seeking help for mental health of underserved student groups. This is the first systematic review to synthesise the available qualitative data which explores attitudes toward seeking help for mental health problems among students from racially minoritised backgrounds.

METHODS

This systematic review includes qualitative studies exploring attitudes towards seeking help for mental health difficulties among racially minoritised university students. A literature search was carried out using PsycINFO, CINAHL, Medline and Web of Science in March 2024. Participants were racially minoritised university students. Data were synthesised using a thematic synthesis.

RESULTS

Of 493 papers identified, 15 were included in the final thematic synthesis following methodological appraisal of their quality using the Critical Appraisal Skills Programme. There were a total of 314 participants across all included papers. Four analytical themes were identified: "cultural attitudes" outlined how culturally specific experiences of stigma, lack of conversations about mental health, faith, and gender influenced attitudes; "interpersonal relationships" explored the impact of family and peer relationships on attitudes; "psychological barriers" described how psychological constructs, such as preference for self-reliance and feared consequences of disclosure, were culturally-informed barriers to help-seeking; and "systemic barriers" encompassed the structural barriers, discriminatory practices and perceived cultural incompetence of services and institutions that negatively impacted on attitudes towards help-seeking for mental health difficulties.

CONCLUSION

Culture, identity and social inequality inform attitudes towards help-seeking among racially minoritised students. Exploration of how these factors interact with university systems may improve the provision of mental health support. Systemic change is needed within universities and mental health services to tackle inequality and improve support for racially minoritised students.

Initial promise of child-parent psychotherapy in reducing stress and postpartum depression among mothers experiencing homelessness: a feasibility and pilot study

PURPOSE

Mothers experiencing homelessness undergo significant stressors in addition to parenting stress, yet the rate and treatment of postpartum depression (PPD) within this population has yet to be explored. We assessed the risk for PPD and examined the changes in PDD and parenting stress following engagement in treatment.

METHODS

Participants included 182 mothers with infants 7 months of age or younger in a shelter setting. After initial assessment of PPD and parenting stress, families participated in Child-Parent Psychotherapy (CPP). Post assessment was then conducted after 16 weeks.

RESULTS

CPP was successfully implemented with high levels of procedural and content fidelity (M = 0.99, SD = 0.04; M = 0.95, SD = 0.09, respectively), treatment satisfaction (94%; M = 4.83, SD = 0.52), and relatively moderate levels of intervention completion (53.8%). Following participation in CPP, mothers reported decreases in parenting stress (d = 0.51) and continuous PPD symptom severity (d = 0.43). The proportion of mothers with clinically elevated self-report PPD symptoms also decreased from 15.3 to 6.7% (p = .013). Lastly, improvements in total parenting stress predicted improvements in PPD symptom severity (B = 0.12, p < .001).

CONCLUSIONS

The findings highlight the relevance of screening for PPD among mothers experiencing homelessness. Most importantly, relationship-based interventions like CPP demonstrate promise in indirectly treating PPD for at-risk populations and within a shelter setting.

A dual-focus approach for evaluating contributors to chronic pain: The roles of psychosocial risk and resilience factors

There has been a predominant focus on psychosocial risk factors associated with poor pain outcomes among individuals with chronic pain. However, it is also important to identify resilience factors that may mitigate the negative impact of or confer successful adaptation to pain. We argue for a dual-focus approach that evaluates the contributions of both risk and resilience factors. Person-centered statistical techniques (cluster analysis) may be beneficial to phenotype individuals based on their psychosocial characteristics to help inform treatment selection. Identifying treatment moderators based on individual-level characteristics (race/ethnicity) may provide insight into differences in treatment efficacy. Utilizing a holistic approach can inform the development and implementation of culturally adapted and personalized treatments aimed at reducing risk and bolstering resilience factors.

Differential associations between race-based traumatic stress and major, everyday, and vicarious racial discrimination among young adults of color

Race-based traumatic stress (RBTS) is a psychological response to racial discrimination among individuals with marginalized racial/ethnic identities, but the literature about how different forms of racial discrimination contribute to RBTS is lacking. We compared the effects of major, everyday, and vicarious racial discrimination on RBTS and evaluated the associations between ethnic-racial identity (ERI) and RBTS. Analyses used cross-sectional survey data from Black, Asian, and Latine young adults (N = 1,342, Mage = 25.9 years) collected in 2022. Demographic variables; major, everyday, and vicarious racial discrimination; ERI commitment and exploration; and RBTS were assessed. Hierarchical multiple regression was used to identify correlates of RBTS. Everyday, β = .37, p < .001; vicarious, β = .16, p < .001; and major racial discrimination, β = .16, p = .004, predicted RBTS. Neither ERI commitment nor ERI exploration was significantly associated with RBTS. Race did not moderate the associations between major, everyday, or vicarious discrimination and RBTS, highlighting that Black, Asian, and Latine young adults appear to be equally at risk. As most vicarious racial discrimination and RBTS research has focused on Black samples, we expand the literature by including Latine and Asian young adults. Our observation that vicarious racial discrimination was a similarly strong predictor of RBTS compared to everyday and major racial discrimination underscores the importance of its inclusion in research focused on discrimination and mental health. Taken together, clinical assessment should focus on questions related to diverse experiences of racial discrimination for individuals with marginalized racial identities.

Lifetime Psychiatric Diagnoses Among NESARC-III Hispanic Participants: A Relative Importance Analysis of Sociodemographic and Social Determinants of Health

Hispanic/Latin American people comprise a health disparity population, in part due to having higher rates of mental illness relative to White counterparts. Much of the extant literature on understanding Hispanic mental health has focused on single outcomes (e.g., substance use, depression) or single indicators (e.g., adverse childhood experiences). However, given the multifinality of mental health outcomes and their predictors, research is needed to understand how protective and risk factors relate to mental health more broadly (i.e., internalizing and externalizing symptomology). Using a sample of Hispanic adults (N = 7037) who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III, we used structural equation modeling to estimate a correlated common factors model with latent variables for lifetime externalizing and internalizing disorders. Using the discrimination stress, coping, and mental health framework as guide, we examined the associations between latent factor scores, sociodemographic characteristics, and social determinants of health (SDOH). The SDOH included adverse childhood experiences (ACEs), nativity status, ethnic discrimination, ethnic identity, and religiosity/spirituality. Finally, we employed relative importance analyses to assess the comparative importance of significant correlates of psychopathology. ACE was the strongest correlate of both internalizing and externalizing psychopathology, underscoring the importance of prevention and ACEs screening to mitigate adverse mental health outcomes. Discrimination and being US born were the next strongest correlates of having internalizing and externalizing psychopathology. Ethnic identity emerged as the strongest negative correlate of both psychopathology factors. The findings are important for improving Hispanic mental health and informing healthcare policy.

Exploring trauma-informed prenatal care preferences through diverse pregnant voices

BACKGROUND

There are no existing standards of care for integrating trauma-informed care into prenatal care in a patient-centered manner. This study aims to explore preferences of pregnant people regarding prenatal care, prenatal providers, resources, and trauma inquiry and response.

METHODS

This study utilized a qualitative descriptive design as part of a longitudinal randomized controlled pilot trial. It was conducted at a university-affiliated federally qualified health center and multi-specialty clinic in a large metropolitan area among a purposive sample of 27 racially/ethnically diverse pregnant individuals. Eligible participants aged ≥ 18 between 10 and 24 weeks gestation were identified via medical charts and recruited in person and by email. Interview-administered structured interviews were provided at the post-intervention assessment. Qualitative data collection extended from June 2023 through April 2024. We performed inductive analysis to generate codes and identify emergent themes derived from participant responses. Participant preferences for prenatal care were interpreted through the lens of the six trauma-informed care principles.

RESULTS

Participants had an average age of (M = 28, SD = 4.5; range = 19-38) years old. Of the 27 participants interviewed, 21 self-identified as Black (77.8%) and 5 as Hispanic (18.5%). Three themes identified optimal prenatal care preferences, including: (1) Agency and Choice; (2) Emphasis on Maternal and Child health and Wellbeing; and (3) Universal and Personalized Provision of Information and Resources. Participants wanted their providers to be Familiar and Experienced; Personally Engaging; and Emotionally Safe and Supportive. Three additional themes focused on patient preferences for addressing trauma during prenatal visits, including: (1) Value of Addressing Trauma; (2) Approaches to Asking about Trauma; and (3) Sensitive and Empathic Inquiry and Response.

CONCLUSIONS

Patient preferences identified by this study underscore the need for prenatal care to address the psychological health needs of pregnant patients to deliver high quality, comprehensive prenatal care that is trauma-informed and culturally-responsive.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov ID: NCT05718479 on 08-02-2023.

Racial Discrimination as a Traumatic Bedrock of Healthcare Avoidance: A Pathway Through Healthcare Institutional Betrayal and Mistrust

Objectives: Experiences of racial discrimination within the healthcare system are potentially traumatic events (PTEs) that have been associated with lowered perceived trust in healthcare providers, ongoing symptoms of PTSD and depression, and anticipated healthcare avoidance. Based on the BITTEN trauma impact model, we test a pathway such that greater past healthcare discrimination would be associated with anticipated future healthcare avoidance among BIPOC college students. We posited that this direct relationship would be sequentially mediated by healthcare institutional betrayal (HIB) during one's worst healthcare event and subsequently reduced trust in healthcare. Methods: Our model was tested in a subsample of undergraduate students, all of whom self-identified with at least one minoritized racial or ethnic identity (n = 472). Participants reported on their past experiences with racial discrimination in healthcare. Each then chose and described their worst and/or most traumatic previous healthcare experience. Subsequently, they indicated if this experience included acts of HIB and/or led to medical mistrust. Finally, they reported on the degree to which they anticipated engaging in future healthcare avoidance. Results: Our model explained 31% of the variance in anticipated healthcare avoidance. As hypothesized via BITTEN, greater HIB during one's worst or most traumatic healthcare experience and resulting mistrust in healthcare sequentially mediated the relationship between past experiences of healthcare racial discrimination and anticipated future healthcare avoidance. However, a direct relationship between racial discrimination in healthcare and anticipated healthcare avoidance was retained. Conclusions: Racial discrimination is a potentially traumatic experience associated with deleterious health outcomes. Current results suggest that healthcare discrimination may drive BIPOC college students' future healthcare avoidance both directly and through experiencing increased healthcare institutional betrayal during one's worst healthcare experience and resultant mistrust in healthcare. Due to the crucial role both discrimination and HIB experiences may play in healthcare outcomes, greater organizational adoption of anti-racist trauma-informed healthcare and the enactment of deliberate system-level repair strategies post discrimination and/or HIB is critical. Understanding the interplay of racial discrimination, HIB, and medical mistrust is also likely to help us address and repair system-level factors leading to anticipated healthcare avoidance behavior among BIPOC emerging adults.

The Role of Race, Social Support, Empowerment, and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder

Black women experience more frequent and severe intimate partner violence (IPV), but there are mixed findings on their posttraumatic stress disorder (PTSD) symptom severity. This may be explained by cultural-salient factors which are associated with fewer posttraumatic cognitions. We hypothesized an indirect effect of race on PTSD symptoms via social support, empowerment, and posttraumatic cognitions, serially. Path analysis revealed Black women reported increased social support, which was associated with higher levels of empowerment, which was associated with lower levels of posttraumatic cognitions. Decreased posttraumatic cognitions were associated with less severe PTSD symptoms. Results increase understanding of culturally-salient factors that may impact PTSD symptoms in Black women.

Post-Traumatic Stress Across Color Lines: A History of Anti-Black Exclusion & PTSD

Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to this inequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental health care. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today. This article aims to provide a necessary historical context of how the U.S. mental health care system has excluded Black Americans from trauma treatment. We use a contemporary trauma lens to demonstrate the ways in which Black trauma has existed throughout U.S. history, but how White psychiatry has cast trauma symptoms as evidence of racial inferiority, has excluded Black individuals from treatment, and has abused Black patients, thereby increasing Black trauma. The purpose of this review is to inform and educate mental health providers about our collective history, to counter a narrative of amnesia which identifies Black underutilization of services but forgets the exclusion from and abuse of Black people within the mental health system. We conclude with recommendations that providers can utilize to engage in antiracist practice and create an affirmative space for Black Americans to utilize trauma treatment and mental health care freely.

Moving Beyond Mandatory Modules: Authentic Discussions About Racism and Health Equity at a Large Academic Medical Center

Introduction

Our institution launched a large-scale virtual training program called "Stepping Stones" that uses allegories to provide an increased understanding of concepts, such as interpersonal, internalized, and structural racism. The goal of this project was to implement facilitated discussions with trained leaders and determine the impact of these sessions in improving the experience of the modules and boosting comfort in discussing race and racism.

Methods

We developed facilitated discussions as a complimentary intervention for colleagues who participated in the virtual system-wide intervention. Our intention was to create a safe space to foster reflection and collaborative learning on how racism shows up in our work environment. We conducted 22 sessions across Massachusetts General Hospital between December 2021 and February 2023. Each session included between 5 and 30 participants who were asked to complete a survey regarding their experience.

Results

We collected post-session surveys from 102 out of 350 participants. Participants found the sessions to be informative and valuable. Over 97% of respondents rated the quality of the discussions as "Excellent" or "Very Good." Similarly, 95% of participants felt "Very" or "Somewhat" comfortable with discussing issues of race and racism in the workplace after the session.

Discussion

Participants reported that the facilitated discussions were valuable, enhanced their ability to talk about racism in clinical environments, and provided an opportunity for reflection. Giving the hospital staff a common language and the ability to discuss such challenging topics may contribute to a culture of equity within our hospital.

Exploring Intersections Between Trauma and Discrimination in Youth of Color Seeking Mental Health Services

OBJECTIVE

The purpose of this study is to explore the intersection between trauma and discrimination among Black and Latino/a/x youth seeking treatment. Specifically, we examine the following: (1) the frequency of various everyday discrimination experiences, averaged across the sample and disaggregated by demographic characteristics; (2) unique associations between exposure to potentially traumatic events (PTEs) and everyday discrimination experiences; and (3) unique associations between everyday discrimination experiences and specific posttraumatic stress symptoms while accounting for demographic characteristics and PTEs.

METHOD

Participants were 573 Black (54.8%) and non-Black Latino/a/x youth (10-18 years of age, 55.8% female, 25.7% first- or second-generation immigrant) who were treatment-seeking and had exposure at least one traumatic event.

RESULTS

Two-thirds of trauma-exposed youth reported having experienced discrimination, with the most common experience being treated as not smart (46%), followed by being treated with less courtesy or respect (40%). Rates of discrimination varied by intersecting demographic characteristics in nuanced ways. Among 11 PTEs, exposure to a natural disaster, experiencing community violence, and witnessing community violence were each positively associated with overall everyday discrimination scores and specific discriminatory encounters. Everyday discrimination experiences were positively associated with posttraumatic stress symptoms after accounting for demographic characteristics and exposure to PTEs.

CONCLUSION

Findings provide important context for understanding experiences of everyday discrimination in Black and Latino/a/x youth seeking mental health services for trauma. Findings further highlight variability in the types of discrimination youth with different intersecting identities experience, the high rates of co-occurrence between discrimination and other traumatic events, and unique associations between specific discrimination experiences and posttraumatic stress reactions.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

An intersectional examination of the relationship between racial/ethnic discrimination and psychotic-like experiences: the role of other psychiatric symptoms

BACKGROUND

Racial and ethnic experiences of discrimination (EODs) are associated with numerous psychiatric symptoms, including outcomes along the psychosis spectrum; however, less is known about mechanisms by which EODs confer risk for psychotic-like experiences (PLEs; common subthreshold psychotic symptoms). Furthermore, work on gendered racism asserts that the intersection of race and gender impacts the nature of EODs experienced and, in turn, may impact the relationship between EODs and PLEs.

AIMS

To utilize an intersectional lens (race and gender) to examine whether psychological correlates of EODs (post-traumatic stress, anxiety, depression, and dissociation) mediate the EOD-PLE relationship.

METHODS

Undergraduates at a diverse, semipublic university (N = 1,759) completed self-report questionnaires (Experiences of Discrimination Scale, Prodromal Questionnaire, Center for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory, Dissociative Experiences Scale, and Post-Traumatic Stress Disorder Checklist - Civilian Version). Analyses stratified the sample by race (non-Hispanic White, Black, and Asian) and examined three multiple mediation models, moderated by gender, examining the pathway from EODs to PLEs, through other psychiatric symptoms.

RESULTS

In the full sample, all psychiatric symptoms significantly mediated the relationship between EODs and PLEs. Only depression varied by gender, such that the indirect effect was only significant in female participants (β = 0.09; 95% CI [0.02, 0.16]). Across race-stratified groups, significant mediators varied by both race and gender.

CONCLUSIONS

These findings underscore the importance of accounting for intersectionality and multiple psychological symptoms in understanding the EOD-PLE associations, which differ by race and ethnicity as well as gender, and should be considered in clinical treatment of individuals with PLEs and history of EODs.

Intersectional Anticipated Discrimination Among Women Experiencing Homelessness in Argentina

Women experiencing homelessness constitute a group with idiosyncratic characteristics and needs that have largely remained invisible. Their discriminatory situation has been studied very little which may limit the design of specific intervention strategies. Buenos Aires (Argentina) is one of the main megalopolises in Latin America, where information on women experiencing homelessness is scarcely available. The main objective of this paper is to analyze different aspects related to intersectional anticipated discrimination perceived by women experiencing homelessness in Buenos Aires (n = 72). A structured interview was used to collect the information. The findings show that the vast majority of women experiencing homelessness in Buenos Aires reported experiencing unfair treatment and anticipated discrimination. In addition, more than two-thirds of the women interviewed indicated that they felt they could be insulted or detained without cause, among other unfair treatment. Among the main reasons attributed by the interviewees to these situations of discrimination were the fact of being homeless, being women (cis or trans), and being poor. The results obtained may be useful to guide the design and implementation of policies, services, and programs for women experiencing homelessness with a gender perspective.

Racial Discrimination-Related Interoceptive Network Disruptions: A Pathway to Disconnection

BACKGROUND

Racial discrimination (RD) disrupts regulatory systems in minoritized individuals, particularly systems that govern attention, including attention to visceral signals (interoception). RD frequency is linked to physiological shutdown responses, characterized clinically by dissociation. We examined associations between RD frequency and functional connectivity of attention and interoceptive networks in a sample of trauma-exposed Black women, investigating potential links between connectivity and dissociation severity.

METHODS

Seventy-two Black women who were recruited as part of two trauma studies underwent magnetic resonance imaging during performance of an affective Stroop (AS) task and completed dissociation and RD measures. Generalized psychophysiological interaction analyses were used to examine seed-to-voxel (seeds: bilateral amygdala and insula) functional connectivity with RD as a regressor; connectivity was examined during presentation of threat-relevant versus neutral AS distractor images. Connectivity values were extracted from significant clusters and examined in association with dissociative symptoms. We also investigated connectivity in association with posttraumatic stress disorder (PTSD) symptoms for comparison analyses.

RESULTS

During attention to threat-relevant AS trials, greater RD frequency was associated with less insula connectivity to several medial prefrontal cortex (mPFC) clusters (false discovery rate-corrected ps < .05). Insula-mPFC connectivity was significantly and negatively associated with derealization symptoms (r = -0.31, p = .009), but not PTSD (r = -0.16, p = .182).

CONCLUSIONS

RD frequency was linked to reduced functional connectivity between the insula and mPFC, 2 interoceptive network nodes, during attention to threat, and diminished connectivity was linked to more severe dissociation. RD may interrupt interoceptive network functioning, and these network alterations may, in turn, influence mind-body disconnection, or physiological shutdown response in Black individuals.

Racism-related experiences and substance use: A systematic and meta-analytic review

Examinations highlighting interpersonal racism-related experiences as risk factors for substance use are well documented, particularly for alcohol use. The associations between racism-related experiences across other levels of influence (e.g., historical trauma, online, internalized) and use of other types of substances, while emerging, have yielded mixed findings. The present systematic review and meta-analyses examined the associations between multilevel racism-related experiences and different types of substances including substance use overall, alcohol, binge drinking, tobacco/nicotine, cannabis, illicit drugs, and polysubstance use among ethnoracially minoritized adolescents and emerging adults (12-29 years old). A systematic literature search and the Newcastle-Ottawa Scale (NOS) were used to identify, assess quality, and bias of included articles. Random-effects meta-analyses estimated pooled effect sizes for seven substance use outcomes and by age, sex, and race/ethnicity. Out of a total of 3190 articles, 91 (N = 190,065 participants) met inclusion criteria, 79 of which were included in the meta-analysis. The studies included were predominantly cross-sectional, school-based samples, and focused on Black individuals. Most examined interpersonal racism and few examined online and historical forms of racism. Meta-analyses demonstrated a significant positive association, with a small pooled effect size, between racism-related experiences and each substance use outcome. Moderations by age, sex, and race/ethnicity were found. Racism-related experiences are a risk factor for substance use among ethnoracially minoritized adolescents and emerging adults. Interventions addressing racism-related experiences across multiple dimensions are critical for the prevention and treatment of substance use among ethnoracially minoritized communities.

Exploring Racial Discrimination, Disability Discrimination, and Perception of the Future Among Black-Identifying Emerging Adults with and without Autism in the United States: A Mixed-Methods Descriptive Study

Discrimination experienced by Black emerging adults with autism is rarely studied nor have their experiences been juxtaposed to Black emerging adults without autism. A mixed methods descriptive approach was used to describe responses to open-ended questions collected as part of a larger study of discrimination experienced by Black emerging adults with autism (n = 14) and Black emerging adults without autism (n = 20). Questions focused around racial discrimination, disability discrimination, and perception of the future. Qualitative and quantitative content analysis were applied. Qualitatively- a manifest approach was used, and quantitatively- frequency counts and ratios were identified within themes and subthemes. Four main themes and twelve subthemes were identified. Racial discrimination had two themes: 1) Impact on mental health, and 2) Societal threats, with five subthemes, each reported at higher rates by people without autism (Theme 1 = 5:7, Theme 2 = 3:11). Disability discrimination was only reported on by those with autism, and had one main theme of neurodiverse/autism bias, and three subthemes. Perception of the future contained the theme of emerging life hopes, with four subthemes. Subthemes relating to work/career/family and future unknown were reported more highly by those without autism than with autism (1:8 and 4:7 respectively), while subthemes describing diverse or unique priorities for fulfillment and mental wellness were reported only by those with autism (6:0 and 4:0 respectively). Study findings suggest unique experiences and needs among Black emerging adults with autism, as well as the consequences of anti-blackness and anti-ableism/neurobigotry which can have double impact in their lives, spanning different ages and stages. Results have implications for building resiliency among Black persons with autism and without autism as they transition to adulthood.

Health Impact of Racism-Based Experiences Among Black African Immigrant Adults in the United States: An Integrative Review

Racism-based experiences among Black African immigrants in the United States are a growing concern due to the prevalence of these events and risk for negative health (mental, behavioral, and physical) outcomes. This integrative review appraised published studies (2012-2023) addressing the relationship between racism-based experiences and adverse health for Black African immigrants. Articles were identified using structured search terms in several databases (APA PsycINFO, CINAHL, PubMed, Web of Science), Google Scholar, and citation mining. A total of fourteen studies met the inclusion criteria. Studies found a significant positive association between racism-based experiences and adverse mental (n = 9), behavioral (n = 3), and physical (n = 2) health outcomes. Racism-based experiences appear to have mental, behavioral, and physical health consequences for Black African immigrant adults. Given the growing population of Black African immigrants in the United States, more work is needed to elucidate the relationship between racism-based experiences and negative health outcomes.

Patterns of Familial and Racial Trauma and Their Associations with Substance Use Disorders among Racial/Ethnic Minority Adults

BACKGROUND

Racial/ethnic minorities in the United States often experience many different types of traumatic events. We examine the patterns of familial and racial trauma and their associations with substance use disorders (SUDs) among racial/ethnic minority adults.

METHODS

We used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III. The study sample included 17,115 individuals who were Hispanic (43.6%), Black (34.9%), Asian American and Pacific Islander (17.0%), and American Indian or Alaska Native (AI/AN, 4.6%). Latent class analysis models with covariates and distal outcomes were analyzed to investigate patterns of trauma exposure and estimate binary outcomes of SUDs. Familial and racial trauma was measured by ten areas of adverse childhood experiences (ACEs) and six items of racial discrimination.

RESULTS

We found four distinctive groups: low trauma (Class 1, 62.1%), high discrimination (Class 2, 17.2%), high ACEs (Class 2, 14.9%), and high trauma (Class 4, 5.9%). Compared to Class 1, other groups were more likely to include Black and AI/AN adults. Participants in Class 2 reported greater risks for alcohol and other drug use disorders. Those in Class 3 and 4 reported greater risks for alcohol, opioid, stimulant, and other drug use disorders.

CONCLUSION

Given a higher risk of trauma exposure in Black and AI/AN adults, racially and ethnically sensitive trauma-focused interventions may help prevent and reduce SUDs in those populations.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination

Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals.Objective: This article addresses this problem in a study of Ukrainian war refugees' experiences with post-migration discrimination and powerlessness (loss of control).Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty.Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty.Conclusions: Understanding the effect of post-migration experiences on war refugees' mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

Stress Exposure and PTSD in a Cross-Sectional Residential Substance Use Treatment Sample

BACKGROUND

Aim 1 of this cross-sectional, observational study with people in residential treatment for substance use disorders (SUDs) was to document stress exposure. Aim 2 was to assess potential sociodemographic and health differences based on probable posttraumatic stress disorder (PTSD) status. Aim 3 was to assess relative contributions of Diagnostic and Statistical Manual (DSM)-congruent versus DSM-incongruent stressors (Criterion A vs non-Criterion A) to mental and physical health. We hypothesized that both types of stressors would significantly contribute to impairment across indicators and that DSM-congruent stressor exposure would be more strongly associated with impairment than DSM-incongruent exposure.

METHODS

We assessed exposure to DSM-congruent traumatic stressors and DSM-incongruent life stressors, PTSD and depressive symptoms, emotion regulation difficulties, substance use recovery capital, and physical/mental health-related quality of life among 136 people in residential SUD treatment who were 64% men, 36% women; 49% white, 41% Black, 11% multiracial/another race; 18% lesbian, gay, or bisexual (LGB+); mean age = 39.82 (standard deviation = 12.24) years.

RESULTS

Participants reported experiencing a mean of 9.76 (SD = 6.11) DSM-congruent events. Those with probable PTSD were younger and more likely to be LGB+ than those without probable PTSD (P < .05). Experiencing higher numbers of DSM-congruent events was associated with more severe PTSD and depressive symptoms, emotion regulation difficulties, and lower physical health-related quality of life (P < .05). DSM-incongruent stressor exposure was not independently associated with any indicators. Recovery capital was not associated with either type of stress exposure.

CONCLUSIONS

Stressful event exposure among people in residential SUD treatment is very high. Those who are younger or LGB+ in residential SUD treatment may be at greater risk of developing PTSD. DSM-congruent stressors are more consistently associated with mental health indicators than are DSM-incongruent stressors. Prioritizing treatment targets and identifying implementable treatment strategies can be challenging with this complex population.

Racism and alcohol-related problems among Black adults: The role of negative emotionality to experiencing racism

INTRODUCTION

Although Black Americans tend to consume less alcohol than non-Hispanic/Latine White Americans, Black Americans who do drink alcohol appear at especially high risk for negative alcohol-related problems. This alcohol-based health disparity indicates a need to identify psycho-sociocultural factors that may play a role in drinking and related problems to inform prevention and treatment efforts. Minority stress-based models posit that stressors such as racism increase negative emotions, which may be associated with using substances such as alcohol to cope with negative emotions. Yet, little research has directly assessed emotional reactions to racism and whether it plays a role in drinking-related behaviors.

METHOD

Participants were 164 Black American undergraduates at a racially/ethnically diverse university who endorsed current alcohol use 18-48 (M = 21.7, SD = 4.3). Participants completed an online survey regarding their experiences with racism and alcohol-related behaviors.

RESULTS

Experiencing more frequent racism was related to greater negative emotions experienced in response to racism (i.e., negative emotional reactivity to racism) and alcohol-related problems. More frequent racism was related to more alcohol-related problems via the sequential effects of negative emotional reactivity to racism and coping motivated drinking.

CONCLUSIONS

These data indicate that the experience of negative emotions that occur after experiencing racism and attempts to cope with those negative emotions by consuming alcohol play important roles in drinking behaviors among Black Americans.

(Re)assessing Clinical Spaces: How do we Critically Provide Mental Health and Disability Support and Effective Care for Black and Brown Young People who are Impacted by Structural Violence and Structural Racism?

We open this article by asking you to consider that the magnitude of racism present in clinical spaces is much larger and more in depth than we can ever begin to cover. In this spirit, we are going to provide you with some context to think about the problem of racism and mental health and disability and ways to deconstruct the problem through the lens of structural violence and structural racism. We offer you a brief discussion on and a definition of structural violence and structural racism and then tie them to two case studies to help contextualize how racism currently exists within the medical field. We hope that the language and framework of structural violence and structural racism will help you think anew about racism and your own interactions with it. Although the difficulties with racial and structural violence are much too pervasive and will take collective action to dismantle, we do think that giving a framework to think and talk about racism may help the ways that you choose to interact with your patients, engage in clinical assessments, diagnosis, treatment, and navigate systems from your current role within the medical field.

The Relationships Among Neighborhood Disadvantage, Mental Health and Developmental Disabilities Diagnoses, and Race/Ethnicity in a U.S. Urban Location

Childhood health disparities by race have been found. Neighborhood disadvantage, which may result from racism, may impact outcomes. The aim of the study is to describe the distribution of mental health (MH) and developmental disabilities (DD) diagnosis across Child Opportunity Index (COI) levels by race/ethnicity. A cross-sectional study using 2022 outpatient visit data for children < 18 years living in the Louisville Metropolitan Area (n = 115,738) was conducted. Multivariable logistic regression analyses examined the association between diagnoses and COI levels, controlling for sex and age. Almost 18,000 children (15.5%) had a MH or DD (7,905 [6.8%]) diagnosis. In each COI level, the prevalence of MH diagnosis was lower for non-Hispanic (N-H) Black than for N-H White children. In adjusted analyses, there were no significant associations between diagnoses and COI for non-White children for MH or DD diagnoses. The odds of receiving a MH [OR: 1.74 (95% CI: 1.62, 1.87)] and DD [OR: 1.69 (95% CI: 1.51, 1.88)] diagnosis were higher among N-H White children living in Very Low compared to Very High COI areas. Current findings suggest that COI does not explain disparities in diagnosis for non-White children. More research is needed to identify potential multi-level drivers such as other forms of racism. Identifying programs, policies, and interventions to reduce childhood poverty and link children and families to affordable, family-centered, quality community mental and physical health resources is needed to ensure that families can build trusting relationships with the providers while minimizing stigma.

Contextualizing the racial gradient in covid-19 outcomes: Narratives from HBCU students

COVID-19 spread across the nation with Black Americans experiencing twice of the prevalence of deaths than White Americans. Black American college students are facing a unique set of biopsychosocial costs including less retention and poorer mental health. Therefore, the purpose of this study was to examine how Historically Black College or University (HBCU) students contextualize COVID-19. Interviews were conducted with 19 participants and lasted 40-60 minutes. They discussed topics including: their COVID-19 knowledge, precautionary measures, and barriers and promoters of school success were covered. Data were coded through semi-open coding and discussed among the research team. Responses were summarized by eight themes: emotional responses, colorblind rhetoric, lack of healthcare, essential work, distrust for the medical field, barriers to precautions like supply shortages and environmental factors, and poor baseline health. These findings may be used to develop interventions that moderate the impact of COVID-19 and future pandemics on mental health.

Racism-Related Experiences and Traumatic Stress Symptoms in Ethnoracially Minoritized Youth: A Systematic Review and Meta-Analysis

OBJECTIVE

Despite growing evidence demonstrating the association between racial and ethnic discrimination and traumatic stress symptoms in adult populations, the research among youth remains sparse. Drawing upon race-based traumatic stress models, and following the PRISMA-2020 guidelines, this systematic review and meta-analysis aimed to identify the state of the empirical evidence in the association between racism-related experiences and traumatic stress symptoms in ethnoracially minoritized youth.

METHOD

Scientific databases were searched to identify articles with ethnoracially minoritized youth participants under age 18 years old that examined the association between racial and/or ethnic discrimination and traumatic stress symptoms.

RESULTS

A total of 18 articles comprising 16 studies (N = 4,825 participants) met inclusion criteria. Studies were largely cross-sectional, used nonrandom sampling strategies, focused on Black and Latinx youth, and were conducted in the United States. Furthermore, most studies were theoretically grounded and operationalized racism-related experiences as frequency of direct, personal, everyday discrimination. Few studies examined other dimensions of racism-related experiences. The meta-analysis demonstrated a significant positive association with a medium effect size, rpooled = .356, 95% confidence interval [CI] = 0.27, 0.44, between racism-related experiences and traumatic stress symptoms. No evidence of moderation by age, sex/gender, race/ethnicity, country, or recruitment setting was detected.

CONCLUSION

Racism-related experiences may confer risk for traumatic stress symptoms in ethnoracially minoritized youth. Attending to racism-related experiences is critical to improve the cultural responsiveness of trauma-informed services.

Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination

In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.

Racial Discrimination, Neural Connectivity, and Epigenetic Aging Among Black Women

Importance

Racial discrimination increases the risk of adverse brain health outcomes, potentially via neuroplastic changes in emotion processing networks. The involvement of deep brain regions (brainstem and midbrain) in these responses is unknown. Potential associations of racial discrimination with alterations in deep brain functional connectivity and accelerated epigenetic aging, a process that substantially increases vulnerability to health problems, are also unknown.

Objective

To examine associations of racial discrimination with brainstem and midbrain resting-state functional connectivity (RSFC) and DNA methylation age acceleration (DMAA) among Black women in the US.

Design, Setting, and Participants

This cohort study was conducted between January 1, 2012, and February 28, 2015, and included a community-based sample of Black women (aged ≥18 years) recruited as part of the Grady Trauma Project. Self-reported racial discrimination was examined in association with seed-to-voxel brain connectivity, including the locus coeruleus (LC), periaqueductal gray (PAG), and superior colliculus (SC); an index of DMAA (Horvath clock) was also evaluated. Posttraumatic stress disorder (PTSD), trauma exposure, and age were used as covariates in statistical models to isolate racial discrimination-related variance. Data analysis was conducted between January 10 and October 30, 2023.

Exposure

Varying levels of racial discrimination exposure, other trauma exposure, and posttraumatic stress disorder (PTSD).

Main Outcomes and Measures

Racial discrimination frequency was assessed with the Experiences of Discrimination Scale, other trauma exposure was evaluated with the Traumatic Events Inventory, and current PTSD was evaluated with the PTSD Symptom Scale. Seed-to-voxel functional connectivity analyses were conducted with LC, PAG, and SC seeds. To assess DMAA, the Methylation EPIC BeadChip assay (Illumina) was conducted with whole-blood samples from a subset of 49 participants.

Results

This study included 90 Black women, with a mean (SD) age of 38.5 (11.3) years. Greater racial discrimination was associated with greater left LC RSFC to the bilateral precuneus (a region within the default mode network implicated in rumination and reliving of past events; cluster size k = 228; t85 = 4.78; P < .001, false discovery rate-corrected). Significant indirect effects were observed for the left LC-precuneus RSFC on the association between racial discrimination and DMAA (β [SE] = 0.45 [0.16]; 95% CI, 0.12-0.77).

Conclusions and Relevance

In this study, more frequent racial discrimination was associated with proportionately greater RSFC of the LC to the precuneus, and these connectivity alterations were associated with DMAA. These findings suggest that racial discrimination contributes to accelerated biological aging via altered connectivity between the LC and default mode network, increasing vulnerability for brain health problems.

Racial Discrimination and Risk for Internalizing and Externalizing Symptoms Among Black Youths

Importance

Racial discrimination is a psychosocial stressor associated with youths' risk for psychiatric symptoms. Scarce data exist on the moderating role of amygdalar activation patterns among Black youths in the US.

Objective

To investigate the association between racial discrimination and risk for psychopathology moderated by neuroaffective processing.

Design, Setting, and Participants

This cohort study used longitudinal self-report and functional magnetic resonance imaging (fMRI) data from Black youth participants in the US from the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from January 2023 to May 2024.

Exposures

At time 1 of the current study (12 months after baseline), youths self-reported on their experiences of interpersonal racial discrimination and their feelings of marginalization. Amygdalar response was measured during an emotionally valenced task that included blocks of faces expressing either neutral or negative emotion.

Main Outcomes and Measures

At 24 and 36 months after baseline, youths reported their internalizing (anxiety and depressive symptoms) and externalizing symptoms (aggression and rule-breaking symptoms).

Results

A total of 1596 youths were a mean (SD) age of 10.92 (0.63) years, and 803 were female (50.3%). Families in the study had a mean annual income range of $25 000 to $34 999. Two factors were derived from factor analysis: interpersonal racial discrimination and feelings of marginalization (FoM). Using structural equation modeling in a linear regression, standardized β coefficients were obtained. Neural response to faces expressing negative emotion within the right amygdala significantly moderated the association between FoM and changes in internalizing symptoms (β = -0.20; 95% CI, -0.32 to -0.07; P < .001). The response to negative facial emotion within the right amygdala significantly moderated the association between FoM and changes in externalizing symptoms (β = 0.24; 95% CI, 0.04 to 0.43; P = .02). Left amygdala response to negative emotion significantly moderated the association between FoM and changes in externalizing symptoms (β = -0.16; 95% CI, -0.32 to -0.01; P = .04).

Conclusions and Relevance

In this cohort study of Black adolescents in the US, findings suggest that amygdala function in response to emotional stimuli can both protect and intensify the affective outcomes of feeling marginalized on risk for psychopathology, informing preventive interventions aimed at reducing the adverse effects of racism on internalizing and externalizing symptoms among Black youths.

Examination of race-based traumatic stress symptom networks in Black adults in the United States: A network analysis

In the United States, racism is theorized to exert its negative effects on Black individuals' mental health by triggering a response known as "race-based traumatic stress" (RBTS), a multidimensional construct comprising seven clusters of symptoms that can occur following exposure to race-based traumatic events (e.g., racial discrimination, racist incidents): depression, intrusion, anger, hypervigilance, physical symptoms, (low) self-esteem, and avoidance. However, little is known about which symptoms and clusters are strongest and most influential in the maintenance of RBTS. Network analysis is a powerful tool for understanding the etiology of traumatic stress, but it has not yet been applied to the examination of this construct. The present study aimed to identify the symptoms most central to RBTS and examine associations between symptoms and symptom clusters. Participants (N = 1,037) identified as Black, and lived in the United States (Mage = 45.12 years, range: 18-82 years) and completed the Race-Based Traumatic Stress Symptom Scale-Short Form (RBTSSS-SF). Regularized partial correlation networks were estimated using R/RStudio. The cluster- and item-level networks demonstrated adequate centrality stability, CS = .44. The depression and physical symptoms clusters were the most central nodes in the cluster network. Feelings of meaninglessness, experiencing mental images of the event, and physical trembling were the most central items within the item-level network. These findings offer insights and implications for assessing and treating symptoms of RBTS in Black adults in the United States who are exposed to race-based traumatic events.

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.

Differential Risk: Gender and Racial Differences in the Relationship between Trauma, Discrimination, and Schizotypy

Traumatic experiences are associated with increased experiences of positive schizotypy. This may be especially important for People of Color, who experience higher rates of trauma and racial discrimination. No study to date has examined how racial disparities in traumatic experiences may impact schizotypy. Furthermore, of the studies that have examined the relationship between trauma and schizotypy, none have examined racial discrimination as a potential moderator. The present study examined if racial discrimination moderates the relationship between trauma and multidimensional (positive, negative, and disorganized) schizotypy. In a sample of 770 college students, we conducted chi-squared analyses, analyses of variance, and stepwise regressions. We found that Black students experienced significantly higher racial discrimination and trauma than Latinx and Asian students. Furthermore, Black and Latinx students experienced significantly more multidimensional schizotypy items than Asian students. Trauma and racial discrimination explained 8 to 23% of the variance in each dimension of schizotypy. Racial discrimination did not moderate the relationships between trauma and multidimensional schizotypy. Our findings suggest that we need to examine risk factors that may prevent recovery from psychotic disorders. Additionally, disorganized schizotypy showed the most robust associations and may be a critical site of intervention.

The emotional impact of baseless discrediting of knowledge: An empirical investigation of epistemic injustice

According to theoretical work on epistemic injustice, baseless discrediting of the knowledge of people with marginalized social identities is a central driver of prejudice and discrimination. Discrediting of knowledge may sometimes be subtle, but it is pernicious, inducing chronic stress and coping strategies such as emotional avoidance. In this research, we sought to deepen the understanding of epistemic injustice's impact by examining emotional responses to being discredited and assessing if marginalized social group membership predicts these responses. We conducted a novel series of three experiments (Total N = 1690) in which participants (1) shared their factual knowledge about how a game worked or their personal feelings about the game; (2) received discrediting feedback (invalidating remarks), validating feedback (affirming remarks), or insulting feedback (general negative social evaluation); and then (3) reported their affect. In all three studies, on average, affective responses to discrediting feedback were less negative than to insulting feedback, and more negative than to validating feedback. Participants who shared their knowledge reported more negative affect after discrediting feedback than participants who shared their feelings. There were consistent individual differences, including a twice-replicated finding of reduced negative affect after receiving discrediting and insulting feedback for Black men compared to White men and women and Black women. Black men's race-based traumatic symptom scores predicted their affective responses to discrediting and insulting feedback, suggesting that experience with discrimination contributed to the emotional processing of a key aspect of epistemic injustice: remarks conveying baseless discrediting of knowledge.

THE IMPACT OF ETHNIC DISCRIMINATION AND INSTITUTIONAL BETRAYAL ON CANADIAN UNIVERSITY STUDENTS' MENTAL HEALTH

The aims of this study were to understand associations among mental health symptoms, ethnic discrimination, and institutional betrayal, and explore the potential role of protective factors (e.g. ethnic identity and racial regard) in attenuating the detrimental effects of discrimination and betrayal. A total of 89 racialized Canadian university students were recruited for this study. Self-report measures investigated demographics, mental health symptoms, experiences of discrimination and institutional betrayal, racial regard, and ethnic identity. Experiencing ethnic discrimination was associated with increased symptoms of depression and PTSD, even when controlling for the buffering effects of protective factors. Marginally significant results suggested that institutional betrayal might play a role in this relationship. Experiencing ethnic discrimination is linked to significant posttraumatic consequences. Unhelpful institutional responses may further aggravate symptoms. Universities have a duty to protect victims, and prevent ethnic discrimination.

[Discrimination-Sensitive Psychotherapy: How High Is The Privilege Awareness Among Psychotherapists?]

OBJECTIVE

Discrimination can have a negative impact on mental health and thus can play a crucial role in the context of psychotherapy. This paper outlines the potentials and the relevance of an (intersectional) privilege awareness of psychotherapists for a discrimination-sensitive psychotherapy. The aim of this study was to assess the privilege awareness of psychotherapists in Germany for the first time as well as its thematization in the training of psychotherapists. In addition, the connection between belonging to a marginalized group and the privilege awareness was investigated.

METHODS

270 psychotherapists (in training) based in Germany participated in an online survey (2022). Privilege awareness was assessed with an adapted version of the Awareness of Privilege and Oppression Scale-2, translated into German, regarding the following axes of discrimination: heterosexism, classism, and racism. Three self-written items additionally surveyed the thematization of discrimination and privilege in psychotherapy training. The relationship between belonging to a marginalized group and privilege awareness was examined using linear regression analysis.

RESULTS

Nearly 65% (N=270) of participants felt unprepared or somewhat unprepared to deal with patients' experiences of discrimination, with approximately 40% (N=270) indicating that discrimination was not addressed in training. Privilege was addressed much less frequently. Belonging to a marginalized group was associated with higher privilege awareness (B=0,47, 95%-confidence interval: 0,27-0,67, F(2, 267)=15,41, p<0,001).

CONCLUSION

There is a need to include the impact of discrimination and privilege on mental health and the therapeutic relationship as an integral part of psychotherapy training to enhance its quality as well as the quality of future psychotherapies.

Experiences of racial discrimination and adverse gene expression among black individuals in a level 1 trauma center sample

Up to 40 % of individuals who sustain traumatic injuries are at risk for posttraumatic stress disorder (PTSD) and the conditional risk for developing PTSD is even higher for Black individuals. Exposure to racial discrimination, including at both interpersonal and structural levels, helps explain this health inequity. Yet, the relationship between racial discrimination and biological processes in the context of traumatic injury has yet to be fully explored. The current study examined whether racial discrimination is associated with a cumulative measure of biological stress, the gene expression profile conserved transcriptional response to adversity (CTRA), in Black trauma survivors. Two-weeks (T1) and six-months (T2) post-injury, Black participants (N = 94) provided a blood specimen and completed assessments of lifetime racial discrimination and PTSD symptoms. Mixed effect linear models evaluated the relationship between change in CTRA gene expression and racial discrimination while adjusting for age, gender, body mass index (BMI), smoking history, heavy alcohol use history, and trauma-related variables (mechanism of injury, lifetime trauma). Results revealed that for individuals exposed to higher levels of lifetime racial discrimination, CTRA significantly increased between T1 and T2. Conversely, CTRA did not increase significantly over time in individuals exposed to lower levels of lifetime racial discrimination. Thus, racial discrimination appeared to lead to a more sensitized biological profile which was further amplified by the effects of a recent traumatic injury. These findings replicate and extend previous research elucidating the processes by which racial discrimination targets biological systems.

C-reactive protein moderates associations between racial discrimination and ventromedial prefrontal cortex activation during attention to threat in Black American women

Prior research has shown that racial discrimination (RD) impacts activation in threat network regions, including the ventromedial prefrontal cortex (vmPFC) and middle occipital cortex during attention to threat-relevant stimuli. However, little is known about the biological mechanisms that may modulate these effects; inflammation may be a pathway linking RD and threat network activation. As such, the current study aimed to explore whether systemic inflammation, measured by C-reactive protein (CRP) levels, may moderate the relationship between RD and activation in the vmPFC and middle occipital cortex during attention to threat. Blood samples for inflammatory marker (CRP) assays were obtained from forty Black American women (mean [SD] age, 39.93 [9.97] years; range, 22-58 years) recruited from an ongoing trauma study; participants also viewed threat-relevant stimuli as part of an attention task during fMRI. We found that CRP moderated the relationship between RD and vmPFC activation during attention to threat, such that participants with relatively higher concentrations of CRP ( ≥ 23.97 mg/L) demonstrated significant positive associations between RD and vmPFC activation [β = 0.18, CI (0.04, 0.32), t = 2.65, p = 0.01]. No significant associations were observed for participants who showed moderate (10.89 mg/L) or low (0.20 mg/L) CRP concentrations. CRP did not moderate the relationship between RD and middle occipital cortex activation. Our data present a mechanism through which RD may influence immune system activation and, in turn, threat network activation. Inflammation may contribute to brain health vulnerabilities in Black Americans via its effects on threat circuits; this merits further investigation in large-scale studies.

The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward

Posttraumatic stress disorder (PTSD) Criterion A, also known as the "stressor criterion," has been a major source of debate ever since PTSD was added to the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980. Since then, the traumatic stress field has held an ongoing debate about how to best define Criterion A and the events that it covers. Because of the COVID-19 pandemic and recent race-based incidents, the Criterion A debate has been reinvigorated. In this paper, we review briefly the history of Criterion A and changes in its language across different editions of the DSM. We then describe the four main positions held by scholars involved in the Criterion A debate and carefully examine the support for those positions. We conclude by offering recommendations for moving forward.

A call to create integrated services to better address the needs of migrants who use drugs in Europe

Each year, thousands of migrants enter the EU. Data on drug use in migrant populations are scarce and inconclusive. However, several risk factors make them particularly vulnerable to engaging in problematic drug use. In this perspective, we summarize the limited information that is available on migrants who use drugs and make a case as to why it is essential to improve access to health and social services, including harm reduction services, for this population. With this aim, we call for the co-creation of integrated services that better address the needs of migrants who use drugs in Europe.

Negative emotional reactivity to minority stress: measure development and testing

The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.

Trauma-Informed Pedagogy: Instructional Strategies to Support Student Success

Over the past several years, the ongoing coronavirus disease 2019 pandemic has contributed to challenging working and life conditions. As a result, the midwifery and health care workforce has faced significant shortages due to burnout. Increased societal awareness of historical trauma and systemic racism embedded within US culture has also led to increased anxiety and signs of trauma among midwifery and health profession students. Now more than ever, innovative teaching strategies are needed to support students, reduce the risks of burnout, and increase diversity in the workforce. One strategy is to adopt a trauma-informed pedagogy within midwifery education. Trauma-informed pedagogy is founded on core assumptions of trauma-informed care and thus supports student success by recognizing that the student cannot be separated from their own life experiences. Faculty and preceptors can develop empathetic, flexible supports that communicate care and concern regarding students' personal and social situations, and emotions. Empathetic behavior from teachers also increases student learning motivation, making it easier for students to actively engage in learning thereby reducing their distress. The purpose of this State of the Science review, therefore, was to describe the literature surrounding trauma-informed pedagogy and to offer concrete educational strategies that faculty members and educational programs can employ to increase the success of a diverse student body. This can be accomplished through flexibility in curriculum design and outcome measurement to ensure attainment of end of program learning outcomes. Institutional and administrative support are essential to develop a faculty who realize the benefit and value of trauma-informed pedagogy underpinning student success.