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Niemi L, Washington N, Workman C, Arcila-Valenzuela M, De Brigard F. The emotional impact of baseless discrediting of knowledge: An empirical investigation of epistemic injustice. Acta Psychol (Amst) 2024; 244:104157. [PMID: 38354565 DOI: 10.1016/j.actpsy.2024.104157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
- Laura Niemi
- Cornell University, Ithaca, NY 14853, United States of America.
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Tyrell FA, Wang YS, Eboigbe LI, Skeeter BD. A multisystem model for understanding stress and adaptation in ethnically and racially diverse youth. Dev Psychopathol 2024:1-13. [PMID: 38506061 DOI: 10.1017/s0954579424000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Contemporary biological and contextually based theoretical frameworks have conceptualized how stress exposure may influence adaptation in youth. However, nearly all of this scholarship neglects the role of specific contextual features and/or biological processes that are involved in ethnic-racial minority youth's responses and adaptation to sociocultural stressors. Drawing on the theoretical principles of the developmental psychopathology framework and contemporary models of stress and adaptation, this article proposes a new multisystem model that explains how multiple levels and systems within and outside of individual youth influence their sociocultural adaptation. We provide empirical evidence to support components of this multisystem model. We propose that research based on our new theoretical framework will capture the sociocultural experiences of ethnic-racial minority youth by centering processes that are relevant to their lived experiences, coping, and adjustment. In doing so, this model will inform psychosocial interventions focused on promoting healthy adaptation among ethnic and racial diverse youth. Finally, we offer recommendations to guide future research on stress and adaptation among ethnic and racial diverse youth, in particular, and developmental psychopathology more broadly.
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Affiliation(s)
- Fanita A Tyrell
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Yuqi S Wang
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Loretta I Eboigbe
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Bailey D Skeeter
- Department of Psychology, University of Maryland, College Park, MD, USA
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Grapin SL, Warner CM, Bixter MT, Cunningham DJ, Bonumwezi J, Mahmud F, Kline EA, Portillo NL, Nisenson D. Online racial discrimination and mental health among Black undergraduates: The moderating role of gender. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:310-318. [PMID: 35380502 DOI: 10.1080/07448481.2022.2034833] [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: 02/02/2021] [Revised: 11/16/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objective: Online racial discrimination (ORD) is rampant; however, little is known about its associations with mental health among undergraduates. This study explored the relations between ORD and mental health among Black undergraduates. It also investigated gender differences in these relations. Participants: Two hundred seventy-eight Black, cisgender men and women enrolled in a minority-serving public university in the Northeast U.S. Methods: Participants completed measures of ORD, depression, generalized anxiety (GA), and social anxiety (SA) via a Web-based survey. Results: Eighty-five percent of participants experienced at least one ORD incident in the last year. Men and women reported comparable exposure. Gender moderated the relations between ORD and depression and SA, respectively; these associations were stronger for women. Conclusions: Exposure to ORD is prevalent among Black undergraduates and is associated with adverse mental health outcomes, especially for women. Campus mental health interventions should address online discrimination in the context of students' intersecting identities.
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Affiliation(s)
| | - Carrie Masia Warner
- Montclair State University, Montclair, New Jersey, USA
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | | | | | | | - Farah Mahmud
- Montclair State University, Montclair, New Jersey, USA
| | - Emily A Kline
- Montclair State University, Montclair, New Jersey, USA
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Stephens BY, Young BE, Nandadeva D, Skow RJ, Greaney JL, Brothers RM, Fadel PJ. Sympathetic transduction at rest and during cold pressor test in young healthy non-Hispanic Black and White women. Am J Physiol Regul Integr Comp Physiol 2023; 325:R682-R691. [PMID: 37781734 PMCID: PMC11178294 DOI: 10.1152/ajpregu.00073.2023] [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: 03/23/2023] [Revised: 09/01/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Non-Hispanic Black (BL) individuals have the highest prevalence of hypertension and cardiovascular disease (CVD) compared with all other racial/ethnic groups. Previous work focused on racial disparities in sympathetic control and blood pressure (BP) regulation between young BL and White (WH) adults, have mainly included men. Herein, we hypothesized that BL women would exhibit augmented resting sympathetic vascular transduction and greater sympathetic and BP reactivity to cold pressor test (CPT) compared with WH women. Twenty-eight young healthy women (BL: n = 14, 22 [Formula: see text] 4 yr; WH: n = 14, 22 [Formula: see text] 4 yr) participated. Beat-to-beat BP (Finometer), common femoral artery blood flow (duplex Doppler ultrasound), and muscle sympathetic nerve activity (MSNA; microneurography) were continuously recorded. In a subset (BL n = 10, WH n = 11), MSNA and BP were recorded at rest and during a 2-min CPT. Resting sympathetic vascular transduction was quantified as changes in leg vascular conductance (LVC) and mean arterial pressure (MAP) following spontaneous bursts of MSNA using signal averaging. Sympathetic and BP reactivity were quantified as changes in MSNA and MAP during the last minute of CPT. There were no differences in nadir LVC following resting MSNA bursts between BL (-8.70 ± 3.43%) and WH women (-7.30 ± 3.74%; P = 0.394). Likewise, peak increases in MAP following MSNA bursts were not different between groups (BL: +2.80 ± 1.42 mmHg; vs. WH: +2.99 ± 1.15 mmHg; P = 0.683). During CPT, increases in MSNA and MAP were also not different between BL and WH women, with similar transduction estimates between groups (ΔMAP/ΔMSNA; P = 0.182). These findings indicate that young, healthy BL women do not exhibit exaggerated sympathetic transduction or augmented sympathetic and BP reactivity during CPT.NEW & NOTEWORTHY This study was the first to comprehensively investigate sympathetic vascular transduction and sympathetic and BP reactivity during a cold pressor test in young, healthy BL women. We demonstrated that young BL women do not exhibit exaggerated resting sympathetic vascular transduction and do not have augmented sympathetic or BP reactivity during cold stress compared with their WH counterparts. Collectively, these findings suggest that alterations in sympathetic transduction and reactivity are not apparent in young, healthy BL women.
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Affiliation(s)
- Brandi Y Stephens
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Benjamin E Young
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Damsara Nandadeva
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rachel J Skow
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Jody L Greaney
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
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Lawrence JA, Kawachi I, White K, Bassett MT, Williams DR. Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults. Am J Epidemiol 2023; 192:1971-1980. [PMID: 37401004 PMCID: PMC10691201 DOI: 10.1093/aje/kwad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.
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Affiliation(s)
- Jourdyn A Lawrence
- Correspondence to Dr. Jourdyn A. Lawrence, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 5th Floor, 3215 Market Street, Philadelphia, PA 19104 (e-mail: )
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Jones DM, Masyn KE, Spears CA. Associations among discrimination, psychological functioning, and substance use among US Black adults aged 18-28: Moderation by racial attribution and sex. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:209080. [PMID: 37230392 PMCID: PMC10526892 DOI: 10.1016/j.josat.2023.209080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/02/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Discrimination is associated with poor mental health and substance use among Black Americans, but research is needed on mediators and moderators of these relationships. This study tested whether: 1) discrimination is associated with current alcohol, tobacco (cigarette or e-cigarette), and cannabis use among US Black emerging adults; 2) psychological distress (PD) and positive well-being (PW) are mediators of discrimination-substance use relationships; and 3) these relationships are moderated by sex and attributions to discrimination (racial vs. nonracial). METHODS Using data from a 2017 US nationally representative survey, we conducted bivariate and multiple-group moderated mediation analyses among 1118 Black American adults aged 18-28. The study assessed discrimination and attribution to discrimination using the Everyday Discrimination scale, past 30-day PD with the Kessler-6 scale, and past 30-day PW with the Mental Health Continuum Short Form. We utilized probit regression for all structural equation models and adjusted final models for age. RESULTS Discrimination was positively associated with past 30-day cannabis and tobacco use directly and indirectly through PD in the overall model. Among males who reported race as the sole/main attribution to discrimination, discrimination was positively associated with alcohol, cannabis, and tobacco use through PD. Among females who reported race as the sole/main attribution to discrimination, discrimination was positively associated with cannabis use through PD. Discrimination was positively associated with tobacco use among those who reported nonracial attributions to discrimination and with alcohol use among those whose attribution was not assessed. Discrimination was positively associated with PD among those who reported race as a secondary attribution to discrimination. CONCLUSIONS Discrimination specifically attributed to race may contribute to greater PD and in turn alcohol, cannabis, and tobacco use among Black emerging adults, especially males. Future substance use prevention and treatment efforts targeted to Black American emerging adults may benefit from addressing racial discrimination and PD.
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Affiliation(s)
- Dina M Jones
- Center for the Study of Tobacco, Department Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box #820, Little Rock, AR 72205, USA.
| | - Katherine E Masyn
- Department of Population Health Sciences, School of Public Health, Georgia State University, 140 Decatur St., Suite 471, Atlanta, GA 30303, USA.
| | - Claire A Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, 140 Decatur St., Suite 612, Atlanta, GA 30303, USA.
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Moitra M, Owens S, Hailemariam M, Wilson KS, Mensa-Kwao A, Gonese G, Kamamia CK, White B, Young DM, Collins PY. Global Mental Health: Where We Are and Where We Are Going. Curr Psychiatry Rep 2023; 25:301-311. [PMID: 37256471 PMCID: PMC10230139 DOI: 10.1007/s11920-023-01426-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE OF REVIEW To summarize recent findings in global mental health along several domains including socioeconomic determinants, inequities, funding, and inclusion in global mental health research and practice. RECENT FINDINGS Mental illness continues to disproportionately impact vulnerable populations and treatment coverage continues to be low globally. Advances in integrating mental health care and adopting task-shifting are accompanied by implementation challenges. The mental health impact of recent global events such as the COVID-19 pandemic, geo-political events, and environmental change is likely to persist and require coordinated care approaches for those in need of psychosocial support. Inequities also exist in funding for global mental health and there has been gradual progress in terms of building local capacity for mental health care programs and research. Lastly, there is an increasing effort to include people with lived experiences of mental health in research and policy shaping efforts. The field of global mental health will likely continue to be informed by evidence and perspectives originating increasingly from low- and middle-income countries along with ongoing global events and centering of relevant stakeholders.
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Affiliation(s)
- Modhurima Moitra
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA.
| | - Shanise Owens
- Department of Public Health, Department of Obstetrics, Gynecology and Reproductive Biology, Charles Stewart Mott, Michigan State University, East Lansing, USA
| | - Maji Hailemariam
- Department of Global Health, University of Washington, Seattle, USA
| | - Katherine S Wilson
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Augustina Mensa-Kwao
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Gloria Gonese
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Christine K Kamamia
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Belinda White
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Dorraine M Young
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
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Auguste EJ, McDuffie DL, Ighodaro ET, Moye J. Enhancing inclusivity of older Black and African American adults in mental health research. Clin Gerontol 2023; 46:5-13. [PMID: 36309844 PMCID: PMC10281593 DOI: 10.1080/07317115.2022.2133453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Elizabeth J. Auguste
- Department of Psychology, University of Massachusetts, Boston, Massachusetts, USA
| | - Danielle L. McDuffie
- Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, Minnesota, USA
| | | | - Jennifer Moye
- VA New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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SenthilKumar G, Gutierrez-Huerta CA, Freed JK, Beyer AM, Fancher IS, LeBlanc AJ. New developments in translational microcirculatory research. Am J Physiol Heart Circ Physiol 2022; 323:H1167-H1175. [PMID: 36306213 PMCID: PMC9678417 DOI: 10.1152/ajpheart.00566.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 01/28/2023]
Abstract
Microvascular disease plays a critical role in systemic end-organ dysfunction, and treatment of microvascular pathologies may greatly reduce cardiovascular morbidity and mortality. The Call for Papers collection: New Developments in Translational Microcirculatory Research highlights key advances in our understanding of the role of microvessels in the development of chronic diseases as well as therapeutic strategies to enhance microvascular function. This Mini Review provides a concise summary of these advances and draws from other relevant research to provide the most up-to-date information on the influence of cutaneous, cerebrovascular, coronary, and peripheral microcirculation on the pathophysiology of obesity, hypertension, cardiovascular aging, peripheral artery disease, and cognitive impairment. In addition to these disease- and location-dependent research articles, this Call for Papers includes state-of-the-art reviews on coronary endothelial function and assessment of microvascular health in different organ systems, with an additional focus on establishing rigor and new advances in clinical trial design. These articles, combined with original research evaluating cellular, exosomal, pharmaceutical, exercise, heat, and dietary interventional therapies, establish the groundwork for translating microcirculatory research from bench to bedside. Although numerous studies in this collection are focused on human microcirculation, most used robust preclinical models to probe mechanisms of pathophysiology and interventional benefits. Future work focused on translating these findings to humans are necessary for finding clinical strategies to prevent and treat microvascular dysfunction.
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Affiliation(s)
- Gopika SenthilKumar
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cristhian A Gutierrez-Huerta
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julie K Freed
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andreas M Beyer
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ibra S Fancher
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Amanda Jo LeBlanc
- Department of Cardiovascular and Thoracic Surgery, School of Medicine, University of Louisville, Louisville, Kentucky
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
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Sheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. J Am Acad Child Adolesc Psychiatry 2022; 61:662-675. [PMID: 34509592 PMCID: PMC8904650 DOI: 10.1016/j.jaac.2021.08.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Suicide among Black youth is a significant public health concern, yet research investigating the epidemiology of suicide in this population is limited. This study examines current trends and precipitating circumstances of suicide by sex and age group in Black youth 5 to 17 years of age, using 2 national databases. METHOD Data from the Web-based Injury Statistics Query and Reporting System (WISQARS) and the National Violent Death Reporting System (NVDRS) were used to investigate trends and precipitating circumstances of Black youth suicide from 2003 to 2017. We hypothesized suicide rates would increase over time for both sexes and all age groups (5-11, 12-14, and 15-17 years), and precipitating circumstances would differ by sex and age group. Trend analyses were conducted using Joinpoint regression software, version 4.8.0.01 (Surveillance Research Program, National Cancer Institute). Sex and age group comparisons of characteristics and precipitating circumstances were conducted using standard univariate statistical tests. RESULTS From 2003 to 2017, Black youth experienced a significant upward trend in suicide with the largest annual percentage change in the 15- to 17-year age group and among girls (4.9% and 6.6%, respectively). Mental health problems, relationship problems, interpersonal trauma and life stressors, and prior suicidal thoughts/behavior were the most common clinical characteristics and precipitating circumstances, with several varying by sex and age group. CONCLUSION Increases in Black youth suicide calls for the prioritization of research aimed at identifying specific risk and protective factors as well as developmental mechanisms associated with Black youth suicidal behavior. To implement effective suicide prevention programming, understanding targets for intervention is necessary.
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Affiliation(s)
- Arielle H Sheftall
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus.
| | - Fatima Vakil
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Donna A Ruch
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Rhonda C Boyd
- Children's Hospital of Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael A Lindsey
- Silver School of Social Work, New York University, New York; McSilver Institute for Poverty Policy and Research, New York
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus
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Akins JD, Richey RE, Campbell JC, Martin ZT, Olvera G, Brothers RM. Contributions of endothelin-1 and l-arginine to blunted cutaneous microvascular function in young, black women. Am J Physiol Heart Circ Physiol 2022; 322:H260-H268. [PMID: 34919455 PMCID: PMC8759956 DOI: 10.1152/ajpheart.00457.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Non-Hispanic black (BL) individuals have the greatest prevalence of cardiovascular disease (CVD), relative to other racial/ethnic groups (e.g., non-Hispanic white population; WH), which may be secondary to blunted vascular function. Although women typically present with reduced CVD relative to men of the same racial/ethnic group, the prevalence is similar between BL women and men though the mechanisms differ. This study hypothesized that reduced microvascular function in young, BL women is associated with endothelin-1 (ET-1) overactivity or insufficient l-arginine bioavailability. Nine BL and nine WH women participated (age: 20 ± 2 vs. 22 ± 2 yr). Cutaneous microvascular function was assessed during 39°C local heating, whereas lactated Ringer's (control), BQ-123 (ET-1 receptor type A antagonist), BQ-788 (ET-1 receptor type B antagonist), or l-arginine were infused via intradermal microdialysis to modify cutaneous vascular conductance (CVC). Subsequent infusion of Nω-nitro-l-arginine methyl ester allowed for quantification of the nitric oxide (NO) contribution to vasodilation, whereas combined sodium nitroprusside and 43°C heating allowed for normalization to maximal CVC (%CVCmax). BL women had blunted %CVCmax and NO contribution to dilation during the 39°C plateau (P < 0.027 for both). BQ-123 improved this response through augmented NO-mediated dilation (P < 0.048 for both). BQ-788 and l-arginine did not alter the CVC responses (P > 0.835 for both) or the NO contribution (P > 0.371 for both). Cutaneous microvascular function is reduced in BL women, and ET-1 receptor type A may contribute to this reduced function. Further research is needed to better characterize these mechanisms in young, BL women.NEW & NOTEWORTHY Cardiovascular disease remains a burden in the United States non-Hispanic black (BL) population, although its manifestation through blunted vasodilation in this population is different between men and women. Accordingly, this study determined that reduced microvascular function in young, BL women may be partially controlled by endothelin-1 (ET-1) type A receptors, although neither type B receptors nor insufficient l-arginine bioavailability seems to contribute to this response. Accordingly, further research is needed to better characterize these ET-1 related mechanisms and illuminate other pathways that may contribute to this disparate vascular function in young, BL women.
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Affiliation(s)
- John D. Akins
- 1Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas
| | - Rauchelle E. Richey
- 1Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas,2Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
| | - Jeremiah C. Campbell
- 1Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas
| | - Zachary T. Martin
- 1Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas
| | - Guillermo Olvera
- 1Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas,3Institute for Exercise and Environmental Medicine, Dallas, Texas
| | - R. Matthew Brothers
- 1Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas
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Clarke LS, Riley HEM, Corwin EJ, Dunlop AL, Hogue CJR. The unique contribution of gendered racial stress to depressive symptoms among pregnant Black women. WOMEN'S HEALTH 2022; 18:17455057221104657. [PMID: 35900027 PMCID: PMC9340355 DOI: 10.1177/17455057221104657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Pregnant Black women are at disproportionate risk for adverse birth outcomes,
in part associated with higher prevalence of stress. Stress increases risk
of depression, a known risk factor for preterm birth. In addition, multiple
dimensions of stress, including perceived stress and stressful life events,
are associated with adverse birth outcomes, independent of their association
with prenatal depression. We use an intersectional and contextualized
measure of gendered racial stress to assess whether gendered racial stress
constitutes an additional dimension to prenatal depression, independent of
stressful life events and perceived stress. Methods: In this cross-sectional study of 428 Black women, we assessed gendered racial
stress (using the 39-item Jackson Hogue Phillips Reduced Common
Contextualized Stress Measure), perceived stress (using the Perceived Stress
Scale), and stressful life events (using a Stressful Life Event Index) as
psychosocial predictors of depressive symptoms (measured by the Edinburgh
Depression Scale). We used bivariate analyses and multivariable regression
to assess the association between the measures of stress and prenatal
depression. Results: Results revealed significant bivariate associations between participant
scores on the full Jackson Hogue Phillips Reduced Common Contextualized
Stress Measure and its 5 subscales, and the Edinburgh Depression Scale. In
multivariable models that included participant Perceived Stress Scale and/or
Stressful Life Event Index scores, the Jackson Hogue Phillips Reduced Common
Contextualized Stress Measure contributed uniquely and significantly to
Edinburgh Depression Scale score, with the burden subscale being the
strongest contributor among all variables. No sociodemographic
characteristics were found to be significant in multivariable models. Conclusion: For Black women in early pregnancy, gendered racial stress is a distinct
dimension of stress associated with increased depressive symptoms.
Intersectional stress measures may best uncover nuances within Black women’s
complex social environment.
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Affiliation(s)
- Lasha S Clarke
- Morehouse School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Halley EM Riley
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Anne L Dunlop
- School of Medicine, Emory University, Atlanta, GA, USA
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13
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Holloway K, Varner F. Parenting despite discrimination: Does racial identity matter? CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2021; 27:781-795. [PMID: 34279979 PMCID: PMC8497417 DOI: 10.1037/cdp0000452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Previous research suggests that parents' characteristics and race-related experiences shape the racial socialization messages they give their children. Parents' beliefs about race may also relate to how they interpret and respond to race-related stressors. The current study drew on the Sociohistorical Integrative Model for the Study of Stress in Black Families to examine the moderating roles of gender and racial identity subscales (i.e., racial centrality, private regard, and public regard) on the relations between race-related stressors (i.e., personal, vicarious, and anticipated racial discrimination) and racial socialization. METHOD Path analyses were conducted in Mplus 8.2 using online survey data from a national sample of 567 African American parents of adolescents. RESULTS There were seven significant three-way interactions. Racial centrality and gender moderated the relations between both personal and vicarious racial discrimination and each racial socialization message. Private regard and gender moderated the relations between personal racial discrimination and preparation for bias and between vicarious racial discrimination and cultural socialization. Public regard and parent gender moderated the relation between personal racial discrimination and cultural socialization. CONCLUSIONS The findings highlighted that parents' experiences of personal, vicarious, and anticipated racial discrimination have different relations with their racial socialization messages. In addition, they highlighted that racial identity and parent gender are related to the type of racial socialization messages African American parents who are exposed to race-related stressors give their children. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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14
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Perez NB, Lanier Y, Squires A. Inequities along the Depression Care Cascade in African American Women: An Integrative Review. Issues Ment Health Nurs 2021; 42:720-729. [PMID: 33306426 DOI: 10.1080/01612840.2020.1853289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression represents a growing health problem and African American women (AAW) disproportionally experience increased risk and broad disparities in health care. This integrative review examines what is known about the equity of depression care provided to AAW. PubMed, PsychINFO, and Web of Science were searched through April 2020 for studies in peer-reviewed journals from 2015 to 2020. Across the studies (n = 7), AAW received inequitable care across a depression care cascade including lower rates of screening, treatment initiation, and guideline-concordant care. Here we explore individual-, relational-, and structural-level factors related to these disparities and implications for research, practice, and education.
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Affiliation(s)
| | - Yzette Lanier
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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15
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Partow S, Cook R, McDonald R. A Literature Review of the Measurement of Coping with Stigmatization and Discrimination. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1080/01973533.2021.1955680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Beatty Moody DL, Waldstein SR, Leibel DK, Hoggard LS, Gee GC, Ashe JJ, Brondolo E, Al-Najjar E, Evans MK, Zonderman AB. Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research. PLoS One 2021; 16:e0251174. [PMID: 34010303 PMCID: PMC8133471 DOI: 10.1371/journal.pone.0251174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/21/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. Methods Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. Results We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05. Conclusions Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.
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Affiliation(s)
- Danielle L. Beatty Moody
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
- * E-mail:
| | - Shari R. Waldstein
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
| | - Daniel K. Leibel
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Lori S. Hoggard
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Gilbert C. Gee
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Jason J. Ashe
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Elizabeth Brondolo
- Department of Psychology, St. John’s University, Queens, New York, New York, United States of America
| | - Elias Al-Najjar
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
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17
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Hendrix CL, Dilks DD, McKenna BG, Dunlop AL, Corwin EJ, Brennan PA. Maternal Childhood Adversity Associates With Frontoamygdala Connectivity in Neonates. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:470-478. [PMID: 33495120 PMCID: PMC8035139 DOI: 10.1016/j.bpsc.2020.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND It is well established that exposure to adversity, especially during sensitive periods of development such as childhood, has both behavioral (e.g., increasing one's risk for psychiatric illnesses) and neurobiological consequences. But could these effects of early-life exposure to adversity also be transmitted across generations? We directly address this question, investigating the associations between maternal exposure to adversity during her own childhood and neural connectivity in her neonate. METHODS Mothers from a sample of Black mother-neonate dyads (n = 48)-a group that is disproportionately affected by early-life adversity-completed questionnaires assessing their current distress (i.e., a composite measure of anxiety, depression, and perceived stress) during the first and third trimesters of pregnancy and retrospectively reported on their own childhood experiences of abuse and neglect. At 1 month postpartum, neonatal offspring of these women underwent a resting-state functional magnetic resonance imaging scan during natural sleep. RESULTS Greater maternal exposure to emotional neglect during her own childhood correlated with stronger functional connectivity of two different frontoamygdala circuits in these neonates, as early as 1 month after birth. This effect was specific to early experiences of emotional neglect and was not explained by maternal exposure to other forms of childhood maltreatment or by maternal distress during pregnancy. CONCLUSIONS These results provide novel evidence that the absence of emotional support early in a mother's life, years before conception, are associated with neural changes-namely, in functional connectivity between the amygdala and medial prefrontal regions-in her offspring shortly after birth.
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Affiliation(s)
- Cassandra L Hendrix
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, New York.
| | - Daniel D Dilks
- Department of Psychology, Emory University, Atlanta, Georgia
| | | | - Anne L Dunlop
- School of Nursing, Emory University, Atlanta, Georgia
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18
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Silva MND, Monteiro JCDS. Self-esteem assessment of young female university students according to race/skin color criteria. Rev Lat Am Enfermagem 2020; 28:e3362. [PMID: 33084772 PMCID: PMC7575243 DOI: 10.1590/1518-8345.3866.3362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/03/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: to evaluate and compare the self-esteem of young female university students
aged between 18 and 24 years old according to race/skin color criteria. Method: a cross-sectional and quantitative study, developed with 240 undergraduate
female students from a public Brazilian university. Data collection took
place online through a structured questionnaire that included the
participants’ sociodemographic and lifestyle habits, and the Rosenberg
Self-Esteem Scale. For data analysis, descriptive statistics, association
test, and comparison of means were used. Results: most of the young women had a mean level of self-esteem. No statistically
significant association was found among the “self-esteem level” and
“self-reported skin color or race” variables. Conclusion: although no significant association was identified between self-reported skin
color or race and level of self-esteem, young black women have lower mean
self-esteem scores than young non-black women. Strategies that strengthen
the self-esteem of young female university students are necessary to prevent
harms to their physical and mental health, and, consequently, to their
academic performance.
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Affiliation(s)
- Monalisa Nanaina da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Juliana Cristina Dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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19
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Sosoo EE, Bernard DL, Neblett EW. The influence of internalized racism on the relationship between discrimination and anxiety. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2020; 26:570-580. [PMID: 31886684 PMCID: PMC7359777 DOI: 10.1037/cdp0000320] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES This study used 2 waves of data to longitudinally examine whether internalized racism moderated the association between racial discrimination and anxiety symptom distress. METHOD Participants were 157 Black college students attending a predominantly White institution who completed measures of racial discrimination, internalized racism, and psychological distress. RESULTS Using hierarchical linear regression, results indicated a positive association between racial discrimination and subsequent anxiety symptom distress for individuals with moderate and high levels of internalization of negative stereotypes and hair change. CONCLUSIONS Findings suggest that experiences of anxiety symptom distress, in the context of racial discrimination, may differ as a function of one's acceptance and internalization of dominant White culture's actions and beliefs toward Black people. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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20
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Brothers RM, Stephens BY, Akins JD, Fadel PJ. Influence of sex on heightened vasoconstrictor mechanisms in the non-Hispanic black population. FASEB J 2020; 34:14073-14082. [PMID: 32949436 DOI: 10.1096/fj.202001405r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022]
Abstract
Cardiovascular disease (CVD) affects individuals of all races and ethnicities; however, its prevalence is highest in non-Hispanic black individuals (BL) relative to other populations. While previous research has provided valuable insight into elevated CVD risk in the BL population, this work has been almost exclusively conducted in men. This is alarming given that BL women suffer from CVD at an equivalent rate to BL men and each has a greater prevalence when compared to all other ethnicities, regardless of sex. The importance of investigating sex differences in mechanisms of cardiovascular function is highlighted by the National Institute of Health requiring sex to be considered as a biological variable in research studies to better our "understanding of key sex influences on health processes and outcomes." The mechanism(s) responsible for the elevated CVD risk in BL women remains unclear and is likely multifactorial. Limited studies in BL women suggest that, while impaired vasodilator capacity is involved, heightened vasoconstrictor tone and/or responsiveness may also contribute. Within this mini-review, we will discuss potential mechanisms of elevated rates of hypertension and other CVDs in BL individuals with a particular focus on young, otherwise healthy, college-aged women. To stimulate academic thought and future research, we will also discuss potential mechanisms for impaired vascular function in BL women, as well as possible divergent mechanisms between BL men and women based on either preliminary data or plausible speculation extending from findings in the existing literature. Last, we will conclude with potential future research directions aimed at better understanding the elevated risk for hypertension and CVD in BL women.
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Affiliation(s)
| | | | - John D Akins
- Department of Kinesiology, University of Texas, Arlington, TX, USA
| | - Paul J Fadel
- Department of Kinesiology, University of Texas, Arlington, TX, USA
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21
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White K, Bell BA, Huang SJ, Williams DR. Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged and Older Black Adults. Innov Aging 2020; 4:igaa041. [PMID: 33324760 PMCID: PMC7724643 DOI: 10.1093/geroni/igaa041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults. RESEARCH DESIGN AND METHODS Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested. RESULTS Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point. DISCUSSION AND IMPLICATIONS Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.
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Affiliation(s)
- Kellee White
- Department of Health Policy and Management, University of Maryland College Park School of Public Health
| | - Bethany A Bell
- College of Social Work, University of South Carolina, Columbia
| | - Shuo J Huang
- Department of Health Policy and Management, University of Maryland College Park School of Public Health
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
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22
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Fadel PJ. Reply from Paul J. Fadel. Exp Physiol 2020. [DOI: 10.1113/ep088847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paul J. Fadel
- Department of Kinesiology University of Texas at Arlington Arlington TX USA
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