Perceived Racial/Ethnic Discrimination and Mental Health: a Review and Future Directions for Social Epidemiology

Relations between adverse childhood experiences, racial and ethnic Identity, and cannabis use outcomes

Adverse childhood experiences (ACEs) and age of cannabis use onset are associated with cannabis use disorder (CUD), but their differential effect across race and ethnicity is unknown. Using NESARC-III, we examined ACEs, age of onset, and their interaction on lifetime cannabis use and CUD across racial and ethnic groups (Non-Hispanic White, Hispanic, Black/African American, Asian, American Indian/Alaska Native). ANOVAs found that American Indian/Alaska Native individuals reported the greatest prevalence of lifetime cannabis use and CUD, the greatest mean number of ACEs, and the earliest age of cannabis onset. Using logistic regressions, stratified by race and ethnic groups and adjusted for sociodemographic characteristics, we found that as ACEs increased, the odds of lifetime use (aORs 1.48-2.48), lifetime CUD (aORs 1.45-3.03), and past-year CUD (aORs 1.46-2.28) increased for all groups. The relations between ACEs and CUD were strongest among Asian/Pacific Islander respondents. Among respondents with lifetime use, increased age of onset was associated with lower lifetime CUD (aORs 0.85-0.94) and past-year CUD (aORs 0.88-0.97) for most groups. Three significant interactions between ACEs and age of onset predicting CUD emerged. Among Black and American Indian/Alaska Native individuals with an early age of cannabis initiation, ACEs exhibited a weaker relation with CUD. For White respondents, as number of ACEs increased, the impact of age of onset on CUD development diminished. Our findings highlight ACEs and age of onset as implicated in the progression from cannabis use to CUD and the importance of considering these factors in relation to racial and ethnic identity.

Allostatic load score and lifestyle factors in the SWAN cohort: A longitudinal analysis

Objectives

Allostatic load (AL) has been used to assess chronic stress. Previous studies have assessed associations between lifestyle factors and the AL. However, those studies have yet to evaluate associations longitudinally. Thus, the effect of lifestyle factors on the AL changes over time remains to be determined.

Study design

A longitudinal analysis was designed.

Methods

Our study included 1976 women identified from the Study of Women's Health Across the Nation (SWAN) who had completed at least seven waves of measurements since baseline. The Poisson mixed effects model was used to model AL and to assess how lifestyle factors affected AL over time.

Results

At baseline, the mean AL score was 2.44 (range 0-11). On average, the AL score increased by 3 % (ORs = 1.03, 95 % CI [1.01, 1.05]) per wave over time. For lifestyle factors, women who smoked cigarettes over time had higher AL than those who never smoked. On the other hand, women who ever drank alcohol at baseline, had leisure physical activity over time, and had at least average sleep quality at baseline, and had lower AL than their counterparts. We also identified a statistically significant interaction between alcohol drinking and time (P < 0.01). Furthermore, we generated a healthy score using the four lifestyle factors above to assess the potential accumulative effect of lifestyle factors on AL. We found that the AL increased by 16 % for each additional unhealthy lifestyle factor (ORs = 1.16, 95%CI: 1.12, 1.2).

Conclusions

This study demonstrates that lifestyle factors can influence the increase of AL over time.

Modeling Heterogeneity in the Long-Term Trajectories of Individuals' Well-Being

Very little is known about how long-term well-being trajectories vary across populations. Using data from 45,160 adults in New Zealand (62% women, Mage = 41 years) surveyed annually over 13 years, we identified latent trajectories for belongingness, social support, self-esteem, and life satisfaction. Through a group-based trajectory modeling approach, we found five trajectory groups: low (3%-5%), moderate (11%-17%), moderate-high (29%-32%), high (35%-45%), and very high (11%-20%) well-being. While most individuals showed minimal changes, those with initially low well-being experienced the greatest change, in the direction of decreasing well-being over time. Individuals with higher education were more likely to follow higher well-being trajectories. Similarly, women were more likely to follow higher well-being trajectories, except for self-esteem, where men tended to score higher over time. Lastly, age and ethnicity demonstrated more complex patterns. These findings highlight the importance of acknowledging long-term heterogeneity in well-being trajectories and emphasize the need for targeted preventive mental health interventions, particularly for individuals who begin with lower well-being levels.

Analyzing multiple types of discrimination using implicit and explicit measures, comparing target vs. Dominant groups, in a study of smoking/vaping among community health center members in Boston, Massachusetts (2020-2022)

BACKGROUND

In the United States (U.S.), the physical and mental health sequelae of diverse types of discrimination are far-reaching, severe, and contribute to population health inequities, with this work informing research on discrimination and health in both the Global North and Global South. To date, limited population health research has examined the joint impacts of discrimination measures that are explicit (i.e., self-report) and implicit (i.e., automatic mental representations), both singly and for multiple types of discrimination.

METHODS

Between May 28, 2020-August 4, 2022, we conducted Life + Health, a cross-sectional population-based study regarding six types of discrimination-racism, sexism, heterosexism, cissexism, ageism, and sizeism-with 699 participants (US-born, ages 25-64) from three community health centers in Boston, Massachusetts. Participants completed a Brief Implicit Association Test (B-IAT) and self-reported survey. Spearman's correlation coefficient was estimated to assess the strength and direction of discrimination types across target/dominant groups; logistic regression models were fit to assess the association of each type of discrimination with smoking/vaping following by random-effects meta-regression modeling to pool effects across discrimination types.

RESULTS

Mean age was 37.9 years (SD = 11.2 years). Overall, 31.6% were people of color; 31.8% identified as transgender or nonbinary/genderqueer; 68.6% were sexual minority. For education, 20.5% had some college/vocational school or no college. Current cigarette/vaping was reported by 15.4% of the study population. Implicit and explicit measures were generally correlated with one another, but associations varied across discrimination types and for target/dominant groups. In random-effects meta-regression modeling, explicit compared to implicit discrimination measures were associated with a 1.18 (95% CI = 1.00-1.39) greater odds of smoking/vaping among dominant group members, but no such difference was observed among target group members.

CONCLUSION

Implicit and explicit discrimination measures yielded distinct yet complementary insights, highlighting the importance of both. Meta-regression provided evidence of health impacts across discrimination types. Future research on discrimination and health, in diverse country contexts, should consider using both implicit and explicit measures to analyze health impacts across multiple types of discrimination.

Perceived discrimination among migrants in Germany: Does social capital moderate harmful effects on mental health?

BACKGROUND

The harmful mental health effects of perceived discrimination for migrant populations are well established. The potential buffering effect of regional-level social capital, however, has not previously been explored.

METHODS

Using data from the German Socio-Economic Panel (SOEP; 2009-2018) we apply multilevel models to assess the effect of frequent or infrequent perceived discrimination on mental health (MCS subscale of the SF-12) adjusting for individual- and regional-level confounding in a cross-sectional research design. We assess interaction with general social capital (civic engagement, electoral participation, generalised trust) and migrant-specific resources (proportion of non-nationals). We juxtapose non-refugee migrants (n = 13478) with refugees subject to mobility restrictions (n = 5558) to account for bias introduced by selective mobility into regions.

RESULTS

In the non-refugee sample, we confirm the negative effects of discrimination experiences on MCS (ß frequent: -3.74, 95%-CI: [-4.40; -3.09]/ß infrequent: -1.88, 95%-CI: [-2.24; -1.52]). Moderation analyses among non-refugees show no buffering of general social capital, but a negative interaction effect of the proportion of non-nationals with experiences of discrimination (ß frequent: -0.54, 95%-CI: [-0.87; -0.21]/ß infrequent: -0.68, 95%-CI: [-1.29; -0.07]). Analyses among refugees also demonstrate a negative effect of discrimination on MCS with stronger overall effects than in the migrant sample (ß frequent: -6.24, 95%-CI: [-7.44; -5.05]/ß infrequent: -3.56, 95%-CI: [-4.25; -2.86]). In the refugee sample, the effect is exacerbated by the proportion of non-nationals (ß frequent: -1.70, 95%-CI: [-2.84; -0.56]) and buffered by generalised trust (ß: 0.87, 95%-CI: [0.13; 1.60]).

CONCLUSIONS

When faced with experiences of discrimination, levels of community trust seem to buffer the negative mental health impacts for refugees. We do not find buffering effects of social capital on the mental health of non-refugee migrants, possibly due to established social networks. Furthermore, our results suggest that the proportion of non-nationals within a community may have a negative reinforcing impact on the relationship between discrimination and mental health for both migrant samples. As this dynamic is currently underexplored in the German context, more community-based research is needed to develop appropriate policy interventions.

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.

Neighborhood opportunity and residential instability: associations with mental health in middle childhood

BACKGROUND

Neighborhood quality may contribute to child mental health, but families with young children often move, and residential instability has also been tied to adverse mental health. This study's primary goal was to disentangle the effects of neighborhood quality from those of residential instability on mental health in middle childhood.

METHODS

1,946 children from 1,652 families in the Upstate KIDS cohort from New York state, US, were followed prospectively from birth to age 10. Residential addresses were linked at the census tract level to the Child Opportunity Index 2.0, a multidimensional indicator of neighborhood quality. The number of different addresses reported from birth to age 10 was counted to indicate residential instability, and the change in COI quintile indicated social mobility. Parents completed three assessments of attention-deficit/hyperactivity disorder, problematic behavior, and internalizing psychopathology symptoms at ages 7, 8, and 10. Child and family covariates were selected a priori to adjust sample characteristics, increase estimate precision, and account for potential confounding.

RESULTS

In unadjusted models, higher neighborhood quality at birth was associated with fewer psychopathology symptoms in middle childhood, but associations were largely mediated by residential instability. In adjusted models, residential instability was associated with more psychopathology symptoms, even accounting for social mobility. Neighborhood quality at birth had indirect effects on child mental health symptoms through residential instability.

CONCLUSIONS

Children born into lower-quality neighborhoods moved more, and moving more was associated with higher psychopathology symptoms. Findings were similar across different timings of residential moves, for girls and boys, and for children who did not experience a major life event. Additional research is needed to better understand which aspects of moving are most disruptive to young children.

Exploring changing trends in depression and anxiety among adolescents from 2012 to 2019: Insights from My World repeated cross-sectional surveys

AIM

Research has indicated a rise in the prevalence of depression and anxiety among adolescents over the past three decades. However, the factors underpinning increases in mental health difficulties remain poorly understood. This study examines psychological, social and environmental risk and protective factors that may explain changes in depression and anxiety among adolescents.

METHODS

Data were taken from two nationally representative My World Surveys of adolescents aged 12-19 years in 2012 (N = 5,490) and 2019 (N = 9,844). Survey data on depression and anxiety and a range of potential risk (e.g., alcohol use, psychotic symptoms) and protective factors (e.g., resilience, self-esteem) were assessed at both time points. Multiple group analyses assessed whether the predictive ability of risk/protective factors changed from wave 1 to wave 2.

RESULTS

Results showed that the prevalence of depression and anxiety increased significantly between 2012 and 2019, particularly among females. Predictors accounted for between 37% and 61% of the variance in outcomes across waves. While some risk/protective factors were consistent predictors of depression and anxiety at both waves (e.g., bullying, discrimination, optimism), reporting female gender and having higher formal help-seeking tendencies more strongly predicted anxiety at wave 2, while lower self-esteem and lower resilience (personal competence) strongly predicted both depression and anxiety at wave 2.

CONCLUSION

Findings highlight the need to prioritize adolescent mental health service provision, especially in females. Self-esteem and resilience are potentially important targets for supporting adolescent mental health. Further research is required to understand the causal factors associated with increases in anxiety and depression.

Drowning in the ripple effect: identifying a syndemic network of health experience (with modifiable health behaviours) using the UK Biobank

A Syndemic model of health experience in severe mental illness (SMI) involving modifiable health behaviour contributors has been theorised but has not yet been investigated. Over the next 10 years mental ill-health and suicidal behaviours have been predicted to increase which will decrease health experience and increase hospitalisation and associated costs. This paper investigated a Syndemic model of health experience in people with SMI informed by physical activity levels, exposure to nature, personal resilience levels, drugs related (tobacco smoking and alcohol consumption), and sleep behaviours using UK Biobank data. Results implementing SEM indicate partial evidence for a Syndemic model, with personal resilience being at its centre. Contrary to previous findings, drugs related behaviours did not play an important role in the model. Implementing a Syndemic framework approach to current health care strategies could be beneficial in the development of self-management strategies for people with SMI. This is the first paper using SEM analyses to investigate SMI under the Syndemic theory paradigm.

Bias-Based Cyberaggression Related To Origin, Religion, Sexual Orientation, Gender, and Weight: Systematic Review of Young People's Experiences, Risk and Protective Factors, and the Consequences

Bias-based cyberaggression-hateful and bias-based content and interactions via information and communication technologies-is a frequent experience for young internet users that can result in detrimental consequences for both individuals and society. Ample research has focused on the factors related to involvement in bias-based cyberaggression. This study systematically reviews the research published in the past decade about the investigations into exposure, vicarious and direct victimization, and aggression among young people (up to age 30). We aimed to provide a complex summarization of the research findings about the risk and protective factors and the consequences of experiences with bias-based cyberaggression-specifically the diverse manifestations of bias-based cyberaggression targeted toward ethnicity, race, nationality, religion, sexual orientation, gender, weight, and disability. Three academic databases (EBSCO, Scopus, and WoS) were searched and 41 articles were included in the review. The results show a dominant research focus on bias-based cyberaggression victimization and on the bias-based cyberaggression that targets ethnicity, race, nationality, and religion, leaving a gap in the knowledge about the different types of targeted group categories and bias-based cyberaggression perpetration. The identified risk factors for bias-based cyberaggression involvement included being a minority, low psychological well-being, other victimization experiences, higher internet use, and risky internet use. An overlap was found for bias-based cyberaggression involvement with other offline and online victimization experiences. This review showed limited knowledge about protective factors, namely the social-level and contextual factors. The identified factors, as well as the gaps in the knowledge, are discussed in relation to research implications and practice and policy implications.

Evaluating the indirect roles of anxiety and depressive symptoms in the relations between negative emotional reactivity to racial/ethnic stress and cigarette smoking among Hispanic adults who smoke

There has been increased recognition that Hispanic/Latinx (hereinafter Hispanic) persons are a tobacco disparities group in the United States. Although some past work has found greater exposure to racial/ethnic discrimination is associated with indices of smoking among Hispanic persons, research has not explored the degree of negative emotional reactivity to racial/ethnic stress in terms of smoking processes. The present cross-sectional study served to evaluate the indirect effects of depressive and anxiety symptoms in terms of relations between racial/ethnic stress reactivity and cigarette dependence, severity of problems when trying to quit, and perceived barriers for quitting among Hispanic persons who smoke in the United States. Participants included 329 Hispanic adults who smoked cigarettes daily (Mage = 35.5 years; SD = 8.67; 37.4% female). Results indicated that depressive symptoms exerted a statistically significant indirect effect in the association between negative emotional reactivity to racial/ethnic stress and cigarette dependence and severity of problems when trying to quit, whereas anxiety symptoms maintained an indirect effect for perceived barriers for smoking cessation. The current findings help characterize the intricacies by which negative emotional reactivity to racial/ethnic stress is related to smoking behavior and beliefs among Hispanic persons who smoke. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Different contexts - different stories: Adolescents' experiences of how ethnicity is addressed in schools and sports and on social media in Sweden

Ethnicity plays a significant role in adolescents' everyday lives, but there is a limited understanding of adolescents' own experiences with how ethnicity is addressed in different contexts. Three contexts of importance during adolescence are investigated in the present study: schools, social media, and sports. A closer contextual examination has the potential to provide insights into how multiple contexts shape experiences with ethnicity. The aim of the study was to understand more about adolescents' experiences of how ethnicity is addressed in schools, on social media, and in sports. Six focus groups with a total of 21 adolescents (Mage = 14.5, SDage = 0.5, female = 76%) discussed their experiences. Data were transcribed verbatim and analyzed using a close-to-data, inductive thematic analysis. The analysis resulted in three main themes and seven subthemes, indicating that ethnicity was addressed differently in the three studied contexts. For the main theme of how ethnicity was addressed in schools, the subthemes were: Addressing ethnicity is important; Ethnicity is addressed through stereotypes and Everyday racism. The main theme of ethnicity on social media consisted of two subthemes: Sharing ethnic and cultural narratives and Hateful remarks. The main theme of ethnicity in sports also consisted of two subthemes: On equal terms and Clear consequences for racist behaviors. To better understand the multiple contexts, the results are discussed guided by the ecological systems theory. The adolescents highlighted that there are many benefits of addressing ethnicity and that it is important to do so in multiple contexts of adolescent life, just not in the same way. When ethnicity was addressed carelessly, such as through stereotypes or via racism masked as jokes, it had the potential to cause harm. When ethnicity was addressed with reflection, it instead had the potential to build understanding, lead to positive experiences, and provide learning opportunities.

Predictive factors for the development of depression in children and adolescents: a clinical study

Background

The prevalence of depression among adolescents has been gradually increasing with the COVID-19 pandemic, and the purpose of this study was to develop and validate logistic regression models to predict the likelihood of depression among 6-17 year olds.

Methods

We screened participants from the National Center for Health Statistics (NCHS) in 2022. Independent risk factors were identified via univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) for feature screening. Area under the curve (AUC) and decision curve analysis (DCA) were used to compare the predictive performance and clinical utility of these models. In addition, calibration curves were used to assess calibration.

Results

Multivariate logistic regression analyses revealed that risk factors for depression included girls, higher age, treated/judged based on race/ethnicity, ever lived with anyone mentally ill, experienced as a victim of/witnessed violence, and ever had autism, ever had attention-deficit disorder (ADD), etc. Afterwards, the results are visualized using a nomogram. The AUC of the training set is 0.731 and the AUC of the test set is 0.740. Also, the DCA and calibration curves demonstrate excellent performance.

Conclusion

Validated nomogram can accurately predict the risk of depression in children and adolescents, providing clues for clinical practitioners to develop targeted interventions and support.

Nightmare experiences and perceived ethnic discrimination amongst female university students in the United Arab Emirates: a cross-sectional study

Perceived ethnic discrimination is known to be associated with anxiety and depression, and in turn, anxiety and depression are known to be associated with nightmare frequency and distress. This elicits a question: is perceived ethnic discrimination associated with nightmare frequency and distress? In this study, 179 female university students from the United Arab Emirates were assessed to answer that question. Results showed that while anxiety and depression were related to nightmare experiences, perceived ethnic discrimination was a stronger predictor of nightmare experiences. We posit two explanations for this finding: one based on psychoanalytical insights, and the other based on the Disposition-Stress model with neurobiological correlates. No significant differences were found across ethnicity when it comes to nightmare experiences or perceived ethnic discrimination. This is an encouraging sign of optimal societal integration in the United Arab Emirates.

Personal- vs. Group-Level Discrimination and Physical and Mental Health Outcomes Among Black Adolescents

BACKGROUND

The negative health consequences of personal experiences of racial discrimination (personal-level discrimination) has been well-documented across developmental stages, including adolescence, in Black individuals. There is also some evidence suggesting perceiving other Black individuals experiencing racial discrimination (group-level discrimination) can protect one's health in Black adults.

METHODS

This study examined the role of personal- and group-level discrimination in Black adolescent health. The study was a secondary analysis of survey data collected from 186 Black adolescents that included reports of discrimination, physical function, anxiety, and depression.

RESULTS

Black adolescents who reported greater, as opposed to lower, personal-level discrimination were more likely to experience poorer physical and mental health outcomes. While group-level discrimination was also associated with physical health outcomes, it was not directly associated with mental health outcomes. Importantly, across all three health outcomes, awareness of group-level discrimination mitigated the negative health consequences of personal-level discrimination. Among adolescents who reported low levels of group-level discrimination, personal-level discrimination was associated negatively with physical function and positively with anxiety and depressive symptoms. Among adolescents who reported high levels of group-level discrimination, there was no association between personal-level discrimination and any of the health outcomes.

DISCUSSION

Consistent with prior research with Black adults, awareness of high group-level discrimination may protect Black adolescents from the negative health consequences of personal-level discrimination. The pattern of the results is also consistent with the literature of the personal-group discrimination discrepancy (PGDD) and psychological wellbeing. Future research should investigate the psychological mechanisms implicated in PGDD (e.g., external attribution of discrimination and intragroup comparison) as potential coping strategies for Black adolescents against the negative health consequences of personal-level discrimination.

Use of cannabis for mental health in the Canadian territories: a cross-sectional study

BACKGROUND

Population prevalence and patterns of cannabis use for mental health (CUMH) are underexplored. This is important to understand in the Canadian territories which has the highest prevalence of cannabis use in Canada. This study aimed to examine socio-demographic factors associated with CUMH in the territories and associations between CUMH and cannabis use outcomes.

METHODS

This study is a cross-sectional analysis of survey data from the 2022 Cannabis Policy Study in the Territories, including 2431 respondents aged 16+. Multivariable logistic regression models were used to examine socio-demographic characteristics associated with CUMH. Among past 12-month cannabis consumers, multivariable logistic regression models were used to examine whether CUMH was associated with daily/near-daily use, cannabis product type, healthcare interactions, and self-reported impacts on mental health, controlling for socio-demographic characteristics.

RESULTS

Overall, 29.6% of all participants, and 55.5% of past 12-month cannabis consumers reported ever using cannabis for mental health. Use for mental health was higher among those with lower education, lower perceived income adequacy, and younger ages. Those reporting CUMH were more likely to report daily/near-daily use (ORadj = 3.00, 95%CI: 2.01-4.49), potent product types like solid concentrates (ORadj = 2.76, 1.62-4.70), and perceived positive impacts on mental health (ORadj = 3.71, 2.49-5.52).

CONCLUSION

Due to the high prevalence of CUMH, more research is needed to examine its long-term impacts and effectiveness. Future research is also needed to understand the social context underlying socioeconomic inequalities in CUMH, including access to mental healthcare and harm reduction measures for mitigating adverse mental health impacts.

Discrimination in Middle Eastern and North African Americans predicts Worse Mental Health as Mediated by Sleep

Discrimination is a salient stressor linked with a variety of health outcomes including depression and anxiety among Middle Eastern and North African Americans (MENA). Among other minoritized racial and ethnic groups, sleep difficulties have been identified as potential mechanisms that explain the relationship between discrimination and mental health. However, this has not been explored within MENA samples. Thus, the focus of this study is to examine if two sleep measures (e.g., sleep disturbance and sleep-related impairment) mediate the relationship between discrimination and two mental health outcomes: depression and anxiety. We recruited 126 MENA adults from across the USA through Prolific. Findings revealed that sleep-related impairment fully mediated the relationship between discrimination and mental health outcomes, whereas sleep disturbances only partially mediated these outcomes. Results suggest sleep difficulties are one pathway that could explain the relationship between discrimination and mental health among MENA. Future work should continue to explore this relationship, as well as investigate discrimination and sleep as possible places of intervention to protect the health of MENA individuals.

A call for sex-positive epidemiology

The World Health Organization specifies that sexual health requires the potential for pleasurable and safe sexual experiences. Yet epidemiologic research into sexual pleasure and other positive sexual outcomes has been scant. In this commentary, we aim to support the development and adoption of sex-positive epidemiology, which we define as epidemiology that incorporates the study of pleasure and other positive features alongside sexually transmitted infections and other familiar negative outcomes. We first call epidemiologists' attention to the potential role that stigma plays in the suppression of sex-positive research. We further describe existing measures of sex-positive constructs that may be useful in epidemiologic research. Finally, the study of sex-positive constructs is vulnerable to biases that are well-known to epidemiologists, especially selection bias, information bias, and confounding. We outline how these biases influence existing research and identify opportunities for future research. Epidemiologists have the potential to contribute a great deal to the study of sexuality by bringing their considerable methodological expertise to long-standing challenges in the field. We hope to encourage epidemiologists to broaden their sexual health research to encompass positive outcomes and pleasure.

Contextualizing school discipline: Examining the role of general peer and teacher discrimination at the individual- and school-level on individual suspension

Past research has linked peer and teacher discrimination to risk factors for school discipline, but few studies have examined whether peer and teacher discrimination have a direct impact on school discipline. This study examines the effects of general peer and teacher discrimination at the individual- and school-level on school suspension using nationally representative, secondary data on almost 12,000 youth across 131 schools. Hierarchical logistic regression models indicated that general teacher discrimination at the individual- and school-level-but not general peer discrimination-increased the odds of receiving school suspension. Findings suggest that general discrimination by direct learning instructors and teachers representing the broader school culture can shape student conduct. Reducing school discipline thus falls on teachers, staff, principals, and learners.

Mental Health Needs of Asian American Older Adults: Bridging the Inequity Gap

The mental health needs of Asian American older adults are complex and multifaceted. Despite their rich diversity, Asian American older adults face significant challenges, including mental health stigma, cultural stress, limited English proficiency, and historical trauma. In addition, the coronavirus disease 2019 pandemic reignited preexisting anti-Asian attitudes of hostility, discrimination, blame, and scapegoating. The historical context of Asian immigration to the United States, impact of race-based discrimination, and recent resurgence of anti-Asian hate crimes impact mental health in Asian American older adults. Thus, there is a need for a culturally sensitive and competent mental health care workforce, culturally tailored interventions, and family involvement. In the context of research and policy, it is critical to prioritize increased funding and research focus on culturally tailored instrument development, interventions, and policy initiatives informed by recent findings to safeguard this population from hate crimes and discrimination. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 11-15.].

Examining Indirect and Direct Effects of Risk and Resilience on the Relation Between Perceived Discrimination and Eating Disorder Symptoms in Ethnic Minority American Women

Direct relationships between perceived discrimination and eating pathology in ethnic minorities are well-documented. However, theoretical work examining unique risk and resilience factors that strengthen or weaken the relation between these constructs in ethnic minorities is lacking. The current study aims to address this gap by incorporating stress-process and tripartite frameworks to examine social and personal resources as they relate to perceived discrimination and eating pathology. In a sample of Black, Asian, and Latine women (N = 296, M age = 30.82), social support did not mediate the relationship between perceived discrimination and eating pathology. A significant interaction effect was observed for thin-ideal internalization strengthening the relation between perceived discrimination and negative emotional eating. Thin-ideal internalization moderated the relation between perceived discrimination and negative emotional eating in Latine Women, and disordered eating in Black Women. Overall, findings suggest ethnic minority Women have both personal and social resources that may influence the strength of effect on the relation between perceived discrimination on eating pathology.

Videoconference-based Creativity Workshops for mental health staff during the COVID-19 pandemic

BACKGROUND

COVID-19 presented significant challenges to psychiatric staff, while social distancing and remote working necessitated digital communications. NHS England prioritised staff wellbeing. Arts-based creativity interventions appear to improve psychological wellbeing, so this study evaluated online Creativity Workshops as a staff support response for COVID-19-related stress.

METHODS

Participants were staff from a South London NHS psychiatric hospital. Group Creativity Workshops were facilitated via Microsoft Teams. Acceptability data on pre- and post-workshop mood and attitudes were self-reported by participants. Feasibility data were gathered from adherence to number of workshop components delivered.

RESULTS

Eight workshops were delivered in May-September 2020 (N = 55) with high adherence to components. Participants reported significantly increased positive mood and attitudes towards themselves and others; and decreased stress and anxiety.

CONCLUSIONS

Online Creativity Workshops appear feasible and acceptable in reducing stress in psychiatric staff. Integrating a programme of Creativity Workshops within healthcare staff support may benefit staff wellbeing.

Perceived Racial Discrimination, Psychological Distress, and Suicidal Behavior in Adolescence: Secondary Analysis of Cross-Sectional Data from a Statewide Youth Survey

Developmental, clinical, and epidemiological research have demonstrated the salience of perceived racial discrimination (PRD) as a contributor to negative mental health outcomes in adolescence. This article summarizes secondary analyses of cross-sectional data from a large-scale youth survey within a predominantly rural state, to estimate the prevalence and strength of the association between PRD and serious psychological distress (SPD), suicidal ideation, and prior suicidal attempts. Data from 93,812 students enrolled in 6th, 8th, 10th, or 12th grade within 129 school districts across Kentucky were examined, to determine prevalence rates for subgroups within the cohort. Logistic regression analyses assessed the differences and established comparative strength of the association among these variables for racial/ethnic subgroups. PRD was self-reported at high rates across several demographic subgroups and was most evident among Black (24.5%) and Asian (22.1%) students. Multiracial students experienced the highest rates of both SPD and suicidality (ideation and prior attempt). Both for the entire cohort and for each racial/ethnic subgroup, PRD was significantly associated with an increased likelihood of negative mental health outcomes, although the strength of these associations varied across the subgroups and developmental levels. The implications for early intervention and prevention are discussed.

Perceived discrimination as a mediator between cultural identity and mental health symptoms among racial/ethnic minority adults in the United States: insights from the Health Information National Trends Survey 6

OBJECTIVE

This study examined the role of perceived discrimination as a mediator between cultural identity and mental health symptoms among adults from racial/ethnic minority groups in the United States.

METHODS

Data were gathered from the National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) 6, a nationally representative survey. The mediating role of perceived discrimination was investigated using structural equation modeling (SEM) analysis.

RESULTS

The study found significant associations between demographic and lifestyle factors and mental health symptoms. Non-Hispanic Blacks or African Americans and Hispanics were less likely than Non-Hispanic Whites to have mental health symptoms. Individuals between the ages of 35 and 49, 50 to 64, 65 to 74, and 75 and older had lower odds of mental health symptoms. Gender differences revealed that females had a higher risk of mental health issues than males. Socioeconomic factors, such as household income and employment status, played a significant role, with higher household income and employment status being associated with a decreased likelihood of mental health symptoms. The study emphasizes the role of perceived discrimination as a mediator, suggesting that it fully mediated the association between cultural identity and mental health symptoms. These findings highlight the significance of addressing discrimination experiences in fostering the mental health of adults from diverse backgrounds.

CONCLUSION

The findings highlight the need to take racial, ethnic, and socioeconomic inequities, as well as cultural identity and prejudice, into account in mental health research and interventions. The identified risk and protective factors can guide interventions and policies to enhance this population's mental health.

More Than Identity: An Intersectional Approach to Understanding Mental-Emotional Well-Being of Emerging Adults by Centering Lived Experiences of Marginalization

Understanding social determinants that shape pertinent developmental shifts during emerging adulthood (i.e., ages 18-25 years) and their associations with psychological health requires a nuanced approach. In our exploratory study, we investigated how multiple social identities and lived experiences generated by systems of marginalization and power (e.g., racism, classism, sexism) intersect in connection to the mental-emotional well-being of emerging adults (EAs). Eating and Activity Over Time (EAT, 2010-2018) data were collected from 1,568 EAs (mean age = 22.2 (standard deviation, 2.0) years) recruited initially in 2010 from Minneapolis/St. Paul schools. Conditional inference tree analyses were employed to treat "social location" and systems of marginalization and power as interdependent social factors influencing EAs' mental-emotional well-being outcomes: depressive symptoms, stress, self-esteem, and self-compassion. Conditional inference tree analyses identified EAs' subgroups with differing mean levels of mental-emotional well-being outcomes, distinguished primarily by marginalized social experiences (e.g., discrimination, financial difficulties) rather than social identities themselves. The relative positioning of EAs' experiences of social marginalization (e.g., discrimination) to their social identities (e.g., race/ethnicity) suggests that the social experiences generated by systems of privilege and oppression (e.g., racism) are more adjacent social determinants of mental-emotional well-being than the social identities used in public health research to proxy the oppressive systems that give them social meaning.

Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.

The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals

INTRODUCTION

Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD.

METHODS

Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD.

RESULTS

The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD.

CONCLUSIONS

Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.

A national examination of discrimination, resilience, and depressive symptoms during the COVID-19 pandemic: the All of Us Research Program

Objective

To examine the impact of resilience on the association between discrimination and trajectories of depressive symptoms during the COVID-19 pandemic across racial and ethnic groups.

Methods

Data were drawn from 5 waves of the All of Us Research Program's survey on the impact of COVID-19 on the lives of American adults. Linear mixed-effects models were fitted to assess the association between discrimination exposure throughout the pandemic and depressive symptoms over time. An interaction term was introduced between resilience and discrimination exposure to assess if resilience buffered the association between discrimination and depressive symptoms over time. Race-stratified linear mixed-effects models examined racial/ethnic differences in the association between resilience, discrimination, and depressive symptoms over time.

Results

Fifty-one thousand nine hundred fifty-eight participants completed surveys between May and December of 2020. Results indicated that exposure to more discrimination was associated with increasing trajectories of depressive symptoms over time (b = 0.48, p < 0.001). However, resilience moderated the association between discrimination and well-being over time such that higher resilience mitigated the detrimental effect of experiencing discrimination on depressive symptoms across time (b = -0.02, p < 0.001).

Conclusion

Identifying protective features such as resilience can promote the development of culturally tailored interventions to address mental health in the context of discrimination.

Elevating community-driven socioecological participation and action: A case study with Black youth

Context is important when considering how racism acts to harm Black youth. Hence, social scientists developed socioecological theories that consider both the individual and the context(s) which shapes them. We used these theories to make sense of the challenges facing Black youth and identify points for intervention. However, these theories were rarely shared with community participants. Theory, at its core, is a way to make sense of the world. Theory shared in an age-appropriate manner can help youth make sense of their experiences in a way that promotes psychological wellness. This paper describes the intentional sharing of socioecological theory with community members engaged in two community-based mental health programs. Our team has collaborated closely with community stakeholders to implement and iteratively improve these programs. This first-person account presents the doctoral students' experiences in engaging community members in using socioecological theory to improve the programs with which they have identified as useful to their community. The article underscores the importance of elevating community voices when engaging in community-based research and how that engagement is more fundamental as programs become well-established.

Utilizing Latent Class Analysis to Assess the Association of Intersectional Stigma on Mental Health Outcomes Among Young Adult Black, Indigenous, and Sexual Minority Women of Color

Purpose: Discrimination has detrimental effects on mental health, particularly among Black, Indigenous, and people of color who are also sexual minority women (BIPOC SMW); however, measurement of multiple intersecting forms of discrimination (e.g., race, gender, and sexual identity discrimination among BIPOC SMW) poses methodological challenges. This analysis uses latent class analysis (LCA) to examine the influences of discrimination on mental health in a convenience sample of BIPOC SMW. Methods: Online survey data from BIPOC SMW aged 18-29 years (n = 324) were used to estimate latent classes for discrimination type (race, gender, and sexual identity). Data for this study were collected from July to October 2018. Adjusted linear regressions examined the influences of discrimination profiles on perceived stress and depressive symptoms. Results: Utilizing LCA, the following four classes emerged: (1) low discrimination; (2) mid-level discrimination; (3) high racial, medium gender, and low sexual identity discrimination; (4) high discrimination. Classes 3 and 4 were positively associated with perceived stress and depressive symptoms relative to Class 1 in adjusted models. Conclusion: This analysis highlights the importance of intersectionality and the adverse impact of multiple forms of discrimination on mental health outcomes for BIPOC SMW. Respondents reporting higher levels of racial or multiple forms of discrimination had poorer mental health outcomes. LCA is a promising analytical tool for investigating intersectional stigma and discrimination. There is an urgent need to develop tailored, culturally appropriate intersectional mental health interventions to address the multiple identities and oppressions faced by BIPOC SMW.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

An Analysis of Temporal Trends in Anti-Asian Hate and Counter-Hate on Twitter During the COVID-19 Pandemic

Recent studies have documented increases in anti-Asian hate throughout the COVID-19 pandemic. Yet relatively little is known about how anti-Asian content on social media, as well as positive messages to combat the hate, have varied over time. In this study, we investigated temporal changes in the frequency of anti-Asian and counter-hate messages on Twitter during the first 16 months of the COVID-19 pandemic. Using the Twitter Data Collection Application Programming Interface, we queried all tweets from January 30, 2020 to April 30, 2021 that contained specific anti-Asian (e.g., #chinavirus, #kungflu) and counter-hate (e.g., #hateisavirus) keywords. From this initial data set, we extracted a random subset of 1,000 Twitter users who had used one or more anti-Asian or counter-hate keywords. For each of these users, we calculated the total number of anti-Asian and counter-hate keywords posted each month. Latent growth curve analysis revealed that the frequency of anti-Asian keywords fluctuated over time in a curvilinear pattern, increasing steadily in the early months and then decreasing in the later months of our data collection. In contrast, the frequency of counter-hate keywords remained low for several months and then increased in a linear manner. Significant between-user variability in both anti-Asian and counter-hate content was observed, highlighting individual differences in the generation of hate and counter-hate messages within our sample. Together, these findings begin to shed light on longitudinal patterns of hate and counter-hate on social media during the COVID-19 pandemic.

Predicting the Behavioral Health Needs of Asian Americans in Public Mental Health Treatment: A Classification Tree Approach

Given the fact that experiencing pandemic-related hardship and racial discrimination worsen Asian Americans' mental health, this study aimed to identify unique characteristics of behavioral health needs among Asian Americans (N = 544) compared to White Americans (N = 78,704) and Black Americans (N = 11,252) who received publicly funded behavioral health services in Indiana before and during the COVID-19 pandemic. We used 2019-2020 Adults Needs and Strengths Assessment (ANSA) data for adults eligible for Medicaid or funding from the state behavioral health agency. Chi-squared automatic interaction detection (CHAID) was used to detect race-specific differences among demographic variables, the pandemic status, and ANSA items. Results indicated that, regardless of age, gender, or pandemic status, Asian Americans who received behavioral health services, struggled more with cultural-related factors compared to White and Black individuals. Within this context, intersections among behavioral/emotional needs (psychosis), life functioning needs (involvement in recovery, residential stability, decision making, medical/physical health), and strengths (job history, interpersonal, and spiritual) further differentiated the mental health functioning of Asian from White and Black Americans. Classification tree algorithms offer a promising approach to detecting complex behavioral health challenges and strengths of populations based on race, ethnicity, or other characteristics.

Perceived discrimination and mental health in college students: A serial indirect effects model of mentoring support and academic self-concept

OBJECTIVE

Examine the direct and indirect effects of perceived discrimination, mentoring support, and academic self-concept on college student mental health.

PARTICIPANTS

Three hundred fifteen undergraduates of minorized gender (72%), ethnic (57%), and sexual (37%) identities.

METHODS

An online survey assessed perceived discrimination, mentoring support, academic self-concept, and mental health.

RESULTS

Perceived discrimination was associated with mentoring support (B=-0.11, p=.019), academic self-concept (B=-0.13, p<.001), and mental health (B=-0.15, p<.001). Additionally, mentoring support (B = 0.29, p<.001) and academic self-concept (B = 0.53, p<.001) were associated with mental health, and each other (B = 0.25, p<.001). Significant indirect effects were observed such that mentoring support and academic self-concept, individually and collectively, contributed to the association between perceived discrimination and mental health.

CONCLUSIONS

Addressing discrimination, creating supportive relationships, and facilitating academic growth may reduce mental health concerns in undergraduate populations, thereby having implications for college transition and retention strategies.

Psychosocial Predictors of Suicidal Thoughts and Behaviors in Mexican-Origin Youths: An 8-Year Prospective Cohort Study

Suicide is the second leading cause of death for youths in the United States. More Latino adolescents report suicidal thoughts and/or behaviors (STBs) than youths of most other ethnic communities. Yet few studies have examined multiple psychosocial predictors of STBs in Latino youths using multiyear longitudinal designs. In this study, we evaluated the progression of STBs in 674 Mexican-origin youths (50% female) from fifth grade (10 years old) to 12th grade (17 years old) and identified psychosocial predictors of changes in STBs across this period. Latent growth curve models revealed that being female and later-generation status were associated with increasing prevalence in STBs across adolescence. Family conflict and peer conflict predicted increased STBs, whereas greater familism predicted less STBs. Thus, interpersonal relationships and cultural values contribute to the development of STBs in Mexican-origin youths and may be key levers for decreasing suicidality in this understudied but rapidly growing portion of the U.S. adolescent population.

A Cross-sectional Study of Perceived Stress and Racial Discrimination Among a National Sample of Young Men Who Have Sex With Men

ABSTRACT

Research regarding the impact of racism on stress among young men who have sex with men (YMSM) is sparse. Secondary data were assessed from a 2018-2020 national mHealth prevention trial for YMSM aged 13-18 years (N = 542). Linear regression models examined associations between perceived stress and interpersonal and vicarious racism, adjusting for covariates. Stratified models by race/ethnicity were included. A subanalysis (n = 288) examined associations between nine interpersonal racial discriminatory events and perceived stress. Over 50% of participants experienced racial discrimination. In the multivariable models, exposure to interpersonal (β = 1.43, p-value: .038) and vicarious (β = 1.77, p-value: .008) racism was associated with perceived stress because there were four interpersonal racial discriminatory events. Stratified analysis by race/ethnicity found significant associations between interpersonal and vicarious racism and perceived stress among some racial/ethnic groups. Racial discrimination was common among YMSM, making them susceptible to the possible effects of vicarious and interpersonal racism on stress.

Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury

OBJECTIVE

To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI).

SETTING

Outpatient research laboratory.

PARTICIPANTS

Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI ( N = 118).

DESIGN

Cross-sectional observational study.

MAIN MEASURES

MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata ( N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes.

RESULTS

EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND.

CONCLUSION

The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.

Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions

INTRODUCTION

Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene × environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation).

METHODS

This was an observational study of 4,102 white/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination Scale items. Polygenic risk scores (PRSs) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium.

RESULTS

We found that greater PRS-BMI was significantly associated with more reports of discrimination (β = 0.04 ± 0.02; p = 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively.

CONCLUSION

Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population level.

Participation of Children and Youth in Mental Health Policymaking: A Scoping Review [Part I]

Although youth participation is oft-acknowledged as underpinning mental health policy and service reform, little robust evidence exists about the participation of children and youth in mental health policymaking. A scoping review based on Arksey and O'Malley's framework was conducted to identify and synthesize available information on children and youth's participation in mental health policymaking. Published studies up to November 30, 2020 were searched in Medline (OVID), PsycINFO (OVID), Scopus, and Applied Social Sciences Index and Abstracts (PROQUEST). Further studies were identified through Google Scholar and a grey literature search was conducted using Google and targeted web searches from October to December, 2020. Three reviewers performed screening and data extraction relevant to the review objective, followed by an online consultation. From 2,981 records, 25 publications were included. A lack of diversity among the youth involved was found. Youth were often involved in situational analysis and policy design, but seldom in policy implementation and evaluation. Both the facilitators of and barriers to participation were multifaceted and interconnected. Despite a range of expected outcomes of participation for youth, adults, organizations, and communities, perceived and actual effects were neither substantially explored nor reported. Our recommendations for mental health policymaking highlight the inclusion of children and youth from diverse groups, and the creation of relational spaces that ensure safety, inclusiveness, and diversity. Identified future research directions are: the outcomes of youth participation in mental health policymaking, the role of adults, and more generally, how the mental health of children and youth shapes and is shaped by the policymaking process.

Intersecting identities and adolescent depression: Patterns of depressed mood and anhedonia in the past decade

BACKGROUND

Research suggests adolescent depression is increasing and certain adolescents may be uniquely vulnerable. However, limited conceptualizations of identity and time, as well as the reliance on unitary conceptualizations of depression, inhibits a nuanced perspective on these trends. In response, we examined how adolescent depressive symptoms, depressed mood, and anhedonia, vary across intersecting identities over time.

METHODS

Secondary data analysis on the National Survey on Drug Use and Health between 2009 and 2017 was conducted. In total 145,499 nationally representative adolescents (ages 12-17) completed a diagnostic assessment for depression. Lifetime and past year reports of depressive symptoms, depressed mood, and anhedonia were treated as separate variables. A novel, mixed-level model in which participants were nested within identity (defined by one's age, gender, race/ethnicity, poverty level) and time was used to test our aims.

RESULTS

Overall, the relation between depression outcomes and identity did not vary over time (p > .01). Further, identity's impact on depression was approximately ten-fold that of temporal effects. Multiracial, late adolescent, female adolescents were at particular risk. Findings concerning depressed mood and anhedonia were similar across analyses.

LIMITATIONS

All facets of identity (e.g., sexual identity) were not included in the model and a unidimensional measure of poverty may have underestimated its depressogenic influence.

CONCLUSION

Adolescent depression outcomes are mostly consistent across criterial symptom subtypes and time, but vary as a function of identity. Prevention protocols that highlight mechanisms of risk tethered to social identity, and include salient experiences of females, late adolescents, and multiracial youth in particular, need to be prioritized in mental health initiatives.

Examination of Race and Autism Intersectionality Among African American/Black Young Adults

Background

African American/Black (AA/B) young adults with diagnoses of autism spectrum disorders rarely are studied in a way that acknowledges both their racial identity and their autism diagnosis. Little is known about intersectional oppression in the lives of these young adults. Early adulthood is a time when a young people of color may come to terms with a society that may not treat them fairly and equally due to their race. Autistic AA/B young adults may be even more vulnerable to stress and psychological disempowerment due to the added impact of negative experiences of being Black and having an autism diagnosis.

Methods

Thirty-two autistic and 30 non-autistic AA/B young adults took part in an online survey examining risk factors of everyday discrimination, perceived stress and potential protective factors of psychological empowerment, and Black identity. Differences in score measures for the autistic and non-autistic samples were examined along with the predictors of perceived stress assessed. Frequencies of intersectional discrimination experiences were also examined.

Results

Autistic AA/B participants reported significantly less everyday discriminatory experiences than non-autistic AA/B participants, whereas perceived stress was not significantly different between the two groups. The majority of non-autistic AA/B participants endorsed race as their prime source of experiences of discrimination, whereas autistic AA/B participants also cited being autistic as a major contributor to reports of discrimination. Although the autistic group had significantly lower reports of self-determination, they reported higher on the Black identity, private regard scale, pertaining to feelings about group membership, which can be considered a protective factor. There is heterogeneity in reasons for discriminatory experiences for autistic AA/B young adults whereby some of the participants (12%-30%) endorsed race + disability as dual reasons for experiencing regular discrimination.

Conclusions

Mental health clinicians and other direct service providers working with autistic AA/B young adults should understand that intersecting identities of race and disability may be at play when they are working with these individuals, and that treatment should consider these factors.

COVID-19 Racism, Depressive Symptoms, Drinking to Cope Motives, and Alcohol Use Severity Among Asian American Emerging Adults

The COVID-19 pandemic has incited widespread anti-Asian racism, which is linked to numerous behavioral health consequences including depressive symptoms. As racism-induced depressive symptoms are linked to coping-related alcohol use and because alcohol-related problems represent a significant public health concern in this population, we investigated whether COVID-19 racism predicted alcohol use severity through depressive symptoms and drinking to cope motives among Asian American emerging adults (N = 139; Mage = 23.04; 50% women, 50% men). We conducted a serial mediation wherein COVID-19 racism predicted alcohol use severity sequentially through depressive symptoms and drinking to cope motives. COVID-19 racism directly and significantly predicted alcohol use severity. The indirect effect via depressive symptoms and drinking to cope motives was also significant, suggesting that COVID-19 racism is likely a risk factor for alcohol-related problems. Results inform intervention science and highlight the need for policy and behavioral health services to curb COVID-19 racism.

Maternal gender discrimination and child emotional and behavioural problems: A population-based, longitudinal cohort study in the Czech Republic

BACKGROUND

Gender discrimination may be a novel mechanism through which gender inequality negatively affects the health of women and girls. We investigated whether children's mental health varied with maternal exposure to perceived gender discrimination.

METHODS

Complete longitudinal data was available on 2,567 mother-child dyads who were enrolled between March 1, 1991 and June 30, 1992 in the European Longitudinal Cohort Study of Pregnancy and Childhood-Czech cohort and were surveyed at multiple time points between pregnancy and child age up to 15 years. The Strengths and Difficulties Questionnaire (SDQ) was administered at child age 7, 11, and 15 years to assess child emotional/behavioural difficulties. Perceived gender discrimination was self-reported in mid-pregnancy and child age 7 and 11 years. Multilevel mixed-effects linear regression of SDQ scores were estimated. Mediation was tested using structural equation models.

FINDINGS

Perceived gender discrimination, reported by 11.2% of mothers in mid-pregnancy, was related to increased emotional/behavioural difficulties among children in bivariate analysis (slope = 0.24 [95% confidence interval (CI): 0.15, 0.32], p<0.0001) and in the fully adjusted model (slope = 0.18 [95% CI: 0.09, 0.27], p<0.0001). Increased difficulties were evident among children of mothers with more depressive symptoms (slope = 0.04 [95% CI: 0.03, 0.05], p<0.0001), boys (slope = 0.26 [95% CI: 0.19, 0.34], p<0.0001), first children (slope = 0.16 [95% CI: 0.09, 0.23], p<0.0001), and families under financial hardship (slope = 0.09 [95% CI: 0.04, 0.14], p<0.0001). Effects were attenuated for married mothers (slope-0.12 [95% CI: -0.22, -0.01], p<0.05]. Maternal depressive symptoms and financial hardship mediated about 37% and 13%, respectively, of the total effect of perceived gender discrimination on SDQ scores.

INTERPRETATION

Perceived gender discrimination among child-bearing women in family contexts was associated with more mental health problems among their children and adolescents, extending prior research showing associations with maternal mental health problems. Maternal depressive symptoms and, to a lesser extent, financial hardship both partially mediated the positive relationship between perceived gender discrimination and child emotional/behavioural problems. This should be taken into consideration when measuring the societal burden of gender inequality and gender-based discrimination. Moreover, gender-based discrimination affects more than one gender and more than one generation, extending to boys in the household even moreso than girls, highlighting that gender discrimination is everyone's issue. Further research is required on the intergenerational mechanisms whereby gender discrimination may lead to maternal and child mental health consequences.

FUNDING

Bill and Melinda Gates Foundation; Ministry of Education, Youth and Sports, Czech Republic and European Structural and Investment Funds.

Treatment Seeking for Anxiety and Depression Among Black Adults: A Multilevel and Empirically Informed Psycho-Sociocultural Model

Black adults with anxiety and/or depressive disorders underutilize outpatient psychotherapy and pharmacological treatment compared to White adults. Notably, anxiety and depressive disorders tend to be chronic and Black individuals with these disorders experience greater functional impairment than White individuals. Documented racial disparities in mental health treatment initiation indicate a need for research that addresses culture-specific barriers to treatment. This review paper critically evaluates existing theoretical models of treatment seeking among Black adults to inform a novel integrated, culturally contextualized model. This model extends previous ones by incorporating factors relevant to treatment seeking among Black adults (e.g., racial identity, perceived discrimination, medical mistrust) and critically examines how these factors intersect with key factors at three levels of influence of the treatment seeking process: the individual level, the community level, and the societal level. We posit interactions among factors at the three levels of influence and how these may impact treatment seeking decisions among Black adults. This model informs suggestions for enhancing interventions designed to support outpatient service use among Black adults.

The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women

Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures.

Experiences of discrimination and endorsement of HIV/AIDS conspiracy beliefs: exploring difference among a sample of Latino, Black, and White young adults

Racial/ethnic discrimination and HIV/AIDS conspiracy beliefs may contribute to disparities in use and satisfaction with healthcare services. Previous studies that examined racial/ethnic experiences of everyday discrimination (EOD), health care discrimination (HCD), and HIV/AIDS conspiracy beliefs (HCB) focused primarily on African Americans with few studies focusing on Latinos. This study used data from in-person structured interviews with 450 Latino, Black, and White young adults from East Los Angeles, California. Multivariable models, adjusting for all demographic covariates, investigated if race/ethnicity and gender were associated with EOD and HCD and endorsing HCB, and if the associations between race/ethnicity and discriminations and HCB varied by gender. Blacks and Latinos reported more experiences of EOD and HCD in almost all forms and endorsed more HIV/AIDS conspiracy beliefs compared to Whites. Additionally, Black and Latino men reported stronger feelings of EOD than their female counterparts. More reports of experiences of HCD and endorsement of HCB beliefs were found for Blacks, Latinos, and participants with children compared to their counterparts. This study contributes to a growing understanding of how different racial/ethnic groups experience discrimination across various settings and everyday activities and their endorsement of HIV/AIDS conspiracy beliefs. The field of Public Health must address the problems of racism and discrimination similar to any other toxic pathogen. In so doing, Public Health becomes proactive in its efforts to mitigate the effects of racial discriminations on population health.

Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change

OBJECTIVE

Racism is a public health crisis that impacts on children's mental health, yet mental health service systems are insufficiently focused on addressing racism. Moreover, a focus on interpersonal racism and on individual coping with the impacts of racism has been prioritized over addressing structural racism at the level of the service system and associated institutions. In this paper, we examine strategies to address structural racism via policies affecting children's mental health services.

METHOD

First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health.

RESULTS

Our analysis highlights gaps and opportunities in the evidence base for policy implementation strategies, including the following: mental health services for youth of color, interventions addressing interpersonal racism and bias in the mental health service system, interventions addressing structural racism, changes to provider licensure and license renewal, and development of the community health workforce.

CONCLUSION

Recommendations are provided both within and across systems to catalyze broader systems transformation.

Associations between discrimination and adverse mental health symptoms and disorder diagnoses among college students in the United States

BACKGROUND

Mental health disorders are prevalent among college students in the US. Perceived discrimination is a known risk factor for adverse mental health and is widespread on college campuses.

METHODS

We estimated the association between perceived discrimination and mental health among US college students using the American College Health Association-National College Health Assessment (ACHA-NCHA), a large national cross-sectional survey of college students.

RESULTS

7.9% of students reported experiences of discrimination, and that discrimination was more common among minority students. Perceived discrimination was associated with 86 excess cases of students reporting being too depressed to function per 1000 students, and 27 excess cases of students reporting seriously considering suicide per 1000 students. Students who experienced discrimination had a 37% increase in the number of mental health symptoms (IRR 1.37 [95% CI 1.35, 1.39], P < .0001) compared to non-discriminated students, and a 94% increase in the number of mental health diagnoses (IRR 1.94 [95% CI 1.89, 1.99], P < .0001). Discrimination was positively associated with all mental health symptoms and diagnoses. This pattern was largely held across sub-analyses by race/ethnicity, gender, and sexual orientation, but with varying magnitudes.

LIMITATIONS

Inability to distinguish between the forms of discrimination experienced, whether involving gender, sexual orientation, or race/ethnicity.

CONCLUSIONS

Consequences of perceived discrimination are of clinical relevance for healthcare providers in general and mental health providers in particular. This study confirms the association between perceived discrimination and adverse mental health in college students. Efforts to reduce discrimination and bias in college campuses may improve the mental health of students.

Police killings and suicide among Black Americans

Black Americans are killed at higher rates by police than whites. Previous studies have shown that discrimination can lead to suicidal ideation, and that mental health of Black Americans deteriorates after police killings. The objective of this study is to examine whether police killings are associated with an increase in suicide rates amongst Black Americans. Controlling for a number of factors, we found that on months with at least one killing of a Black person by police, there were, on average, 0.0472 additional suicides per 100,000 Black Americans in the U.S. Census Division where the killing occurred. We did not find any spillover effects on other divisions. This association persisted when controlling for gun ownership, and did not seem to be a result of variance in deaths by assault. There was no association between killings of Black Americans and white suicides; white killings and Black suicides; or white killings and white suicides. This study highlights another reason for urgent action on reducing police killings.