The Conceptualization of Everyday Racism in Research on the Mental and Physical Health of Ethnic and Racial Groups: a Systematic Review

Discrimination and microaggressions as mediators of food insecurity among transgender college students

Objective: We examined the association between microaggressions, discrimination, and transgender students' experience of food insecurity (FI). Participants: Data were from the National College Health Assessment conducted 2019-2022. Of 334,957 participants, 8,618 were transgender. Methods: Descriptive statistics and mediation analyses were calculated to test microaggressions, discrimination, and related distress, as mediators between transgender identity and FI. This study only included participants who indicated their gender identity by answering the yes/no survey question "Do you identify as transgender?" Results: Discrimination and related distress partially mediated the association between transgender identity and FI, accounting for 44% and 25%, respectively, of the total effect. Microaggressions and related distress also partially mediated this association, accounting for 49% and 30%, respectively, of the total effect. Conclusion: Experiencing discrimination and microaggressions partially explains FI among transgender students. Collaborating with stakeholder transgender students to promote food assistance programs to this population could mitigate these experiences.

Health-related social needs mitigate ethnoracial inequities in patient-reported mental health

PURPOSE

To characterize the relationship between ethnoracial identity, health-related social needs (HRSNs), and mental health (MH), and to examine the mediating role of HRSNs on the relationship between MH and ethnoracial identity.

METHODS

Data from 30,437 adults who were seeking care within Mass General Brigham integrated health system in United States and had completed PROMIS Global Health within three years of their most recent HRSNs screening between March 1, 2018 and January 31, 2023 were included. The presence and magnitude of PROMIS Global MH score differences for six ethnoracial groups (White non-Hispanic, White Hispanic, Black (Hispanic and non-Hispanic), Asian non-Hispanic, Other non-Hispanic and Other Hispanic (includes Asian Hispanic) was assessed. Regression-based mediation analyses were used to examine mediating role of four HRSNs (food insecurity, housing instability, transportation barriers and inability to pay for housing utilities) on relationship between ethnoracial identity and MH.

RESULTS

Compared to White Non-Hispanic patients, ethnoracial minorities had worse MH, after adjusting for age, sex, education, employment, marital status, comorbidities, and insurance type. This relationship remained statistically significant (p < 0.001) for White Hispanic, Asian non-Hispanic and Other non-Hispanic patients, where HRSNs mediated 57%, 88% and 70% of the relationship between ethnoracial identity and MH respectively. For Blacks and Other Hispanic patients, HRSNs fully mediated this relationship.

CONCLUSION

Disparities in MH may be driven by structural racism and experiences of racism that result in differentials in HRSNs, rather than ethnoracial identity. Efforts directed at measuring and addressing the HRSNs, in addition to structural factors are critical to achieving MH equity.

Social Maltreatment and Symptomatology: Validating the Social Discrimination and Maltreatment Scale-Short Form in a Diverse Online Sample

There are few psychometrically valid measures of exposure to social maltreatment that simultaneously assess sexism, racism, and anti-LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other nonheteronormative) behavior, despite the commonness of these phenomena. The Social Discrimination and Maltreatment Scale (SDMS) meets this requirement but is, as a result, somewhat lengthy (36 items). This article introduces a short form of the SDMS containing only half the number of items but generally retaining the psychometric qualities of the original measure. The 18-item Social Discrimination and Maltreatment Scale-Short Form (SDMS-SF) consists of six SDMS stem items (e.g., I have been disrespected, People made cruel or demeaning jokes about me) each of which is rated according to how often it had happened "because of my sex," "because of my race," and "because of my sexual orientation or gender identity." In the SDMS online sample (N = 528), SDMS-SF Sexism, Racism, and Cisheterosexism subscales were validated by confirmatory factor analysis and were internally consistent (α = .91-.95) and highly correlated with the original SDMS subscales (r = .94 in all cases). All SDMS-SF subscales correlated with self-reported anxiety, depression, and posttraumatic stress (mean r = .29), corresponding to a medium effect size. In all but one instance, related SDMS and SDMS-SF subscales did not differ significantly in the strength of their association with symptomatology. Together, these results suggest that the SDMS-SF is a reliable and valid measure of social discrimination, generally equivalent to the SDMS despite containing only half as many items.

The Reporting of Race and Ethnicity in the Conduct Disorder Literature: A Time-Sensitive Review

Background

Among presenting conditions in pediatric acute care settings, conduct disorder (CD) is a potentially stigmatizing yet common diagnosis in the setting of behavioral dysregulation requiring psychiatric admission. Concerns exist about over-diagnosis of CD in non-Hispanic Black children relative to White peers and the potential for the CD diagnosis to obfuscate manifestations of co-occurring psychiatric conditions.

Methods

We evaluated the number of manuscripts on CD diagnoses that report race and ethnicity and co-occurring mental health characteristics (i.e., history of trauma, attention-deficit hyperactivity disorder [ADHD], or substance use disorders [SUDs]) that are often undertreated in racially minoritized children. Using the keywords "conduct disorder" or "externalizing disorder," we screened peer-reviewed articles in PubMed published from January 2013 to November 2023.

Results

We screened 2791 manuscripts for potential inclusion, of which 136 were original research articles with data on children with CD diagnoses. Thirteen articles contained racial and ethnic data for people with CD diagnoses, with the majority illustrating that Black children were overrepresented among those with CD diagnoses. No studies provided details on how race and ethnicity were ascertained and few mentioned racism as a potential explanation for racial disparities in CD diagnoses. No studies contained data collected after 2016, with three studies using data collected as early as 2001-2002. Across all articles, data on co-occurring trauma, ADHD, and SUDs were scarce.

Conclusions

The overwhelming majority of studies on CD diagnoses did not provide comprehensive data on race and ethnicity and co-occurring psychiatric disorders in children receiving diagnoses of CD.

Systematic Review and Meta-Analysis: Reporting and Representation of Race/Ethnicity in 310 Randomized Controlled Trials of Attention-Deficit/Hyperactivity Disorder Medications

OBJECTIVE

To evaluate the reporting of race/ethnicity data in randomized controlled trials (RCTs) of attention-deficit/hyperactivity disorder (ADHD) medications. Secondary objectives were to estimate temporal trends in the reporting, and to compare the pooled prevalence of racial/ethnic groups in RCTs conducted in the US to national estimates.

METHOD

We drew on, adapted, and updated the search of a network meta-analysis by Cortese et al. (2018) up to March 2022. We calculated the percentage of RCTs reporting data on race/ethnicity of participants in the published article or in related unpublished material. Temporal trends were estimated with logistic regression. The pooled prevalence of each racial/ethnic group across US RCTs was calculated using random-effects model meta-analyses.

RESULTS

We retained 310 RCTs (including 44,447 participants), of which 231 were conducted in children/adolescents, 78 in adults, and 1 in both. Data on race/ethnicity were reported in 59.3% of the RCTs (75% of which were conducted in children/adolescents and 25% in adults) in the published article, and in unpublished material in an additional 8.7% of the RCTs. Reporting improved over time. In the US RCTs, Asian and White individuals were under- and overrepresented, respectively, compared to national estimates in the most recent time period considered.

CONCLUSION

More than 30% of the RCTs of ADHD medications retained in this review did not include data on race/ethnicity in their published or unpublished reports, and more than 40% in their published articles, even though reporting improved over time. Results should inform investigators, authors, editors, regulators, and study participants in relation to efforts to tackle inequalities in ADHD research.

PLAIN LANGUAGE SUMMARY

A systematic review of 310 randomized controlled trials for attention-deficit/hyperactivity disorder (ADHD) medications found that race/ethnicity were reported in only 30% of trials. Compared to national estimates, Asian individuals were underrepresented and non-Hispanic Whites individuals were overrepresented, drawing attention to the inequities in participation in ADHD research.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

STUDY PREREGISTRATION INFORMATION

Reporting and representation of race/ethnicity in double blind randomised controlled trials of medications for ADHD; https://osf.io/; hfgz8.

Denial of Personal Racial Discrimination and Its Impact Among People of Color Who Use Substances: Implications for Measuring Racial Discrimination in Substance Use Research

BACKGROUND

Even though racism is pervasive, some people of color may deny experiencing racial discrimination or may report being unaffected by it. This study examines the contexts and factors that may contribute to these responses among people who use substances.

METHODS

We conducted seven focus groups (5-9 participants per group, total N = 43) among Black, Latino, and Asian American adults between the ages of 21 to 44 years old who reported current use of two or more of the following substances: alcohol, cigarettes, e-cigarettes, or cannabis. Data were analyzed using reflexive thematic analysis.

RESULTS

Across all three ethno-racial groups, we found some respondents minimized or denied personal experiences of racial discrimination or hesitated to identify their experiences as racial discrimination, which in turn led to respondents to express uncertainty about seeing any sort of connection between racial discrimination and substance use. Themes included a minority comparison effect; a drowning out effect; diversity and racial composition of context; passing as White; and covertness of racism. Also, there were contradictions in accounts, and responses often depended on orienting cues.

CONCLUSIONS

While researchers continue to find associations between racial discrimination and substance use, some people of color may not acknowledge this connection. Recommendations include aligning definitions of racism between academic and public/popular discourse; updating measures to keep up with the evolving forms of racism using context-specific examples; combining subjective measures of racial discrimination with objective measures of racism; and dialoguing with the public to raise awareness around how racism is defined.

"Mentally you don't function the same": a Qualitative Examination of the Normalization, Embodiment, and Psychological Impact of Everyday Racism

Everyday racism consists of covert and oppressive practices that uphold systems of power and reproduce White supremacy through subtle forms of repetitive and normalized discriminatory actions. While attention to the material and physical damage everyday racism evokes upon Black Americans is receiving increased attention, inconsistencies regarding its conceptualization and operationalization are impeding our understanding of the impact of everyday racism. Utilizing critical race theory (CRT) as an analytical framework, this article intends to respond to gaps in the literature and deepen the understanding of the psychological burden experiences of everyday racism places upon a sample of (n = 40) Black Americans. We engaged with the racial realism and Whiteness as property tenets to analyze individual in-depth interviews and (1) enhance our interrogation of micro/macro-level interactions and (2) aid in the conceptualization of everyday racism. Three themes emerged from the data: hypervigilance and the normalization of everyday racism, mental preparation for navigating White spaces, and the mental health impact of everyday racism. Participant narratives reveal how the normalization of everyday racism impacts them on a psychological and corporeal (i.e., bodily) level. Their accounts also spoke to how Whiteness operates as a property right that exacerbates everyday racism and places invisible boundaries upon how they navigate space. This study provides conceptual clarity about the realities of racism, deeper awareness of structural and individual measures, and an in-depth understanding of how often taken for granted and assumed "normal" forms of racism generate pathways to negative mental health outcomes.

Adding Insult to Injury: Everyday Discrimination Moderates Stressor-Related Negative Affect

Studies examining the effects of discrimination on emotional well-being have often overlooked (a) differential effects of both everyday and lifetime discrimination and (b) how both types of discrimination may exacerbate stressor-related affect-even when daily stressors are unrelated to discrimination. The current study examined the effects of daily stressors not attributed to discrimination (i.e., nondiscrimination-related daily stressors) on daily negative and positive affect in the presence of either form of discrimination (everyday and lifetime). Participants who completed the second wave of the Survey of Midlife Development in the US (MIDUS-II) and the National Study of Daily Experiences (NSDE-II) answered questionnaires about everyday and lifetime discrimination. Later, they completed daily phone interviews across 8 consecutive days, asking about the nondiscrimination-related daily stressors and the positive and negative affect they had experienced that day. Multilevel model analyses revealed that everyday discrimination was associated with decreased daily positive affect and lifetime discrimination was associated with increased daily negative affect. Moreover, higher frequency of everyday discrimination exacerbated the within-person effects of nondiscriminatory daily stressors on negative affect. Results underscore the importance of considering both independent and synergistic effects of discrimination on daily emotional well-being.

Investigating discrimination in the workplace. Translation and validation of the Everyday Discrimination Scale for nursing staff in Germany

BACKGROUND

The Everyday Discrimination Scale (EDS) is a frequently used questionnaire in the field of health and social psychology that aims to explore perceptions of discrimination, especially instances of injustice related to various diversity characteristics. No adaptation to health care staff exists. The present study translates and adapts the EDS to nursing staff in Germany and examines its reliability and factorial validity as well as its measurement equivalence between men and women and different age groups.

METHODS

The study was based on an online survey conducted among health care staff of two hospitals and two inpatient care facilities in Germany. The EDS was translated using a forward-backward translation approach. Direct maximum likelihood confirmatory factor analysis (CFA) was conducted to examine the factorial validity of the adapted EDS. Differential item functioning (DIF) related to age and sex was investigated by means of multiple indicators, multiple causes (MIMIC) models.

RESULTS

Data on 302 individuals was available, of whom 237 (78.5%) were women. The most commonly employed one-factor, 8-item baseline model of the adapted EDS showed a poor fit (RMSEA = 0.149; CFI = 0.812; TLI = 0.737; SRMR = 0.072). The model fit improved considerably after including three error covariances between items 1 and 2, items 4 and 5, and items 7 and 8 (RMSEA = 0.066; CFI = 0.969; TLI = 0.949; SRMR = 0.036). Item 4 showed DIF related to sex and age, item 6 showed DIF related to age. DIF was moderate in size and did not bias the comparison between men and women or between younger and older employees.

CONCLUSIONS

The EDS can be considered a valid instrument for the assessment of discrimination experiences among nursing staff. Given that the questionnaire, similar to other EDS adaptations, may be prone to DIF and also considering that some error covariances need to be parameterized, latent variable modelling should be used for the analysis of the questionnaire.

Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil

OBJECTIVE

To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study.

RESULTS

The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83.

CONCLUSIONS

Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.

A systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes

Discrimination has consistently been associated with multiple adverse health outcomes. Like other psychosocial stressors, discrimination is thought to impact health through stress-related physiologic pathways including hypothalamic-pituitary-adrenal (HPA) axis activation, dysregulation of inflammation responses, and accelerated cellular aging. Given growing attention to research examining the biological pathways through which discrimination becomes embodied, this systematic review and meta-analysis synthesizes empirical evidence examining relationships between self-reported discrimination and four biomarker outcomes (i.e., cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length) among studies that have used the Everyday Discrimination Scale. We conducted a systematic review of studies discussing self-reported, everyday, or chronic discrimination in the context of health by searching Medline / PubMed (National Library of Medicine, NCBI), PsycInfo (APA, Ebsco) and Web of Science Core Collection (Clarivate). Twenty-five articles met the criteria for meta-analysis, with several reporting on multiple outcomes. Discrimination was associated with elevated CRP levels (r = 0.11; 95% CI: 0.01, 0.20, k = 10), though not cortisol (r = 0.05; 95% CI: -0.06, 0.16, k = 9), IL-6 (r = 0.05; 95% CI: -0.32, 0.42, k = 5), or telomere length (r = 0.03; 95% CI: -0.01, 0.07, k = 6). We identify several points of consideration for future research including addressing heterogeneity in assessment of biomarker outcomes and the need for longitudinal assessments of relationships between discrimination and biomarker outcomes.

Racial Stress and Trauma and the Development of Adolescent Depression: A Review of the Role of Vigilance Evoked by Racism-Related Threat

There are known disparities in the burden of illness and access/quality of care for African, Latino/a, Asian, and Native American (ALANA) patients diagnosed with depressive disorders, which may occur because of health inequities. Racial stress and trauma (RST), or the significant fear and distress that can be imparted from exposure to racism, is one such inequity linked to the development of depression. The current review summarizes past research examining the association between racism, RST, and depression, as well as avenues in which RST becomes biologically embedded in ALANA individuals. We describe multimodal research that supports vigilance as a potential mediator of the association between RST and depression and consider the nuanced role that vigilance plays during experiences with racism. Finally, we describe methodological advances in the assessment of vigilance evoked by RST and the clinical implications that may be generated by future improvements. In each of these areas, we present examples of how ongoing and future research can be leveraged to provide support for psychosocial programs that facilitate autonomous community healing and resilience, increase calls for public policy changes, and support clinical interventions that lessen the burden of racism on ALANA communities.

[Impact of social distancing on reports of violence against children and adolescents in Rio Grande do Sul, Brazil]

This study aimed to analyze the rates of reports of violence against children and adolescents in the state of Rio Grande do Sul, Brazil, from 2015 to 2020, and the changes in trends by period due to the novel coronavirus pandemic (COVID-19). This is an ecological time series study with secondary data obtained from the Bi Saúde Portal in the panel on Interpersonal Violence and Suicide. The study collected reports on violence in individuals 0 to 19 years of age in the months of March and April each year, stratified by sex, age bracket, race/color, and type of violence. Prais-Winsten regression was used to analyze the time trend. Of the 7,718 reports analyzed, there was a drop of 54% in the year 2020 compared to the same period in 2019. The analysis of the trend until 2019 indicated an increase in the reporting rates (2.04, 95%CI: 1.01; 3.07, p = 0.002), but with the inclusion of the year 2020 in the time series, the direction of the trends in reporting rates was reversed to negative, losing statistical significance (-0.39, 95%CI: -1.16; 2.14, p = 0.632). The study concludes that social distancing due to the pandemic reduced the reporting rates of violence against children and adolescents due to underreporting, thus requiring strategies to improve the identification of suspected cases of violence during the pandemic. This highlights the need for inter-sector planning and rapid and specific actions (health, social protection, justice, and public security) in order to guarantee the rights of children and adolescents.