The influence of internalized racism on the relationship between discrimination and anxiety

Unpacking the complexities in racial and ethnic discrimination and tobacco use and cannabis co-use behaviors among young adults in the U.S

Introduction

There is a general paucity of research describing the relationship between racial and ethnic discrimination (RED) and coping strategies on use of little filtered cigars and cigarillos (LCCs) across racial and ethnic identities. This research sought to unravel some of the complex, multilayered experiences of RED and subsequent coping strategies to examine the impact on LCC use.

Methods

Data come from a cross-sectional survey conducted among a nationally representative sample of U.S. young adults (n = 1,178) in May 2022. Respondents were asked about their exposure to LCC marketing (systemic RED), interpersonal experiences of RED, coping strategies, and use of LCCs as-sold (tobacco only) or as a blunt (with marijuana). Multivariable logistic regression was used to examine odds of LCC use examining systemic and interpersonal RED and the relationship between emotion-focused and problem-focused coping strategies among those who have experienced RED.

Results

Exposure to systemic RED was associated with increased odds of blunt use. Interpersonal experiences of RED were associated with increased odds of LCC use as-sold and as blunts. Among those who experienced any RED, the impact of problem-focused and emotion-focused coping was differential across racial and ethnic identities in the impact on LCC use modality.

Conclusion

Systemic and interpersonal RED are independently associated with LCC use. There are considerable differences in how young adults cope with RED which necessitates additional research to further elucidate the complex pathways between RED and product use to more effectively inform strategies to address the undeniable racial and ethnic inequities in tobacco-related health outcomes.

Understanding Signs and Sources of Anxiety in Urban Elementary Schools Serving Predominately Ethnically/Racially Minoritized Children

OBJECTIVE

This mixed-methods study examined teachers' perceptions of student anxiety in urban elementary schools serving predominantly low-income and ethnically/racially minoritized youth.

METHOD

Most participating teachers were female (87.7%) and from minoritized backgrounds themselves (89.2%), teaching in schools serving predominantly Black/African American (40%) or Hispanic (60%) students, and in which > 70% of students are eligible for free meals. Teachers were asked in surveys (N = 82) and interviews (n = 12) about the nature of student anxiety, and cultural/contextual considerations that influence anxiety.

RESULTS

Overall, teachers reported prevalence and signs of student anxiety that were consistent with the literature, but they reported higher levels of impairment than in previous community samples. Regressions revealed that greater levels of student exposure to community violence and higher proportions of Black students were associated with higher teacher-perceived prevalence and concern about student anxiety, respectively. Moreover, greater emotional exhaustion in teachers was associated with higher reports of anxiety-related impairment in students. Thematic coding of interviews emphasized how teachers perceived 1) most student anxieties to be proportional responses to realistic threats and stress in students' lives (e.g. resource insecurity), 2) systems-level problems (e.g. pressure to perform on standardized tests) contribute to student anxiety, and 3) school-based anxiety sources often interact with traumas and stressors students experience outside of school (e.g. immigration experiences).

CONCLUSIONS

Relative to the predominant literature that has focused on biological, cognitive, and other intraindividual factors as sources of anxiety, the present work underscores the importance of considering how broader economic and systems-level influences exacerbate anxiety in marginalized youth.

Online Racial/Ethnic Discrimination, Suicidal Ideation, and Alcohol Misuse Among Ethnoracially Minoritized College Students: The Roles of Internalized Racism and Ethnic Identity

Over the past decade, mental health problems have disproportionately increased among U.S. ethnoracially minoritized college students, though explanations for this disparity remain understudied. In the present study, we examined the direct and indirect associations between online racial/ethnic discrimination, suicidal ideation (SI), and alcohol misuse. We also investigated whether internalized racism helps explain the association between online racial/ethnic discrimination (i.e., individual or vicarious exposures) and SI and alcohol misuse. Lastly, we examined the moderating role of ethnic identity dimensions (i.e., exploration and commitment) in this indirect association. Participants included 494 ethnoracially minoritized college students ages 18-30 years (M = 19.62, SD = 2.08; 79% female; 60% Latine; 83% U.S.-born) from the U.S. who completed an online survey. Findings revealed that online racial/ethnic discrimination (i.e., individual and vicarious exposures) was directly associated with increased SI and alcohol misuse. The indirect association of online racial/ethnic discrimination (i.e., individual and vicarious) on SI via internalized racism was statistically significant. These indirect associations, however, were not observed with alcohol misuse. Ethnic identity commitment moderated the indirect association of vicarious, though not individual, online racial/ethnic discrimination on SI via internalized racism. These findings underscore the impact of online racial/ethnic discrimination on ethnoracially minoritized college students' mental health, identify internalized racism as a potential pathway through which this type of discrimination may confer risk for SI, as well as ethnic identity commitment as a potential protective factor that may buffer these harmful effects.

Internalized oppression and deaf people's mental health

Deaf people experience ableism (able-bodied oppression), audism (hearing-ability oppression), and linguicism (sign language-use oppression) and this study investigated if internalizing these oppressive experiences predicts their mental health. Deaf participants (N = 134) completed a 54-item Deaf Oppression Scale, developed for this study with Ableism, Audism, and Linguicism Subtests, along with the Beck Depression Inventory-II and the State and Trait Anxiety Inventory. The Deaf Oppression Scale and its Ableism, Audism, and Linguicism Subscales carry good reliability and the model fit indices for a confirmatory factor analysis indicated a good fit. Sixteen (16%) percent (n = 22) of the sample had depression, 36% (n = 48) had state anxiety, and 64% (n = 86) had trait anxiety. Internalized ableism predicted greater characteristics and symptoms of depression, internalized ableism and linguicism predicted greater state anxiety, and internalized audism predicted greater trait anxiety. This is the first empirical evidence dissociating three types of oppression that deaf people experience and their separate and different effects on their psychological well-being.

Racial Discrimination and Mental Health: Analyzing the Impact of Discrimination, Stress, Depressive Symptoms and Self-Esteem on Anxiety Experiences

BACKGROUND

Existing research demonstrates that racial inequity influences mental health outcomes. However, few studies simultaneously analyze the multiple factors influencing racial disparities regarding these outcomes. Our study addresses this gap by analyzing the impact of discrimination, stress, self-esteem, racial identity, depressive symptoms, and demographic factors on anxiety symptoms.

METHODS

Participants were adults recruited from a primary care clinic in the Southeastern region of the United States. We utilized a stratified random sampling strategy to select 383 participants. Participants completed a survey designed to assess levels of anxiety, depression, perceived stress, self-esteem, racial identity, experiences with discrimination, and demographic information. A hierarchical regression analyzed which factors most impact symptoms of anxiety.

RESULTS

Of the 363 participants in our study, the majority were female (71.3%), 57% were White identifying, 43% were Black identifying, and the average age was 54.4 (SD = 12.3). Model 4 accounted for 58% of the variance of anxiety symptoms and included a combination of depressive symptoms, perceived stress, self-esteem, experiences of everyday discrimination, and interaction terms. Within this model, perceived stress (t = 3.81, p < .01), experiences of everyday discrimination, (t = 2.33, p < .01), and income (t = -1.96, p < .01) were significantly associated with increased anxiety.

CONCLUSIONS AND IMPLICATIONS

Multiple contextual factors influence the relationship between race and anxiety. In particular, anxiety increases with lower rates of self-esteem and income. Conversely, anxiety increases with higher rates of stress, discrimination, and depressive symptoms. Social workers should consider each of these factors when treating patients presenting with symptoms of anxiety.

Depressive symptoms, racism, and school belonging: examining correlates of substance use behaviors among Black college students

College is a context in which Black adults are at heightened risk for substance use behaviors and subsequently more harmful consequences. Increasingly, scholars are recognizing that to better understand shifts in patterns of substance use behaviors and health disparities among Black adults, mental health and racism are important factors to consider. Racism is multidimensional; thus, research is needed to investigate its multiple forms. Currently, it is unknown how the occurrence of depressive symptoms and various racism experiences influence patterns of substance use behaviors among Black college students. Further, while school belonging is evidenced to promote better health outcomes during adolescence, research is needed to understand school belonging in relation to substance use among Black college students. Using latent profile analysis (LPA), we identify patterns of substance use behaviors among Black college students (N = 152) and examine whether depressive symptoms, racism experiences (i.e., racial discrimination stress, internalized racism, negative police encounters), and school belonging are associated with the unique patterns. Latent profiles included indicators of substance use behavior frequency. Four patterns emerged: 1) low substance use, 2) predominant alcohol use, 3) co-use, 4) high polysubstance use. Depressive symptoms, internalized racism, and negative police encounters were significant correlates of patterns of substance use behaviors. School belonging, specifically, participation in student, cultural, spiritual, and Greek organizations, was also associated with profile membership. Findings suggest a need to integrate a broader understanding of how mental health and racism impacts the lives of Black college students, in addition to processes for supporting school belonging.

Ethnic disparities in perceived racism, patient-provider communication and healthcare utilization: Asian Americans

BACKGROUND

Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities by influencing patient-provider communication and utilization of healthcare services.

OBJECTIVE

This study aimed to investigate how Asian American subgroups differ in their perception of everyday racism, internalized racism, and perceived racism in healthcare settings and whether these perceptions predict their interactions with their health care providers and their utilization of healthcare services.

METHODS

An online survey study was conducted. ANOVA tests were employed to compare the differences in perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system among Filipino (N = 310), Japanese (N = 242), Chinese (N = 287), Asian Indian (N = 304), Korean (N = 199) and Vietnamese (N = 151) participants. Multiple regression analyses assessed whether perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system predicted healthcare service utilization and patient-provider communication among the Asian subgroups sampled.

RESULTS

There were significant group differences in perceived everyday racism (F = 8.56, p < .001), internalized racism (F = 3.46, p < .01), perceived racism in healthcare (F = 4.57, p < .001). Perceptions of racism and socioeconomic variables were found to predict patient-provider communication and utilization of healthcare services disparately across various Asian subgroups. For instance, the perception of everyday racism was a significant predictor of patient-provider communication for each of the subgroups, excluding the Vietnamese participants. Internalized racism was a significant predictor only for Filipino and Chinese participants. Surprisingly, perceived racism in healthcare was not a predictor for any of the subgroups.

CONCLUSION

Findings highlight the complex interplay of sociodemographic factors and perceived racism in shaping patient-provider communication and healthcare service utilization within the Asian American community. Implications are suggested for addressing the unique challenges faced by different Asian American subgroups and for promoting equitable healthcare access and fostering positive patient-provider relationships among the Asian American subgroups.

Internalized Racism and Mental Health: The Moderating Role of Collective Racial Self-Esteem

Internalized racism is the internalization of beliefs about racism and colonization that contribute to the acceptance of negative messaging or stereotypical misrepresentations that inform perceptions about worth and ability. Internalized racism is associated with psychological distress in racially diverse people. Collective racial self-esteem is a potential protective factor that can serve as a moderator in reducing distress and facilitating psychological well-being. The sample for the present study consisted of 526 participants who self-identified as African American, Asian American/Pacific Islander, Latinx American, or American of Arab or Middle Eastern descent. The researchers used regression with the Process macro to investigate the potential moderating properties of collective racial self-esteem on the relationship between internalized racism and psychological distress in the sample. The findings indicated that specific domains of collective racial self-esteem moderated the internalized racism-psychological distress relationship.

Camouflaged prejudice and the affirmation of skin colour differences: assessment of racism among Brazilian undergraduate dental students

The negative oral health outcomes of disadvantaged racial groups have been well-documented, as racial disparity in oral health persists over time and in different locations1. However, it is important to note that skin colour has no biological meaning, and the observed differences can be physiological expressions of social injustice such as racism. Aim: The aim of this study was to analyse the association between levels of modern racism (camouflaged prejudice and affirmation of differences) and sociodemographic characteristics of Brazilian dental students. Material and Method: An epidemiological cross-sectional online survey was conducted on 441 Brazilian undergraduate dental students using Google Forms. Participants were recruited via emails and social media, using the snowball technique. The Checklist for Reporting of Survey Studies (CROSS) was followed. The survey used sociodemographic variables, and the Brazilian version of the Modern Racism Scale (B-MRS), which measures the cognitive component of subtle racial attitudes. The scale assesses the central notion of disguised prejudice and has two domains: 'denial of prejudice' and 'affirmation of differences'. Participants' self-declared skin colour was categorized as "white" and "non-white" (black, brown, indigenous, yellow). Univariate analysis and Poisson regression with robust variance were applied. Results: Participants' mean age was 24.1 years (±5.4). Most participants were self-declared as white (54%) and 46% as non-white skin colour. Higher B-MRS overall-scores were observed in male (p=0.008) and non-white (p=0.002) students. B-MRS scores for the domain 'affirmation of differences' (representation of those who believe that whites and non-whites are truly different) were higher among male dental students (PR=1.138; CI 95%: 1.019-1.271) and those from low-income families (PR=1.306; CI 95%: 1.089-1.565). Scores for the domain 'denial of prejudice' (the idea that non-whites use their race to receive legal benefits) were higher among male dental students (PR=1.328; CI 95%: 1.129-1.562). Conclusions: In general, male non-white students had higher modern racism indicators. Male students from low-income families believed that whites and non-whites are truly different, accounting for the affirmation of difference in this sample.

Afrocentric Cultural Norms, Mental Health Functioning, and the Perception of Intimate Partner Violence Among Young Black Men

Intimate partner violence (IPV) is a serious public health concern that profoundly impacts the lives of women globally. While IPV cuts across race, socioeconomic status, age groups, and geography, Black women are disproportionately affected. Prior studies report that Black women predominantly couple with Black men and thus, understanding factors associated with IPV perpetration among Black men is essential. Subsequently, the present study explored an important gap in the literature, exploring how collectivism, a core belief ascribed to Afrocentric cultural norms, and factors associated with mental health functioning in emerging adult Black men in the USA is associated with their views of IPV. Data for the study was drawn from a sample of self-identifying Black American males between the ages of 18 and 25 (n=300). Regression analysis demonstrated no significant relationship between age, household income, and education level among participants. Anxiety had a significant relationship with intimate partner beliefs with participants with increased anxiety having more problematic intimate partner beliefs. A model including anxiety, collectivism, and aggressiveness was a significant predictor of problematic intimate partner beliefs. In the final model, collectivism and aggressiveness were statistically significant predictors of perceptions endorsing IPV. Participants who reported higher levels of global aggressive confrontation with others were more likely to endorse IPV. Overall, participants with a sense of value for collectivism over individualism were least likely to endorse IPV. This study provides evidence that cultural norms potentially have a role in Black men's beliefs about IPV. Implications for future research are provided.

Perceived discrimination, anxiety and mood disorders among university students during the COVID-19 era: evidence from a cross-sectional survey in a Ghanaian public university

Introduction

Before 2020 and the advent of the COVID-19 pandemic, mental disorders, including anxiety and mood disorders, were considered the leading causes of the global disease burden. There is evidence from multiple countries and social contexts that suggest the high risk of anxiety and mood disorders among students. Yet, there is a knowledge gap concerning understanding the association between the experience of discrimination and the risk of anxiety and mood disorders. We examined the association between the experience of discrimination and the risk of anxiety and mood disorders among university students.

Methods

This study is a cross-sectional survey among university students in Ghana. A quota sampling technique was used to recruit 1,601 students. Data were collected using structured questionnaires. All data were analyzed using Stata. Binary logistic regression model was used to examine the significant association between the outcome variable and the explanatory variables.

Results

The prevalence of anxiety disorder among the respondents was 67 per cent. Students who had experienced discrimination or had any member of their family experienced discrimination had higher odds (OR = 4.59, Cl = 2.64, 7.96) of anxiety and mood disorder compared to those who had not experienced any form of discrimination. Respondents aged 20-24 years had higher odds (OR = 1.47, Cl = 1.16, 1.85) of anxiety and mood disorder than those aged 15-19. Students with a high perceived risk of contracting COVID-19 had a higher odd (OR = 1.52, CI = 1.10, 2.10) compared to those with a low perceived risk.

Conclusion

The findings underscore a need for university authorities to lay out clear initiatives that will reinforce and meet the mental health needs of university students during and after periods of crisis, such as returning from COVID-19 lockdown. There must be a conscious effort to advocate and raise students' awareness of anxiety disorders. Also, it is imperative to create support groups within the university set up to address the mental health needs of all students. Younger students should be the primary focus of these interventions.

National Institutes of Health R-series Grants portfolio of racism and healthcare, 2017-2022

BACKGROUND

Any form of racism in healthcare is an unacceptable barrier to receiving equitable and quality care, further contributing to health disparities among populations. For these reasons, it is critical to have a better understanding on the amount of research and scientific advances of funded projects aimed at racism in healthcare. An examination of the distribution of R-series funded research by the National Institutes of Health (NIH) on racism in healthcare during a 5-year fiscal year (FY) period (2017-2022) was conducted by the study team.

METHODS

This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) for research project grants awarded on racism and healthcare during the FYs of 2017 to 2022. The number of R-series NIH funded projects on racism in healthcare were examined, including the abstract and public health relevance statement, number of publications, spending category, fiscal start and end dates, total amount of funding each year, funding agency/center(s), and type of funding opportunity announcements. Descriptive statistics were performed on the data by the research team.

RESULTS

There were a total of 93 R-series grants funded during the FYs of 2017 to 2022. Most of the grants were R01s (77.4%); focused primarily on racism at the system-wide level (68.8%), and on patients (64.5%); the largest racial and ethnic minority group reported were African/American/Black (20.4%); and close to 40% did not report race or ethnicity. None of the grants focused in internalized racism, which is at the individual -level. From the FYs of 2017 to 2022, 0.07% of all NIH research funding was awarded to racism in healthcare.

CONCLUSION

The findings of this study showed the need for continued funding and of the need of more research on racism in healthcare, that potentially can reduce health disparities and inequities.

Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan

The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID-19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21-2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36-2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.

Pour une santé publique en faveur d'une justice épistémique

La santé publique s'oriente de plus en plus vers l'étude des structures oppressives (telles que le racisme, le sexisme, ou le validisme) et de leur influence sur le marché de l'emploi, les systèmes éducatifs et judiciaires, et l'accès aux systèmes de santé de qualité. Ce commentaire vise à proposer une réflexion sur la manière dont ces structures influencent également la façon de faire de la santé publique. À travers le concept d'injustice épistémique, qui décrit le fait que l'organisation sociale influence la possibilité de connaître et de faire valoir sa connaissance dans une société donnée, nous montrons qu'en tant qu'acteur.rice de santé publique, nous pouvons reproduire et renforcer des injustices sociales. Les injustices épistémiques sont la plupart du temps le fruit de structures et de pratiques quotidiennes. Il est nécessaire de développer l'utilisation d'outils permettant de favoriser la réflexivité pour faciliter la mise en perspective des injustices et des privilèges.

"We grew up in the church": A critical discourse analysis of Black and White rural residents' perceptions of mental health

RATIONALE

Known as the "Black-White mental health paradox," Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources.

OBJECTIVE

The purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents.

METHODS

We conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping.

RESULTS

White rural residents' condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism.

CONCLUSIONS

Our findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations.

Associations among discrimination, psychological functioning, and substance use among US Black adults aged 18-28: Moderation by racial attribution and sex

INTRODUCTION

Discrimination is associated with poor mental health and substance use among Black Americans, but research is needed on mediators and moderators of these relationships. This study tested whether: 1) discrimination is associated with current alcohol, tobacco (cigarette or e-cigarette), and cannabis use among US Black emerging adults; 2) psychological distress (PD) and positive well-being (PW) are mediators of discrimination-substance use relationships; and 3) these relationships are moderated by sex and attributions to discrimination (racial vs. nonracial).

METHODS

Using data from a 2017 US nationally representative survey, we conducted bivariate and multiple-group moderated mediation analyses among 1118 Black American adults aged 18-28. The study assessed discrimination and attribution to discrimination using the Everyday Discrimination scale, past 30-day PD with the Kessler-6 scale, and past 30-day PW with the Mental Health Continuum Short Form. We utilized probit regression for all structural equation models and adjusted final models for age.

RESULTS

Discrimination was positively associated with past 30-day cannabis and tobacco use directly and indirectly through PD in the overall model. Among males who reported race as the sole/main attribution to discrimination, discrimination was positively associated with alcohol, cannabis, and tobacco use through PD. Among females who reported race as the sole/main attribution to discrimination, discrimination was positively associated with cannabis use through PD. Discrimination was positively associated with tobacco use among those who reported nonracial attributions to discrimination and with alcohol use among those whose attribution was not assessed. Discrimination was positively associated with PD among those who reported race as a secondary attribution to discrimination.

CONCLUSIONS

Discrimination specifically attributed to race may contribute to greater PD and in turn alcohol, cannabis, and tobacco use among Black emerging adults, especially males. Future substance use prevention and treatment efforts targeted to Black American emerging adults may benefit from addressing racial discrimination and PD.

A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility

BACKGROUND

Experiencing racial microaggressions has clear effects on physical and psychological health, including obsessive-compulsive disorder symptoms (OCS). More research is needed to examine this link. Psychological flexibility is an important process to examine in this work.

AIMS

This study aimed to examine if, while controlling for depression and anxiety, experiences of microaggressions and psychological flexibility helped explain OCD symptoms within a university-affiliated sample (undergraduate, graduate and law students). This was a pilot exploration of the relationships across themes.

METHOD

Initial baseline data from a longitudinal study of psychological flexibility, OCD symptoms, depression, anxiety and experience of microaggressions was utilized. Correlations and regressions were utilized to examine which OCD symptom dimensions were associated with experiencing racial microaggressions in addition to anxiety and depression, and the added role of psychological flexibility was examined.

RESULTS

OCD symptoms, experiences of microaggressions and psychological flexibility were correlated. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms above and beyond psychological distress. Exploratory results support the relevance of psychological flexibility.

CONCLUSION

Results support other work that experiences of racial microaggressions help explain OCS and they add some support for psychological flexibility as a relevant risk or protective factor for mental health in marginalized populations. These topics should be studied longitudinally with continued consideration of all OCD themes, larger sample sizes, intersecting identities, clinical samples, and continued exploration of psychological flexibility and mindfulness and values-based treatments.

Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety

Increases in adolescent anxiety over the past several years suggest a need for trauma-informed, culturally responsive interventions that help teens cope with environmental stressors like those associated with the COVID-19 pandemic. Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT. CBT does not typically include strategies that address important family factors that may be impacting the teen's functioning, such as the attachment relationship. Attachment-based family therapy (ABFT) addresses the attachment relationship and other factors that contribute to the adolescent's anxiety and related distress. By enhancing positive parenting behaviors, such as acceptance and validation of the adolescent's distress and promotion of their autonomy, ABFT sessions may repair the attachment relationship and increase the family's ability and willingness to engage in CBT tasks aimed at reducing anxiety. This theoretical paper describes the ABFT model and proposes that implementing ABFT sessions prior to CBT could result in better clinical outcomes for adolescents with anxiety disorders by improving the context within which the anxiety symptoms and treatment are experienced. Given that ABFT is sensitive and responsive to family and other contextual factors, adolescents from marginalized communities and those from less individualistic cultures may find the model to be more acceptable and appropriate for addressing factors related to their anxiety. Thus, a combined ABFT+CBT model might result in better outcomes for adolescents who have not historically responded well to CBT alone.

Gendered racial microaggressions, internalized racism, and suicidal ideation among emerging adult Asian American women

BACKGROUND

Despite suicide being the leading cause of death among emerging adult Asian American women (AAW), little is known about the risk factors.

AIM

We tested whether gendered racial microaggressions stress (GRMS) would be associated with AAW's suicidal ideation, and whether internalized racism (self-negativity, IRSN; weakness stereotypes, IRWS; and appearance bias, IRAB) would exacerbate this link based on self-devaluating implications of internalized racism.

METHOD

Using a sample of 309 AAW (M_age = 20.00, SD = 6.26), we conducted a moderated logistic regression with GRMS predicting suicidal ideation (endorsement or no endorsement) and the three internalized racism factors (IRSN, IRWS, and IRAB) as moderators.

RESULTS

GRMS significantly predicted suicidal ideation with a threefold increase in the odds of suicidal ideation. Only IRSN significantly exacerbated this link at low to mean levels.

CONCLUSION

Gendered racial microaggressions is likely a risk factor for suicidal ideation among AAW, particularly for those who internalize negative images of themselves as Asian individuals.

Racial discrimination and its impact on mental health

There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.

Latent syndemic profiles among sexual and gender minority college students and psychological distress amid the COVID-19 pandemic

Sexual and gender minority (SGM) college students experience compounding psychological effects as a result of the COVID-19 pandemic. Using latent profile analysis of cross-sectional data from a sample of SGM students (n=565) we tested for a syndemic of victimization, internalized LGBTQ+ stigma, racism, racialized heterosexism/cisgenderism, family rejection, and isolation associated with psychological distress. We also tested if increases in these factors since the start of the COVID-19 pandemic were associated with greater psychological distress among syndemic profiles. We identified four profiles: "Lowest syndemic factors" (reference), "High isolation only," "High isolation and rejection only," and "High syndemic." The greatest distress was observed among the "High syndemic" profile (aPR=2.99, 95% CI 2.20, 4.06), followed by the "High isolation and rejection only" profile (aPR=2.11, 95% CI 1.61, 2.76), and the "High isolation only" profile (aPR=1.32, 95% CI 1.03, 1.70). Among the "High syndemic profile," increases in every factor since the start of the COVID-19 pandemic were associated with greater psychological distress. The strongest associations were seen among increased victimization (aPR=5.85, 95% CI 1.33, 25.71). Victimization, internalized LGBTQ+ stigma, racism, family rejection, and isolation form a syndemic among SGM students, which has magnified since the start of the COVID-19 pandemic.

Brain-body pathways linking racism and health

Racial disparities in health are a major public health problem in the United States, especially when comparing chronic disease morbidity and mortality for Black versus White Americans. These health disparities are primarily due to insidious anti-Black racism that permeates American history, current culture and institutions, and interpersonal interactions. But how does racism get under the skull and the skin to influence brain and bodily processes that impact the health of Black Americans? In the present article, we present a model describing the possible neural and inflammatory mechanisms linking racism and health. We hypothesize that racism influences neural activity and connectivity in the salience and default mode networks of the brain and disrupts interactions between these networks and the executive control network. This pattern of neural functioning in turn leads to greater sympathetic nervous system signaling, hypothalamic-pituitary-adrenal axis activation, and increased expression of genes involved in inflammation, ultimately leading to higher levels of proinflammatory cytokines in the body and brain. Over time, these neural and physiological responses can lead to chronic physical and mental health conditions, disrupt well-being, and cause premature mortality. Given that research in this area is underdeveloped to date, we emphasize opportunities for future research that are needed to build a comprehensive mechanistic understanding of the brain-body pathways linking anti-Black racism and health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Anxiety Trajectories the First 10 Years Following a Traumatic Brain Injury (TBI): A TBI Model Systems Study

OBJECTIVE

Determine anxiety trajectories and predictors up to 10 years post-traumatic brain injury (TBI).

DESIGN

Prospective longitudinal, observational study.

SETTING

Inpatient rehabilitation centers.

PARTICIPANTS

2,836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points.

MAIN OUTCOME MEASURE

Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups.

RESULTS

Linear mixed models showed higher GAD-7 scores were associated with Black race (p<.001), public insurance (p<.001), pre-injury mental health treatment (p<.001), 2 additional TBIs with loss of consciousness (LOC) (p=.003), violent injury (p=.047), and more years post-TBI (p=.023). An interaction between follow-up year and age was also related to GAD-7 scores (p=.006). A latent class mixed model identified three anxiety trajectories: low-stable (n=2,195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had ≥mild GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16).

CONCLUSIONS

A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years, but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and two prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.

Prevalence and correlates of anxiety symptoms among Black people in Canada: A significant role for everyday racial discrimination and racial microaggressions

OBJECTIVE

Anxiety disorders are highly prevalent worldwide but vary significantly by country and ethnoracial background. Minimal published data exist on the prevalence of clinically significant anxiety among Black people in Canada and none using validated measures. Therefore, this study sought to establish the frequency of clinically significant anxiety symptoms among a sample of Black people living in Canada as well as examine the association with two forms of racism (racial discrimination and racial microaggressions).

METHODS

Data collected from the Black Community Mental Health project in Canada was analyzed. Participants provided (N= 845) sociodemographic information and completed measures assessing anxiety symptomology (GAD-7), everyday racial discrimination, racial microaggressions, and resilience. Prevalence of anxiety symptomatology was determined across sociodemographic variables as well as categories of everyday racial discrimination and racial microaggressions. Two regression models were conducted to examine the relationship between anxiety symptoms and the two forms of racism controlling for sociodemographic factors.

RESULTS

Overall, nearly a third of participants endorsed clinically significant levels of anxiety symptoms, with higher rates observed among men, unemployed people, those with higher education, people who are separated, and those with no reported family history of mental health problems. Logistic regression models demonstrated that, except for those reporting the greatest frequency of racial discrimination, there is a general linear trend such that those experiencing higher levels of racial discrimination or racial microaggressions are increasingly more likely to present with anxiety symptoms when compared to those reporting low levels of discrimination or microaggressions. Psychological resilience afforded nominal protection but only against exposure to racial microaggressions.

CONCLUSIONS

Rates of clinically significant anxiety are higher among Black people in Canada than reported previously. Both racial discrimination and racial microaggressions predicted higher rates of anxiety symptoms. The results are discussed in relation to previous findings from the US that report similar findings.

COVID-19-related anxiety: How do coping and optimism relate to substance use in African-American young adults?

The COVID-19 pandemic has greatly affected college students nationwide. Recent research suggests that the COVID-19 pandemic has disproportionately impacted African-American young adults. The infection case rates, hospitalizations, and death rates in African-American populations are 2-5 times higher than among White populations. The intergenerational trauma and systemic racism that African-Americans have faced in past and present times have fomented conditions that lead to vulnerability within this historically resilient community. These stresses and losses increase the risks of anxiety and substance use. This study examined the relationship between COVID-19-related anxiety and substance use, and how adaptive coping and optimism influence this relationship in African-Americans young adults. Results reveal that COVID-related anxiety predicts alcohol and drug use. Optimism and adaptive coping are related to lower pandemic-related anxiety, alcohol, and drug use among African-American young adults.

Antiracism, Black Lives Matter, and Critical Race Theory: The ABCs of Promoting Racial Equity in Pediatric Practice

Police shootings of unarmed Black men, women, and children at the intersection of disparities in the setting of the coronavirus disease 2019 pandemic have resulted in a long overdue national awakening regarding race and racism in society. This article defines some of the key terms, providing a foundation to help promote equity in pediatric practice. Although no single article can result in full competency regarding such complex issues, it is meant to provide a foundation for pediatricians on a journey to deepen their knowledge and understanding toward a path to action. [Pediatr Ann. 2022;51(3):e95-e106.].

A Population Health Perspective on Racism and Racial Microaggressions

Racism, one of the social determinants of health, often goes unnoticed by those less affected by its pernicious effects. The lived social experience of race has been linked to significant physical and mental health disparities. Individually or together, we know that racism and discrimination are associated with poorer health of persons from racial minority groups as evidenced in higher rates of mortality, earlier onset of disease, greater severity and progression of disease and higher levels of comorbidity and impairment. These disparities are persistent over time and, although may lessen in degree, are evident at every level of income and education. This article provides a glimpse of the impact of racism on individuals and groups, with a focus on microaggressions as a subtle but pervasive form of racism, and how it is an underlying causative factor for health disparities.

Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis

Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.

Contrariwise obesity through organic food consumption in Malaysia: a signaling theory perspective

Background: the context and purpose of the study

Unhealthy food consumption has raised an alarming situation of obesity among Asian nations and posing serious threats to human health. Recent studies have acknowledged that organic food consumption has been contrariwise associated with obesity. The consumption of healthy food has received research attention in social marketing and several antecedents and consequences have been identified. However, to date, there is a void in literature that how social, individual, and marketing elements together tradeoff in predicting a healthy lifestyle. Thus, the current investigation unfolds the antecedents of healthy foods’ adoption in Asia by integrating the brand signaling and theory of planned behavior.

Methods

The data of 241 respondents were collected from selected social media Facebook communities through a survey using assessed 42 questions. For this purpose, participants’ Facebook accounts were selected from the online healthy communities such as ‘Diet Suku Suku Separuh’ (469,000 followers), ‘Hiking, and Camping around Malaysia’ (351,200 followers), and ‘Healthy Malaysia’ (332 followers). The enumerator also engaged with the online community by liking posts and following health accounts.

Results

The data was analyzed using PLS (SEM) approach, the outcomes of hypotheses revealed interesting information that health consciousness not significantly predicts the purchase intention of healthy food. All antecedents were significant contributors to the prediction of foods’ purchase intentions in this study. However, the findings indicated that no positive relationship exists between brand image identifications and brand credibility identifications, and healthy foods’ purchase intentions identifications. The findings also indicated that no positive relationship exists between health consciousness identifications and healthy foods’ purchase intentions identifications.

Conclusions: (summary and potential implications)

Owing to the perilous increase in obesity among the general public in Asia. This study reinforced the factor that can help in the adoption of a healthy lifestyle. The study validated that a healthy lifestyle is reliant on the consumers’ health consciousness, environmental concern, and innovativeness through motivating the consumers’ healthy foods’ purchase intentions. Surprisingly, the results highlighted that respondents have not identified brand image and credibility as an antecedent of purchase intention. Given that organic food brands are somewhat new in Asian markets and therefore, brands must endure crisis marketing practices to improve their brand recognition. Therefore, policymakers must facilitate the food promotional activities that are critical to enhancing the perceived benefits of organic food to combat issues like obesity. This paper offers a foundation for future empirical investigations in Asia and various stakeholders on how to promote a healthy lifestyle in Asia. Specifically, the results will help policymakers to offer positive policies and procedures for the improvement of a healthy lifestyle through the understanding of the antecedents and consequences of health-conscious consumers’ healthy foods’ purchase intentions.

Racial Discrimination and Resting-State Functional Connectivity of Salience Network Nodes in Trauma-Exposed Black Adults in the United States

Importance

For Black US residents, experiences of racial discrimination are still pervasive and frequent. Recent empirical work has amplified the lived experiences and narratives of Black people and further documented the detrimental effects of racial discrimination on both mental and physical health; however, there is still a need for further research to uncover the mechanisms connecting experiences of racial discrimination with adverse health outcomes.

Objective

To examine neurobiological mechanisms that may offer novel insight into the association of racial discrimination with adverse health outcomes.

Design, Setting, and Participants

This cross-sectional study included 102 Black adults who had recently experienced a traumatic injury. In the acute aftermath of the trauma, participants underwent a resting-state functional magnetic resonance imaging scan. Individuals were recruited from the emergency department at a Midwestern level 1 trauma center in the United States between March 2016 and July 2020. Data were analyzed from February to May 2021.

Exposures

Self-reported lifetime exposure to racial discrimination, lifetime trauma exposure, annual household income, and current posttraumatic stress disorder (PTSD) symptoms were evaluated.

Main Outcomes and Measures

Seed-to-voxel analyses were conducted to examine the association of racial discrimination with connectivity of salience network nodes (ie, amygdala and anterior insula).

Results

A total of 102 individuals were included, with a mean (SD) age of 33 (10) years and 58 (57%) women. After adjusting for acute PTSD symptoms, annual household income, and lifetime trauma exposure, greater connectivity between the amygdala and thalamus was associated with greater exposure to discrimination (t(97) = 6.05; false discovery rate (FDR)-corrected P = .03). Similarly, racial discrimination was associated with greater connectivity between the insula and precuneus (t(97) = 4.32; FDR-corrected P = .02).

Conclusions and Relevance

These results add to the mounting literature that racial discrimination is associated with neural correlates of vigilance and hyperarousal. The study findings extend this theory by showing that this association is apparent even when accounting for socioeconomic position, lifetime trauma, and symptoms of psychological distress related to an acute trauma.

The Associations Between Internalized Racism, Racial Identity, and Psychological Distress

Internalized racism, or the acceptance of negative stereotypes about one's own racial group, is associated with psychological distress; yet, few studies have explored the longitudinal impact of internalized racism on the psychological well-being of African American emerging adults. Furthermore, racial identity's role as a protective factor in the context of internalized racism remains unclear. This study examined the longitudinal impact of internalized racism on psychological distress (depressive and anxiety symptoms) and the moderating role of racial identity beliefs among 171 African American emerging adults. Full cross-lagged panel models revealed no main effects of internalized racism beliefs on psychological distress. However, several racial identity beliefs moderated the relationship between internalized racism beliefs and changes in psychological distress over a year later. Initial levels of alteration of physical appearance, internalization of negative stereotypes, and hair change internalized racism beliefs were related to subsequent psychological distress, but only for those with certain levels of racial centrality, private regard, public regard, and assimilationist, humanist, and nationalist ideology beliefs. These findings suggest that, over time, internalized racism and racial identity beliefs can combine to influence the psychological well-being of African American emerging adults.

Racism and mental health and the role of mental health professionals

The concept of "race" and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be "the others," who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of "the other" on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of "race" is genetically incorrect. Therefore, the implicit racism that underlies many established "scientific" paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.

Racial differences in anxiety, depression, and quality of life in women with polycystic ovary syndrome

OBJECTIVE

To evaluate racial differences in the anxiety and depression prevalence and scores in women with polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional.

SETTING

Academic institution.

PATIENTS

Reproductive-aged women with PCOS (n = 272) and controls (n = 295).

INTERVENTIONS

Hospital anxiety and depression scale and modified PCOS quality-of-life survey (MPCOS-Q).

MAIN OUTCOME MEASURES

Differences in depression and anxiety scores and quality-of-life score measured using the hospital anxiety and depression scale and MPCOS-Q were determined between White and Black women with PCOS. Multivariable correlation regressions assessed the association of the Ferriman-Gallwey score, total testosterone, body mass index (BMI), and homeostatic model assessment of insulin resistance with anxiety, depression, and quality-of-life scores.

RESULTS

Multivariable regression controlling for age, BMI, and socioeconomic status showed that White women with PCOS had a significantly higher prevalence of anxiety than Black women with PCOS (75.9% vs. 61.3%) and significantly higher anxiety scores (mean ± SD, 10.3 ± 4.1 vs. 8.7 ± 4.6). The prevalence of depression (24.4% vs. 29%) and depression scores (4.8 ± 3.6 vs. 5.1 ± 4.0) was not significantly different. In multivariable correlation regressions, the interaction between BMI and race in its association with anxiety scores was significant. The association of race with Ferriman-Gallwey score, total testosterone, or homeostatic model assessment of insulin resistance was not significant. In multivariable models, although the total MPCOS-Q scores were similar, the infertility domain was significantly lower in Black women with PCOS (mean ± SD, 12.6 ± 7.8 vs. 17.5 ± 6.8) indicating a lower quality of life related to infertility.

CONCLUSION

Racial differences identified in the prevalence of anxiety and MPCOS-Q domains suggest the importance of routine screening and provide an opportunity for targeted interventions based on race.

The Relationship Between Social Anxiety and Internalized Racism in Black Young Adults

The study examined the relationships between social anxiety (SA), generalized anxiety (GA), and depression with racial microaggressions and internalized racism (IR) among Black young adults. Given SA's core features, we expected it to have a unique association with IR, and to moderate the connection between racial microaggressions and IR. Participants were 182 Black university students who completed measures of SA, GA, depressive symptoms, racial microaggressions, and IR. Linear regression models indicated that IR was a significant predictor of SA, but not GA or depression. Racial microaggressions were only positively associated with depressive symptoms. SA and racial microaggressions each predicted IR, but no interaction was found. Black young adults with elevated concerns of others' evaluation may be more prone to accepting negative stereotypes about one's racial group.