Development and Validation of a Short Form of the Index of Race-Related Stress (IRRS)—Brief Version

Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population

BACKGROUND

Race-related stress (RRS) is an unrecognized source of moral injury (MI)-or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined.

METHODS

Black Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity.

RESULTS

MIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (β = 0.10, p < 0.005).

CONCLUSIONS

All types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.

Intergenerational Transmission of Depression: Examining the Roles of Racism and Trauma Among Black Mothers and Youth

OBJECTIVE

Racism is a multifaceted system of oppression that disproportionately harms Black mothers and children across the lifespan. Despite reliable evidence that racism is associated with worse mental health outcomes (eg, increased depressive symptoms), less is known about potential intergenerational effects of Black mothers' experiences of racism on children's mental health, as well as how traumatic experiences influence these pathways. In this cross-sectional quantitative study, we aimed (1) to replicate the finding that maternal experiences of racism are associated with both maternal and child depression; (2) to identify whether maternal experiences of racism are indirectly associated with child depression via the effect of maternal depression; and (3) to test whether the indirect effect of racism on child depression via maternal depression is conditioned on maternal trauma.

METHOD

Black mothers and their children (N = 148 dyads) were recruited from an urban hospital and were interviewed about their experiences of racism, trauma, and mental health symptoms. The mothers' average age was 35.16 years (SD = 8.75) and the children's average age was 10.03 years (SD = 1.51).

RESULTS

First, we found that maternal experiences of racism were associated with more severe maternal depression (r = 0.37, p < .01) as well as more severe child depression (r = 0.19, p = .02). Second, we found that maternal experiences of racism were indirectly associated with child depression through the effect of maternal depression (ab = 0.76, 95% CI = 0.26, 1.37). Third, we found that maternal trauma exposure moderated this indirect effect such that, at relatively lower levels of maternal trauma exposure, the indirect effect of maternal experiences of racism on child depression was nonsignificant (ωlow = -0.05, 95% CI = -0.50, 0.45), whereas at relatively higher levels of maternal trauma exposure, the indirect effect of maternal experiences of racism on child depression was statistically significant (ωhigh= .65, 95% CI = 0.21, 1.15).

CONCLUSION

These findings suggest that the indirect effect of maternal experiences of racism on child depression through the effect of maternal depression depends on the degree of maternal trauma exposure. This study advances the literature by shedding light on key processes that can explain the intergenerational effects of racism as well as contextual factors that can exacerbate racism's downstream consequences across generations.

Indirect effect of race-related stress on traumatic stress and depression symptoms via subjective social status in a Black community sample

Experiencing racism is linked to lower subjective social status (SSS), defined as one's perception of their position in society. SSS is influenced by power, prestige, and objective socioeconomic status (SES). Previous findings suggest that race-related stress may be related to adverse mental health outcomes through SSS in Black Americans, a population that has been deeply affected by continuing legacies of oppression. The current study examines the indirect association between race-related stress and posttraumatic stress disorder (PTSD) and depression symptoms through SSS in a community sample of largely trauma-exposed Black Americans (N = 173). Hierarchical regression analyses indicated that overall race-related stress significantly predicted lower SSS, higher PTSD symptoms, and higher depression symptoms. Analyses also revealed indirect effects of cultural race-related stress on PTSD and depression symptoms through SSS after controlling for SES. Results suggest that the experience of race-related stress, particularly cultural race-related stress, which involves the degradation and disparagement of one's culture and worldview, is associated with more severe PTSD and depression symptoms potentially due to these experiences decreasing Black Americans' SSS. Findings support the need for systemic intervention strategies to disrupt the cultural oppression of Black Americans and improve the societal value and mental health of this population.

Race-Related and Mental Health Factors of Powder Cocaine Use Among Black Incarcerated Men

Incarceration disproportionately impacts Black men in the United States, which can have compounding effects on mental health and substance use among this population. Cocaine use, in particular, carries higher severity of dependence and overdose risks among Black Americans, though research examining cocaine use correlates among Black incarcerated men is limited. The present study examines race-related and mental health correlates of powder cocaine use among a sample of incarcerated Black men (n = 208) using the General Strain Theory. Specifically, the present study was a secondary analysis examining race-related stress, psychological distress (i.e., anxiety and depression), and stigma about receiving psychological help as correlates of lifetime powder cocaine use. Results indicated that the likelihood of lifetime powder cocaine use was higher among those reporting lifetime psychological distress and greater race-related stress. Stigma about receiving psychological help was not significantly associated with lifetime powder cocaine use among this sample. Results of this study have important implications for substance use treatment interventions. Identifying adaptive coping strategies to manage anxiety and depression symptoms and race-related stress among incarcerated Black men may help reduce rates of cocaine use among this population and increase successful reintegration into the community post-incarceration.

"Now I just need something sweet": Racism, emotional eating, and health among African Americans

BACKGROUND

The Environmental Affordances Model theorizes that systemic racism disproportionately exposes African Americans in the United States to chronic everyday stressors (e.g., individual racism) while simultaneously shaping the availability of coping resources (e.g., fast food outlets) and engagement in self-regulatory strategies (e.g., emotional eating). Greater engagement in self-regulatory strategies is theorized to preserve mental health while contributing to medical morbidities and mortality.

OBJECTIVE

However, few studies have tested the Environmental Affordances Model, limiting our understanding of how the proposed pathways operate in the lives of African Americans.

METHODS

In the present study, the associations between systemic racism (institutional racism, cultural racism, neighborhood disadvantage), chronic everyday stressors (exposure to individual racism), emotional eating, and mental (anxiety symptomatology) and physical (self-rated overall physical health) health are assessed in a sample of 751 African Americans aged 18 to 88.

RESULTS

The path analysis reveals that institutional and cultural racism are both positively associated with individual racism. Neighborhood disadvantage is inversely associated with individual racism. Individual racism is significantly associated with greater anxiety symptomatology but is unrelated to self-rated overall physical health. Institutional and cultural racism are associated with emotional eating although individual racism and neighborhood disadvantage are not. Moreover, engagement in emotional eating exacerbates, rather than mitigates, the impacts of individual racism on anxiety symptomatology.

CONCLUSIONS

We conclude that institutional and cultural racism contribute to individual racism experiences and emotional eating whereas emotional eating exacerbates associations among individual racism and anxiety symptomatology.

Examining racism and firearm-related risks among Asian Americans in the United States during the COVID-19 pandemic

Firearm-related injury is a major public health concern in the U.S. Experience of racism and discrimination can increase the risk of minority group members engaging in or being victims of firearm-related violence. Given the increased racism endured by Asian Americans during the COVID-19 pandemic, it is imperative to understand firearm-related behaviors in this population. The purpose of this study was to examine how Asian Americans' racism and discrimination experiences were related to firearm-related behaviors during the COVID-19 pandemic. Cross-sectional data were collected between December 2020 and January 2021 from a national sample of 916 Asian Americans. Measures included demographics, firearm-related risks, and three measures of racism/discrimination experiences since the start of the COVID-19 pandemic. Among individuals who purchased a gun since the start of the pandemic, 54.6% were first-time gun owners. Among household gun owners, 42.8% stored loaded guns and 47.1% stored guns unlocked. More than 38% of individual gun owners have carried a gun more frequently since the pandemic. After controlling for family firearm ownership and demographics, regression analyses showed that Asian Americans who experienced racial discrimination were more likely to purchase a gun and ammunition and intend to purchase more ammunition during the COVID-19 pandemic. AAs who perceived more cultural racism were more likely to purchase a gun. Individuals who reported higher anticipatory racism-related stress reported greater intent to purchase guns. Our findings suggest an urgent need to investigate further the compounded effects of racism, the COVID-19 pandemic, and firearm-related behaviors in this population.

The relationship between racial discrimination and substance use: Does locus of control help explain risk?

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The racial discrimination, locus of control, substance use pathway was tested.

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The sample was comprised of racial/ethnic minority adults.

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Indirect effects were found for chance and powerful others external locus of control.

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Internal locus of control was not found to be a significant mediator.

Introduction

Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of externalizing and affect-based factors, few other mechanisms have been examined. One potential candidate is locus of control, a learning processes that involves the degree to which one attributes rewards as resulting from their own control (internal locus of control) versus outside control (external locus of control). There is evidence that exposure to stressors is associated with locus of control, with a separate body of literature linking locus of control with substance use. Thus, it is plausible that locus of control may be a mechanism underlying the relationship between racial discrimination and substance use.

Methods

The current study investigated this pathway among 503 racial/ethnic minority adults aged 18–35 who completed an online questionnaire including measures on racial discrimination related stress, locus of control, and substance use.

Results

Results indicated a significant indirect effect between racial discrimination related stress, two external domains of locus of control (i.e., powerful others and chance), and substance use. A significant indirect effect was not found for internal locus of control.

Conclusion

These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming.

Lawyering While Black: Perceived Stress as a Mediator of Impostor Feelings, Race-Related Stress and Mental Health Among Black Attorneys

Attorneys suffer from high rates of stress and mental health problems, and Black attorneys, who make up only five percent of all attorneys in the United States, are especially vulnerable due to underrepresentation and experiences of bias. The present study examined perceived stress as a mediator of the impostor phenomenon, race-related stress, and mental health among a sample of 142 Black attorneys (114 women, 25 men). Gender, age, impostor phenomenon, race-related stress, and perceived stress accounted for 51% and 57% of the variance in depression and anxiety, respectively. Perceived stress fully mediated the links between the impostor phenomenon and depression, cultural racism and depression, and impostor feelings and anxiety and partially mediated the link between cultural racism and anxiety. Results suggest that perceived stress is an important mechanism for understanding why the impostor phenomenon and race-related stress negatively impact the mental health of Black attorneys.

Project COALESCE-An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community’s voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5–10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.

App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (Preprint)

Background

People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care.

Objective

This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined.

Methods

Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively.

Results

Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses.

Conclusions

To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups.

Trial Registration

ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113

International Registered Report Identifier (IRRID)

DERR1-10.2196/35196

Use of Food to Cope With Culturally Relevant Stressful Life Events Is Associated With Body Mass Index in African American Women

BACKGROUND

Although stress is an established contributor to obesity (in general population studies), mechanisms to explain this association in African American women that incorporate culturally relevant frameworks have received little attention.

OBJECTIVE

To investigate how stress is associated with body mass index (BMI) in this population, we examined multivariate models of BMI predicted by race-related, gender-related, and generic stressful life events and by use of food to cope with stress. We hypothesized that the three types of stressful life events would be indirectly associated with BMI through using food to cope with stress.

METHODS

Psychometrically robust measures were included in surveys administered to a socioeconomically diverse sample of 189 African American women aged 21-78 years. Hypotheses were tested using structural equation modeling. We examined race-related, gender-related, and generic stressful life events as latent constructs indicated by exposure to and appraisal of potential stressors predicting a mediator, using food to cope, which predicted BMI; this model also included direct paths from the three latent stressful life event constructs to BMI.

RESULTS

Almost every participant reported using food in some way to cope with stress; 33% and 42% met established criteria for overweight and obesity, respectively. The race-related stressful life event construct was the only latent construct predicting using food to cope with stress, and using food to cope with stress predicted BMI. A significance test of indirect effects demonstrated that the race-related stressful life event construct was indirectly associated with BMI through the mediator, using food to cope.

DISCUSSION

Culturally relevant stress exposures and stress-related eating are important areas of foci for tackling overweight, obesity, and related health inequities in African American women. Findings highlight the importance of developing more complex models to understand the stress-related factors that elevate risk for overweight and obesity in this population.

Focusing the Lens to See More Clearly: Overcoming Definitional Challenges and Identifying New Directions in Racial Microaggressions Research

Despite significant advances in research on racial microaggressions, key challenges remain regarding how to define and classify them. Resolving these challenges is necessary to reduce misunderstanding and the subsequent minimization of racial microaggression research. Our goals in this article are to discuss the definitional challenges, to discuss implications for the creation of taxonomies, and to offer directions for how a revised definition and corresponding taxonomies can be used to further racial microaggression research. Regarding our first aim, we assert that racial microaggressions are observable events that occur independently of intention (i.e., regardless of whether they are intentional or unintentional) or impact (i.e., regardless of how they are perceived by recipients). Moreover, we assert that racial microaggressions are most validly defined by people of color and can have different meanings on the basis of situational context. The second aim is to propose a refinement and expansion of racial microaggression taxonomies. Sue and colleagues' taxonomy has been invaluable, yet other ways of classifying microaggressions and moving toward dimensional taxonomies are needed to advance scholarship. We highlight key dimensions related to the experience, perpetration, characteristics, and sociopolitical function of racial microaggressions that may be useful for future taxonomies. Overall, overcoming definitional challenges and expanding taxonomies holds potential to advance the literature on racial microaggression.

Igniting Collective Freedom: An Integrative Behavioral Model of Acceptance and Commitment Toward Black Liberation

Racism continues to reveal disastrous effects on the Black community. There exists no behavior-analytic literature with a specific focus on ending Black psychological suffering due to continual acts of violence perpetrated against the community. I present a behavioral model to promote Black psychological liberation, infusing preestablished frameworks of Black psychology and cultural healing practices with acceptance and commitment therapy. The model addresses behaviors observed within systemic and internalized racism.

Investigating Race-related Stress, Burnout, and Secondary Traumatic Stress for Black Mental Health Therapists

The present study examined the relationships among burnout, secondary traumatic stress (STS), and race-related stress among a national sample of 250 Black mental health therapists (counselors, social workers, psychologists, and marriage and family therapists). We investigated the predictive nature of the three subscales (Individual Racism, Cultural Racism, and Institutional Racism) of the Index of Race-Related Stress–Brief Version (IRRS-B) and selected demographic variables on therapists’ reports of burnout and STS assessed on the Professional Quality of Life Scale–Version 5 (ProQOL-5). All three forms of race-related stress significantly predicted both burnout and STS for Black mental health therapists. Of the demographic variables, hours worked per week significantly predicted burnout and STS. Additionally, highest degree obtained significantly predicted STS for Black mental health therapists. The utility of these findings in understanding the connections among race-related stress, burnout, and STS are discussed as well as directions for future research.

Sankofa: A Testimony of the Restorative Power of Black Activism in the Self-Care Practices of Black Activists

The current study investigates the relationship between Black activism and self-care among five Black womxn scholar-activists. Through collaborative autoethnography, we demonstrate that one byproduct of our Black activism is a cultural-relevant form of self-care that works to buffer the psychological impacts of racism and other forms of oppression. Findings suggest that our pathway to Black activism involves an “awakening,” which furthers identity development, and facilitates connectedness and self-love, underscores the salience of representation, and creates opportunity for broad social and structural change. This is to suggest that despite the potential deleterious psychophysiological consequences that accompany the engagement in activism, we have identified five unintended self-care benefits that play a central role in bolstering activists’ psychological well-being.

Preliminary evidence for a race-based stress reduction intervention for Black women at risk for cardiovascular disease

OBJECTIVE

Despite evidence that chronic stress, racism, and discrimination impact the well-being and the risk for cardiovascular disease (CVD) in Black women, there are few evidence-based interventions that improve well-being and reduce the risk for CVD in women of minority groups. The purpose of this pilot study was to evaluate the psychobehavioral and anti-inflammatory benefit of a race-based stress reduction program "Resilience, Stress, and Ethnicity (RiSE) for Black women at risk for CVD.

METHODS

Black women were recruited from the Chicagoland community and randomized to either the 8-week RiSE intervention (n = 40) or control group (n = 34). Participants were assessed for coping strategies, psychological distress, and blood levels of TNF-alpha and high sensitivity C-reactive protein (hsCRP) at baseline and at 4 and 8 weeks after baseline.

RESULTS

Participation in RiSE was associated with a more rapid decline in the use of avoidance coping (b = -0.3585, SE = 0.1705, p < .01). Reductions over time in TNF-alpha (b = -0.0163, SE = .0087, p = .08) and hsCRP (b= -0.4064, SE = 0.2270, p = .08) approached statistical significance.

CONCLUSIONS

Findings provide preliminary evidence in Black women at risk for CVD that RiSE contributes to decreases in avoidance coping. Although preliminary, these results suggest RiSE to be an effective intervention to promote improved coping associated with racism and discrimination in minorities.

African American Activism: The Predictive Role of Race Related Stress, Racial Identity, and Social Justice Beliefs

Historically, African American activism has played a pivotal role in advancing social change in the United States. As such, there is an interest in examining possible factors that may engender activism among African Americans. Therefore, the purpose of this study was to extend research by Szymanski and Lewis (2015), which explored potential predictors of activism among African Americans. With a sample of 458 African American undergraduates, race-related stress, racial identity dimensions, and social justice variables were examined. A four-stage, multiple linear hierarchical regression model and two multiple mediation bootstrap analyses were employed. Race-related stress and racial identity attitudes significantly and uniquely predicted involvement in African American activism, complementing existing literature. Beyond that, social justice beliefs predicted African American activism over and above racial identity and race-related stress. More specifically, social justice subjective norms (i.e., social influence) was the most important predictor of activism for African American undergraduates. Implications for social justice development within institutions of higher education are discussed.

Gendered racism and the sexual and reproductive health of Black and Latina Women

Objective: To understand health disparities, it is important to use an intersectional framework that examines unique experiences of oppression faced by particular groups due to their intersecting identities and social positions linked to societal structures. We focus on Black and Latina women and their experiences with 'gendered racism' - unique forms of oppression due to the intersection of race/ethnicity and gender - to foster understanding of disparities between Black and Latina versus White women in sexual and reproductive health outcomes in the U.S. Specifically, we focus on stereotype-related gendered racism (ongoing discrimination and stereotype threat based on historically-rooted stereotypes about Black and Latina women's sexuality and motherhood) and birth control-related mistrust (ongoing mistrust of the government and medical system related to birth control due to historical and current abuses).Design: We analyzed data from two survey studies with adult women in New York (Study 1: paper-and-pencil community data collection, N = 135, M_age= 43.35) and across the U.S. (Study 2: online data collection, N = 343, M_age= 29.49) who were currently pregnant or had at least one child and identified as Black, Latina, or White.Results: Black and Latina women reported greater frequency of and concern over stereotype-related gendered racism (F(3,131) = 17.90, p < .001 Study 1; F(3,339) = 22.23, p < .001 Study 2) and greater birth control-related mistrust (F(3,131) = 7.55, p < .001 Study 1; F(3,339) = 17.32, p < .001 Study 2) than White women did. In turn, stereotype-related gendered racism was positively associated with pregnancy-specific stress (ß = .40, p < .001 Study 1; ß = .33, p < .001 Study 2), and birth control-related mistrust was negatively associated with sexual relationship power (ß = -.19, p = .002 Study 2), which are factors known to contribute to birth outcomes and sexual risk, respectively.Conclusion: Findings suggest that gendered racism may play an important role in existing racial/ethnic disparities in women's sexual and reproductive health outcomes, and interventions addressing gendered racism at multiple levels are needed to promote health equity.

The Role of Coping Strategies in Understanding the Effects of Institutional Racism on Mental Health Outcomes for African American Men

The purpose of this study was to examine coping strategies as moderators of the effects of institutional racism on psychological outcomes for a sample of 283 self-identified African American men. We hypothesized that the use of strategies that have been conceptualized as adaptive (e.g., spirituality, problem-oriented coping) would influence the severity of institutional racism on psychological symptoms, such that more frequent use would be associated with less severe symptoms. Furthermore, we hypothesized that more frequent use of avoidant strategies (e.g., substance use, disengagement) would be associated with greater severity of psychological symptoms in relation to exposure to institutional racism. Moderated hierarchical regression analyses were performed to test these hypotheses. Statistically significant main effects revealed that coping strategies that involved more self-reliance were associated with greater severity in mental health symptoms. A statistically significant interaction effect was also revealed, which suggested that greater reliance on spirituality was associated with increased symptoms of interpersonal sensitivity in relation to experiences of institutional racism. Implications of the findings are discussed.

The cost of minority stress: Risky alcohol use and coping-motivated drinking behavior in African American college students

A motivational drinking framework is utilized to understand the relationship between minority stressors (e.g., race-related stress and acculturative stress) and alcohol use behaviors (risky alcohol use and coping-motivated drinking) among a large sample of Black American college students. Six hundred forty-nine Black college students from 8 colleges and universities in the United States were recruited as part of a large, multiwave, cross-sectional study investigating the stress and coping experiences of Black emerging adults. Results from the current investigation provide support for the independent contributions of acculturative stress and race-related stress to the risky alcohol use behavior of Black college students, while acculturative stress significantly predicted coping-motivated drinking behaviors in the sample. Findings underscore the need to better understand the unique relationships between minority stress and risky alcohol use behaviors of Black college students, namely, relationships not shared by their nonminority peers that increase their risk of problem drinking.

Engaged Against the Machine: Institutional and Cultural Racial Discrimination and Racial Identity as Predictors of Activism Orientation among Black Youth

The current study examines how experiences of institutional and cultural racial discrimination relate to orientations toward activism in the Black community among Black adolescents and emerging adults. Furthermore, we investigate the role of racial identity (centrality, public regard, nationalism) as moderators of those relations. In a national sample of 888 Black adolescents and emerging adults, we found that experiences of cultural racial discrimination, racial centrality, and nationalism ideology were related to a greater orientation toward low-risk Black community activism. For high-risk activism, nationalism was associated with a greater likelihood to participate in future social action in the Black community. The relation between experiences of institutional racial discrimination and high-risk activism orientation was moderated by public regard. For Black adolescents and emerging adults who believe others view Black people negatively, more experiences of institutional racial discrimination were related to a greater high-risk activism orientation. Findings highlight the importance of investigating racial discrimination as a multidimensional construct that extends beyond individual interactions and microaggressions. Furthermore, these findings underscore how phenomenological variation in experiences of racial discrimination and racial identity differentially influence adolescent and emerging adult orientations toward social action in and for the Black community.

Experiences of chronic stress and mental health concerns among urban Indigenous women

We measured stress, depression and post-traumatic stress disorder (PTSD) levels of urban Indigenous women living with and without HIV in Ontario, Canada, and identified correlates of depression. We recruited 30 Indigenous women living with HIV and 60 without HIV aged 18 years or older who completed socio-demographic and health questionnaires and validated scales assessing stress, depression and PTSD. Descriptive statistics were conducted to summarize variables and linear regression to identify correlates of depression. 85.6 % of Indigenous women self-identified as First Nation. Co-morbidities other than HIV were self-reported by 82.2 % (n = 74) of the sample. High levels of perceived stress were reported by 57.8 % (n = 52) of the sample and 84.2 % (n = 75) had moderate to high levels of urban stress. High median levels of race-related (51/88, IQR 42-68.5) and parental-related stress (40.5/90, IQR 35-49) scores were reported. 82.2 % (n = 74) reported severe depressive symptoms and 83.2 % (n = 74) severe PTSD. High levels of perceived stress was correlated with high depressive symptoms (estimate 1.28 (95 % CI 0.97-1.58), p < 0.001). Indigenous women living with and without HIV reported elevated levels of stress and physical and mental health concerns. Interventions cutting across diverse health care settings are required for improving and preventing adverse health outcomes.

The Roles of Shared Racial Fate and a Sense of Belonging With African Americans in Black Immigrants’ Race-Related Stress and Depression

Objectives: The first goal was to examine whether race-related stress was associated with depression in Black immigrants, as has been found in African Americans. The second goal was to determine whether intergroup relations identity factors—Black immigrants’ shared racial fate or sense of belonging with African Americans—were related to depression, above and beyond race-related stress. Third, we examined if Black immigrants’ shared racial fate or a sense of belonging with African Americans moderated the relationship between race-related stress and depression. Method: Data were collected from 110 individuals who identified as first- or second-generation Black immigrants. Results: Greater race-related stress was related to higher depression. Greater endorsement of a sense of belonging with African Americans was related to lower depression over and above the influence of race-related stress; this was not the case for shared racial fate, which was not associated with depression. Neither shared racial fate nor a sense of belonging with African Americans moderated the association between race-related stress and depression. Intergroup relations facilitate our understanding of well-being in immigrant populations.

Examining the Role of Culture-Specific Coping as a Predictor of Resilient Outcomes in African Americans From High-Risk Urban Communities

This investigation examined the role of culture-specific coping in relation to resilient outcomes in African Americans from high-risk urban communities. Participants (N = 385) were administered a survey questionnaire packet containing measures of culture-specific coping, traditional resilience factors (cognitive ability, social support, and familial factors), and resilient outcomes (physical, psychological, social, and environmental quality of life). Structural equation modeling was used to test the degree to which culture-specific coping would uniquely contribute to the prediction of quality of life above and beyond traditional predictive factors of resilience. Findings indicated that spiritual and collective coping were statistically significant predictors of quality of life outcomes above and beyond the traditional predictive factors. Overall, the findings indicated that both traditional and cultural factors were predictors of resilient outcomes (i.e., positive quality of life indicators) for African Americans.

The Relationships Between Race-Related Stress, Racial Identity, and Mental Health for Black Americans

The purpose of this study was to explore the relationships between race-related stress, racial identity, and mental health in a sample of 255 Black American adults. Hierarchical regression analyses indicated that racial identity and race-related stress predicted mental health; however, racial identity accounted for more of the variance in mental health. These findings provide evidence that a person’s racial identity must be considered when understanding race-related stress and mental health. Implications for practice and research are discussed.

The Relationship Between Racial Identity, Ethnic Identity, and Perceptions of Racial Discrimination in an Afro-Caribbean Descent Sample

Racial identity ego statuses (i.e., one’s psychological orientation to his or her racial group membership) can have an important impact on how some Blacks perceive and experience racial discrimination in the United States. The present study investigates the relationships between racial identity status attitudes, ethnic identity, and perceptions of racial discrimination among 82 Afro-Caribbeans. Results indicate that racial identity and ethnic identity are significant predictors for perceptions of racial discrimination during the course of one’s lifetime. Implications for the field of psychology are discussed.

Perceived Racism and Ambulatory Blood Pressure in African American College Students

Experiences with racial discrimination may contribute to stress-induced blood pressure (BP) elevations among African Americans. It was reported that perceived racism was associated with ambulatory BP (ABP) during waking hours. This study examined perceived racism and ABP among 40 African American college students, who completed an ABP assessment from which daytime and nighttime averages were computed. Perceived frequency of experiences with racism and racial discrimination was measured using the Perceived Racism Scale. Controlling for gender and body mass index, perceived racism in academic settings was associated with higher diastolic BP (DBP) during waking hours and nighttime sleep. Systolic BP (SBP) was unrelated to perceived racism, and perceived racism in the public realm and in statements from Whites was unrelated to ABP. Perceived racism in academic settings predicted ambulatory DBP among college students. Previous laboratory research has found stronger effects of perceived racism for DBP than SBP. The hemodynamic regulation of BP may explain this phenomenon. Future laboratory and ambulatory studies should assess the contributions of vascular resistance and cardiac output to BP elevations associated with perceived racism.

An Examination of the Factor Structure of the Index of Race-Related Stress among a Sample of African American Adolescents

In the present study, the Index of Race-Related Stress (IRRS) was administered to a sample of urban African American adolescents. This instrument has been used among samples of adult and collegiate African Americans, and the purpose of the present study was to examine the factor structure of adolescent responses. The scale was modified and administered to a sample of 324 African American adolescents. The results provided empirical evidence of validity for the IRRS, particularly as a measure of race-related stress among adolescents. The measure required some modifications, which included deletion of items and rewording some questions to make them relevant for an adolescent sample. Future research should consider the assessment of race-related stress among adolescent samples to understand its association with mental and physical health.

Racism and Psychological and Emotional Injury

The purpose of this article is to discuss the psychological and emotional effects of racism on people of Color. Psychological models and research on racism, discrimination, stress, and trauma will be integrated to promote a model to be used to understand, recognize, and assess race-based traumatic stress to aid counseling and psychological assessment, research, and training.

The stressors of being young and Black: Cardiovascular health and Black young adults

OBJECTIVE

To examine the impact of stressors relevant to the lives of Black young adults including racial, financial, occupational, and general stress and psychological distress on cardiovascular disease (CVD) risk. Specifically, this study examined the relationship between multiple psychosocial stressors and two CVD risk indicators (i.e. obesity and blood pressure).

DESIGN

This study used a quantitative design which included surveys, the collection of anthropometric and blood pressure (BP) measures. Participants were 124 Black college students aged 18 to 27 years old.

MAIN OUTCOME MEASURES

Participants completed measures to assess psychological distress, general, occupational, financial and racial stress. Measures of body mass index (BMI), waist-to-hip ratio (WHR) and BP were collected to assess CVD risk.

RESULTS

Findings indicated a significant effect of internalised racism on BMI and a significant effect of individual racial stress on diastolic BP. Also, depression was significantly associated with systolic BP. There were no significant results for WHR.

CONCLUSION

Findings suggested that the relationship among racial stress, psychological distress and CVD be further explored.

Vile vigilance: An integrated theoretical framework for understanding the state of Black surveillance

The family is the principal source of socialization and protection against racism for many Blacks. Transmitting values, norms, morals, and beliefs (i.e., racial socialization) to successive generations is done to promote racial awareness and to prepare an individual to survive in racist environments. Further, developing a sense of security, resiliency, and cultural pride provides psychological protection against racial prejudice and discrimination. Protective socialization is even more critical when it becomes the difference between life and death at the hands of law enforcement-a fate faced by too many Black males as a result of racist policing practices, including the over-patrolling of Black communities. Because discriminatory surveillance and over-patrolling can incite a number of social, physical, and mental health issues, a holistic approach to understanding the interaction between Blacks and law enforcement is critical. This article reviews the Mundane Extreme Environmental Stress (MEES) model, racial socialization theory, and Family Stress Model in the development of a theoretical framework for understanding the patterns of interactions between Blacks and law enforcement, the immediate and long-term effects of unjustified shootings on Black families and communities, and the response of sociopolitical systems. The new theoretical framework will be used to inform the work of human service providers and practitioners by identifying targets for interventions to improve relations and trust between Black communities and law enforcement institutions.

Effects of Perceived Discrimination on Depressive Symptoms Among Black Men Residing in the United States: A Meta-Analysis

Research reports that perceived discrimination is positively associated with depressive symptoms. The literature is limited when examining this relationship among Black men. This meta-analysis systematically examines the current literature and investigates the relationship of perceived discrimination on depressive symptoms among Black men residing in the United States. Using a random-effects model, study findings indicate a positive association between perceived discrimination and depressive symptoms among Black men ( r = .29). Several potential moderators were also examined in this study; however, there were no significant moderation effects detected. Recommendations and implications for future research and practice are discussed.

The association of perceived stress, contextualized stress, and emotional eating with body mass index in college-aged Black women

A growing body of literature supports the association between adverse stress experiences and health inequities, including obesity, among African American/Black women. Adverse stress experiences can contribute to poor appetite regulation, increased food intake, emotional eating, binge eating, and sedentary behavior, all of which can contribute to weight gain and obesity. Most research studies concerning the effect of psychological stress on eating behaviors have not examined the unique stress experience, body composition, and eating behaviors of African American/Black women. Even fewer studies have examined these constructs among Black female college students, who have an increased prevalence of overweight and obesity compared to their counterparts. Therefore, the aim of the current study is to examine the associations among emotional eating, perceived stress, contextualized stress, and BMI in African American female college students. All participants identified as African American or Black (N=99). The mean age of the sample was 19.4 years (SD=1.80). A statistically significant eating behavior patterns×perceived stress interaction was evident for body mass index (BMI) (β=0.036, S.E.=.0118, p<.01). In addition, a statistically significant eating behavior patterns×contextualized stress interaction was observed for BMI (β=0.007, S.E.=.0027, p=.015). Findings from this study demonstrate that the stress experience interacts with emotional eating to influence BMI. Based on these findings, culturally relevant interventions that target the unique stress experience and eating behavior patterns of young African American women are warranted.

Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

Instruments measuring perceived racism/racial discrimination: review and critique of factor analytic techniques

Several compendiums of instruments that measure perceived racism and/or discrimination are present in the literature. Other works have reviewed the psychometric properties of these instruments in terms of validity and reliability and have indicated if the instrument was factor analyzed. However, little attention has been given to the quality of the factor analysis performed. The aim of this study was to evaluate the exploratory factor analyses done on instruments measuring perceived racism/racial discrimination using guidelines from experts in psychometric theory. The techniques used for factor analysis were reviewed and critiqued and the adequacy of reporting was evaluated. Internet search engines and four electronic abstract databases were used to identify 16 relevant instruments that met the inclusion/exclusion criteria. Principal component analysis was the most frequent method of extraction (81%). Sample sizes were adequate for factor analysis in 81 percent of studies. The majority of studies reported appropriate criteria for the acceptance of un-rotated factors (81%) and justified the rotation method (75%). Exactly 94 percent of studies reported partially acceptable criteria for the acceptance of rotated factors. The majority of articles (69%) reported adequate coefficient alphas for the resultant subscales. In 81 percent of the studies, the conceptualized dimensions were supported by factor analysis.

Hope, Agency, or Disconnect

Social cohesion and agency in Blacks have not been sufficiently explored in a culturally relevant context. The current study ( n = 242 Black college students) explores the concept of racial cohesion, or the intersection of racial identity, common fate destiny, and sociopolitical agency by determining the psychometric properties of the Racial Cohesion Questionnaire. Confirmatory factor analysis established that the Racial Cohesion Questionnaire had two factors, Racial Agency and Psychological Cohesion. Additionally, racial ambivalence and disconnect was measured by the Black Racial Dissonance Inventory, which was determined using exploratory factor analysis. Racial cohesion and dissonance were also investigated for their relationship with community engagement and racism stress.

Dimensions of Race-Related Stress and African American Life Satisfaction

This study used a cultural stress and coping framework to investigate the influence of three dimensions of discrimination-based race-related stress (i.e., individual, institutional, and cultural) and collective efficacy on African American life satisfaction. African American adults ( N = 247) completed self-report measures of race-related stress, collective efficacy, and life satisfaction. Analyses indicated that all three forms of race-related stress were significantly associated with lower life satisfaction, and that collective efficacy was significantly associated with greater life satisfaction. Moderated analyses further revealed that collective efficacy significantly protected against the influence of race-related stress on life satisfaction for cultural race-related stress and, possibly, individual race-related stress. The results suggest that sociocultural resources such as collective efficacy may serve as protective factors against racial discrimination through enhanced social cohesion and community agency. Results are further considered in the context of stress and coping models that emphasize secondary coping processes and use of collective coping. Clinical and theoretical implications of collective efficacy as a sociocultural resource for the promotion of African American mental health are discussed.

Perceived racism and suicide ideation: mediating role of depression but moderating role of religiosity among African American adults

Suicide is a public health problem for African Americans who are young and of working age. The purpose of this study was to examine mediated and moderated effects of perceived racism on suicide ideation in a community sample of 236 African American men and women. Measures of suicide ideation, depression symptoms, intrinsic/extrinsic religiosity, and perceived racism were administered. Perceived racial discrimination was directly and indirectly associated with suicide ideation. For participants who reported low levels of extrinsic religiosity, the mediated effect of perceived racism (via depression symptoms) was significant. These findings provide some insight into suicide vulnerability for specific subgroups of African Americans.

Predictors of depression in black women with hypertension

Black women have the highest prevalence of hypertension in the world, and depression is associated with both hypertension and lack of health promoting behaviors. Thus, it is important to identify factors that may contribute to depression in hypertensive women. This cross-sectional study was conducted with a convenience sample of 80 black women ages 18-60 who were prescribed anti-hypertensive medication. Data were collected using self-report instruments. The study showed that lower income level, greater number of comorbidities, lower active coping scores, and poorer medication adherence were significantly associated with higher depression scores. These findings have important implications for the development of screening protocols and interventions for black women.

Race-Related Stress and Racial Identity as Predictors of African American Activism

The purpose of this study was to examine three forms of race-related stress (i.e., cultural, institutional, and individual) and six racial identity dimensions (i.e., Pre-Encounter Assimilation, Miseducation, and Self-Hatred, Immersion-Emersion Anti-White, and Internalization Afrocentricity and Multiculturalist Inclusive) as predictors of involvement in African American activism in a sample of 185 African American undergraduate women and men. When examined concurrently, these race-related variables accounted for more than one fourth of the variance in involvement in African American activism scores. Results indicated that cultural race-related stress, Immersion-Emersion Anti-White, Internalization Afrocentricity, and Internalization Multiculturalist Inclusive were the only significant and unique positive predictors of involvement in African American activism. In addition, Internalization Afrocentricity attitudes mediated the cultural race-related stress → activism link and both Immersion-Emersion Anti-White and Internalization Afrocentricity attitudes mediated the institutional race-related stress → activism link.

Cultural Racism–Related Stress in Black Caribbean Immigrants

Scholars maintain that with greater length of residence, the U.S. context adversely affects Black immigrants (e.g., via racism-related stress). Yet, the psychological mechanisms that account for increases in racism-related stress over time are unclear. Racial identity scholarship provides reason to suspect Black immigrants’ racial identities may partially explain these increases. In this study, Black Americans and Black Caribbean immigrants ( N = 171) responded to measures of cultural racism–related stress and the “identity” (importance of racial group membership to the self-concept) component of racial identity. We expected identity importance to (a) positively predict cultural racism–related stress for both populations and (b) mediate the association between length of residence and cultural racism–related stress in Black Caribbean immigrants. Although no significant mean difference in identity importance existed between groups, identity predicted cultural racism–related stress only in Black Americans. In Black Caribbean immigrants, identity was not a mediator, but length of residence positively predicted cultural racism–related stress. Differences in results across the two populations may indicate important distinctions in racial identity function between Black Caribbean immigrants and Black Americans.

A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12-18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health.