Racism and mental health: the African American experience

Heterogeneity in racist events and posttraumatic mental health among Black, Indigenous, People of Color (BIPOC) first responders

Background: Black, Indigenous, People of Color (BIPOC) first responders in Canada report experiencing racism and an increased risk of trauma-related mental health symptoms.Objective: Using a BIPOC first responder sample in Canada, the present study examined subgroups of BIPOC first responders based on the frequency of different types of racist events, and their relations with mental health symptoms (posttraumatic stress disorder [PTSD] symptom clusters of intrusion, avoidance, negative alterations in cognitions and mood [NACM], and alterations in arousal and reactivity [AAR]; depression severity; anxiety severity).Method: The sample included 196 BIPOC first responders who reported more than one traumatic experience (Mage = 35.30; 71.4% men).Results: Latent profile analyses indicated a best-fitting 3-profile solution: Low (Profile 1), Moderate (Profile 2), and High (Profile 3) Frequency of Racist Events. Multinomial logistic regression indicated that BIPOC first responders reporting more frequent racist events endorsed greater depression severity, anxiety severity, and PTSD's NACM symptom severity.Conclusions: Findings improve our understanding of subgroups of BIPOC first responders based on the frequency and types of racist events they experience. Results highlight the need to incorporate assessments of racism-related experiences into therapeutic work, and to target depression, anxiety, and NACM symptoms among those who encounter more racist events.

Racism in Education among Black Youth in Canada and its Association with Depression, Anxiety, Stress, and Post-Traumatic Stress Disorder

Racial discrimination in educational settings remains a significant barrier to equitable learning environments and is toxic for the mental health of Black youth in Canada. This study employed a mixed-methods multi-study approach to document the rates, dynamics, and mental health impacts of racial discrimination in education experienced by Black youths aged 14 to 24. Quantitative data were collected from two large samples (N = 558 and N = 914) to measure racial discrimination in education, stress, anxiety, depression, and post-traumatic stress disorder (PTSD). Additionally, qualitative data from semi-structured interviews with 32 youths provided deeper insights into their racial discrimination's experiences in educational settings. Over 40% of participants reported racial discrimination in education, which was significantly associated to elevated symptoms of anxiety, depression, stress, and PTSD. In both quantitative datasets, experience of racial discrimination in education moderated the association between resilience and internalized mental health problems (β = .53, p = .037, β = .34, p = .015, respectively). Racial discrimination in education lowers the protective role of resilience against internalized mental health problems. Thematic analysis of qualitative data uncovered key themes, including pervasive assumptions of low academic potential for Black students by authority figures, lack of appropriate intervention by educators and administrators when racial discrimination occurred, and ongoing enablement of a racist environment within schools. These findings underscore a critical need for systemic reform in Canadian schools and universities to prevent racism and address its mental health impacts. Implementing culturally responsive policies and antiracist interventions can foster safer, more inclusive educational environments, supporting well-being and academic success of Black Canadians youth.

Racial diversity, interracial trust, and mental distress in post-apartheid South Africa

The emerging difficulties and tensions in establishing inclusive and multicultural societies in the contemporary globalised world have necessitated the generation of ample empirical evidence in support of the socioeconomic and health benefits of racial diversity. This study contributes to the scholarly and policy discourses by examining the effect of racial diversity on mental distress in post-apartheid South Africa after several decades of racial segregation. We used all five waves (2008, 2010, 2012, 2014, and 2017) of the National Income Dynamics Survey (NIDS). After addressing the endogeneity problem in the racial diversity-mental distress nexus, our findings show that an increase in racial diversity is associated with a decrease in mental distress across the 52 districts of South Africa. This finding is consistently established when different quasi-experimental methods and alternative conceptualisations of racial diversity are employed to generate the results. We also found that racial diversity decreases mental distress more among females and urban residents. Further analyses revealed that interracial trust serves as a potential pathway through which racial diversity transmits to mental distress. We argue that people living in highly racially diverse neighbourhoods have the potential to experience a decrease in their mental distress through improved interracial trust.

Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19

The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.

Racism and Redlining in the History of Psychiatric Policy and Practice in Atlanta: Implications for Nursing

Recently, the Georgia state House of Representatives passed House Bill 1013, also called The Mental Health Parity Act. The bill sought to address access to and insurance coverage for mental health services, first identified in a report in 2020. The budget for mental health services was reduced by $8 m in 2020, despite an all-time high demand due to the beginning of the Covid-19 pandemic. There is an increasing inability to secure mental health care in the state. Georgia is ranked 37th in the country for access to quality mental health care (Reinert, Fritze, and Nguyen, 2022) and half the counties in the state have no psychiatrist; the projected mental health workforce will be able to meet only 12% of consumer demand by 2025. Problems with mental health care in Georgia have a long history which intersects with the history of racism, geographical segregation, and policing. HB1013 does not consider any of this history in its recommendations, which barely include nursing. At the same time, policy and practice in Georgia continues to entangle nurses and other professionals with a carceral and punitive system which not only threatens the safety of patients, but also nurses themselves. Nurses need to understand this history if they hope to develop policy that will intervene in the mental health care crisis.

Police Contact, Sleep, and Mental Health in the Adolescent Brain Cognitive Development (ABCD) Study

Using data from the Adolescent Brain Cognitive Development study (n = 3928), we examined how police contact relates to sleep problems, anxiety, and depressive symptoms during middle adolescence (M age = 14.09; SD = 0.68). Consistent with racialized disparities in the presence of police in schools and communities, descriptive data revealed that Black children, particularly boys, reported more positive and negative contact with police than other children. Results of regression analyses that adjusted for potential selection factors further revealed that negative interactions with police were associated with increased risk for sleep disturbances and/or internalizing symptoms among White boys, Black girls, and Hispanic youth. Contact with police was not, however, associated with outcomes assessed here for White girls or Black boys, findings that likely reflect fundamentally different lived experiences with police, gendered racial socialization processes, and access to social support that warrant continued investigation in future research.

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.

The state of (mis) trust: Human-centered technology development & implementation in intensive mental health settings

Innovative technology-based solutions in mental healthcare promise significant improvements in care quality and clinical outcomes. However, their successful implementation is profoundly influenced by the levels of trust patients hold toward their treatment providers, organizations, and the technology itself. This paper delves into the complexities of building and assessing patient trust within the intensive mental health care context, focusing on inpatient settings. We explore the multifaceted nature of trust, including interpersonal, institutional, and technological trust. We highlight the crucial role of therapeutic trust, which comprises both interpersonal trust between patients and providers, and institutional trust in treatment organizations. The manuscript identifies potential key barriers to trust, from sociocultural background to a patient's psychopathology. Furthermore, it examines the concept of technological trust, emphasizing the influence of digital literacy, socio-economic status, and user experience on patients' acceptance of digital health innovations. By emphasizing the importance of assessing and addressing the state of trust among patients, the overarching goal is to leverage digital innovations to enhance mental healthcare outcomes within intensive mental health settings.

Racism-related experiences and substance use: A systematic and meta-analytic review

Examinations highlighting interpersonal racism-related experiences as risk factors for substance use are well documented, particularly for alcohol use. The associations between racism-related experiences across other levels of influence (e.g., historical trauma, online, internalized) and use of other types of substances, while emerging, have yielded mixed findings. The present systematic review and meta-analyses examined the associations between multilevel racism-related experiences and different types of substances including substance use overall, alcohol, binge drinking, tobacco/nicotine, cannabis, illicit drugs, and polysubstance use among ethnoracially minoritized adolescents and emerging adults (12-29 years old). A systematic literature search and the Newcastle-Ottawa Scale (NOS) were used to identify, assess quality, and bias of included articles. Random-effects meta-analyses estimated pooled effect sizes for seven substance use outcomes and by age, sex, and race/ethnicity. Out of a total of 3190 articles, 91 (N = 190,065 participants) met inclusion criteria, 79 of which were included in the meta-analysis. The studies included were predominantly cross-sectional, school-based samples, and focused on Black individuals. Most examined interpersonal racism and few examined online and historical forms of racism. Meta-analyses demonstrated a significant positive association, with a small pooled effect size, between racism-related experiences and each substance use outcome. Moderations by age, sex, and race/ethnicity were found. Racism-related experiences are a risk factor for substance use among ethnoracially minoritized adolescents and emerging adults. Interventions addressing racism-related experiences across multiple dimensions are critical for the prevention and treatment of substance use among ethnoracially minoritized communities.

Use of calibration to improve the precision of estimates obtained from All of Us data

OBJECTIVES

To highlight the use of calibration weighting to improve the precision of estimates obtained from All of Us data and increase the return of value to communities from the All of Us Research Program.

MATERIALS AND METHODS

We used All of Us (2017-2022) data and raking to obtain prevalence estimates in two examples: discrimination in medical settings (N = 41 875) and food insecurity (N = 82 266). Weights were constructed using known population proportions (age, sex, race/ethnicity, region of residence, annual household income, and home ownership) from the 2020 National Health Interview Survey.

RESULTS

About 37% of adults experienced discrimination in a medical setting. About 20% of adults who had not seen a doctor reported being food insecure compared with 14% of adults who regularly saw a doctor.

CONCLUSIONS

Calibration using raking is cost-effective and may lead to more precise estimates when analyzing All of Us data.

The next generation of developmental psychopathology research: Including broader perspectives and becoming more precise

The current Special Issue marks a major milestone in the history of developmental psychopathology; as the final issue edited by Cicchetti, we have an opportunity to reflect on the remarkable progress of the discipline across the last four decades, as well as challenges and future directions for the field. With contemporary issues in mind, including rising rates of psychopathology, health disparities, and international conflict, as well as rapid growth and accessibility of digital and mobile technologies, the discipline of developmental psychopathology is poised to advance multidisciplinary, developmentally- and contextually- informed research, and to make substantial progress in supporting the healthy development of individuals around the world. We highlight key future directions and challenges for the next generation of developmental psychopathology research including further investigation of culture at multiple levels of analysis, incorporation of macro-level influences into developmental psychopathology research, methods advances to address heterogeneity in translational research, precision mental health, and the extension of developmental psychopathology research across the lifespan.

Exploring religiosity, perceived mental health, and coping behaviors of undergraduate African American college students in the South

Objective: The current study explored the relationships of religiosity and coping behaviors on the perceived mental health of undergraduate African American (AA) college students enrolled at a large public university in the Southern United States. Methods: We used a cross-sectional survey design. AA and/or African descent adult college participants (n = 131) were recruited from an online chat group (ie, GroupMe) and completed the Brief-COPE, a demographic questionnaire, and a single-item mental health tool. Data analyses employing descriptive statistics and correlational analyses examined relationships between variables. Results: There was a positive correlation between increased religious activity and overall mental health. Those who specified their religion as "other" had a lower total mental health score than those with an identified religion. Conclusions: Findings underscore the importance of supportive interventions that account for religious beliefs and activities on overall mental health outcomes for undergraduate AA college students in the South.

Structural influences on psychiatric emergency department visits among racial and ethnic minority youth in North Carolina: A neighborhood-level analysis

Mental health continues to be a growing crisis for children, adolescents, and young adults. Yet, increasing trends in subgroups are not uniform, and key differences exist across geographic, racial, and age groups. Few studies examine structural factors like economic and racial inequality, important upstream structural inequities that impact mental health. This study examines the association between individual drivers and structural factors like neighborhood privilege and youth mental health (i.e., depression, schizophrenia, suicide ideation, anxiety) and associated racial and ethnic disparities. Data on mental health were obtained from psychiatric emergency department (ED) visits for the state of North Carolina from 2012 to 2021 for residents under age 24. Multilevel logistic regressions were employed to examine trends and drivers of psychiatric ED visits compared to non-psychiatric ED visits. Results show an increase in psychiatric ED visits from 2012 to 2021 across all races and ethnicities. Although white youth represent the majority of psychiatric ED visits, increasing trends among minorities, including Black and Hispanic youth, were notable, particularly for severe mental health conditions like schizophrenia and suicide-related outcomes and for urban neighborhoods with greater segregation. Findings underscore the need for policies addressing economic and racial inequalities at the neighborhood level to mitigate youth mental health disparities.

A triple trust penalty? The majority-minority gap in subjective wellbeing

This study introduces a social capital perspective to the majority-minority gap in wellbeing. We explore the role of social trust and test specifically whether racial and ethnic minorities may experience a triple trust penalty. First is a level penalty, where minorities exhibit lower levels of trust, potentially adversely affecting their wellbeing. Second, there may be a return penalty, where minorities may experience a diminished return from being trustful. Third, there may be a protection penalty, where minorities experience reduced benefits from residing in a high-trust context. Our empirical analyses are based on data from multiple waves of the European Social Survey (Round 4-10, 2008-2020) with over 300,000 individuals from 38 European countries. Our analyses indicate support for the level penalty, but we found no evidence for the return or protection penalties. Specifically, we show that racial and ethnic minorities' lower levels of trust can have harmful impacts on their happiness and life satisfaction. However, an increase in trust yields greater wellbeing among racial and ethnic minorities, and residing in a high-trust context also appears to have a more substantial impact on the well-being of racial and ethnic minorities as compared to their counterparts. The results suggest that promoting trust can effectively narrow the wellbeing gap among various racial groups.

Crossroads of Care: A Black Social Worker's Insights into the Lives of Black Men from Adolescence to Adulthood

This autoethnographic study, "Crossroads of Care: A Black Social Worker's Insights into the Lives of Black Men from Adolescence to Adulthood," explores the intersections of race, education, and mental health throughout the life course of Black men. Drawing on varied professional and personal experiences - from providing telehealth services for college students to being a resource within a predominantly Black high school - the research illuminates systemic barriers and profound effects of marginalization and isolation. Emphasizing evidence-based social work interventions and culturally relevant care, the study underscores the importance of narrative therapy and self-disclosure in addressing Black men's multifaceted needs. The findings contribute to discussions on racial equity in mental health and education, offering actionable recommendations for practitioners, policymakers, and educators to strengthen support systems. Advocating for a comprehensive care model, this research endeavors to empower Black men across various life milestones, enhancing well-being by addressing the complexities of race, education, and mental health.

Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program

INTRODUCTION

Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.

METHODS

Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024.

RESULTS

About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05.

CONCLUSIONS

The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.

Is racism a barrier to HIV care continuum engagement among Black People in the United States? A scoping review to assess the state of the science and inform a research agenda

People living with HIV can achieve viral suppression through timely HIV care continuum (HCC) engagement (ie, diagnosis, linkage to HIV care, retention in care, and adherence to prescribed treatment regimens). Black populations have poorer viral suppression, suboptimal HCC engagement, and higher levels of racism-related mistrust. The state of the evidence linking suboptimal HCC engagement to racism among US Black populations is assessed in this article. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 6 English language databases were searched using 3 sets of key terms related to HCC engagement (eg, HIV diagnosis), racism (eg, discrimination), and the population (eg, Black people). To exclude articles, 3 rounds of reviews were conducted and results assessed for interrater reliability (κ = 99.00%; P < 0.00). From 2027 articles initially retrieved, the final set of analyses (n = 32) included clinical and nonclinical samples of people living with or at risk for HIV. Overall, the evidence was conceptually robust but methodologically simple. Studies primarily targeted intrapersonal and interpersonal racism and the late stage of HCC engagement: adherence. Sample-specific prevalence of racism ranged considerably; for example, 20% to 90% of sample members in clinical settings perceived or experienced interpersonal forms of racism. To date, the evidence suggests the relationship between racism and HCC engagement is mixed. Racism is salient among Black people living with or at risk for HIV. It appears not to impede HIV testing, though it may limit retention in HIV care, especially among men who have sex with men.

Black mothers' ethnic-racial socialization one year after highly publicized anti-Black murders during the pandemic

Although research on ethnic-racial socialization is well established, limited studies have examined the influence of specific, highly publicized anti-Black murders. We assessed Black mothers' (N = 12, mean age = 37.45) concerns and ethnic-racial socialization with adolescents aged 11-18 years old approximately 1 year following the murders of George Floyd and other unarmed Black people. Researchers generated the following themes using reflexive thematic analysis: protecting adolescents from physical harm; protecting adolescents from psychological harm; parents' emotional distress; and parents' lack of confidence in their ethnic-racial socialization practices. Black mothers exhibit exceptional amounts of strength and courage as they navigate pervasive physical and psychological threats to their adolescents while experiencing worry and low confidence in their ability to socialize their adolescents about anti-Black racism.

Providing antiracist cognitive-behavioral therapy: Guidelines, tools, and tips

This article addresses gaps in cognitive-behavioral therapy (CBT) when it comes to integrating racial issues that affect racialized patients' mental health. Traditional adaptations of CBT focused on social, religious, and linguistic challenges but neglected the critical aspects of interpersonal, institutional and systemic racism, internalized racism and complex racial trauma. This oversight has resulted in less effective outcomes for racialized individuals. The article proposes clear, applicable guidelines for clinicians to provide anti-racist CBT interventions. They cover clinical self-development, re-design the CBT triangular (thoughts, feelings, behaviors) theoretical framework, provide practical tools and tips to facilitate antiracist CBT interventions. Clinicians are encouraged to engage in self-assessment to understand their own racial biases and develop competencies to address racial issues and dynamics in therapy. CBT theoretical framework is re-envisioned to include environmental factors that impact the lives of racialized people, acknowledging the pervasive effects of racism on mental and physical health. The article also highlights the importance of creating a culturally safe therapeutic environment for racialized children, adolescents, and families, and emphasizes the need for specialized training to effectively serve these groups. The proposed guidelines aim to transform CBT practice, increase confidence of racialized individuals in mental health care, and ultimately decolonize CBT interventions.

Adverse Infant Health Outcomes Increased After the 2016 U.S. Presidential Election Among Non-White U.S.-born and Foreign-born Mothers

Macro-level events such as elections can improve or harm population health across existing axes of stratification through policy changes and signals of inclusion or threat. This study investigates whether rates of, and disparities in, adverse birth outcomes between racialized and nativity groups changed after Donald Trump's November 2016 election, a period characterized by increases in xenophobic and racist messages, policies, and actions in the United States. Using data from 15,568,710 U.S. births between November 2012 and November 2018, we find that adverse birth outcomes increased after Trump's election among U.S.- and foreign-born mothers racialized as Black, Hispanic, and Asian and Pacific Islander (API), compared with the period encompassing the two Obama presidencies. Results for Whites suggest no change or a slight decrease in adverse outcomes following Trump's election, yet this finding was not robust to checks for seasonality. Black-White, Hispanic-White, and API-White disparities in adverse birth outcomes widened among both U.S.- and foreign-born mothers after Trump's election. Our findings suggest that Trump's election was a racist and xenophobic macro-level political event that undermined the health of infants born to non-White mothers in the United States.

Coping While Black: Comparing Coping Strategies Across COVID-19 and the Killing of Black People

In the same year the world was thrown into turmoil with COVID-19, the USA also experienced a surge in attention given to the plight of Black people in the policing system, following the killing of George Floyd. Both the COVID-19 pandemic and the ongoing "pandemic" of police and White violence against Black people in the USA cause significant amounts of stress, disproportionately affecting Black people. Utilizing qualitative analysis of responses from 128 Black-identifying participants to an online survey, this investigation seeks to understand how the coping strategies of Black people in the USA compare between the racism-related stressor of police killings of Black people and the generalized stressor of the COVID-19 pandemic. Findings demonstrate that while Black people use overlapping strategies to deal with stress, clear patterns exist with regard to differences across racism-related and non-racism-related stressors. We report important implications for understanding the impact of COVID-19 on Black people, cultural understandings of research on coping, and Black mental health more broadly.

Historical trauma and oppression: Associations with internalizing outcomes among American Indian adults with type 2 diabetes

American Indian (AI) people experience disproportionate exposure to stressors and health inequities, including type 2 diabetes (T2D) and mental health problems. There is increasing interest in how historical trauma and ongoing experiences of discrimination and marginalization (i.e., historical oppression) interact to influence AI health. The purpose of this study is to examine the relationships between historically traumatic experiences (i.e., boarding schools, relocation programs, and foster care), current reports of historical cultural loss, microaggressions, and their relationship to internalizing symptoms among AI adults living with T2D. This community-based participatory research study with five AI tribal communities includes data from 192 AI adults with T2D recruited from tribal clinics. Results from structural equation modeling revealed that personal experiences in foster care and ancestral experiences in boarding schools and/or relocation were associated with increased reports of historical loss, and indirectly associated with internalizing symptoms through racial microaggressions and historical losses. The findings highlight the importance of considering multiple dimensions of historical trauma and oppression in empirical and practice-based assessments of mental health problems.

Antiracism and positive intergenerational (infant) outcomes: A county-level examination of low birth weight and infant mortality

Racism is associated with negative intergenerational (infant) outcomes. That is, racism, both perceived and structural, is linked to critical, immediate, and long-term health factors such as low birth weight and infant mortality. Antiracism-resistance to racism such as support for the Black Lives Matter (BLM) movement-has been linked to positive emotional, subjective, and mental health outcomes among adults and adolescents. To theoretically build on and integrate such past findings, the present research asked whether such advantageous health correlations might extend intergenerationally to infant outcomes? It examined a theoretical/correlational process model in which mental and physical health indicators might be indirectly related to associations between antiracism and infant health outcomes. Analyses assessed county-level data that measured BLM support (indexed as volume of BLM marches) and infant outcomes from 2014 to 2020. As predicted, in the tested model, BLM support was negatively correlated with 1) low birth weight (Ncounties = 1,445) and 2) mortalities (Ncounties = 409) among African American infants. Given salient, intergroup, policy debates tied to antiracism, the present research also examined associations among White Americans. In the tested model, BLM marches were not meaningfully related to rates of low birth weight among White American infants (Ncounties = 2,930). However, BLM support was negatively related to mortalities among White American infants (Ncounties = 862). Analyses controlled for structural indicators of income inequality, implicit/explicit bias, voting behavior, prior low birth weight/infant mortality rates, and demographic characteristics. Theory/applied implications of antiracism being linked to nonnegative and positive infant health associations tied to both marginalized and dominant social groups are discussed.

Cross-cultural variation in experiences of acceptance, camouflaging and mental health difficulties in autism: A registered report

Recent findings suggest that stigma and camouflaging contribute to mental health difficulties for autistic individuals, however, this evidence is largely based on UK samples. While studies have shown cross-cultural differences in levels of autism-related stigma, it is unclear whether camouflaging and mental health difficulties vary across cultures. Hence, the current study had two aims: (1) to determine whether significant relationships between autism acceptance, camouflaging, and mental health difficulties replicate in a cross-cultural sample of autistic adults, and (2) to compare these variables across cultures. To fulfil these aims, 306 autistic adults from eight countries (Australia, Belgium, Canada, Japan, New Zealand, South Africa, the United Kingdom, and the United States) completed a series of online questionnaires. We found that external acceptance and personal acceptance were associated with lower levels of depression but not camouflaging or stress. Higher camouflaging was associated with elevated levels of depression, anxiety, and stress. Significant differences were found across countries in external acceptance, personal acceptance, depression, anxiety, and stress, even after controlling for relevant covariates. Levels of camouflaging also differed across countries however this effect became non-significant after controlling for the covariates. These findings have significant implications, identifying priority regions for anti-stigma interventions, and highlighting countries where greater support for mental health difficulties is needed.

"That Was a State of Depression by Itself Dealing with Society": Atmospheric racism, mental health, and the Black and African American faith community

Despite increased societal focus on structural racism, and its negative impact on health, empirical research within mental health remains limited relative to the magnitude of the problem. The current study-situated within a community-engaged project with members of a predominantly Black and African American church in the northeastern US-collaboratively examined depressive experience, recovery, and the role of racism and racialized structures. This co-designed study featured individual interviews (N = 11), a focus group (N = 14), and stakeholder engagement. A form of qualitative, phenomenological analysis that situates psychological phenomena within their social structural contexts was utilized. Though a main focal point of the study was depressive and significantly distressing experience, participant narratives directed us more towards a world that was structured to deplete and deprive-from basic neighborhood conditions, to police brutality, to workplace discrimination, to pervasive racist stereotypes, to differential treatment by health and social services. Racism was thus considered as atmospheric, in the sense of permeating life itself-with social, affective, embodied, and temporal dimensions, alongside practical (e.g., livelihood, vocation, and care) and spatial (e.g., neighborhood, community, and work) ones. The major thematic subsections-world, body, time, community, and space-reflect this fundamental saturation of racism within lived reality. There are two, interrelated senses of structural racism implicated here: the structures of the world and their impact on the structural dimensions of life. This study on the atmospheric nature of racism provides a community-centered complement to existing literature on structural racism and health that often proceed from higher, more population level scales. This combined literature suggests placing ever-renewed emphasis on addressing the causes and conditions that make this kind of distorted world possible in the first place.

Eating vegan due to cancer: A different social experience than other vegan dieters?

Many diagnosed with cancer change their diet in response to the diagnosis, with a vegan diet being a common choice. There may be health benefits to this, but research has demonstrated that following a vegan diet can have negative social ramifications. These social ramifications seem to be experienced to a lesser extent by those who following a vegan diet for health versus moral reasons, but this is a heterogeneous group; people may choose the diet for a myriad of different health reasons. In two pre-reregistered studies, we examined the social experience of those who adopt a vegan diet following a cancer diagnosis. Study 1, an experimental study, demonstrated that omnivores responded more positively to a friend who was vegan for cancer reasons than animal or general health reasons, which was explained by increased empathy. In Study 2, a cross-sectional survey study, those who adopted a vegan diet due to cancer reported (overall) less negative social experiences than those following a vegan diet more generally. These participants reported that cancer represented a greater social challenge than their diet. Taken together, these findings suggest that "vegan due to cancer" is a unique social identity and a unique social experience, relative to that of those motivated by other reasons, including general health reasons.

The association between community-level economic deprivation and incidences of emergency department visits on account of attempted suicides in Maryland

Background

Suicide is a major cause of mortality in the United States, accounting for 14.5 deaths per 100,000 population. Many emergency department (ED) visits in the United States are due to attempted suicides. Suicide attempts predict subsequent completed suicides. Socioeconomic factors, such as community-level socioeconomic deprivation, significantly affect many traditional risk factors for attempted suicides and suicides.

Aim

To determine the association between community-level socioeconomic deprivation and ED visits for attempted suicide in Maryland.

Methods

A retrospective analysis of attempted suicides in the Maryland State Emergency Department Database from January 2018 to December 2020. Community-level socioeconomic deprivation was measured using the Distress Community Index (DCI). Multivariate regression analyses were conducted to identify the association between DCI and attempted suicides/self-harm.

Results

There were 3,564,987 ED visits reported in the study period, with DCI data available for 3,236,568 ED visits; 86.8% were younger than 45 years, 64.8% were females, and 54.6% non-Hispanic Whites. Over the study period, the proportion of ED visits due to attempted suicide was 0.3%. In the multivariate logistic regression, compared to prosperous zones, those in comfortable (OR = 0.80, 95% CI: 0.73-0.88, p < 0.01), Mid-Tier (OR = 0.76, 95%CI:0.67-0.86, p < 0.01), At-Risk (OR = 0.77; 95%CI: 0.65-0.92, p < 0.01) and Distressed zones (OR = 0.53; 95% CI:0.42-0.66, p < 0.01) were less likely to visit the ED for attempted suicide.

Conclusion

Prosperous communities had the highest rate of attempted suicides, with the risk of attempted suicide increasing as individuals move from the least prosperous to more prosperous areas.

Personal Mastery Attenuates the Association between Greater Perceived Discrimination and Lower Amygdala and Anterior Hippocampal Volume in a Diverse Sample of Older Adults

There is limited research investigating whether perceived discrimination influences brain structures that subserve episodic memory, namely the hippocampus and amygdala. Our rationale for examining these regions build on their known sensitivity to stress and functional differences along the long-axis of the hippocampus, with the anterior hippocampus and amygdala implicated in emotional and stress regulation. We defined perceived discrimination as the unfair treatment of one group by a dominant social group without the agency to respond to the event. A potential moderator of perceived discrimination is personal mastery, which we operationally defined as personal agency. Our primary goals were to determine whether perceived discrimination correlated with amygdala and anterior hippocampal volume, and if personal mastery moderated these relationships. Using FreeSurfer 7.1.0, we processed T1-weighted images to extract bilateral amygdala and hippocampal volumes. Discrimination and personal mastery were assessed via self-report (using the Experiences of Discrimination and Sense of Control questionnaires, respectively). Using multiple regression, greater perceived discrimination correlated with lower bilateral amygdala and anterior hippocampal volume, controlling for current stress, sex, education, age, and intracranial volume. Exploratory subfield analyses showed these associations were localized to the anterior hippocampal CA1 and subiculum. As predicted, using a moderation analysis, personal mastery attenuated the relationship between perceived discrimination and amygdala and anterior hippocampal volume. Here, we extend our knowledge on perceived discrimination as a salient psychosocial stressor with a neurobiological impact on brain systems implicated in stress, memory, and emotional regulation, and provide evidence for personal mastery as a moderating factor of these relationships.

Black therapists' experiences with their Black clients: A systematic review

This systematic review explores Black therapists' experiences with their Black clients. The search initially identified 459 possible articles. Through the study selection process, following the Cochrane Collaboration's guidelines, the 459 studies were narrowed down to 11 studies. A total of eight qualitative studies and three quantitative studies were identified. The analytic process of this review mirrored that of a thematic analysis due to the proportion of qualitative articles. Five themes emerged: Understanding the Black Experience, Connection to Clients, Working with Black Clients, Working While Black, and Training Black Therapists. Implications for training and supervision are discussed.

Racial disparities in Death rates and Death incidences in Xinjiang: A study of multilevel ecological mechanisms

Health disparities based on racial status are well-researched by social scientists, but this field of knowledge has rarely been investigated beyond the Western context. As the largest province in China, Xinjiang has over 50% non-Han populace-and this group is subjected to various forms of inequalities. The current study is the first to quantitatively demonstrate the disparity in mortality between the Han majority and Turkic minority in Xinjiang. We have developed a theory-driven framework to approach race as a fundamental cause of mortality disparity through both individual and context-level pathways that trigger the proximate determinants of death. We compiled the 2015 China Microcensus with the Sixth Decennial Census (2010) and web-extracted point-of-interest information for data at different ecological levels. The results reveal that the mortality rate is significantly pronounced for Turks at the county-level and Turks' death incidence is elevated at the household level. The inclusion of variables at the individual- and context-level explains about 38% of the mortality disparity between Han and Turks, but the significant disparity remains strong after considering the covariates, the "healthy migrant" scenario, geographical clustering, and exposure risk. We cautiously suggest the remaining unexplained portion of the mortality disparity may be due to unobserved racial inequity and urge the academic community to further investigate this underexplored subject.

Correlation of Positive Psychological Health among US Adults (Aged ≥ 50 Years) with Pain and Documented Opioid Treatment

In this study, we aimed to identify the factors correlated with positive psychological health among United States older adults (≥50 years) with pain and documented opioid treatment. This retrospective cross-sectional study utilized a nationally representative dataset (Medical Expenditure Panel Survey). A multivariable logistic regression model was developed to assess the correlation of positive psychological health in the eligible population. The logistic regression model showed having excellent/very good/good (versus fair/poor) perceived health (adjusted odds ratio [AOR] = 9.062; 95% confidence interval [CI] = 5.383, 15.254) had a statistically significant correlation with positive psychological health among the eligible population. This finding offers important insights for clinicians and policymakers to consider when formulating approaches to better manage the psychological health of United States older adults with pain and documented opioid treatment.

Trauma-Informed Cultural Humility Mental Health Practice: Centering History among African American Women

Social work has made significant strides in providing mental health services. However, advancement in mental health practices grounded in social work values, such as trauma-informed care and cultural humility mental health practice (CHMHP), is still lacking. One possible reason is that many strategies overlook clients' historical contexts, particularly the collective history held by the community to which the client belongs. By centering "history" in social work practices, clinical social workers can be more equipped to provide high-quality, client-centered services. This article advocates for adopting trauma-informed CHMHP as a critical strategy to elevate history in clinical social work practice and proposes that trauma-informed CHMHP can improve mental health service quality among clients of color who are profoundly disrupted by historical trauma. Specifically, this article proposes that using trauma-informed CHMHP to address historical trauma can enhance mental health treatment outcomes and experiences for African American women. Clinical social workers trained to address these interconnected issues can help reduce disparities in quality treatment access.

A systematic review of how social connectedness influences associations between racism and discrimination on health outcomes

Racial discrimination is a well-known risk factor of racial disparities in health. Although progress has been made in identifying multiple levels through which racism and racial discrimination influences health, less is known about social factors that may buffer racism's associations with health. We conducted a systematic review of the literature with a specific focus on social connectedness, racism, and health, retrieving studies conducted in the United States and published between January 1, 2012, and July 30, 2022, in peer-reviewed journals. Of the 787 articles screened, 32 were selected for full-text synthesis. Most studies (72%) were at the individual level, cross-sectional, and among community/neighborhood, school, or university samples. Studies had good methodological rigor and low risk of bias. Measures of racism and racial discrimination varied. Discrimination scales included unfair treatment because of race, schedule of racist events, experiences of lifetime discrimination, and everyday discrimination. Measures of social connectedness (or disconnectedness) varied. Social-connectedness constructs included social isolation, loneliness, and social support. Mental health was the most frequently examined outcome (75%). Effect modification was used in 56% of studies and mediation in 34% of studies. In 81% of studies, at least 1 aspect of social connectedness significantly buffered or mediated the associations between racism and health. Negative health associations were often weaker among people with higher social connectedness. Social connectedness is an important buffering mechanism to mitigate the associations between racial discrimination and health. In future studies, harmonizing metrics of social connectedness and racial discrimination can strengthen causal claims to inform interventions.

Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010-2016

INTRODUCTION

Mental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This study investigates racial and socioeconomic inequalities in primary healthcare usage, hospitalisation and mortality for mental health disorders in Rio de Janeiro, Brazil.

METHODS

A cohort of 1.2 million low-income adults from Rio de Janeiro, Brazil with linked socioeconomic, demographic, healthcare use and mortality records was cross-sectionally analysed. Poisson regression models were used to investigate associations between self-defined race/colour and primary healthcare (PHC) usage, hospitalisation and mortality due to mental disorders, adjusting for socioeconomic factors. Interactions between race/colour and socioeconomic characteristics (sex, education level, income) explored if black and pardo (mixed race) individuals faced compounded risk of adverse mental health outcomes.

RESULTS

There were 272 532 PHC consultations, 10 970 hospitalisations and 259 deaths due to mental disorders between 2010 and 2016. After adjusting for a wide range of socioeconomic factors, the lowest PHC usage rates were observed in black (adjusted rate ratio (ARR): 0.64; 95% CI 0.60 to 0.68; compared with white) and pardo individuals (ARR: 0.87; 95% CI 0.83 to 0.92). Black individuals were more likely to die from mental disorders (ARR: 1.68; 95% CI 1.19 to 2.37; compared with white), as were those with lower educational attainment and household income. In interaction models, being black or pardo conferred additional disadvantage across mental health outcomes. The highest educated black (ARR: 0.56; 95% CI 0.47 to 0.66) and pardo (ARR: 0.75; 95% CI 0.66 to 0.87) individuals had lower rates of PHC usage for mental disorders compared with the least educated white individuals. Black individuals were 3.7 times (ARR: 3.67; 95% CI 1.29 to 10.42) more likely to die from mental disorders compared with white individuals with the same education level.

CONCLUSION

In low-income individuals in Rio de Janeiro, racial/colour inequalities in mental health outcomes were large and not fully explainable by socioeconomic status. Black and pardo Brazilians were consistently negatively affected, with lower PHC usage and worse mental health outcomes.

Stigmatising and Racialising COVID-19: Asian People's Experience in New Zealand

The Asian community - the second largest non-European ethnic community in New Zealand - plays an important role in combatting the COVID-19 pandemic, evidenced by their active advocation for border control and mass masking. Despite the long history of racial discrimination against the Asian population, the Asian community has experienced certain degrees of racial discrimination associated with the stigmatisation as the cause of the COVID-19 outbreak in New Zealand. Based on data from a quantitative online survey with 402 valid responses within the Asian communities across New Zealand and the in-depth interviews with 19 Asian people in Auckland, New Zealand, this paper will illustrate Asian people's experience of racial discrimination and stigmatisation during the pandemic in the country. The survey shows that since the outbreak of COVID-19, under a quarter of the participants reported experiencing discrimination, and a third reported knowing an immediate contact who had experienced discrimination. However, when looking beyond their immediate social circle, an even higher proportion reported noticing racism and stigmatisation through the traditional or social media due to COVID-19. Major variations of the degree of racial discrimination experienced are determined by three demographic variables: ethnicity, age, and region. The in-depth interviews largely echoed the survey findings and highlighted a strong correlation between the perceived racial discrimination among the local Asian community and the stigmatisation associated with COVID-19. These findings are important for improving the way we manage future pandemics and other disasters within the context of the UN Sendai Framework for Disaster Risk Reduction.

Racial Discrimination and Romantic Relationship Dynamics among Black Americans: A Systematic Review

Despite increasing research, the links between racial discrimination and Black Americans' romantic relationship dynamics remain unclear. Guided by models of mundane extreme environmental stress (Peters & Massey, 1983), sociocultural family stress (McNeil Smith & Landor, 2018), and Black marital outcomes (Bryant et al., 2010), we conducted a systematic review of the literature examining racial discrimination and relationship dynamics among Black Americans in same-race and interracial romantic relationships. Synthesizing findings from 32 published empirical articles, we find support for manifestations of each component of MEES in Black intimate life. We uncover evidence that racial discrimination is associated with compromised relationship functioning for Black Americans. Several psychosocial resources were also identified as either buffering these associations or posing drawbacks/limitations for Black Americans. We discuss notable gaps in the literature and directions for future research including intersectional investigations, broader examination of the MEES context, and de-centering whiteness among studies of interracial relationship dynamics.

Decolonising dental educational research: reflections from a white researcher

While there is an emerging scholarship on decolonising dentistry, the debate about reflexivity, positionality and white privilege in dental educational research and practice is still at a developmental stage. This article aims to contribute to this nascent debate by contemplating the question- is it appropriate, or possible, for a white researcher to undertake decolonisation work in dental education? If so, what would it entail or 'look' like? To answer this important question, the author offers a reflective account of their ethical and epistemological journey with this very question. This journey begins with how I, a white researcher, first became aware of the everyday racism experienced by my racially and ethnically minoritized students, the whiteness of dental educational spaces and how my white privilege and position as a dental educator consciously and unconsciously implicated me in these processes of exclusion and discrimination. While this revelation led to a personal commitment to do better in my practice, both as an educator and a researcher, I continue to struggle with my white ignorance and white fragility as I strive to make my work more inclusive. To illustrate this, I discuss an ethnodrama project on everyday racism that I lead on and how, despite choosing a more democratic research method, hegemonic whiteness continued to make its presence felt through my 'going it alone' method of work. This reflective account reaffirms that regular and routine self-reflection is key to ensuring that racialised inappropriate and damaging assumptions, frameworks of thinking, and ways of working are checked for. However, my praxis won't evolve through critical introspection alone. I need to be open to making mistakes, educating myself about racism and anti-racist practice, asking for help and guidance from my minoritized colleagues and more importantly, committing to working with people from minoritized communities rather than on them.

Intergenerational Continuity of Child Maltreatment, Parenting, and Racism: Commentary on Valentino et al., (2012)

Recent editorials published in Child Maltreatment bring much needed attention to racism in child maltreatment reporting and investigation. In this commentary, we extend these efforts by responding to Valentino et al., (2012) and addressing prior omissions in our race-related work by explicitly discussing the role of racism in our explanation of key study findings. Together with scholars with expertise in the impact of racism on children and families, this commentary (a) discusses theoretical models of child maltreatment and of the influence of racism on parenting and child development; (b) discusses parental responses to racism in relation to the Valentino et al., (2012) findings; and (c) highlights future research directions.

Racial Context and Health Behaviors Among Black Immigrants

Testing the Racial Context Hypothesis (Read and Emerson 2005), we examine the relationship between racial context of origin and three health behaviors (smoking, drinking, and physical activity) among Black immigrants in the USA. We conduct multinomial logistic regression analyses using data from the 2000-2018 National Health Interview Survey (N = 248,401) to determine if racial context of origin is a mechanism of health differential between Black immigrants and US-born Black Americans. Supporting the Racial Context Hypothesis, we find that Black immigrants from racially mixed (Mexico, Central America, the Caribbean, South America) and majority-Black contexts (Africa) are significantly less likely to be current or former smokers and drinkers than US-born Black Americans. Black immigrants from majority-white (Europe) contexts, on the other hand, look more similar to US-born Black Americans - again supporting the premise that racial context of origin is consequential for health. After controlling for a host of covariates, Black immigrants do not significantly differ from US-born Black Americans in exercise status. Together, these findings suggest that the impacts of racism and white supremacy have lasting effects on people of color, where Black immigrants from majority-white contexts exhibit worse health behaviors than their counterparts from majority-Black and racially mixed regions.

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.

Police Bias and Low Relatability and Diet Quality: Examining the Importance of Psychosocial Factors in Predominantly Black Communities

How police bias and low relatability may contribute to poor dietary quality is poorly understood. In this cross-sectional study, we analyzed data from 2021 from a cohort of n = 724 adults living in predominantly Black communities in Pittsburgh, Pennsylvania; these adults were mostly Black (90.6%), low-income (median household income $17,500), and women (79.3%). We estimated direct and indirect paths between police mistrust and dietary quality (measured by Healthy Eating Index (HEI)-2015) through perceived stress, community connectedness, and subjective social status. Dietary quality was poor (mean HEI-2015 score was 50) and mistrust of police was high: 78% of participants either agreed or strongly agreed that something they say might be interpreted as criminal by the police due to their race/ethnicity. Police bias and low relatability was associated with lower perceived social status [Formula: see text]=  - 0.03 (95% confidence interval [CI]: - 0.05, - 0.01). Police bias and low relatability was marginally associated with low dietary quality β =  - 0.14 (95% CI: - 0.29, 0.02). Nineteen percent of the total association between police bias and low relatability and lower dietary quality β =  - 0.16 (- 0.01, - 0.31) was explained by an indirect association through lower community connectedness, or how close respondents felt with their community [Formula: see text] Police bias and low relatability may play a role in community connection, social status, and ultimately dietary disparities for Black Americans. Addressing police bias and low relatability is a continuing and pressing public health issue.

The Impact of Language on the Mental Health of Black Quebecers

Quebec's English-speaking Black community finds itself at the intersection of racial and linguistic discrimination, which presents challenges to mental wellness. The present study aims to add necessary detail to the conversations surrounding racism and mental health in Canada while including language as a determinant of health and intersecting element affecting the wellbeing of English-speaking Black Quebecers. We recruited 531 Black adults who are currently living in Quebec to complete a survey on various community-relevant items, including their mental and physical health, their experiences of discrimination, and barriers to accessing mental healthcare. Our analyses revealed that English-speaking participants experience more discrimination across all types and report more barriers to mental healthcare and lower mental health than their French-speaking counterparts. Furthermore, we found that language also had a mediated effect on mental health through discrimination and barriers to mental healthcare. Our study adds to the sparse race-based and intersectional literature about Black people in Canada and substantiates a mechanism by which language affects mental health by exposing Black Quebecers to more discrimination and thus higher barriers to care.

Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources

Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22-35), middle-aged (ages 36-49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.

Gender differences in perceived racism threat and activism during the Black Lives Matter social justice movement for Black young adults

A longitudinal study involving 455 Black young adults living in Canada investigated whether gender and autonomous motivation influenced the relationship between perceived racism threat and Black Lives Matter (BLM) activism, and whether BLM activism influenced life satisfaction over time. A moderated mediation analysis using PROCESS Macro Model 58 tested the indirect effect of autonomous motivation on the relationship between perceived racism threat and BLM activism varying by gender. Multiple linear regression assessed how well BLM activism predicted life satisfaction. Black women perceived greater racism threat than Black men related to increases in BLM activism via the influence of autonomous motivation. BLM activism had a positive influence on life satisfaction over time, regardless of gender. This research suggests Black young women are playing pivotal roles in the BLM movement and helps us understand how motivation may be influencing involvement and well-being in social justice issues.

COVID-19-Related Racial Discrimination during Lockdown and Its Impact on Asian American Women

During the lockdown period of the COVID-19 pandemic, Asian American (AA) women have experienced a surge in anti-Asian hate crimes and racial discrimination, and a majority of studies have quantitatively shown the negative impact of these incidents on Asian Americans' well-being. Our research expands on the existing literature by qualitatively investigating types of COVID-19-related racial discrimination during lockdown and its impacts on changes in emotions, behaviors, well-being, and racial identity development among AA women. This study covered two timepoints (December 2019 to May 2020) and the data were collected using an open-ended survey with 40 AA women. Thematic analysis identified core themes related to types of racial discrimination, emotional and behavioral changes, and racial identity status that emerged due to COVID-19-related racial discrimination experiences. The findings shed light on the long-lasting impacts of racial discrimination on AA women's overall well-being and dynamic development of racial identity. Altogether, our findings underscore the need for systematic forms of advocacy to combat anti-Asian racism and call for solidarity for AA women's well-being.

The Person Beneath the Hair: Hair Discrimination, Health, and Well-Being

Discrimination toward black hair is pervasive in today's society. Hair discrimination is negative bias manifested toward black natural or textured hair styles typically worn by persons of African descent. This commentary discusses the potential effects of hair discrimination on the health and well-being of persons of African descent. Specifically, it explores the mental and physical health implications of hair discrimination and situates it within the broader context of social determinants of health. The Creating a Respectful and Open World for Natural Hair Act has been recently passed in the United States House of Representatives, but more work is needed to eliminate hair discrimination and its negative effects.

Development and Implementation of a Maryland State Program Providing Hospital Payment Incentives for Reduction in Readmission Disparities

BACKGROUND

Social factors are a key determinant of hospital readmission. We describe the development of the country's first statewide policy providing hospitals with financial incentives to reduce readmission disparities.

OBJECTIVE

To describe the development and evaluation of a novel program that measures hospital-level disparity in readmission and rewards hospitals for improvement.

RESEARCH DESIGN

Observational study using inpatient claims.

PARTICIPANTS

Baseline data included 454,372 all-cause inpatient discharges in 2018 and 2019. Of the included discharges, 34.01% involved Black patients, 40.44% involved female patients, 33.1% involved patients covered by Medicaid, and 11.76% involved patients who were readmitted. Mean age was 55.18.

MEASURES

The key measure was the percentage change over time within the hospital in readmission disparity. Readmission disparity was measured using a multilevel model that gauged the association between social factors and readmission risk at a given hospital. Three social factors (Race, Medicaid coverage, and Area Deprivation Index) were combined into an index reflecting exposure to social adversity.

RESULTS

Of the State's 45 acute-care hospitals, 26 exhibited improved disparity performance in 2019.

LIMITATIONS

The program is limited to inpatients within a single state; the analysis does not provide evidence on the causal relationship between the intervention and readmission disparities.

CONCLUSION

This represents the first large-scale effort in the US to link disparities to hospital payment. Because the methodology relies on claims data, it could easily be adopted elsewhere. The incentives are directed to within-hospital disparities, thus mitigating concerns about penalizing hospitals with patients with greater social exposure. This methodology could be used to measure disparity in other outcomes.

Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic

The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.

"Could Be Even Worse in College": Social Factors, Anxiety, and Depressive Symptoms Among Black Men on a College Campus

Understanding mental health risks among Black men is a step forward in reducing health and educational disparities that are persistent in today's society. Semi-structured focus groups were conducted with 20 Black male undergraduate students from a college campus in the Southeast. The aim was to identify and understand the social and contextual factors impacting their risk of experiencing anxiety and depressive symptoms. A thematic analysis, theoretically grounded in the social-ecological model (SEM), was conducted, revealing three overarching themes: 1) what is known or felt about mental health 2) causes of stressors and 3) signs as symptoms. Discussions with men offered insight into their perspectives and personal experiences related to mental health issues and perceived risk factors. Themes suggest that the college transition, academic workload, perceived financial distress, and their desire and need to conform to ideals of masculinity were significant risk factors and stressors. Men offered descriptions of specific symptoms and health behaviors associated with such stress, including social isolation, anger, irritability, and changes in their own personal behaviors. Key findings paint a picture of college mental health experiences for some Black male college students. Moving forward, more research is needed to expand on this study's findings and improve mental health risk among this underserved population. Future directions are discussed alongside the results presented in this paper.

Are Distressed Black Women Also Depressed? Implications for a Mental Health Paradox

PURPOSE

Recent research suggests the determinants of and links between psychological distress and psychiatric disorder are distinct among Black Americans. Yet, these associations have not been explored among Black women, despite the unique social experiences, risks, and mental health patterns they face. The present study assessed the sociodemographic and psychosocial determinants of distress and disorder and evaluated the distress-disorder association, including whether it was conditional on sociodemographic and psychosocial characteristics among Black women.

METHODS

Data were from 328 Black women in the Nashville Stress and Health Study, a cross-sectional community epidemiologic survey of Blacks and Whites in Nashville, Tennessee, and was used to assess the correlates of distress (CES-D depressive symptoms scale) and major depressive disorder (MDD; based on the CIDI). Multinomial logistic regression models estimated the extent to which greater distress was associated with higher risk of "chronic" or "resolved MDD".

RESULTS

Stress exposure and marital status were associated with greater distress, while stress exposure and childhood SES were associated with elevated disorder risk. Although increased distress was associated with greater disorder risk, significant interactions indicated these associations depend on differences in age and adult socioeconomic status within this population.

CONCLUSIONS

This study identifies distinct correlates of distress and disorder and shows that the distress-disorder association varies among subgroups of Black women. Results have important implications for public health research and practice, as they highlight the factors that matter most for the mental health outcomes of Black women.