Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments

BACKGROUND AND AIMS

Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments.

STUDY DESIGN

PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review.

STUDY RESULTS

SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling.

CONCLUSIONS

Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.

Racial Identity and Mindfulness as Predictors of Posttraumatic Growth in Black Adults Experiencing Race-Based Trauma

Racial discrimination and race-based trauma (RBT) have led to the development of various negative psychological and physiological effects among Black adults in the USA. There is a lack of understanding in relation to how various psychosocial factors influence posttraumatic growth (PTG) in the context of RBT among Black adults. The authors examined associations of RBT, racial identity, and mindfulness with PTG among Black adults while controlling for gender, household income, and duration of trauma. The sample consisted of 134 self-identified Black adults who met the criteria for RBT from the USA. The hierarchical regression analysis showed the final model with all the predictors accounted for 35% of the total variance of PTG, with racial identity and mindfulness facets accounting for 26% of the variance. The study provides a foundation for future research addressing RBT and promoting PTG in Black adults.

The Relational Wear and Tear of Everyday Racism Among African American Couples

The wear and tear of adapting to chronic stressors such as racism and discrimination can have detrimental effects on mental and physical health. Here, we investigated the wider implications of everyday racism for relationship quality in an adult sample of 98 heterosexual African American couples. Participants reported on their experiences of racial discrimination and positive and negative affect for 21 consecutive evenings. Using dyadic analyses, we found that independently of age, gender, marital status, income, racial-discrimination frequency, neuroticism, and mean levels of affect, participants' relationship quality was inversely associated with their partner's negative affective reactivity to racial discrimination. Associations did not vary by gender, suggesting that the effects of affective reactivity were similar for men and women. These findings highlight the importance of a dyadic approach and call for further research examining the role of everyday racism as a key source of stress in the lives of African American couples.

Differentiating competency from content: Parental racial socialization profiles and their associated factors

For Black parents, the racial socialization (RS) process represents a critical parenting practice. Although the field has historically focused on the content of parents' RS, it is also important to consider caregivers' perception of their competence to effectively teach their children to navigate their racialized world. The present study investigated patterns of RS by exploring 332 Black caregivers' report of both content and competency. Using Latent Profile Analysis (LPA), we identified three profiles of RS: Multifaceted & More Competent (MMC), Unengaged & Moderately Competent (UModC), and Negative, Stressed, & Less Competent (NSLC). Additionally, we explored the role of several previously established correlates of parental RS, including sociodemographic factors (i.e., age, gender, and socioeconomic status), caregiving status (e.g., mother, father, and aunt), and parents' race-related experiences (i.e., history of RS, racial identity, and experiences with racial discrimination). Generally, the NSLC profile consisted of caregivers who were younger than those in the other two profiles, while those in the UModC profile tended to have younger children, relatively. Interestingly, caregivers in the UmodC profile reported receiving significantly less RS in childhood and experienced less racial discrimination than those in the other two profiles. Numerous differences were found across profiles for dimensions of racial identity. The emergence of these varied profiles, as well as the identification of factors that differentiated them, extends our understanding of RS and highlights the importance of considering parents' notions of feeling confident, skillful, and less stressed as they navigate such a vital developmental process for their children.

Experiences of Discrimination and Urinary Catecholamine Concentrations: Longitudinal Associations in a College Student Sample

BACKGROUND

Experiences of discrimination are a risk factor for subsequent cardiovascular disease. However, there is a lack of longitudinal research examining associations between discrimination and urinary catecholamines. This is surprising given the likely mediating role of sympathetic nervous system dysregulation in the association between psychosocial stress and cardiovascular morbidity.

PURPOSE

The current study examined the 3 year longitudinal association between experiences of discrimination and urinary catecholamines.

METHODS

The sample included 149 college students (mean age at baseline = 18.8, standard deviation = 0.96; 45% Black/African American; 55% White/European American). Concentrations of epinephrine and norepinephrine-urinary catecholamines with established links to psychosocial stress exposure and subsequent morbidity-were determined from 12 hr overnight samples.

RESULTS

Results indicated that experiences of discrimination were associated with increases in both epinephrine (β = .284, standard error [SE] = .117, p = .015) and norepinephrine (β = .306, SE = .114, p = .001). These longitudinal associations persisted after adjusting for negative affect, depression, and rejection sensitivity and did not vary as a function of race/ethnicity.

CONCLUSIONS

Results suggest that examination of overnight urinary catecholamines as a biological mediator of associations between experiences of discrimination and cardiovascular morbidity is warranted.

Interrupting the Pathway From Discrimination to Black Adolescents' Psychosocial Outcomes: The Contribution of Parental Racial Worries and Racial Socialization Competency

Racial discrimination can lead to psychosocial problems for Black adolescents, including internalization (e.g., depression) and externalization (e.g., conduct problems). Black parents (N = 186; M_age  = 42.9) of adolescents (ages 10-18) were assessed to investigate how parental worries and racial socialization competency (i.e., confidence, skills, and stress) contribute to the association between parental discrimination experiences and their adolescents' psychosocial problems. Mediation analyses indicated that the total direct models with discrimination, worries, and problems had good fit, and that the addition of worry mediated the discrimination-problems association. Furthermore, racial socialization competency moderated the association between worry and problems, wherein greater competency was associated with less impact of worry on problems. Findings illuminate potential intervention targets for buffering discrimination's influence on adolescents' psychosocial functioning.

Police Brutality and Mistrust in Medical Institutions

BACKGROUND

People bring the social contexts of their lives into the medical encounter. As a social determinant of health, police brutality influences physical and mental health. However, negative experiences with institutions such as law enforcement might decrease trust in other institutions, including medical institutions. Mistrust might limit engagement with the healthcare system and affect population health. This study investigates the relationship between police brutality and medical mistrust and assesses whether it varies by race.

BASIC PROCEDURES

Data were obtained from a 2018 cross-sectional survey of adults living in urban areas in the USA (N = 4389). Medical mistrust was regressed on police brutality (experiences and appraisal of negative encounters with the police), controlling for socio-demographics, health status, and healthcare access. Means of mistrust were predicted by racial group after including interactions between police brutality and race.

MAIN FINDINGS

Respondents who had negative encounters with the police, even if they perceived these encounters to be necessary, had higher levels of medical mistrust compared to those with no negative police encounters. Police brutality increased mistrust for all racial groups.

PRINCIPAL CONCLUSIONS

Conditions outside the medical system such as experiencing police brutality impact relationships with the medical system. Given that clinicians are in a unique position of having access to firsthand information about the struggles and injustices that shape their patients' health, advocating for systemic change on behalf of their patients might build trust.

The Portuguese Version of the Schedule of Racist Events

OBJECTIVE

There is a lack of research tools in Portuguese to evaluate racial discrimination. The purpose of this study was to psychometrically assess the Portuguese version of the Schedule of Racist Events (SRE) in a sample of individuals enrolled in a research trial with antiretroviral medications in southern Brazil.

METHODS

Sample of 147 individuals living with HIV and/or AIDS. Research participants completed the Schedule of Racist Events and the WHOQOL-HIV BREF questionnaires.

RESULTS

The SRE scores of non-white participants were significantly higher than the scores of white-participants. The Crombach's alpha coefficients, for the three subscales of the Portuguese version of the SRE, were high and significant. There were significant correlations between all subscales of the SRE and relevant domains of the WHOQOL-HIV BREF.

CONCLUSION

The original English version of the SRE was successfully adapted to Portuguese. The Portuguese version of SRE constitutes a valid research instrument for evaluating racial discrimination.

Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans

PURPOSE OF REVIEW

Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health.

RECENT FINDINGS

Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.

Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults

Introduction

Methods

Results

Conclusions

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Reports of health care discrimination were common in a national sample of older adults.

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Reported health care discrimination was associated with elevated CRP and HbA1c.

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Interactions between health care discrimination and race/ethnicity were detected for HbA1c.

Affective reactivity to daily racial discrimination as a prospective predictor of depressive symptoms in African American graduate and postgraduate students

This study examined whether individual differences in affective reactivity, defined as changes in positive or negative affect in response to daily racial discrimination, predicted subsequent depressive symptoms. Participants were African American graduate and postgraduate students (N = 174; M age = 30 years) recruited for a measurement-burst study. Data on depressive symptoms were gathered at two assessment points 1 year apart. Affective reactivity data was obtained from participants via a 14-day diary study of daily racial discrimination and affect. Participants who experienced pronounced increases in negative affect on days when racial discrimination occurred had elevated depressive symptoms 1 year later. Heightened positive affect reactivity was also associated with more depressive symptoms at follow-up. The results suggest that affective reactivity (either greater increases in negative affect or greater decreases in positive affect in the context of racial discrimination) may be an underlying psychological mechanism that confers vulnerability to future depressive symptoms.

Microaggressions and Ethnic Identity in the Career Development of Latina College Students

Counseling psychologists have noted the importance of examining the intersection of sociocultural identity and vocational psychology. In our study, we considered this intersection in a sample of 202 Latina college and graduate students from a perspective informed by social cognitive career theory. We examined how ethnic identity and experiences of self-reported microagressions were related to career decision self-efficacy and outcome expectations, including relationships to both positive and negative outcome expectations in our model. Findings indicated that higher endorsement of ethnic identity was positively related to career decision self-efficacy and to negative outcome expectations, whereas higher endorsement of experiences of microaggressions was related to lower career-decision self-efficacy, greater negative outcome expectations, and lower positive outcome expectations. Career decision self-efficacy was associated with lower negative outcome expectations and higher positive outcome expectations. Indirect relationships and two alternative models were also explored. We discuss implications for future research and career counseling with Latinas.

Addressing the Mental Health Needs of Black American Youth and Families: A Case Study from the EMBRace Intervention

Black American youth are vulnerable to the consequences of repeated exposure to racial discrimination, particularly through hampered coping abilities and greater internalizing and externalizing problems. One way in which Black American parents have protected their children from these deleterious consequences is through racial socialization, or communication regarding aspects of racialized experiences and contexts. Less is known, however, about the potential therapeutic benefits of racial socialization via clinical intervention. The five-week Engaging, Managing, and Bonding through Race (EMBRace) racial socialization intervention was developed to enhance coping strategies for parents and adolescents and reduce adolescent internalizing and externalizing problems. The purpose of this study is to describe a case study of one family through a mixed methods approach. Variables of interest included racial discrimination, racial socialization, coping, and psychological well-being. Quantitative and qualitative assessments were performed two weeks prior to and one week after the implementation of EMBRace, with qualitative data collected throughout the intervention. Results indicate a developing sense of coping for the adolescent and parent and reduced adolescent psychosocial problems despite increased racialized stress. Results will be used to further investigate the hypotheses proposed in the pilot with a powered sample, and future studies will explore how sociodemographic and biopsychosocial variables relate to policy recommendations, program implementation, and psychosocial outcomes.

Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions

BACKGROUND

Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings.

METHODS

For Black, White, and Hispanic respondents with chronic disease in the 2008-2014 Health and Retirement Study (N = 13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals ("never" vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+ .

RESULTS

The estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27% (95% CI: 23, 30) in 2008 and declined to 20% (95% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17%, 95% CI: 16, 19 in 2014). The Black-White difference in reporting any health care discrimination declined from 8.2% (95% CI: 4.5, 12.0) in 2008 to 2.5% (95% CI: -1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination.

CONCLUSIONS

Findings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.

Interethnic Group and Intraethnic Group Racism: Perceptions and Coping in Black University Students

This study explored perceived racism and the usual ways of coping with these perceptions in a sample of 269 Black university students (53% female). Perceptions of inter- and intragroup racism were assessed with the Life Experiences and Stress scale, and coping was measured with the Coping Orientations to Problems Experienced scale. A principal component analysis suggested that inter- and intragroup racism were separable constructs. Correlation analyses revealed that inter- and intragroup racism were negatively associated with self-deception.Relative to females, t-test analyses indicated that males perceived more inter- and intragroup racism. The t-test analyses also revealed that females were more likely than males to use emotion-focused and religious coping responses, when negotiating perceptions of inter- and intragroup racism; and, when negotiating perceptions of intragroup racism, males were more likely than females to use alcohol as a coping response. The limitations of the study and directions for future research are discussed.

Perceived Racism as a Predictor of Paranoia Among African Americans

Recent theoretical models suggest that perceived racism acts as a stressor for African Americans and may be associated with a variety of negative psychological consequences, notably paranoia. Paranoia among African Americans is believed to reflect the lower end of the paranoia continuum based on experiences with racism. Thus, it may be beneficial to measure paranoia on a continuum, but few studies have adopted this strategy. This study examined the relationship between perceived racism and paranoia across the continuum in 128 African American college students. Participants completed three measures of paranoia and measures of perceived racism, depression, anger, self-consciousness, and hostile perceptions. The continuum of paranoia included measures reflecting cultural, nonclinical, and clinical paranoia. Perceived racism predicted cultural mistrust and nonclinical paranoia (lower end of the paranoia continuum) but not clinical paranoia. The implications of perceived racism in the prediction of paranoia for African Americans are discussed.

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.

Cross-Validation of the Schedule of Racist Events

This article presents a cross-validation study of the Schedule of Racist Events (SRE), a brief inventory that assesses the frequency of various types of racist dis-crimination in Blacks’lives. A new, larger, more representative sample of 520 Af-rican Americans residing in 10 randomly-selected southern California census tracts completed the SRE and a measure of psychiatric symptoms. Results re-vealed that 96% of Blacks reported experiencing some type of racist discrimina-tion in the past year, 98% reported experiencing racism at some point in their lives, and 95% found racism to be stressful. Factor analyses revealed that all items in the SRE subscales load on a single factor, and reliability and validity co-efficients were high and were similar to those previously reported. Participants’ reports of the frequency of racism in their lives were unrelated to participants’ age, social class, and education, but were related to gender, with men reporting more frequent racism than women. Experiencing racism was strongly related to total psychiatric symptoms. This cross-validation study provides further evi-dence on the reliability and validity of the SRE.

Internalized Racial Oppression and Higher Education Values

A plethora of research underscores the deleterious effects that racial discrimination can have on the higher education pursuits and experiences of African Americans. The current study investigated the relationship between internalized racial oppression, higher education values, academic locus of control, and gender among a sample of African Americans. Participants were 156 African Americans currently attending college. All participants completed measures of internalized racial oppression, perceived value of higher education, and academic locus of control. Results indicated that greater internalized racial oppression correlated with a lower valuing of higher education and a more external academic locus of control. Subsequent mediational analyses showed that academic locus of control was an intervening variable in the relationship between internalized racial oppression and the value placed on higher education for men, but not women. For African American men, greater experiences of internalized racial oppression predicted a more external locus of control, which subsequently predicted a lower valuing of higher education. Implications for mental health providers and educators were discussed herein.

Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study

Perceived racial discrimination (PRD) has been associated with altered diurnal cortisol rhythms in past cross-sectional research. We investigate whether developmental histories of PRD, assessed prospectively, are associated with adult diurnal cortisol profiles. One-hundred and twelve (N=50 Black, N=62 White) adults from the Maryland Adolescent Development in Context Study provided saliva samples in adulthood (at approximately age 32 years) at waking, 30min after waking, and at bedtime for 7 days. Diurnal cortisol measures were calculated, including waking cortisol levels, diurnal cortisol slopes, the cortisol awakening response (CAR), and average daily cortisol (AUC). These cortisol outcomes were predicted from measures of PRD obtained over a 20-year period beginning when individuals were in 7th grade (approximately age 12). Greater average PRD measured across the 20-year period predicted flatter adult diurnal cortisol slopes for both Black and White adults, and a lower CAR. Greater average PRD also predicted lower waking cortisol for Black, but not White adults. PRD experiences in adolescence accounted for many of these effects. When adolescent and young adult PRD are entered together predicting cortisol outcomes, PRD experiences in adolescence (but not young adulthood) significantly predicted flatter diurnal cortisol slopes for both Black and White adults. Adolescent, but not young adult PRD, also significantly predicted lower waking and lower average cortisol for Black adults. Young adult PRD was, however, a stronger predictor of the CAR, predicting a marginally lower CAR for Whites, and a significantly larger CAR for Blacks. Effects were robust to controlling for covariates including health behaviors, depression, income and parent education levels. PRD experiences interacted with parent education and income to predict aspects of the diurnal cortisol rhythm. Although these results suggest PRD influences on cortisol for both Blacks and Whites, the key findings suggest that the effects are more pervasive for Blacks, affecting multiple aspects of the cortisol diurnal rhythm. In addition, adolescence is a more sensitive developmental period than adulthood for the impacts of PRD on adult stress biology.

Social Cognitive Career Theory, the Theory of Work Adjustment, and Work Satisfaction of Retirement-Age Adults

Despite a recent increase in the number of adults who work past traditional retirement age, existing theories of vocational behavior have not yet received adequate empirical support. In a large sample of adults age 60-87, we evaluated the relationship between theorized predictors of work satisfaction proposed by Social Cognitive Career Theory (SCCT), work satisfaction as a predictor of continued work, as proposed by the Theory of Work adjustment (TWA), as well as the influence of reported experiences of discrimination on these relationships. While the results supported most of the predicted relationships, the effects of discrimination were stronger than the variables proposed by either SCCT or TWA for the present sample.

Effects of Perceived Discrimination and Length of Residency on the Health of Foreign-Born Populations

This study explores the relationship between chronic conditions, perceived discrimination, and length of residency among three racial groups of foreign-born respondents: Afro-Caribbean, Asian, and Latino Americans. Analysis utilized Collaborative Psychiatric Epidemiology Surveys (CPES) merged data from the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). Afro-Caribbean subgroups were more likely than Asian and Latino American subgroups to report perceived discrimination. Logistic regression analysis was conducted to determine which groups within the model were more likely to report chronic health conditions. Perceived discrimination was found to vary by race and was inversely associated with chronic respiratory conditions for Afro-Caribbeans. In general, years of US residency were associated with health across all chronic conditions where those in the USA longer were more likely to experience health-related problems. Perceived discrimination revealed mixed results.

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.

Development and Validation of the Prolonged Activation and Anticipatory Race-Related Stress Scale

This article describes two separate studies that were conducted to develop and validate a measure of the prolonged stress activation and anticipatory race-related stress response in African American adults (Prolonged Activation and Anticipatory Race-Related Stress Scale [PARS]). In Study 1, an exploratory factor analytic procedure ( N = 292) resulted in a17-item measure with four underlying factors: (a) Perseverative Cognition, (b) Secondary Appraisal, (c) Anticipatory Race-Related Stress Scale–Psychological, and (d) Anticipatory Race-Related Stress Scale–Physiological. In Study 2 ( N = 227), a confirmatory factor analytic procedure was conducted to evaluate and compare the underlying factor structure for several competing models of the PARS. This procedure supported a four-factor oblique solution as having the best fit to the data. Study 2 also provided evidence for the convergent validity of the PARS in that its factor scores correlated, in the anticipated direction, with scores on measures of related constructs.

Impact of Racial Macro- and Microaggressions in Black Women’s Lives

Most studies on perceived racial discrimination do not differentiate between macroaggressions (i.e., overt, purposeful discrimination) and microaggressions (i.e., subtle, typically unconscious discrimination) or examine gender. This study addresses these gaps by exploring: (a) the prevalence of perceived racial macroaggressions (PRMa) and perceived racial microaggressions (PRMi) in Black women’s lives and (b) how PRMa and PRMi influence depressive and anxious symptoms in this group. Participants were 187 undergraduate students who self-identified as Black women. Sixty-three percent of the participants reported experiencing some type of PRMa at least once in a while during the past year, and 96% reported experiencing some type of PRMi at least a few times a year. As hypothesized, PRMa and PRMi significantly predicted depressive symptoms; however, PRMa made a stronger unique contribution. Contrary to hypotheses, PRMa but not PRMi significantly predicted anxious symptoms. Findings suggest that PRMa and PRMi are common occurrences for Black women and are associated with negative mental health outcomes, with PRMa being the less common but more detrimental of the two.

Sense of belonging in secondary schools: a survey of LGB and heterosexual students in Flanders

This study focuses on differences in sense of belonging between lesbian, gay, and bisexual (LGB) and heterosexual students. Data from 1,745 secondary school students were collected with an online survey. Step-wise multiple regression analyses was used to investigate the relationship between sexual orientation and sense of school belonging. The results show that sexual orientation has an impact on sense of belonging for girls, but not for boys. Perceived discrimination and LGB friendliness of the school appeared to be important indicators of sense of belonging for all the respondents, irrespective of their sexual orientation.

Racial Discrimination and Resilience in African American Young Adults: Examining Racial Socialization as a Moderator

Research has indicated that racial discrimination places African Americans at risk for psychological distress, in which they experience low levels of well-being. Yet many African Americans are resilient, or have preserved well-being, when faced with this adversity. Using a strength-based approach, this study determined whether racial socialization messages preserved African Americans’ resilience when experiencing racial discrimination. Results with a sample of 290 young adult African American college students indicated that overall racial socialization messages, as well as specific messages to appreciate cultural legacy, moderated the relationship between racial discrimination and resilience. As expected, racial discrimination was negatively related to resilience for students who reported fewer racial socialization messages, and racial discrimination was no longer negatively associated with resilience for students reporting a greater number of these messages. Additionally, racial socialization messages predicted unique variance in resilience.

Racial discrimination and health: a systematic review of scales with a focus on their psychometric properties

The literature addressing the use of the race variable to study causes of racial inequities in health is characterized by a dense discussion on the pitfalls in interpreting statistical associations as causal relationships. In contrast, fewer studies have addressed the use of racial discrimination scales to estimate discrimination effects on health, and none of them provided a thorough assessment of the scales' psychometric properties. Our aim was to systematically review self-reported racial discrimination scales to describe their development processes and to provide a synthesis of their psychometric properties. A computer-based search in PubMed, LILACS, PsycInfo, Scielo, Scopus and Web of Science was conducted without any type of restriction, using search queries containing free and controlled vocabulary. After initially identifying 3060 references, 24 scales were included in the review. Despite the fact that discrimination stands as topic of international relevance, 23 (96%) scales were developed within the United States. Most studies (67%, N = 16) were published in the last 12 years, documenting initial attempts at scale development, with a dearth of investigations on scale refinements or cross-cultural adaptations. Psychometric properties were acceptable; sixteen of all scales presented reliability scores above 0.7, 19 out of 20 instruments confirmed at least 75% of all previously stated hypotheses regarding the constructs under consideration, and conceptual dimensional structure was supported by means of any type of factor analysis in 17 of 21 scales. However, independent researchers, apart from the original scale developers, have rarely examined such scales. The use of racial terminology and how it may influence self-reported experiences of discrimination has not yet been thoroughly examined. The need to consider other types of unfair treatment as concurrently important health-damaging exposures, and the idea of a universal instrument which would permit cross-cultural adaptations, should be discussed among researchers in this emerging field of inquiry.

Acculturation, Enculturation, Perceived Racism, Minority Status Stressors, and Psychological Symptomatology Among Latino/as

The purpose of this study was to examine the possible relations between perceived racism and minority status stressors as experienced by Latino/ as and their mental health functioning, as operationalized in terms of somatization, anxiety, and hostility. In addition, the potentially protective moderating role of enculturation and potentially harmful moderating role of acculturation on these relationships were investigated. As hypothesized, the results indicated that perceived racism and minority status stressors were positively correlated with somatization, anxiety, and hostility. Although enculturation did moderate the relationship between perceived racism and minority status stressors and anxiety and hostility, it was in an unexpected direction. Results did not indicate that acculturation played a moderator role.

A Meta-Study of Black Male Mental Health and Well-Being

Aggregating and interpreting available qualitative data is a necessary next step to understanding the mental health needs and experiences of Black men. This study describes the findings from a meta-synthesis of qualitative research on Black men’s mental health and well-being using Paterson, Thorne, Canam, and Jillings’s qualitative meta-study approach. Though previous studies have reported various forms of racism as salient concerns for Black men’s mental health and well-being, findings from this meta-study revealed seven themes that present an initial step toward advancing the knowledge pertaining to how Black men perceive and express their mental health and well-being. For instance, male gender socialization and economic status were found to play as large a role in Black men’s mental health and well-being as racism. Additional theoretical perspectives are proposed, and implications for clinical practice and research are discussed.

Racism, Parent Support, and Math-Based Career Interests, Efficacy, and Outcome Expectations Among African American Adolescents

Using an extended model of social cognitive career theory, this study investigated ways in which African American middle school adolescents perceive racism and the associations among various aspects of perceptions of racism, other background factors, and math-based career interests, efficacy, and outcome expectations. Results indicated that African American adolescents clearly delineated among various types of interpersonal and institutional racism. Results also showed that various types of perceived racism were negatively associated with math efficacy and outcome expectations but positively associated with math and science interests. Greater interests in math were negatively related to poor academic performance, which in turn was negatively related to lack of peer support. Math outcome expectations was positively related to math efficacy and parent support. Adolescents who had lower academic performance also received greater parental support. The authors suggest that perceptions of racism be included as a factor in studies that examine the development of math/science interests among African American middle school adolescents.

The Impact of Everyday Racism on the Occupations of African Canadian Women

Background. Occupational therapy has increasingly explored the impact of cultural differences on occupations but has not yet begun to explore the impact of racism on human occupation. Purpose. This study with 50 African Canadian women used mixed methods to explore the effects of racism on their occupational experiences. Methods. Women aged 40–65 were interviewed in-depth about everyday experiences with racism and overall well-being. Three standardized instruments assessed frequency and stressfulness of race-related experiences. Findings. Everyday racism had subtle, almost intangible, impacts, shaping women's engagement with and the meaning of leisure, productive, and caring occupations. Implications. As occupational therapy increasingly attends to issues of cultural difference, it is critical to also attend to racism. This means learning to ask thoughtful questions about how racism may shape clients' occupations. Attention to this aspect of the social environment will enhance practice with African-heritage clients and clients from other racial minority groups.

Differences in the self-reported racism experiences of US-born and foreign-born Black pregnant women

Differential exposure to minority status stressors may help explain differences in United States (US)-born and foreign-born Black women's birth outcomes. We explored self-reports of racism recorded in a survey of 185 US-born and 114 foreign-born Black pregnant women enrolled in Project Viva, a prospective cohort study of pregnant women in Boston, Massachusetts, USA. Self-reported prevalence of personal racism and group racism was significantly higher among US-born than foreign-born Black pregnant women, with US-born women having 4.1 and 7.8 times the odds, respectively, of childhood exposure. In multivariate analyses, US-born women's personal and group racism exposure also was more pervasive across the eight life domains we queried. Examined by immigrant subgroups, US-born women were more similar in their self-reports of racism to foreign-born women who moved to the US before age 18 than to women who immigrated after age 18. Moreover, US-born women more closely resembled foreign-born women from the Caribbean than those from Africa. Differential exposure to self-reported racism over the life course may be a critically important factor that distinguishes US-born Black women from their foreign-born counterparts.

Racism and child health: a review of the literature and future directions

OBJECTIVE

Racism is a mechanism through which racial/ethnic disparities occur in child health. To assess the present state of research into the effects of racism on child health, a review of the literature was undertaken.

METHODS

A MEDLINE review of the literature was conducted between October and November 2007. Studies reporting on empirical research relating to racism or racial discrimination as a predictor or contributor to a child health outcome were included in this review. The definition of "child health" was broad and included behavioral, mental, and physical health.

RESULTS

Forty articles describing empirical research on racism and child health were found. Most studies (65%) reported on research performed on behavioral and mental health outcomes. Other areas studied included birth outcomes, cardiovascular and metabolic diseases, and satisfaction with care. Most research has been conducted on African-American samples (70%), on adolescents and on older children, and without a uniformly standardized approach to measuring racism. Furthermore, many studies used measures that were created for adult populations.

CONCLUSIONS

There are a limited number of studies evaluating the relationship between racism and child health. Most studies, to date, show relationships between perceived racism and behavioral and mental health. Future studies need to include more ethnically diverse minority groups and needs to consider studying the effects of racism in younger children. Instruments need to be developed that measure perceptions of racism in children and youth that take into account the unique contexts and developmental levels of children, as well as differences in the perception of racism in different ethnocultural groups. Furthermore, studies incorporating racism as a specific psychosocial stressor that can potentially have biophysiologic sequelae need to be conducted to understand the processes and mechanisms through which racism may contribute to child health disparities.

Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective

Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the "battered child syndrome" dramatically increased attention to-and prompted new research on-the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.

Racial/ethnic discrimination and health: findings from community studies

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Structures of the Schedules of Racist and Sexist Events: Confirmatory Factor Analyses of African American Women's Responses

Use of the Schedule of Racist Events (SRE; Landrine & Klonoff, 1996 ) and the Schedule of Sexist Events (SSE; Klonoff & Landrine, 1995 ) has advanced research on experiences of perceived racism and sexism. The present study responds to calls for further investigation of the structural properties of data from these instruments and is the first study to do so using (a) responses of African American/Black women ( N = 246) and (b) confirmatory factor analysis. Regarding the SRE, results supported the unidimensional structures reported by Klonoff and Landrine (1999) for SRE Lifetime, SRE Recent, and SRE Appraisal data. Regarding the SSE, results supported the two-factor structures for SSE Lifetime and SSE Appraisal data and the three-factor structure for SSE Recent data derived by Matteson and Moradi (2005) . Thus, the present results support the structural stability of SRE and SSE data with African American/Black women and can inform future use of these measures with this population.

Interactive effects of perceived racism and coping responses predict a school-based assessment of blood pressure in black youth

BACKGROUND

Research indicates that perceived racism and coping responses are associated with basal blood pressure (BP) levels and BP reactivity in Black adults. No study could be found, however, that has explored the independent and interactive effects of perceived racism and coping responses in a cohort who probably has the greatest risk of developing primary hypertension--Black youth.

PURPOSE

This study examined the relationship of perceived racism and coping responses to a continuous measure of BP and to a categorical measure of BP status (normal vs. high-normal or high).

METHODS

The convenience sample consisted of 217 Black youth (M age = 11.4 years, SD = 1.3). Participants reported on perceived racism and coping responses (Accepting It, Self-Blame, Taking Action, and Talking to Someone). BP was assessed with an automated monitor in school.

RESULTS

Approximately 32% of the sample had average BP levels that were high-normal or high. Hierarchical linear and logistic regression analyses were used to assess the predictive utility of perceived racism and the four coping responses to the continuous and categorical BP assessments. Although perceived racism and the coping response variables did not emerge as significant independent predictors in the linear or logistic regression analyses, perceived racism interacted with Accepting It (p = .009) in the linear regression analysis predicting systolic BP. Follow-up linear regression analyses indicated that perceived racism was not significantly associated with systolic BP among participants low in Accepting It but was inversely related to systolic BP among participants high in Accepting It. Perceived racism also interacted with Accepting It (p = .016) and Talking to Someone (p = .0009) in the logistic regression analysis predicting BP status. Follow-up logistic regression analyses revealed that (a) perceived racism was not significantly associated with BP status among participants low in Accepting It but was inversely related to BP status among participants high in Accepting It, and (b) perceived racism was inversely associated with BP status among participants low in Talking to Someone but was not significantly related to BP status among participants high in Talking to Someone.

CONCLUSIONS

The contribution of environmental and psychosocial factors to hypertension risk should be considered when exploring correlates of continuous and categorical assessments of BP in Black youth.