From identity-based distress to thinking "I am better off being dead:" Minority stress, posttraumatic cognitions, and suicidal ideation

BACKGROUND

Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress - i.e., traumatic, insidious distress that results from acts of discrimination - may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI.

METHODS

Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337).

RESULTS

Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions.

LIMITATIONS

Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used.

CONCLUSIONS

Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality.

The emotional impact of baseless discrediting of knowledge: An empirical investigation of epistemic injustice

According to theoretical work on epistemic injustice, baseless discrediting of the knowledge of people with marginalized social identities is a central driver of prejudice and discrimination. Discrediting of knowledge may sometimes be subtle, but it is pernicious, inducing chronic stress and coping strategies such as emotional avoidance. In this research, we sought to deepen the understanding of epistemic injustice's impact by examining emotional responses to being discredited and assessing if marginalized social group membership predicts these responses. We conducted a novel series of three experiments (Total N = 1690) in which participants (1) shared their factual knowledge about how a game worked or their personal feelings about the game; (2) received discrediting feedback (invalidating remarks), validating feedback (affirming remarks), or insulting feedback (general negative social evaluation); and then (3) reported their affect. In all three studies, on average, affective responses to discrediting feedback were less negative than to insulting feedback, and more negative than to validating feedback. Participants who shared their knowledge reported more negative affect after discrediting feedback than participants who shared their feelings. There were consistent individual differences, including a twice-replicated finding of reduced negative affect after receiving discrediting and insulting feedback for Black men compared to White men and women and Black women. Black men's race-based traumatic symptom scores predicted their affective responses to discrediting and insulting feedback, suggesting that experience with discrimination contributed to the emotional processing of a key aspect of epistemic injustice: remarks conveying baseless discrediting of knowledge.

Using Network Analysis to Assess the Effects of Trauma, Psychosocial, and Socioeconomic Factors on Health Outcomes Among Black Women Living with HIV

Black women living with HIV (BWLWH) face intersectional adversities impacting their wellbeing. This study utilized network analysis to assess the associations among adversities linked to racism, sexism, HIV stigma, and socioeconomic status (income, housing, education) and determine which adversities predict mental health outcomes, HIV viral load, and medication adherence more consistently among BWLWH. 119 BWLWH aged 18 years or older completed self-report measures on sociodemographics, adversity factors, and mental health outcomes. Viral load count was obtained through blood draws, and medication adherence was measured via Wisepill adherence monitoring device. Multiple regression analysis was used to assess if the more central factors in the network also predicted health outcomes more consistently than the less central factors. The four most central factors in the network were income, housing, gendered racial microaggression (GRM) frequency, and GRM appraisal. Multiple regression analysis revealed that GRM frequency, GRM appraisal, and the number of traumas contributed uniquely and were positively associated with both depressive symptoms and posttraumatic stress disorder symptoms. HIV-related discrimination contributed uniquely and was positively associated with HIV viral load.

Representation of Asian American Populations in Medical School Curricula

Importance

Despite being one of the fastest-growing populations in the US, the Asian American population is often misrepresented in and omitted from health research and policy debate. There is a current lack of understanding of how Asian American populations are portrayed in medical school curricula.

Objective

To assess how Asian American populations and their subgroups are represented in medical school curricula.

Design, Setting, and Participants

In this qualitative study, the content of 632 lectures from all 19 courses of the preclinical curriculum at a single US institution from the academic year 2020 to 2021 was analyzed to identify and characterize unique mentions of race and ethnicity as well as granular ethnicity. Among the 632 lectures, we identified 256 nonrepetitive, unique mentions of race and ethnicity or granular ethnicity. These unique mentions were coded and analyzed for emerging patterns of use.

Main Outcomes and Measures

Study outcomes included (1) the frequency of specific racial and ethnic categories mentioned in the curriculum, (2) the relative proportion of mentions of race and ethnicity that involved or included Asian American data by courses and context, and (3) key themes representing emerging patterns found from qualitative analysis of curriculum content for mentions of Asian American populations or lack thereof.

Results

Among the 632 lectures, 256 nonrepetitive mentions of race and ethnicity or granular ethnicity were identified; of these, Asian American populations and/or their subgroups were mentioned in 79 of the instances (30.9%). The most common terms used to denote Asian American populations were Asian, with 36 mentions (45.6%); followed by Japanese, with 10 mentions (12.7%); and Chinese, with 8 mentions (10.1%). Overall, there were 26 mentions (10.2%) of American Indian or Alaska Native populations, 12 mentions (4.7%) of Asian and Pacific Islander or Asian American and Pacific Islander populations, 67 mentions (26.2%) of Asian or Asian American populations, 143 mentions (55.9%) of Black or African American populations, 62 mentions (24.2%) of Hispanic or Latino populations, 4 mentions (1.6%) of Native Hawaiian or Pacific Islander populations, and 154 mentions (60.2%) of White populations. During the analysis of the curriculum for representation of Asian American populations, the following 5 key themes emerged from the data: (1) omission, (2) aggregation, (3) inconsistent categorization, (4) misidentification of granular ethnicity, and (5) association of race and ethnicity with disease.

Conclusions and Relevance

This qualitative study suggests that the curriculum from a single US medical school largely mirrors the inappropriate use of race and ethnicity found in published health literature and clinical guidelines. Solutions with long-term results will require collaboration among diverse groups of interest to adopt inclusive research programs and design. Such solutions could better equip students in combating race-based medicine and could promote community outreach programs built based on trust.

Microaggressions, Everyday Discrimination, Workplace Incivilities, and Other Subtle Slights at Work: A Meta-Synthesis

Subtle slights refer to a wide range of ambiguous negative interactions between people that may harm individual health, wellbeing and performance at work. This literature review aims to help human resource development practitioners and researchers understand the similarities and distinguishing features of disparate bodies of subtle slight research. A systematic review yielded 338 papers, the majority of which concerned three constructs: microaggressions, everyday discrimination and workplace incivilities. Meta-synthesis revealed that all three categories related to subtle, low-intensity interactions but differed in their descriptions of the type of perceived violation. The most common demographic factors under scrutiny were race or ethnicity, gender, sexual orientation, and age. We propose a framework that involves four dimensions common to all subtle slights: type of violation, intensity, duration and intent (VIDI). This framework may help future efforts to understand, monitor and address this issue of contemporary concern in the workplace.

The Effects of Microaggressions on Depression in Young Adults of Color: Investigating the Impact of Traumatic Event Exposures and Trauma Reactions

Microaggressions are a common way that individuals experience racism in the United States. The current study examined the extent to which microaggressions contribute to mental health difficulties, namely trauma reactions and depression, after controlling for other traumatic event exposures. We sought to address gaps in the literature by quantitatively assessing the associations among microaggressions, posttraumatic stress symptoms, and depression symptoms. Participants were 140 young adults of color (68.8% female) who were recruited online. Linear regression analyses evidenced that microaggressions were uniquely associated with depression symptoms, B = 0.27, after controlling for lifetime traumatic event exposures, with this association partially mediated by trauma reactions, B = 0.49. These results suggest that microaggressions are a clinically relevant factor in understanding mental health problems reported by Black, Indigenous, and People of Color in the United States and warrant analysis, assessment, and intervention through a trauma lens.

Race, social pain minimization, and mental health

People often believe Black individuals experience less social pain and require less social support to cope with distress than White individuals (e.g., Deska, Kunstman, Lloyd, et al., 2020). However, researchers have not tested whether biases in third-person pain judgments translate to first-person experiences with social pain minimization. For example, do Black individuals feel their social pain is underrecognized to a greater extent than White individuals? The current work tested whether Black individuals felt their social pain was minimized more than White individuals and if the experience of social pain minimization was related to worse mental health and greater life stress. Data from two cross-sectional, correlational studies provide initial support for these predictions ( Ntotal = 1,501). Black participants felt their social pain was minimized more than White participants and this race difference in social pain minimization was associated with worse mental health and greater life stress. These results suggest that Black individuals feel their pain is underrecognized and this experience of social pain minimization is related to worse mental health outcomes.

'You Learn How to Hate': Adapting a Healthy Relationship Curriculum Using a Trauma-Informed Race Equity Lens

Teen dating violence is a public health concern that can lead to short- and long-term mental and physical health consequences, including depression, anxiety, risky behaviors, and unhealthy future relationships. Research shows that social and structural determinants of health, such as racism, low socio-economic status, and neighborhood conditions, may predispose certain communities to violence. To better understand methods to reduce TDV among ethnically and economically diverse populations, we used a trauma-informed race equity lens to adapt an efficacious prevention program known as Fourth R. This universal program has been shown to reduce some dating violence, substance use, and risky sexual behaviors, but there remains room for improvement. Specifically, more attention to trauma and the importance of societal risk and protective factors may improve the program’s effectiveness. Thus, focus group discussions were conducted with students and we then adapted Fourth R lessons specific to trauma, racism, and discrimination. Major themes discussed are that Fourth R and other prevention programs should focus attention on social and structural issues, such as racism and discrimination.

The Logic of Microaggressions Assumes a Racist Society

This commentary draws attention to core assumptions about the nature of society that underlie the current debate on microaggressions. For proponents of microaggression research, the starting assumption is one of a racist society. That is, microaggressions have their source and power within an inequitable, racially stratified society. In contrast, critics of microaggressions begin with the assumption of an equitable society, or at least would not endorse the assumption of a racist society. These two different starting assumptions lead to dramatically different conclusions about the concept of microaggressions. As long as these assumptions are not explicitly recognized, debates on methods, findings, and so on will never be reconciled.

Pushing Back Against the Microaggression Pushback in Academic Psychology: Reflections on a Concept-Creep Paradox

Echoing the 1960s, the 2020s opened with racial tensions boiling. The Black Lives Matter movement is energized, issuing pleas to listen to Black voices regarding day-to-day discrimination and expressing frustrations over the slow progress of social justice. However, psychological scientists have published only several opinion pieces on racial microaggressions, primarily objections, and strikingly little empirical data. Here I document three trends in psychology that coincide with the academic pushback against microaggressions: concept-creep concerns, especially those regarding expanded notions of harm; the expansion of right-leaning values in moral judgments (moral foundations theory); and an emphasis on prejudice symmetry, with the political left deemed equivalently biased against right-leaning targets (e.g., the rich, police) as the right is against left-leaning targets (e.g., Black people, women, LGBT+ people). Psychological scientists have ignored power dynamics and have strayed from their mission to understand and combat prejudice against disadvantaged populations, rendering researchers distracted and ill-equipped to tackle the microaggression concept. An apparent creep paradox, with calls to both reduce (e.g., harm) and expand (e.g., liberal prejudices, conservative moral foundations) concepts, poses a serious challenge to research on prejudice. I discuss the need for psychology to better capture Black experiences and to "tell it like it is" or risk becoming an irrelevant discipline of study.

Reviewing Racial Microaggressions Research: Documenting Targets' Experiences, Harmful Sequelae, and Resistance Strategies

In this article, we review the theoretical and empirical literature on racial microaggressions from 2007 to 2020 (N = 138 articles). First, we refine racial microaggressions theory and update the definition to address mischaracterizations in the literature and clarify the term (i.e., "micro" refers to microlevel interactions rather than degree of harm). Next, we used four superordinate categories (i.e., pathologizing differences, denigrating and pigeonholing, excluding or rendering invisible, and perpetuating color-blind racial attitudes) in which to situate racial microaggression themes from the extant literature. Moreover, we consolidated and renamed existing themes to privilege targets' perspectives (e.g., facing assumptions of inferior status and enduring exoticization). We then synthesized qualitative and quantitative research that shows harmful sequelae of racial microaggressions (i.e., psychological and physiological symptoms). Extending prior research on coping with gendered racial microaggressions, we describe empirical findings on collective, resistance, and self-protective strategies to mitigate the harmful impact of racial microaggressions. We conclude with directions for future research.

The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review

OBJECTIVE

To understand racial bias in clinical settings from the perspectives of minority patients and healthcare providers to inspire changes in the way healthcare providers interact with their patients.

METHODS

Articles on racial bias were searched on Medline, CINAHL, PsycINFO, Web of Science. Full text review and quality appraisal was conducted, before data was synthesized and analytically themed using the Thomas and Harden methodology.

RESULTS

23 articles were included, involving 1,006 participants. From minority patients' perspectives, two themes were generated: 1) alienation of minorities due to racial supremacism and lack of empathy, resulting in inadequate medical treatment; 2) labelling of minority patients who were stereotyped as belonging to a lower socio-economic class and having negative behaviors. From providers' perspectives, one theme recurred: the perpetuation of racial fault lines by providers. However, some patients and providers denied racism in the healthcare setting.

CONCLUSION

Implicit racial bias is pervasive and manifests in patient-provider interactions, exacerbating health disparities in minorities. Beyond targeted anti-racism measures in healthcare settings, wider national measures to reduce housing, education and income inequality may mitigate racism in healthcare and improve minority patient care.

Implicit racism, colour blindness, and narrow definitions of discrimination: Why some White people prefer 'All Lives Matter' to 'Black Lives Matter'

The Black Lives Matter (BLM) movement has been called the 'civil rights issue of our time' (Holt & Sweitzer, 2020, Self and Identity, 19(, p. 16) but the All Lives Matter (ALM) movement swiftly emerged as an oppositional response to BLM. Prior research has investigated some predictors of support for ALM over BLM, but these predictors have thus far not included levels of racial bias or potentially relevant constructions of racism. This pre-registered, cross-sectional study (N = 287) tested the degree to which White participants' support for ALM could be predicted using measures of racism (implicit and explicit) and ideological stances around the construction of 'racism' (that discourage the recognition of contemporary inequalities and discrimination). Using multiple regression analyses, we found that implicit racism, colour-blind ideology, and narrow definitional boundaries of discrimination positively predicted support for ALM over BLM. Explicit racism, collective narcissism, and right-wing political orientation did not predict ALM support, nor did any (2-way) interaction of these predictors. Implications for our understanding of the All Lives Matter movement are discussed.

Examining the role of ethnic microaggressions and ethnicity on cortisol responses to an acute stressor among young adults

Objective: This study examined whether the frequency of experiences of ethnic microaggressions and the sensitivity to such experiences were associated with cortisol responses to an acute social stressor (Trier Social Stress Test; TSST) among an ethnically diverse sample of young adults (N = 109, Mage = 18.82 years, SD = 1.40 years, 74% female, 44% Latinx). Method: Self-reported experiences of and sensitivity to microaggressions were assessed using the Everyday Microaggressions Scale. Participants' salivary cortisol was collected before, immediately after, and at three 15-min intervals after the TSST (for a total of 5 salivary samples) to assess their cortisol responses to an acute social stressor. Results: Mixed model analyses revealed that experiencing a higher frequency of microaggressions (p = .005) and being more sensitive to those experiences (p = .001) were associated with a more blunted cortisol response (i.e., lower cortisol reactivity and recovery) to the TSST, relative to experiencing a lower frequency of microaggressions and being less sensitive to them. Furthermore, this blunted cortisol response to the TSST was more prominent among young adults of Latinx and other ethnic backgrounds (i.e., biracial, African American, and Native American) compared to their Asian American and non-Hispanic White peers (p = .034). Conclusion: Findings provide insight into the different ways in which experiences of ethnic microaggressions can be associated with biological markers of stress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Is microaggression an oxymoron? A mixed methods study on attitudes toward racial microaggressions among United States university students

To best understand the possible negative health and social consequences associated with racial microaggression, in-depth understanding of how people judge these events is needed. People of Color (POC) and White participants (N = 64) were recruited for a mixed-methods study that incorporated quantitative attitude ratings and focus group interviews. Participants read and discussed their attitudes toward five vignettes that reflected microassault, microinsult, and microinvalidation scenarios. Semantic differential ratings showed that participants judged microassaults to be most unacceptable, followed by microinsults and then microinvalidations. Using a grounded theory approach, our qualitative analysis of interview data revealed five thematic categories. First, participants judged receivers’ psychological harm to be a critical consideration for their attitudes toward microaggression scenarios; they discussed factors associated with individual differences in appraisals, prior exposures to discrimination, and sensitivity to race. Second, participants were less consistent in their opinion about the role of the deliverers’ intent on their judgment of microaggressions; many considered microaggression events to be results of deliverers’ cultural ignorance and racial insensitivity. Third, our analysis revealed the central importance of contexts that shaped participants’ attitudes toward microaggression. Fourth, participants also discussed the notion that receivers of microaggression were racist for calling attention to race issues. Finally, POC participants tended to relate to the vignettes and use their lived experiences to contextualize their opinions about racial microaggression. The current results raise concerns regarding the conceptualization and utility of the word “microaggression,” especially within the broader contexts of racism and major discrimination. Other empirical and practical implications are discussed.

Rumination longitudinally mediates the association of minority stress and depression in sexual and gender minority individuals

Minority stress theory describes the excess stressors to which individuals from stigmatized groups are exposed as a result of their marginalized status(es), which can contribute to higher rates of depression among sexual and gender minority (SGM) individuals. The psychological mediation framework expanded on minority stress theory by proposing that rumination may link minority stressors to depression. Although previous studies have shown that rumination mediates associations between minority stressors and psychological distress among SGM individuals, many have done so using cross-sectional data, despite mediation being a process that occurs over time. To address this limitation, the present longitudinal study examined rumination as a mediator of the associations of three minority stressors (i.e., victimization, microaggressions, and internalized stigma) with depressive symptoms among 1,130 young men who have sex with men (YMSM) and young transgender women (YTW). The data were taken from baseline, 6-month, and 1-year assessments from a large cohort of YMSM and YTW. Consistent with hypotheses, rumination at 6-month follow-up fully longitudinally mediated associations between victimization, microaggressions, and internalized stigma at baseline and depression at 1-year follow-up. Results suggest that rumination is an important area of intervention for clinicians treating SGM individuals who experience symptoms of depression. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Microaggression Research and Application: Clarifications, Corrections, and Common Ground

In this issue, Williams (pp. 3-26) responds to my 2017 critique in this journal of the scientific status of the microaggression research program (MRP). In some cases, she presents helpful data that partially address several of my recommendations for enhancing the MRP's rigor. Nevertheless, because she appears to misconstrue many of my arguments regarding the MRP, many of her rebuttals are not relevant to my criticisms. Furthermore, her assertions notwithstanding, Williams does not effectively address my concerns regarding the (a) excessively fuzzy boundaries of the microaggression construct, (b) psychometric hazards of relying exclusively on subjective reports when detecting microaggressions, and (c) hypothesized causal impact of microaggressions on mental health. In other cases, Williams appears to draw causal inferences from correlational data and conflate within-group with between-group differences. Although several of Williams's recommendations for MRP research are worth considering, I contend that some others are unlikely to be conducive to a scientific approach to microaggressions. The MRP remains a promising but provisional research program that would benefit from greater openness to outside criticism. I conclude with a discussion of areas of potential common ground in microaggression research and application.