Discrimination, symptoms of depression, and self-rated health among african american women in detroit: results from a longitudinal analysis

Examining Race-Based and Gender-Based Discrimination, Trust in Providers, and Mental Well-Being Among Black Women

OBJECTIVES

To examine experiences of discrimination among Black women, and to determine if experiencing race- and gender-based discrimination is associated with mental well-being and trust.

METHODS

Data from the TRUST study were used to examine experiences of discrimination among 559 Black women with hypertension receiving healthcare at a safety-net hospital in Birmingham, Alabama. A three-level variable was constructed to combine the race-based and gender-based measures of the Experiences of Discrimination scale. Linear regression was used to examine the association between experiences of discrimination with mental well-being and trust.

RESULTS

Women who reported no experiences of race- or gender-based discrimination were older and reported higher mental well-being scores and greater trust. Fifty-three percent of study participants reported experiencing discrimination. Compared to participants who did not experience race- or gender-based discrimination, participants reporting experiences of race- or gender-based discrimination and those reporting experiencing both race- and gender-based discrimination were more likely to report poorer mental health.

CONCLUSION

Reported experiences of gender- and/or race-based discrimination in this study were associated with lower mental health scores and less trust in health care providers. Our findings highlight the importance of examining experiences of discrimination among Black women, and the role of discrimination as a stressor and in reducing trust for providers. Incorporating an understanding and acknowledgement of experiences of discrimination into interventions, programs, and during clinical encounters may foster more trusting relationships between providers and patients.

Deciphering the mechanism of women's mental health: a perspective of urban-rural differences

Background

Mental health accounts for a significant proportion of holistic health and affects women more significantly than men. Livelihood capital, defined as an indicator of these sources available for individuals or households to survive and develop, is a cost-effective field for ameliorating women's mental health. However, the impact of these multiple factors of livelihood capital on mental health still requires further research Therefore, this study evaluates women's mental health and investigates the correlation between livelihood capital (including human capital, physical capital, social capital, and financial capital) and women's mental health.

Methods

Based on the 2018 China Labor-force Dynamics Survey, this study explores the relationship and pathways between livelihood capital and women's mental health, with the structural equation model. It also aimed to examine the impact of relative deprivation under the influence of livelihood capital on women's mental health, focusing on urban-rural differences.

Results

The results of this study are as follows: (1) Human capital, social capital and physical capital were positively correlated with women's mental health, while financial capital showed a negative correlation; (2) Relative deprivation mediates the impact of livelihood capital on women's mental health; (3) The impact of livelihood capital on women's mental health is different between urban and rural regions. Urban women were more likely to be influenced by financial capital, whereas human capital, social capital and physical capital were key factors affecting rural women's mental health. (4) Relative deprivation mediates the impact of livelihood capital on mental health in the rural sample, but not in the urban sample.

Discussion

This study shows a complex relationship among livelihood capital, relative deprivation, and women's mental health, with notable urban-rural differences. In rural areas, human, social, and physical capital positively affect women's mental well-being. For example, better education reduces relative deprivation. Social support and improved housing also help. Conversely, financial capital has a negative link with mental health, more so in urban areas, likely due to urban pressure and the wealth-mental health relationship. Based on the findings, several actions are warranted. In social welfare, allocate more resources to rural areas for stronger women's livelihood capital. Public services should improve rural housing and community integration. Expand and enhance mental health education for rural women. These steps can ease rural women's mental health challenges and promote fairness in mental health outcomes.

Discrimination, Depression, and Anxiety Among US Adults

Importance

Examining how discrimination is associated with mental health across different demographic groups can guide efforts to improve mental well-being.

Objectives

To analyze associations between discrimination and mental health and explore how these associations may vary by race and ethnicity and sex.

Design, Setting, and Participants

Cross-sectional data of 29 522 adults weighted to represent a population of 258 237 552 US adults from the 2023 US National Health Interview Survey were analyzed.

Exposures

Exposure to discrimination was measured using the Everyday Discrimination Scale, which assesses frequency of being treated with less courtesy, receiving poor service, being treated as not smart, being feared, and experiencing harassment. A summative scale and a nominal variable (none, low, and high) measured degree and levels of discrimination exposure.

Main Outcomes and Measures

Outcomes included depression (measured with the Patient Health Questionnaire-2 scale) and anxiety (measured with the Generalized Anxiety Disorder-2 scale), with scores of 3 or greater indicating positive screening results for each scale. Multinomial logistic regression analyses examined associations of interest and tests of interaction explored effect modification by race and ethnicity and sex.

Results

Among a sample of 29 522 adults weighted to represent a population of 258 237 552 US adults (mean age, 48.1 years [95% CI, 47.8-48.4 years]; 51.1% female; 17.5% Hispanic or Latino, 2.5% multiracial or other, 6.2% non-Hispanic Asian, 11.6% non-Hispanic or non-Latino Black, and 62.2% non-Hispanic or non-Latino White), each unit increase in exposure to discrimination was associated with increased odds of positive screening results for depression (odds ratio [OR], 1.15 [95% CI, 1.12-1.17]), anxiety (OR, 1.14 [95% CI, 1.12-1.16]), and both depression and anxiety (OR, 1.19 [95% CI, 1.16-1.21]). Compared with no exposure to discrimination, low and high exposure to discrimination were associated with increased odds of positive screening results for depression (low exposure: OR, 2.20 [95% CI, 1.77-2.72]; high exposure: OR, 5.39 [95% CI, 3.61-8.04]), anxiety (low exposure: OR, 1.97 [95% CI, 1.66-2.33]; high exposure: OR, 4.98 [95% CI, 3.59-6.91]), and both depression and anxiety (low exposure: OR, 2.60 [95% CI, 2.13-3.18]; high exposure: OR, 8.84 [95% CI, 6.44-12.14]). Associations between discrimination and positive screening results for depression alone (F4,607 = 3.35; P = .01) and between discrimination and positive screening results for both depression and anxiety (F4,607 = 2.80; P = .03) varied by race and ethnicity. Associations of interest did not differ by sex.

Conclusions and Relevance

Findings of this cross-sectional study suggest an association between discrimination and mental health across US adults, emphasizing the need for further evaluation and increased awareness of how these associations may vary across different demographic groups.

Genome-wide transcriptome differences associated with perceived discrimination in an urban, community-dwelling middle-aged cohort

Discrimination is a social adversity that is linked to several age-related outcomes. However, the molecular drivers of these observations are poorly understood. Social adverse factors are associated with proinflammatory and interferon gene expression, but little is known about whether additional genes are associated with discrimination among both African American and White adults. In this study, we examined how perceived discrimination in African American and White adults was associated with genome-wide transcriptome differences using RNA sequencing. Perceived discrimination was measured based on responses to self-reported lifetime discrimination and racial discrimination. Differential gene expression and pathway analysis were conducted in a cohort (N = 59) stratified by race, sex, and overall discrimination level. We found 28 significantly differentially expressed genes associated with race among those reporting high discrimination. Several of the upregulated genes for African American versus White adults reporting discrimination were related to immune function IGLV2-11, S100B, IGKV3-20, and IGKV4-1; the most significantly downregulated genes were associated with immune modulation and cancer, LUCAT1, THBS1, and ARPIN. The most enriched gene ontology biological process between African American and White men reporting high discrimination was the regulation of cytokine biosynthetic processes. The immune response biological process was significantly lower for African American women compared to White women reporting high discrimination. Discrimination was associated with the expression of small nucleolar RNAs, long noncoding RNAs, and microRNAs associated with energy homeostasis, cancer, and actin. Understanding the pathways through which adverse social factors like discrimination are associated with gene expression is crucial in advancing knowledge of age-related health disparities.

Stress across the lifecourse and adult mental and physical health outcomes

INTRODUCTION

Economic, social, and traumatic stressors have been shown to impact mental and physical health. Few studies have considered whether different domains of stressors have a differential effect on health outcomes or have considered stressors across the lifecourse. We characterize stress cumulatively (life stress) and across different domains and examine their relation to adult mental and physical health using prospectively collected data from the DISPAR study.

METHODS

At 4 timepoints (birth, age 9, 15, and 50), economic, relational, and traumatic stressors were assessed, and interviews were conducted between 1959 and 2012. Experiences of major discrimination were assessed at age 50. Life stress scores and domain-specific stress scores, (occurring in either childhood or adulthood), were created. The Kessler distress scale, self-reported health, and objective measured allostatic load (AL) were assessed at age 50.

RESULTS

Adjusting for race and sex, life stress was associated with all 3 outcomes. Domain-specific analysis showed that only SES stressors impacted all outcomes (poorer self-rated health, higher distress, and higher AL). Relational stress was associated with distress only; experiences of discrimination were associated with poor self-rated health and distress.

CONCLUSION

Stressors across the lifecourse have been proposed to affect wear and tear on multiple bodily systems and to affect multiple health outcomes. Our empirical test supported this hypothesis in a 50-year old cohort and in particular the impact of economic stress across physical and mental health outcomes.

Microaggressions and Cultural Ruptures in Psychiatry: Extending Multicultural Counseling Orientation to Psychiatric Services

Racial microaggressions and cultural ruptures have a significant impact on mental health care for Black, Indigenous, and people of color (BIPOC) communities. This article reviews the application of the multicultural counseling orientation framework in psychiatry to address these challenges and improve therapeutic outcomes. The authors outline strategies to integrate cultural humility into psychiatric practice, with an emphasis on self-reflection, feedback, and the recognition of microaggressions. By fostering cultural humility, providers can create therapeutic spaces where patients feel safe and validated. The article also discusses cultural opportunities for exploring patients' identities and advocates for open dialogue that addresses these aspects early in treatment. Structural recommendations include enhancing training programs to incorporate equity-focused coursework, promoting recruitment and retention of BIPOC clinicians, and developing institutional policies to address systemic inequities. Adopting these approaches can reduce the adverse effects of microaggressions, build trust, and improve mental health outcomes for BIPOC patients. The authors suggest that future efforts should emphasize systemic changes in training, recruitment, and community engagement to create a more inclusive mental health care system.

Early life racial/ethnic discrimination effects on behavioral control and health outcomes in young adults

Early life trauma has been shown to facilitate habitual behavior, which may predispose individuals toward perpetuating maladaptive behaviors. However, previous investigations did not account for other traumatic childhood experiences like racial/ethnic discrimination exposure, nor have they examined the interaction of trauma and habits on real-world adverse outcomes. To examine these effects, we recruited 96 young adults (20.06 ± 1.89 years old) in a study probing early life racial/ethnic discrimination influences on habitual learning, and the conjunctive influences of early life discrimination and habit on disordered eating and substance use. To measure habit responses, participants completed a noise avoidance task during which they responded to abstract stimuli via associated keyboard presses to avoid an aversive screaming sound, after which they performed a devaluation test to measure avoidance habit responses. Participants then completed a series of questionnaires examining early life racial/ethnic discrimination exposure, disordered eating and substance use, and other psychological characteristics. Hierarchical regression results showed that certain early life discrimination subtypes, particularly threat/aggression experienced due to racial/ethnic background, significantly predicted habitual responding above and beyond the effects of psychological confounds. Additionally, overall early life discrimination exposure positively predicted binge eating, but no variables of interest predicted alcohol and drug use. These results expand on extant literature showing the negative impacts of childhood stressors on behavioral control and real-world outcomes.

Neighborhood social environment and mental health of older adults in China: the mediating role of subjective well-being and the moderating role of green space

Introduction

With the continuous development of the global aging trend, the mental health of older adults has been a concern by the world. The living space of older adults is limited due to the decline of their activity function. Neighborhood environment, especially the neighborhood social environment, has become an important factor affecting the mental health of older adults. Therefore, this study explores the mechanism that influences the social environment of the neighborhood and the mental health of older adults, the mediating effect of subjective well-being (SWB), and the moderating effect of green space.

Methods

Based on the 2018 China Labor Dynamics Survey, this study used the structural equation model to explore the mediating effect of neighborhood social environment (neighborhood ties, social trust, community security) on the mental health of older adults through SWB and the moderating effect of green space.

Results

Social trust and community security are both directly and positively associated with older adults' mental health. At the same time, neighborhood ties, social trust, and community security can promote the mental health of older adults by positively affecting SWB, while green space has an enhanced moderating effect between neighborhood ties and mental health.

Discussion

This study enriches the empirical research on neighborhood social environment and mental health. First of all, older adults living in communities with good safety conditions and high social trust are less affected by negative emotions and tend to have good mental health. Second, deeper neighborhood ties, higher social trust, and safer community environments help older adults to be less disturbed by negative situations, have a positive effect on their SWB, and indirectly promote mental health. At the same time, green space can provide a place for older adults to socialize, enhance the positive impact of neighborhood ties on SWB, and further promote the mental health of older adults. Finally, this study suggests that the government and community managers pay attention to the construction of neighborhood social environment and green space, and provide support for "healthy community" and "healthy aging" planning.

Prolonged Boarding and Racial Discrimination and Dissatisfaction Among Emergency Department Patients

Importance

Emergency department (ED) boarding times have increased rapidly, but their health equity outcomes are unknown.

Objective

To investigate whether prolonged ED boarding is associated with increased perceived racial discrimination and dissatisfaction and whether associations vary between patients from marginalized racial and ethnic groups vs non-Hispanic White patients.

Design, Setting, and Participants

This is a cross-sectional study of hospitalized adults who boarded in the ED during internal medicine admissions at a large, urban hospital in Boston, Massachusetts, from June 2023 to January 2024. Equal proportions of non-Hispanic White patients and patients from marginalized racial and ethnic groups (American Indian or Alaska Native, Hispanic, non-Hispanic Black and/or African American, and multiracial) were selected randomly.

Exposure

The duration of ED boarding was categorized as less than 4 hours (reference), 4 to less than 24 hours, and 24 or more hours.

Main Outcomes and Measures

Primary outcomes were odds of reporting (1) discrimination via the Discrimination in Medical Settings scale, and (2) dissatisfaction via the adapted Picker Patient Experience-15 questionnaire. Marginalized race and ethnicity was tested as an effect modifier. Multivariable logistic regression models adjusted for patient age, sex, language, and insurance payer.

Results

Of 598 patients approached, 527 were enrolled, and 525 completed the surveys (response rate, 87.8%). The mean age (SD) was 60.6 (18.7) years, 300 patients (57.1%) were female, 246 patients (47.3%) identified as non-Hispanic White, and 274 (52.7%) were from a marginalized racial or ethnic group. In total, 135 (25.7%) boarded less than 4 hours (reference), 202 (38.5%) boarded 4 to less than 24 hours, and 188 (35.8%) boarded 24 hours or longer. Compared with less than 4 hours, boarding 24 hours or longer was associated with increased perceived discrimination (odds ratio [OR], 1.84; 95% CI, 1.14-2.99; P = .01). An increased association was observed in the subgroup of patients from racial and ethnic marginalized groups (OR, 2.36; 95% CI, 1.20-4.65; P = .01); effect modification was not significant (P for interaction, .10). For all patients, boarding 24 hours or longer was associated with increased dissatisfaction with care (OR, 1.77; 95% CI, 1.03-3.06; P = .04); effect modification was not significant (P for interaction, .80).

Conclusions and Relevance

In this cross-sectional study, hospitalized patients who boarded in the ED 24 hours or longer reported more discrimination and dissatisfaction with care, which may disproportionately affect patients from marginalized racial and ethnic groups. As ED boarding times increase nationally, it is critical to recognize their potential to exacerbate health inequities and to respond with equity-focused solutions.

Exploring pathways to successful aging among older black lesbians and sexual minority women: A focus on life satisfaction and intersectional factors

PURPOSE

Satisfaction with life is a core aspect of successful aging, which is influenced by a broad range of factors, including health, socioeconomic status, and social relationships. Black lesbians experience various social challenges, including racism, sexism, ageism, and heterosexualism, that may present as deterrents to aging successfully. To develop better policies and programs in support of successful aging among all adults, an understanding of the unique components associated with their intersecting identities must be explored. This study was carried out to gain a better understanding of how Black lesbians and other Black sexual minority women (BSMW) view successful aging within the context of life satisfaction.

METHODS

Inferential statistics were used to determine relationships between satisfaction with life (SWLS-3) and selected independent variables. Backward stepwise regression was conducted to ascertain significant relationships of the study outcome variable.

RESULTS

The respondents were 118 Black lesbians and other BSMW aged 50 and above. Independent t-tests showed that those living with a partner had a significantly higher SWLS-3. Backwards stepwise regression indicated the predictor variables for higher rates of SWLS-3 to be harmony in life, annual household income, and provider sensitivity/cultural competence to their patient being Black.

CONCLUSION

This study provides insight on factors increasing and diminishing satisfaction with life for aging Black lesbians and other BSMW. Future research should replicate this study with a more diverse and nationally representative sample, especially given the study limitations of having recruited a highly educated sample during a global pandemic.

Discrimination Experiences among Asian American and Pacific Islander Adults during the COVID-19 Pandemic and Their Association with Mental Health Outcomes: Updated Findings from the COMPASS Study

BACKGROUND

Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue.

METHODS

Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes.

RESULTS

Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01-1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health.

CONCLUSIONS

The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

Working Through It: Lifetime Experiences of Employment Discrimination Among Older Black Americans and Implications for Labor Force Participation, Job Dissatisfaction, and Mental Health in Older Adulthood

OBJECTIVES

To examine lifetime experiences of employment discrimination and their association with Black older adults' employment status and well-being.

METHODS

We use data from the Health and Retirement Study's leave-behind questionnaire to characterize lifetime experiences of being unfairly fired, not hired, or not promoted among Black older adults (N = 2331) and test associations with labor force status at age 62, job satisfaction among those working, and depressive symptoms.

RESULTS

Employment discrimination was commonly reported by Black older adults, especially among men and those with college educations. Employment discrimination was not associated with employment status at age 62 but was associated with job dissatisfaction (OR = 2.25, p = 0.016) and depressive symptoms (Beta = 0.13, p = 0.021).

DISCUSSION

Findings suggest a negative association between employment discrimination at any point in the life course and Black older adults' well-being. Employment discrimination is an obstacle to healthy aging, yet improved discrimination survey items are needed to fully capture its impact on Black Americans.

Interpersonal discrimination and depressive symptoms among older Black and African American adults

To examine the association between recent experiences of discrimination and depressive symptom presentation and severity among a U.S. sample of older Black and African American adults. A cross-sectional survey of 124 Black and African American adults aged 50 and older in the United States was conducted assessing interpersonal discrimination and depressive symptoms. The Perceived Ethnic Discrimination Questionnaire assessed four forms of interpersonal discrimination. A measure of heightened vigilance to bias assessed anticipatory coping with discrimination experiences. Past-month affective and somatic symptoms of depression were assessed using the Depressive and Somatic Symptoms Scale. All forms of interpersonal racial discrimination were positively associated with greater affective symptom severity. Being avoided, devalued, and threatened or actively physically harmed were associated with greater somatic symptom severity. Vigilant coping was positively associated with affective symptom severity but not somatic symptom severity. Racial discrimination is linked to depression severity among older Black and African American and varies by symptom. This study helps inform work on processes linking discrimination with poorer psychological outcomes and will allow for more effective interventions and prevention efforts that are tailored to older minority populations.

Exploring the occurrence of microaggressions in the genetic counseling student-supervisor relationship: A mixed-methods study

While research has shown that genetic counseling students with minoritized racial or ethnic identities face microaggressions throughout graduate training, quantitative data regarding the frequency of these experiences have not been reported. The purpose of this mixed-methods study was to investigate the frequency and types of microaggressions experienced by graduates of accredited genetic counseling programs in the United States during fieldwork rotations. A quantitative survey was administered to assess how frequently 14 different types of microaggressions occurred in interactions with supervisors. Survey responses were analyzed using situation-based coding (the number of different types of microaggressions experienced) and frequency-based coding (the sum of participants' weighted Likert answers). Select survey respondents with minoritized identities were interviewed to better contextualize and categorize microaggression experiences. Analysis of 87 survey responses revealed that participants with minoritized racial and ethnic identities experience significantly more types of microaggressions (t(61) = 2.77; p = 0.007) at a significantly higher frequency (t(55) = 2.67; p = 0.010) than their white counterparts. Participants who identified as part of the disability community were also found to experience significantly more types of microaggressions (t(10) = 3.25; p = 0.009) at a significantly higher frequency (t(9) = 2.32; p = 0.045) than those who did not. Qualitative analysis of 11 interviews revealed that microaggressions from supervisors included offensive and inappropriate comments, unequal treatment, cultural intolerance, and disparaging feedback. Overall, our data present evidence that students with minoritized racial and ethnic identities and students with disabilities are subjected to a variety of inequitable, exclusionary, and harmful interactions. As a result, we recommend that all supervisors receive training about recognizing and preventing microaggressions to ensure that students are provided with an equitable and inclusive training experience, regardless of identity.

Coping With Discrimination Among African Americans With Type 2 Diabetes: Factor Structure and Associations With Diabetes Control, Mental Distress, and Psychosocial Resources

Introduction

Type 2 diabetes undermines diabetes-related health outcomes among African Americans, who have a disproportionately high incidence of the disease. Experiences of discrimination are common among African Americans and compound diabetes-related stress, exacerbating poor health outcomes. Appropriate use of coping strategies may mitigate the detrimental effect of discrimination on diabetes-related outcomes, but examining associations between coping strategies and health outcomes is needed to inform potential interventions. This study assessed the factor structure of the Coping with Discrimination Scale (CDS) among African American adults with type 2 diabetes and examined associations of CDS subscales with measures of diabetes control, mental distress, and psychosocial resources.

Methods

The CDS was administered primarily through churches to African Americans with type 2 diabetes residing in Austin, Texas, and surrounding areas. Data were collected from August 2020 through April 2023. We conducted principal axis factor analysis of the CDS and determined internal consistency for each factor. We computed bivariate and partial correlations between CDS subscales and indicators of diabetes control (hemoglobin A1c, diabetes self-management), mental distress (diabetes distress, perceived stress, depressive symptoms), and psychosocial resources (resilience, social support, self-efficacy).

Results

The 284 African American adults (204 women, 80 men) ranged in age from 23 to 86 years (mean [SD] = 62 [11] y). We identified 4 factors: education/advocacy, internalization, strong response, and detachment. Scores were highest for education/advocacy items and lowest for strong response items. Education/advocacy was associated with higher scores on psychosocial resources, whereas detachment was associated with lower scores. Internalization and strong response were associated with higher mental distress. Strong response was associated with higher hemoglobin A1c, and education/advocacy was associated with enhanced diabetes self-management.

Conclusion

We suggest health care professionals create culturally tailored interventions that aid individuals in educating others, advocating for themselves, or recognizing situations outside one's control and detaching from responsibility, rather than internalizing experiences of discrimination or engaging in strong responses that upon reflection are detrimental to one's health.

Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator

Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.

How deep is the cut? The influence of daily microaggressions on bisexual women's health

Bisexual women experience disproportionately poorer health outcomes in comparison to lesbian and gay groups, and the general population, including inequities related to mental and physical health. Although bisexual-specific health inequities are increasingly well-documented, research examining putative causes of such inequities, as well as research that accounts for differences within bisexual populations - particularly among racial minorities- remains limited. To address these gaps, this paper reports findings from the Women's Daily Experiences Study (WoDES), a multi-method study that explored the relationship between microaggressions and health outcomes among racially/ethnically diverse cisgender, bisexual women in Chicago. Data from 28-day daily e-diaries (N = 2,104 observations; 99 participants, 57% women of color) were analyzed using multilevel modeling to (1) measure the frequency of microaggressions among bisexual women; (2) examine the influence of sexual orientation, racial, and gender microaggressions on mental and physical health; and (3) investigate how race influences relationships between microaggressions and health. Participants reported an average of 8.1 microaggressions in the previous 28 days, and at least one microaggression was reported for more than 42% of days (n = 802). Microaggressions of any type were associated with increased same-day negative affect and somatic complaints. Latina bisexual women experienced worse health outcomes in comparison to Black bisexual women. This study demonstrated the detrimental impact of microaggressions on the health of bisexual women and highlights the critical need for strategies on broader structural changes that could improve the health and well-being of bisexual women.

Perceived discrimination and mental health in the Japanese general population

BACKGROUND

Research has shown that discrimination is prevalent in many countries and associated with poorer mental health. However, little is known about discrimination and its effects in Japan.

AIMS

To address this deficit this study examined the association between perceived discrimination and mental health outcomes in the Japanese general population and the role of general stress in these associations.

METHOD

Data were analyzed from 1,245 individuals (age 18-89) that were collected in an online survey in 2021. Perceived discrimination was assessed with a single-item measure as was lifetime suicidal ideation. Depressive and anxiety symptoms were respectively measured with the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale. General stress was assessed with the Perceived Stress Scale (PSS-14). Logistic regression was used to assess associations.

RESULTS

Perceived discrimination was prevalent (31.6%) in the study sample. In fully adjusted analyses discrimination was associated with all of the mental health outcomes/general stress with odds ratios (ORs) ranging from 2.78 (suicidal ideation) to 6.09 (general stress) among individuals with a high level of discrimination. When the analyses were adjusted for general stress (as a continuous score) there was a large reduction in the ORs although high discrimination continued to be significantly associated with anxiety (OR: 2.21), while a mid level of discrimination was related to depressive symptoms (OR: 1.87) and had a borderline association with suicidal ideation.

CONCLUSION

Perceived discrimination is common in the Japanese general population and associated with worse mental health, with stress possibly playing a role in this association.

More Than Identity: An Intersectional Approach to Understanding Mental-Emotional Well-Being of Emerging Adults by Centering Lived Experiences of Marginalization

Understanding social determinants that shape pertinent developmental shifts during emerging adulthood (i.e., ages 18-25 years) and their associations with psychological health requires a nuanced approach. In our exploratory study, we investigated how multiple social identities and lived experiences generated by systems of marginalization and power (e.g., racism, classism, sexism) intersect in connection to the mental-emotional well-being of emerging adults (EAs). Eating and Activity Over Time (EAT, 2010-2018) data were collected from 1,568 EAs (mean age = 22.2 (standard deviation, 2.0) years) recruited initially in 2010 from Minneapolis/St. Paul schools. Conditional inference tree analyses were employed to treat "social location" and systems of marginalization and power as interdependent social factors influencing EAs' mental-emotional well-being outcomes: depressive symptoms, stress, self-esteem, and self-compassion. Conditional inference tree analyses identified EAs' subgroups with differing mean levels of mental-emotional well-being outcomes, distinguished primarily by marginalized social experiences (e.g., discrimination, financial difficulties) rather than social identities themselves. The relative positioning of EAs' experiences of social marginalization (e.g., discrimination) to their social identities (e.g., race/ethnicity) suggests that the social experiences generated by systems of privilege and oppression (e.g., racism) are more adjacent social determinants of mental-emotional well-being than the social identities used in public health research to proxy the oppressive systems that give them social meaning.

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.

Inflation hardship, gender, and mental health

Inflation hit a 40 year high in the United States in 2022, yet the impact of inflation related hardships on distress is poorly understood, particularly the impact on women, whose income is already more limited. Using data from the US Household Pulse Survey (September-November 2022), we test whether exposure to inflation hardships is associated with greater distress and whether this association is moderated by gender (n = 119,531). We draw on a list of eighteen inflation related hardships (e.g., purchasing less food, working additional jobs, delaying medical treatment) to construct an ordinal measure of exposure to inflation hardship ranging from "no inflation hardship" to "five or more inflation hardships." We observe that an increasing number of inflation hardships is associated with higher levels of distress. We find no evidence of gender differences in the magnitude of that association at lower levels of inflation hardship (four inflation hardships or less). However, our findings suggest that exposure to five or more inflation hardships is more strongly associated with distress among men compared to women. The current study provides new insights into the cumulative burden of inflation hardships on mental health and the role that gender plays in this association.

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents

Grocery store environments are recognized as one of the most crucial community settings for developing and maintaining healthy nutritional behaviors in children. This is especially true for disadvantaged ethnic minority families, such as immigrants, who reside in the Detroit Metropolitan area and have historically experienced inequities that result in poor health outcomes. Rates of obesity and type II diabetes have affected Detroit 38% more than the rest of the state and nationwide. In 2019, almost 54% of children aged 0-17 in Metro Detroit lived in poverty, and 21.6% experienced food insecurity, compared with the state level of 14.2%. Moreover, nearly 50% of ethnic minority children in Metro Detroit consume sports drinks, and 70% consume soda or pop in an average week. The primary purpose of this study was to explore immigrant parents' perspectives on (1) how in-store Sugar-Sweetened Beverage (SSB) marketing impacts the purchasing behaviors of parents and the eating behaviors of toddlers, and the secondary objective was to (2) determine strategies to reduce SSB purchases and consumption within grocery environments from the viewpoints of immigrant parents. A qualitative multiple-case study design was used to achieve the aims of this study. Semi-structured individual interviews were completed with 18 immigrant parents of children aged 2 to 5 years old who were consumers in 30 independently owned full-service grocery stores within the immigrant enclaves of Detroit, Dearborn, Hamtramck, and Warren, Michigan. Three key thematic categories emerged from the parents' narratives. These themes were: (1) non-supportive grocery store environments; (2) acculturation to the American food environment; and (3) strategies to support reduced SSB consumption among young immigrant children. The findings of this study revealed widespread SSB marketing targeting toddlers within the participating independently owned grocery stores. Even if families with young children practiced healthy nutritional behaviors, the prices, placements, and promotion of SSBs were challenges to establishing and sustaining these healthy eating habits. The parents believed that planning and implementing retail-based strategies in collaboration with families and considering families' actual demands would assist in managing children's eating patterns and reducing early childhood obesity.

Creating havens for Black lesbian elders during COVID-19

Black lesbians experience more adverse health outcomes and economic insecurity in older age than their White counterparts due to enduring a lifetime of marginalization associated with the intersections of race, gender, and sexual orientation. Yet, there is a lack of organizations dedicated to empowering and supporting this population. ZAMI NOBLA (National Organization of Black Lesbians on Aging) is the only Black lesbian led national organization in the United States solely invested in improving the wellbeing of Black lesbian elders. Throughout the COVID-19 pandemic, they worked in solidarity with community partners across the country to leverage technological innovation and community solidarity to combat ageist ideology and elevate the spaces in which Black lesbians and their networks were able to learn, heal, thrive, and live. The organization's efforts fostered solidarity across generations of lesbians and the wider LGBTQ + community.

The citizenship shield: Mediated and moderated links between immigration status, discrimination, food insecurity, and negative health outcomes for latinx immigrants during the COVID-19 pandemic

A framework termed "the citizenship shield" is introduced to conceptualize how legal protections buffer against negative health outcomes among Latinx immigrants in the United States. In this study, we tested the citizenship shield framework in the context of the disproportionate impact of the COVID-19 pandemic on Latinx immigrants. We investigated the connection between immigration status, discrimination, food insecurity, and negative health outcomes. Analyses involved testing mediation and moderation models among a community-based sample of 536 Latinx immigrants holding five statuses (i.e., U.S. citizenship, permanent residency, Deferred Action for Childhood Arrivals, undocumented, and temporary status). Results suggested that food insecurity mediated the link between discrimination and negative impacts from the pandemic for Latinx immigrants across all statuses. Follow up analyses suggested that two of the three paths were moderated by immigration status. This research provides novel, important data to inform health interventions and federal policy targeted for the most vulnerable immigrants in the United States.

Racial discrimination and 12-month and lifetime anxiety disorders among African American men and women: Findings from the National Survey of American Life

BACKGROUND

The purpose of this study was to assess the associations between racial discrimination and 12-month and lifetime DSM-IV anxiety disorders among African American men and women.

METHODS

Data was drawn from the African American sample of the National Survey of American Life (N = 3570). Racial discrimination was assessed with the Everyday Discrimination Scale. 12-month and lifetime DSM-IV outcomes were any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were utilized to assess the relationships between discrimination and anxiety disorders.

RESULTS

The data indicated that racial discrimination was associated with increased odds for 12-month and lifetime anxiety disorders, AG, and PD and lifetime SAD among men. Regarding 12-month disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, SAD, and PD. With respect to lifetime disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, GAD, SAD, and PD.

LIMITATIONS

The limitations of this study include the utilization of cross-sectional data, self-reported measures, and the exclusion of non-community dwelling individuals.

CONCLUSIONS

The current investigation showed that African American men and women are not impacted by racial discrimination in the same ways. These findings suggest that the mechanisms through which discrimination operates among men and women to influence anxiety disorders is potentially a relevant target for interventions to address gender disparities in anxiety disorders.

Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans

OBJECTIVES

This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS

Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N = 1,934) and IADL limitations (N = 2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS

One-unit increase in everyday discrimination was associated with a 25% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION

Everyday discrimination represents a significant stressor that negatively affects older African Americans' performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

Discrimination, Sexual Violence, Depression, Post-traumatic Stress Disorder, and Social Support among Black Women

BACKGROUND

Black Americans face significant discrimination associated with mental health disorder, which may be exacerbated among sexually victimized people. Social support may buffer that relationship.

METHODS

Cross-sectional data from a retrospective cohort study were analyzed to examine if discrimination and sexual victimization overlap to exacerbate symptoms of depression and post-traumatic stress disorder (PTSD) and to determine the extent to which social support moderated that association among Black women living in Baltimore, Maryland [138 non-abused (no physical/sexual victimization) and 98 abused (sexually victimized) since age 18].

RESULTS

Symptoms of depression and PTSD were independently associated with discrimination. Multilinear regression showed social support from friends moderated the association between discrimination and depressive symptoms among sexually abused participants only.

CONCLUSION

Discrimination may exacerbate symptoms of depression and PTSD more for sexually victimized Black women, but sources of informal social support may attenuate adverse effects of discrimination on depressive symptoms among members of that group.

How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans

OBJECTIVES

As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans.

METHODS

Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims.

RESULTS

Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women.

DISCUSSION

This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the "why" is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.

The Role of Internalized Transphobia, Loneliness, and Social Support in the Psychological Well-Being of a Group of Italian Transgender and Gender Non-Conforming Youths

Although transgender and gender non-conforming (TGNC) youth represent a highly resilient community capable of successfully overcoming adverse life circumstances, they still face social stigma that negatively impacts their health, being at risk of developing negative feelings toward their own TGNC identity (i.e., internalized transphobia). A poorly investigated dimension in TGNC health research is perceived loneliness. Thus, within the minority stress theory, the present study aimed to investigate the mediating role of loneliness and the moderating role of social support in the relationship between internalized transphobia and psychological well-being among 79 Italian TGNC youths aged 18 to 30-years-old who participated in an online survey. The main results show that loneliness partially mediated the relationship between internalized transphobia and psychological well-being. In addition, social support emerged as a significant moderator, as the impact of internalized transphobia on psychological well-being decreased at moderate and high levels of social support, but not at low levels. The findings have significant implications for clinical practice and psychosocial interventions to reduce the impact of internalized stigma and stress on psychological health.

Disrupting Monolithic Thinking about Black Women and Their Mental Health: Does Stress Exposure Explain Intersectional Ethnic, Nativity, and Socioeconomic Differences?

Guided by the intersectionality framework and social stress theory, this study provides a sociological analysis of Black women's psychological health. Using data from the National Survey of American Life (N=2972), we first examine U.S. Black women's psychological health through the intersections of their ethnicity, nativity, and socioeconomic status. Next, we assess the extent to which stress exposure (e.g., discrimination, financial strain, and negative interactions with family members) explains any discovered status differences in psychological health among Black women. Results reveal that foreign-born Afro-Caribbean women living in the United States experience a mental health advantage vis-á-vis their U.S.-born African American female counterparts. In addition, college-educated African American women experience fewer depressive symptoms but similar rates of lifetime PTSD relative to African American women without a college education. Last, though stress exposure was associated with poor mental health, it did not explain status differences in mental health. Overall, this study reveals that Black women, despite shared gendered and racialized oppression, are not a monolithic group, varying along other dimensions of stratification. The results suggest that other stress exposures and psychological resources should be explored in future work examining status differences in mental health among Black women.

Experiences of ethnic discrimination and COMT rs4680 polymorphism are associated with depressive symptoms in Latinx adults at risk for cardiovascular disease

BACKGROUND

Ethnic discrimination is frequently experienced among U.S. Latinx communities, and is linked to CVD risk factors, such as depression. Genetic variants may influence this relationship.

OBJECTIVES

The objectives of this study were to examine associations between experiences of discrimination, rs4680 genotype, and depressive symptoms in Latinx adults.

METHODS

We analyzed data from 124 Latinx adults with two or more CVD risk factors, and conducted hierarchical linear regression, adjusting for sex, age, income, education, and acculturation.

RESULTS

Participants were predominately female (74.2%) and aged 40.2 ± 9.3 years. More experiences of discrimination were associated with higher depressive symptoms (p = 0.041). Those with Met-Met-and Val-Met-genotypes had increased depressive symptoms than those with Val-Val-genotype (p = 0.049). Rs4680 was not a moderator.

CONCLUSION

Findings suggest discrimination and rs4680 genotype are associated with depressive symptoms in Latinx adults, which may increase CVD risk. Further research is needed to better understand biological mechanisms of these relationships.

Maternal depression and adolescent optimism

The life course perspective posits that parents' and children's lives are linked through shared experiences and interdependent contexts such as the household. In this paper, we draw on the life course perspective to examine the relationship between maternal depression and adolescent optimism, an important trait that reflects adolescents' positive expectations for the future, and how features of the family context explain this association. We use data from the Fragile Families and Child Wellbeing Study (N = 3013), taking advantage of the study's longitudinal measures of maternal depression that span a 15-year period. First, we find that current maternal depression is negatively associated with optimism among adolescents. Second, we find that the family environment and parent-child relationships, but not economic wellbeing, explain the association between maternal depression and adolescent optimism. These findings inform our understanding of how parent and adolescent wellbeing are linked and, importantly, how the family environment conditions how adolescents envision their futures.

The COVID-19/racial injustice syndemic and mental health among Black Americans: The roles of general and race-related COVID worry, cultural mistrust, and perceived discrimination

This study explored intersecting concerns about COVID-19 and racial injustice against Black people in the United States using a syndemic perspective. Findings from a multistate COVID-19 needs assessment project examined the association of general and race-related concerns about COVID-19 and concerns about police violence against Black people with mental health symptoms in a sample of 2480 Black Americans. The role of cultural mistrust in vaccination status was also examined. Concerns about COVID-19 were positively associated with concerns about police violence and associated with worse mental health. Nonvaccinated individuals were higher in cultural mistrust but lower in perceived discrimination than vaccinated individuals. Perceived discrimination partially mediated the relationship between race-related concerns about COVID-19 and mental health symptoms. Findings can inform the development of culturally responsive strategies to address the syndemic effects of COVID-19 and racial injustice.

Everyday Discrimination and Depressive Symptoms among Gujarati Adults: Gender Difference in the Role of Social Support

Discrimination against Asians in the USA and its impact on their mental health are urgent public health concerns. Most research on discrimination against Asians has used aggregated Asian group samples. Focusing on Gujaratis, a specific subgroup of Asian Indians, the second-largest Asian group in the USA, this study examined the relationships between everyday discrimination and psychological distress and how they vary by gender. Data were collected via computer-assisted telephone interviews with a representative sample of 553 Gujaratis aged 18 to 65 years residing in a Midwestern state. Negative binomial regression analyses were conducted to examine how exposure to unfair treatment and three types of social support, respectively, was associated with depressive symptoms. For both women and men, unfair treatment was positively associated with depressive symptoms, controlling for sociodemographic characteristics. For women, but not for men, the incidence rate ratio became non-significant when adding social support measures to the model. All three social support measures for women, and only satisfaction with social support for men, were significantly associated with lower depressive symptoms. The findings highlight the need for further research on the role of different types of social support and gender differences, which can inform gender- and socioculturally-relevant intervention efforts.

Stress is a Latent Construct: Exploring the Differential Experience of Stress and Discrimination on Depressive Symptoms Among Black Older Adults

Objectives: While evidence highlights the detrimental mental health consequences of chronic stress exposure, the impact of this stress exposure on older Black Americans' mental health varies by exposure to other types of stressors like discrimination as well as subjective evaluations of stress like chronic stress appraisal. Methods: Using data from the 2010/2012 Health and Retirement Study, we use latent profile analysis (LPA) to describe 2,415 Black older adults experience with chronic stress exposure, appraisal, and discrimination and examine which stress contexts are associated with depressive symptomology. Results: Analyses revealed five stress clusters-demonstrating the diversity in the stress experience for older Black adults. Black older adults with stress profiles that include lower stress appraisal report fewer depressive symptoms regardless of number of stress exposures. Discussion: LPA is as an alternative approach to examining the stress-mental health link that can define stress profiles by both exposure and appraisal-based measures.

Perceived healthcare discrimination and well-being among older adults in the United States and Brazil

Despite well-documented evidence illustrating the relationship between discrimination and health, less is known about the influence of unfair treatment when receiving medical care. Moreover, our current knowledge of cross-national and racial variations in healthcare discrimination is limited in aging populations. This article addresses these gaps using two harmonized data sets of aging populations to clarify the relationship between healthcare discrimination and health in the United States and Brazil. We use nationally representative, harmonized data from the Health and Retirement Study in the United States and the Brazilian Longitudinal Study of Aging to examine and compare perceived discrimination in the healthcare setting and its relationship to self-rated health, depression diagnosis, and depressive symptoms across national contexts. Using Poisson regression models and population attributable risk percent estimates, we found that aging adults reporting healthcare discrimination were at higher risk of poor self-rated health, diagnosed depression, and depressive symptoms. Our results also suggest that reducing perceived healthcare discrimination may contribute to improved self-rated health and mental well-being in later life across racialized societies. In two comparative settings, we highlight the differential impact of healthcare discrimination on self-rated health and depression. We describe the implications of our study's findings for national public health strategies focused on eliminating discrimination in the healthcare setting, particularly among aging countries.

Vicarious Discrimination, Psychosocial Resources, and Mental Health among Black Americans

Does hearing about or witnessing someone else experience discrimination harm individuals’ mental health? Using data from the Nashville Stress and Health Study, we answer this question by examining how vicarious discrimination impacts depressive symptoms, anxiety symptoms, and anger among black Americans. We also test whether mastery and self-esteem moderate the association between vicarious discrimination and each mental health outcome. Findings indicate experiencing vicarious discrimination via a family member has a similar impact on mental health to personally experiencing discrimination. While experiencing vicarious discrimination via a close friend also increased mental health problems, it appeared to be less harmful than personally experiencing discrimination. Moreover, self-esteem moderated the association between vicarious discrimination via a family member and via a close friend and mental health, while mastery did not. This study provides new insights into ways vicarious discrimination impacts health as well as the role that psychosocial resources play in shaping this relationship.

Weight Discrimination Experienced Prior to Enrolling in a Behavioral Obesity Intervention is Associated with Treatment Response Among Black and White Adults in the Southeastern U.S

BACKGROUND

The current study evaluated the associations between history of weight discrimination and race on pre-treatment depressive symptoms, treatment session attendance, and weight loss among Black and White adults enrolled in a 16-week obesity intervention.

METHODS

Participants (N = 271; mean BMI = 35.7 kg/m²; 59% Black; 92% women) reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. All models adjusted for baseline BMI, age, and sex.

RESULTS

Participants with a history of weight discrimination scored 2.4 points higher on the CES-D (B = 2.432, p = .012) and lost 2% less weight relative to those without weight discrimination (B = 0.023, p = .002). Race modified the association between weight discrimination and treatment session attendance, such that Black individuals attended fewer sessions if they had prior experience of weight discrimination, but prior weight discrimination was not significantly associated with treatment attendance among White individuals.

CONCLUSION

Weight discrimination is associated with pre-treatment depressive symptoms and may hinder weight loss regardless of race. Black individuals may attend fewer weight loss treatment sessions if they have prior experience of weight discrimination.

The Role of Church Support Networks in the Relationship between Discrimination and Psychiatric Disorders among Older African Americans

Background

Few studies have examined the effects of discrimination on mental health specifically among older African Americans despite it being a common experience in this population. Further, knowledge on social resources, such as social relationships, that could mitigate the effects of discrimination is limited in this population. Given the historical and contemporaneous importance of the Black church in African American communities, church members are important support network members and a major source of social support for older African Americans.

Purpose

To address these knowledge gaps, this study will (1) examine the association between racial discrimination and psychiatric disorders; and (2) determine whether church relationships moderate the impact of racial discrimination on psychiatric disorders.

Methods

Data from African American respondents aged 55 and older were drawn from the National Survey of American Life (N = 837). Church relationship variables included receipt of emotional support from, frequency of contact with, and subjective closeness to church members. Regression analyses were used to test the study aims.

Results

Analyses indicated that more frequent experiences of racial discrimination were associated with meeting criteria for any DSM-IV disorder and a greater number of DSM-IV disorders. Significant interactions revealed that frequency of contact with and subjective closeness to church members mitigated the association between discrimination and meeting criteria for any 12-month disorder and number of 12-month disorders.

Conclusions and Implications

Altogether, these findings support the literature on the detrimental effects of discrimination on the mental health of older African Americans and provide a more nuanced understanding of the role of church members in the lives of older African Americans. The study findings suggest that church relationships are effective stress coping resources for older African Americans dealing with discrimination. Given the importance and relevance of church members, initial clinical assessments should assess clients' level of religious involvement and relationships with church members.

African Americans, Caribbean Blacks and Depression: Which Biopsychosocial Factors Should Social Workers Focus On? Results from the National Survey of American Life (NSAL)

Research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in African American and first generations Caribbean Black clients. Data was from the National Survey of American Life (NSAL). Bivariate associations showed that respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having Major Depressive Disorder (MDD). The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease. Caribbean Blacks were more likely to report depression compared to African Americans. Additionally, respondents who reported higher discrimination scores were more likely to report depression. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.

Life Course Racism and Depressive Symptoms among Young Black Women

The objective of this study is to evaluate the life course effects of racism on depressive symptoms in young Black women and to identify particularly sensitive periods. Guided by life-course theory and using logistic regression, we analyzed baseline data on racism frequency and stress from racism at two time periods (before age 20 and during the 20s) and follow-up data (at approximate 20-month intervals) on depressive symptoms (using a modified 11-item Center for Epidemiologic Studies Depression Scale, CES-D) among 1612 Black women participants aged 23-34 years living in Detroit, MI. Of the 1612 women, 65% reported experiencing some racism at baseline, and 36.5% had high depressive symptoms at follow-up. Those who experienced high frequency of racism before age 20 had an increased risk for high depressive symptoms (RR = 1.26, 95% CI:  1.07, 1.46) compared to participants in the low racism frequency group. We observed similar associations for high vs. low stress from racism (RR = 1.30, 95% CI : 1.06, 1.54) and high vs. low combination of racism frequency and stress (RR = 1.38, 95% CI: 1.13, 1.64). These findings did not hold or were weaker when assessing racism during the 20s. Among women who experienced high racism across the two time periods, the risk of high depressive symptoms was higher than those who experienced low racism during both periods (RR = 1.49, 95% CI:  1.14, 1.86). The slightly stronger associations between racism and depressive symptoms in childhood and adolescence than in young adulthood suggest that early life might be a sensitive period for experiencing racism.

The role of experiential avoidance in the relation between racial discrimination and negative mental health outcomes

Objective Racial discrimination has been shown to be associated with negative mental health outcomes among people of color (POC), and students of color (SOC) specifically. The current study examines experiential avoidance (EA) as a potential moderator in the relation between discrimination and mental health outcomes. Sample: Two-hundred students of color at a large, public university in Northeastern United States. Methods: We evaluated the associations between racial discrimination frequency and stress appraisal (GEDS and GEDS-A), EA (AAQ), and the Depression, Anxiety, and Stress Scales (DASS). Results: Discrimination frequency and appraised stress were associated with each DASS subscale. EA moderated the relation between GEDS and depression, and between GEDS-A and the stress subscale. Conclusions: Discrimination frequency and appraised stress were positively associated with DASS subscales, and at low EA scores, frequency and appraised stress of discrimination were no longer associated with depressive or stress symptoms, respectively.

Discrimination Experiences during COVID-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders: COMPASS Findings

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020-February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed.

Comparing the Different Manifestations of Postpartum Mental Disorders by Origin, among Immigrants and Native-Born in Israel According to Different Mental Scales

We conducted a prospective study, aimed to study whether the prevalence of mental disorders after birth differs by country of origin. Parturient mothers of Ethiopian origin, Former-USSR (FSU) origin, or nonimmigrant, native-Israeli origin (n = 974, all Jewish) were recruited in hospitals in Israel and were followed 6–8 weeks and one year after birth. General linear models were used to study the associations between origin and mental health, comparing Ethiopian and FSU origin with native-Israeli. Ethiopian and FSU mothers were more likely to report on somatic symptoms, compared with native-Israeli women. Ethiopian origin was negatively and significantly associated with anxiety in all three interviews (β = −1.281, β = −0.678 and β = −1.072, respectively; p < 0.05 in all). FSU origin was negatively associated with depression after birth (β = −0.709, p = 0.036), and negatively associated with anxiety after birth and one-year postpartum (β = −0.494, and β = −0.630, respectively). Stressful life events were significantly associated with all mental disorders in the three time points of interviews. Our findings suggest that immigrants tend to express higher mental distress with somatic symptoms. Additional tools are needed for mental distress screening among immigrants.

The effect of stress and acculturation on the self-rated health of Arab Americans

BACKGROUND:

The self-rated health of Arab Americans has been found to be worse than non-Hispanic whites. Psychosocial factors such as stress and acculturation may explain this disparity. As a result, we designed this survey to better understand the effects of stress and acculturation on the self-rated health of the Arab-American community.

MATERIALS AND METHODS:

Using a convenience sample, we surveyed 142 self-identified Arab Americans regarding demographics, stress, acculturation, and self-rated health. Stress was measured using instruments assessing perceived stress, everyday discrimination, and acculturative stress. Acculturation was measured using a modified Vancouver Index of Acculturation. To measure self-rated health, participants were asked to rate their current health on a scale of 1 (very poor) to 5 (very good).

RESULTS:

A logistic regression model adjusted for age, sex, body mass index, and education did not find that stress significantly affected the odds of having poor self-rated health in Arab Americans. Heritage identity was associated with lower odds of having poor self-rated health (odds ratio = 0.37, 95% confidence interval [CI] 0.15, 0.94, P < 0.05). No association was found between acculturation and poor self-rated health.

CONCLUSION:

Greater levels of stress were not significantly associated with greater odds of poor self-rated health in Arab Americans. We also found that greater heritage identity significantly decreased the odds of poor self-rated health in Arab Americans. The effects of everyday discrimination, perceived stress, and acculturation on self-rated health in Arab Americans remain unclear and need to be examined further.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

The effect of racial discrimination on mental and physical health: A propensity score weighting approach

RATIONALE

The preponderance of research documents the negative consequences of racial discrimination for the mental and physical well-being across several racial/ethnic groups including Black Americans, Hispanic Americans, and Asian Americans. Despite this large body of research, few studies have attempted to evaluate racial discrimination as a casual factor of worse health among racial minority groups. The current study utilized nationally representative data to estimate the causal effect of racial discrimination on cardiovascular disease (CVD), self-rated physical health (SRH), body mass index (BMI), depression disorder, and substance use disorder. In addition, we examined whether the effect of racial discrimination on health was moderated by socio-demographic characteristics (i.e., age, race/ethnicity, sex, socioeconomic status, marital status, geographic location, and health insurance coverage).

METHODS

Data were from the combined National Survey of American Life and the National Latino and Asian American Study. We applied a propensity score weighting approach to estimate the differences between individuals who reported ever (N = 4358) or never (N = 1836) experiencing racial discrimination on a list of health outcomes (e.g., CVD, SRH, BMI, depression disorder, and substance use disorder).

RESULTS

Participants who reported ever experiencing racial discrimination were about 5 % higher CVD risk, had 0.12 points lower SRH, a 3 % higher probability of a depression disorder, and a 2 % higher probability of a substance use disorder. Moderation effects by race/ethnicity, sex, socioeconomic status, geographic region, and health insurance coverage were found.

CONCLUSION

Our study represents one of the first attempts to apply a propensity score weighting approach to causally link racial discrimination to worse health for racial minority individuals. This study adds to a larger body of research documenting the negative association between racial discrimination and health.

Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults

Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities.

Racism, Mental Health, Healthcare Provider Trust, and Medication Adherence Among Black Patients in Safety-Net Primary Care

There has been a growing research focus on social determinants to health disparities in general and medication adherence more specifically in low-income Black populations. The purpose of this study was to examine whether prior experiences of racism among Black patients in safety-net primary care indirectly predicts poor medication adherence through increased mental health symptoms and low healthcare provider trust. Two competing models were run whereby mental health leads to provider trust or provider trust leads to mental health in this multiple mediational chain. A group of 134 Black patients (76 men, average age 45.39 years) in a safety-net primary care clinic completed measures of these constructs. Results revealed that in the first model, mental health mediated the relationship between racism and provider trust, and provider trust mediated the relationship between mental health and medication adherence. All paths within this model were statistically significant, except the path between provider trust and medication adherence which approached significance. In the second model, provider trust and mental health significantly mediated the relationship between racism and medication adherence, and all direct and indirect paths were statistically significant, though the path between provider trust and medication adherence was omitted. These results may serve as catalysts to assess and attempt to mitigate specific minority-based stressors and associated outcomes within safety-net primary care settings.

Living in Between: A Grounded Theory Study of Depression Among Middle-Class Black Women

Empirical evidence consistently has linked the identification and treatment of depression among low-income Black women. Research on depression and Black women also suggests Black women are a monolithic group who experience depression similarly. The purpose of this qualitative study was to gain a deeper understanding of how the identity of middle-class Black women may shape their experiences with depression. Using grounded theory as the guiding method, I conducted 30 in-depth, semistructured interviews with Black women between 30 and 45 years old who self-identified as middle class. The core experience of depression among middle-class Black women was “living in between” because they straddled two worlds—one Black world and one White world—with competing sociocultural messages about depression. Two major categories emerged that informed the experiences of depression among the middle-class Black women in this study: (a) strategies to deal with depression and (b) minimizing depression. Each of these categories highlighted consequences for the women’s mental health. The women also described coping strategies for managing these experiences. Implications for research and practice are included.