Cross-sectional and longitudinal effects of racism on mental health among residents of Black neighborhoods in New York City

Longitudinal Relationships Between Depressive Attributional Style and Internalizing Symptoms in an Autism-Enriched Sample of Incoming College Students

Background

Anxiety and depression are among the most common psychiatric conditions reported in first-year college students. Autistic adults are estimated to face double the rate of anxiety and depression compared with non-autistic peers, influencing quality of life, social success, and academic performance. One potential avenue to understand and address internalizing symptoms in autistic adults beginning their college careers is depressive attributional style, a biased causal explanatory style in which negative life events are attributed to internal, stable, and global causes. The current study evaluates the relationship between depressive attributional style and symptoms of anxiety and depression across the first semester of college, as moderated by autistic traits. We also explore baseline depressive attributional style across additional marginalized aspects of identity based on race/ethnicity, gender, and sexual orientation, and examine potential interaction effects of autistic traits on these relationships.

Methods

Undergraduate students were recruited from four northeastern universities. Our sample (n = 144) includes 47 participants who self-identified or reported a formal autism diagnosis, and 97 non-autistic participants. Participants completed baseline and endpoint questionnaires, as well as a 2-minute biweekly survey, tracking changes in sadness, anhedonia, and anxiety throughout their first semester.

Results

Longitudinal analyses demonstrate that elevated depressive attributional style at baseline predicted biweekly anxiety, sadness, and anhedonia symptoms across the semester. This pattern extended across (was not moderated by) levels of autistic traits, however, participants who reported higher autistic traits endorsed a significantly greater depressive attributional style at baseline, and greater anxiety, sadness, and anhedonia throughout the semester. The relationship between autistic traits and depressive attributional style was strongest for participants with a nonheterosexual orientation.

Conclusion

This study underscores the autistic community-identified need for mental health research, with attention to intersecting identities, and suggests depressive attributional style for further investigation as a potential treatment target.

Abstract

In the first year of college, many students face challenges with anxiety and depression. Autistic students report even higher mental health concerns than non-autistic students. One way to understand why this happens is by looking at how college students explain negative events in their lives. Autistic students may have a more depressive attributional style, in which they see themselves as a cause of negative events and believe that bad things will persist. This outlook is known to contribute to anxiety and depression.

Abstract

We wanted to see how a depressive attributional style might relate to anxiety and depression over the first semester of college, and whether this is affected by autistic traits and stress. We also looked at how autistic traits influence the relationship between depressive attributional style and the marginalized aspects of identity based on race/ethnicity, gender, and sexual orientation.

Abstract

We gave surveys to college students about their attributional style and experiences with depression and anxiety. Participants completed several surveys both before and after their first semester at college. They also completed a brief survey two times per week during the semester.

Abstract

We found that a depressive attributional style at baseline (presemester) was related to depression and anxiety symptoms across the semester. Participants with higher levels of autistic traits reported a more depressive attributional style and greater depression and anxiety during the semester. Individuals with higher autistic traits who identify as LGBTQIA+ were more likely than heterosexual individuals with high autistic traits to have a more depressive attributional style.

Abstract

This study helps us understand that a depressive attributional style might be related to anxiety and depression in both autistic and non-autistic students. In addition, a depressive attributional style may be more common in autistic individuals. These findings could mean that helping people develop a more adaptive thinking about negative events could help prevent or treat anxiety and depression in college students.

Abstract

Because we wanted our study to be accessible for autistic students without a formal diagnosis, we were unable to look at how the social identity of being autistic related to anxiety and depression throughout the semester.

Abstract

These findings give us first evidence that a depressive attributional style appears to be related to anxiety and depression in autistic students. This suggests that interventions designed to address the depressive attributional style in non-autistic individuals could potentially benefit autistic individuals as well, which may support access to mental health treatment for the autistic community.

Police Harassment and Psychiatric, Sexual, and Substance Use Risk Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort

BACKGROUND

Black sexual minority men and Black transgender women (BSMM/BTW) experience disproportionate levels of HIV/STI-related risk factors as well as police harassment (PH). PH is linked to psychiatric risk and could play a role in substance use, sexual risk behavior, and HIV/STI risk.

METHODS

We used data from the HIV Prevention Trials Network 061(HPTN 061) study to examine associations between PH and HIV/STI-related outcomes. Using PH exposure measured at baseline and 6-month study visits, we examined an ordinal exposure (PH reported at both visits, PH reported at either visit, versus PH reported at neither baseline nor 6 months) and a binary exposure of persistent PH reported at both visits (yes versus no). We estimate risk ratios (RR) for associations between PH and depression, use of alcohol and methamphetamine, multiple partnerships, condomless sex, and syphilis.

RESULTS

Persistent PH (binary) was associated with a 20% or greater increase in the risk of depression (RR, 1.26 (1.07, 1.47)) and multiple partnerships (RR, 1.20 (1.05, 1.39)). There was evidence that ordinal PH was associated with elevated risk of alcohol use (RR, 1.17 (1.00, 1.36)); the point estimate for the association between persistent PH and alcohol use was similar but the imprecision was greater (RR, 1.16 (0.95, 1.42)).

CONCLUSION

PH may influence not only mental health but also behavioral risks that contribute to HIV/STI among BSMM/BTW, highlighting the potential wide-ranging and downstream effects of PH on health. Further research is required to confirm associations and elucidate pathways through which PH may influence HIV/STI among BSMM/BTW.

Implicit Biases and Racial Microaggressions: Examining the Impact on Black Social Work Students' Well-Being

This paper explores the concept of racial microaggressions, everyday slights and offensive behaviors experienced by people of color, particularly focusing on their manifestation within social work education programs. Black social work students, in particular, frequently encounter instances tied to stereotypes about their intellectual abilities, perpetuating historical prejudices and contributing to mental health challenges such as anxiety and impostor phenomenon (IP). The historical trauma endured by Black individuals adds a distinct layer to the struggles faced by Black, Indigenous, and People of Color (BIPOC) students in social work education. Despite the evident impact, there exists a significant gap in scholarship addressing these issues, emphasizing the urgent need for the social work profession to confront and comprehend how implicit biases and racial microaggressions impede the success of Black social work students. This theoretical exploration aims to spark vital dialogue on the manifestations of implicit biases and racial microaggressions, probing their link to feelings of IP and historical trauma. Central to this inquiry is the examination of the critical consciousness framework's efficacy in social work education, uncovering its role in raising awareness among professionals regarding their inadvertent perpetuation of oppressive systems. By leveraging this framework, the paper seeks to unearth structures of oppression and privilege, promoting awareness of unintentional complicity in upholding these structures. Recommendations align with the critical consciousness framework, advocating for future dialogues and the implementation of effective microaggression scales to incorporate and analyze frequencies and the impact of racism in social work research.

Intersectionality and the Association Between State-Level Structural Racism, Binge Alcohol Consumption, and Smoking Status Among Black Americans

BACKGROUND

Structural racism is associated with alcohol and tobacco use among Black Americans. There is a need to understand how this relationship differs within varying groups of Black Americans. This study assessed the moderating roles of age, gender, and income in the association between structural racism and binge alcohol consumption and tobacco smoking status among Black Americans.

METHODS

A state-level index of structural racism was merged with data from a national probability sample of 1946 Black Americans. Hierarchical linear and logistic regression models tested associations between structural racism (measured by residential segregation, and economic, incarceration, and educational inequities) and binge alcohol use and smoking status among Black Americans by stratified by age, gender, and income. Moderating effects of age, gender, and income were tested using slope estimate comparisons.

RESULTS

Results indicated statistically significant positive associations between incarceration disparities and binge drinking and smoking status among Black Americans below age 65. An inverse association was detected between education disparities and smoking status among Black Americans below age 65 and among higher-income Black Americans. Age, gender, and income were not significant moderators of these associations.

CONCLUSIONS

Age, gender, and income do not moderate the association between state-level structural racism and binge alcohol or tobacco use behaviors among the current sample of Black Americans.

IMPACT

Addressing structural racism may have implications for reducing participation in binge drinking and tobacco use behaviors among Black Americans, regardless of their age, gender, or income. This has implications for healthy equity and cancer prevention and control.

Public drinking water contaminant estimates for birth cohorts in the Environmental Influences on Child Health Outcomes (ECHO) Cohort

BACKGROUND

The United States Environmental Protection Agency (USEPA) regulates over 80 contaminants in community water systems (CWS), including those relevant to infant health outcomes. Multi-cohort analyses of the association between measured prenatal public water contaminant concentrations and infant health outcomes are sparse in the US.

OBJECTIVE

Our objectives were to (1) develop Zip Code Tabulation Area (ZCTA)-level CWS contaminant concentrations for participants in the Environmental Influences on Child Health Outcomes (ECHO) Cohort and (2) evaluate regional, seasonal, and sociodemographic inequities in contaminant concentrations at the ZCTA-level. The ECHO Cohort harmonizes data from over 69 extant pregnancy and pediatric cohorts across the US.

METHODS

We used CWS estimates derived from the USEPA's Six-Year Review 3 (2006-2011) to develop population-weighted, average concentrations for 10 contaminants across 7640 ZCTAs relevant to the ECHO Cohort. We evaluated contaminant distributions, exceedances of regulatory thresholds, and geometric mean ratios (with corresponding percent changes) associated with ZCTA sociodemographic characteristics via spatial lag linear regression models.

RESULTS

We observed significant regional variability in contaminant concentrations across the US. ZCTAs were most likely to exceed the maximum contaminant level for arsenic (n = 100, 1.4%) and the health-protective threshold for total trihalomethanes (n = 3584, 64.0%). A 10% higher proportion of residents who were American Indian/Alaskan Native and Hispanic/Latino was associated with higher arsenic (11%, 95% CI: 7%, 15%; and 2%, 95% CI: 0%, 3%, respectively) and uranium (15%, 95% CI: 10%, 21%; and 9%, 95% CI: 6%, 12%, respectively) concentrations.

IMPACT

Nationwide epidemiologic analyses evaluating the association between US community water system contaminant concentration estimates and associated adverse birth outcomes in cohort studies are sparse because public water contaminant concentration estimates that can be readily linked to participant addresses are not available. We developed Zip Code Tabulation Area (ZCTA)-level CWS contaminant concentrations that can be linked to participants in the Environmental Influences on Child Health Outcomes (ECHO) Cohort and evaluated regional, seasonal, and sociodemographic inequities in contaminant concentrations for these ZCTAs. Future epidemiologic studies can leverage these CWS exposure estimates in the ECHO Cohort to evaluate associations with relevant infant outcomes.

The neurophysiological consequences of racism-related stressors in Black Americans

Racism-related stressors, from experiences of both implicit and explicit racial discrimination to systemic socioeconomic disadvantage, have a cumulative impact on Black Americans' health. The present narrative review synthesizes peripheral (neuroendocrine and inflammation markers), psychophysiological (heart-rate variability, skin conductance), and neuroimaging (structural and functional) findings that demonstrate unique associations with racism-related stress. Emerging evidence reveals how racism-related stressors contribute to differential physiological and neural responses and may have distinct impacts on regions involved with threat and social processing. Ultimately, the neurophysiological effects of racism-related stress may confer biological susceptibility to stress and trauma-related disorders. We note critical gaps in the literature on the neurophysiological impact of racism-related stress and outline additional research that is needed on the multifactorial interactions between racism and mental health. A clearer understanding of the interactions between racism-related stress, neurophysiology, and stress- and trauma-related disorders is critical for preventative efforts, biomarker discovery, and selection of effective clinical treatments for Black Americans.

The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans

BACKGROUND

Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans.

METHODS

An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates.

RESULTS

Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status.

CONCLUSIONS

Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans.

IMPACT

Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.

Racial segregation and genomics-related knowledge, self-efficacy, perceived importance, and communication among medically underserved patients

Purpose

There is limited research on the relationship between structural environmental factors and genomics-related knowledge, self-efficacy, perceived importance, and communication. We examined the potential impact of racial segregation on these genomics-related outcomes among medically underserved patients.

Methods

We analyzed data from a sample of 546 patients recruited from a primary care clinic in St. Louis, Missouri. Multivariable models were used to examine associations between racial composition of social environments across the life course and genomics-related knowledge, self-efficacy, perceived importance, and communication.

Results

Non-Hispanic White patients reporting multiple past White social environments had higher genetic knowledge than non-Hispanic White patients reporting one or no past White social environments (P = .021), Black patients reporting 1 or no past White social environments (P = .002), and Black patients reporting multiple past White social environments (P < .001). We also found that among those reporting multiple current White social environments, Black patients were more likely than non-Hispanic White patients to frequently communicate about family history with family (P = .003).

Conclusion

These findings indicate that structural factors may affect understanding of genetic information and communication about family history among medically underserved patients. Targeted interventions may increase the use of genetic services among this population and reduce health inequities.

COVID-19 Racism and Chinese American Families' Mental Health: A Comparison between 2020 and 2021

This study compared rates of multiple forms of COVID-19 racism-related discrimination experiences, fear/worries, and their associations with mental health indices among Chinese American parents and youth between 2020 and 2021. Chinese American parents of 4- to 18-year-old children and a subsample of their 10- to 18-year-old adolescents completed surveys in 2020 and 2021. A high percentage of Chinese American parents and their children continued to experience or witness anti-Chinese/Asian racism both online and in person in 2021. Parents and youth experienced less vicarious discrimination in person but more direct discrimination (both online and in person) and reported poorer mental health in 2021 than in 2020. Associations with mental health were stronger in 2021 than in 2020 for parents' and/or youth's vicarious discrimination experiences, perceptions of Sinophobia, and government-related worries, but weaker only for parents' direct discrimination experiences. The spillover effect from parents' vicarious discrimination experiences and Sinophobia perceptions to all youth mental health indices were stronger in 2021 than in 2020. Chinese American families experienced high rates of racial discrimination across multiple dimensions, and the detrimental impacts on their mental health were still salient in the second year of the pandemic. Vicarious and collective racism may have even stronger negative impacts on mental health and well-being later in the pandemic. Decreasing health disparities for Chinese Americans and other communities of color requires extensive, long-term national efforts to eliminate structural aspects of racism.

Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention

BACKGROUND

Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation.

METHODS

Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention.

CONCLUSION

This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05422638.

Nationwide geospatial analysis of county racial and ethnic composition and public drinking water arsenic and uranium

There is no safe level of exposure to inorganic arsenic or uranium, yet recent studies identified sociodemographic and regional inequalities in concentrations of these frequently detected contaminants in public water systems across the US. We analyze the county-level association between racial/ethnic composition and public water arsenic and uranium concentrations from 2000-2011 using geospatial models. We find that higher proportions of Hispanic/Latino and American Indian/Alaskan Native residents are associated with significantly higher arsenic and uranium concentrations. These associations differ in magnitude and direction across regions; higher proportions of non-Hispanic Black residents are associated with higher arsenic and uranium in regions where concentrations of these contaminants are high. The findings from this nationwide geospatial analysis identifying racial/ethnic inequalities in arsenic and uranium concentrations in public drinking water across the US can advance environmental justice initiatives by informing regulatory action and financial and technical support to protect communities of color.

Black Love, Activism, and Community (BLAC): The BLAC Model of Healing and Resilience

The purpose of this article is to describe the Black Love, Activism, and Community (BLAC) model of healing and resilience. The assumption of the BLAC model is that Black activism is inspired and sustained by love and community. Building on empirical research, liberation psychology, and African-centered psychology, the BLAC model identifies four culturally grounded domains of resilience (relationships, spirituality, identity, and active expression) that are hypothesized to serve as protective factors. These domains are also postulated to be critical components of culturally centered healing practices. Within the context of anti-Black racism, it is important to understand how activism can mitigate mental health outcomes among Black activists. The BLAC model also describes culturally centered intervention approaches for healing and wellness. Finally, applications of the BLAC model are discussed.

Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers

There have been over 100 years of literature discussing the deleterious influence of racism on health. Much of the literature describes racism as a driver of social determinants of health, such as housing, employment, income, and education. More recently, increased attention has been given to measuring the structural nature of a system that advantages one racialized group over others rather than solely relying on individual acknowledgement of racism. Despite these advances, there is still a need for methodological and analytical approaches to complement the aforementioned. This commentary calls on epidemiologists and other health researchers at large to engage the discourse on measuring structural racism. First, we address the conflation between race and racism in epidemiologic research. Next, we offer methodological recommendations (linking of interdisciplinary variables and data sets and leveraging mixed-method and life-course approaches) and analytical recommendations (integration of mixed data, use of multidimensional models) that epidemiologists and other health researchers may consider in health equity research. The goal of this commentary is to inspire the use of up-to-date and theoretically driven approaches to increase discourse among public health researchers on capturing racism as well as to improve evidence of its role as the fundamental cause of racial health inequities.

The Mental Health of Black Youth Affected by Community Violence: Family and School Context as Pathways to Resilience

Black youth who experience community violence occupy multiple environments with varying levels of influence on how they display resiliency to prevent adverse mental health outcomes. Considering the recent rise of mental health concerns (i.e., increase in suicidal outcomes) among Black youth, along with the abundance of research illustrating the detrimental impact of community violence, more research is needed to examine how different environmental factors (e.g., family and school) shape how youth protect their mental health while displaying resiliency navigating community violence. The purpose of this study was to examine how family and school contexts predict Black youths' ability to display resiliency to navigate community violence and prevent adverse mental health outcomes. This study utilized a path analysis to examine the associations between parent relationships, parent bonding, school climate, resilience to adverse community experiences, community violence, and mental health among 548 Black adolescents in Chicago. Findings highlight that parent relationships, parent bonding, and school climate influence the association between resilience to community violence and mental health outcomes among Black youth. Implications for mental health practice and policy among Black youth are discussed.

Diversions: How the Underrepresentation of Research on Advantaged Groups Leaves Explanations for Health Inequalities Incomplete

We identify a gap in health inequalities research that sociologists are particularly well situated to fill-an underrepresentation of research on the role advantaged groups play in creating inequalities. We name the process that creates the imbalance health-inequality diversions. We gathered evidence from awarded grants (349), major health-related data sets (7), research articles (324), and Healthy People policy recommendations. We assess whether the inequality-generating actions of advantaged groups are considered either directly by capturing their behaviors or indirectly by asking disadvantaged people about discrimination or exploitation from advantaged groups. We further assess whether there is a tendency to locate the problem in the person or group experiencing health inequalities. We find that diversions are prevalent across all steps of the research process. The diversion concept suggests new lines of sociological research to understand why diversions occur and how gaps in evidence concerning the role of the advantaged might be filled.

Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism

Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Hidden internet-based measure of discrimination and mental health of Black people

Incorporating the internet-based measure of discrimination obtained by Google Trends into state-level panel data, we conduct a fixed-effect model estimation to elucidate the relationship between racial discrimination and depression among Black people. We find that the deterioration of mental health among Black people, measured as the percentage of Black people with depression, is closely associated with our measure of discrimination.

Racial Discrimination Predicts Mental Health Outcomes Beyond the Role of Personality Traits in a Community Sample of African Americans

Despite a consistent body of work documenting associations between racial discrimination and negative mental health outcomes, the utility and validity of these findings have recently been questioned because some authors have posited that personality traits may account for these associations. To test this hypothesis in a community sample of African Americans ( n = 419, age: M = 43.96 years), we used bivariate relations and hierarchical regression analyses to determine whether racial discrimination accounted for additional variance in depression, anxiety, and posttraumatic stress symptoms beyond the role of personality. Bivariate relations between personality traits and racial discrimination were small and positive (i.e., rs ≈ .10). Regression results demonstrated that racial discrimination accounted for variance in depression, anxiety, and posttraumatic stress independent of personality traits ( ps < .01). These results suggest that personality traits do not fully explain associations between racial discrimination and negative mental health outcomes, further supporting the detrimental impact of racial discrimination on the mental health of African Americans.

Can success deflect racism? Clothing and perceptions of African American men

We examined the effect of different clothing styles on the perceptions of African American men. Using a between-group design, we tested whether participants perception of African American models wearing sweatpants and sweatshirts ("swagger"), clothing showing they won an event, or formal clothing, would vary. Participants (N = 143) viewed four African American models in one of three conditions. Multivariate analyses of covariance (MANCOVA) with Symbolic Racism Scale scores as a covariate revealed that participants rated models in Formal clothing significantly higher than models in winning clothing in intelligence, p <.001, trustworthiness, p <.001, and warmth p =.005. Models wearing formal clothing or winning clothing were also rated significantly higher than models wearing swagger clothing on several traits. Participant's Symbolic Racism Score significantly affected their ratings of models. Results suggest that the clothing that an African American wears, as well as viewer prejudice, affects the impression that the viewer makes.

COVID-19 Racism and Mental Health in Chinese American Families

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has fueled xenophobia against Chinese Americans. We examined the rates of 6 types of COVID-19 racism and racial discrimination experienced by Chinese American parents and youth and the associations with their mental health.

METHODS

We recruited a population-based sample of Chinese American families to participate in this self-reported survey study conducted from March 14, 2020, to May 31, 2020. Eligible parent participants identified as ethnically/racially Chinese, lived in the United States, and had a 4- to 18-year-old child; their eligible children were 10 to 18 years old.

RESULTS

The sample included 543 Chinese American parents (mean [SD] age, 43.44 [6.47] years; 425 mothers [78.3%]), and their children (N = 230; mean [SD] age, 13.83 [2.53] years; 111 girls [48.3%]). Nearly half of parents and youth reported being directly targeted by COVID-19 racial discrimination online (parents: 172 [31.7%]; youth: 105 [45.7%]) and/or in person (parents: 276 [50.9%]; youth: 115 [50.2%]). A total of 417 (76.8%) parents and 176 (76.5%) youth reported at least 1 incident of COVID-19 vicarious racial discrimination online and/or in person (parents: 481 [88.5%]; youth: 211 [91.9%]). A total of 267 (49.1%) parents and 164 (71.1%) youth perceived health-related Sinophobia in America, and 274 (50.4%) parents and 129 (56.0%) youth perceived media-perpetuated Sinophobia. Higher levels of parent- and youth-perceived racism and racial discrimination were associated with their poorer mental health.

CONCLUSIONS

Health care professionals must attend to the racism-related experiences and mental health needs of Chinese Americans parents and their children throughout the COVID-19 pandemic via education and making appropriate mental health referrals.

A Creative Action Plan for Mental Wellness: Tools for Primary Care in Rural and Underserved Settings

Primary care settings have many opportunities to support patients who have anxiety and/or depression, but resources are often scarce. Our faculty team developed an education tool to support mental health awareness and provide suggested wellness activities. Health-care professionals from various disciplines and settings have demonstrated eagerness to use this tool with patients and with health-care students to improve resilience and mental wellness.

Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged and Older Black Adults

BACKGROUND AND OBJECTIVES

Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults.

RESEARCH DESIGN AND METHODS

Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested.

RESULTS

Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point.

DISCUSSION AND IMPLICATIONS

Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.

Shortened telomere length is associated with unfair treatment attributed to race in African Americans living in Tallahassee, Florida

OBJECTIVES

Experiences of interpersonal discrimination are pervasive stressors in the lives of African Americans. Increased discrimination stress may cause premature aging. Telomere length (TL) is a plastic genetic trait that is an emerging indicator of cellular health and aging. Short TL is a risk factor for the earlier onset of disease. TL shortens with age, a process that may be accelerated by psychosocial stress. Our study explores the relationship between TL and experiences of discrimination in the form of self-reported unfair treatment (UT).

METHODS

Using a qPCR-based method, we measured TL in DNA from saliva samples provided by 135 African American adults from Tallahassee, FL. We developed discrimination measures using a modified survey that explores nine social domains of self-reported unfair treatment experienced both directly and indirectly. We used multiple regression to examine associations between UT and TL.

RESULTS

We found that racial discrimination in the form of self-reported unfair treatment attributed to race (UT-Race-Self) is inversely associated with TL.

CONCLUSIONS

The significant association between increased UT-Race-Self and shorter telomeres supports the hypothesis that psychosocial stress stemming from racial discrimination may affect TL. The potential impact of discrimination on TL may contribute to premature biological aging and racial health inequalities seen in African Americans.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

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

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

Exploring Racial-Ethnic Pride & Perceived Barriers in PYD: A Latent Profile Analysis

This study sought to identify profiles of positive youth development (PYD) integrating racial-ethnic factors, specifically racial-ethnic pride and perceived racial-ethnic barriers in a sample of African American (77%) and Latino (23%) children (N = 234, Mean age = 8). Using a latent profile analysis, we found three profiles: The High PYD, Proud & Optimistic (High PYD, racial-ethnic pride, and low perceived racial-ethnic barriers), the High PYD, Proud & Aware (high PYD, pride, and perceived barriers), and the Low PYD and Disconnected (low PYD, pride and high barriers). The Optimistic profile exhibited fewer overall adjustment problems and higher standardized achievement at Time 2 than both the Aware and the Disconnected profiles. The Aware and the Disconnected showed similar adjustments. This study highlights the critical role of helping youth to feel competent, caring, connected, and proud, further supporting the role of socio-cultural factors in the PYD of African American and Latino children.

Does Religious Involvement Mitigate the Effects of Major Discrimination on the Mental Health of African Americans? Findings from the Nashville Stress and Health Study

Several decades of scholarly research have revealed the significant toll of discrimination experiences on the well-being of African Americans. Given these findings, investigators have become increasingly interested in uncovering any potential resources made available to African Americans for mitigating the psychosocial strains of discrimination. The current study contributes to this literature by testing whether various indicators of religious involvement—e.g., church attendance, prayer, and religious social support—buffer the noxious effects of major discrimination experiences on the mental health outcomes (i.e., depression and life satisfaction) of African Americans. We analyze data from the African American subsample (n = 627) of Vanderbilt University’s Nashville Stress and Health Study, a cross-sectional probability sample of adults living in Davidson County, Tennessee between the years 2011 and 2014. Results from multivariate regression models indicated (1) experiences of major discrimination were positively associated with depression and negatively associated with life satisfaction, net of religious and sociodemographic controls; and (2) religious social support offset and buffered the adverse effects of major discrimination on both mental health outcomes, particularly for those respondents who reported seeking support the most often. We discuss the implications and limitations of our study, as well as avenues for future research.

Perceived Racial/Ethnic Discrimination and Mental Health: a Review and Future Directions for Social Epidemiology

PURPOSE OF REVIEW

Recent literature on racial or ethnic discrimination and mental health was reviewed to assess the current science and identify key areas of emphasis for social epidemiology. Objectives of this review were to: 1) Determine whether there have been advancements in the measurement and analysis of perceived discrimination; 2) Identify the use of theories and/or frameworks in perceived discrimination and mental health research; and 3) Assess the extent to which stress buffers are being considered and evaluated in the existing literature.

RECENT FINDINGS

Metrics and analytic approaches used to assess discrimination remain largely unchanged. Theory and/or frameworks such as the stress and coping framework continue to be underused in majority of the studies. Adolescents and young adults experiencing racial/ethnic discrimination were at greater risk of adverse mental health outcomes, and the accumulation of stressors over the life course may have an aggregate impact on mental health. Some growth seems evident in studies examining the mediation and moderation of stress buffers and other key factors with the findings suggesting a reduction in the effects of discrimination on mental health.

SUMMARY

Discrimination scales should consider the multiple social identities of a person, the context where the exposure occurs, how the stressor manifests specifically in adolescents, the historical traumas, and cumulative exposure. Life course theory and intersectionality may help guide future work. Despite existing research, gaps remain in in elucidating the effects of racial and ethnic discrimination on mental health, signaling an opportunity and a call to social epidemiologists to engage in interdisciplinary research to speed research progress.

Area racism and birth outcomes among Blacks in the United States

There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditionally used survey methods. In this study, we circumvent some of these limitations by examining a previously developed Internet query-based proxy of area racism (Stephens-Davidowitz, 2014) in relation to preterm birth and low birthweight among Blacks. Area racism was measured in 196 designated market areas as the proportion of total Google searches conducted between 2004 and 2007 containing the "n-word." This measure was linked to county-level birth data among Blacks between 2005 and 2008, which were compiled by the National Center for Health Statistics; preterm birth and low birthweight were defined as <37 weeks gestation and <2500 g, respectively. After adjustment for maternal age, Census region, and county-level measures of urbanicity, percent of the Black population, education, and poverty, we found that each standard deviation increase in area racism was associated with relative increases of 5% in the prevalence of preterm birth and 5% in the prevalence of low birthweight among Blacks. Our study provides evidence for the utility of an Internet query-based measure as a proxy for racism at the area-level in epidemiologic studies, and is also suggestive of the role of racism in contributing to poor birth outcomes among Blacks.

O quesito raça/cor nos estudos de caracterização de usuários de Centro de Atenção Psicossocial

Resumo Este trabalho teve como objetivo apresentar, por meio de revisão narrativa da literatura científica, o perfil dos usuários atendidos em Centros de Atenção Psicossocial (CAPS), para verificar a inclusão do quesito raça/cor nessa produção. O levantamento bibliográfico foi realizado de maio a agosto de 2015 no Google Acadêmico e em bases que compõem a Biblioteca Virtual de Saúde: Medline, BDENF, Paho, Index Psicologia e Lilacs. As estratégias de busca foram: (1) “mental health services”/“serviços de saúde mental” AND “epidemiological profile”/“perfil epidemiológico” e (2) “mental health services”/“serviços de saúde mental” AND “health profile”/“perfil de saúde”. Dois revisores avaliaram títulos e resumos dos 452 artigos recuperados. A partir disso, foram excluídos os artigos repetidos e os que não tratam do perfil de usuários de CAPS, restando então 17 artigos. Desses, apenas três apresentaram dados de raça/cor, mas nenhum discutiu esses dados. Verificou-se que dois CAPS têm proporcionalmente mais negros em tratamento do que a população em geral, e evidenciou-se que o uso da variável raça/cor para caracterizar usuários dos serviços de CAPS ainda é reduzido, mesmo que seja importante marcador de cunho social - isso vai ao encontro da maneira como as desigualdades raciais no Brasil são tratadas pela sociedade: como inexistentes, o que reforça as iniquidades. Essas desigualdades têm se revelado persistentes e requerem que a política de saúde mental e a academia iniciem discussão que vá além de recomendações de conferências, para que se definam estratégias para esse enfrentamento e se produzam e reproduzam conhecimentos que possam ajudar na elaboração e implementação dessas estratégias.

What Influences Mental Illness? Discrepancies Between Medical Education and Conception

OBJECTIVE

This preliminary study examined the differences between what was taught during a formal medical education and medical students' and psychiatry residents' conceptions of notions regarding the causes and determinants of mental illness.

METHODS

The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant's formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception.

RESULTS

Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences.

CONCLUSIONS

If these notions are therefore part of students' and residents' conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

Cognitive reappraisal and expressive suppression: Links to racial-ethnic discrimination and adjustment among Latino/a and Asian-heritage college students

OBJECTIVE

We examined whether two key emotion regulation strategies, cognitive reappraisal and expressive suppression, moderated the relations between discrimination (i.e., foreigner objectification and general denigration) and adjustment.

METHODS

Participants were U.S. Latino/a and Asian-heritage college students (N = 1,279, 67% female, 72% U.S. born) from the Multi-Site University Study of Identity and Culture (MUSIC). Students completed online self-report surveys in 2009.

RESULTS

Multi-group path analysis demonstrated that a fully constrained model fit well for both Latino/a and Asian-heritage student data. The results showed that with increasing levels of denigration (but not foreigner objectification), the combination of lower cognitive reappraisal and higher expressive suppression was related to greater depressive symptoms, anxiety, and aggression.

CONCLUSIONS

Our findings highlight the importance of examining multiple emotion regulation strategies simultaneously-considering what strategies are available to individuals and in what combination they are used-to understand how best to deal with negative emotions resulting from experiencing discrimination.

Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the United Kingdom

OBJECTIVES

To examine the longitudinal association between cumulative exposure to racial discrimination and changes in the mental health of ethnic minority people.

METHODS

We used data from 4 waves (2009-2013) of the UK Household Longitudinal Study, a longitudinal household panel survey of approximately 40 000 households, including an ethnic minority boost sample of approximately 4000 households.

RESULTS

Ethnic minority people who reported exposure to racial discrimination at 1 time point had 12-Item Short Form Health Survey (SF-12) mental component scores 1.93 (95% confidence interval [CI] = -3.31, -0.56) points lower than did those who reported no exposure to racial discrimination, whereas those who had been exposed to 2 or more domains of racial discrimination, at 2 different time points, had SF-12 mental component scores 8.26 (95% CI = -13.33, -3.18) points lower than did those who reported no experiences of racial discrimination. Controlling for racial discrimination and other socioeconomic factors reduced ethnic inequalities in mental health.

CONCLUSIONS

Cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people in the United Kingdom. Studies that examine exposure to racial discrimination at 1 point in time may underestimate the contribution of racism to poor health.