Racism-related stress and mental health among black women living in Los Angeles County, California: A comparison of postpartum mood and anxiety disorder screening scales.

PURPOSE: To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms. METHODS: Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15. RESULTS: The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p = < 0.001) compared to the EPDS-3 (R2 = 0.46, p = < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035). CONCLUSIONS: Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health.

Discrimination during childbirth and postpartum care utilization among Black birthing people in California, United States.

BACKGROUND: The purpose of this study was to investigate the relationship between discrimination during childbirth hospitalization and postpartum care utilization among Black birthing people in California, United States. METHODS: This was a secondary analysis of data from the Listening to Mothers in California survey, a population-based survey of individuals with a singleton hospital-based birth in California in 2016. The primary outcome was number of postpartum care visits. The primary exposures were racial, language, and insurance discrimination. A multiple linear regression model was used to estimate associations between discrimination and postpartum care use, adjusting for sociodemographic covariates. RESULTS: Black birthing people in the sample had an average of two postpartum visits. Almost 15% of the sample reported one or more forms of discrimination during hospital-based childbirth. In adjusted models, racial discrimination (ß = 0.09, 95% CI = 0.04-0.14, p < 0.01) and language discrimination (ß = 1.03, 95% CI = 0.98-1.07, p < 0.01) were associated with increased postpartum visits, while insurance discrimination was linked to decreased postpartum visits (ß = -0.96, 95% CI = -1.04 to -0.89, p < 0.01). CONCLUSION: Among Black birthing people in California, the drivers of postpartum care utilization after childbirth are complex. There are multiple negative drivers (e.g., experiencing racial and language discrimination and unmet needs), barriers (e.g., insurance discrimination), and positive drivers (e.g., clinician type and education) that affect postpartum care utilization among Black birthing people.

Vicarious Experiences of Major Discrimination and Psychological Distress among Black Men and Women.

Racism-related stress frameworks posit that the discriminatory experiences of one's loved ones may threaten one's well-being, but relatively few studies have examined how they may impact mental health beyond childhood and adolescence. Using data from the Nashville Stress and Health Study (N = 1,252), the present study assessed the prevalence of vicarious experiences of discrimination among subsamples of Black men (n = 297) and women (n = 330), examined the association between vicarious experiences of discrimination and psychological distress among Black men and women, and evaluated the impact of vicarious discrimination on psychological distress in the context of other stressors. Results suggest that Black women report more vicarious exposure to specific types of discrimination. Furthermore, vicariously experienced discrimination was associated with higher levels of psychological distress among Black women, but not among Black men. Our findings extend the literature on racism-related stress and offer new insights for interventions aimed at reducing racial disparities in mental health.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men.

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men's AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the "quality" rather than the "quantity" of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

Distinguishing distress from disorder: Black-white patterns in the determinants of and links between depressive symptoms and major depression.

BACKGROUND: Black Americans experience higher levels of psychological distress but similar or lower rates of psychiatric disorders than Whites. This study aimed to clarify discordant distress-disorder patterns by distinguishing the sociodemographic and psychosocial risks (e.g. socioeconomic status, stress exposure) associated with distress and disorder among Blacks and Whites and by evaluating the distress-disorder linkage within and across racial groups. METHODS: Secondary analysis of the Nashville Stress and Health Study (n=1,246), a cross-sectional community epidemiologic survey of Blacks and Whites in Nashville, Tennessee, was used to assess distress (CES-D depressive symptoms scale) and major depressive disorder (MDD; based on the CIDI). Race-stratified models assessed correlates of each outcome and the distress-disorder association among racial groups; interactions considered potential moderating effects of SES and stress exposure on this association within each group. RESULTS: Distress and disorder were differentially shaped by risk factors and varied by race. Increases in distress were associated with greater disorder risk among both racial groups. However, a significant interaction between distress and stress exposure indicated that odds of "chronic" MDD (lifetime and past-year prevalence) depends on level of stress exposure for Blacks only. CONCLUSIONS: This study informs the "race paradox in mental health" by demonstrating that distress and disorder have etiologies that vary within and across racial groups, and the distress-disorder association depends on stress exposure among Black Americans. This has implications for public health practice, as pinpointing the protective mechanisms underlying Blacks' low disorder rates despite elevated risk exposure may inform more effective avenues of intervention.