Black women's distress matters: Examining gendered racial disparities in psycho-oncology referral rates.

OBJECTIVE: Presently, there is a lack of research examining gendered racial disparities in psycho-oncology referral rates for Black women with cancer. Informed by intersectionality, gendered racism, and the Strong Black Woman framework, this study sought to examine the possibility that Black women are adversely affected by such phenomena as evidenced by lower probability of being referred to psycho-oncology services compared to Black men, White women and White men. METHODS: Data for this study consisted of 1598 cancer patients who received psychosocial distress screening at a comprehensive cancer center in a large Midwest teaching hospital. Multilevel logistic modeling was used to examine the probability of referral to psycho-oncology services for Black women, Black men, White women, and White men while controlling for patient-reported emotional and practical problems and psychosocial distress. RESULTS: Results indicated that Black women had the lowest probability of being referred to psycho-oncology services (2%). In comparison, the probability of being referred to psycho-oncology were 10% for White women, 9% for Black men, and 5% for White men. Additionally, as nurses' patient caseload decreased, the probability of being referred to psycho-oncology increased for Black men, White men, and White women. In contrast, nurses' patient caseload had little effect on the probability of being referred to psycho-oncology for Black women. CONCLUSIONS: These findings suggest unique factors influence psycho-oncology referral rates for Black women. Findings are discussed with particular focus on how to enhance equitable care for Black women with cancer.

Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia.

Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.