The impact of racism on Black American mental health.

Black individuals in the USA experience disparities in mental health that lead to unfavorable health outcomes and increased morbidity from mental illness due to centuries of racism. We emphasize the need to understand the roots of racial injustice to achieve racial equity. Historical factors such as European imperialism, enslavement, the myth of Black inferiority, and scientific racial classification have all perpetuated disparities, leading to the current underestimation, misdiagnosis, and inadequate treatment of mental illness in Black populations. Many of the issues discussed herein apply to Black people globally; however, our focus is on Black Americans and the inequities that result from the current US mental health system. We discuss the limitations of using the DSM-5 classification system and common epidemiological surveys, which do not capture or call for a comprehensive analysis of the systems producing mental health issues, to understand mental illness among Black Americans.

Race and nonrace-specific attributions of discrimination: Implications for major depressive disorder among African American, Black Caribbean, and White adults.

The discrimination and health literature has not clearly resolved whether race-based experiences with discrimination are meaningfully distinct from other forms of unfair treatment or whether race-based experiences affect racial and ethnic minorities differently than non-Hispanic Whites. This study compared the effects of racial and nonrace-specific discrimination on lifetime risk for major depressive disorder (MDD) using data from the National Survey of American Life (NSAL), a nationally representative sample of African Americans, Caribbean Blacks, and non-Hispanic Whites (N = 6,082). Discrimination was defined in two ways: (a) nonrace-specific (any experience of discrimination regardless of the attribution) and (b) racial (discrimination attributed to a race-related reason such as race or skin color), which allowed for an assessment of any unique effects of racial discrimination on MDD risk for each ethnic group. Nonrace-specific discrimination was associated with increased MDD risk among both African Americans and non-Hispanic Whites. However, race-specific discrimination was associated with increased MDD risk for African Americans and Black Caribbeans, but not non-Hispanic Whites. These findings suggest that nonrace-specific discrimination measures-used commonly in the existing literature-may obscure unique associations between racial discrimination and depression; race-related discrimination may have uniquely detrimental consequences for MDD risk among Black people (e.g., African Americans and Black Caribbeans). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Digital White Racial Socialization: Social Media and the Case of Whiteness.

The Internet has become a ubiquitous central element in the lives of adolescents. In this conceptual paper, we focus on digital white racial socialization (D-WRS), arguing: (1) for an expanded conceptualization of WRS as doings, and (2) that social media may be changing processes of WRS through an extension of traditional settings and through the creation of unique social contexts. We highlight the uniqueness of social media contexts due to the designed normalization of whiteness, weak-tie racism, social media affordances, and racialized pedagogical zones allowing adolescents to practice doing race. We introduce a conceptual framework for D-WRS and end with an expressed need for conceptually guided research on the multidimensional relationship between social media and WRS processes.

Cultivating Empathy Through Virtual Reality: Advancing Conversations About Racism, Inequity, and Climate in Medicine.

PROBLEM: Racism and bias are fundamental causes of health inequities, and they negatively affect the climate of academic medical institutions across the United States. APPROACH: In 2019, the Zucker School of Medicine and Northwell Health piloted a virtual reality (VR) racism experience as a component of professional development for medical school and health system leaders, faculty, and staff. Participants experienced a 60-minute, interactive, large-group session on microaggressions and, as individuals, a 20-minute VR module. These were followed by group reflection and debriefing. The sessions, developed in collaboration with a VR academic team, represented a response to institutional climate assessment surveys, which indicated the need for expanded professional training on cross-cultural communication and enhancing inclusion. OUTCOMES: In October 2019, 112 faculty and staff participated in the workshop. On a postworkshop survey, completed by 76 participants (67.9%), most respondents (90.8%) reported feeling engaged in the VR experience. Additionally, the majority agreed that VR was an effective tool for enhancing empathy (94.7%), that the session enhanced their own empathy for racial minorities (85.5%), and that their approach to communication would change (67.1%). In open-ended responses, participants frequently conveyed enthusiasm, powerful emotional and physiologic responses, and enhanced empathy. They also suggested more time for follow-up discussions. NEXT STEPS: Next steps include assessing the scalability of the VR module; determining effective complementary engagements; and measuring the module's longitudinal effects on racial empathy, discrimination, and institutional climate. As VR becomes more common in medical education, developing VR modules to address other forms of discrimination (e.g., sexism, homophobia) could also benefit the institutional climates of medical schools and health systems as academic medicine continues to build toward health equity.

Culture, Race, and Health: Implications for Racial Inequities and Population Health.

Policy Points Racism is a fundamental cause of health inequities and disease, which requires policy solutions that address this cause directly rather than only targeting mechanisms. Cultural systems, such as cultural racism, undergird the social conditions that shape racial inequities in health, including social and health policy decision making, governance, practice, and public reception. Policies targeting racial health equity benefit from integrating social theory and meaningful assessments of the social context concerning race, racism, and health. CONTEXT: Improving the health of the total population may be insufficient in eliminating racial disparities in population health. An expanding commitment to understanding social determinants of health aims to address the social conditions that produce racialized patterns in health inequity. There is also a resurging and evolving interest in the influence of cultural barriers and assets in shaping racial inequities in health. The meaning and function of culture, however, remains underspecified. METHODS: This paper synthesizes analogous but fragmented concepts of cultural threat related to social and racial inequity as examined in public and population health, psychology, sociology, communications, media studies, and law. It draws on an existing typology of culture and social inequity to organize concepts related to cultural racism. Employing a transdisciplinary approach, the paper integrates multiple scholarly perspectives on cultural threat to frame cultural racism as cultural systems that promote false presumptions of white superiority relative to non-whites. FINDINGS: The lack of shared conceptual grounding and language regarding cultural threats to health hinders a more precise identification and measurement of cultural processes as well as comparisons of relative prevalence and influence of pathways linking cultural processes and social inequity. Evaluating intersections among culture, structures, and racism is a valuable analytical tool for understanding the production of social and racial inequities in health. To adequately address health inequities rooted in systemic racism, it is imperative to discuss the function of cultural racism in shaping population health in the United States. CONCLUSIONS: Building a culture of health and achieving health equity requires that we assess cultural racism in a more meaningful way. Cultural processes are commonly referenced in health inequity scholarship, but the empirical literature generally lags behind the conceptual emphasis. A rich literature across disciplines has substantively engaged conceptualizations of culture and cultural processes, the importance of these processes as part of a system of racism, and mechanisms that may link cultural threats to health. When integrated, this literature offers essential insights for ways population health may address the complex issue of eradicating racial disparities in health.

Racial Disparities in the Association between Alcohol Use Disorders and Health in Black and White Women.

Adverse health attributed to alcohol use disorders (AUD) is more pronounced among black than white women. We investigated whether socioeconomic status (education and income), health care factors (insurance, alcoholism treatment), or psychosocial stressors (stressful life events, racial discrimination, alcoholism stigma) could account for black-white differences in the association between AUD and physical and functional health among current women drinkers 25 years and older (N = 8,877) in the National Epidemiological Survey on Alcohol and Related Conditions. Generalized linear regression tested how race interacted with the association between 12-month DSM-IV AUD in Wave 1 (2001-2002) and health in Wave 2 (2004-2005), adjusted for covariates (age group, alcohol consumption, smoking, body mass index, physical activity, diabetes, cardiovascular disease, and arthritis). Black women with AUD had poorer health than white women with AUD (ß = -3.18, SE = 1.28, p < .05). This association was partially attenuated after adjusting for socioeconomic status, health care, and psychosocial factors (ß = -2.64, SE = 1.27, p < .05). In race-specific analyses, AUD was associated with poorer health for black but not white women. Accounting for black-white differences in AUD and physical and functional health among women requires investigation beyond traditional explanatory mechanisms.

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA.

Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.

Major discriminatory events and risk for psychotic experiences among Black Americans.

Racism is a multidimensional construct that impacts risk for psychosis through various complex pathways. Previous research has yet to fully explore how major racial discriminatory events contribute to risk for psychotic experiences in the general population. We examined the National Survey of American Life to analyze the effects of 9 major racial discriminatory events on lifetime psychotic experiences among Black Americans. By examining each event separately, we found that police discrimination was associated with increased risk for lifetime psychotic experiences after adjusting for demographic variables, socioeconomic status, and co-occurring psychological or social problems. Being denied a promotion, being a victim of police abuse, and being discouraged from pursuing education were associated with lifetime visual hallucinations, and being discouraged from pursuing education was also associated with lifetime delusional ideation. None of the events were associated with lifetime auditory hallucinations. As a count of events, experiencing a greater range of major racial discriminatory events was associated with higher risk, particularly for lifetime visual hallucinations. Our findings point to the need for early detection and intervention efforts in community settings and multilevel efforts to eliminate racial discrimination. (PsycINFO Database Record

Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues.

Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.

Racial identity and depressive symptoms among Black emerging adults: the moderating effects of neighborhood racial composition.

In the current study, we explored patterns of change in Black emerging adults' racial identity beliefs during the transition to adulthood, assessed neighborhood racial composition effects on Black emerging adults' racial identity beliefs, and tested the moderating effects of neighborhood racial composition on the associations between Black emerging adults' racial identity beliefs and depressive symptoms over time. Participants in the current study included 570 Black adolescents (52% female) who were transitioning into adulthood (senior year of high school through 5 years post- high school). We did not find average patterns of change in Black emerging adults' racial identity beliefs over time. Further, neighborhood racial composition did not predict participants' beginning status or growth in racial identity beliefs over time. We, however, found evidence that neighborhood racial composition may moderate the associations between Black emerging adults' racial identity beliefs and symptoms of depression over time. Findings from the current study underscore the importance of considering how the larger social context may interact with individuals' racial identity beliefs to influence Black emerging adults' psychological health.

Racial discrimination and substance use: longitudinal associations and identity moderators.

Current research indicates that racial discrimination is pervasive in the lives of African Americans. Although there are a variety of ways in which discrimination may contribute to health, one potentially important pathway is through its impact on substance use. Addressing the paucity of longitudinal research on this topic, the present study examined the influence of teacher discrimination on changes in substance use over time among African American adolescents and considered three dimensions of racial identity as moderators of this association (centrality, private regard, and public regard). Latent variable SEM analyses indicated that, on average, levels of discrimination were associated with increases in substance use across the high school years. However, public regard was found to moderate this association such that discrimination was less strongly associated with increases in substance use for individual who reported lower levels of public regard. The implications of these findings are discussed.

School-Based Racial and Gender Discrimination among African American Adolescents: Exploring Gender Variation in Frequency and Implications for Adjustment.

The present study examined school-based racial and gender discrimination experiences among African American adolescents in Grade 8 (n = 204 girls; n = 209 boys). A primary goal was exploring gender variation in frequency of both types of discrimination and associations of discrimination with academic and psychological functioning among girls and boys. Girls and boys did not vary in reported racial discrimination frequency, but boys reported more gender discrimination experiences. Multiple regression analyses within gender groups indicated that among girls and boys, racial discrimination and gender discrimination predicted higher depressive symptoms and school importance and racial discrimination predicted self-esteem. Racial and gender discrimination were also negatively associated with grade point average among boys but were not significantly associated in girls' analyses. Significant gender discrimination X racial discrimination interactions resulted in the girls' models predicting psychological outcomes and in boys' models predicting academic achievement. Taken together, findings suggest the importance of considering gender- and race-related experiences in understanding academic and psychological adjustment among African American adolescents.

Perceived Racial Discrimination as a Predictor of Health Behaviors: the Moderating Role of Gender.

Perceived racial discrimination (PRD) has been implicated in undermining the mental and physical health of racial/ethnic minorities. Researchers have begun to explore the indirect role of health behaviors as one factor in helping to explain this relationship. The goal of the present study was to examine the relationship between PRD and a wide range of health behaviors using a prospective, longitudinal design and to explore the role of gender in moderating these relationships. Using data from the Maryland Adolescent Development in Context Study, we examined the relationship between adolescent PRD (accumulated across ages 14-21) and health behaviors (i.e., diet, substance use, exercise) at age 30 in a sample of middle-class black men and women. Using structural equation modeling, results revealed that more cumulative PRD during adolescence was associated with less healthy eating, more substance use (among men), and more exercise (among women) in young adulthood. Implications of these findings for understanding the role of health behaviors in explaining the link between PRD and health outcomes are considered.