Revisiting the Black-White Mental Health Paradox During the Coronavirus Pandemic.

Black Americans have lower rates of depression and anxiety than Whites, despite greater exposure to stressors known to negatively impact mental health, characterized as the Black-White mental health paradox. This study revisited the paradox during the coronavirus pandemic. Drawing on stress process theory, minority stress theory, and the rejection-identification model of discrimination, in-group identity, and well-being, we analyzed original survey data from a quota sample of African American and White adults (N = 594). The survey included a range of stressors and coping resources, including those relevant to the pandemic (e.g., COVID-19 illness) and race (e.g., witnessing anti-Black police violence). Results indicate that despite African Americans' greater exposure and vulnerability to racial discrimination, the Black-White mental health paradox holds, owing in part to protective effects of African American's higher self-esteem. Directions for future exploration of the paradox are presented based on this study's findings.

Attribution for everyday discrimination typologies and mortality risk among older black adults: Evidence from the health and retirement study?

BACKGROUND: The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults. METHODS: This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006-2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates. RESULTS: Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7%) attributed everyday discrimination to age, race, and physical disability; Class Two (72%) attributed everyday discrimination to few/no sources, Class Three (19%) attributed everyday discrimination to race and national origin; and Class Four (2%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, multisystem physiological dysregulation, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95% Confidence Interval [C.I.]: (1.09-2.98) and Class Four (H.R.: 3.92, 95% C.I.: 1.62-9.49) compared to respondents in Class Two. CONCLUSIONS: Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults.

Chronic Stress, Coping, and Mental Health Among Older African Americans.

OBJECTIVES: African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population. METHODS: Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults. RESULTS: Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress. DISCUSSION: Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.

Fictive Kin Networks among African Americans, Black Caribbeans, and Non-Latino Whites.

Using data from the National Survey of American Life, we investigated the social and demographic correlates of fictive kin network involvement among African Americans, Black Caribbeans, and non-Latino Whites. Specifically, we examined the factors shaping whether respondents have fictive kin, the number of fictive present kin in their networks, and the frequency with which they received support from fictive kin. Eighty-seven percent of respondents had a fictive kin relationship, the average network size was 7.5, and 61% of participants routinely received fictive kin support. Affective closeness and contact with family, friends, and church members were positively associated with fictive kin relations. Age, region, income and marital and parental status were related to fictive kin network involvement, though these associations varied by race/ethnicity. Collectively, findings indicate that fictive kin ties extend beyond marginalized communities, and they operate as a means to strengthen family bonds, rather than substitute for family deficits.

COVID-19 and Psychological Distress: Racial Differences Among Middle-Aged and Older Adults.

BACKGROUND AND OBJECTIVES: COVID-19 has disproportionately impacted older adults and Black individuals. Research has focused on physical outcomes, with less attention to the psychological effects of COVID-19. The objective of this study was to examine the interplay between perceptions of the COVID-19 outbreak as a threat to one's day-to-day life, race, and psychological distress among middle-aged and older men and women. RESEARCH DESIGN AND METHODS: Analyses were conducted on a subsample of self-identified non-Latino Whites and Black individuals aged 50 and older (N = 3,834) from the American Trends Panel. Psychological distress was assessed with 5 items adapted from the Center for Epidemiologic Studies Depression Scale and Generalized Anxiety Disorder-7. Perceived COVID-19 day-to-day threat was assessed with a single question. Negative binomial regressions tested the study aim. RESULTS: Perceptions of COVID-19 day-to-day threat were positively associated with psychological distress. Black individuals reported lower distress than Whites. Regardless of gender, greater perceptions of COVID-19 day-to-day threats were associated with greater distress among both White respondents and Black respondents. However, this association was weaker among Black respondents than White respondents. Among men only, the association between COVID-19 day-to-day threat and distress varied by race, patterned similarly to the race differences identified in the total sample. This association did not vary by race among women. DISCUSSION AND IMPLICATIONS: This study contributes to the emerging literature focused on older adults and COVID-19 related stressors and psychological distress. An intersectional lens shows how structural oppression may shape perceptions of the pandemic. Future work should consider coexisting intersections in marginalized identities and mental health during COVID-19.

Severe Intimate Partner Violence, Sources of Stress and the Mental Health of U.S. Black Women.

Background: We investigate the mental health risk of U.S. Black women by examining the roles of intimate partner violence (IPV), major discrimination, neighborhood characteristics, and sociodemographic factors using one of the largest and most complete datasets on U.S. Blacks. Materials and Methods: The National Survey of American Life (NSAL) used a slightly modified version of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) with a sample of 6082 participants. We also assess intraracial group differences based on ethnicity and nativity status (U.S.-born African American, U.S.-born Caribbean Black, and foreign-born Caribbean Black). Results: The study provides evidence that severe physical intimate partner violence (SPIPV) is a significant threat to the mental health of U.S. Black women. Bivariate and multivariate analyses indicate that those with a history of SPIPV were at greater risk for mental disorders than women who did not experience violence by a spouse or partner. Racial discrimination was associated with higher odds of anxiety and substance disorders, whereas gender discrimination was associated with higher odds of mood disorders. Neighborhood drug problems also increased the odds of mood, anxiety, and substance use disorders. Older age and being an Afro-Caribbean immigrant were associated with lower odds of three of four mental disorders. Conclusions: Findings from the study indicate the need for community and clinical interventions aimed at addressing IPV and other community factors that influence Black women's mental health.

Social Support, Everyday Discrimination, and Depressive Symptoms Among Older African Americans: A Longitudinal Study.

BACKGROUND AND OBJECTIVES: The purpose of the study was to explore the long-term effects of everyday discrimination on depressive symptoms among older African Americans, as well as the moderating role of social support in this association. RESEARCH DESIGN AND METHODS: Mixed-effects negative binomial regression analyses were performed on data selected from 6 waves of the Health and Retirement Study (2006-2016; baseline N = 1,144). The number of depressive symptoms was calculated based on an 8-item Center for Epidemiologic Studies Depression measure. Everyday discrimination was measured using a 6-item scale. Contact with and perceived support from extended family and friends were assessed. RESULTS: Older African Americans who experienced more frequent perceived discrimination had more depressive symptoms over time. Significant interactions between discrimination and perceived support from extended family and friends were found, indicating that among older African Americans who reported higher support from extended family and friends, perceived discrimination was positively associated with depressive symptoms over time. However, perceived discrimination and depressive symptoms were not longitudinally related among those who reported lower levels of perceived support. DISCUSSION AND IMPLICATIONS: This is one of the few studies to examine the effects of discrimination on depressive symptoms over time and the first longitudinal study to test the role of social support in coping with discrimination in older African Americans. This study extends cross-sectional works on discrimination and mental health, indicating that experiences of discrimination can result in worse mental health over time. The significant interactions are consistent with the resource mobilization framework, which suggests that individuals who are more negatively affected by discrimination (more depressive symptoms) are more likely to reach out to friends and family to cope with discrimination.

Gender differences in marriage, romantic involvement, and desire for romantic involvement among older African Americans.

BACKGROUND: Despite research on the dramatic changes in marriage, there is a dearth of research on the correlates of marriage and romantic involvement among older African Americans. This is an important omission because although the marriage decline is universal, African Americans show the steepest decline in marriage rates. METHODS: Based on data from the National Survey of American Life, multinomial logistic regression analysis is used to identify demographic and health correlates of: 1) being married or cohabiting, 2) having a romantic involvement, 3) not having a romantic involvement but desiring one, and lastly, 4) not having and not desiring a romantic involvement. RESULTS: Four in 10 older African Americans are either married or cohabiting, 11% are unmarried but romantically involved, 9.5% are unmarried and not romantically involved but open to the possibility of a relationship, and 38% neither have nor desire a romantic involvement. More men than women are married or cohabiting, a gap that increases with advanced age. Across all age groups, African American women are more likely than their male counterparts to report that they neither have nor desire a romantic relationship. CONCLUSION: Almost as many older African Americans do not want a romantic relationship as those who are married/cohabiting. Findings support social exchange theories and the importance of an unbalanced sex ratio. Furthermore, the results suggest that singlehood among older African Americans (especially women) is not necessarily an involuntary status. Nonetheless, this group is at higher risk of economic and health problems as they age.

Everyday Discrimination Typologies Among Older African Americans: Gender and Socioeconomic Status.

OBJECTIVES: Discrimination is associated with several negative social, economic, and health consequences. Past research focuses on the impact of discrimination while less is known about both the type and correlates of discrimination, particularly among older adults. METHODS: Using the National Survey of American Life, we used latent class analysis to identify discrimination typologies (frequency and type) among African Americans aged 55 and older. We then used multinomial logistic regression to identify demographic correlates of discrimination types, including a statistical interaction between gender and educational attainment. RESULTS: We identified three discrimination typologies. Increasing age was associated with lower probability of belonging to the high discrimination and disrespect and condescension subtypes. Men and non-Southern residents were most likely to belong in the high discrimination subtype. Higher levels of education increased the probability of belonging in the high discrimination and disrespect and condescension subtypes for older men, but not women. DISCUSSION: Older African American men, particularly those with more education, are vulnerable to both high-frequency discrimination and discrimination characterized by disrespect and condescension. This finding suggests that, for men with more years of education, increased exposure to discrimination reflects efforts to maintain social hierarchies (male target hypothesis).

Social support from friends and depression among African Americans: The moderating influence of education.

BACKGROUND: This cross-sectional study examined the association between various characteristics of friendships and 12-month major depressive disorder (MDD) and whether these associations vary by education level among African Americans. METHODS: The analytic sample included 3434 African American respondents drawn from the National Survey of American Life: Coping with Stress in the 21st Century. Logistic regression analyses were performed to test the associations between friendship characteristics (i.e., frequency of contact, subjective closeness, receipt of support, provision of support) and 12-month MDD. Interaction terms between education and each of the four friendship variables were used to test whether these associations varied by education level. Analyses adjusted for sociodemographic factors and chronic health problems. RESULTS: Frequency of contact and subjective closeness were negatively associated with 12-month MDD. An interaction between education and contact indicated that contact was negatively associated with MDD among high education respondents but unrelated to MDD among low education respondents. The interactions between education and receipt of support and education and provision of support demonstrated that receipt and provision of support were negatively associated with MDD among high education respondents but was positively associated with MDD among low education respondents. LIMITATIONS: Given the cross-sectional design, it is not possible to make causal inferences. CONCLUSION: This investigation provides an important first step to understanding within-group differences in how social relationships function as both a risk and protective factor for MDD among African Americans.

Intergenerational Mobility and Goal-Striving Stress Among Black Americans: The Roles of Ethnicity and Nativity Status.

Goal-striving stress refers to the psychological consequences of seeking but failing to reach upward mobility and is more common among low-income and people of color. Intergenerational mobility-or improved socioeconomic standing relative to one's parents-may be an important predictor of goal-striving stress for Blacks. We used the National Survey of American Life to investigate the association between intergenerational mobility and goal-striving stress among U.S.-born African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Intergenerational mobility was associated with lower goal-striving stress and U.S.-born African Americans and Caribbean Blacks reported lower goal-striving stress than foreign-born Caribbean Blacks. Goal-striving stress was relatively high among foreign-born Blacks, regardless of level of intergenerational mobility attained. Goal-striving is an important stressor for foreign-born Caribbean Blacks, regardless of their level of educational success. Given increasing Black migration, future studies should disaggregate the Black racial category based on ethnicity and nativity.

Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin.

OBJECTIVES: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. DESIGN: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. RESULTS: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. CONCLUSION: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.

Reviewing the Assumptions About Men's Mental Health: An Exploration of the Gender Binary.

Many researchers take for granted that men's mental health can be explained in the same terms as women's or can be gauged using the same measures. Women tend to have higher rates of internalizing disorders (i.e., depression, anxiety), while men experience more externalizing symptoms (i.e., violence, substance abuse). These patterns are often attributed to gender differences in socialization (including the acquisition of expectations associated with traditional gender roles), help seeking, coping, and socioeconomic status. However, measurement bias (inadequate survey assessment of men's experiences) and clinician bias (practitioner's subconscious tendency to overlook male distress) may lead to underestimates of the prevalence of depression and anxiety among men. Continuing to focus on gender differences in mental health may obscure significant within-gender group differences in men's symptomatology. In order to better understand men's lived experiences and their psychological well-being, it is crucial for scholars to focus exclusively on men's mental health.

Discrimination and symptoms of obsessive-compulsive disorder among African Americans.

This study examined symptoms of obsessive-compulsive disorder (OCD) in a nationally representative sample of African American adults (n = 3,570) and correlations between OCD symptom dimensions and experiences of discrimination. Two categories of discrimination were examined, everyday racial discrimination and everyday nonracial discrimination (e.g., because of gender, age, and weight), to determine if racial discrimination had a unique impact on OCD symptoms. Results indicated that everyday racial discrimination was related to both categories of obsessions and all 4 categories of compulsions. Everyday nonracial discrimination, however, was not related to any of the categories of obsessions or compulsions. This indicates that racial discrimination is uniquely related to obsessions and compulsions for African Americans. The implications of these findings are discussed. (PsycINFO Database Record

Microaggressions, Discrimination, and Phenotype among African Americans: A Latent Class Analysis of the Impact of Skin Tone and BMI.

Data from the 2001-2003National Survey of American Life are used to investigate the effects of phenotype on everyday experiences with discrimination among African Americans (N=3343). Latent class analysis is used to identify four classes of discriminatory treatment: 1) low levels of discrimination, 2) disrespect and condescension, 3) character-based discrimination, and 4) high levels of discrimination. We then employ latent class multinomial logistic regression to evaluate the association between skin tone and body weight and these four classes of discrimination. Designating the low level discrimination class as the reference group, findings revealed that respondents with darker skin were more likely to be classified into the disrespect/condescension and the high level microaggression types. BMI was unrelated to the discrimination type, although there was a significant interaction effect between gender and BMI. BMI was strongly and positively associated with membership in the disrespect and condescension type among men but not among women. These findings indicate that skin tone and body weight are two phenotypic characteristics that influence the type and frequency of discrimination experienced by African Americans.

Everyday Racial Discrimination, Everyday Non-racial Discrimination, and Physical Health Among African Americans.

Past research has identified a link between discrimination and health outcomes among people of color. Perceptions of the cause of discrimination (racial vs. other) seem to be important for mental health; however, this relationship has not been fully examined for physical health. Using data from the National Survey of American Life, we find that, among African Americans, racial discrimination and overall discrimination regardless of attribution are associated with negative health outcomes while non-racial discrimination is not. The results suggest that racial discrimination has a unique adverse effect on physical health for African Americans that practitioners need to better understand.

Discrimination and psychiatric disorders among older African Americans.

OBJECTIVES: This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans. METHODS: This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6). RESULTS: Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination. CONCLUSIONS: This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John Wiley & Sons, Ltd.

Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks.

OBJECTIVES: The tripartite model of racism includes personally mediated racism, institutionalized racism, and the less-oft studied internalized racism. Internalized racism - or negative beliefs about one's racial group - results from cultural racism that is endemic in American society. In this project, we studied whether these negative stereotypes are associated with mental health among African-Americans and Caribbean Blacks. DESIGN: Using secondary data from the National Survey of American Life, we investigated the association between internalized racism and mental health (measured by depressive symptoms and serious psychological distress (SPD)) among these two groups. We also explored whether ethnicity/nativity and mastery moderate the association between internalized racism and mental health among African-Americans and Caribbean Blacks. RESULTS: Internalized racism was positively associated with depressive symptoms and SPD among all Black subgroups. However, internalized racism was a weaker predictor of SPD among foreign-born Caribbean Blacks than US-born Caribbean Blacks and US-born African-Americans. Additionally, higher mastery was protective against distress associated with internalized racism. CONCLUSION: Internalized racism is an important yet understudied determinant of mental health among Blacks. Future studies should take into account additional heterogeneity within the Black population (e.g. African-born individuals) and other potential protective mechanisms in addition to mastery (e.g. self-esteem and racial identity).

Reciprocal Family, Friendship and Church Support Networks of African Americans: Findings from the National Survey of American Life.

This study examined reciprocal support networks involving extended family, friends and church members among African Americans. Our analysis examined specific patterns of reciprocal support (i.e., received only, gave only, both gave and received, neither gave or received), as well as network characteristics (i.e., contact and subjective closeness) as correlates of reciprocal support. The analysis is based on the African American sub-sample of the National Survey of American Life (NSAL). Overall, our findings indicate that African Americans are very involved in reciprocal support networks with their extended family, friends and church members. Respondents were most extensively involved in reciprocal supports with extended family members, followed closely by friends and church networks. Network characteristics (i.e., contact and subjective closeness) were significantly and consistently associated with involvement with reciprocal support exchanges for all three networks. These and other findings are discussed in detail. This study complements previous work on the complementary roles of family, friend and congregational support networks, as well as studies of racial differences in informal support networks.