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Racism and Mental Health

     

Racism and racial discrimination adversely affect mental health, producing depression, anxiety, and heightened psychological stress in those who experience it.1 We’ve recently seen an increase in hate crimes, deadly violence at a white nationalist rally in Charlottesville, Virginia, and football players across the NFL taking a knee during the national anthem to draw attention to social injustice.

How Does Racism Affect the Mental Health of People of Racial Minorities?

Stress and PTSD

Chronic emotional stress is known to have negative physical and mental health effects. Racism and racial discrimination create a unique environment of pervasive, additional stress for people of racial and ethnic minorities in the United States.2 These repeated traumatic interactions can result in reduced self-esteem and internalized hatred as they’re forced into conservative and apologetic thinking.

In a University of Arizona study on emotional and physical stress from perceived racism, 18.2 percent and 9.8 percent of black participants reported emotional and physical stress, respectively. The rates of stress were significantly lower among white participants, with 3.5 percent and 1.6 percent reporting emotional and physical stress, respectively.3

During a conference on racism led by the Missouri Psychiatric Association, Marva Robinson, Psy.D., a clinical psychologist and president of the St. Louis Association of Black Psychologists, shared her findings on mental health in the African-American community. Robinson led a study on the stress levels in Ferguson, Missouri, after the shooting death of Michael Brown in 2014. Thirty-four percent of the community and 14 percent of police officers met the criteria for post-traumatic stress disorder (PTSD) as defined by the DSM-5. About 7.8 percent of people meet the criteria for PTSD nationwide.4

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Blatant acts of racism are not the only ways that racial stress has a negative impact on health. Microaggression, a term first coined in 1969 by the late psychiatrist Chester Pierce, M.D., is today known as a brief and commonplace daily verbal, behavioral, or environmental indignity, whether intentional or unintentional, that communicates hostile, derogatory, or negative racial slights and insults toward people of color. While they may seem like small offenses, the effects of microaggressions accumulate over time, contributing to mental health difficulties, such as depression or anxiety, and physical health consequences, such as pain and fatigue.5

Just the anticipation of experiencing racial discrimination can be enough to cause a significant spike in stress responses.6 A study showed that Latina students who interacted with a person with presumably racist ideas showed an increased “fight or flight” response with higher blood pressure and faster heart rates.7

Depression and Anxiety

Racial discrimination is more closely associated with the development of lifetime depressive and mood disorders.8 The national rate of occurrence for depression is 6.7 percent. In the study led by Robinson in Ferguson, Missouri, 43 percent of the community sample and 33 percent of the police sample met the criteria for depression.4 In Wisconsin, a statewide survey reported alarming rates of suicidal ideation among black high school students. While 4 percent of white students reported that they attempted suicide at least once, within the past year, 16 percent of black students reported suicide attempts.9 Experiencing racial discrimination as a black man between the ages of 20 and 23 has been shown to be a predictive factor for anxiety and depression up to age 32.10 Such levels of mental distress can create an environment that is conducive to unhealthy coping methods.11 With little access to quality medical care and treatment, alcohol and drugs are available to fill the void to cope with stress and pain.

Difficult Past

In 2001, a report by the Surgeon General reported that, “Racial and ethnic minorities have less access to mental health services than do whites. They are less likely to receive needed care. When they receive care, it is more likely to be poor in quality.”12 This was not a new phenomenon. The medical profession has not always been an ally to marginalized groups in the United States, which has led to tension with and distrust among those communities.

Improving Relationships with Communities of People of Racial and Ethnic Minorities

Understanding this difficult past is imperative to improving the current relationship between the medical and mental health professions and communities of people of racial and ethnic minorities. The past influences people today, and understanding a person’s culture, including their community’s significant history, disparities and stigma, is important to provide the highest quality of care.

To be a complete clinical assessment, there should be an understanding of how social determinants of mental health, such as discrimination, have affected the patients’ life.8 Social determinants of mental health have community-wide effects that should be “addressed through changes in public policies and social norms.”8, 13

As stated in its 2006 resolution against racism, the APA believes that it’s important to “be mindful of the existence and impact of racism and racial discrimination in the lives of patients and their families, in clinical encounters, and in the development of mental health services.” The organization is committed to this issue by “[furthering] research into the impacts of racism and racial discrimination as an important public mental health issue.”

Resources

  1. Yin Paradies, et al. Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLoS One. 2015.
  2. Physiological & Psychological Impact of Racism and Discrimination for African-Americans. American Psychological Association. 2017.
  3. Kathryn Freeman Anderson. Diagnosing Discrimination: Stress from Perceived Racism and the Mental and Physical Health Effects. University of Arizona. 2013.
  4. Tara Galovski, Ph.D. Understanding and Healing Pain Following the Events of Ferguson. Center for Trauma Recovery. 2015.
  5. Nadal, KL. 2012. Featured Commentary: Trayvon, Troy, Sean: When racial biases and microaggressions kill. Communiqué, American Psychological Association.
  6. Margaret O'Brien Caughy ScD, et al. Experiences of Racism Among African American Parents and the Mental Health of Their Preschool-Aged Children. American Journal of Public Health. 2011.
  7. Jason Silverstein. How Racism Is Bad for Our Bodies. The Atlantic. 2013.
  8. Michael T. Compton, M.D., M.P.H. and Ruth S. Shim, M.D., M.P.H. The Social Determinants of Mental Health. American Psychiatric Association Publishing. 2015.
  9. Rory Linnane. Kids in Crisis | For young people of color, racism's toll on mental health. USA Today. 2017.
  10. Shervin Assari, et al. Racial Discrimination during Adolescence Predicts Mental Health Deterioration in Adulthood: Gender Differences among Blacks. Frontiers in Public Health. 2017.
  11. Elizabeth A. Pascoe and Laura Smart Richman. Perceived Discrimination and Health: A Meta-Analytic Review. NIH. 2009.
  12. Mental Health: Culture, Race, and Ethnicity. Office of the Surgeon General. 2001.
  13. Social Determinants of Mental Health. World Health Organization. 2014.

     

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