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'More than Skin Deep': Stress Neurobiology and Mental Health Consequences of Racial Discrimination.
Abstract and Figures
Abstract Ethnic minority groups across the world face a complex set of adverse social and psychological challenges linked to their minority status, often involving racial discrimination. Racial Discrimination is increasingly recognised as an important contributing factor to health disparities among non-dominant ethnic minorities. A growing body of literature has recognised these health disparities and has investigated the relationship between racial discrimination and poor health outcomes. Chronically elevated cortisol levels and a dysregulated hypothalamic-pituitary-adrenal (HPA) axis appear to mediate effects of racial discrimination on allostatic load and disease. Racial discrimination seems to converge on the anterior cingulate cortex (ACC) and may impair the function of the prefrontal cortex (PFC), hence showing substantial similarities to chronic social stress. This review provides a summary of recent literature on hormonal and neural effects of racial discrimination and a synthesis of potential neurobiological pathways by which discrimination affects mental health.
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... A previous study scrutinized in details stress neurobiology and mental aftermath of racial discrimination [6]. Racial/ ethnic bias can create dysregulation in mediators of allostasis, such as altered hypothalamic-pituitary-adrenal-axis activity, altered heart rate variability, altered sympathetic nervous system and parasympathetic nervous system [6]. ...
... A previous study scrutinized in details stress neurobiology and mental aftermath of racial discrimination [6]. Racial/ ethnic bias can create dysregulation in mediators of allostasis, such as altered hypothalamic-pituitary-adrenal-axis activity, altered heart rate variability, altered sympathetic nervous system and parasympathetic nervous system [6]. Another study examined the relationship between racial discrimination and real-time physiological stress responses and concluded that the parallel use of salivary biomarkers and ecological momentary assessments functioned to examine this temporal relationship [7]. ...
Introduction:
Racial/ethnic discrimination indicates the stereotyped or unkind conduct of superiority towards other persons based on their race or skin color. The UK General Medical Council published a statement supporting zero-tolerance approach to racism in the workplace. We aimed to systematically review racial discrimination in surgery and answer the following questions: (1) Does racial/ethnic discrimination in surgery exist in citations from the last 5 years. (2) If yes, are ways suggested to reduce racial/ethnic discrimination in surgery?
Methods:
The systematic review was performed in compliance with the PRISMA guidelines along AMSTAR 2. A 5-year literature search was carried out on PubMed for articles published from 1/1/2017 to 01/11/2022. Search terms were 'racial discrimination and surgery', 'racism OR discrimination AND surgery', 'racism OR discrimination AND surgical education'. The retrieved citations were quality assessed by MERSQI and evidence graded by GRADE.
Results:
A total of 9116 participants responded with a mean of 1013 (SD = 2408) responses per citations reported in 9 studies from a final list of 10 included citations. Nine studies were from USA and 1 from South Africa. There was evidence of racial discrimination in the last 5 years and the results were justified on strong scientific evidence constituting the basis for evidence grade I. The second question's answer was 'yes' which was defendable on moderate scientific recommendation and thereby establishing the basis for evidence grade II.
Conclusion:
There was sufficient evidence for the presence of racial discrimination in surgical practice in the last 5 years. Ways to decrease racial discrimination in surgery exist. Healthcare and training systems must increase the awareness of these issues to eliminate the harmful effect on the individual as well as on the level of the surgical team performance. The existence of the discussed problems must be managed in more countries with diverse healthcare systems.
... It has been shown that being a victim of racism may induce brain changes which are similar to alteration observed in anxiety, depression and psychosis, involving in particular hippocampus (reduced in its volume), prefrontal cortex, anterior cingulate cortex, amygdala, and thalamus (Berger & Sarnyai, 2015). These regions become more active in response to social rejection, and their activity is correlated with self-reported levels of distress. ...
Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic-discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated.
... Taken together, these findings are consistent with models that conceptualize racism as an acute and chronic psychosocial stressor that contributes to poor physiological and mental health via neurobiological stress pathways and negative health behaviors [5,14,51]. Chronic stress interventions have been fruitful in many contexts; for example, AL has been shown to be modifiable via group behavioral interventions among African-American women at risk for diabetes [59], Chinese women with metastatic breast cancer [68], and older adults with insomnia [13]. The Race-Based Stress and Trauma Empowerment (RBSTE) group [12] is a novel health promotion intervention designed to address individuallevel direct (i.e., chronic stress) and indirect (i.e., health behaviors) factors that sustain health disparities among VOC. ...
Background:
Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation.
Methods:
Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention.
Conclusion:
This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research.
Clinical trial registration number:
NCT05422638.
... The mechanistic underpinnings of the impact on racism on health are increasingly understood. For example, the "high-effort coping" required to live in a social environment rife with daily microaggressions is linked to a "weathering" effect manifest across a range of metrics (Geronimus, Hicken, Keene, & Bound, 2006), including premature aging and shortened telomere length (Chae et al., 2014), in turn a re ection of living under chronic stress (Berger & Sarnyai, 2015). Although direct causation cannot be established from association, downstream consequences may include the recently documented secular increase in Black adolescent suicide rates (Sheftall et al., 2021). ...
Introduction
It is well documented that race plays a role in health care access and outcomes. However, discussions about race in the workplace are often avoided.
Aim/Question
We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff.
Methods
We conducted individual interviews about perceptions of race and racism using a purposive sample of twenty-two individuals in an acute child psychiatric inpatient service. We analyzed interviews systematically with thematic analysis guided by a constructivist grounded theory conceptual framework.
Results
We identified two countervailing processes: 1) Entrenching – factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating; and 2) Uprooting – factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements in a “6P” model organized along a temporal sequence around sentinel racist events. For each of the six components we go on to include: Contributing Factors, Emotional Reactions, and Behavioral Responses as reported by participants.
Implications for Practice
Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. These interventions could be applied to milieu-based inpatient settings serving patients of all ages.
... They may evoke negative emotions that comprise psychological (i.e., anxiety, depression, psychiatric disorders) and physical health functioning (i.e., elevated cortisol, vulnerability to chronic diseases), amplifying reliance on maladaptive coping responses. Ultimately, these challenges have been associated with ineffective parenting and parental substance use disorders (Berger & Sarnyai, 2015). In addition, Murry et al. (2018 illustrated ways in which chronic racial discrimination induces negative emotionality and heightened reactivity that spillover to adversely affects parent-child relationship quality. ...
Critical action—defined as actions and behaviors aimed at disrupting systems of oppression—is a developmental asset for Black and Latinx youth. Over the past two decades, research on Black and Latinx youth’s critical action has proliferated, particularly with respect to the development of quantitative measures. In this chapter, we review current conceptualizations and measures of critical action. We then highlight potential barriers (e.g., citizenship status) and facilitators (e.g., ethnic-racial identity) of critical action for Black and Latinx youth, with special consideration of differences during childhood, adolescence, and adulthood. Our review reveals the need for further measurement development that accounts for (1) experiences unique to specific ethnic-racial groups, (2) a wider spectrum of critical action, and (3) intention, frequency, and risk of critical action. We also assert that future research should consider how various contextual and demographic factors impact critical action across the lifespan. We conclude with recommendations for research on Black and Latinx youth’s critical action.KeywordsCritical actionBlack youthLatinx youthMeasurementRacismSociopolitical development
... They may evoke negative emotions that comprise psychological (i.e., anxiety, depression, psychiatric disorders) and physical health functioning (i.e., elevated cortisol, vulnerability to chronic diseases), amplifying reliance on maladaptive coping responses. Ultimately, these challenges have been associated with ineffective parenting and parental substance use disorders (Berger & Sarnyai, 2015). In addition, Murry et al. (2018 illustrated ways in which chronic racial discrimination induces negative emotionality and heightened reactivity that spillover to adversely affects parent-child relationship quality. ...
This chapter applies critical multiracial theory to advance the conceptualization and measurement of multiracial experiences and identity in developmental science. We aim to illustrate the complexity in how multiracials navigate, negotiate, and challenge (mono)racism and white supremacy in the United States. First, we investigate the historic exclusion and invisibility of multiracials in developmental science, as well as how multiracials complicate traditional understandings of racism, racial formation, and racial identity. Next, we review past and present approaches taken to study the theory and measurement of multiracial experiences and identity. In addition, we introduce a new Model of Multiracial Racialization that situates multiracial racialization experiences (including racial identity, racial identification, and racial category) within six ecological levels: (1) Individual Characteristics; (2) Interpersonal Experiences; (3) Contextual Factors; (4) Social, Economic, and Political Environments; (5) Systems of Oppression; and (6) Time. Finally, we offer specific examples of research topics and questions that attend to each level of our model with the hope of stimulating future research and advancing our developmental science understanding of multiraciality.KeywordsMultiracial Racial identity Multiracial racialization Racial formation Critical race theory
Demand for multicultural counseling services in Korea will increase due to the number of people with diverse cultural backgrounds, yet more efforts are required to prepare counselors regarding their awareness and attitude towards people with diverse cultural backgrounds. In North America, with a long history of multiculturalism, counselors’ racial identity is adopted as a key factor to enhance counseling competence. Researchers have examined White racial identity models from the North America and discussed the need for Korean racial identity model in the Korean context of: 1) ethnic nationalism, 2) paternalism, 3) low awareness of privilege, and 4) racial hierarchism. Korean racial identity model based on these considerations is expected to advance multicultural counseling competence among Korean counselors.
Critical issues facing diverse minoritized children and families include socializing and developing an affirming racial-ethnic identity at a time when social justice, anti-immigrant sentiment, and discrimination across multiple racial-ethnic groups are in the foreground. Developmental science is attuned to these vital areas of research on the experiences of diverse racial-ethnic families who have been marginalized in the United States for far too long. This chapter builds upon the previous chapters in the volume, offering suggestions for translating the relevant conceptual, measurement, and empirical research into actionable practices and policies in family, school, and community contexts. This chapter focuses on prevention and intervention approaches that are anti-racist, equitable, and culturally relevant, in the context of systemic racism. We also challenge developmental science to train more community-engaged scientist-practitioners who tackle macro-level, historical, and structural inequalities that greatly affect the lives of an increasingly diverse US population.KeywordsFamily-school-communityMinoritizedPrevention/interventionAnti-racistCulturally relevant
Importance
Relative risk for the brain disorder schizophrenia is more than doubled in ethnic minorities, an effect that is evident across countries and linked to socially relevant cues such as skin color, making ethnic minority status a well-established social environmental risk factor. Pathoepidemiological models propose a role for chronic social stress and perceived discrimination for mental health risk in ethnic minorities, but the neurobiology is unexplored.Objective
To study neural social stress processing, using functional magnetic resonance imaging, and associations with perceived discrimination in ethnic minority individuals.Design, Setting, and Participants
Cross-sectional design in a university setting using 3 validated paradigms to challenge neural social stress processing and, to probe for specificity, emotional and cognitive brain functions. Healthy participants included those with German lineage (n = 40) and those of ethnic minority (n = 40) from different ethnic backgrounds matched for sociodemographic, psychological, and task performance characteristics. Control comparisons examined stress processing with matched ethnic background of investigators (23 Turkish vs 23 German participants) and basic emotional and cognitive tasks (24 Turkish vs 24 German participants).Main Outcomes and Measures
Blood oxygenation level–dependent response, functional connectivity, and psychological and physiological measures.Results
There were significant increases in heart rate (P < .001), subjective emotional response (self-related emotions, P < .001; subjective anxiety, P = .006), and salivary cortisol level (P = .004) during functional magnetic resonance imaging stress induction. Ethnic minority individuals had significantly higher perceived chronic stress levels (P = .02) as well as increased activation (family-wise error–corrected [FWE] P = .005, region of interest corrected) and increased functional connectivity (PFWE = .01, region of interest corrected) of perigenual anterior cingulate cortex (ACC). The effects were specific to stress and not explained by a social distance effect. Ethnic minority individuals had significant correlations between perceived group discrimination and activation in perigenual ACC (PFWE = .001, region of interest corrected) and ventral striatum (PFWE = .02, whole brain corrected) and mediation of the relationship between perceived discrimination and perigenual ACC–dorsal ACC connectivity by chronic stress (P < .05).Conclusions and Relevance
Epidemiologists proposed a causal role of social-evaluative stress, but the neural processes that could mediate this susceptibility effect were unknown. Our data demonstrate the potential of investigating associations from epidemiology with neuroimaging, suggest brain effects of social marginalization, and highlight a neural system in which environmental and genetic risk factors for mental illness may converge.
Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011-2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.
Anterior cingulate cortex (ACC) is a part of the brain's limbic system. Classically, this region has been related to affect, on the basis of lesion studies in humans and in animals. In the late 1980s, neuroimaging research indicated that ACC was active in many studies of cognition. The findings from EEG studies of a focal area of negativity in scalp electrodes following an error response led to the idea that ACC might be the brain's error detection and correction device. In this article, these various findings are reviewed in relation to the idea that ACC is a part of a circuit involved in a form of attention that serves to regulate both cognitive and emotional processing. Neuroimaging studies showing that separate areas of ACC are involved in cognition and emotion are discussed and related to results showing that the error negativity is influenced by affect and motivation. In addition, the development of the emotional and cognitive roles of ACC are discussed, and how the success of this regulation in controlling responses might be correlated with cingulate size. Finally, some theories are considered about how the different subdivisions of ACC might interact with other cortical structures as a part of the circuits involved in the regulation of mental and emotional activity.
The "aberrant salience" model proposes that psychotic symptoms first emerge when chaotic brain dopamine transmission leads to the attribution of significance to stimuli that would normally be considered irrelevant. This is thought to occur during the prodromal phase of psychotic disorders, but this prediction has not been tested previously. In the present study, we tested this model in 18 healthy volunteers and 18 unmedicated individuals at ultra-high risk of psychosis. Subjects performed the Salience Attribution Test, which provides behavioral measures of adaptive and aberrant motivational salience, during functional magnetic resonance imaging to assess neural responses to relevant and irrelevant stimulus features. On a separate occasion, the same subjects were also studied with [(18)F]fluorodopa positron emission tomography to measure dopamine synthesis capacity. Individuals at ultra-high risk of psychosis were more likely to attribute motivational salience to irrelevant stimulus features (t(26.7) = 2.8, P = .008), and this bias was related to the severity of their delusion-like symptoms (r = .62, P = .008). Ventral striatal responses to irrelevant stimulus features were also correlated with delusion-like symptoms in the ultra-high risk group (r = .59, P = .017). Striatal dopamine synthesis capacity correlated negatively with hippocampal responses to irrelevant stimulus features in ultra-high risk individuals, but this relationship was positive in controls. These data are consistent with the hypothesis that aberrant salience processing underlies psychotic symptoms and involves functional alterations in the striatum, hippocampus, and the subcortical dopamine system.
On the basis of historical and contemporary arguments and discourses, we discuss the development and context of the "race" concept and its utilisation in science and society. The scientific lines of reasoning and the associated stereotypes are discussed and scrutinised with respect to their scientific, clinical and social relevance. An short overview over migrational movements of human populations provides an alternative account of population differences that is based on clinical, i. e. gradual variations among human populations rather than categorical differences as implied in the "race" construct. We provide a critical perspective on reductionist theses about human differences, which have contributed during the past century and in some contemporary discourses to inappropriate and discriminating classifications of "human races". We show how reductionist accounts of human variability can be abused to justify social and economic differences and discuss an alternative view based on anthropological and genetic studies, which emphasize the diversity and variability of human populations.
Heart rate variability (HRV), thought to reflect autonomic nervous system function, is lowered under conditions such as posttraumatic stress disorder (PTSD). The potential confounding effects of traumatic brain injury (TBI) and depression in the relationship between HRV and PTSD have not been elucidated in a large cohort of military service members. Here we describe HRV associations with stress disorder symptoms in a large study of Marines while accounting for well-known covariates of HRV and PTSD including TBI and depression.
Four battalions of male active-duty Marines (n = 2430) were assessed 1 to 2 months before a combat deployment. HRV was measured during a 5-minute rest. Depression and PTSD were assessed using the Beck Depression Inventory and Clinician-Administered PTSD Scale, respectively.
When adjusting for covariates, including TBI, regression analyses showed that lower levels of high-frequency HRV were associated with a diagnosis of PTSD (β = -0.20, p = .035). Depression and PTSD severity were correlated (r = 0.49, p < .001); however, participants with PTSD but relatively low depression scores exhibited reduced high frequency compared with controls (p = .012). Marines with deployment experience (n = 1254) had lower HRV than did those with no experience (p = .033).
This cross-sectional analysis of a large cohort supports associations between PTSD and reduced HRV when accounting for TBI and depression symptoms. Future postdeployment assessments will be used to determine whether predeployment HRV can predict vulnerability and resilience to the serious psychological and physiological consequences of combat exposure.
Stress initiates an intricate response that affects diverse cognitive and affective domains, with the goal of improving survival chances in the light of changing environmental challenges. Here, we bridge animal data at cellular and systems levels with human work on brain-wide networks to propose a framework describing how stress-related neuromodulators trigger dynamic shifts in network balance, enabling an organism to comprehensively reallocate its neural resources according to cognitive demands. We argue that exposure to acute stress prompts a reallocation of resources to a salience network, promoting fear and vigilance, at the cost of an executive control network. After stress subsides, resource allocation to these two networks reverses, which normalizes emotional reactivity and enhances higher-order cognitive processes important for long-term survival.