Preliminary evidence for a race-based stress reduction intervention for Black women at risk for cardiovascular disease

ObjectiveDespite evidence that chronic stress, racism, and discrimination impact the well-being and the risk for cardiovascular disease (CVD) in Black women, there are few evidence-based interventions that improve well-being and reduce the risk for CVD in women of minority groups. The purpose of this pilot study was to evaluate the psychobehavioral and anti-inflammatory benefit of a race-based stress reduction program “Resilience, Stress, and Ethnicity (RiSE) for Black women at risk for CVD. Methods: Black women were recruited from the Chicagoland community and randomized to either the 8-week RiSE intervention (n = 40) or control group (n = 34). Participants were assessed for coping strategies, psychological distress, and blood levels of TNF-alpha and high sensitivity C-reactive protein (hsCRP) at baseline and at 4 and 8 weeks after baseline. Results: Participation in RiSE was associated with a more rapid decline in the use of avoidance coping (b = -0.3585, SE = 0.1705, p < .01). Reductions over time in TNF-alpha (b = -0.0163, SE = .0087, p = .08) and hsCRP (b= -0.4064, SE = 0.2270, p = .08) approached statistical significance. Conclusions: Findings provide preliminary evidence in Black women at risk for CVD that RiSE contributes to decreases in avoidance coping. Although preliminary, these results suggest RiSE to be an effective intervention to promote improved coping associated with racism and discrimination in minorities.     

Racial Discrimination and Blood Pressure: Perceptions,Emotions, and Behaviors of Black American Adults

This study examined racial discrimination and blood pressure (BP) in 211 Black Americans. Racial discrimination is a chronic stressor for many Black Americans and hypertension prevalence is high in this population. Secondary analyses of data from the study, “Everyday Life for Black American Adults,” were conducted to examine relationships among perceived racial discrimination, emotional and behavioral responses to racism, and BP. Although racial discrimination was not correlated with BP, sadness and frustration were significantly but negatively correlated with BP. Speaking out and prayer were frequent behavioral responses to racism. Findings should sensitize healthcare providers to the effects of racial discrimination on the health of Black Americans.     

Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review

Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models – socioecological, cumulative stress, and biopsychosocial – related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP.PerspectiveThis narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models – socioecological, cumulative stress, biopsychosocial –, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.     

Associations between social determinants of health,perceived discrimination,and body mass index on symptoms of depression among young African American mothers

PurposeThe association between symptoms of depression and risks for cardiovascular disease (CVD) remains equivocal for African American (AA) mothers. We examined the association between social determinants of health (perceived discrimination), and cardiovascular risk (BMI) on symptoms of depression in a sample of young AA mothers.MethodsSecondary data from 219 adult AA mothers between the ages of 21 and 46 with an average BMI of 29.8 and yearly family income of $14,999 were analyzed using a latent growth model that evaluated four time points to assess changes in symptoms of depression.ResultsInitial BMI was significantly associated with initial symptoms of depression (b = 0.12, p = .019). Perceived discrimination (unfair treatment) was associated with higher initial symptoms of depression (b = 1.14, p = .017).ConclusionThe findings suggest that elevated BMI and perceived discrimination are associated with higher reported symptoms of depression among young, socioeconomically disadvantaged AA mothers. These results advance the scientific understanding of young AA mothers' risk for symptoms of depression and CVD by elucidating the impact of perceived discrimination and social experiences on mental health. Further studies of SDoH and CVD risk factors and perceived racism and depression are needed to shed light on the long-term mental health impact on AA mothers and their children.     

Stress,Inflammation and Preterm Birth in African American Women

In 2011, 11.7% of babies in the U.S. were born prematurely. African American women have higher rates of preterm birth compared with non-Hispanic white women. Chronic stressors experienced by African American women, such as living in disadvantaged neighborhoods and experiencing racial discrimination, have been related to higher rates of preterm birth. One potential pathway by which neighborhood disadvantage and racial discrimination can affect preterm birth is by increasing cumulative stress burden for these women. Psychological stress has been linked to preterm birth. The effects of chronic stress on preterm birth may occur through alterations of immune functions, thereby predisposing women to infection/inflammation. This review focuses on stress and inflammation as potential mechanisms for disparities in preterm birth in African American women. Prior research provides some evidence that stress-related immune interactions may contribute to preterm birth. Nurses need to be aware that African American women may experience chronic stressors in addition to the acute stress of having a premature infant.     

Results of a mindfulness intervention feasibility study among elder African American women: A qualitative analysis

Objectives. Older African Americans have a significantly higher risk than older white Americans for cognitive decline and other health problems. Much of this may be due to the unique stressors, both historically and in-the-moment, that African Americans face in contrast to whites, such as gentrification and health disparities. Gender further exacerbates this effect. This study aims to understand stressors unique to older African American women, as well as coping strengths that have emerged organically over time for use in tailoring stress-reduction mindfulness classes in this communityDesign and setting. A four-week mindfulness training class adapted from mindfulness-based stress reduction (MBSR) was implemented in a historically black, gentrifying neighborhood in Portland, Oregon with 10 older African American women aged 50–89.Main outcome measures. Focus groups discussed stressors, coping, responses to mindfulness classes, and preferences to better reflect older African American cultural values and norms.Results. Stressors reflected participants’ intersectionality as older black women, including neighborhood and workplace race-based microagressions, and gentrification-related cultural and generational incongruences. Coping strategies included self-care, remembering core-self amidst stress, and drawing strength from family and faith. Participants found mindfulness classes appropriate for addressing stress and felt that classes provided a forum for connecting on issues of race and community.Conclusion. Tailoring classes to older African American women should consider integrating biblical teachings, African American instructors who understand socio-historical contexts of older black women’s stressors and strengths, and time for group-reflection to support community building.     

Millennium milestones: looking back, moving forward in your research career.

The author discusses the mission of the National Institute on Aging (NIA), Office of Special Populations, the trends in appropriations, use of census data and the need to disentangle the social and political meaning of race from the presumed biological meaning, the potential effect of slavery on the health of African Americans, Federal racial and ethnic minority initiatives, definitions of race, culture, ethnicity, class and racism; formal recommendations from the NIA review of minority aging research; and NIA training and career development opportunities for minorities. Lastly, the author discusses minority aging research, health disparities and strategies for recruiting minorities into aging research.     

Giving while grieving: Racism-related stress and psychological resilience in Black/African American registered nurses

BackgroundStudies have found race-related stress psychologically and physiologically harms members of stigmatized racial groups. However, the stressor is racism, not race.PurposeThis study examined the relationship between racism-related stress and psychological resilience in Black/African American nurses.MethodThis study used a cross-sectional, quantitative, correlational design with two instruments, an investigator-developed demographic questionnaire and a convenience sample.FindingsParticipants perceived they have low psychological resilience in stressful situations. With racism-related stress, in particular, participants perceived they are affected by both lived and vicarious racism – ruminating over past occurrences, and expecting/worrying that racism will happen to them or other Black/African American people. There was a significant positive correlation between participants’ perceived psychological resilience, their ability to assess the nature of the racism-related stressor and their ability to mitigate its harmful effects by identifying and utilizing their coping resources. There was a negative correlation between racism-related stress and psychological resilience.DiscussionThere is a need for continued research on racism-related stress among Black/African American nurses. Further, healthcare organizations, advisably through their diversity, equity and inclusion (DEI) programs, must develop systemic approaches to meeting the unique needs of the Black/African American workforce.     

Stress and Coping among Black Women Employed in Non-professional Service and Professional Occupations in Florida and Georgia

Culture enhances the ability to address the stressors related to ethnicity/race, employment, and lifestyle. From this interaction, two coping patterns emerge: individualist-oriented or collectivist-oriented, of which women prefer the latter. However, there is limited knowledge about the impact of ethnicity/race on the coping strategies of Black working women in the USA. Therefore, the purpose of this cross-sectional survey was to examine the coping strategies of two groups of Black women, those who work in non-professional service-related jobs and those employed as professionals. We explored Black women from two southern states, Florida and Georgia, in their use of coping strategies for everyday stressors. A modified version of Lazarus and Folkman's Transactional Model was used as the framework of this study. The sample for this cross-sectional survey consisted of 313 Black women employed in non-professional service jobs and 343 in professional roles. The thoughts and actions related to coping in everyday stressors were measured with The Ways of Coping Questionnaire.     

Injustice Appraisal,but not Pain Catastrophizing,Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain

Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies.PerspectiveMore frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.     

Assessment and Treatment Recommendations for Pediatric Pain: The Influence of Patient Race,Patient Gender,and Provider Pain-Related Attitudes

Previous studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as "providers"), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers’ pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups.PerspectiveProviders’ pain assessment (ie, pain distress/pain interference) and treatment (ie, opioids) of pediatric pain differs across patient race and to a lesser extent, patient gender. This study represents a critical step in research on pain-related disparities in pediatric pain.     

The Role of Perceived Stress and Life Stressors in the Development of Chronic Musculoskeletal Pain Disorders: A Systematic Review

The etiologic role of work-related psychological stress in the development of musculoskeletal pain disorders (MDs) has been systematically investigated. Less clear, however, is the role of perceived stress and life stressors. This review aimed to assess the evidence for an etiologic role of perceived stress and life stressors in the development of chronic MDs. Database searches were conducted to identify prospective longitudinal studies that assessed perceived stress and life stressors in individuals without, or in the first 6 weeks of, musculoskeletal pain. The primary outcome was the development of a chronic MD. Methodologic quality was investigated using an adapted version of the Quality Assessment Tool for Observational Cohort studies and Cross-Sectional studies, and the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Seven studies were included representing data from 6 independent cohorts. There was some evidence to support the etiologic role of perceived stress and life stressors in the development of arthritis (low quality) and chronic spinal pain (low quality). The limited number of studies, the poor quality of the evidence, and the heterogeneity of stress measures used across studies suggest that further high quality prospective studies are required to clarify the role of perceived stress and life stressors in the development of chronic MDs.PROSPERO: CRD42017059949PerspectiveThis review summarizes and critically appraises the evidence for the etiologic role of perceived stress and life stressors in the development of chronic MDs. The limited number of studies, the low quality of the evidence, and the heterogeneity across studies suggest that further research is needed on perceived stress and life stressors in MDs.     

Everyday life for black american adults: stress, emotions, and blood pressure

The purpose of this study was to examine the stress process in Black Americans by exploring chronic stress, emotions, age, body mass index, and blood pressure within the context of gender and socioeconomic position (SEP). The convenience sample of middle-class Black Americans ( N = 211) ranged from ages 25 to 79 years. A sociopsychophysiological model of everyday life for Black American adults was tested using structural equation modeling. The model explained 27% of the variance in systolic and 17% of the variance in diastolic blood pressure. SEP had a significant effect on chronic stress, and chronic stress had a significant effect on negative affect. Although men had lower negative affect scores than women, men's diastolic blood pressures were on average 4 mm Hg higher than women's. These findings are useful to the development and implementation of interventions to eliminate health disparities and improve years of healthy life for Black Americans.     

Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients

The purpose of this study was to identify stressors, level of stress, coping strategies, and coping effectiveness in Egyptian female mastectomy patients. A total of 64 women who had had mastectomies participated in the study. Coping effectiveness was measured by McNett's Coping Effectiveness Questionnaire (MCEQ). Factor analysis and reliability measures were established on MCEQ using the study sample. Data were collected using a structured interview method. Participants were also asked about age, education, and time since mastectomy. These data were examined in an effort to predict coping effectiveness. The participants reported five stressors: hope for cure, treatment effectiveness, fear of the unknown, progression of the disease, and pain. The treatment effectiveness stressor had the highest mean level of stress. There was a significant difference in the level of stress among the five stressors. Coping strategies reported were categorized into four groups: faith, compliance with the medical regimen, seeking information and social support, and self-distraction. Coping effectiveness was significantly and positively correlated with age and time since mastectomy, which accounted for 35% of the variance in coping effectiveness. Findings suggest that continuing assessments of Egyptian mastectomy patients' needs, further research studies, and an intervention program to ameliorate cancer-related anxiety and to help cancer patients cope effectively may be helpful.     

Body Mass Index and Quality of Life: Examining Blacks and Whites With Chronic Pain

Obesity contributes to several chronic pain conditions, negatively affecting quality of life (QOL). However, obesity's relationship with chronic pain is poorly understood. This prospective survey study examines obesity's role in chronic pain and subsequent impact on QOL. Black and white patients with chronic pain (N = 183, 18–50 years of age, 64% women, 50% black) were studied to determine predictors for the presence of body mass index (BMI) information in medical records, group BMI differences, and how BMI and pain contribute to mental/physical outcomes. BMI was calculated by using medical records nearest the enrollment date. Sociodemographic data, sleep, pain, functioning, disability, and depression were measured. BMI data were available for 143 subjects (78%), with blacks having a higher BMI (P = .002). Black (P = .08), people with higher pain (P < .01), affective distress (P < .01), and post-traumatic stress disorder scores (P = .07) were less likely to have their BMI recorded. Path analysis tested relationships between sociodemographics, BMI and pain with functioning, depression, and disability. BMI was positively associated with black race and age and predicted poorer physical functioning and greater disability. Pain was not predicted by race or age but was associated with all outcomes. These findings support assessing BMI when managing chronic pain and its negative impact on QOL, especially for minority patients.PerspectiveThis study examines the relationships among sociodemographic factors, BMI, and QOL in chronic pain. Our results demonstrate significant racial disparity among chronic pain patients in assessing BMI and quality of pain care. These findings support obesity's negative impact on overall health and the importance of measuring BMI in patients with chronic pain, especially racial and ethnic minorities.     

Minority Voices: Addressing the Lived Experience of Black Nurses and Nurse Leaders Confronting Racism in the Nursing Profession

Racism continues to erect substantial barriers for Blacks and minorities within the nursing profession, even while the shifting US population demographics and increasing numbers of minorities make diversifying the profession imperative. Interviews with Black nurses at virtually every career stage indicate that racism remains a significant obstacle and may prevent them from ascending to leadership. Building a diverse nursing workforce and leadership is necessary to serving a diverse community, especially underserved populations. A more diverse nursing organization is better equipped to identify and address the social determinants of health affecting a given patient population and thereby more effectively alleviate health disparities.     

Minority Stress and Attributions for Discriminatory Events Predict Social Anxiety in Gay Men

This study revealed that attributional style can identify gay men at risk for adverse mental health correlates of discrimination, as well as those resilient in the face of frequent discriminatory events. Men identifying as gay (N = 307) completed online self-reports of social anxiety, perceived frequency of discriminatory events, attributions for discriminatory events, and key minority stress constructs: internalized homonegativity and gay identity development. A new measure was constructed to assess different types of attributions regarding discrimination, with factor analyses yielding promising psychometric properties. Global attributions and the importance ascribed to discrimination were associated with increased social anxiety, above and beyond other minority stress constructs related to mental health in gay men. Attribution style also served as a moderator, as perceived discrimination was only associated with increased social anxiety in gay men who attributed high globality/importance to discriminatory events. Attributions may serve as risk or protective factors in the context of discrimination.     

Racial and Ethnic Disparities in Pain: Causes and Consequences of Unequal Care

The purpose of our review is to evaluate critically the recent literature on racial and ethnic disparities in pain and to determine how far we have come toward reducing and eliminating disparities in pain. We examined peer-reviewed research articles published between 1990 and early 2009 that focused on racial and ethnic disparities in pain in the United States. The databases used were PubMed, Medline, Scopus, CINAHL, and PsycInfo. The probable causes of minority group disparities in pain are discussed, along with suggested strategies for eliminating pain-related disparities. This review reveals the persistence of racial and ethnic disparities in acute, chronic, cancer, and palliative pain care across the lifespan and treatment settings, with minorities receiving lesser quality pain care than non-Hispanic whites. Although health and health care disparities attract local, state, and federal attention, disparities in pain care continue to be missing from publicized public health agendas and health care reform plans. Ensuring optimal pain care for all is critically important from a public health and policy perspective. A robust research program on disparities in pain is needed, and the results must be successfully translated into practices and policies specifically designed to reduce and eliminate disparities in care.PerspectiveThis review evaluates the recent literature on racial and ethnic disparities in pain and pain treatment. Racial and ethnic disparities in acute pain, chronic cancer pain, and palliative pain care continue to persist. Rigorous research is needed to develop interventions, practices, and policies for eliminating disparities in pain.