Discrimination: Effects, Coping Strategies, and Treatment Implications in Multiple Marginalized Populations

Broderick Sawyer, PhD Chair
University of Louisville
Louisville, KY 
United States
 
Lauren P Wadsworth, PhD Chair
McLean Hospital/Harvard Medical School
Belmont, MA 
United States
 
Jessica Graham-LoPresti, PhD Discussant
Suffolk Universuty
Boston, MA 
United States
 
Sunday, March 31: 11:00 AM  - 1:00 PM 
314R 
Symposium 
Meeting Room Level 2 
Room: Superior B 
Credits:

Description

Individuals who hold one or more marginalized identities (e.g. being a person of color; being lesbian/bisexual/gay/queer; being transgender) experience discrimination in many forms, including microaggressions, violence, harassment, and barriers to employment and housing (Grant et al., 2010; Smith & Silva, 2011). Frequency of discrimination has been linked to higher levels of anxiety and depression (Barzgan & Galvan, 2012; Barzgan & Galvan, 2012). This symposium is designed to take a deeper dive into the experience of discrimination in people of color and trans and gender diverse individuals. We will discuss 1. Correlations between experiences of discrimination and psychological health; 2. Coping strategies employed in response to discrimination; 3. Adaptive skills that may help buffer the effects of discrimination; 4. Treatment implications of working with individuals experiencing discrimination; and 5. Treatment suggestions in helping people respond to discrimination in a more sustainable way. First, Sierra Carter will present on the impact of race-related stress on the relationship between PTSD and functional impairment in a population of African American women living in an urban area. Sierra's findings suggest that race related stress is positively correlated with PTSD symptoms and greater functional impairments. Next, Kevin Foster will report on the buffering effects of having a greater differentiation of self (interpersonal capacities: I-position, emotional reactivity, fusion with others, and emotional cutoff) on the relations between frequency of microaggressions and mood (anxiety, depression, psychological distress) in Black individuals. Relatedly, Mariah Corey will present data investigating the interaction of ethnic identity, discrimination, and anxiety/depression in Black and Hispanic participants, reporting an interaction of ethnic identity and depression in the Black (but not Hispanic) sample. Lauren Wadsworth will present data from a Trans and Gender Diverse sample showing that greater frequency of discrimination is correlated with higher use of coping strategies (detachment, drug and alcohol use, and internalization; not education/advocacy or resistance). Further, greater use of withdrawal based coping skills (detachment/drug use/internalization) were correlated to higher depression and anxiety. Finally, Broderick Sawyer will present data showing that racial/ethnic minorities show greater psychopathology, avoidance, and anger rumination in the presence of greater microaggressions. Further, results indicate that mindfulness and self-compassion may be advantageous skills that buffer negative emotional effects of microaggressions. Overall, our symposium will report these recent findings on the impact of discrimination, coping strategies, skills, and will provide added discussion on relevant and timely clinical interventions.

Learning Objectives

1. Identify psychological impacts of discrimination in people of color and trans and gender diverse individuals.
2. Learn a range of coping strategies used to cope with discrimination
3. Apply psychological impacts and coping strategies into treatment with people impacted by discrimination and/or holding marginalized identities 

Audience Level

Intermediate/Advanced

Demographic

Multicultural

Diversity/Content

Diversity - Yes

Duration

120 minutes

Disorder

Anxiety

Treatment Approach

CBT

Presentations

Coping with Discrimination: The Insidious Effects of Transphobia on the Mental Health of Gender Diverse Individuals

Transgender and other gender diverse individuals experience significant discrimination and health disparities. Response to, and effects of, this discrimination have been vastly under-researched. The present study investigated the impact of experiences of discrimination on mental health in a sample of gender diverse individuals via a one-time online study. The 695 participants were 30.4% trans men, 16.6% trans women, and the remainder were genderqueer, non-binary, and other options, mostly White (75.7%), low levels of annual income. The study included measures of discrimination (Discrimination Subscale of the Gender Minority Stress and Resilience Measure), coping (Coping with Discrimination Scale), anxiety and depression (Patient-Reported Outcomes Measurement Information System). Results indicated that experiencing greater past year discrimination was associated with greater depression and anxiety and positively associated with all forms of coping, except drug and alcohol use. Depression and anxiety symptoms were positively associated with withdrawal strategies (coping via detachment, drug and alcohol use, internalization), not approach strategies (education/advocacy or resistance). Results from multiple mediation analyses revealed a significant positive association between discrimination and depression and anxiety. Past year discrimination was related to greater coping via withdrawal strategies, which was in turn related to greater symptoms of depression and anxiety. Consistent with research, higher levels of discrimination were positively correlated with anxiety and depression. Further, as frequency of discrimination increased, anxiety and depression symptoms increased, which may be explained partially by individuals increasingly engaging in withdrawal strategies at these higher levels of discrimination. As discrimination increases, perhaps it becomes more difficult to respond with approach strategies, as the individual’s resources diminish. As discrimination increases, perhaps coping via withdrawal strategies becomes more likely, as less emotional resources are available, and withdrawal may be protective. Our results provide evidence for an insidious cycle experienced by gender minorities (i.e. people that do not identify as cisgender) including being discriminated against, attempts to cope via a range of approach and withdrawal strategies, and increased levels of anxiety and depression symptoms associated with withdrawal strategies.  

Presenter

Lauren P Wadsworth, PhD, McLean Hospital/Harvard Medical School Belmont, MA 
United States

Racial Microaggressions, Negative Outcomes, Mindfulness and Self-Compassion

Background: In comparison to overt discrimination (e.g., racial slurs), racial microaggressions may occur more frequently and are harder to interpret given their covert nature. Correctly interpreting the microaggression becomes important if victims are somehow relying on a potential aggressor (e.g., hoping that a boss treats them fairly in the workplace), or when contemplating whether or not the victim should confront the perpetrator to remediate the harm of the discriminatory act. Provided the rigorous interpersonal analysis necessary to detect true intention in such dynamics, it becomes clear that increased cognitive and emotional coping resources are needed to prevent the development of negative psychological outcomes. Trait mindfulness has been shown to moderate the relationship between past year experiences of discrimination and anxious arousal, providing evidence that trait mindfulness may buffer the deleterious effects of racist experiences. Both mindfulness and self-compassion have been shown to improve emotion regulation, and used to treat difficulties similar to those brought on by encountering racial microaggressions such as anxiety, depressive symptoms, rumination, and chronic stressors. The aim of this study is to assess relationships among racial microaggressions and psychological outcomes, and test the buffering potential of mindfulness and self-compassion. Method: Data for the current study was gathered using an online self-report battery of measures. Respondents were recruited utilizing social media websites, an online university research database, and encouraging participation in undergraduate courses. The sample was comprised of 110 non-clinical undergraduate and community dwelling adults between the ages of 18 and 40 years of age, identifying racially/ethnically as racial/ethnic minorities (i.e., non-White). Results/Conclusions: Results indicated strong associations between the experience of racial microaggressions and DSM symptoms, experiential avoidance, and anger rumination. Mindfulness and self-compassion were found to buffer deleterious psychological effects of racial microaggressions.  

Presenter

Broderick Sawyer, PhD, University of Louisville Louisville, KY 
United States

The Impact of Race-Related Stress in the Relationship Between PTSD Symptoms and Functional Impairments among Urban African American Women

Background: Traumatic experiences that can lead to PTSD have been found to impair multiple facets of daily life functioning. Several studies have identified a link between PTSD, functional impairments, and poor health-related outcomes. A majority of these studies were conducted with veteran populations and have found that PTSD is associated with higher levels of chronic health problems, poor general well-being, and increased hospital visits. Yet, very few studies have examined the link between PTSD and functional impairments among urban, civilian populations of African Americans while considering culturally relevant factors. Higher rates of PTSD have been found amongst African Americans, even after controlling for trauma exposure, and researchers have noted that race-specific experiences such as racism before or during a traumatic event could potentially exacerbate PTSD symptom responses. This presentation will discuss study findings that denote the importance of considering how PTSD, racial discrimination, and functional impairments interact with each other. Method: Data was collected from approximately 80 African American women who were recruited as part of the Grady Trauma Project. Participants were recruited from a public hospital and interviews included demographic characteristics and self-report of functional impairments (i.e., health status/chronic pain, sleep difficulties, poor social support, suicidal behaviors, arrest history and current disability status). Further assessments of variables of interest were completed utilizing the Modified PTSD Symptom Scale, the Clinician-Administered PTSD Scale, and the Index of Race-Related Stress scale. Results: Results revealed that PTSD symptoms were associated with more experiences of race-related stress (β = .25, SE, 0.25, p <.01), and more experiences of race-related stress were associated with greater functional impairments (β = .02, SE, 0.01, p <.01). Mediation analyses indicated that race-related stress significantly mediated the relationship between PTSD symptoms and functional impairment, whereby after race-related stress the PTSD-functional impairment link was no longer significant (β = .02, SE = .01, p = .09; 95% percentile CI = .01 to .03). Age, employment, and income were controlled for in all analyses. Conclusions: This data highlights the importance of research examining how culturally-relevant factors influences PTSD symptoms relationship to health for underserved populations. 

Presenter

Sierra Carter, PhD, Georgia State Universityy Decatur, GA 
United States

The Moderating Role of Ethnic Identity and Perceived Discrimination on Anxiety and Depression

In the United States, Major Depressive Disorder (MDD) and Anxiety Disorders are among the most prevalent of mental health disorders with disproportionate rates across racial and ethnic groups. Key models of predicting depression and anxiety differentially across racial and ethnic groups emphasize the role of ethnic identity as protective and perceived discrimination as a risk factor for psychopathology. However, there are mixed findings as to whether these variables are in fact protective and/or risk factors for depression/anxiety outcomes and how ethnic identity and perceived discrimination combined predicts depression and anxiety within African American and Hispanic populations compared to Whites (Smith & Silva, 2011). Therefore, the goals of the current study are to examine the role of ethnic identity and discrimination on symptoms of depression/anxiety in African American and Latinos within a community sample. We hypothesize: 1.) Ethnic identity will serve as a protective factor against depression/anxiety and higher discrimination scores will serve as a risk factor for depression and anxiety only for Blacks and Hispanics and 2.) The relation between discrimination and depression/anxiety scores will be moderated by ethnic identity such that higher levels of ethnic identity in the face of high discrimination will predict lower depression and/or anxiety scores for minorities compared to Whites and compared to lower scores of ethnic identity. Black/African American, White, and Hispanic participants (expected n = 300) were recruited from Amazon Mechanical Turk to complete a battery of questionnaires. Preliminary analyses (n = 159) to test hypothesis 1 indicate no significant relationship between ethnic identity and discrimination predicting depression and anxiety in Hispanics, no significant relationship between discrimination and depression in Blacks, and no interaction of race and discrimination on depression scores in Blacks. There however was a significant interaction of race and ethnic identity on depression (β = -1.04, t(3,117) = -3.18, p = .002) and anxiety (β = 1.02, t(3,117) = 3.43, p = .001) in the Black sample. Future analyses will utilize structural equation modeling to examine how ethnic identity moderates the association of discrimination with depression and anxiety differentially across racial groups (hypothesis 2).  

Presenter

Mariah Corey, BS, University of Washington Seattle, WA 
United States