A04 – The Influence of Racism Within Integrated Care Settings

Summary

Background. In 2020, COVID-19 has disproportionately and negatively impacted people of color while rampant racial injustice has increased experiences of racial stress for communities of color. These realities have increased mental distress for individuals of color and have led to a growing interest in making mental healthcare more equitable. The extant research provides general connections between race, racism and mental health. However, racism is a complex phenomenon, involving myriad, complex dynamics—experiences with racism, racial identity/centrality, racial stress, internalized racism, and racial self-esteem, to name a few. There is a paucity of studies that examine how the intersection of these racial dynamics affect one’s mental health symptomatology. Moreover, research seldom examines how racism and discrimination affect specific types of mental illness, such as depression. Toward this end, the purpose of this study was 1) to examine the associations between depression and patients’ perceived stress, experiences with discrimination, and their self-esteem and 2) to examine how demographic variables moderate these associations. Methods. This study was conducted in a Federally Qualified Health Center (FQHC) located in the southeastern region of the United States. The FQHC provides mental health and primary care services to over 8,500 patients each year. With a confidence interval at 95% and a margin of error of 5%, the ideal sample size for this study was 363 participants. This study employed a convenient sampling strategy. Overall, there were 421 participants (55.8% White and 37.8% Black); 71.3% were female and 75.8% had incomes under $30k per year. Participants completed a 25-minute survey that consisted of the Beck Depression Scale, Beck Anxiety Inventory, Perceived Stress Scale, Rosenberg’s Self-esteem Scale, The Everyday Discrimination Scale, Experiences with Discrimination Scale, Modern Racism Scale, and demographics. Analyses consisted of correlational analyses, t-test, and hierarchical linear regressions. Results. Findings from a series of t-test analyses suggest that White participants scored higher than Black participants in income levels, depression, anxiety, perceived stress, and modern racism. Black participants scored higher on experiences with discrimination, everyday discrimination, and self-esteem (p values were all less than .01). A hierarchical regression was conducted to examine what variables best predicted depression. Overall, Model 1 showed that anxiety, perceived stress, and self-esteem all predicted depression when controlling for the other variables in the model. Model 2 suggested that perceived stress, self-esteem, and experiences with discrimination predicted depression; anxiety was no longer a predictor nor was everyday discrimination. Model 3 was the full model and showed that perceived stress, self-esteem, and experiences with discrimination continued to be significant predictors of depression