Clinical Impact Statement: This manuscript provides information to mental health clinicians, clinicians in training, and those who educate and train them to assist them to better meet the mental health needs of African Americans. Information is provided to assist mental health clinicians to design and implement culturally relevant services and interventions for African Americans.
Health disparities have been gaining attention in recent years (Centers for Disease Control and Prevention, 2013). Many health disparities have been related to social and cultural factors. The CDC has indicated that identifying population-specific precursors to health outcomes are necessary to reduce health disparities. To gain a comprehensive understanding of these disparities, racial socialization and cultural identity must be taken into consideration.
Cultural Identity and Ethnic-Racial Socialization
Culture is the set of behaviors from a group of people reflective of shared values, social experiences, norms, attitudes, and beliefs. Culture is passed down from generation to generation, and changes over time (Eshun & Gurung, 2009). African/Black psychologists assert that every person operates out of some group’s concept of reality, whether consciously or unconsciously (Baldwin, 1984, 1985; Baldwin & Hopkins, 1990; Kambon, 1992). It is this perception that is shared with other members of an identified reference group. Therefore, one’s cultural reality is dependent upon the culture with which one identifies. Racial and ethnic identity are vital processes in psychological development (Williams et al., 2012).
Racial socialization denotes the process through which individuals learn about specific cultural beliefs and values pertaining to their ethnic, racial, and/or cultural group memberships (Berkel et al., 2009; Hughes et al., 2006; Umaña-Taylor & Fine, 2004). It is an important socialization process that prepares individuals for a racially and ethnically diverse society. Ethnic-racial socialization practices focus on teaching children their cultural origins in order to inculcate a sense of ethnic and racial pride. Ethnic-racial socialization can encourage ethnic-racial identity formation, moderate the negative effects of discrimination, and increase cognitive and social-emotional outcomes (e.g., Brittian, Umaña-Taylor, & Derlan, 2013; Caughy, Nettles, & Lima, 2011; Neblett, Hammond, Seaton, & Townsend, 2010; Neblett, Rivas-Drake, & Umaña-Taylor, 2012; Neblett et al., 2008). In addition, ethnic-racial socialization and ethnic-racial identity offer individuals a sense of community and belonging when ostracized by other groups.
A consensus in psychology, sociology, and epidemiology is that racial discrimination against African Americans is linked to damaging mental health outcomes, including distress, negative affect, anxiety, depression and depressive symptoms, and other psychiatric symptoms (Brondolo et al., 2008; Pascoe & Richman, 2009; Pieterse, Todd, Neville, & Carter, 2012; Williams & Mohammed, 2009). Gaylord-Harden and Cunningham (2009) report that racial discrimination was positively correlated to anxiety and depression among African American adolescents in lower income communities. These findings, along with comparative analyses, have led some researchers to suggest that racially based stressors may be experienced more deeply than nonracially based stressors (Utsey, Giesbrecht, Hook, & Stanard, 2008).
Racial pride and socialization are vital communal coping mechanisms for dealing with the reality of racism and discrimination. Theorists and researchers in the development of racial identity argue that psychological well-being requires the affirmation of one’s ethnic, racial, cultural identities. Bynum, Burton, and Best (2007) found parental messages that emphasized racial and cultural pride were shown to reduce race-related stress and showed a negative correlation to psychological distress.
Cultural socialization has been shown to be positively associated with psychological well-being (Bannon, McKay, Chacko, Rodriguez, & Cavaleri, 2009) and negatively associated with depression (McHale et al., 2006). Racial socialization, for example, buffers the negative effects of racial discrimination, psychological distress, and chronic stress (Bynum et al., 2007; Harris-Britt, Valrie, Kurtz-Costes, & Rowley, 2007; Neblett et al., 2008) in both adolescents and young adults. Racial socialization buffers the relationship between anxiety and mental health risk factors in much the same way that it defends against race-related stressors (Bannon et al., 2009). Children who received higher rates of racial socialization reported less anxiety in spite of exposure to mental health risk factors (e.g., exposure to domestic violence/substance abuse). Affirmative outcomes related to preparation for biases and strong cultural socialization amongst African American youth are associated with: (a) development of a sense of self-worth or pride, (b) feeling efficacious, and (c) positive identity, all of which can be advantageous across contexts.
Stress and Mental Health in African Americans
Historically, stress and coping models have posited that environmental stressors, role strains, and daily hassles, in the absence of adequate coping resources, potentially disrupt an individual’s psychological equilibrium and cause psychological and physiological distress. Psychosocial resources (e.g., optimism, ego resilience) may reinforce and strengthen a person’s psychological equilibrium and emotional stability, thus reducing the likely onset of possible distress. Such resources are seen as having both a deterring and a coping function, helping to maintain positive self-identity and self-esteem, reduce distress, preserve psychological and social equilibrium, and reduce the likelihood of encountering stressful experiences.
Stress and coping theories emphasize cognitive facets of the stress process or external environmental factors. In the early 2000s the conservation of resources (COR) theory (Hobfoll, 2001) suggested that one’s conceptualization of stress should be based on the “individual nested in family nested in tribe.” Focus on the individual, with no reference to the individual’s placement in relation to the greater whole, will provide limited insight for social systems and groups. An encounter with stressful situations involves social consequences and is embedded within the greater social context. Much of the historical research that has been conducted on stress and coping has been greatly influenced by the conceptualization of stress as being an outcome of personal appraisal. Although the literature supports this, Hobfoll (2001) argued that this tactic provides little insight into why certain appraisals are made and the extent to which these appraisals are socially and culturally shared. Individuals also make appraisals and select coping responses within a group of personal strengths and social attachments, along with a sense of cultural belonging (Scott, 2003). The appraisals (and experiences) of race-related stress among African Americans are embedded in a larger historical, social, and legal context that lays the foundation for shared racial interactions.
Although stress has been extensively studied for decades, more recent research has contributed to the understanding of the effects of “minority” stressors and race related stressors to physical, psychological, and emotional outcomes among people of African descent. A meta-analysis (Pieterse et al., 2012) revealed a positive relationship between psychological distress and racial discrimination for African Americans. Depression, psychiatric symptoms, and anxiety were the strongest mental health outcomes related to discrimination among all of the variables incorporated in the overall relationship between psychological distress and racial discrimination.
The extent to which African Americans affiliate and identify with members of their own ethnic and/or racial group is identified as a healthy coping mechanism to racial discrimination (Brondolo, Brady ver Halen, Pencille, Beatty, & Contrada, 2009). Brondolo and colleagues recognized three related factors that may be connected to discrimination-distress—ethnic identity, racial identity, and racial socialization—and concluded that these factors may influence whether discriminatory occurrences are appraised as being stressors, consequently determining the occurrence of discrimination-distress. Brondolo and colleagues (2009) advanced that ethnic identity, racial identity, and racial socialization mediate the impact racial discrimination has on mental health. Advocates argue that socialized individuals who more strongly identify with members within their own ethnicity/race are sheltered from negative effects of racial discrimination. This connection provides individuals with awareness that discriminatory experiences are a result of societal injustices as opposed to personal deficits (Pascoe & Richman, 2009). This awareness, in turn, prevents one’s self-concept from being negatively affected when threatened by varying forms of discrimination. In addition, ethnic identity, racial identity, and cultural socialization offer individuals a sense of community and belonging when ostracized by other groups.
Stress and Physical Health
Members of various “minority” groups reported overt and subtle stressful discrimination experiences as being a part of their daily lives (Myers, 2009; Sue et al., 2007). Numerous investigators focusing on the relationship between perceptions of discrimination and mental health outcomes, have reported that higher perceptions of discrimination are consistently linked to poorer mental health (Kessler et al., 2010; Lee & Ahn, 2011a; Pascoe & Richman, 2009; Williams & Mohammed, 2009). In several notable reviews and cross-sectional studies, discrimination has been found to be linked with indicators of poor physical health and chronic health conditions (Mays, Cochran, & Barnes, 2007; Smedley, 2012; Williams & Mohammed, 2009). Meta-analyses (Lee & Ahn, 2011a, 2011b; Pieterse et al., 2012) presented evidence that racial discrimination has adverse effects on the participants’ mental health.
Research shows evidence of early health deterioration among minorities, specifically African Americans (Chae et. al., 2014; Singh & Siahpush, 2014). To account for early health deterioration among African Americans, the “weathering” hypothesis posited that African Americans experience early health deterioration as a result of the cumulative impact of repeated experiences with economic or social adversity and political marginalization. The weathering effects of living in a race-conscious society are expected be greatest among African Americans who engage in high effort coping, meaning coping with more intense stressors and for longer periods of time (Geronimus, 1992).
High-effort coping with acute and chronic stressors can have a profound effect on physiological health (Lewis et al., 2013; Pascoe & Richman, 2009; Williams & Mohammed, 2009). For example, high effort coping has been found to increase blood pressure and heart rate, impacting cardiovascular and overall physiological health (Geronimus, 1992). The stress that is inherent in living in this race-conscious society, which stigmatizes and disadvantages African Americans, may cause disproportionate physiological deterioration, such that an African American may show the morbidity and mortality typical of a White American who is significantly older (Deuster, Kim-Dorner, Remaley, & Poth, 2011; Duru, Harawa, Kermah, & Norris, 2012). Because the response to stress disrupts the regulation of several systems throughout the body, including the cardiovascular, metabolic, and immune systems, the concept of weathering encompasses multiple systems and includes impacts that may not yet register clinically.
In a longitudinal study, Duru and colleagues (2012) investigated whether allostatic load (i.e., the cumulative physical effect of prolonged exposure to stress) among middle-aged adults at baseline was associated with racial differences in mortality rates. It was postulated that after adjusting for socioeconomic (SES) measures, health insurance status, and health behaviors, allostatic load would significantly reduce disparities in African-White American mortality. Furthermore, differences in allostatic load scores have the ability to partially explain the disparities. These findings indicate that at baseline, racial disparities in physiological irregularities (e.g., metabolic markers, cardiovascular markers, inflammatory markers, and a marker for organ dysfunction), measured by biomarkers of allostatic load, assist in explaining African-White American disparities in mortality.
Additionally, numerous epidemiological studies validate that acute and chronic trauma is related to increased risks for adult psychiatric disorders (Benjet, Borges, & Medina-Mora, 2010; Green et al., 2010; McLaughlin et al., 2010). Individuals strongly identifying with other members of their race are assumed to be protected from the negative effects of racial discrimination. This prevents adverse effects on their self-concept when challenged with race related stressors (Pascoe & Richman, 2009); decreasing the likelihood of the onset of the aforementioned stress-related physical health outcomes.
We conducted research to examine relationships among racial socialization, cultural identity, and perceived stress with mental and physical health; as well as to explore possible predictors of health in African Americans. Once IRB approval was obtained, 229 college students (128 women, 101 men) were administered a 35- to 45-minute battery of measures of: racial socialization (Stevenson, Cameron, Herrero-Taylor, & Davis, 2002), cultural identity (Baldwin & Bell, 1985), perceived stress (Cohen, Kamarck, & Mermelstein, 1983), and mental health and physical health (Ware et al., 1997).
Results and Conclusions
The results of the current investigation of African American college students showed that higher racial socialization and higher cultural identity were significantly related to better outcomes on measures of mental health.
The current study provided much insight into possible predictors of mental health. The degree to which participants identified with and internalized race, ethnicity, and/or culture was shown to significantly impact emotional well-being, with more developed knowledge and awareness of cultural heritage/identity correlating with better mental health. This is consistent with previous research that found African self-consciousness was associated with a reduction in mental illness (Baldwin, 1984). Knowledge/practice of African traditions, rituals, and ideologies apparently serves as a protective buffer for people of African descent (Akbar, 2004; Kambon, 2012). This validates the idea that there are other factors aside from socioeconomic status and health behaviors that impact the health of African Americans.
In keeping with research suggesting that parental endorsement of reinforcing cultural pride messages moderates the relationship between child anxiety and risk factors associated with child mental health (Bannon et al., 2009), cultural socialization in this study was positively correlated to psychological well-being. This emphasizes the need for culturally specific mental health protective factors for people of African descent, as African self-consciousness and racial socialization have demonstrated important protective effects in African Americans.
African self-consciousness and ethnic-racial socialization accounted for an increased percentage of variance within the mental health of the participants. Bannon et al. (2009) found that cultural socialization was positively related to psychological well-being. The significant relationship between racial socialization and African self-consciousness suggests that there are intersecting characteristics between the two. This also suggests that ethnic-racial socialization may influence the development of African self-consciousness. It is promising that ethnic-racial socialization and African self-consciousness showed such a strong relationship. Because these two variables encompass the internalization of one’s ethnic, racial, and cultural values, the finding makes sense in light of previous research in this arena.
Taken together, these findings yield important implications for parenting, education, social development, and mental health outcomes for individuals of African descent. These findings are particularly critical in efforts to move from therapy-centered to patient-centered psychotherapy and interventions (including parenting and similar educational programs). The current study adds to previous research suggesting that knowledge, awareness, and identification with one’s race, ethnicity, and/or culture both support and predict improved mental health. It is reasonable to conclude that race congruent cultural identity results in healthier outcomes compared to non-congruent identity. In summary, awareness, knowledge, and connection to varying aspects of their history, cultural norms/practices, race, and ethnicity are all vital to mental health in African Americans.
Cite This Article
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