A recent study published in the Journal of Racial and Ethnic Health Disparities found that racial discrimination against Black women had “a significant, indirect effect” on PTSD, manifesting in symptoms of anxiety and depression.
Black Americans constantly experience disparities within the U.S. healthcare system, including lower life expectancies and higher burdens of disease, and are disproportionately affected by PTSD compared to white Americans. A separate study published in 2010 found that Black participants had the highest rate of lifetime prevalence of PTSD, and Black women in particular have higher rates than those of white women.
PTSD has overlapping symptoms with racial trauma, or race-based traumatic stress (RBTS), which is caused by a social determinant of both physical and mental health: racial discrimination.
This study focused on exploring whether anxiety and depression play a role in linking racial discrimination and symptoms of PTSD, specifically among Black women.
This cross-sectional survey included survey data from 377 Black women in Chicago from September 2021 to March 2022. Researchers recruited participants through word of mouth, in-person and virtual methods, social media, and referrals. The women’s average age was 35.7. Nearly 73 percent were single, 59 percent reported a household income under $20,000, and 43 percent had a high school diploma or GED.
The questionnaire assessed the participants’ health and community-related attitudes and behaviors. The survey measured PTSD using the PCL-5 (a posttraumatic stress disorder checklist) and measured racial discrimination using the Everyday Discrimination Scale (EDS), which touches on employment, housing, and education. The study measured mental health using the Generalized Anxiety Disorder-7 (GAD-7) scale. For all measures, higher scores indicated a higher incidence.
Researchers have been identifying the effects of racial discrimination on the mental health of Black Americans, and this study’s findings indicate that racial discrimination is associated with symptoms of PTSD among Black women. Specifically, it suggested that the burden of experiencing racial discrimination manifests as anxiety and depression before it manifests as PTSD.
This study was guided by minority stress theory (MST), which explains the relationship between minority stressors and biological outcomes, such as mental or physical health.
According to the study results, the women reported on average experiencing PTSD symptoms “less than a little bit” during the previous month. They reported experiencing discrimination “less than once” to “a few times” within the past year.
Researchers found a moderately significant association between discrimination and PTSD, and a strong association between PTSD and both depression and anxiety. Though the women reported lower rates of challenges with their mental health than expected, the study still emphasized the impact of racial discrimination on mental health.
Mental Health America defines racial trauma, or race-based traumatic stress, as “the mental and emotional harm caused by experiencing racism.” RBTS can be caused by acts of discrimination, microaggressions, slurs, witnessing acts of racism, and experiencing unequal policies or health disparities. According to the Association for Behavioral and Cognitive Therapies, at least 63 percent of Black Americans report experiencing at least one trauma in their lifetime that was racially charged. Besides its potential link with mental illnesses — such as anxiety, depression, and PTSD — RBTS can have negative physiological effects, including headaches, digestive issues, and nightmares.
PTSD and race-based traumatic stress share many characteristics, and race-based trauma can exacerbate symptoms of existing PTSD. According to the National Center for PTSD, racial trauma can cause intrusive thoughts or memories about traumatic experiences, leading individuals to “avoid thoughts, feelings, and reminders of racial trauma.” It can also cause negative self-esteem, negative moods, higher stress, and issues with sleep and concentration, to name a few symptoms.
Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) does not account for race-based trauma in the criteria for PTSD, though there is a movement to expand the definition to include it and how it can affect existing PTSD.
To fully understand and support not just the health of female Black patients but all patients of color, it is vital for providers to understand the severity and consequences of race-based trauma, particularly how it relates to anxiety, depression, and PTSD. Not only do Black Americans report some of the highest levels of racial discrimination, but they are also less likely to report mental illnesses and to seek out and receive mental health care.
For providers, this research emphasizes the importance of education on PTSD and RBTS and using frameworks, like minority stress theory, to advocate for their patients of color. Providers should prioritize trauma-informed care and understand that these patients may require greater support in recognizing symptoms of anxiety, depression, PTSD, and RBTS.
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