Originally published here.
Inequities in physical and mental health among racial and ethnic subgroups in the United States have been well‐documented. For instance, Black Americans experience chronic cardiometabolic conditions (e.g., diabetes, hypertension, obesity), premature death, and disability at two to four times the rates of their White counterparts [1–3]. Black Americans are also more likely to experience comorbidities that are associated with a greater risk of disease progression [4], accelerated physiological aging [5], and reduced quality of life [6].
To inform more effective clinical and community‐based interventions needed to improve these health outcomes, there is a pressing need to identify the factors that contribute to heightened risks among Black Americans. As previous research has demonstrated a significant, and often bidirectional, link between mental and physical health [7,8], efforts to reduce the high rates of chronic physical health conditions (hereafter referred to as “chronic conditions”) among Black Americans may be enhanced by a focus on depressive symptoms among this population.
The association between depression and chronic conditions is well‐established in the literature. It is estimated that more than one‐third of people with chronic illnesses will experience depression in their lifetime [9,10]. Studies have also found an increased prevalence of chronic diseases including asthma, arthritis, cardiovascular disease, cancer, diabetes, hypertension, and obesity, among individuals with depressive disorders [8,11]. Despite relatively low rates of major depression among Black Americans, many studies document elevated levels of depressive symptoms [12,13].
Given that greater depressive symptoms have been linked to worsening physical health and more chronic conditions in the general population, addressing depressive symptoms’ levels may be an important point of intervention to reduce the risk of chronic conditions among Black Americans. Nevertheless, evidence from prior studies suggest that the association between depressive symptoms and chronic conditions may be distinct among Black Americans. For instance, studies indicate that depressive symptoms are more chronic and physically debilitating among Black relative to White Americans [12,14–16].
Other studies showed that Black Americans face more stressors, including lifetime experience of racism and discrimination, which have been linked to both depressive symptoms and chronic conditions [17]. However, in their longitudinal study, Assari, Burgard, and Zivin [16] found a stronger, long‐term association between depressive symptoms and chronic medical conditions among White compared to Black Americans. Thus, the significance of depressive symptoms in shaping the risk of chronic conditions among Black Americans remains unclear.
Since most studies have utilized comparative approaches to understand the nature of racial disparities in these relationships, additional research is needed to clarify this association and the factors that may contribute to distinct patterns among Black Americans. As a fundamental determinant of health [3,18–21], racism may also condition the linkage between depressive symptoms and chronic conditions among Black Americans.
Specifically, racism serves as a critical driver of health inequalities by patterning health risks and resources across cultural, institutional, interpersonal, and individual levels. Although most studies have focused on the role of interpersonal forms of racism, such as everyday discrimination, scholars have increasingly recognized the health significance of structural racism [22,23]. While everyday discrimination captures the ongoing slights and hassles that Black Americans face every day (e.g., people treat them with less courtesy or act as if they are afraid of them), major discrimination experiences encompass individuals’ encounters with unfair treatment across numerous social and institutional domains, including housing, employment, and education.
As such, major discrimination often represents Black people’s experiences of structural racism and may contribute to distinct health outcomes among this population. Yet, several limitations of prior research hinder our knowledge of the ways in which major discrimination shapes the onset and progression of mental and physical health co‐ morbidities among Black Americans. Since many studies only assessed everyday but not major discrimination experiences, our knowledge of racialized, inequitable treatment at a structural level remains limited.
In addition, discrimination studies have disproportionately focused on mental health rather than physical health outcomes [24]. This is insufficient given our incomplete understanding of the drivers that undergird the excess rates of poor physical health and disability among Black people. Finally, few studies have considered the indirect pathways through which individuals’ lifetime experiences of major discrimination may modify their health risks. Recent studies suggest that Black Americans’ lifetime stress experiences, including major discrimination, may modify the physical health consequences of depressive symptoms [12]. Thus, it is possible that major discrimination may shape the ways in which depressive symptoms influence the risk of chronic, comorbid mental and physical health conditions among Black Americans.
To clarify the ways in which Black Americans’ experiences of structural racism may influence their mental and physical health in distinct ways, the present study evaluated whether major discrimination moderates the association between depressive symptoms and chronic physical health conditions among this population.
Overall, our study demonstrated that the impact of depressive symptoms on chronic conditions depends upon prior exposure to major discrimination among Black Americans. These findings align with recent work assessing the association between psychological distress and psychiatric disorders among Black Americans, indicating that this association is conditional upon stress exposure among Black Americans [12]. Furthermore, results from the current study underscore the importance of examining within‐group differences, given that the moderating role of major discrimination in the depressive symptoms– chronic condition association differed between women and men.
Taken together, the findings in the present study extend and provide insight into paradoxical health patterns among Black Americans by assessing within‐group differences. The present study makes several significant contributions to the literature. We examined the role of major discrimination as a dimension of structural racism that shapes both physical and mental health outcomes. More specifically, ourfindings underscore that there are distinct pathways [3,19,21,41] through which experiencing racism across the life course shapes mental and physical health among Black populations.
As such, our study provides important insight into understanding the role of racism in shaping the link between physical and mental health among Black Americans. Additionally, our within‐ group approach to evaluating health patterns among Black Americans contributes to a growing body of evidence highlighting key sources of heterogeneity among Black women and men [42]. Given this, there are substantial implications for future research and practice from these findings. Considering that major discrimination conditioned the depressive symptoms–chronic conditions association in our sample, this has provided insight into potential pathways forintervention in efforts to offset the detrimental mental and physical consequences of experiencing racism.
Nevertheless, to comprehensively address this issue and eliminate the health burden of unjust and inequitable systems among Black Americans and other disenfranchised communities, it is of utmost importance to focus on and dismantle the root cause of these health trends, namely racism, to enact a significant change both intentionally and collectively.
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