Journal of Behavioral Medicine

, Volume 40, Issue 4, pp 539–552 | Cite as

Discrimination and the HPA axis: current evidence and future directions

  • David Busse
  • Ilona S. YimEmail author
  • Belinda Campos
  • Christopher K. Marshburn


Numerous studies suggest that discrimination is associated with poor physical and mental health outcomes. Whereas the cardiovascular system has been extensively studied as a potential pathway linking discrimination with disease, the role of the hypothalamic–pituitary–adrenal (HPA) axis remains understudied. We conducted a systematic review of research on discrimination and related constructs as predictors and correlates of HPA axis activity. Twenty seven studies (10 experimental, 17 observational) met inclusion criteria. Studies suggest that discrimination is associated with alterations in HPA axis activity and that the direction of this association depends on the timing and chronicity of the discrimination experience. There is also evidence of important modulating variables (race, socioeconomic status) and contextual confounders (emotional, situational) that warrant further study. Accounting for the HPA axis in addition to the cardiovascular system will contribute to a more comprehensive understanding of the biobehavioral pathways contributing to physical and mental health inequities related to discrimination.


Discrimination Stigma Prejudice Stress Cortisol 


Compliance with ethical standards

Conflict of interest

David Busse, Ilona S. Yim, Belinda Campos and Christopher K. Marshburn declare that they have no conflict of interest.

Human and animal rights and Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • David Busse
    • 1
  • Ilona S. Yim
    • 1
    Email author
  • Belinda Campos
    • 2
  • Christopher K. Marshburn
    • 1
    • 3
  1. 1.Department of Psychology and Social BehaviorUniversity of California, IrvineIrvineUSA
  2. 2.Department of Chicano/Latino StudiesUniversity of California, IrvineIrvineUSA
  3. 3.Department of Psychological ScienceUniversity of North Carolina at CharlotteCharlotteUSA

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