Discrimination and the HPA axis: current evidence and future directions
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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.
KeywordsDiscrimination 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.
- Adam, E. K., Heissel, J. A., Zeiders, K. H., Richeson, J. A., Ross, E. C., Ehrlich, K. B., et al. (2015). Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study. Psychoneuroendocrinology, 62, 279–291. doi: 10.1016/j.psyneuen.2015.08.018 CrossRefPubMedPubMedCentralGoogle Scholar
- Brody, G. H., Lei, M. K., Chae, D. H., Yu, T., Kogan, S. M., & Beach, S. R. (2014). Perceived discrimination among African American adolescents and allostatic load: a longitudinal analysis with buffering effects. Child Development, 85, 989–1002. doi: 10.1111/cdev.12213 CrossRefPubMedPubMedCentralGoogle Scholar
- Cohen, S., Schwartz, J. E., Epel, E., Kirschbaum, C., Sidney, S., & Seeman, T. (2006). Socioeconomic status, race, and diurnal cortisol decline in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Psychosomatic Medicine, 68, 41–50. doi: 10.1097/01.psy.0000195967.51768.ea CrossRefPubMedGoogle Scholar
- Hudson, D. L., Bullard, K. M., Neighbors, H. W., Geronimus, A. T., Yang, J., & Jackson, J. S. (2012). Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men? Journal of Men’s Health, 9, 127–136. doi: 10.1016/j.jomh.2012.03.006 CrossRefPubMedPubMedCentralGoogle Scholar
- Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., et al. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS One, 10(9):e0138511. doi: 10.1371/journal.pone.0138511.
- Skinner, M. L., Shirtcliff, E. A., Haggerty, K. P., Coe, C. L., & Catalano, R. F. (2011). Allostasis model facilitates understanding race differences in the diurnal cortisol rhythm. Development and Psychopathology, 23, 1167–1186. doi: 10.1017/s095457941100054x CrossRefPubMedPubMedCentralGoogle Scholar
- Utsey, S. O. (1999). Development and validation of a short form of the index of race-related stress (IRRS)-Brief Version. Measurement and Evaluation in Counseling and Development, 32, 149–167.Google Scholar
- Zeiders, K. H., Hoyt, L. T., & Adam, E. K. (2014). Associations between self-reported discrimination and diurnal cortisol rhythms among young adults: The moderating role of racial-ethnic minority status. Psychoneuroendocrinology, 50, 280–288. doi: 10.1016/j.psyneuen.2014.08.023 CrossRefPubMedPubMedCentralGoogle Scholar