Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study

  • Rachel R. HardemanEmail author
  • Sylvia P. Perry
  • Sean M. Phelan
  • Julia M. Przedworski
  • Diana J. Burgess
  • Michelle van Ryn



Diversification of the physician workforce continues to be a national priority; however, a paucity of knowledge about the medical school experience for African American medical students limits our ability to achieve this goal. Previous studies document that African American medical students are at greater risk for depression and anxiety. This study moves beyond these findings to explore the role of racial identity (the extent to which a person normatively defines her/himself with regard to race) and its relationship to well-being for African American medical students in their first year of training.


This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study; a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the US racial identity for African American students (n = 301) was assessed using the centrality sub-scale of the Multidimensional Inventory of Black Identity. Generalized linear regression models with a Poisson regression family distribution were used to estimate the relative risks of depression, anxiety, and perceived stress.


First year African American medical students who had lower levels of racial identity were less likely to experience depressive and anxiety symptoms in their first year of medical school. After controlling for other important social predictors of poor mental health (gender and SES), this finding remained significant.


Results increase knowledge about the role of race as a core part of an individual’s self-concept. These findings provide new insight into the relationship between racial identity and psychological distress, particularly with respect to a group of high-achieving young adults.


Depression Anxiety Medical student Racial identity 



Dr. Hardeman acknowledges the support of the Veterans Affairs Associated Health Postdoctoral Fellowship Training Program.

Conflict of Interest

The authors declare that they have no competing interests.

Compliance with Ethical Standards

There are no potential conflicts of interest.

Research Involving Human Participants

All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This research study was approved by the human subjects Institutional Review Boards of the University of Minnesota (IRB #0905S66901, approved 6/5/2009) and Mayo Clinic (IRB #13-004612, approved 7/13/2013).

Informed Consent

Informed consent was obtained from all individual participants included in the study.


Support for this research was provided by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health under award number R01 HL085631. Dr. Hardeman was additionally supported by the NHLBI Supplement to Promote Diversity in Health Related Research of the NIH under award number 3 R01 HL085631-02S2. Mx. Przedworski was additionally supported by the National Cancer Institute Cancer Education and Career Development Program under award number 5R25CA163184.

Other Disclosures





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Copyright information

© W. Montague Cobb-NMA Health Institute 2015

Authors and Affiliations

  • Rachel R. Hardeman
    • 1
    Email author
  • Sylvia P. Perry
    • 2
  • Sean M. Phelan
    • 1
  • Julia M. Przedworski
    • 3
  • Diana J. Burgess
    • 4
  • Michelle van Ryn
    • 1
  1. 1.Division of Health Care Policy and Research, Department of Health Sciences ResearchMayo ClinicRochesterUSA
  2. 2.Department of Psychological ScienceUniversity of VermontBurlingtonUSA
  3. 3.Division of Health Policy and ManagementUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of Medicine, Core Investigator, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical CenterUniversity of MinnesotaMinneapolisUSA

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