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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff. 2002;21:90–102. doi:10.1377/hlthaff.21.5.90.

    Article  Google Scholar 

  2. Sullivan LW. Missing persons: minorities in the health professions, a report of the Sullivan Commission on Diversity in the Healthcare Workforce. 2004.

  3. Nunez-Smith M, Curry LA, Bigby J, Berg D, Krumholz HM, Bradley EH. Impact of race on the professional lives of physicians of African descent. Ann Intern Med. 2007;146:45–51.

    Article  PubMed  Google Scholar 

  4. Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS, Power DV, et al. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med. 2007;167:2103–9. doi:10.1001/archinte.167.19.2103.

    Article  PubMed  Google Scholar 

  5. Hardeman RR, Przedworski JM, Burke SE, Burgess DJ, Phelan SM, Dovidio JF, et al. Mental well-being in 1st year medical students: a comparison by race and gender a report from the medical student change study. J Racial Ethn Health Disparities. 2015. doi:10.1007/s40615-015-0087-x.

    PubMed  PubMed Central  Google Scholar 

  6. Burford B. Group processes in medical education: learning from social identity theory. Med Educ. 2012;46:143–52.

    Article  PubMed  Google Scholar 

  7. Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012;34:641–8.

    Article  Google Scholar 

  8. Rees CE. Identities as performances: encouraging visual methodologies in medical education research. Med Educ. 2010;44:5–7.

    Article  PubMed  Google Scholar 

  9. Monrouxe L. Identity, identification and medical education: why should we care? Med Educ. 2010;44:40–9.

    Article  PubMed  Google Scholar 

  10. Brown CMMA. Effort or escape: self-concept structure determines self-regulatory behavior. Self Identity. 2009;8:365–77.

    Article  Google Scholar 

  11. Mavor KI, McNeill KG, Anderson K, Kerr A, O’Reilly EPM. Beyond prevalence to process: the role of self and identity in medical student well-being. Med Educ. 2014;48:351–60. doi:10.1111/medu.12375.

    Article  PubMed  Google Scholar 

  12. Turner JOP. The significance of the social identity concept for social psychology with reference to individualism, interactionism and social influence. Br J Soc Psychol. 1986;25:237–52. doi:10.1111/j.2044-8309.1986.tb00732.x. 2.

    Article  Google Scholar 

  13. Deaux K. Social identity. In: Worrell J, editor. In Encyclopedia of women and gender. San Diego: Academic; 2001. p. 1059–67.

    Google Scholar 

  14. Munford MB. Relationship of gender, self-esteem, social class, and racial identity to depression in blacks. J Black Psychol. 1994;20:157–74. doi:10.1177/00957984940202005.

    Article  Google Scholar 

  15. Sellers RM, Caldwell CH, Schmeelk-Cone KH, Zimmerman M. a. Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Soc Behav. 2003;44:302–17.

    Article  PubMed  Google Scholar 

  16. Wang K. Racial identity of minority adolescents : a review of empirical research 2011.

  17. Miller DB. Racial socialization and racial identity: can they promote resiliency for African American adolescents? Adolescence. 1999;34:493–501.

    CAS  PubMed  Google Scholar 

  18. Azibo DAY, Allen DF. Some psychological concomitants and consequences of the black personality: mental health implications. J Non-White Concerns Pers Guid. 1983;11:59–66.

    Article  Google Scholar 

  19. Cross WE, Parham TA, & Helms JE. Nigrescence revisited: theory and research. In: Jones RL, editor. African Am. identity dev. res. interv. 1998.

  20. Parham TA. Cycles of psychological nigrescence. Couns Psychol. 1989;17:187–227.

    Article  Google Scholar 

  21. White JL, Parham TA. The psychology of blacks: an African-American perspective. New Jersey: Prentice-Hall; 1990.

    Google Scholar 

  22. Arroyo CG, Zigler E. Racial identity, academic achievement, and the psychological well-being of economically disadvantaged adolescents. J Pers Soc Psychol. 1995;69:903–14.

    Article  CAS  PubMed  Google Scholar 

  23. Martinez RO, Dukes RL. The effects of ethnic identity, ethnicity, and gender on adolescent well-being. J Youth Adolesc. 1997;26:503–16.

    Article  Google Scholar 

  24. Phinney JS. Ethnic identity in adolescence and adulthood: a review and integration. Psychol Bull. 1990;108:499–514.

    Article  CAS  PubMed  Google Scholar 

  25. Chavous TM, Bernat DH, Schmeelk-Cone K, Caldwell CH, Kohn-Wood L, Zimmerman MA. Racial identity and academic attainment among African American adolescents. Child Dev. 2003;70:1076–90.

    Article  Google Scholar 

  26. Sanders MG. Overcoming obstacles: academic achievement as a response to racism and discrimination. J Negro Educ. 1997;66:83–93.

    Article  Google Scholar 

  27. Wong CA, Eccles JS, Sameroff A. The influence of ethnic discrimination and ethnic identification on African American adolescents’ school and socioemotional adjustment. J Pers. 2003;71:1197–232.

    Article  PubMed  Google Scholar 

  28. Vitaliano PP, Russo J, Carr JE, Heerwagen JH. Medical school pressures and their relationship to anxiety. J Nerv Ment Dis. 1984;172:730–6.

    Article  CAS  PubMed  Google Scholar 

  29. Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, et al. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student changes study. Obesity. 2014;22:1201–8. doi:10.1002/oby.20687.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sarndal C, Swensson B, Wretman J. Model assisted survey sampling. New York: Springer; 1992.

    Book  Google Scholar 

  31. Dyrbye LN, Thomas MR, Power DV, Durning S, Moutier C, Massie FS, et al. Burnout and serious thoughts of dropping out of medical school: a multi-institutional study. Acad Med. 2010;85:94–102. doi:10.1097/ACM.0b013e3181c46aad.

    Article  PubMed  Google Scholar 

  32. Dyrbye LN, Thomas MR, Harper W, Massie FS, Power DV, Eacker A, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43:274–82. doi:10.1111/j.1365-2923.2008.03282.x.

    Article  PubMed  Google Scholar 

  33. Przedworski J, Dovidio J, Hardeman R, Phelan S, Burke S, Ruben M, et al. A comparison of the mental health and well-being of sexual minority and heterosexual medical students: a report from the medical student change study. Acad Med. 2015;90.

  34. Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D. Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): depression, anxiety, and anger. Assessment. 2011;18:263–83.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yost KJ, Eton DT, Garcia SF, Cella D. Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol. 2011;64:507–16. doi:10.1016/j.jclinepi.2010.11.018.

    Article  PubMed  PubMed Central  Google Scholar 

  36. System P-ROMI. Anxiety a brief guide to the PROMIS anxiety instruments. 2013.

  37. Warttig SL, Forshaw MJ, South J, White AK. New, normative, English-sample data for the short form perceived stress scale (PSS-4). J Health Psychol. 2013;18:1617–28.

    Article  PubMed  Google Scholar 

  38. Cohen S, Janicki-Deverts D. Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006 and 2009. J Appl Soc Psychol. 2012;42:1320–34.

    Article  Google Scholar 

  39. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    Article  CAS  PubMed  Google Scholar 

  40. Sellers RM, Rowley SAJ, Chavous TM, Shelton JN, Smith M. Multidimensional inventory of black identity: a preliminary investigation of reliability and constuct validity. J Pers Soc Psychol. 1997;73:805–15.

    Article  Google Scholar 

  41. Vandiver BJ, Worrell FC, Delgado-Romero EA. A psychometric examination of multidimensional inventory of black identity (MIBI) scores. Assessment. 2009;16:337–51.

    Article  PubMed  Google Scholar 

  42. Thompson WE, Hickey JV. Social Stratification in the U.S. class system. Soc. Focus. 5th ed., Bosto: Pearson; 2005;183–7.

  43. Cummings P. The relative merits of risk ratios and odds ratios. Arch Pediatr Adolesc Med. 2009;163:438–45.

    Article  PubMed  Google Scholar 

  44. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6. doi:10.1093/aje/kwh090.

    Article  PubMed  Google Scholar 

  45. Jetten J, Haslam C, Haslam SA. The social cure: identity, health and wellbeing. Hove: Psychology Press; 2011.

    Google Scholar 

  46. Griffith EEH, Delgado A. On the professional socialization of black residents in psychiatry. J Med Educ. 1979;54:471–6.

    CAS  PubMed  Google Scholar 

  47. Sani F. Group identification, social relationships, and health. In: Jetten J, Haslam C, Haslam SA E, editor. Soc. Cure, Hove, UK: Psychology Press; 2011, p. 21–39.

  48. Gardner S. Fitting the mold of graduate school: a qualitative study of socialization in doctoral education. Innov High Educ. 2008;33:125–38.

    Article  Google Scholar 

  49. Beagan B. Neutralizing differences: producing neutral doctors for (almost) neutral patients. Soc Sci Med. 2000;51:1253–65.

    Article  CAS  PubMed  Google Scholar 

  50. Frost HD, Regehr G. “I am a doctor”: negotiating the discourses of standardization and diversity in professional identity construction. Acad Med. 2013;88:1570–7.

    Article  PubMed  Google Scholar 

  51. Weidman JC, Twale DJ, Stein E. Socialization of graduate and professional students in higher education: a perilous passage? San Francisco: Jossey-Bass Publishers, Inc.; 2001.

    Google Scholar 

  52. Lewis CW, Ginsberg R, Davies T, Smith K. Experiences of African American PhD students at a predominately white Carnegie I research institution. Coll Stud J. 2004;38:231.

    Google Scholar 

  53. Daniel C. Outsiders-within: critical race theory, graduate education and barriers to professionalization. J Sociol Soc Welf. 2007;34:25–42.

    Google Scholar 

  54. Settles I. When multiple identities interfere: the role of identity centrality. Personal Soc Psychol Bull. 2004;30:487–500.

    Article  Google Scholar 

  55. Sellers RM, Shelton JN. The role of racial identity in perceived racial discrimination. J Pers Soc Psychol. 2003;84:1079–92. doi:10.1037/0022-3514.84.5.1079.

    Article  PubMed  Google Scholar 

  56. Cross, William E, Parham, Thomas A, Helms JE. The Stages of Black Identity Development: Nigrescence Models. In: Jones R, editor. Black Psychol. Berkeley: Cobb and Henry; 1991. p. 319–38.

    Google Scholar 

  57. Schulz AJ, Gravlee CC, Williams DR, Israel BA, Mentz G, Rowe Z. Discrimination, symptoms of depression, and self-rated health among African American women in Detroit: results from a longitudinal analysis. Am J Public Health. 2006;96:1265–70.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Sellers RM, Martin PP. Racial Identity Matters : The Relationship between Racial Discrimination and Psychological Functioning in African American Adolescents. 2006;16:187–216.

  59. Brody GH, Chen YF, Murry VM, Ge X, Simons RL, Gibbons FX, et al. Perceived discrimination and the adjustment of African American youths: a five‐year longitudinal analysis with contextual moderation effects. Child Dev. 2006;77:1170–89.

    Article  PubMed  Google Scholar 

  60. Burrow AL, Ong AD. Racial identity as a moderator of daily exposure and reactivity to racial discrimination. Self Identity. 2010;9:383–402.

    Article  Google Scholar 

  61. Becker HS, Geer B, Hughes ECSAL. Boys in White. New Brunswick: 1961.

  62. Merton RK, Reader GGKP. The student physician. Boton: Harvard University Press; 1957.

    Book  Google Scholar 

  63. Hafferty F. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7.

    Article  CAS  PubMed  Google Scholar 

  64. Light DW. Toward a new sociology of medical education. J Health Soc Behav. 1988;29:307–22.

    Article  CAS  PubMed  Google Scholar 

  65. Dyrbye LN, Thomas MR, Shanafelt T. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80:1613–22. doi:10.4065/80.12.1613.

    Article  PubMed  Google Scholar 

  66. Harris AL, Marsh K, College M. Is a raceless identity an effective strategy for academic success among blacks? Soc Sci Q. 2010;91.

  67. Burgess DJ, Joseph A, van Ryn M, Carnes M. Does stereotype threat affect women in academic medicine? Acad Med. 2012;87:506–12. doi:10.1097/ACM.0b013e318248f718.

    Article  PubMed  PubMed Central  Google Scholar 

  68. McNeil KG, Kerr A, Mavor K. Identity and norms the role of group membership in medical student wellbeing. Perspect Med Educ. 2014;3:101–12.

    Article  Google Scholar 

  69. Bowleg L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health. 2012;102:1267–73. doi:10.2105/AJPH.2012.300750.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Monrouxe LV. When I say… intersectionality in medical education research. Med Educ. 2015;49:21–2.

    Article  PubMed  Google Scholar 

  71. Tsouroufli M, Rees CE, Monrouxe LVSV. Gender, identities, and intersectionality in medical education research. Med Educ. 2011;45:213–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

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.

Funding/Support

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.

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Correspondence to Rachel R. Hardeman.

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Hardeman, R.R., Perry, S.P., Phelan, S.M. et al. Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. J. Racial and Ethnic Health Disparities 3, 250–258 (2016). https://doi.org/10.1007/s40615-015-0136-5

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