Journal of Racial and Ethnic Health Disparities

, Volume 3, Issue 3, pp 519–526 | Cite as

The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study

  • Sylvia P. Perry
  • Rachel Hardeman
  • Sara E. Burke
  • Brooke Cunningham
  • Diana J. Burgess
  • Michelle van Ryn


Positive psychological well-being is an important predictor of and contributor to medical student success. Previous work showed that first-year African American medical students whose self-concept was highly linked to their race (high racial identity centrality) were at greater risk for poor well-being. The current study extends this work by examining (a) whether the psychological impact of racial discrimination on well-being depends on African American medical students’ racial identity centrality and (b) whether this process is explained by how accepted students feel in medical school. 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 USA (n = 243). Regression analyses were conducted to test whether medical student acceptance mediated an interactive effect of discrimination and racial identity centrality on self-esteem and well-being. Both racial identity centrality and everyday discrimination were associated with negative outcomes for first-year African American medical students. Among participants who experienced higher, but not lower, levels of everyday discrimination, racial identity centrality was associated with negative outcomes. When everyday discrimination was high, but not low, racial identity was negatively related to perceived acceptance in medical school, and this in turn was related to increased negative outcomes. Our results suggest that discrimination may be particularly harmful for African American students who perceive their race to be central to their personal identity. Additionally, our findings speak to the need for institutional change that includes commitment and action towards inclusivity and the elimination of structural racism.


Racial identity Discrimination Medical student well-being 



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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict 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 5 June 2009) and Mayo Clinic (IRB #13-004612, approved 13 July 2013).

Informed Consent

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


The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.


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. Perry was additionally supported by the NHLBI Supplement to Promote Diversity in Health Related Research of the NIH under award number R01 HL085631-S1. 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.

Supplementary material

40615_2015_170_MOESM1_ESM.docx (38 kb)
ESM 1 (DOCX 37 kb)


  1. 1.
    Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine. 2006;81(4):354–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS, Power DV, Huschka M, Novotny PJ, Sloan JA, Shanafelt TD. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med. 2007;167(19):2103–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. J Am Med Assoc. 2010;304(11):1181–90.CrossRefGoogle Scholar
  4. 4.
    Broman CL, Mavaddat R, Hsu SY. The experience and consequences of perceived racial discrimination: a study of African Americans. Journal of Black Psychology. 2000;26:165–80.CrossRefGoogle Scholar
  5. 5.
    Jackson JS, Brown TN, Williams DR, Torres M, Sellers SL, Brown K. Racism and the physical and mental health status of African Americans: a thirteen year national panel study. Ethnicity and Disease. 1996;6:132–47.PubMedGoogle Scholar
  6. 6.
    Kessler RC, Michelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior. 1999;40:208–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Landrine H, Klonoff EK. The schedule of racist events: a measure of racial discrimination and a study of its negative physical and mental health consequences. Journal of Black Psychology. 1996;22:144–68.CrossRefGoogle Scholar
  8. 8.
    Sanders-Thompson V Perceived experiences of racism as stressful life events. Community Mental Health Journal. 1996;32:223–33.CrossRefGoogle Scholar
  9. 9.
    Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine; 2002.Google Scholar
  10. 10.
    Smedley BD, Butler AS, Bristow LR. In the nation's compelling interest: ensuring diversity in the health care workforce. Washington, DC: Institute of Medicine; 2004.Google Scholar
  11. 11.
    Walton GH, Cohen GL. A brief social-belonging intervention improved academic and health outcomes of minority students. Science. 2011;331:1447–51.CrossRefPubMedGoogle Scholar
  12. 12.
    Munford M Relationship of gender, self-esteem, social class, and racial identity to depression in blacks. Journal of Black Psychology. 1994;20:157–74.CrossRefGoogle Scholar
  13. 13.
    Turner JC, Oaks PJ. 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.CrossRefGoogle Scholar
  14. 14.
    Sellers RM, Shelton JN. The role of racial identity in perceived racial discrimination. Journal of Personality and Social Psychology. 2003;84:1079–92.CrossRefPubMedGoogle Scholar
  15. 15.
    Sellers RM, Caldwell CH, Schmeelk-Cone KH, Zimmerman M. Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. Journal of Health and Social Behavior. 2003;44:302–17.CrossRefPubMedGoogle Scholar
  16. 16.
    Wang K. Racial identity of minority adolescents: a review of empirical research. American Counseling Association VISTAS Online 2011; Retrieved from Available at. Accessed June 2, 2015, 2015.
  17. 17.
    Miller D Racial socialization and racial identity: can they promote resiliency for African American adolescents? Adolescence. 1999;34:493–501.PubMedGoogle Scholar
  18. 18.
    Azibo D, Allen DF. Some psychological concomitants and consequences of the black personality: mental health implications. Journal of Non-White Concerns in Personal Guidance. 1983;11:59–66.CrossRefGoogle Scholar
  19. 19.
    Cross WE, Parham TA, Helms JE. Nigrescence revisited: theory and research. In: Jones R, editor. African American identity development: theory, research and intervention. 1 ed. Hampton, VA: Cobb & Henry; 1998. p. 3–72.Google Scholar
  20. 20.
    Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, Hardeman R, Perry S, van Ryn M. 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
  21. 21.
    Parham T Cycles of psychological nigrescence. The Counseling Psychologist. 1989;17:187–227.CrossRefGoogle Scholar
  22. 22.
    White JL, Parham TA. The psychology of blacks: an African American perspective. New Jersey: Prentice-Hall; 1990.Google Scholar
  23. 23.
    Arroyo CG, Carmen G, Zigler E. Racial identity, academic achievement, and the psychological well-being of economically disadvantaged adolescents. Journal of Personality and Social Psychology. 1995;69:903–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Martinez RO, Dukes RL. The effects of ethnic identity, ethnicity, and gender on adolescent well-being. Journal of Youth and Adolescence. 1997;26:503–16.CrossRefGoogle Scholar
  25. 25.
    Phinney J Ethnic identity in adolescence and adults: review of research. Psychological Bulletin. 1990;108:499–514.CrossRefPubMedGoogle Scholar
  26. 26.
    Shih M, Sanchez DT. Perspectives and research on the positive and negative implications of having multiple racial identities. Psychological Bulletin. 2005;131:569.CrossRefPubMedGoogle Scholar
  27. 27.
    Sellers RM, Rowley SA, Chavous TM, Shelton JN, Smith MA. Multidimensional inventory of black identity: a preliminary investigation of reliability and construct validity. Journal of Personality and Social Psychology. 1997;73:805–15.CrossRefGoogle Scholar
  28. 28.
    Sellers RM, Smith MA, Shelton JN, Rowley SA, Chavous TM. Multidimensional model of racial identity: a reconceptualization of African American racial identity. Personality and Social Psychology Review. 1998;2:18–39.CrossRefPubMedGoogle Scholar
  29. 29.
    Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior. 1999;208-230.Google Scholar
  30. 30.
    Thompson WE, Hickey J V. Social stratification in the U.S. class system. Soc. Focus. 5th ed., Boston: Pearson; 2005. pp. 183–187.Google Scholar
  31. 31.
    Heatherton TF, Polivy J. Development and validation of a scale for measuring state self-esteem. Journal of Personality and Social Psychology. 1991;60:895–910.CrossRefGoogle Scholar
  32. 32.
    Purdie-Vauhns V, Steele CM, Davies PG, Ditlmann R, Crosby JR. Social identity contingencies: how diversity cues signal threat or safety for African Americans in mainstream institutions. Journal of Personality and Social Psychology. 2008;94:615–30.CrossRefGoogle Scholar
  33. 33.
    Cohen GL, Garcia J. Identity, belonging, and achievement: a model, interventions, implications. Current Directions in Psychological Science. 2008;17(6):365–9.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2015

Authors and Affiliations

  • Sylvia P. Perry
    • 1
  • Rachel Hardeman
    • 2
    • 3
  • Sara E. Burke
    • 4
  • Brooke Cunningham
    • 5
  • Diana J. Burgess
    • 6
    • 7
  • Michelle van Ryn
    • 2
    • 3
  1. 1.Department of Psychological ScienceUniversity of VermontBurlingtonUSA
  2. 2.Division of Health Care Policy and ResearchMayo ClinicRochesterUSA
  3. 3.Department of Health Sciences ResearchMayo ClinicRochesterUSA
  4. 4.Department of PsychologyYale UniversityNew HavenUSA
  5. 5.Department of Family Medicine and Community Health, School of MedicineUniversity of MinnesotaMinneapolisUSA
  6. 6.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  7. 7.Center for Chronic Disease Outcomes ResearchMinneapolis Veterans Affairs Medical CenterMinneapolisUSA

Personalised recommendations