Skip to main content

Advertisement

SpringerLink
Log in

The Association between Racial Discrimination, Posttraumatic Stress Disorder, and Cardiovascular-Related Conditions Among Non-Hispanic Blacks: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objectives

To test the association between racial discrimination and cardiovascular-related conditions and whether PTSD mediates this relationship in a nationally representative sample of non-Hispanic Blacks.

Methods

We used data from the 2013 National Epidemiologic Survey on Alcohol and Related Conditions to conduct logistic regression analyses to examine the association between racial discrimination, PTSD, and cardiovascular-related conditions. We also performed mediation analyses to assess whether the association between racial discrimination and cardiovascular conditions was partly explained by PTSD.

Results

Racial discrimination was positively associated with both PTSD and cardiovascular-related conditions. Additionally, PTSD was positively associated with cardiovascular conditions. Results from the fully adjusted mediation models suggest that PTSD significantly mediated the association between racial discrimination and cardiovascular conditions.

Conclusions

Our results demonstrate an association between racial discrimination and cardiovascular-related conditions that is significantly mediated by PTSD. To improve cardiovascular functioning among non-Hispanic Blacks, health care professionals in conjunction with Black communities must adopt culturally competent screening for and treatment for PTSD. To address racial differences in cardiovascular conditions, public health efforts must address institutional policies that negatively alter health opportunities among the Black population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Williams DR. Miles to go before we sleep racial inequities in health. J Health Soc Behav. 2012;53:279–95. https://doi.org/10.1177/0022146512455804.

    Article  PubMed  PubMed Central  Google Scholar 

  2. National Center for Health Statistics. Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville; Maryland 2016.

  3. Williams DR. Stress and the mental health of populations of color: advancing our understanding of race- related stressors. J Health Soc Behav. 2018;59(4):466–85. https://doi.org/10.1177/0022146518814251.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bleich SN, Findling MG, Casey LS, Blendon RJ, Benson JM, SteelFisher GK, et al. Discrimination in the United States: experiences of black Americans. Health Serv Res. 2019;54:1399–408. https://doi.org/10.1111/1475-6773.13220.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Williams DR, Lawrence J, Davis B. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105–25. https://doi.org/10.2246/annurev-publhealth-04218-043750.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407–40.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cuevas AG, Ho T, Rodgers J, DeNufrio D, Alley L, Allen J, et al. Developmental timing of initial racial discrimination exposure is associated with cardiovascular health conditions in adulthood. Ethn Health. 2019. https://doi.org/10.1080/13557858.2019.1613517.

  8. Chae DH, Lincoln KD, Adler NE, Syme SL. Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes. Soc Sci Med. 2010;71(6):1182–8. https://doi.org/10.1016/j.socscimed.2010.05.045.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Okhomina VI, Glover L, Taylor H, Sims M. Dimensions of responses to perceived discrimination and subclinical disease among African-Americans in the Jackson Heart Study. J Racial Ethn Health Disparities. 2018;5(5):1084–92. https://doi.org/10.1007/s40615-017-0457-7.

    Article  PubMed  Google Scholar 

  10. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10:e0138511. https://doi.org/10.1371/journal.pone.0138511.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Goosby BJ, Heidbrink C. Transgenerational consequences of racial discrimination for African American health. Sociol Compass. 2013;7(8):630–43. https://doi.org/10.1111/soc4.12054.

    Article  PubMed  PubMed Central  Google Scholar 

  12. McEwen BS, Seeman T. Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load. Ann N Y Acad Sci. 1999;896:30–47.

    Article  CAS  PubMed  Google Scholar 

  13. Colen CG, Ramey DM, Cooksey EC, Williams DR. Racial disparities in health among nonpoor African Americans and Hispanics: the role of acute and chronic discrimination. Soc Sci Med. 2018;199:167–80. https://doi.org/10.1016/j.socscimed.2017.04.051.

    Article  PubMed  Google Scholar 

  14. Freidman MJ, Resick PA, Bryant RA, et al. Considering PTSD for DSM5. Depress Anxiety. 2011;28:750–69. https://doi.org/10.1002/da.20767.

    Article  Google Scholar 

  15. Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2011;41(1):71–83. https://doi.org/10.1017/S0033291710000401.

  16. Asnaani A, Richey JA, Dimaite R, Hinton DE, Hofmann SG. A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. J Nerv Ment Dis. 2010;198(8):551–5. https://doi.org/10.1097/NMD.0b013e3181ea169f.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Himle JA, Baser RE, Taylor RJ, Campbell RD, Jackson JS. Anxiety disorders among African Americans, blacks of Caribbean descent, and non-Hispanic whites in the United States. J Anxiety Disord. 2009;23(5):578–90. https://doi.org/10.1016/j.janxdis.2009.01.002.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Holliday SB, Dubowitz T, Haas A, et al. The association between discrimination and PTSD in African Americans: exploring the role of gender. Ethn Health. 2018;25:1–15. https://doi.org/10.1080/13557858.2018.1444150.

    Article  Google Scholar 

  19. Sibrava NJ, Bjornsson AS, Pérez Benítez ACI, Moitra E, Weisberg RB, Keller MB. Posttraumatic stress disorder in African American and Latinx adults: clinical course and the role of racial and ethnic discrimination. Am Psychol. 2019;74(1):101–16. https://doi.org/10.1037/amp0000339.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chou T, Asnaani A, Hofmann SG. Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups. Cult Divers Eth Min. 2012;18(1):74–81. https://doi.org/10.1037/a0025432.

    Article  Google Scholar 

  21. Pierterse AL, Todd NR, Neville HA, Carter RT. Perceived racism and mental health among Black American adults: a meta-analytic review. J Couns Psychol. 2012;59(1):1–9.

    Article  Google Scholar 

  22. Ryder AL, Azcarate PM, Cohen BE. PTSD and physical health. Curr Psychiatry Rep. 2018;20(12):116. https://doi.org/10.1007/s11920-018-0977-9.

    Article  PubMed  Google Scholar 

  23. Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disorders. 2013;27(1):33–46. https://doi.org/10.1016/j.janxdis.2012.08.004.

    Article  Google Scholar 

  24. Vidal C, Polo R, Alvarez K, Falgas-Bague I, Wang Y, Lê Cook B, et al. Co-occurrence of posttraumatic stress disorder and cardiovascular disease among ethnic/racial groups in the United States. Psychosom Med. 2018 Sep;80(7):680–8. https://doi.org/10.1097/PSY.0000000000000601.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grant BF, Amsbary M, Chu A, et al. Source and accuracy statement: National Epidemiologic Survey on alcohol and related conditions-III (NESARC-III). Rockville: National Institute on Alcohol Abuse and Alcoholism; 2014.

    Google Scholar 

  26. Substance Abuse and Mental Health Administration Services. Results from the 2013 National Survey on Drug Use and Health. 2014. Substance Abuse and Mental Health Services Administration, Rockville.

  27. Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61:1576–96. https://doi.org/10.1016/j.socscimed.2005.03.006.

    Article  PubMed  Google Scholar 

  28. Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aivadyan C, Morita K, et al. Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules: substance abusers and others in the general population. Drug Alcohol Depend. 2015;152:246–56. https://doi.org/10.1016/j.drugalcdep.2015.03.027.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Breen R, Karlson KB, Holm A. Total, direct, and indirect effects in logit and probit models. Sociol Methods Res. 2013;42(2):164–91. https://doi.org/10.1177/0049124113494572.

    Article  Google Scholar 

  30. Kohler U, Karlson KB, Holm A. Comparing coefficients of nested nonlinear probability models. Stata J. 2011;11(3):420–38. https://doi.org/10.1177/0049124113494572.

    Article  Google Scholar 

  31. Jansen T, Rademakers J, Waverijn, Verheij R, Osborne R, Heijmans M. The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study. Am Behav Sci. 2013;57(8):394. https://doi.org/10.1177/0002764213487340.

    Article  Google Scholar 

  32. Marwaha S, Bebbington P. Mood as a mediator of the link between child sexual abuse and psychosis. Soc Psychiatry Psychiatr Epidemiol. 2015;50(4):661–3. https://doi.org/10.1007/s00127-014-0966-1.

    Article  CAS  PubMed  Google Scholar 

  33. Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32:20–47. https://doi.org/10.1007/s10865-008-9185-0.

    Article  PubMed  Google Scholar 

  34. Carlson E. Trauma assessments: a clinician’s guide. New York: Guilford Press; 1997.

    Google Scholar 

  35. Kirkinis K, Pieterse AL, Martin C, Agiliga A, Brownell A. Racism, racial discrimination, and trauma: a systematic review of the social science literature. Ethn Health. 2018. https://doi.org/10.1080/13557858.2018.1514453.

  36. Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013, 57(8). https://doi.org/10.1177/0002764213487340.

  37. McEwen CA, McEwen BS. Social structure, adversity, toxic stress, and intergenerational poverty: an early childhood model. Annu Rev Sociol. 2017;43:445–72. https://doi.org/10.1146/annurev-soc-060116-053252.

    Article  Google Scholar 

  38. Rubin L. Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics. Pediatr Res. 2016;79:127–35 org.offcampus.lib.washington.edu/10.1038/pr.2015.203.

    Article  CAS  PubMed  Google Scholar 

  39. Desalu JA, Goodhines PA, Aesoon P. Racial discrimination and alcohol use and negative drinking consequences among Black Americans: a meta-analytic review. Addiction. 2019;114(6):957–67. https://doi.org/10.1111/add.14578.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Rose SW, Mayo A, Ganz O, Perreras L, D’Silva J, Cohn A. Perceived racial/ethnic discrimination, marketing, and substance use among young adults. J Ethn Subst Abus. 2019;18(4):558–77. https://doi.org/10.1080/15332640.2018.1425949.

    Article  Google Scholar 

  41. Gee GC, Ro A, Gavin A, Takeuchi D. Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans. Am J Public Health. 2008;98:493–500. https://doi.org/10.2105/AJPH.2007.114025.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Clark R, Anderson NB, Clark VR, Williams DR. Racism as a stressor for African Americans: a biopsychosocial model. Am Psychol. 1999;54(10):805–16.

    Article  CAS  PubMed  Google Scholar 

  43. Brewer LC, Cooper LA. State of the art and science: race, discrimination, and cardiovascular disease. AMA J Ethics. 2014;16(6):455–60.

    Article  Google Scholar 

  44. Greer TM. Perceived racial discrimination in clinical encounters among African American hypertensive patients. J Health Care Poor Underserved. 2010;21:251–63. https://doi.org/10.1353/hpu.0.0265.

    Article  PubMed  Google Scholar 

  45. Lurie N, Fremont A, Jain AK, Taylor SL, McLaughlin R, Peterson E, et al. Racial and ethnic disparities in care: the perspectives of cardiologists. Circulation. 2005;111:1264–9. https://doi.org/10.1161/01.CIR.0000157738.12783.71.

    Article  PubMed  Google Scholar 

  46. Koenen KC, Galea S. Post-traumatic stress disorder and chronic disease: open questions and future directions. Soc Psychiatry Psychiatr Epidemiol. 2015;50:511–3. https://doi.org/10.1007/s00127-015-1035-0.

    Article  PubMed  Google Scholar 

  47. Garcia JJL, Sharif MZ. Black lives matter: a commentary on racism and public health. AJPH. 2015;105(8):e27–30. https://doi.org/10.2105/AJPH.2015.302706.

    Article  Google Scholar 

Download references

Acknowledgments

This is a secondary analysis on public access data set of the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). We thank the anonymous reviewers for their assistance with earlier draft manuscripts.

Author information

Authors and Affiliations

  1. School of Social Work, University of Washington, Seattle, WA, USA

    Amelia R. Gavin & David Takeuchi

  2. College of Social Work, University of South Carolina, Columbia, SC, USA

    Bongki Woo

  3. College of Social Work, University of Tennessee, Knoxville, TN, USA

    Anne Conway

Authors
  1. Amelia R. Gavin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bongki Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Conway
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Amelia R. Gavin designed the current work and drafted the manuscript, revised the manuscript, and confirmed the final draft. Bongki Woo acquired the data, conducted the data analysis, drafted the manuscript, and revised the manuscript. Anne Conway and David Takeuchi revised the manuscript.

Corresponding author

Correspondence to Amelia R. Gavin.

Ethics declarations

Conflict of Interest

The authors declare that they have conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gavin, A.R., Woo, B., Conway, A. et al. The Association between Racial Discrimination, Posttraumatic Stress Disorder, and Cardiovascular-Related Conditions Among Non-Hispanic Blacks: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). J. Racial and Ethnic Health Disparities 9, 193–200 (2022). https://doi.org/10.1007/s40615-020-00943-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-020-00943-z

Keywords

Search

Navigation