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Background In the U.S., poorer breast cancer survival in Black women relative to white women has persisted for over 30 years, with recent data showing a 38% higher mortality in Black women with breast cancer. Stage at diagnosis is the most powerful predictor of survival. However, despite rates of mammographic screening having become approximately equal in the two groups, Black women are more likely to be diagnosed at later stages. We examined whether perceived experiences of discrimination due to race in receipt of health care is associated with a late stage at diagnosis of breast cancer. Methods Nested within the prospective Black Women’s Health Study (BWHS), this case-only study included 1,617 self-identified U.S. Black women diagnosed with a first invasive breast cancer in 2003 through 2022. Eligible cases had completed a BWHS questionnaire in 2003 in which participants were asked whether they received differential health care due to their race or insurance status. The primary outcome in the present research was stage at breast cancer diagnosis, obtained from medical records and cancer registry data. Odds ratios (OR) for the association of perceived racial discrimination in health care with later stage at diagnosis were estimated in logistic regression analyses, with each of stages II, III, and IV compared with stage I diagnosis. Results In multivariable analyses controlled for age, body mass index, socioeconomic factors, and mammographic screening, perceived racial discrimination in healthcare was associated with an increased odds of breast cancer diagnosis at stage IV versus stage I (OR = 2.10, 95% CI 1.15–3.83). The association was present even among women who reported having a mammogram in the two years before diagnosis. No associations were observed for stage II or III versus stage I. Conclusions The findings support reducing healthcare discrimination to alleviate the disproportionate burden of worse prognosis and survival experienced by Black women.

Previous studies have shown that medical student mistreatment and burnout are common. However, few longitudinal data exist to describe how mistreatment and other learning environment experiences are associated with subsequent burnout and other student characteristics. To examine the association between mistreatment and perceptions of the learning environment with subsequent burnout, empathy, and career regret among US medical students. This cohort study analyzed data from the 2014-2016 Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire (Y2Q) and 2016-2018 AAMC Graduation Questionnaire (GQ). Medical students from 140 allopathic medical schools who responded to both AAMC surveys were included in the analysis. Data were analyzed from December 1, 2019, to January 11, 2021. Self-reported medical student mistreatment (eg, experiences of negative behaviors and discrimination related to sex, race/ethnicity, and sexual orientation) and perceptions of the learning environment (Medical School Learning Environment Survey subscales for faculty, emotional climate, and student-student interactions). Burnout, empathy, and career regret as measured by Oldenburg Burnout Inventory data for burnout, Interpersonal Reactivity Index scores for empathy, and a single item assessing career regret. Data from 14 126 medical students were analyzed; 52.0% were women, and the mean (SD) age was 27.7 (2.9) years at graduation. Mistreatment was reported by 22.9% of respondents on the Y2Q. In multivariable analysis adjusted for Y2Q measures, mistreatment reported on the Y2Q was associated with a higher exhaustion score (1.81 [95% CI, 1.60-2.02]), a higher disengagement score (0.71 [95% CI, 0.58-0.84]), and higher likelihood of career regret on the GQ (186 of 989 [18.8%]; all P < .001). A more positive emotional climate reported on the Y2Q was associated with a lower exhaustion score (for each 1-point increase, -0.05 [95% CI, -0.08 to -0.02]; P = .001) and lower disengagement score (for each 1-point increase, -0.04 [95% CI, -0.06 to -0.02]; P < .001) on the GQ. More positive faculty interactions on the Y2Q were associated with higher empathy score on the GQ (for each 1-point increase, 0.02 [95% CI, 0.01-0.05]; P = .04). Better student-student interactions were associated with lower odds of career regret during year 4 of medical school (odds ratio for each 1-point increase, 0.97 [95% CI, 0.95-1.00]; P = .04). The findings of this cohort study suggest that medical students who experienced mistreatment and perceived the learning environment less favorably were more likely to develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret compared with medical students with more positive experiences. Strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment and improve the learning environment.

Organizational culture and workplace interactions may enhance or adversely impact the wellness of all members of learning and work environments, yet a nuanced understanding of how such experiences within health care organizations impact the health and wellness of their membership is lacking. To identify and characterize the reported health and wellness outcomes associated with perceived discrimination among academic medicine faculty, staff, and students. This qualitative study analyzed anonymously submitted written narratives from 2016 that described experiences related to inclusion in the workplace or lack thereof. Narratives that described health outcomes associated with work- or school-based discrimination were purposively sampled. Participants were faculty, staff, and students at health-related schools or hospitals affiliated with the University of Pennsylvania. Data analysis was performed from March 2019 to January 2020. Self-reported experiences, both witnessed and personal, of discrimination in the workplace. A total of 315 narratives were collected, and 115 narratives from 115 participants were analyzed. Most respondents identified as female (70 respondents [60.9%]), non-Hispanic White (68 respondents [59.1%]), and heterosexual (89 respondents [77.4%]) and had worked at the institution for at least 1 year (99 respondents [86.0%]). The outcomes associated with adverse workplace experiences were broad and ranged in nature from emotional to mental and physical. Most reported outcomes were emotional (101 respondents [87.8%]), and more than 1 in 10 narratives (14 respondents [12.2%]) described a mental or physical health outcome. Many of the participants felt devaluated, overexerted, and hopeless, resulting in clinically relevant manifestations, such as increased stress and anxiety levels and even elevated blood pressure. This qualitative study identified a continuum of negative outcomes on employee health and well-being associated with perceived discrimination and chronic exclusion in the workplace. These findings suggest the need for organizations to promote inclusion as a component of workplace wellness interventions.

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation-based Native Americans. In 2011, data were collected from Native American (N = 288; 15–24 years of age) tribal members from a remote plains reservation using an anonymous web-based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post-traumatic stress disorder (PTSD) symptoms, depression symptoms, poly-drug use, and suicide attempt. Seventy-eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant ( p  < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly-drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation-based populations must be developed, tested and evaluated longitudinally.

While scholarly literature indicates that both refugee and non-refugee migrant young people display increased levels of psychosocial vulnerability, studies comparing the mental health of the two groups remain scarce. This study aims to further the existing evidence by examining refugee and non-refugee migrants’ mental health, in relation to their migration history and resettlement conditions. The mental health of 883 refugee and 483 non-refugee migrants (mean age 15.41, range 11-24, 45.9% girls, average length of stay in the host country 3.75 years) in five European countries was studied in their relation to family separation, daily material stress and perceived discrimination in resettlement. All participants reported high levels of post-traumatic stress symptoms. Family separation predicted post-trauma and internalizing behavioral difficulties only in refugees. Daily material stress related to lower levels of overall well-being in all participants, and higher levels of internalizing and externalizing behavioral difficulties in refugees. Perceived discrimination was associated with increased levels of mental health problems for refugees and non-refugee migrants. The relationship between perceived discrimination and post-traumatic stress symptoms in non-refugee migrants, together with the high levels of post-traumatic stress symptoms in this subsample, raises important questions on the nature of trauma exposure in non-refugee migrants, as well as the ways in which experiences of discrimination may interact with other traumatic stressors in predicting mental health.

Racial discrimination is associated with alcohol use and risky sex cognitions and behaviors, which are risk factors for negative health outcomes, including human immunodeficiency virus infection. The current study investigated the causal impact of racial discrimination on alcohol and sexual-risk cognitions while exploring potential mediators that might help explain this relation: negative affect, perceived control, and meaningful existence. We also examined if past discrimination impacts the strength of (moderates) these effects. Participants were 287 Black/African American young adults aged 18–25. They were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted greater: perceived racial discrimination, negative affect, alcohol use willingness, and reduced perceived control and meaningful existence. Furthermore, excluded participants who experienced more past racial discrimination reported the lowest perceived control, and greatest negative affect and alcohol-risk cognitions. The findings suggest that past racial discrimination exacerbates the harmful health effects of immediate experiences of discrimination.

Cultural factors are often neglected in studies of suicidal behavior among emerging adults. The present study examined acculturative stress and perceived discrimination as statistical predictors of a suicide attempt history among an ethnically diverse sample of 969 emerging adults, ages 18–25 ( M  = 18.8). Females made up 68% of the sample, and the racial/ethnic composition included Asian, Latino, Black, and White (US-born and non-US-born) individuals. There were no statistically significant racial/ethnic differences in endorsement of a suicide attempt history, with an overall rate of 8% in the sample. Asian participants reported higher acculturative stress than all other racial/ethnic groups, while both Asian and Black participants reported having experienced more discrimination in the previous year, compared to other groups. Logistic regression analyses suggested that familial acculturative stress was associated with 2 times higher odds of endorsing a past suicide attempt, overall. More specifically, it was associated with over 2 times higher odds among Asian participants, over 4 times higher odds among Black participants, and over 3 times higher odds among non-US-born White participants, while social acculturative stress was associated with over 3 times higher odds of endorsing a past suicide attempt among Latino participants. Environmental acculturative stress was associated with decreased odds of endorsing a suicide attempt history, overall, but not when examined separately by racial/ethnic group. Perceived discrimination was associated with over 5 times higher odds of a suicide attempt, overall, and specifically was associated with over 3 times higher odds among Latino participants and over 10 times higher odds among White, US-born participants. These findings suggest the importance of addressing culturally-related variables in treatment with emerging adults of racially/ethnically diverse backgrounds to reduce risk for suicidal behavior.

Purpose Higher rates of psychosis have been reported in minority groups. Since individuals belonging to such groups are vulnerable to the experiences of discrimination, and in line with models proposing that social and life adversity may play a causal role in development and maintenance of psychotic experiences, it has been proposed that perceived discrimination may represent an important determinant of psychotic experiences. This paper reviews the literature examining the relationship between perceived discrimination and psychosis, examining whether discrimination is associated with an increased risk of psychosis, the severity of psychotic symptoms and whether there is an association with specific psychotic symptoms. Methods A systematic database search of PsycINFO, Embase and PubMed was conducted to identify quantitative cross-sectional and prospective studies that examined the association between discrimination and psychosis. Results Twenty-four studies met the inclusion criteria, four of which used prospective designs and twenty used cross-sectional designs. The main findings indicated that discrimination may be associated with an increased risk of psychosis (too few studies to determine whether discrimination is associated with severity). Some studies found associations between discrimination and positive psychotic experiences and/or specific psychotic experiences such as paranoia. A small number of studies found that greater exposure to discrimination was associated with a greater likelihood of reporting psychotic experiences, tentatively indicating a dose–response relationship. Conclusions This review indicates that discrimination plays an important role in the experience of psychosis; however, future research is required to clarify the nature of this relationship. Avenues for further research and clinical implications are proposed.

Perceived discrimination is associated with poorer psychological adjustment and greater problem behaviors among rural-to-urban migrant adolescents. Yet, the predictors and the consequences of distinct changing patterns of perceived discrimination are less clear. The current study sought to identify distinct patterns of perceived discrimination trajectories and examine the developmental implications of these patterns among 385 Chinese rural-to-urban migrant early adolescents (Mage = 10.49, SDage = 0.69; 62% boys). Four distinct patterns of perceived discrimination trajectories, i.e., Low-stable (79.59%), Decreasing (9.08%), High-stable (6.11%), and Increasing (5.22%), were identified. Predictors including resilience, family support, peer support, and demographic characteristics (i.e., gender and school types) contributed to differences in pattern membership. Moreover, the Low-stable pattern exhibited more favorable distal outcomes (i.e., lower levels of social anxiety and loneliness and higher levels of self-esteem) than the other three patterns; the Decreasing group had lower levels of loneliness than the High-stable group. The findings extend the understanding of the predictors and consequences of perceived discrimination among rural-to-urban migrant early adolescents from a developmental perspective.

Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW’s substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one’s sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.