Racial Discrimination and Racial Identity: Examining Predictors of Perceived Stress Among Black Patients

Background. Research on racial discrimination and mental health has increasingly become a focus of scientific inquiry. Compared to White Americans, Black Americans experience higher levels of psychological stress – and racial discrimination is one contributing factor. Racial identity is also linked to the psychological health and well-being of Black Americans. Yet, more research is needed that fully examines the nature of the relationship between racial identity, racial discrimination, and other psychological factors (i.e., anxiety and self-esteem) that affect stress levels. The purpose of this study was to examine which of these factors best predict the perceived stress of Black patients who are currently receiving behavioral health services.

Methods. This study is a subset a larger study conducted at a Federally Qualified Health Center (FQHC) located in the Southeast region of the United States. The FQHC provides mental health and primary care services to over 8,500 patients each year. A stratified random sampling strategy was employed where race (i.e., Black and White) represented the strata. For the larger study, we randomly selected patients from each stratum who received primary care and/ or behavioral health services over the past year. The larger study had 383 participants (n=228 White and n = 155 Black). The current study focused only on the Black participants who completed key psychological measures on the survey. Overall, there were 78 Black participants in this study. Approximately, 70% were female, 39.7% had an associate degree or higher, and 93.2% defined themselves as being moderately or very religious.

Participants completed a 25-minute survey that consisted of the Beck Anxiety Inventory, Perceived Stress Scale, Rosenberg’s Self-esteem Scale, The Everyday Discrimination Scale, Experiences with Discrimination Scale, the Multidimensional Inventory of Black Identity (MIBI), and demographics. Three subscales from the MIBI were examined: 1) racial centrality is the extent to which an individual normatively emphasize racial group membership as part of their overall self-concept; 2) racial public regard is the extent to which an individual feels that others view the Black community in a positive or negative manner; and 3) racial private regard is the extent to which an individual feels positively or negatively toward the community. Analyses consisted of descriptive statistics, correlational analyses, and hierarchical linear regressions.

Results and Discussion. Findings from a series of correlational analyses show that racial centrality was positively associated with racial private regard (r=.43***) and negatively associated with perceived stress (r=-.31**) and anxiety (r=-.34**). Racial private regard was positively associated with self-esteem (r=.39***). Moreover, racial public regard was negatively associated with both forms of discrimination. A hierarchical regression was conducted to examine what variables best predicted perceived stress. Overall, the full model showed main effects for self-esteem, anxiety, racial centrality, and age. For Black participants [F(4, 63) = 7.24***] in this study, lower self-esteem, lower racial centrality, lower age, and higher anxiety levels were associated with higher levels of perceived stress. Participants’ experiences with discrimination were not strongly associated with their perceived stress levels. Implications for strategies for mental health services for Black populations are discussed.