Racism and trauma
Today, I address three recent studies related to racism and trauma. First, Pieterse, Johnson & Carter (2023) published “The Relationship Between Posttraumatic Stress Disorder and Race-Based Traumatic Stress” in Psychological Trauma: Theory, Research, Practice, and Policy. Here’s the edited abstract and impact statement:
This study examined the relationships between race-based traumatic stress symptoms (RBTSS), posttraumatic stress disorder (PTSD) symptoms, and negative affect (NA) in the past year. Participants were 185 community-based respondents who completed a paper and pencil survey of the race-based traumatic stress symptoms scale (RBTSSS), diagnostic and statistical manual (DSM)-related PTSD symptoms, and negative emotions. Two canonical correlation analyses were conducted for two participant groups: those with no race-based traumatic stress (RBTS) elevations and those with one or more RBTS elevations. Results showed a significant relationship between RBTS symptoms and PTSD symptoms for the no elevation group, and a significant relationship between RBTS symptoms and NA for the race-based stress/traumatic stress group. Notably, RBTS inclusion was not significantly correlated with NA. Those with average-level RBTS symptoms appear to endorse more PTSD criteria, while those with elevated RBTS scores do not. The study, therefore, highlights the need for further investigation of how diagnostic measures of trauma may differentiate from trauma symptoms related to race-based experiences.
Understanding the psychological effects of racism is now being understood within the context of trauma, both in regard to posttraumatic stress disorder (PTSD) and race-based trauma as emotional injury. This study suggests that the relationship between race-based traumatic stress (RBTS) and trauma might be associated with the level of RBTS symptoms exhibited. Higher scores of RBTS symptoms were associated with negative emotions and not with PTSD symptoms. Therefore, given the complex manner in which RBTS symptoms can present, clinicians are encouraged to routinely undertake an assessment of racial trauma as part of a standard intake procedure.
This is one of those violation of expectations studies. We could have expected PTSD symptoms and race-based traumatic stress to be more highly correlated in those with elevations on the RBTS. Instead, for those with elevated RBTS scores, negative affect was higher. The next study looks specifically at clients with migraine. Parker et al. (2023) published “Injustice, Quality of Life, and Psychiatric Symptoms in People with Migraine” in Rehabilitation Psychology. Here’s the edited abstract and impact statement:
To describe and examine the relationships between perceived injustice, quality of life (QoL), and psychiatric symptoms through a mixed-methods, cross-sectional observational study design in people with migraine. Participants completed a series of online quantitative questionnaires, including the Injustice Experience Questionnaire (IEQ). Then, 10 participants took part in qualitative phenomenological interviews. One hundred twenty-seven participants were included in the sample. Correlations revealed higher IEQ scores were strongly associated with lower QoL (r = −.676, p < .001). Higher scores on the IEQ were related to higher migraine attack frequency (r = .403, p < .001), migraine pain intensity (r = .352, p < .001), no association with reports of nausea/vomiting (r = .110, p = .220), and higher report of allodynia symptoms (r = .281, p < .001). Participants who reported a migraine with aura in the past year reported higher IEQ scores than people with no aura in the past year (t[125] = −2.34, p = .02). Higher IEQ scores were associated with higher anxiety (r = .447, p < .001) and depression symptom scores (r = .495, p < .001). The phenomenological interviews revealed 4 core themes describing perceived injustice and QoL with migraine: coping, loss, illness burden, and misunderstanding. Higher levels of perceived injustice showed lower levels of QoL, was associated with higher headache frequency attack severity, and rates of depressive and anxiety symptoms. Participants described their QoL similarly, regardless of reported high or low levels of perceived injustice. Perceptions of injustice are important patient experiences in pain populations, with risk factors for poor pain outcomes, higher pain severity, and poor quality of life.
Migraine is a baffling disorder but this may help clinicians ask better questions about experiences of injustice. The final study has specific recommendations for mental health professionals. Pieterse, Austin, Nicolas, Martin, Agiliga & Kirkinis (2023) published “Essential Elements for Working with Racial Trauma: A guide for health service psychologists” in Professional Psychology: Research and Practice. Here’s the edited abstract:
As the experience of racism has been found to be associated with a plethora of adverse mental health outcomes across racial groups, it is imperative for clinicians to consider the role of racism-related stress and racial trauma when working with clients of color. As such, the current article provides a review of racial trauma and presents clinical guidelines for health service psychologists with a focus on intervention and prevention. We identify these essential elements as including facilitative knowledge, facilitative process, and facilitative techniques associated with assisting the healing process and establishing empowerment. Through a combination of therapist racial awareness, relational skills, stress-reduction/emotion-focused interventions, and antiracism advocacy, psychologists can play an important role in the healing and amelioration of racial trauma.
These studies illustrate the importance of asking clients about experiences of racism and injustice and the strategies clinicians can employ to help them.