Reeves Alexis, Michaels Eli K, Thomas Marilyn D, Okoye Uche, Price Melisa M, Hasson Rebecca E, Chae David H, Allen Amani M
From the Division of Epidemiology, School of Public Health (Reeves, Michaels, Okoye, Allen), University of California, Berkeley; Department of Epidemiology and Population Health (Reeves), Stanford University, Palo Alto, California; Departments of Epidemiology and Biostatistics (Thomas) and Psychiatry and Behavioral Sciences (Thomas), and Phil R. Lee Institute for Health Policy Studies (Price), University of California San Francisco, San Francisco, California; Department of Kinesiology and Nutritional Sciences (Hasson), University of Michigan, Ann Arbor, Michigan; Department of Social, Behavioral, and Population Sciences (Chae), Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; and Division of Community Health Sciences, School of Public Health (Allen), University of California, Berkeley, California.
Psychosom Med. 2024 Jan 1;86(1):20-29. doi: 10.1097/PSY.0000000000001255. Epub 2023 Sep 29.
Psychosocial stress is a major predictor of chronic disease among African American (AA) women. Stress is a process involving exposure, appraisal of threat, coping, and psychobiologic adaptation. However, many studies focus on the frequency of stress events and/or coping; few explicitly study stress events and their appraisals; and AA women experience high levels of racial discrimination, a well-known form of social identity threat (i.e., negative experiences due to judgment based on identity). Stressors related to social identity threat may be differentially appraised and associated with divergent physiologic outcomes. This study examined the differences in the frequency and stressfulness associated with general stressors and racial discrimination in relation to blood pressure (BP) among AA women.
Multivariable regression was used on cross-sectional data from 208 middle-aged AA women residing in the San Francisco Bay Area.
AA women reported less frequency of racial discrimination compared with general stressors, but were more likely to appraise racial discrimination events as stressful. Racial discrimination stressfulness was more strongly associated with systolic BP (SBP) than the number of racial discrimination events. There was a U-shaped association between racial discrimination stress and SBP, with those reporting "none" and "high/very high" distress having the highest SBP ( b = 12.2 [2.7 to 21.8] and b = 15.7 [1.5-29.8], respectively, versus moderate stress). Conversely, those reporting "very low" general stressfulness had the lowest SBP ( b = -7.9 [-15.8 to -0.1], versus moderate stress). Diastolic BP followed a similar pattern, although results were nonsignificant.
This study highlights the importance of stress appraisal measures and adds to the body of evidence documenting racial discrimination as a salient psychosocial stressor for AA women.
心理社会压力是非洲裔美国（AA）女性慢性病的主要预测因素。压力是一个涉及暴露、威胁评估、应对和心理生物学适应的过程。然而，许多研究关注压力事件的频率和/或应对方式；很少有研究明确探讨压力事件及其评估；并且AA女性经历着高水平的种族歧视，这是一种众所周知的社会身份威胁形式（即基于身份的判断所导致的负面经历）。与社会身份威胁相关的压力源可能会被不同地评估，并与不同的生理结果相关联。本研究调查了AA女性中与一般压力源和种族歧视相关的频率及压力程度差异与血压（BP）的关系。
对居住在旧金山湾区的208名中年AA女性的横断面数据进行多变量回归分析。
与一般压力源相比，AA女性报告的种族歧视频率较低，但更有可能将种族歧视事件评估为有压力。种族歧视的压力程度与收缩压（SBP）的关联比种族歧视事件的数量更强。种族歧视压力与SBP之间存在U型关联，报告“无”和“高/非常高”困扰的人SBP最高（分别为b = 12.2 [2.7至21.8]和b = 15.7 [1.5 - 29.8]，与中度压力相比）。相反，报告“非常低”一般压力程度的人SBP最低（b = -7.9 [-15.8至-0.1]，与中度压力相比）。舒张压遵循类似模式，尽管结果不显著。
本研究强调了压力评估措施的重要性，并补充了将种族歧视作为AA女性重要心理社会压力源的证据。
