Chronic stress and health disparities
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Racial and socioeconomic groups exposed to institutionalized mechanisms of discrimination have disproportionately higher rates of many stress-related illnesses. This study used a biopsychosocial model to investigate the a priori theory that exposure to the persistent social stress of institutionalized discrimination affects the psychological appraisal process to create the perception of stress, resulting in a biological stress reaction that creates or exacerbates stress-related illness. A mixed-methods design utilizing surveys, focus groups, and photovoice methods was used to answer the following research questions: 1) how much of the variance in stress scores is accounted for by race and SES, 2) how much of the variance in stress-related illness is accounted for by exposure to stressors and perceived stress, and 3) how are mechanisms of discrimination in our society (forced migration, social closure, and relative deprivation) perceived to contribute to chronic stress (through differential exposures, perceived lack of control, engagement in tasks, and perceived inadequate resources) for different racial and socioeconomic groups? A convenience sample of low-SES Blacks, low-SES Whites, middle-SES Blacks, and middle-SES Whites was recruited from doctor's offices in a large metropolitan area of the Southeast. Findings revealed that race (as a proxy for institutionalized racial discrimination) was not found to have an influence on general stress exposure checklists, global perceived stress, the stress appraisal process for important stressors, or stress-related illnesses previously known to display racial disparities for this group. Low-socioeconomic status was associated with higher exposure to traumatic events, higher total stress exposures, and higher levels of perceived stress. Higher perceived stress was further found to be associated with higher stress-related illness burden, especially as it relates to hypertension, depression, and anxiety. Qualitative data suggest that these differential exposures and stress appraisals are a result of structural class discrimination which limits social and financial safety net resources for housing, transportation, medical care, legal issues, and drug and alcohol rehabilitation for low-SES populations through mechanisms such as social closure and relative deprivation. Additional research is needed to further explore the relationship between stress, discrimination, and illness, utilizing a greater sample size and more sensitive survey instruments.