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Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (β =.13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (β =.11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (β =.10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (β =.10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (β =.15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (β =.15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality. [ABSTRACT FROM AUTHOR]

Gun violence is a serious public health problem that places surviving victims at increased risk for a variety of mental health problems, including posttraumatic stress disorder (PTSD) and depression. Recognizing that many gunshot injury survivors lack access to mental health care in the early aftermath of a shooting, there has been growing interest in the use of early, preventive mental health interventions to help prevent long-term mental health complications like PTSD as part of routine care for survivors in acute medical settings, where initial outreach to survivors may be more successful. This study evaluates clinical outcomes associated with one such early intervention—Skills for Psychological Recovery (SPR)—provided to gunshot injury survivors as part of a hospital-based early intervention program embedded in a Level 1 trauma center in the Midwestern United States. Clinic data from 100 survivors (74.0% male, 78.0% Black/African American) who received SPR were included in the present study. Results suggest that receiving SPR in the early aftermath of a shooting is associated with statistically significant reductions in both PTSD, F(1, 26.77) = 22.49, p <.001, and depression, F(1, 29.99) = 6.49, p =.016, symptoms. Outcomes did not vary as a function of either PTSD risk status or intervention delivery method (i.e., in-person, telehealth). These findings support the effectiveness and acceptability of SPR as an early intervention for gunshot injury survivors when delivered as part of a hospital-based early intervention program. Public Policy Relevance Statement: With a growing number of hospitals across the United States developing early intervention programs for gunshot injury survivors and other patients traumatically injured as a result of community violence, the need for structured interventions that aim to prevent long-term mental health complications and address risk factors for future reinjury is critical. These findings suggest that one early, skills-based intervention—Skills for Psychological Recovery (SPR)—was associated with reductions in both PTSD and depression symptoms among recent gunshot injury survivors who were seen as part of a hospital-based early mental health intervention program, typically within the first 3 months postinjury. Identifying data-driven interventions like SPR that flexibly address mental health and social determinants of health should be considered essential to a comprehensive approach to patient care and ensuring the sustainability of hospital-based violence and early mental health intervention programs. [ABSTRACT FROM AUTHOR]