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Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews ( N =30) with patients ( n =15) and providers ( n =15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings., Competing Interests: The authors declare no conflicts of interest., (© The Author(s) 2024.)

Objective: Online racial discrimination (ORD) is rampant; however, little is known about its associations with mental health among undergraduates. This study explored the relations between ORD and mental health among Black undergraduates. It also investigated gender differences in these relations. Participants: Two hundred seventy-eight Black, cisgender men and women enrolled in a minority-serving public university in the Northeast U.S. Methods: Participants completed measures of ORD, depression, generalized anxiety (GA), and social anxiety (SA) via a Web-based survey. Results: Eighty-five percent of participants experienced at least one ORD incident in the last year. Men and women reported comparable exposure. Gender moderated the relations between ORD and depression and SA, respectively; these associations were stronger for women. Conclusions: Exposure to ORD is prevalent among Black undergraduates and is associated with adverse mental health outcomes, especially for women. Campus mental health interventions should address online discrimination in the context of students' intersecting identities.

Background: Racism-related stress is a root cause of racial and ethnic disparities in mental health outcomes. An individual may be exposed to racism directly or vicariously by hearing about or observing people of the same racial and/or ethnic group experience racism. Although the healthcare setting is a venue by which healthcare workers experience both direct and vicarious racism, few studies have assessed the associations between direct and vicarious racism and mental health outcomes among healthcare workers., Methods: In this cross-sectional study, we assessed the relationships between direct and vicarious racism and symptoms of posttraumatic stress, depression, and anxiety among healthcare workers in the USA in 2022., Results: Our sample consisted of 259 healthcare workers identifying as a racialized minority, including 68 (26.3%) who identified as mixed-race, 61 (23.6%) East Asian, 36 (13.9%) Black, 33 (12.7%) South Asian, 22 (8.5%) Southeast Asian, 21 (8.1%) Middle Eastern/North African, and 18 (6.9%) another race. The mean age was 37.9 years (SD 10.1). In multivariable linear regression models that adjusted for demographics, work stressors, and social stressors, we found that increased reporting of vicarious racism was associated with greater symptoms of anxiety (B = 0.066, standard error = 0.034, p = .049). We did not identify significant relationships between vicarious and direct racism and symptoms of posttraumatic stress or depression in the fully adjusted models., Conclusions: Our findings should be considered by academic health systems to mitigate the negative impact of racism on healthcare workers' mental health., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: Racial and ethnic diversity of healthcare workers have benefits on team functioning and patient care. However, a significant barrier to retaining diverse providers is discrimination., Objective: To assess the predictors, perpetrators, and narratives of racial discrimination among healthcare workers., Design: Survey study., Participants: Healthcare workers employed at academic hospitals., Main Measures: We assessed prevalence and perpetrators of racial and ethnic discrimination using the General Ethnic Discrimination Scale. We included an open-ended question asking respondents to recount experiences of discrimination and analyzed responses using grounded theory., Key Results: Of the 997 participants, 12.2% were females from backgrounds underrepresented in medicine (URM), 4.0% URM males, 10.1% Asian females, 4.7% Asian males, 49.1% non-Hispanic White females, and 19.8% non-Hispanic White males. Among healthcare workers of color, 85.2% reported discrimination. Over half of URM females (51.4%), URM males (52.6%), and Asian females (62.5%) reported discrimination by patients. About 20-25% of URM females, URM males, and Asian females reported discrimination by teachers, supervisors, co-workers, and institutions. In adjusted binary logistic models, URM females had 10.14 odds (95% confidence interval [95%CI]: 5.13, 20.02, p<.001), URM males 6.23 odds (95%CI: 2.59, 14.98, p<.001), Asian females 7.90 odds (95%CI: 4.07, 15.33, p<.001), and Asian males 2.96 odds (95% CI: 1.47, 5.97, p=.002) of reporting discrimination compared with non-Hispanic White males. Needing more support was associated with 2.51 odds (95%CI: 1.54, 4.08, p<.001) of reporting discrimination. Our qualitative findings identified that the murder of George Floyd intensified URM healthcare workers' experiences of discrimination through increased fear of violence and requests for unpaid diversity work. Asian healthcare workers reported that pandemic-related anti-Asian violence shaped their experiences of discrimination through increased fear of violence and care refusal from patients., Conclusions: Our findings provide insights into experienced discrimination among healthcare workers and opportunities for hospitals to create programs that improve inclusivity., (© 2021. Society of General Internal Medicine.)

Racial and gender discrimination are risk factors for adverse mental health outcomes in the general population; however, the effects of discrimination on the mental health of healthcare workers needs to be further explored, especially in relation to competing stressors. Thus, we administered a survey to healthcare workers to investigate the associations between perceived racial and gender discrimination and symptoms of depression, anxiety, posttraumatic stress, and burnout during a period of substantial stressors related to the COVID-19 pandemic and a national racial reckoning. We used multivariable linear regression models, which controlled for demographics and pandemic-related stressors. Of the 997 participants (Mean Age = 38.22 years, SD = 11.77), 688 (69.01%) were White, 148 (14.84%) Asian, 86 (8.63%) Black, 73 (7.32%) Latinx, and 21 (2.11%) identified as another race. In multivariable models, racial discrimination predicted symptoms of depression (B = 0.04; SE: 0.02; p = .009), anxiety (B = 0.05; SE: 0.02; p = .004), and posttraumatic stress (B = 0.01; SE: 0.01; p = .006) and gender discrimination predicted posttraumatic stress (B = 0.11; SE: 0.05; p = .013) and burnout (B = 0.24; SE: 0.07; p = .001). Discrimination had indirect effects on mental health outcomes via inadequate social support. Hospital-wide diversity and inclusion initiatives are warranted to mitigate the adverse mental health effects of discrimination.

This mixed-methods study aimed to gain knowledge of the lived experience of posttraumatic growth (PTG) in 32 low-income Black mothers whose New Orleans' homes were damaged or destroyed by Hurricane Katrina, and half of whom had relocated indefinitely to Houston. Data from in-depth interviews with participants were examined in conjunction with quantitative scores on the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996). Participants were interviewed face-to-face on a range of postdisaster experiences, including positive changes, in 2009. Participants also completed the PTGI via a telephone survey within six months of being interviewed. Most (26 out of 32) participants described experiencing PTG within the 5 domains of the PTGI, with the domains most frequently coded, in descending order, being New Possibilities, Relating to Others, Personal Strength, Appreciation for Life, and Spiritual Change. PTG stemmed heavily from exposure to opportunities in survivors' postdisaster communities, including increased racial diversity, improved neighborhoods, and new educational and economic opportunities. Participants' frequency of all PTG codes was associated with their overall PTGI scores with a small-to-moderate effect size (r = .32; p = .078) in a relationship that trended toward significance. Without minimizing the catastrophic losses they entail, disasters may in some cases create spaces for PTG for survivors, including through new opportunities in areas where survivors formerly experienced oppression. Policymakers should examine how to make such opportunities available, visible and accessible to individuals absent a disaster. (PsycINFO Database Record (c) 2019 APA, all rights reserved).