Mental Health and Substance Use Among Black Women Attending STD Clinics in Baltimore: The Role of Overt and Subtle Discrimination - PubMed (original) (raw)

Mental Health and Substance Use Among Black Women Attending STD Clinics in Baltimore: The Role of Overt and Subtle Discrimination

Stephanie A Meyers-Pantele et al. J Urban Health. 2025 Apr.

Abstract

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013-2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

Keywords: Black women; Depression; PTSD; Sexually transmitted infections; Stigma; Substance use.

© 2024. The New York Academy of Medicine.

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Figures

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Fig. 1

An integration of the concepts and processes within the minority stress model and the stigma and substance use process model

References

    1. Brody DJ, Pratt LA, Hughes JP. Prevalence of depression among adults aged 20 and over: United States, 2013–2016, vol 303. Hyattsville, MD; 2018. pp. 1–8. -PubMed
    1. Courchesne NS, Meyers SA. Women and pregnancy. In: Marienfeld C, editor. Absolute addiction psychiatry review: An essential board exam study guide. Springer International Publishing; 2020. p. 259–75.
    1. Pinedo M. A current re-examination of racial/ethnic disparities in the use of substance abuse treatment: do disparities persist? Drug Alcohol Depend. 2019;202:162–7. 10.1016/j.drugalcdep.2019.05.017. -DOI -PMC -PubMed
    1. Copeland VC, Snyder K. Barriers to mental health treatment services for low-income African American women whose children receive behavioral health services: an ethnographic investigation. Social Work in Public Health. 2011;26(1):78–95. -DOI -PubMed
    1. Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11): e1001547. -DOI -PMC -PubMed

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