Social and environmental adversity predict poor mental health in a Milwaukee, WI community sample

Abstract

Racism functions as a system of continued devaluation, disempowerment, and inequitable allotment driven by racial hierarchy. Operating at multiple levels – individual, interpersonal, community, and societal – racism perpetuates significant mental and physical health disparities. Though evidence evinces the impact of racism across domains, few studies have assessed factors rooted in structural racism simultaneously and how they relate together to predict outcomes. The current study examines how racism impacts the mental health (MH) of Black Americans adults across multiple levels. Risk and protective factors were analyzed to understand the collective impact of racism in this population. Black adults (N = 400) in Milwaukee, WI completed a battery of surveys assessing demographic, mental health, behavioral health, physical/built environment, sociocultural environment, healthcare, and neighborhood context. Bivariate analyses, exploratory factor analyses (EFA), and general linear modeling were conducted, with anxiety, depression, and post-traumatic stress symptoms (PTSS) as outcomes. Participants (M = 43.8 years; 86.1 % earning <$40,000 annually) exhibited elevated depression, anxiety, and PTSD risk. All three mental health outcomes were positively correlated with alcohol/drug use, pain, exposure to violence, housing insecurity, racism-related vigilance, ethnic discrimination, and everyday discrimination while neighborhood social cohesion was negatively correlated. Depression was negatively correlated with social support (p < .05). EFA produced three factor clusters: Social & Environmental Adversity (SEA), Psychosocial Resilience (PR), and Substance Use (SU). SEA and SU were strongly and positively related to all MH outcomes (p < .001) but PR was not. Socioecological frameworks provide a more comprehensive method to evaluate the impact of racism and identify and address mental health disparities. In the current study, results showed that social and environmental factors predicted poor mental health and highlight a need to understand these factors collectively to inform intervention.