Journal Article Annotations
2022, 2nd Quarter

Diversity, Equity and Inclusion 2022

Annotations by Arslann Arshed, MD, MS, MSHA
July, 2022

Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems.
The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression.

- A Developmental Framework for Progression to Anti-racism in Academic Psychiatry.

PUBLICATION #1 — Diversity, Equity and Inclusion 2022

Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems.

Kiara Alvarez, Lillian Polanco-Roman, Aaron Samuel Breslow, Sherry Molock

Abstract: Am J Psychiatry. 2022 Jun;179(6):422-433. doi: 10.1176/appi.ajp.21101001.

Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.

Annotation

The finding:
The Structural Racism and Suicide Prevention Systems Framework includes cultural racism, institutional racism, interpersonal racism and intrapersonal racism. The authors describe how these elements impact suicide risk identification and management. Cultural racism is defined as negative attitudes and beliefs about racially and ethnically minoritized populations embedded in societal values and practices. Institutional racism is defined as laws, policies, and regulations embedded in organizations that consolidate power among White people. Interpersonal racism is defined as behavioural manifestation of racial or ethnic prejudices during interpersonal exchanges. Intrapersonal racism is defined as the internalization of negative attitudes and beliefs about oneself due to exposure to racism. Critical opportunities to measure and mitigate structural racism include provision of culturally informed behavioural health services in outpatient and schools settings as well as through community crisis response interventions.

Strengths and weaknesses:
The article introduces a new suicide prevention framework based on well-defined existing thought on health disparities. However, there remain limited data around the application of this theoretical framework.

Relevance:
C-L psychiatrists must consider the impact of racism and its manifestations in different aspects of social and health systems when evaluating suicidality in ethnoracially minoritized youth.

PUBLICATION #2 — Diversity, Equity and Inclusion 2022

The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression.

Sidney H Hankerson, Nathalie Moise, Diane Wilson, Bernadine Y Waller, Kimberly T Arnold, Cristiane Duarte, Claudia Lugo-Candelas, Myrna M Weissman, Milton Wainberg, Rachel Yehuda, Ruth Shim

Abstract: J Rural Health. 2021 Sep;37(4):780-787. doi: 10.1111/jrh.12523. Epub 2020 Oct 6.

Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.

Annotation

The finding
Cumulative trauma is a concept that is used to explain syndromes that result from repeated injury or are aggravated by repetitive insults. The authors emphasize how cumulative trauma due to structural racism may contribute to the intergenerational transmission of depression. As ethnoracially minoritized individuals are exposed to the insults of structural racism, this increases their risk of depression in themselves and their offspring.

Strengths and weaknesses
The article uniquely intersects intergenerational trauma with structural racism and provides concrete examples on how to disrupt structural racism. There are limited data and experience to inform the implementation of this framework

Relevance
C-L psychiatrists should consider the impact of intergenerational transmission and family history of structural racism in the evaluation of depression in medical settings.

PUBLICATION #3 — Diversity, Equity and Inclusion 2022

A Developmental Framework for Progression to Anti-racism in Academic Psychiatry.

Amanda J Calhoun, Andrés Martin, Joshua W Calhoun

Abstract: Acad Psychiatry. 2022 Apr 29. doi: 10.1007/s40596-022-01627-y. Online ahead of print.

Annotation

The finding:
The article discusses an anti-racist framework for academic psychiatry that begins with the intentional decision to strive towards antiracism. Anti-racism is defined as ideas and behaviours that aim to mitigate or eradicate racism and establish justice and equity across all races. A four-stage developmental framework of anti-racist progression is introduced: Dismissing, Acknowledging, Analysing, and Enacting when witnessing racism or racist policies. The article uses language introduced by Ibram X,. Kendi, advocating for an anti-racist framework, which can be applied to all ethnoracial backgrounds, as well as non-Hispanic White Americans. As psychiatry and C-L programs develop DEI curricula, this article introduces foundational language and framework for evaluating and changing current structures.