Research roundup: How COVID-19 impacts African Americans

Discrimination and racism have long contributed to negative emotional, mental, and physical health outcomes in African American communities. The COVID-19 pandemic has highlighted this fact, with recent data showing that 1 in 1,000 Black individuals have died from the coronavirus (APM Research Lab, 2020).

In this installment of “Research Roundup,” we look at studies that explore how discrimination has impacted the overall health of African Americans and ways psychologists can support Black communities now and when the pandemic subsides.

Novacek, D. M., Hampton-Anderson, J. N., Ebor, M. T., Loeb, T. B., and Wyatt, G. E. (2020). Mental health ramifications of the COVID-19 pandemic for Black Americans: Clinical and research recommendations. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 449–451.

Sneed, R. S., Key, K., Bailey, S., and Johnson-Lawrence, V. (2020). Social and psychological consequences of the COVID-19 pandemic in African-American communities: Lessons from Michigan. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 446–448.

Two articles in the journal Psychological Trauma: Theory, Research, Practice, and Policy^® give an overview of the trauma African American communities have faced during previous public health crises and call attention to the differential impact of COVID-19 on communities of color. The studies show that Hurricane Katrina, the HIV/AIDS epidemic, and the Flint water crisis in Michigan all provide lessons for reducing negative outcomes among Black Americans during current times of crisis.

Discrimination and racism, along with economic and environmental disparities, already reduce access to education, health care, and resources in Black communities. And during the COVID-19 health emergency, government restrictions on public activities have further reduced or completely eliminated access to the care (Lund, 2020). Studies show that even when African American individuals do seek care, the assumed bias and lack of trust in providers plays a large role in continuation and quality of care. Because of the Flint water crisis, for example, many members of the Black community continue to experience adverse health effects and have significant distrust in government and public health officials.

Black communities also experience high rates of posttraumatic stress disorder (PTSD) compared to other ethnic/racial groups. When crises result in exclusion or isolation, adverse mental health issues like depression and PTSD are only exacerbated. These outcomes are also expected to occur as a result of the COVID-19 pandemic.

Early COVID-19 rates in Michigan show that Black Americans make up 41% of deaths, while only making up 13% of the population (Sneed, Key, Bailey, and Johnson-Lawrence, 2020). Given the ongoing community concerns in Flint, the state government has taken a multitude of steps to engage the community and local leaders in order to prevent adverse outcomes during the COVID-19 pandemic. These efforts are targeted at increasing community engagement, for example, through creation of diverse, multisector task forces and ongoing, virtual videoconferences and webinars that involve local organizations. Community engagement and support increase resilience within African American communities.

Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., ... and Sullivan, P. S. (2020). Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology, 47, 37–44.

Early, national data show that counties with a predominantly African American population are more heavily impacted by COVID-19, both in rates of diagnosis and death. While the COVID-19 pandemic is cited as one of the most unprecedented periods in recent history, this disparate impact of crises on Black communities regularly occurs.

Researchers gathered public, county-level data across the U.S. to assess which counties made up a disproportionate population of African Americans, compared to the national average (greater than or equal to 13%). This data was then compared to the Centers for Disease Control and Prevention (CDC) rates of COVID-19 cases and deaths, as reported by each state. Counties with less than a 13% population of Black Americans were used as a control group. Demographics, preexisting comorbidities, social, and environmental factors were also included, and the Bayesian hierarchical model was used to assess whether any of these factors confounded COVID-19 rates and deaths in Black counties.

At the time of this study, states largely did not account for or did not disaggregate ethnicity/race when submitting COVID-19 data, a common issue in public health data collection. The study concluded just over 20% of U.S. counties met criteria for Black communities (≥13%), yet African Americans made up 52% of COVID-19 cases and 58% of COVID-19 deaths. Higher rates of diagnosis and death persisted after controlling for confounding factors.

Priest, J. B., McNeil Smith, S., Woods, S. B., and Roberson, P. N. E. (2020). Discrimination, family emotional climate, and African American health: An application of the BBFM. Journal of Family Psychology, 34(5), 598–609.

For African Americans, family support appears to buffer the impact of negative stress on health brought on by discrimination. The biobehavioral family model (BBFM) has been used to explain the connection between social relationships and biobehavioral reactivity since 2008. This study extends the research on the BBFM to Black communities while additionally controlling for discrimination.

Researchers looked at the support and strain of relationships for African Americans as it intersects with racial discrimination and their effects on health. Between 2004–2006, 592 eligible African American adults from Milwaukee County, Wisconsin, were interviewed twice: first in-person using computer assistance and then by self-guided questionnaire. Four scales were used to assess aspects of support and strain in close family and intimate partner relationships (about 40% of participants met criteria for intimate partner relationships). Participants’ experience of discrimination was measured both across the lifetime and as a daily occurrence, and then participants were asked how much discrimination impacts quality of life. Biobehavioral reactivity was operationalized as depression and anxiety.

Research in African American communities shows the interdependent nature of relationships and its influence on health vis-à-vis stress. This study concluded that family support mediates the negative stress effects from discrimination on health. Intimate partner relationships in this study (and other studies done with BBFM) did not have significant associations with support or strain on health outcomes.

Discrimination and racism impact all areas of Black lives, individually and collectively, including where people live, education, types of jobs, access to health care, insurance coverage, and a host of other factors. Public health crises like the COVID-19 pandemic magnify this impact and highlight the disproportionate negative effect in Black communities.

Recognizing the differential impact of COVID-19 on Black communities and individuals and understanding why it occurs is essential in order to mitigate this situation. Psychologists can help flatten the curve of the emotional and mental health trauma associated with racial discrimination before, during, and after the COVID-19 pandemic. Research highlights the importance of belonging and community support for African Americans. Collaborating with local groups may help individuals and families to build trust with government and public health officials, likely increasing access and quality of care. Highlighting challenging experiences and how they were overcome helps to foster resilience and may benefit care. Including families in psychological care and building support networks may be especially critical for Black individuals given their powerful role in mitigating the negative impact of discrimination on health.

Steps are being taken to improve access and resources during the COVID-19 pandemic for underserved ethnic and racial groups in the United States. For example, the Boston University Center for Antiracist Research has developed a COVID Racial Data Tracker in collaboration with the National Institutes of Health to improve COVID-19 testing in these communities. APA also submitted a letter to the Senate Special Committee on Aging (PDF, 299KB) to support legislation that would advance care and services for older minority adult populations, in addition to creating a resource to build trust to improve participation (PDF, 108KB) of marginalized communities in COVID-19 testing and contact tracing.