Black women are disproportionately impacted by HIV and depression has been linked to negative HIV outcomes. Little attention has been given to social/structural factors that may drive depression among Black women living with HIV (BWLWH), including discrimination and gendered racial microaggressions (GRM). One hundred BWLWH completed measures on GRM, race- and HIV-related discrimination, and depressive symptoms, as well as a clinical interview for major depressive episode (MDE). GRM and race- and HIV-related discrimination were significantly associated with depressive symptoms and increased likelihood of MDE, but only GRM contributed uniquely in associations with both. Interventions targeting depression among BWLWH should address GRM and race- and HIV-related discrimination.
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Uthman OA, Magidson JF, Safren SA, Nachega JB. Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep. 2014;11(3):291–307. https://doi.org/10.1007/s11904-014-0220-1.
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveill Suppl Rep. 2019;24(1):89.
Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238–43. https://doi.org/10.1016/j.annepidem.2017.02.003.
Dale SK, Pierre-Louis C, Bogart LM, O’Cleirigh C, Safren SA. Still I rise: the need for self-validation and self-care in the midst of adversities faced by Black women with HIV. Cultur Divers Ethnic Minor Psychol. 2018;24(1):15–25. https://doi.org/10.1037/cdp0000165.
Kelso GA, Cohen MH, Weber KM, Dale SK, Cruise RC, Brody LR. Critical consciousness, racial and gender discrimination, and HIV disease markers in African American women with HIV. AIDS Behav. 2014;18(7):1237–46. https://doi.org/10.1007/s10461-013-0621-y.
Lewis JA, Neville HA. Construction and initial validation of the Gendered Racial Microaggressions Scale for Black women. J Couns Psychol. 2015;62(2):289–302. https://doi.org/10.1037/cou0000062.
Dale SK, Dean T, Sharma R, Reid R, Saunders S, Safren SA. Microaggressions and discrimination relate to barriers to care among black women living with HIV. AIDS Patient Care STDs. 2019;33(4):175–83. https://doi.org/10.1089/apc.2018.0258.
So-Armah K, Gupta SK, Kundu S, Stewart JC, Goulet JL, Butt AA, et al. Depression and all-cause mortality risk in HIV-infected and HIV-uninfected US veterans: a cohort study. HIV Med. 2019;20(5):317–29. https://doi.org/10.1111/hiv.12726.
Dale SK, Safren SA. Gendered racial microaggressions predict posttraumatic stress disorder symptoms and cognitions among Black women living with HIV. Psychol Trauma Theory Res Pract Policy. 2019;11(7):685–94. https://doi.org/10.1037/tra0000467.
Bogart LM, Wagner GJ, Galvan FH, Landrine H, Klein DJ, Sticklor LA. Perceived discrimination and mental health symptoms among Black men with HIV. Cultur Divers Ethnic Minor Psychol. 2011;17(3):295–302. https://doi.org/10.1037/a0024056.
Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurses AIDS Care. 2010;21(2):144–52. https://doi.org/10.1016/j.jana.2009.07.008.
Sue DW. Microaggressions in Everyday Life: Race, Gender, and Sexual Orientation. 1st ed. Hoboken, N.J: Wiley; 2010.
Carbado DW, Crenshaw KW, Mays VM, Tomlinson B. INTERSECTIONALITY: mapping the movements of a theory. Bois Rev Soc Sci Res Race. 2013;10(2):303–12. https://doi.org/10.1017/S1742058X13000349.
Lewis JA, Mendenhall R, Harwood SA, Browne HM. “Ain’t I a woman?”: perceived gendered racial microaggressions experienced by Black women. Couns Psychol. 2016;44(5):758–80. https://doi.org/10.1177/0011000016641193.
Lewis JA, Williams MG, Peppers EJ, Gadson CA. Applying intersectionality to explore the relations between gendered racism and health among Black women. J Couns Psychol. 2017;64(5):475–86. https://doi.org/10.1037/cou0000231.
Robinson-Wood T, Balogun-Mwangi O, Fernandes C, et al. Worse than blatant racism: a phenomenological investigation of microaggressions among black women. J Ethnogr Qual Res. 2015;9(3):221–36.
Logie C, Ll J, Tharao W, Loutfy M. Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario, Canada. AIDS Patient Care STDs. 2013;27(2):114–22. https://doi.org/10.1089/apc.2012.0296.
Swann G, Minshew R, Newcomb ME, Mustanski B. Validation of the sexual orientation microaggression inventory in two diverse samples of LGBTQ youth. Arch Sex Behav. 2016;45(6):1289–98. https://doi.org/10.1007/s10508-016-0718-2.
Ong AD, Burrow AL, Fuller-Rowell TE, Ja NM, Sue DW. Racial microaggressions and daily well-being among Asian Americans. J Couns Psychol. 2013;60(2):188–99. https://doi.org/10.1037/a0031736.
Hudson DL, Neighbors HW, Geronimus AT, Jackson JS. Racial discrimination, John Henryism, and depression among African Americans. J Black Psychol. 2016;42(3):221–43. https://doi.org/10.1177/0095798414567757.
Lee DL, Ahn S. Discrimination against Latina/os: a meta-analysis of individual-level resources and outcomes. Couns Psychol. 2012;40(1):28–65. https://doi.org/10.1177/0011000011403326.
Tummala-Narra P, Alegria M, Chen C-N. Perceived discrimination, acculturative stress, and depression among South Asians: mixed findings. Asian Am J Psychol. 2012;3(1):3–16. https://doi.org/10.1037/a0024661.
Brown TN, Williams DR, Jackson JS, et al. “Being black and feeling blue”: the mental health consequences of racial discrimination. Race Soc. 2000;2(2):117–31. https://doi.org/10.1016/S1090-9524(00)00010-3.
O’Keefe VM, Wingate LR, Cole AB, Hollingsworth DW, Tucker RP. Seemingly harmless racial communications are not so harmless: racial microaggressions lead to suicidal ideation by way of depression symptoms. Suicide Life Threat Behav. 2015;45(5):567–76. https://doi.org/10.1111/sltb.12150.
Donovan RA, Galban DJ, Grace RK, Bennett JK, Felicié SZ. Impact of racial macro- and microaggressions in black women’s lives: a preliminary analysis. J Black Psychol. 2013;39(2):185–96. https://doi.org/10.1177/0095798412443259.
Williams MG, Lewis JA. Gendered racial microaggressions and depressive symptoms among black women: a moderated mediation model. Psychol Women Q. 2019;43(3):368–80. https://doi.org/10.1177/0361684319832511.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. https://doi.org/10.1016/j.jbi.2008.08.010.
Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-Serostatus, race, and sexual orientation among African–American men with HIV. Ann Behav Med. 2010;40(2):184–90. https://doi.org/10.1007/s12160-010-9200-x.
Bogart LM, Landrine H, Galvan FH, Wagner GJ, Klein DJ. Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men. AIDS Behav. 2013;17(4):1431–41. https://doi.org/10.1007/s10461-012-0397-5.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. https://doi.org/10.1177/014662167700100306.
Santor DA, Zuroff DC, Ramsay JO, Cervantes P, Palacios J. Examining scale discriminability in the BDI and CES-D as a function of depressive severity. Psychol Assess. 1995;7(2):131–9. https://doi.org/10.1037/1040-35220.127.116.11.
Dale SK, Weber KM, Cohen MH, Kelso GA, Cruise RC, Brody LR. Resilience moderates the association between childhood sexual abuse and depressive symptoms among women with and at-risk for HIV. AIDS Behav. 2015;19(8):1379–87. https://doi.org/10.1007/s10461-014-0855-3.
French AL, Gawel SH, Hershow R, et al. Trends in mortality and causes of death among women with HIV in the US: a ten-year study. J Acquir Immune Defic Syndr. 2009;51(4):399–406. https://doi.org/10.1097/QAI.0b013e3181acb4e5.
Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar G: The Mini International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview. J. Clin Psychiatry, 1998;59(suppl 20): 22–33.
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IVand ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33. quiz 34–57
Dozois DJ, Beck AT. Cognitive schemas, beliefs and assumptions. Risk Factors Depress -1st Ed. 2008:119–143.
Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res. 2012;36(5):427–40. https://doi.org/10.1007/s10608-012-9476-1.
Abrams JA, Maxwell M, Pope M, Belgrave FZ. Carrying the world with the grace of a lady and the grit of a warrior: deepening our understanding of the “strong black woman” schema. Psychol Women Q. 2014;38(4):503–18. https://doi.org/10.1177/0361684314541418.
We would like to extend extensive gratitude to the women who participated in this study, research staff and volunteers, and community stakeholders. The research reported in this publication and the principal investigator (Dr. Sannisha Dale) were funded by K23MH108439 and R56MH121194 from the National Institute of Mental Health. Steven Safren was funded by grant K24 DA040489.
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Dale, S.K., Safren, S.A. Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV. J Urban Health 97, 377–386 (2020). https://doi.org/10.1007/s11524-020-00432-y
- Black women