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. Author manuscript; available in PMC: 2023 Jan 1.
Published in final edited form as: J Am Acad Child Adolesc Psychiatry. 2021 May 18;61(1):56–65. doi: 10.1016/j.jaac.2021.04.020

Longitudinal Effects of Racial Discrimination on Depressive Symptoms Among Black Youth: Between- and Within-Person Effects

Justin A Lavner 1, Ariel R Hart 1, Sierra E Carter 2, Steven R H Beach 3
PMCID: PMC8599529  NIHMSID: NIHMS1704434  PMID: 34015482

Abstract

Objective:

Black youth experience racial discrimination at high rates. This study sought to further understand the longitudinal effects of racial discrimination on their mental health by examining cross-lagged associations between perceived racial discrimination and depressive symptoms at the between-person (interindividual) level and the within-person (intraindividual) level.

Method:

Three hundred and forty-six Black youth (Mage = 10.9 years) from the rural Southern United States reported racial discrimination and depressive symptoms four times over 24.5 months. A cross-lagged panel model (CLPM) was used to examine between-person concurrent and lagged effects, and a random intercept cross-lagged panel model (RI-CLPM) was used to examine within-person concurrent and lagged effects.

Results:

There were significant concurrent associations at all waves in both models. Additionally, there were significant lagged effects from perceived racial discrimination to depressive symptoms but not from depressive symptoms to perceived racial discrimination in both models.

Conclusion:

Youth experiencing higher levels of racial discrimination subsequently develop more depressive symptoms than youth experiencing less discrimination (between-person effects) and youth experiencing higher levels of discrimination relative to their own average subsequently report increases in depressive symptoms (within-person effects). These findings provide a rigorous test of conceptual models outlining the harmful effects of racial discrimination on mental health, add to a growing body of work documenting these effects among Black youth, and underscore the need for systemic changes to reduce the amount of discrimination Black youth experience and for interventions to promote resilience among Black youth in the face of cultural marginalization.

Keywords: racial discrimination, depressive symptoms, Black youth, longitudinal, cross-lagged

Introduction

Experiences of racial discrimination are prevalent and frequent among Black youth. Studies of Black children during early and middle adolescence (age 10–17) indicate that nearly all report experiencing at least one discriminatory incident in the past year1,2 and daily surveys of Black adolescents indicate that they experience racial microaggressions an average of five times per day.3 The level of overt and covert racial discrimination experienced by Black youth is thought to be high even relative to that experienced by other racial minority groups, perhaps because the historical context of discrimination directed toward Black individuals is particularly prolonged and pronounced.4 Racial discrimination is likely further elevated among Black children living in the rural South, the area from which the current sample was drawn, as entrenched oppressive social structures in this region lead to frequent experiences of racial discrimination.5–7

These patterns have concerning implications. Racism is a core driver of health inequities and has been linked to a wide range of physical, psychological, and academic outcomes throughout the lifespan,8–10 suggesting that the high level of discrimination experienced by Black children and adolescents is likely to have a significant impact on their health and well-being. To better understand these effects and inform efforts to improve outcomes for Black youth, the current study sought to examine the impact of racial discrimination on mental health over time. Specifically, we used four waves of data from 346 Black youth living in the rural South to examine concurrent and cross-lagged associations between racial discrimination and depressive symptoms, considering both between-person (interindividual) and within-person (intraindividual) associations.

Racial Discrimination and Depressive Symptoms

The biopsychosocial model of racism outlined by Clark and colleagues11 argues that racial discrimination triggers psychological and physiological stress responses, including chronic activation of stress response systems (i.e., “fight or flight”12) as well as more passive, maladaptive coping responses such as rumination. Together, these responses can lead to the development of depressive symptoms by posing threats to self-esteem and contributing to a sense of helplessness.13,14 Other scholars have similarly argued that experiences with racism and messages of racial inferiority may be damaging to Black youth because they lead to negative self-perceptions and decrease youths’ sense of perceived control,15 and that discriminatory experiences create a type of “prolonged activation” due to anticipatory stress before the stressor is encountered and perseverative cognition after the stressor ends.16 Consistent with these ideas, findings from several studies indicate that higher levels of racial discrimination are associated concurrently with elevated levels of depressive symptoms among Black youth.8,17–19

There is growing evidence that racial discrimination and depressive symptoms are associated longitudinally as well.20 Most longitudinal studies have focused on how experiences of racial discrimination at one time point are associated with depressive symptoms at a later time point,20 providing some support for the idea that the effects of racial discrimination persist over time. There is also evidence of covariation between increases in racial discrimination and increases in depressive symptoms. For example, Black youth experiencing greater increases in racial discrimination over time report greater increases in depressive symptoms relative to youth experiencing smaller increases in racial discrimination.1 Additionally, Black adolescents report higher levels of depressive symptoms on days they experience more racial discrimination relative to days they experience less racial discrimination.21–23

Cross-Lagged Associations Between Racial Discrimination and Depressive Symptoms

An important gap in the literature on the impact of racial discrimination has been the limited number of studies examining cross-lagged associations between racial discrimination and various health outcomes.20 Cross-lagged analyses are important for theory building because they test the direction(s) of effects between two variables—in this case, whether racial discrimination leads to depressive symptoms, depressive symptoms lead to racial discrimination, or both effects occur. Recently, it has been noted that lagged associations can exist at the between-person (interindividual) level and/or the within-person (intraindividual) level, and these convey different information.24 Between-person lagged associations address whether individuals with high levels of racial discrimination go on to develop more depressive symptoms than individuals with lower levels of racial discrimination (and similarly for depressive symptoms to later racial discrimination). Within-person lagged associations refer to whether individuals experiencing higher levels of racial discrimination relative to their own average go on to develop more depressive symptoms relative to times when they are experiencing less racial discrimination (and similarly for depressive symptoms to later racial discrimination). Testing both between- and within-person lagged associations provides a more robust test of theory, yields results that are easier to translate into robust recommendations for action, and is necessary because findings at one level may not replicate at the other level.24–26

Prior studies examining cross-lagged associations between racial discrimination and depressive symptoms are few in number and provide incomplete tests of between- and within-person effects. English and colleagues analyzed cross-lagged associations between racial discrimination and depressive symptoms in a study of Black youth assessed annually between grades 7 and 10.17 Perceived racial discrimination predicted increases in depressive symptoms over the following year but depressive symptoms did not predict increases in perceived racial discrimination. The authors concluded that results supported theoretical models linking racial discrimination to subsequent psychological functioning, and provided no evidence that depression leads to greater appraisals of racial stress. However, this study cannot speak to within-person effects given that it used the cross-lagged panel model (CLPM)27 and that model only generates estimates of between-person lagged effects24 (for additional discussion, see Hamaker et al.28). To date, within-person lagged effects have been tested in the context of daily diary studies, which have examined whether increased experiences of racial discrimination are associated with elevated depressive symptoms the following day. Results of these studies have been inconsistent. One study of Black adolescents found that racial discrimination experiences significantly predicted next day depressive symptoms.21 A second study found that the overall association between racial discrimination and change in next day depressive symptoms was not significant, though it was significant on days that youth experienced lower public regard (e.g., beliefs of how society views Blacks) than they typically did.23 Notably, neither study examined lagged associations from depressive symptoms to racial discrimination. Additional research is needed to test whether the between-person effects replicate in other samples of Black youth and to examine within-person cross-lagged effects over more extended periods of time that have greater potential for clinical translation (e.g., months rather than a single day).

The Current Study

To address these gaps, the current study used four waves of data over 8-month lags from a study of 346 Black youth living in the rural South to test between- and within-person associations between perceived racial discrimination and depressive symptoms over time. We have previously used data from this study to examine between-person effects of discrimination at Wave 1 on change in depressive symptoms from Wave 1 to Wave 229 and from Wave 2 to Wave 330, but have yet to examine between-person associations using all four waves of data or in the context of a cross-lagged model, which is necessary to examine the direction of effects and to rule out alternative paths. Additionally, we have not used this dataset to examine within-person concurrent or cross-lagged associations, which address different conceptual questions than between-person effects and may demonstrate different patterns of association. In the current study, we examined:

  1. Between-person associations, including: (1) concurrent effects, or whether, at a given time point, youth reporting more racial discrimination tend to report more depressive symptoms than youth reporting less discrimination; (2) lagged effects from perceived racial discrimination to depressive symptoms, or whether youth reporting more discrimination subsequently developed more depressive symptoms over the following 8 months than youth experiencing less discrimination; and (3) lagged associations from depressive symptoms to perceived racial discrimination, or whether youth reporting more depressive symptoms subsequently reported more discrimination over the following 8 months than youth reporting fewer depressive symptoms. On the basis of prior research,17 we predicted significant concurrent associations and significant lagged associations from perceived racial discrimination to depressive symptoms, but not from depressive symptoms to perceived racial discrimination.

  2. Within-person associations, including: (1) concurrent effects, or whether youth reported more depressive symptoms when they reported more racial discrimination than they typically did (relative to their own average); (2) within-person lagged effects from perceived racial discrimination to depressive symptoms, or whether youth reported increases in depressive symptoms over the following 8 months after reporting more discrimination than they typically did, and (3) within-person lagged effects from depressive symptoms to perceived racial discrimination, or whether youth reported increases in discrimination over the following 8 months after reporting more depressive symptoms than they typically did. Consistent with prior research,21 we predicted significant concurrent within-person associations. We did not make hypotheses for the within-person cross-lagged effects given that previous research has yet to consider within-person lags beyond a single day.21,23 However, the biopsychosocial model of racism11 leads to the prediction of within-person lagged effects from perceived racial discrimination to depressive symptoms and not the reverse.

Together, these analyses provide a rigorous test of theorized associations between perceived racial discrimination and depressive symptoms among Black youth through internal replications of hypothesized relationships and directly addressing both the direction and the nature of observed effects.

Method

Participants and Procedures

This study used data from the Protecting Strong African American Families (ProSAAF) project, a randomized controlled trial of a family-centered intervention to promote strong couple, coparent, and parent-child relationships in 346 Black American families (full study overview is provided in Barton et al.31). The intervention did not specifically aim to reduce discrimination or lower depressive symptoms and intervention and control participants did not significantly differ in perceived racial discrimination or depressive symptoms at any time point (all p > .05). Because controlling for intervention condition did not change the pattern of results (results available upon request from the first author), for parsimony, all participants are included in the analyses and intervention condition was not controlled.

All youth were members of Black families residing in small rural towns and communities in the southern U.S., where poverty rates are among the highest in the nation and unemployment rates are above the national average.32 Families with a child between the ages of 9 and 14 years were recruited from schools. To be eligible, youth had to be members of a two-parent family and couples had to be in a relationship for 2 years or more, living together, and coparenting an African American child in the targeted age range for at least 1 year. Subject enrollment began in 2013 and continued into 2014. At the start of the study, children’s mean age was 10.9 years (SD = 0.90) and most were 10 or 11 (0.6% were 9, 40.7% were 10, 36.2% were 11, 17.7% were 12, 4.5% were 13, and 0.3% were 14). Fifty-four percent of youth were boys (n = 186). The majority of families in the study could be classified as working poor: 51% had incomes below 100% of the federal poverty level and an additional 17% had incomes between 100% and 150% of that level. Median monthly income was $1,375 (SD = $1,375; range $1 to $7,500) for men and $1,220 (SD = $1,440; range $1 to $10,000) for women.

Project staff visited families’ homes, explained the study in greater detail, and obtained assent and parental permission for child participation. Families completed four waves of assessments during the study; Wave 2 (W2), W3, and W4 assessments occurred a mean of 9.4 months, 17.0 months, and 24.5 months respectively after W1. Youth completed the assessments using audio computer-assisted self-interview software installed on laptop computers. All procedures were approved by the University of Georgia Institutional Review Board (study title: “Protecting Strong African American Families”; IRB approval number 2012104112).

Measures

Racial Discrimination

Youths’ experiences of perceived racial discrimination were assessed at each wave using 9 items from the 18-item daily life experiences subscale of the Racism and Life Experiences Scale.33–35 This measure (and other measures in the larger project) were adapted based on feedback from focus groups with the target population to increase understanding, improve cultural relevance, and reduce participant burden. The scale asks participants to report the frequency with which they experienced several racial stressors over the last 6 months and includes items such as: “Have you been treated rudely or disrespectfully because of your race?” and “Have you been called a name or harassed because of your race?” Responses are on a four-point Likert scale (1 = never, 2 = once or twice, 3 = a few times, 4 = frequently). Scores were summed such that higher scores indicated higher levels of racial discrimination. Alpha was ≥ .85 at all waves.

Depressive Symptoms

Youths’ reports of depressive symptomatology in the past week were assessed at each wave using the 20-item Center for Epidemiological Studies-Depression scale (CES-D).36 Sample items include: “How often did you feel depressed?” and “In the past week, how often did you think your life was a failure?” Response options ranged from 0 (Rarely or none of the time [0–1 days]) to 3 (Most or all of the time [6–7 days]). Scores were summed such that higher scores indicated more depressive symptoms. Alpha was ≥ .75 at all waves.

Analytic Plan

Structural Equation Modeling (SEM) was conducted using Mplus version 7.4.37 Missing data were handled using Full Information Maximum Likelihood (FIML), which computes model parameters with all available information in the variance/covariance matrix. To justify the assumption of FIML that missing data were random, we conducted a series of t tests comparing Wave 1 scores on racial discrimination and depressive symptoms among participants who provided data at each of the subsequent time points and among those who did not. There were no significant differences in any instance (all ps > .05), supporting the appropriateness of FIML. There were also no significant differences in missingness for racial discrimination or for depressive symptoms at any wave based on child sex (all ps > .05).

We began by examining between-person concurrent and lagged effects using the cross-lagged panel model (CLPM).27 The CLPM is commonly used to test the direction of influence between two time-varying variables and has been recommended for analyzing between-person lagged effects.24 The CLPM is more conservative than a regression analysis because both dependent variables are entered into the model and allowed to correlate, thereby accounting for the multicollinearity between the two dependent variables and leaving less variance in the dependent variables to be explained by the independent variables. The model includes autoregressive paths (reflecting rank-order stability within the sample), concurrent associations, and bidirectional cross-lagged effects.

We examined within-person effects using the random intercept-cross lagged panel model (RI-CLPM).28,38 The RI-CLPM builds upon the traditional CLPM by examining concurrent and bidirectional lagged associations between two variables, but separates within-person and between-person processes.28 As such, it has been recommended for analyzing within-person lagged effects.24 Between-person effects are captured in the correlations between random intercepts, reflecting overall interindividual differences across the course of the study (i.e., whether youth reporting more racial discrimination report more depressive symptoms than youth reporting less racial discrimination). Within-person associations include autoregressive paths (reflecting within-person stability), concurrent associations (e.g., whether youth reporting more racial discrimination relative to their own average simultaneously report greater depressive symptoms), and bidirectional lagged effects (e.g., whether individuals reporting more racial discrimination relative to their own average subsequently report increases in depressive symptoms).

For both the CLPM and the RI-CLPM, we began by estimating unconstrained models in which all paths were free to vary. We then imposed equality constraints on the autoregressive and lagged paths and examined whether doing so worsened model fit.24 Overall model fit was evaluated with commonly used global fit indices: the chi-square test (χ2), the root mean square error of approximation (RMSEA), the comparative fit index (CFI), and standardized root mean square residual (SRMR). A non-significant chi-square, values greater than .95 for CFI, and values smaller than .06 and .08 for RMSEA and SRMR suggest good model fit, and a CFI greater than .90 and RMSEA and SRMR smaller than .10 suggest acceptable model fit.39

Results

Descriptive statistics and bivariate associations are presented in Table 1. Racial discrimination and depressive symptoms were not significantly associated with child age or household income. Racial discrimination at W4 and depressive symptoms at W3 and W4 were significantly associated with child sex, with girls having higher scores than boys.

Table 1:

Bivariate Correlations and Descriptive Statistics of Study Variables

Variable 1 2 3 4 5 6 7 8 9 10 11
1. Racial discrimination W1 —
2. Racial discrimination W2 .43*** —
3. Racial discrimination W3 .34*** .45*** —
4. Racial discrimination W4 .27*** .37*** .48*** —
5. Depressive symptoms W1 .45*** .26*** .22*** .14* —
6. Depressive symptoms W2 .37*** .46*** .20** .14* .58*** —
7. Depressive symptoms W3 .16** .21*** .35*** .24*** .37*** .46*** —
8. Depressive symptoms W4 .10 .17** .25*** .31*** .31*** .43*** .51*** —
9. Child age (years) .04 −.03 .08 .04 .00 .01 .09 .06 —
10. Child gender .07 .02 −.10 −.12* .04 −.09 −.19** −.16** −.01 —
11. Family income ($) −.02 −.04 .01 −.01 −.06 −.04 −.05 −.10 −.03 .06 —
M 13.43 12.99 12.00 11.80 13.23 13.11 12.36 12.55 10.86 .54 2830.00
SD 4.94 5.20 4.19 4.47 7.77 7.94 8.10 8.01 0.89 — 2113.74
Range 9–30 9–35 9–36 9–36 1–43 0–40 0–48 0–51 9–14 — 2–13,500
Skewness 1.23 1.76 2.02 2.42 1.12 1.10 1.63 1.38 0.72 — 1.47
Kurtosis 0.72 2.95 5.13 7.18 1.26 1.04 3.82 2.91 −0.07 — 3.09
N 346 298 304 301 346 298 304 301 334 346 328
% missing 0 13.87 12.14 13.01 0 13.87 12.14 13.01 3.47 0 5.20
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Note: W1 = Wave 1. W2 = Wave 2. W3 = Wave 3. W4 = Wave 4. Child gender was scored 0 = female, 1 = male. Family income was monthly gross income.

*

p < .05;

**

p < .01;

***

p < .001.

Between-Person Associations Between Racial Discrimination and Depressive Symptoms: Results from the CLPM

The unconstrained CLPM had acceptable fit for most indices (χ2(12) = 57.458, p < .001; RMSEA = .105; CFI = .926; SRMR = .059). Constraining the autoregressive paths to be equal over time and the lagged paths to be equal over time did not worsen model fit (Δχ2(8) = 12.188, p = .143), so we retained this more parsimonious model. The final CLPM model demonstrated acceptable model fit (χ2(20) = 69.646, p < .001; RMSEA = .085; CFI = .920; SRMR = .068) and is depicted in Figure 1. All autoregressive paths were significant, indicating rank-order stability in racial discrimination and depressive symptoms (e.g., youth experiencing high racial discrimination relative to others at one assessment were likely to be experiencing high racial discrimination relative to others at the next assessment).

Figure 1: Cross-Lagged Panel Model (CLPM) of Racial Discrimination and Depressive Symptoms.

Figure 1:

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Note: Waves are denoted in subscripts; time lags between waves are ~8 months. Squares represent observed variables. All estimates are standardized and numbers in brackets represent 95% CIs. DS = depressive symptoms. RD = racial discrimination.

**p < .01; ***p < .001.

Regarding associations between racial discrimination and depressive symptoms, there were significant concurrent associations at all waves, indicating that youth reporting more racial discrimination also reported more depressive symptoms than youth reporting less racial discrimination. Additionally, there were significant positive lagged associations from racial discrimination to depressive symptoms, indicating that youth reporting more racial discrimination subsequently developed more depressive symptoms than youth reporting less racial discrimination. In contrast, the lagged association from depressive symptoms to perceived racial discrimination was not significant, indicating that depressive symptoms did not predict later racial discrimination. Wald tests indicated that the significant lagged path from racial discrimination to depressive symptoms was significantly stronger than the non-significant path from depressive symptoms to racial discrimination (Wald χ2(1) = 4.465, p = .035).

Within-Person Associations Between Racial Discrimination and Depressive Symptoms: Results from the RI-CLPM

The unconstrained RI-CLPM model had good model fit (χ2(9) = 7.402, p = .60; RMSEA = .000; CFI = 1.00; SRMR = .018). Constraining the lagged paths to be equal over time did not worsen model fit (Δχ2(8) = 12.059, p = .149), so we retained this more parsimonious model. The final RI-CLPM model demonstrated good model fit (χ2(17) = 19.461, p = .30; RMSEA = .020; CFI = .996; SRMR = .037) and is depicted in Figure 2. Of note, there was a significant positive between-person association between racial discrimination and depressive symptoms (Β = .37, p < .01), indicating that youth who averaged higher levels of racial discrimination across the study reported higher levels of depressive symptoms than youth averaging lower levels of racial discrimination. Additionally, all autoregressive paths were significant, indicating that after youth reported more racial discrimination than they typically did, they reported elevated levels of racial discrimination (relative to their own average) at the subsequent assessment, with a similar pattern for depressive symptoms.

Figure 2: Random Intercept Cross-Lagged Panel Model (RI-CLPM) of Racial Discrimination and Depressive Symptoms.

Figure 2:

Open in a new tab

Note: Waves are denoted in subscripts; time lags between waves are ~8 months. Squares represent observed variables and circles represent latent variables. RI represents random intercepts and c represents within-person centered. All estimates are standardized and numbers in brackets represent 95% CIs. DS = depressive symptoms. RD = racial discrimination.

**p < .01. ***p < .001.

Overall, the pattern of within-person concurrent and lagged associations between racial discrimination and depressive symptoms was identical to that of the between-person results from the CLPM. Specifically, within-person concurrent associations were significant and positive, indicating that at times when youth reported more racial discrimination than they typically did, they also reported more depressive symptoms than usual. There were also significant positive within-person lagged associations from racial discrimination to depressive symptoms, indicating that after reporting more racial discrimination than they typically did, youth reported increases in depressive symptoms over the next 8 months. In contrast, the within-person lagged association from depressive symptoms to racial discrimination was not significant, indicating that youth reporting more depressive symptoms than usual did not go on to report increases in experiences of perceived racial discrimination. Wald tests indicated that the significant within-person lagged path from racial discrimination to depressive symptoms was significantly stronger than the non-significant path from depressive symptoms to racial discrimination (Wald χ2(1) = 8.949, p < .01).

Discussion

This longitudinal study of Black youth in the rural Southern United States used sophisticated statistical modeling approaches to better dissect concurrent and cross-lagged associations between racial discrimination and depressive symptoms at the between-person (interindividual) and within-person (intraindividual) level. This work builds on a large body of research highlighting harmful effects of racism on physical, psychological, and academic outcomes10 and answers recent calls for more research on cross-lagged associations between racial discrimination and mental health.20 Examining these issues among Black children in the rural South is particularly important in light of continued systemic racism and oppressive social structures in this region.5–7 The pattern of results was consistent across both sets of analyses and revealed significant concurrent associations between racial discrimination and depressive symptoms, significant lagged associations from racial discrimination to depressive symptoms, and no significant lagged associations from depressive symptoms to racial discrimination. These findings replicate and extend previous findings in important ways, with significant implications for our understanding of the effects of racial discrimination on Black youth.

Results from the between-person analyses (using the CLPM) build on previous work showing that Black youth reporting more racial discrimination report more depressive symptoms than youth reporting less discrimination.8,17–19 Additionally, they replicate findings from the only study to date that has examined between-person lagged associations between racial discrimination and depressive symptoms among Black youth,17 similarly showing that perceived racial discrimination predicted depressive symptoms several months later but depressive symptoms did not predict perceived racial discrimination several months later. We additionally showed that the significant path from racial discrimination to depressive symptoms significantly differed from the non-significant path from depressive symptoms to racial discrimination, increasing confidence in these results.

Our tests of within-person associations (using the RI-CLPM) are the first to our knowledge to test concurrent and lagged effects with data from a multi-year panel study, as prior studies of within-person effects have used daily diary designs.21–23 Here we show that during periods when youth report experiencing more racial discrimination than they typically do, they also report more depressive symptoms. Additionally, these effects amplified over time so that experiencing more racial discrimination than usual predicted increased depressive symptoms 8 months later. Once again, lagged effects from depressive symptoms to perceived racial discrimination were not significant, and these non-significant associations were significantly different from the significant effect from racial discrimination to depressive symptoms.

Taken together, these findings support theoretical models such as the biopsychosocial model of racism11 that propose strong directional hypotheses with racism-related stress preceding negative changes in mental health11,40 and provide no evidence that depressive symptomatology leads to increases in perceived racial discrimination. Although we cannot establish causal claims on the basis of our observational design, cross-lagged analyses are uniquely advantageous for establishing the temporal precedence of associations. Moreover, examining cross-lagged effects at both the between- and within-person level provides an especially rigorous test of theorized causal associations between constructs, as effects do not always replicate across levels.24–26 Accordingly, our findings that racial discrimination predicts subsequent depressive symptoms at both the between- and within-person level provide some of the most rigorous evidence to date that racial discrimination is harmful for Black youths’ mental health.

This study had several methodological strengths, including its inclusion of a large sample of Black youth studied across four waves at eight-month intervals and its rigorous analyses testing between- and within-person concurrent and cross-lagged effects of racial discrimination. Nonetheless, there are several limitations to note. First, as mentioned previously, observational designs cannot provide causal evidence. Second, our measure of racial discrimination focused on overall levels of perceived interpersonal discrimination (e.g., being called a name or treated rudely because of race). Additional research is needed to separate the impact of different types of interpersonal discrimination such as from peers versus adults, as both types of discrimination have been positively associated with levels of depressive symptoms and with accelerated increases in depressive symptoms over time.41 Additional research is also needed to examine the impact of other types of racial discrimination, including institutional, cultural, and structural racism.9 Third, our focus was solely on rural Black youth and may not speak to the experience of Black youth in urban or suburban settings or to youth from other racial and ethnic minority groups. Additionally, the majority of the sample was 10 or 11 years old, meaning that the study assessed these associations over the early adolescent period (i.e., ages 10–13). Although the lagged effect of racial discrimination on depressive symptoms was consistent as children progressed through the study, further research is needed to explore the generalizability of these patterns across developmental stages.8 It will also be important for future research to include larger samples that allow for robust tests of gender differences in the pattern of concurrent and cross-lagged associations between racial discrimination and depressive symptoms, as our sample size was not large enough to support such analyses.

Notwithstanding these limitations, these results add to the growing body of research on the longitudinal effects of racial discrimination on mental health20 and provide further support for conceptual models outlining racial discrimination’s pernicious effects on psychological functioning.11,40 At a practical level, these results indicate that youth experiencing high levels of racial discrimination relative to others are at increased risk of reporting elevated depressive symptoms concurrently and developing more depressive symptoms over the next eight months, and also that youth experiencing increases in racial discrimination relative to their own usual experience are at increased risk of reporting elevated depressive symptoms concurrently and reporting increases in depressive symptoms over the next 8 months. This set of findings provides a strong foundation for the hypothesis that reducing racism-related stress and enhancing buffers of its impact should be useful in decreasing the burden of depressive symptoms among Black youth.

Given these findings, mental health professionals must assess and consider the impact of racial discrimination when working with Black youth, validate their experiences of racism-related stress, assist them in working through these issues, and incorporate protective factors such as racial and ethnic identity, racial socialization, and an Afrocentric worldview into treatment.40,42,43 Continued disparities in access to high quality mental health care among Black youth and their families,44 as well as individual, provider, and historical barriers to treatment, must also be addressed.45 At the same time, the onus of dealing with racial discrimination must not fall solely or primarily on the families of Black youth—there is an urgent need to reduce and eliminate racial discrimination itself. These efforts must target both interpersonal and structural racism through a variety of mechanisms, such as school-based prejudice reduction interventions46 as well as broader efforts focused on neighborhood-level initiatives and changes in public policies.47 Through interventions that protect against the adverse effects of cultural marginalization and systemic changes that reduce the amount of racial discrimination in society, we may be able to eliminate the effects observed here and create more positive trajectories of psychological well-being for Black youth.

Acknowledgments

This research was supported by award R01 AG059260 funded by the National Institute on Aging and R01 HD069439 funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development to Steven R. H. Beach and by award P50 DA051361 to Gene H. Brody funded by the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This article is part of a special series devoted to addressing bias, bigotry, racism, and mental health disparities through research, practice, and policy. The series is edited by Assistant Editor Eraka Bath, MD, Deputy Editor Wanjiku F.M. Njoroge, Associate Editor Robert R. Althoff, MD, PhD, and Editor-in-Chief Douglas K. Novins, MD.

Dr. Lavner served as the statistical expert for the research.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Disclosure: Drs. Lavner, Carter, and Beach and Ms. Hart have reported no biomedical financial interests or potential conflicts of interest.

Contributor Information

Sierra E. Carter, Georgia State University, Atlanta..

Steven R. H. Beach, University of Georgia, Athens..

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