Intergenerational Effects of Racism– Can Psychiatry and Psychology Make a Difference for Future Generations

The fields of psychiatry and psychology have not sufficiently attended to the detrimental and pervasive effects of racism and racial discrimination on the mental health of historically and currently marginalized racial and ethnic minority populations. Over the past three decades, Williams, Cooper, Krieger, and others have reported how structural racism and the experience of racial discrimination across the lifespan have deleterious consequences for physical and mental health¹. Importantly, these effects are distinct from those of poverty: racism is a fundamental cause of socioeconomic disparities, which in turn are principal drivers of health disparities. Considerably less attention has been paid to understanding the intergenerational ramifications of racism. Herein, we argue that just as exposure to adversity (a common consequence of racism) likely has intergenerational ramifications, the harms of racism can cross generations. Discussion of the consequences of racism intergenerationally is not free of challenging ethical implications, including the risk of increasing stigma by suggesting a type of biological determinism. Nevertheless, adopting an intergenerational approach in understanding of the effects of racism can provide opportunities for prevention and intervention in psychiatry and psychology.

In this context, an intergenerational framework considers how the experiences of one generation impact the mental health of next generations. Intergenerational mental health research has advanced in the last decade and is positioned to elucidate a number of pathways and mechanisms, including transmission of epigenetic changes, fetal programming, and parenting. An intergenerational approach expands the lens from the individual to the familial and societal, amplifying understanding of risk and resilience and spurring identification of interventions that may impact successive generations.

Racism, a “system of structuring opportunity and assigning value based on the social interpretation of how one looks (i.e., ‘race’) that unfairly disadvantages some individuals and communities, and saps the strength of the whole society through the waste of human resources”² – clearly affects mental health. Conceptualizing racism intergenerationally implies that like risk for psychopathology, the nefarious effects of structural racism and of the experience of discrimination can be transmitted to subsequent generations. Research on the intergenerational transmission of adversity and trauma – potential consequences of racism exposure – points to possible mechanisms like allostatic load and weathering. An example of weathering with intergenerational implications are studies showing that among US born Black women, maternal age at birth poses a disproportionally high risk of birth complications than their US born White or non-US born counterparts³. Disparities in prematurity are also seen in children of US born Black women from high socioeconomic backgrounds, which are likely associated with racism, independent of poverty⁴. Taken further, the association between prematurity and risk for a number of neurodevelopmental and psychiatric disorders⁵ exemplifies how one generation’s experiences of racism may have cascading effects on the next. Biological and non-biological transmission mechanisms are likely at play. For example, one generation’s systematic experiences of racism and abuse when interacting with medical institutions has deservedly translated into widespread mistrust of medical institutions. One need not look as far back as the Tuskegee Syphilis Study for an example; the present-day unjust use of Henrietta Lacks cells and racial inequalities in pain treatment indicate that disparities and inequities persist. These experiences can erode trust and lead to low service use (racial and ethnic disparities in COVID-19 vaccination provide a timely example).

How does thinking intergenerationally help address racism and disparities in mental health? First, it is important to avoid any type of fatalistic formulation. Recognizing intergenerational sources of influences creates new opportunities for action, as demonstrated by studies supporting the familial aspect of depression and how parental treatment is associated with improvement in children’s symptoms⁶. New opportunities for intervention may be identified and researched with new understanding of how the experience of structural racism (e.g., via a life-threatening encounter with the police) can result in alterations in response to stress. For example, following such life-threatening exposure, hypothalamic–pituitary–adrenal axis dysregulation /or increased inflammation may be associated with epigenetic changes that can impact offspring⁷. Second, it is important to address intergenerational resilience and how models of healing and values can be carried forward. One example is The Elders’ Resilience Curriculum, a suicide prevention curriculum developed by the White Mountain Apache Tribe that connects youth to their cultural values, traditions, and heritage, all which are considered protective factors in Native American communities⁸. This program exemplifies how the power of intergenerational resilience can be harnessed to improve mental health outcomes.

Agility is fundamental in translating emerging intergenerational knowledge to existing interventions and policy. At the clinical level, mental health practitioners can incorporate actions related to intergenerational effects of structural racism and the experience of discrimination to their practices. For example, improving and increasing the accessibility and cultural responsiveness of existing of perinatal psychiatric treatments (e.g., cognitive behavioral therapy⁹) to address the mental health needs of racial and ethnic minority groups could have meaningful intergenerational effects. Similarly, bringing into a child’s treatment plan how structural racism and the experience of racial discrimination by parents and ancestors may be relevant to the current experiences of a family. Although the intergenerational ramifications of such interventions are still being understood, enough is known about the efficacy of some interventions (e.g., perinatal interpersonal therap⁹). within an individual’s life course to merit serious consideration. At a broader level, the research that scholars (many of which are members of marginalized racial and ethnic groups) have been doing for decades to identify social determinants of health of risk and resilience that operate within one life course provide a solid foundation to build on. Structural interventions based on selected social determinants that address structural racism¹⁰ (e.g., cash transfer, improved housing, employment, anti-racist community development¹, and reparations) may be poised to have the systemic and intergenerational effects that efficacious individually-focused clinical treatment are not widely able to achieve.

Recognizing the effects of racism on intergenerational transmission in mental health can help address the effects of this powerful structural influence in the lives of patients, families, and communities as they interact with marginalizing health systems. Historically, racial and ethnic minority individuals have disproportionately borne the burden of society’s ills. This unfair burden was amplified by the public killing of George Floyd while in police custody. Racial inequities in access to resources, including quality health services, were further exacerbated by the COVID-19 pandemic that has disproportionately affected Black and Hispanic/Latinx communities. Such blatant displays of structural racism in the US health care system have prompted a re-examination of standard practices – including long overdue apologies from the American Psychiatric Association and National Institute of Health for their roles in perpetuating structural racism. An intergenerational framework positions psychiatry and psychology to expand focus from individual-level care and begin to redress some of the longstanding systems-level harm. Applied during this critical and historic moment, an intergenerational approach to mental health research and care can promote preventative measures, like interventions to decrease racism-related perinatal distress, to secure the well-being of this generation of historically and currently marginalized children and of generations to come. Prioritizing the social determinants of health that are connected to legacies of oppression, marginalization, economic distress, medical and scientific exploitation, and other environmental threats will advance the ability to better meet the mental health needs of these children and their families to break the cycle of adversity.