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Published in final edited form as: Aging Ment Health. 2022 Aug 29;27(6):1103–1110. doi: 10.1080/13607863.2022.2117792

Lifetime Vicarious Experiences of Major Discrimination and Depressive Symptoms among Middle-Aged and Older Black Adults

Myles D Moody 1,*, Joshua C J Lewis 2
PMCID: PMC9971339  NIHMSID: NIHMS1846357  PMID: 36038955

Abstract

Objectives:

Racial disparities in later-life depression among Americans are well-documented. Perceived discrimination has been linked to depressive symptoms among aging Black adults, but little research has considered how vicarious exposure to discrimination shapes the mental health of middle-aged and older Black adults.

Methods:

A subsample of Black adults aged 50–69 years (N=273) were drawn from the Nashville Stress and Health Study. Lifetime vicarious exposures to major discrimination were assessed. Additionally, multivariate linear regression was employed to examine the association between vicarious experiences of major discrimination and depressive symptoms.

Results:

Once the Black adults in the sample had reached ages 50 and older, the most common discriminatory events that they had vicariously experienced in their lifetime occurred as a result of their loved ones’ unfair interactions with law enforcement and the job market, respectively. Furthermore, our findings revealed that vicarious experiences of major discrimination were associated with higher levels of depressive symptoms among middle-aged and older Black adults.

Conclusion:

Vicarious, as well as personal, exposures to discrimination shape the mental health of Black Americans over the lifespan. The secondhand effects of discrimination must be considered for interventions aimed at reducing the mental health consequences of racism-related adversity as Black adults age.

Keywords: Vicarious racism, perceived discrimination, depressive symptoms, Black Americans, middle-aged adults, older adults, life course

Background and Objectives

As older populations have become the largest growing segment of our society (Roberts et al., 2018), racial disparities in later-life depression among Americans have evoked significant concern. Findings from comprehensive reviews consistently demonstrate that older Black populations exhibit higher rates of depression and depressive symptoms relative to older non-Hispanic White Americans (Abrams & Mehta, 2019; Pickett, Bazelais, & Bruce, 2012). Equally concerning are the lower rates of recognition of depression and treatment, greater severity in outcomes, and higher rates of comorbidities associated with depression that are found among older Black adults compared to older White adults (Pickett et al., 2012; Woodard et al., 2013). While early sociological research has long recognized that racial inequities in health are largely determined by social factors (Du Bois, 1899), findings from recent decades offer strong support for this work and emphasize racism—and, more specifically, racism-related stress—as a fundamental cause of racial differences in health and well-being (Brown, 2003; Phelan & Link, 2015; Williams et al., 1997).

Racism-related stress refers to the strain that minoritized populations endure because of acute and chronic experiences of racial discrimination, or perceived unfair treatment, that they may experience within interpersonal, collective, cultural-symbolic, and sociopolitical contexts (Harrell, 2000). Moreover, the racism-related stress framework, informed by stress theory (Lazarus & Folkman, 1984; Pearlin et al., 1981), asserts that racism-based stress may threaten mental health and personal well-being through biopsychosocial processes (Clark et al., 1999; Goosby et al., 2018). While studies have considered age-patterned exposures as an explanation for how racism shapes mental health (Gee et al., 2019; Jones et al., 2020; Thomas Tobin, & Moody, 2021; Williams et al., 2019), stress theory and life course frameworks (Thoits, 2010) suggest that racism-induced stressors may accumulate and proliferate for Black Americans over their life span such that they may be more vulnerable in later life stages. In addition to the findings on mental health, researchers have uncovered considerable evidence, among older Black adults, of the associations of discrimination with several crucial health outcomes, such as inflammatory markers (Cobb et al., 2020), obesity (Thorpe et al., 2017), elevated blood pressure (Lewis et al., 2009), and all-cause mortality (Cobb et al., 2021). Previous research has also linked perceived discrimination to lower telomere length among older Black Americans but not among older White Americans (Liu & Kawachi, 2017), underscoring the significance of discrimination-related stress and its impact on Black adults’ psychological, as well as physiological, outcomes over time. However, despite the ongoing advancements linking discrimination and health outcomes, studies tend to focus on personal experiences of discrimination and do not typically account for vicarious exposures to perceived unfair treatment (Gee et al., 2012; Heard-Garris et al., 2018).

The term “vicarious racism” is defined as the stressful experiences of racial bias that occur among an individual’s loved ones, as well as strangers who are members of that individual’s racial group (Harrell, 2000). The life course framework argues that our lives are “linked” and that the adversity that one endures throughout the stages of life are likely to affect those who share social ties with that individual (Elder, 1994; Pearlin, 2010). Prior findings, for example, have shown that stress from partners is associated with worse self-rated health among Black Americans later in life (Moody et al., 2019). Thus, witnessing, or simply being made aware of, the racism-related adversity that others endure may expose Black adults to stress and depression as a result of heightened enthnoracial identification and ideological perceptions of “linked fate” (Monk, 2020). Fewer than 20% of studies on racism and health between 1983 and 2013, however, had considered the vicarious effects of racism on health (Paradies et al., 2015). Evidence that shows how vicarious racism shapes physical health outcomes among Black Americans continues to grow (Boulter et al., 2015: Colen et al., 2019; Daniels et al., 2020; Goosby & Heidbrink, 2013; Martz et al., 2019; McFarland et al., 2018; Quinlan et al., 2016). While important strides have been made to understand how vicarious exposure to unfair treatment influences mental health and well-being (Bor et al., 2018; Chae et al., 2021; Louie & Upenieks, 2022; Moody, 2022; Moody et al., 2022; Truong et al., 2015), the bulk of this research has not examined these relationships beyond childhood and adolescence from a theoretically-driven stress perspective. Furthermore, more research is needed to understand how lifetime vicarious exposure to major discrimination may affect the mental health of middle-aged and older Black adults specifically.

The goal of this study is to examine the vicarious exposures to major discrimination (unfair treatment experienced by one’s spouse, child, other relative, and friends) by the time Black adults reach the age of 50 and older, and how these vicarious exposures to discrimination may be associated with depressive symptoms. This work addresses two main research aims: First, we examine the various lifetime vicarious exposures to major discrimination among mid-life and older Black adults. Second, we examine the association between vicarious experiences of major discrimination and depressive symptoms, and whether this association persists after accounting for additional social stressors. As Williams and Mohammed (2009) argue, racism-related stress should be assessed within the larger social context of numerous stressful exposures within which it is embedded because such experiences may lead to other stressors. By examining vicarious discrimination and its association with depressive symptoms among middle-aged and older Black adults, this study will extend our understanding of the role of pervasive racism-related stressors in shaping the well-being over the life course of Black Americans.

Methods

Sample

Data for this study are derived from the Nashville Stress and Health Study (NSAHS), which is specifically aimed toward clarifying of Black-White and socioeconomic status disparities in health and well-being. The NSAHS is a random sample (N = 1252) of 627 Black men and women, and 625 White men and women residing within Davidson County, Tennessee, which includes and extends beyond the greater Nashville, Tennessee area. A sampling weight was constructed to account for the complex survey design and data collection process, and to increase confidence in the generalizability for the Black and White population who resided in Davidson County at the time of the study. After 2400 potential respondents were randomly sampled—one individual from every household—1252 participants successfully completed computer-assisted interviews with interviewers who were race-matched with the respondents and trained by the investigators of the study. Success across screening and interviewing phases (Response Rate 1=30.2, Cooperation Rate 1=74.2, Refusal Rate 1=30.2, and Contact Rate 1=40.7) were assessed by American Association for Public Opinion Research (AAPOR) rates. Data were collected between April 2011 and January 2014 as respondents were interviewed about their personal and familial backgrounds, health behaviors, health histories, and stress and coping experiences. The data were collected in a cross-sectional manner, and no clinical trials were performed during this study. Informed consent was provided by every study participant. All study procedures were approved by the Vanderbilt University Institutional Review Board and have been described in more detail elsewhere (Brown et al., 2016; Turner, 2013; Turner et al., 2016). The present study includes a subsample of Black adults between the ages of 50–69 years (n=273). The characteristics for this group are provided in Table 1.

TABLE 1.

Sample Characteristics of Black Adults, Nashville Stress and Health Study (2011–2014)

50 and Older (n=273)
Mean (SD) n(%)
Depressive Symptoms [0–42] 12.24 (8.75) --
Vicariously Experienced Discrimination
 Major Discrimination [0–5] 0.77 (0.98) --
Personally Experienced Discrimination
 Major Discrimination [0–7] 1.19 (1.45) --
 Everyday Discrimination [0–34] 9.95 (6.16) --
General Social Stressors
 Recent Life Events [0–15] 1.89 (1.91) --
 Chronic Stress [9–61] 28.54 (10.15) --
 Lifetime Trauma [1–27] 8.24 (4.80) --
Sociodemographic Characteristics
 Age [50–69] 56.40 (8.75) --
 Gender
  Women (Ref.) -- 47.99
  Men -- 52.01
 Socioeconomic Position (SEP) [−2.93–1.68] −0.58 (0.73) --
 Marital Status
  Unmarried (Ref.) -- 60.94
  Married -- 39.06
 Parental Status
  Non-Parent (Ref.) -- 11.56
  Parent -- 88.44
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Note: Ref.=reference category; ranges are included in brackets for continuous variables

Measures

Depressive Symptoms.

Subjective well-being, the outcome variable, was assessed based on a measure of the respondents’ self-reported past-month depressive symptoms (α50 and Older=0.90) derived from the 20-item Center for Epidemiologic Studies Depression (CES-D) scale (Radloff, 1977). Items included “sleep was restless,” “could not shake off the blues,” and “felt depressed.” Responses were based on how much the respondents agreed with each statement: (0) not at all, (1) occasionally, (2) frequently, and (3) almost all the time. The responses were recoded such that higher scores reflect higher levels of depressive symptoms.

Personally Experienced Discrimination.

Two types of personally experienced discrimination were examined. Major discrimination, also based on the Major Experiences of Discrimination scale (Williams et al., 2008), assessed individuals’ own lifetime exposure to major unfair treatment. As previously noted, this measure captured the personal experiences of major discrimination of the respondents who answered “Yes” to items regarding unfair treatment, and “(1) self” to the question regarding who experienced the discrimination. The total count of “Yes” items were used to create a major discrimination score for each respondent. Higher values indicated greater levels of exposure to personally experienced major discrimination.

Everyday discrimination captures day-to-day experiences of unfair treatment and was measured using the Everyday Discrimination Scale (Williams et al., 1997). The Everyday Discrimination Scale (α50 and Older=0.84) was comprised of nine items such as “You are treated with less courtesy than other people” and “You receive worse service than other people at restaurants or Stores.” Respondents were asked to report the frequency with which these events occur: (0) never, (1) rarely, (2) sometimes, (3) often, and (4) almost always. Responses were summed such that higher scores indicated greater levels of personal exposure to everyday discrimination experiences.

Vicarious Experiences of Discrimination.

Vicarious experiences of major discrimination were evaluated using the Major Experiences of Discrimination scale (Williams et al., 2008), which is a 7-item measure based on a count of lifetime exposure to major incidents of unfair treatment. Respondents were asked if they had ever experienced unfair treatment such as “been unfairly fired or denied a promotion,” “been unfairly treated by the police,” and “been unfairly discouraged by teacher from pursuing a job/career” in their lifetime. Respondents who answered “Yes” were then asked to whom the discrimination occurred: (1) spouse, (2) child, (3) other relative, or (4) close friend. Discriminatory events faced by loved ones were coded as 1, while non-events and events experienced directly by the respondent were coded as 0. Responses of “self” were not included in the final construction of this measure. The responses were summed such that higher scores indicated higher levels of vicarious exposure to discrimination over their lifetime.

General Social Stressors.

Exposure to other social stressors was captured through the measures of recent life events, chronic stress, and lifetime trauma. Recent life events were measured by a 32-item inventory, and respondents were asked to report if each event (e.g., “Did a child die,” “Was there a marital separation or divorce,” “Did someone have a major financial crisis,” and “Was demoted at work or took a pay cut”) happened to them or someone close within the past 12 months. Exposure to recent life events was determined by using a count of the number of events reported. Chronic stress was measured using a 41-item scale (α50 and Older=0.87) that captures exposure to chronic stressors across several domains of life such as general strain (e.g., “You’re trying to take on too many things at once”), employment strain (e.g., “You want to change jobs but don’t feel you can”), relationship strain (e.g., “You have a lot of conflict with your partner”), and children (e.g., “A child’s behavior is a source of serious concern for you”). Respondents were asked about the extent to which such experiences were (0) not true, (1) somewhat true, or (2) very true for them. Items were summed, and higher scores indicate higher levels of exposure to chronic strains. Lifetime trauma was indexed with a 43-item inventory that evaluates the lifetime experience (0=no, 1=yes) of major and potentially traumatic stressors (Turner & Avison, 2003). The measure includes items related to both violent and non-violent stressors (e.g., parental divorce, failing a grade in school), along with items concerning life traumas (e.g., sexual assault, physical and emotional abuse, being injured with a weapon), witnessing violence, receiving information about bad events, and the death of relatives or close friends. Exposure to lifetime trauma was based on a count of the number of events respondents reported experiencing.

Sociodemographic Characteristics.

All multivariate analyses accounted for covariates including gender, age, socioeconomic position, marital status, and parental status. Gender was coded based on how each respondent self-identified (0=women, 1=men), and age was employed as a continuous measure in years. Respondents’ socioeconomic position (SEP) was measured using a standardized index of years of completed education, self-reported annual household income, and occupational prestige level based on the Nam–Powers–Boyd occupational scores (Nam & Boyd, 2004). Further information on the NSAHS coding procedure for occupational prestige can be found elsewhere (see Turner et al., 2016). For the current study, socioeconomic position scores were calculated by first standardizing and summing the three dimensions; scores were then divided by the number of dimensions on which data were available (Brown, 2014; Gayman et al., 2011). These calculations resulted in a socioeconomic position score that characterizes the number of standard deviations above or below the sample’s mean socioeconomic position, with greater values indicating higher socioeconomic position. By equally weighting education, income, and occupational prestige, this method captures individuals’ placement within a social hierarchy and provides a comprehensive assessment of socioeconomic position while minimizing data loss on individual indicators (Brown, 2014). Marital status was reported by respondents based on if they were married (0=unmarried, 1=married), and parental status was reported by respondents based on whether they had children (0=no children, 1=have children).

Analytic Strategy

Estimations of the weighted means and proportions were conducted for each of the study variables among the subsample of Black adults aged 50–69 years (Table 1). The different vicarious exposures to major discriminatory events, and the sources of vicarious discrimination, were also identified (Table 2). Multivariate linear regression models were used to assess the association between vicarious experiences of major discrimination and depressive symptoms. Associations between depressive symptoms and age, gender, SEP, marital status, parental status, and vicarious experiences of major discrimination were considered in Model 1 among Black adults aged 50 and older (Table 3). In Model 2, personal experiences of major and everyday discrimination experiences were added to determine whether the effects of vicariously experienced discrimination are discrete relative to personal experiences of discrimination. Finally, Model 3 added general stressors (recent life events, chronic stress, and lifetime trauma) to determine whether vicarious experiences of discrimination make a discrete impact on depressive symptoms within the context of other stressors. We chose this modeling strategy based on prior theory-driven analyses of racism-related stress among Black adult populations (Turner, 2013; Williams et al., 1997).

TABLE 2.

Vicarious Experiences of Major Discrimination among Blacks Adults, Nashville Stress and Health Study (2011–2014)

50 and Older (n=273)
Vicarious Discrimination Events
 Been unfairly fired or denied a promotion 22.02%
 For unfair reasons, not been hired for a job 11.76%
 Been unfairly treated by the police 28.45%
 Been unfairly discouraged by a teacher or advisor from continuing education 1.41%
 Been unfairly discouraged by a teacher/advisor from pursuing a job/career 0.39%
 For unfair reasons, did a landlord or realtor ever refuse to sell or rent you a house or apartment 2.7%
 For unfair reasons, have neighbors ever made life difficult for you 7.96%
Sources of Vicarious Exposure to Discrimination
 Spouse 7.97%
 Child 24.11%
 Other Relative 15.39%
 Friend 14.03%
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Note: The prevalence of vicarious discrimination items presented are based on lifetime experience values of 1 or more counts

TABLE 3.

Depressive Symptoms and Vicarious Discrimination among Black adults Aged 50–69 (n=273), Nashville Stress and Health Study (2011–2014)

Model 1
 Model 2
 Model 3
b (SE) b (SE) b (SE)
Age −0.53*** (0.12) −0.41*** (0.08) −0.28** (0.10)
Gender
 Women (Ref.)
 Men −1.26 (1.21) −1.84 (1.25) −1.39 (1.40)
Socioeconomic Position (SEP) −1.85 (1.46) −2.78* (1.33) −2.82* (1.16)
Marital Status
 Unmarried (Ref.)
 Married −3.21* (1.60) −2.13 (1.70) −3.15 (1.77)
Parental Status
 Non-Parent (Ref.)
 Parent −1.99 (1.24) −0.70 (1.52) −1.54 (1.70)
Vicariously Experienced Discrimination
 Major Discrimination 1.74** (0.52) 1.68** (0.51) 1.32* (0.59)
Personally Experienced Discrimination
 Major Discrimination 1.51*** (0.39) 1.04** (0.33)
 Everyday Discrimination 0.32** (0.11) 0.24** (0.08)
General Social Stressors
 Recent Life Events 0.42 (0.36)
 Chronic Stress 0.11* (0.05)
 Lifetime Trauma 0.18 (0.17)
Intercept 43.22*** (7.74) 30.01*** (5.66) 19.41* (7.56)
R2 0.15 0.32 0.36
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*

p<0.05

**

p<0.01

***

p<0.001 (two-tailed tests)

Note: Ref.=reference category

Results

Table 1 presents the weighted means and proportions of the sample’s characteristics for Black adults between the ages 50–69 years. Results show that this group reported relatively low levels of depressive symptoms on average (m=12.24, SD=8.75, range=0–47), which was expected based on prior research on the self-reported mental health of Black Americans (Williams, 2018). On average, the respondents in this sample reported experiencing less than one vicarious experience of major discrimination in their lifetime (m=0.77, SD=0.98), but slightly more than one personal experience of major discrimination in their lifetime (m=1.19, SD=1.45) and regular personal experiences of everyday discrimination (m=9.95, SD=6.16). The respondents in the sample reported moderate levels of chronic strains (m=28.54, SD=10.15) and lifetime trauma (m=8.24, SD=4.80). The sample was comprised of a relatively even split between women (47.99%) and men (52.01%). Less than half of the sample reported being married (39.06%), and most of the respondents reported having children (88.44%). The average age of the respondents was 56 years (m=56.40, SD=8.75).

Lifetime Vicarious Exposure to Discrimination among Black Adults Aged 50 and Older

Table 2 shows the percentage of mid-life and older Black adult respondents’ reporting of vicarious discrimination events and the sources of vicarious exposure to discrimination in their lifetime. More than one in four of the respondents said that their loved ones had endured being “unfairly treated by the police” (28.45%). Additionally, more than one in five respondents reported that their loved ones had “been unfairly fired or denied a promotion” (22.02%), and about twelve percent of the respondents reported that their loved ones had “not been hired for a job” for unfair reasons (11.76%). Fewer respondents reported that their loved ones had endured unfair challenges from their neighbors (7.96%). Approximately one in four (24.11%) respondents reported that their children had endured major discrimination in their lifetime, while 15.39% of respondents reported that some other relative had experienced major discrimination. Finally, 14.03% of respondents reported that their friends had experienced major discrimination over their lifetime.

Vicarious Discrimination and Depressive Symptoms among Black Adults Aged 50 and Older

In Table 3, the relationship between vicarious experiences of discrimination and depressive symptoms among Black adults between the ages of 50 and 69 years is displayed. Model 1 shows that older age (b=−0.53, SE=0.12, p<0.001) and being married (b=−3.21, SE 1.60, p<0.05) were both associated with lower levels of depressive symptoms. However, vicarious experiences of major discrimination (b=1.74, SE=0.52, p<0.01) were associated with higher levels of depressive symptoms. In Model 2, after accounting for personal experiences of major discrimination and everyday discrimination, greater levels of socioeconomic position (b=−2.78, SE=1.33, p<0.05) were associated with lower levels of depressive symptoms. Furthermore, vicarious experiences of major discrimination (b=1.68, SE=0.51, p<0.01), personal experiences of major discrimination (b=1.51, SE=0.39, p<0.001), and everyday experiences of discrimination (b=0.32, SE=0.11, p<0.01) were all associated with higher levels of depressive symptoms. After accounting for general social stressors, these patterns persisted in Model 3. Vicarious experiences of major discrimination (b=1.32, SE=0.59, p<0.05), personal experiences of major discrimination (b=1.04, SE=0.33, p<0.01), and everyday experiences of discrimination (b=0.24, SE=0.08, p<0.01) were all associated with higher levels of depressive symptoms. Furthermore, chronic strains (b=0.11, SE=0.05, p<0.05) were associated with higher levels of depressive symptoms. Recent life events and lifetime trauma were not associated with depressive symptoms in this model. Collectively, these factors accounted for about 36% of the variation in depressive symptoms among older Black adults (R2=0.36). Findings indicate that personal and vicarious exposures to discrimination were significant determining factors for depressive symptoms for this group, whereas general stressors appeared to matter less for this group.

Discussion

The purpose of this study was to examine lifetime vicarious exposures to major discrimination (discrimination experienced by one’s spouse, child, other relative, and friends) for middle-aged and older Black adults, and how these experiences may be associated with depressive symptoms while accounting for direct experiences of discrimination and other stressors. Overall, results from this study provide evidence that vicarious experiences of discrimination are linked with poorer subjective well-being for middle-aged and older Black adults, and underscores the pervasiveness of the negative effects of the racism-related stress experience for this population. This study offers several notable findings and important new insights of interest for future research on discrimination and health.

Our first goal was to assess the vicarious exposure to major discrimination events among mid-life and older Black adults, while also observing which sources of vicarious exposure to major discrimination were most common among Black adults by the age of 50 and older. Our findings revealed that the most common discriminatory events that Black adults had vicariously experienced in their lifetime occurred as a result of their loved ones’ interactions with law enforcement and the job market. These findings are consistent with results from prior studies on vicarious racism. For example, McFarland and colleagues (2018) found that Black men report higher levels of lifetime vicarious exposure to unfair treatment from police relative to White men. Furthermore, given the persistent hiring discrimination against Black adults in the United States that meta-analyses (Quillian et al., 2017) have indicated over the past several decades, it stands to reason that the effects reach beyond the direct target of discrimination and impact their loved ones. Regarding the specific sources of vicarious exposure to major discrimination, respondents reported the highest levels of vicarious exposures to discrimination through their children. These findings align with a longstanding body of literature that examines how the effects of racism and racism-related stress are transgenerational. Systematic review of empirical evidence has demonstrated how parents’ experiences of racism may impact the biological and physiological health of their children (Goosby & Heidbrink, 2013; Heard-Garris, 2018), in addition to their well-being (Anderson et al., 2015). However, research on how children’s experiences of discrimination impact their parents remains limited. Recent findings have shown children’s experiences of discrimination are longitudinally associated with increased rapid decline in their mothers’ health at mid-life (Colen et al., 2019), offering strong support for the argument that the effects of vicarious racism-related stress may operate bidirectionally. Our findings suggest that middle-aged and older Black adults are most commonly made aware of the discrimination that their children experience over their lifetime, and that these vicarious exposures are potentially harmful for them.

The second goal of this study was to examine the association between lifetime vicarious exposures to discrimination and depressive symptoms among middle-aged and older Black adults. Our findings revealed that vicarious experiences of major discrimination were associated with higher levels of depressive symptoms among middle-aged and older Black adults after accounting for sociodemographic factors. These findings are consistent with prior research that emphasizes the pervasiveness of exposure to racism-related adversity (Bonilla-Silva, 2015), regardless of sociodemographic characteristics, and its deleterious effects on mental health and well-being (Pascoe & Richman, 2009). Systematic review (Paradies et al., 2015) has demonstrated that of the 124 studies that examined the association between racism and depression between 1987 and 2007, 109 studies found that racism was associated with higher levels of depression. Yet, the overwhelming majority of these studies focused on personal experiences of racism and did not consider how vicarious exposures to discrimination may contribute to depression among middle-aged and older Black adults. Findings from our study reveal that the secondhand effects of discrimination are distinctively associated with greater levels of depressive symptoms among this population and should be considered in future studies on discrimination and health. Additionally, our goal was to evaluate the impact of vicarious discrimination on depressive symptoms in the context of personal discrimination experiences and other social stressors. As we expected, a significant association of vicarious discrimination in the presence of multiple stress factors supports how stressors do not necessarily operate additively, but more so with synergistic qualities amongst one another. These findings are relevant additions to the discrimination literature as we consider all three forms of discrimination in the context of other general factors of stress (Williams & Mohammed, 2009) and most prior research, in contrast to our study, focuses squarely on either, if not both, major experiences of discrimination or everyday discrimination (Lewis, Cogburn, & Williams 2015).

Our findings have implications on integrated health and behavioral health practice with older Black adults as well. These findings are in no way deterministic as they are probabilistic but have implications for the practice of patient centered care with middle-aged and older Black Americans. Culturally sensitive and high-quality behavioral healthcare are increasingly being recognized as the greater yielding methods for decreasing depressive symptomatology when compared to more traditional alternatives (Rathod et al., 2018; Kalibatseva & Leong, 2014). Our findings suggest that aging related and mental health practitioners working with older Black adults should also consider how social ties may be dually both a pathway of alleviation and propagation of discrimination-related stress. Practitioners must not only emphasize understanding the personal discriminatory experiences of their older Black patients, but also the vicarious nature of their patients experiences as well during diagnosis, projected prognosis, and treatment. In addition to the utility of attuning treatment and encouraging tailored patient engagement in certain activities like social integration, modifying coping, and seeking support for secondhand exposures of racism-related stress, access to integrated behavioral health care that takes into consideration vicarious exposures is also important. Institutions of practice and policy makers should work collaboratively to ensure that Black adults, whether from a low socioeconomic and/or other marginalized background, should ensure access to care that adjusts for the heterogeneity within this population.

Although the present study contributes to the literature on discrimination and health, there were several limitations. First, as this study utilized cross-sectional data from Black Americans in the NSAHS, we are unable to draw definitive conclusions about causal relationships. However, prior longitudinal studies have linked discrimination to mental health outcomes, establishing a temporal model for this study. In addition, the use of a regional sample from Nashville, Tennessee limits our ability to generalize these results to other contexts. However, the NSAHS is well suited for this study because it allows for the comprehensive assessment of general and racism-related stressors, including vicarious and personal exposures to discrimination. It is also a solid place-based study comprised of a socioeconomically diverse sample of Black adults. Nevertheless, as our understanding of these processes would be strengthened by studies within other social settings over time, future studies should evaluate these relationships in nationally representative longitudinal data. Second, the present study utilizes a single measure of vicarious discrimination, based on respondents’ exposure to major discrimination faced by loved ones. While this scale provides insights into individuals’ indirect experiences with major discrimination, there are other forms of discrimination, such as everyday discrimination, which individuals may encounter vicariously. While the present study was able to adapt the Major Experiences of Discrimination (Williams et al., 2008) scale to assess vicarious experiences, the Everyday Discrimination (Williams et al., 1997) scale only assesses direct encounters with day-to-day bias. As such, there is a need for more comprehensive measures of vicarious and other forms of racism-related stressors within community-based surveys. Furthermore, we were not able to assess additional vectors of exposure to vicarious discrimination. Particularly with the rise of digital platforms, increased online connectivity, and new forms of engagement in online spaces, revisiting the factors that influence digital discrimination seems pertinent (Lewis, Cogburn, & Williams, 2015). For example, social media and news broadcast are mediums that often convey images, videos, and audio of fatal and aggressive police interactions with Black Americans. This exposure is increasingly being associated as commensurate with poorer mental health and well-being of Black Americans. Third, we were limited in our ability to explore intersecting social positions of Black Americans within our analytical sample. As our sample is comprised of middle-aged and older Black Americans it is plausible that those surveyed are the social intermediaries between not only their friends but also their children and relatives. Nearly 90% of those surveyed were parents within our sample. While it is not clear from our NSAHS sample data which relatives had the vicarious events (e.g., if relatives included respondent’s parents), the middle-aged and older parents in our sample are likely to be sandwiched generationally between the experiences of their younger children and older relatives. Being juxtaposed between two generations places a unique form of stress on those in the middle generation who offer various forms of support to both younger and older generations (Miller, 1981). In addition to this generational position of stress, filial and child relationship quality may also modify stress responses depending on who the major vicarious event was most proximal to, i.e., experienced by young/adult child or elderly parent of the individual assessed (Fuentecilla et al., 2020). Furthermore, this compression of stressors may be distributed unequally by gender. Finally, given the significance of historical context, future studies should consider the timing of experiences to more accurately assess and interpret how this population may impacted by personal and vicarious experiences of discrimination.

Findings from the current study offer novel insights for how racism-related stress and well-being should be examined and understood among middle-aged and older Black adults in the United States. We know that vicarious exposures to discrimination are linked with negative mental health outcomes among racialized minorities. However, this study specifically examines how vicarious discrimination-related stress exposure can shape depressive symptoms among aging Black adults from a more comprehensive stress perspective, which previous investigations have lacked. More research is needed to further better understand the relationships between vicarious racism and mental health, and this study helps to extend our knowledge on life course exposures to racism-related stressors. Furthermore, this study provides insights regarding the types of vicarious exposures to major discrimination and resulting racialized stress among minoritized populations. Future research should consider the findings from this study when making recommendations for intervention.

Supplementary Material

Supp 1

Acknowledgements:

Data collection for the Nashville Stress and Health Study was supported by a grant (R01-AG034067) from the Office of Behavioral and Social Science Research and the National Institute on Aging to R. Jay Turner. Support for this research was received from the Deep South Resource Center for Minority Aging (RCMAR) and the National Institute on Aging (3P30AG031054–14S1).

Footnotes

Declaration of Interest Statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript.

Ethical Approval Statement: Informed consent was provided by every study participant. All study procedures were approved by the Vanderbilt University Institutional Review Board.

Contributor Information

Myles D. Moody, Department of Sociology, University of Alabama-Birmingham, Heritage Hall, Rm. 460, 1401 University Blvd., Birmingham, Alabama 35233.

Joshua C. J. Lewis, Department of Sociology, University of Alabama-Birmingham, Heritage Hall, Rm. 460, 1401 University Blvd., Birmingham, Alabama 35233.

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