The COVID-19/Racial Injustice Syndemic and Mental Health among Black Americans

By: Kevin Cokley, Ph.D. | University of Michigan

During the height of the COVID-19 pandemic, the National Urban League commissioned a multi-racial needs assessment research study to examine disparities among four priority communities of color (COC): Black (African American, Caribbean American, Afro-Latinx, African immigrant), Latinx, Asian Pacific Islander, and Native American. The study was conducted by an interdisciplinary research team involving the Alliance of National Psychological Associations for Racial and Ethnic Equity.

This alliance consisted of the National Latinx Psychological Association, the Asian American Psychological Association, the Society of Indian Psychologists, the American Psychological Association, and the Association of Black Psychologists. Led by Dr. Cheryl Grills, the COC research team conducted a mixed methods design for their respective COC that included targeted community surveys/polls, key informant interviews, and a collection of stories from various community groups.

The core ABPsi research team[i] was led by Dr. Suzanne Cunningham. The first empirical study from the data was published last year in the Journal of Community Psychology (Cokley et al., 2021). Highlights of the study and results are summarized below.

After COVID-19 was declared a pandemic in March 2020, the Journal of the American Medical Association noted that Black Americans were more likely to contract COVID-19 and die than other racial or ethnic groups. One of the reasons was because of disparities in preexisting conditions and comorbid risk facts (e.g., hypertension, diabetes, obesity, and cardiovascular disease). Additionally, the ABPsi research team believed that cultural mistrust was a contributing factor to the disproportionate impact of COVID-19 among Black people. The ABPsi research team believed that cultural mistrust contributed to vaccination hesitancy among Black people. This was a common narrative in the media; however, there had been no data to support this belief.

In addition to the COVID-19 pandemic, Black people were in the midst of a racial injustice pandemic fueled by the deaths of Ahmaud Arberry, Breonna Taylor, and George Floyd. The combination and simultaneous impact of the COVID-19 and racial injustice pandemics were labeled a syndemic, which describes the synergistic interacting of epidemics.

As a result of the COVID-19 and racial injustice syndemic, the mental health of Black people was made worse, with depression and anxiety disproportionately surging among Black people. Given this context, the ABPsi research team examined the associations of general concerns about COVID-19, race-related concerns about COVID-10, and concerns about police violence against Black people with self-reported mental health symptoms. Hypotheses included the following: (1) concerns about COVID-19 would be positively associated with concerns about police brutality; (2) concerns about COVID-19 and police brutality would be positively associated with poor mental health; and (3) there would be vaccination status differences in cultural mistrust and perceived discrimination.

The sample consisted of 2480 participants that self-identified as Black/Africana (1631 women, 732 men, 9 nonbinary/gender fluid individuals, 5 transgender individuals). Participants primarily lived in the following states: California, District of Columbia, Louisiana, Maryland, Michigan, the Mississippi Delta, and Texas as well as three additional states: Georgia, Florida, and Ohio. These states included cities and/or counties that had been identified as COVID-19 hotspots with a high concentration of Black people. [Refer to the Cokley et al. 2021 article for a full description of the methods].

We found that concerns about COVID-19 were positively associated with concerns about police violence and associated with worse mental health. Contrary to our expectations, perceptions about police violence were not associated with mental health symptoms. Consistent with our expectations, we found that nonvaccinated individuals were higher in cultural mistrust than vaccinated individuals. However, surprisingly we found that nonvaccinated individuals were lower in perceived discrimination than vaccinated individuals. We also found that perceived discrimination partially mediated, or explained, the relationship between race-related concerns about COVID-19 and mental health symptoms.

Implications of the results suggest that an understanding of cultural mistrust and perceived discrimination can assist psychologists in building collaborative relationship with community members to address social problems related to vaccine hesitancy and police violence. We concluded that Black people’s mental and physical health outcomes are inextricably intertwined with each other as well as other race-based factors.