Jama Psychiatry. Author manuscript; available in PMC 2022, October 1.

Published in final edited form as:

JAMA Psychiatry. Oct 1, 2021; 78 (10): 1065—1066.

doi: 10.1001/jamapsychiatry.2021.1852

PMCID: PMC8802140

NIHMSID: NIHMS1768671

PMID: 34319368

Intergenerational effects of racism — Can psychiatry and psychology make a difference for future generations

Claudia Lugo-Candelas , PhD, ¹ Lillian Polanco Novel , PhD, ² and Cristiane S. Duarte , PhD, MPH ¹

Author Information Copyright and License Information PMC Disclaimer

The publisher's final edited version of this article is available at JAMA Psychiatry

The fields of psychiatry and psychology have paid insufficient attention to the harmful and profound effects of racism and racial discrimination on the mental health of historically and currently marginalized racial and ethnic minority groups. For the past thirty years, Williams, Cooper, Krieger, and others have reported how structural racism and the lifelong experience of racial discrimination have harmful effects on physical and mental health ¹ . Importantly, these effects are different from those of poverty: racism is a fundamental cause of socio-economic disparities, which in turn are the main causes of health disparities. Considerably less attention has been paid to understanding the intergenerational consequences of racism. Here, we argue that, just as exposure to adversity (a common consequence of racism) is likely to have intergenerational consequences, the damage of racism can cross generations. Intergenerationally discussing the consequences of racism is not free from challenging ethical implications, including the risk of increasing stigma through the suggestion of a type of biological determinism. Nevertheless, adopting an intergenerational approach to understanding the effects of racism may provide opportunities for prevention and intervention in psychiatry and psychology.

In this context, an intergenerational framework considers how one generation's experiences affect the mental health of subsequent generations. Intergenerational mental health research has made progress over the past decade and is positioned to elucidate a number of pathways and mechanisms, including epigenetic change transmission, fetal programming, and parenting. An intergenerational approach broadens the lens from the individual to the family and society, increasing understanding of risk and resilience and stimulating the identification of interventions that may affect successive generations.

Racism, a “system for structuring opportunities and assigning value based on the social interpretation of how someone looks (i.e., 'race') that unfairly disadvantages some individuals and communities, and undermines the strength of the entire society by wasting human resources” ² — clearly affects mental health. Intergenerationally conceptualizing racism implies that, like the risk to psychopathology, the nefarious effects of structural racism and the experience of discrimination can be transferred to future generations. Research into the intergenerational transmission of adversity and trauma — possible consequences of exposure to racism — points to possible mechanisms such as allostatic load and weathering. One example of weathering with intergenerational implications are studies showing that U.S.-born black women of maternal age at birth have a disproportionately high risk of birth complications than their U.S.-born white or non-U.S.-born counterparts. ³ . Differences in premature birth are also seen among children born to U.S.-born black women with a high socio-economic background, likely to be associated with racism, independent of poverty. ⁴ . Taken further, the association between premature birth and the risk of a number of neurological and psychiatric disorders illustrates ⁵ how one generation's experiences of racism can have cascading effects on the next. Biological and non-biological transmission mechanisms are likely at play. One generation's systematic experiences with racism and abuse in dealing with medical institutions, for example, have rightly translated into widespread distrust of medical institutions. For example, you don't have to look as far back as the Tuskegee Syphilis Study; the current unjust use of Henrietta Lacks cells and racial disparity in pain treatment suggest that inequality and inequality still exist. These experiences can undermine trust and lead to low use of services (racial and ethnic disparities in COVID-19 vaccination are a good example).

How does intergenerational thinking help address racism and inequalities in mental health care? First, it's important to avoid any form of fatalistic wording. Recognizing intergenerational sources of influence creates new opportunities for action, as shown by studies that support the familial aspect of depression and how parental treatment is associated with improvement in children's symptoms. ⁶ . New opportunities for intervention can be identified and investigated with new insight into how the experience of structural racism (e.g. via a life-threatening encounter with the police) can result in changes in response to stress. After such a life-threatening exposure, for example, dysregulation of the hypothalamic-pituitary-adrenal axis and/or increased inflammation may be associated with epigenetic changes that may have consequences for the offspring ⁷ . Second, it is important to address intergenerational resilience and how models of healing and values can be further transferred. 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 viewed as protective factors in Native American communities ⁸ . This program illustrates how the power of intergenerational resilience can be harnessed to improve mental health outcomes.

Agility is fundamental in translating emerging intergenerational knowledge into existing interventions and policies. At the clinical level, mental health practitioners can incorporate actions related to the intergenerational effects of structural racism and the experience of discrimination into their practices. Improving and increasing the accessibility and cultural responsiveness of existing perinatal psychiatric treatments (e.g. cognitive behavioral therapy) ⁹ ) to meet the mental health needs of racial and ethnic minority groups, for example, could have meaningful intergenerational effects. Similarly, a child's treatment plan can include how structural racism and the experience of racial discrimination by parents and ancestors may be relevant to a family's current experiences. Although the intergenerational consequences of such interventions are still understood, sufficient is known about the effectiveness of some interventions (e.g. perinatal interpersonal therapy). ⁹ ). within an individual's lifetime to merit serious consideration. On a broader level, the research that scientists (many of whom are members of marginalized racial and ethnic groups) have been doing for decades to identify social determinants of health, risk, and resilience that operate within a lifetime provides a solid basis to build on. Structural interventions based on selected social determinants that address structural racism ¹⁰ (e.g. money transfer, better housing, employment, anti-racist community development ¹ and reparations) may be ready to have the systemic and intergenerational effects that effective, individualized clinical treatment brings. They cannot widely achieve.

Recognizing the effects of racism on intergenerational transmission in mental health care can help address the effects of this powerful structural impact on the lives of patients, families, and communities in their interactions with marginalizing healthcare systems. Historically, racial and ethnic minority individuals have borne the burden of societal ills disproportionately. This unfair burden was compounded by the public assassination of George Floyd while in police custody. Racial inequality in access to resources, including quality healthcare services, was exacerbated by the COVID-19 pandemic that disproportionately affected black and Hispanic/Latinx communities. Such blatant manifestations of structural racism in the U.S. health care system have prompted a re-examination of standard practices — including long-awaited apologies from the American Psychiatric Association and the National Institute of Health for their role in perpetuating structural racism. An intergenerational framework positions psychiatry and psychology to shift focus away from individual-level care and begin to repair some of the long-standing damage at the systemic level. Applied to this critical and historic moment, an intergenerational approach to mental health research and care can promote preventive measures, such as interventions to reduce racism-related perinatal problems, to secure the well-being of this generation of historic and currently marginalized children and generations to come. Prioritizing the social determinants of health associated with legacies of oppression, marginalization, economic distress, medical and scientific exploitation, and other environmental threats increases the ability to better meet the mental health needs of these children and their families, thus breaking the cycle of poverty. difficulties.

Go to:

Recognition

Dr. Lugo-Candelas, Dr. Polanco-Roman, and Dr. Duarte have no potential conflicts of interest to report.

This study was partly supported by NIH grants: UH3OD023328, MH121070, and K08MH117452.

Go to:

References cited

1. Williams DR, Cooper LA. Reducing racial inequality in health care: Using what we already know to take action. Int J Environ Public Health Research 2019; 16 (4): 606. [ PMC free article ] [ PubMed ] [ Google Scholar ]

2. Camara Phyllis J Confronting Institutionalized Racism. Phylon (1960-) 2002; 50 (1/2): 7—22. [ Google scholar ]

3. Elo IT, Vang Z, Culhane JF. Variation in birth outcomes by maternal country of birth among non-Hispanic black women in the United States. Maternal and Child Health J 2014; 18 (10): 2371—81. [ PMC free article ] [ PubMed ] [ Google Scholar ]

4. Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial disparities among premature infants persist among women with a high socio-economic status. Am J Obstet Gynecol MFM 2020; 2 (3) :100104. [ PMC free article ] [ PubMed ] [ Google Scholar ]

5. Chung EH, Chou J, Brown KA. Neurodevelopmental outcomes of premature infants: a recent review of the literature. Translational Pediatrics 2020; 9 (Supplement 1): S3. [ PMC free article ] [ PubMed ] [ Google Scholar ]

6. Gunlicks ML, Weissman MM. Change in child psychopathology with improvement in parental depression: a systematic review. Journal of the American Academy of Child & Adolescent Psychiatry 2008; 47 (4): 379—89. [ PubMed ] [ Google Scholar ]

7. Buss C, Entringer S, Moog NK, et al. Intergenerational transmission of exposure to maternal child abuse: implications for fetal brain development. J Am Acad Child Adolescent Psychiatry 2017; 56 (5): 373—82. [ PMC free article ] [ PubMed ] [ Google Scholar ]

8. Cwik M, Goklish N, Masten K, et al. “Let our Apache heritage and culture live on forever and educate the young”: developing the elderly's resilience curriculum, an upstream approach to suicide prevention for Native American youth. Ben J Community Psychol 2019; 64 (1—2): 137—45. [ PubMed ] [ Google Scholar ]

9. by Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJG, Kamperman AM. Interventions to treat mental disorders in pregnancy: a systematic review and meta-analysis of multiple treatments. PLoS One 2017; 12 (3): e0173397—e. [ PMC free article ] [ PubMed ] [ Google Scholar ]

10. Brown AF, Ma GX, Miranda J, et al. Structural interventions to reduce and eliminate health inequalities American Journal of Public Health 2019; 109 (S1): S72—S8. [ PMC free article ] [ PubMed ] [ Google Scholar ]