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In 2019, the American Academy of Pediatrics identified racism as an insidious social determinant of health with chronic and sustained adverse health effects across the lifespan (Trent, Dooley, & Dougé, 2019). There continues to be a growing call for health care systems, health care professionals and research scientists to acknowledge the role of racism in the lives of marginalized communities. This acknowledgment can aid in the development of holistic strategies to optimize care for these populations. In our current sociopolitical climate of unrest that is laden in the systemic perpetuation of injustice, the need to consider how systemic and interpersonal racism “gets under the skin” to affect health is vital.

My area of research interest focuses on the ways that psychosocial and contextual stressors, often rooted in historical legacies of racism, affect both mental and physical health outcomes for Black Americans across the life course. There is a strong body of literature indicating that Black Americans live sicker and die younger than other racial/ethnic groups (Williams et al., 2019). The research I conduct with my team and collaborators focuses on understanding this process and considering innovative avenues for prevention and intervention. A recent research project (Carter et al., 2019) examined the role of depressive symptoms in mediating the relationship between early life experiences of racial discrimination and accelerated biological aging in adulthood for 368 Black Americans (i.e., prediction over a 19-year period from ages 10-29). Results from this study indicated that higher self-reported racial discrimination at ages 10-15 was associated with high depression from ages 20-29, controlling for earlier depression at ages 10-15. This elevated depression, in turn, was related to accelerated cellular-level aging. These findings support research conceptualizations that early-life stress due to experiences of racial discrimination lead to sustained negative affective states continuing into young adulthood that confer risk for accelerated aging and possibly premature disease (i.e., cardiovascular disease and metabolic syndrome) and mortality in Black Americans. 

As we watch accumulating news stories of Black American women, men and children being killed due to racial injustice, our research on racism as a chronic stressor has taken on a new area of emphasis. We have begun to consider what the mental and physical health toll is for Black Americans, as a collective, to continuously bear witness to deaths of other Black Americans that could provoke imagery of harm to oneself, family members or close friends—the constant reminder that your society does not fully value you or your community’s life or well-being. Below are some televised cases that we believe potentially demonstrate the toll of this form of stress.

  • Eric Garner’s daughter Erica Garner, an activist after her father’s death at the hands of New York police officers, died at the age of 27 when an asthma episode precipitated a major heart attack.
  • Marquis Jefferson, father of Atatiana Jefferson, a Black American woman fatally shot by a white police officer inside her Fort Worth, Texas, home, died battling chronic obstructive pulmonary disease. He was reportedly under a lot of stress in the few weeks since his daughter's death. When asked about the cause of this death, a family spokesman stated “I can only sum it up as a broken heart.” 
  • Darnella Frazier, the 17-year-old witness to the brutal death of George Floyd at the hands of police officers in Minneapolis, Minnesota, is receiving therapy for the trauma she experienced after filming the moments leading up to George Floyd’s death.

What we can gather from these narratives is that these experiences of racial injustice are inextricably rooted in Black American history as well as current lived experiences. Research has found that police shootings of unarmed Black Americans have a spillover effect on the mental health of Black Americans within the state in which the incident(s) occurred for at least three months post-incident(s) (Bor et al., 2018). My colleagues and I think it is time for our field to take a critical lens to the ways in which the traumatic impact of these racism-related experiences invoke harm to the mind and body of entire Black communities over time, even if it is not a direct interpersonal experience. Therefore, some of our current research focuses on “The Biological Embedding of Chronic Stress Across Two Generations Within Marginalized Communities” (Conradt, Carter, & Crowell, under review), which underscores potential clinical implications for the intergenerational biological toll of historical trauma and racism in Black American populations that could influence racial health disparities (i.e., maternal morbidity and mortality). Our current research is also taking a mixed-methods approach to amplify the lived experiences of Black American communities that have disproportionate rates of trauma exposure and further grasp identifiable strengths and resilience mechanisms that may offset the psychophysiological toll of racism-related stress. Some of our research is beginning to highlight the potential need for collective healing approaches to address the collective wounds experienced among Black Americans who have witnessed and experienced racial injustice. These healing approaches could include communal spaces where Black communities can share their stories and discuss the impact of historical injustice on their collective lives as well as engage in community action to resist oppression (French et al., 2020; Grills, Aird, & Row, 2016). We hope future work in this area will fully recognize racism as a multifaceted chronic stressor that will need multi-systemic approaches to offset its dire effects.

About the Author

Dr. Sierra Carter is an assistant professor in clinical and community psychology at Georgia State University. A common theme throughout much of her work has been examining how racial discrimination, as an acute and chronic stressor, affects development and exacerbation of chronic illnesses and stress-related disorders across the life course. Her research aims to aid in improved identification of mechanisms that can be targeted in prevention and treatment efforts to reduce racial health disparities.


Bor, J., Venkataramani, A. S., Williams, D. R., & Tsai, A. C. (2018). Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. The Lancet392(10144), 302-310.

Carter, S. E., Ong, M. L., Simons, R. L., Gibbons, F. X., Lei, M. K., & Beach, S. R. (2019). The effect of early discrimination on accelerated aging among African Americans. Health Psychology.

Conradt, E., Carter, S., Crowell, S. (under review). The biological embedding of chronic stress across two generations among marginalized communities.

French, B. H., Lewis, J. A., Mosley, D. V., Adames, H. Y., Chavez-Dueñas, N. Y., Chen, G. A., & Neville, H. A. (2020). Toward a psychological framework of radical healing in communities of color. The Counseling Psychologist48(1), 14-46.

Grills, C. N., Aird, E. G., & Rowe, D. (2016). Breathe, baby, breathe: Clearing the way for the emotional emancipation of Black people. Cultural Studies? Critical Methodologies16(3), 333-343.

Trent, M., Dooley, D. G., & Dougé, J. (2019). The impact of racism on child and adolescent health. Pediatrics144(2), e20191765.

Williams, D. R., Lawrence, J. A., Davis, B. A., & Vu, C. (2019). Understanding how discrimination can affect health. Health Services Research54, 1374-1388.