Trainings focused on pain coping skills may also reduce depression linked with perceived discrimination among Black patients

February 16, 2021

Black patients are more likely than members of any other racial group to experience discrimination in health care settings — and discrimination has negative effects on mental health.

A new study shows that over-the-phone training sessions focused on skills for coping with pain may reduce the association between discrimination experiences and depressive symptoms.

Ida Griesemer

Ida Griesemer

In a study published February 15 in The Journal of Health Care for the Poor and Underserved, lead author Ida Griesemer, MSPH, shares findings from a randomized controlled trial of pain coping skills training for 164 Black patients with osteoarthritis. Griesemer is a doctoral candidate in the Department of Health Behavior at the UNC Gillings School of Global Public Health and a predoctoral fellow at the Sheps Center for Health Services Research.

She and co-authors observed that discrimination was linked with depressive symptoms among study participants in the control group, but not among participants who received phone-based pain coping skills training. The training, therefore, may have reduced the association between discrimination and depression among participants in this sample.

“The fact that Black patients experience discrimination in health care settings is an urgent problem that health services researchers need to work to address by changing health care organizations,” Griesemer says. “Since structural racism in health care can’t be solved overnight, we also need research on strategies to support coping skills for people who do experience discrimination.”

Griesemer conducted her work in partnership with Kelli Allen, PhD, principal investigator on the study and research faculty at UNC’s Thurston Arthritis Research Center, along with researchers from the University of Pittsburgh, East Carolina University, Duke University, the Duke University Medical Center, and Veterans Affairs organizations in Pittsburg and Durham.

While the pain coping skills training program did not actually focus on reducing the mental health burden associated with perceived discrimination, the skills taught may have helped participants manage prejudice-related stress. The findings align with Social Stress Theory, which suggests that access to coping resources may buffer the association between stressful experiences and mental health outcomes.

The program introduced participants to skills such as physical exercise, muscle relaxation, pleasant activities and managing unhelpful moods, all of which may play a role in reducing stress as well as alleviating pain. Participants who found new ways to manage their stress may have reported fewer depressive symptoms at the end of the study. Another possible explanation for the study findings could be that working with a counselor served as a positive, corrective experience tied to the health care setting.

While counseling interventions that enhance coping skills may have mental health benefits for Black patients who have experienced discrimination, these interventions are limited in that they do not address the root of the problem: the fact that this population experiences discrimination in health care settings in the first place.

Health services researchers must address racism in health care by studying organizational change strategies to address racial biases and prevent discriminatory behavior among health care professionals. Simultaneously, researchers should continue to build evidence for the effectiveness of coping skills-based counseling programs to mitigate the ongoing harm associated with experiencing discrimination.

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