Stress-related health disparities: Class discrimination more relevant than racial discrimination?

Disadvantaged racial and socioeconomic groups have disproportionately higher rates of many stress-related illnesses. This study investigated stress perceptions and stress-related illnesses among low- and middle-SES Blacks and Whites. The study further investigated underlying mechanisms of race and class discrimination as potential sources of stress. Surveys were administered to a convenience sample of 310 participants to assess self-reported stress and stress-related illness. A sub-set of each population took pictures of their sources of stress and discussed their selected pictures during focus groups. Participants were asked about their psychological assessments of the stressors and how people from different racial/economic groups might have responded to the same questions. Multiple regression analyses were conducted to analyze quantitative data, while pile sorting and inductive analysis were used to analyze qualitative data. Quantitative and qualitative data were then triangulated. Low-socioeconomic status was associated with higher exposure to stressors, higher perceived stress, and higher stress-related illness burden, especially as it relates to hypertension, depression, and anxiety. Qualitative data revealed that differential exposures and stress appraisals are a result of institutionalized class discrimination which limits social and economic resources for housing, transportation, physical and behavioral health care, and legal representation for low-SES populations. Race was not found to have an influence on stress scores or stress-related illnesses previously known to display racial disparities for this group. It is possible that historical mechanisms of institutionalized race discrimination have resulted in socioeconomic circumstances that make SES more relevant as a stressor for Blacks today.