Race-related differences in the economic, healthcare-access, and psychological impact of COVID-19: personal resources associated with resilience

Abstract

Background: The impact of the coronavirus disease 2019 (COVID) is worse among those with fewer financial resources, in jobs not amenable to remote work, and in denser living conditions. People of color are more likely to be among these vulnerable groups. Although race itself is a social construction and not based on underlying genetic/biological differences, this study investigated race/ethnicity differences in the negative repercussions of COVID and in the benefits of psychological and social resources.

Methods: This cross-sectional, web-based study (n = 4817) was administered to a heterogeneous United States sample in Spring/Summer 2020. Information was gathered on the following COVID-specific variables: Infection Status, Coping with Lockdown, Social Support, Post-traumatic Growth, Interpersonal Conflict, Worry about Self, Financial Impact on Family, Lack of Money, Inadequate Access to Healthcare, and Housing Instability. Resilience was operationalized as the ability to maintain a sense of wellness in the face of the pandemic, using the DeltaQuest Wellness measure. Multivariate linear regression (adjusting for demographics) and propensity-matched cohort analysis (matched on demographics) evaluated the impact of COVID-specific variables on Wellness in separate models for Whites and Non-Whites.

Findings: Both sets of models retained the same COVID-specific variables and explained about half of the variance in wellness. Coping with Lockdown, Social Support, and Post-traumatic Growth were associated with higher levels of Wellness in both Whites and Non-Whites, while Interpersonal Conflict and Worry about Self were associated with lower levels of Wellness. While these associations are similar, Non-Whites reported worse levels of some positive resources (e.g., social support) and more challenging levels of negative stressors (e.g., interpersonal, worry, financial). Non-Whites also reported much higher levels of post-traumatic growth.

Conclusion: COVID was a source of worry and even conflict, but also unlocked people's resources in use of health-enhancing behavioral strategies, social support, and renewed gratitude for sources of personal meaning and value. The similar relationships between Whites and Non-Whites on wellness and COVID-specific stressors across racial groups underscore that race is a social construction, not a biological fact. Focusing on a renewed appreciation for sources of personal meaning, and particularly faith, seemed to buffer much of the COVID-related stress for Non-Whites.

Keywords: COVID; Economic; Healthcare access; Psychological; Resilience; Wellness.

Fig. 1

Box and whisker plot showing means and 95% confidence intervals of DQ Wellness scores by race group. Although on average, all participants had negative DQ Wellness scores indicating poor levels of wellness, those with the worst scores were those endorsing multiple races

Fig. 2

a–i. Bar chart of racial group differences on COVID-specific variable mean scores. There were marked differences on average levels of all variables compared to Whites

Fig. 3

PRO Score Differences by Hispanic vesus Non-Hispanic. Statistically significant differences are indicated by an asterisk above the bars

Fig. 4

COVID-specific variables by racial grouping: Cohorts matched on propensity scores. Asterisks indicate group comparisons with eta² of at least a small ES (i.e., ≥ 0.01)