Discrimination and Cognition in Midlife Black Women: The Roles of Social Support and Spirituality

Abstract

Objectives: Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition.

Methods: Participants were midlife Black women (N = 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors.

Results: Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition.

Discussion: Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.

Keywords: African American; Attention; Learning; Psychosocial factors; Stress exposure.

Figure 1.

Model diagrams of path analyses. (A) Main effects model regressing Immediate Recall on Discrimination. The same models were run separately for the other cognitive outcomes (Delayed Recall, Processing Speed, and Working Memory) collected at the 7th follow-up visit. (B) Two-Way interaction model with Discrimination × Spirituality. (C) Two-Way interaction model with Discrimination × Total Social Support. The same models were run separately for Discrimination × Emotional Support and Discrimination × Instrumental Support interactions. Discrimination indicators were collected at the initial, 1st, 2nd, and 3rd follow-up visits. Spirituality indicators were collected at the initial visit. Social support was collected at the initial visit. Cognitive Outcomes were collected at the 7th follow-up visit.

Figure 2.

Emotional Support Moderating Discrimination and Immediate Recall. Discrimination scores were averaged across the 10 items so that the final score ranged between 1 (low discrimination) and 4 (high discrimination). Higher scores indicate more perceived everyday discrimination. SD = standard deviation. ^a Low emotional support = 1 SD below; average emotional support = mean; high emotional support = 1 SD above.