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. 2024 Oct 8;9(1):69.
doi: 10.1186/s41235-024-00588-0.

Racial biases, facial trustworthiness, and resting heart rate variability: unravelling complexities in pain recognition

Ilenia Ceccarelli #  1 , Arianna Bagnis #  2 , Cristina Ottaviani  3   4 , Julian F Thayer  5 , Katia Mattarozzi  1
Affiliations

Racial biases, facial trustworthiness, and resting heart rate variability: unravelling complexities in pain recognition

Ilenia Ceccarelli et al. Cogn Res Princ Implic. .

Abstract

The study explores whether racial identity and appearance-based trustworthiness judgments can affect recognition of pain in medical students differing in levels of resting heart rate variability (HRV), a measure of parasympathetic control of the heart. After undergoing HRV assessment, 68 medical students (37 females) participated in a dynamic pain recognition task, viewing video clips of White and Black faces, which differed in perceived trustworthiness based on facial appearance, transitioning from neutral to intense pain expressions. Response time, pain intensity attribution and treatment recommendations were analyzed. Pain was recognized slower and estimated as less intense in Black compared to White faces, leading to a lower likelihood of recommending therapy. Pain recognition was faster for untrustworthy-looking White faces compared to trustworthy ones, while perceived trustworthiness had a minimal impact on the speed of pain recognition in Black faces. However, untrustworthy-looking faces were estimated to express more pain, particularly for Black faces. Notably, these biases were more pronounced in individuals with low, rather than high, resting HRV. Considering that therapeutic decisions mirrored pain intensity attribution, it would be important to increase awareness of these biases during medical training in order to promote equity in future pain assessment and treatment.

Keywords: Appearance-based trustworthiness; Facial appearance; Healthcare; Heart rate variability; Pain recognition.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic representation of the main variables involved in the experimental design. Note HRV = Heart Rate Variability
Fig. 2
Fig. 2
Response time (ms) for the pain recognition on White and Black targets in trustworthy-looking and trustworthy-looking faces. Error bars represent standard error of the mean. Note **p < 0.01
Fig. 3
Fig. 3
Pain intensity ratings on trustworthy-looking and trustworthy-looking White and Black faces by HRV group. Error bars represent standard error of the mean. Note HRV= Heart Rate Variability; **p < 0.01, ***p < 0.001
See this image and copyright information in PMC

References

    1. Al-Hashimi, M., Scott, S., Griffin-Teall, N., & Thompson, J. (2015). Influence of ethnicity on the perception and treatment of early post-operative pain. British Journal of Pain,9(3), 167–172. 10.1177/2049463714559254 - PMC - PubMed
    1. Allen, B., Jennings, J. R., Gianaros, P. J., Thayer, J. F., & Manuck, S. B. (2015). Resting high-frequency heart rate variability is related to resting brain perfusion. Psychophysiology,52(2), 277–287. 10.1111/psyp.12321 - PMC - PubMed
    1. Anderson, K. O., Green, C. R., & Payne, R. (2009). Racial and ethnic disparities in pain: Causes and consequences of unequal care. The Journal of Pain,10(12), 1187–1204. 10.1016/j.jpain.2009.10.002 - PubMed
    1. Antelmi, I., De Paula, R. S., Shinzato, A. R., Peres, C. A., Mansur, A. J., & Grupi, C. J. (2004). Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. The American Journal of Cardiology,93(3), 381–385. 10.1016/j.amjcard.2003.09.065 - PubMed
    1. Bagnis, A., Caffo, E., Cipolli, C., De Palma, A., Farina, G., & Mattarozzi, K. (2020a). Judging health care priority in emergency situations: Patient facial appearance matters. Social Science and Medicine,260, 113180. 10.1016/j.socscimed.2020.113180 - PubMed