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Abstract

Sars-CoV-2 COVID-19-related stress has been associated with post-traumatic stress symptoms in several communities; however, insight into protective factors for pandemic stressors and trauma symptoms in Black Adults remains limited. While research suggests that resilience, or the ability to bounce back following exposure to stressful events, is an essential factor in how individuals cope with trauma symptoms, few studies have examined its role in COVID-19-related stress. This preliminary study aimed to examine the association between COVID-19-related stress and post-traumatic stress symptoms and the moderating effect of resilience for Black adults. The sample included 169 Black adults (52.9% female; M_age = 28.21) who endorsed experiences of COVID-19-related stress. Participants completed a questionnaire battery consisting of self-report measures of COVID-19-related stress, trauma symptoms within the past month, and resilience. Sixty-two percent of the sample demonstrated a pattern of responding to survey measures consistent with high or very high risk for post-traumatic stress disorder. Consistent with hypotheses, bivariate correlation analyses revealed a significant positive association between COVID-related stress and trauma symptoms (r = .29, p < .001), such that higher self-reported COVID-related stress was related to higher levels of trauma symptoms. Resilience, however, did not serve as a significant moderator of this association (β = .23, 95% CI [−0.06, 0.17], p = .35). Findings suggest that an individual conceptualization of resilience may not be a sufficient buffer for the heavier allostatic load and the cumulative impact of COVID-related stress on traumatic stress for Black communities, who culturally tend to center communal relationships.

Keywords

COVID-19 traumatic stress resilience Black Americans stress

SARS-CoV-2 (COVID-19) is a global public health concern with consequential impacts on mental health, physical health, and financial well-being (Cao et al., 2020; Oosterhoff et al., 2020; Wang et al., 2020). The Center for Disease Control (Dong & Bouey, 2020) has emphasized the need for individuals to find ways to manage their stress and protect their mental health, recognizing that increased stress and exposure to a community trauma may lead to maladaptive coping behaviors and subsequent mental health distress. Various factors such as forced isolation, loss of stable employment/income, concerns about contracting the COVID-19 virus, and engagement in antisocial behaviors, such as hoarding, are significant influencers in ongoing COVID-19-related stress (Probst et al., 2020; Trougakos et al., 2020; Verger & Peretti-Watel, 2021). Further, it is evident from disparities in infection and mortality rates that COVID-19 has brought social and racial inequity to the forefront of public health. In response, studies have begun investigating structural disparities in COVID-19’s impact on the mental health of varied communities based on race, socioeconomic status, and previous stressful life conditions. In general social-ecological determinants of health such as biology, individual behavior, socioeconomic status, physical and social environment, racism, discrimination, health services, literacy levels, and legislative policies have been found to be associated with risk factors for COVID-related stress for communities of color (Njoku, 2021).

Recent research has identified various areas of COVID-19-related stress that have been particularly salient for Black communities, such as health, employment, and racial discrimination (Selden & Berdhal, 2020). However, research surrounding the early psychological consequences of these increased, potentially traumatic COVID-related stressors on the Black community has remained limited.

The purpose of the current study was to examine whether there were significant associations between pandemic stressors and trauma symptoms amongst Black adults. Further, these ongoing psychological stressors have called for increased attention to investigating strength-based approaches to mitigating the adverse mental health effects of COVID-related stress on Black adults. Therefore, this study also investigated whether resilience served as a protective moderating factor between COVID-related stress and trauma symptoms.

Post-Traumatic Stress and Black Americans

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), trauma symptoms are characterized by re-experiencing (i.e., spontaneous memories of an event), avoidance (i.e., avoiding distressing reminders of an event), negative alterations of cognition and mood (i.e., distorted sense of blame of self or others), and hyperarousal (i.e., hypervigilance) that persist for longer than 1 month. Black Americans, in general, are at a higher risk of developing post-traumatic stress symptoms and report higher levels of symptom severity and disorder chronicity than White Americans, partially due to being exposed to chronically stressful environments and multigenerational oppression (Alegría et al., 2013; Douglas et al., 2021; Sibrava et al., 2019; Wilkins et al., 2013). Further, recent work has found that Black people are more likely to receive a racial trauma diagnosis than any other racial/ethnic group; such findings suggest that Black people may experience considerable traumatic distress and impairment due to racism (M. Williams & Zare, 2022).

For some Black Americans navigating multiple stressors, living in a state of constant hypervigilance or avoidance to protect oneself from further trauma exposure can be necessary for survival (Gaylord-Harden et al., 2016). However, having chronic trauma symptoms can come with significant consequences, such as loss of the capacity to grieve appropriately or reasonably anticipate the future, problems with authority, loss of basic sense of safety, substance abuse, violent behavior, decreases in emotional regulation, declines in effective communication, and impaired judgment (Bloom & Farragher, 2013). These behaviors can increase the risk of further trauma exposure for Black Americans who are also more likely to experience the consequences of institutional racism and discrimination when displaying mental health symptoms, such as misdiagnosis, underdiagnosis, involuntary commitment to psychiatric wards, arrests, incarceration, and police brutality (Hardeman et al., 2016).

Further, post-traumatic stressors among Black communities are more likely to expand beyond emotional distress and create lasting socioeconomic consequences, including financial instability, lack of physical security, and issues of safety (Range et al., 2018). Generally, collective traumas can elicit grief, sorrow, and intense feelings of loss from affected individuals and their communities (Webb, 2004). For Black Americans in particular, these experiences of trauma, grief, and loss can become pervasive due to the concurrent experiences of different traumatic events related to intense injustices that reflect the collective history of oppression and discrimination (Range et al., 2018). This overlap of COVID-19-related stressors such as infection and mortality rates, along with ongoing stressors could create a heavier allostatic load and exert a cumulative impact, resulting in higher reports of post-traumatic stress symptoms and long-term adverse health outcomes in Black communities (Assari, 2018; Saltzman et al., 2021; D. R. Williams & Mohammed, 2009). Given these findings, there is a need for research examining the relationship between COVID-19-related stress and post-traumatic stress symptoms in Black Americans, particularly.

COVID-19, in general, has been identified as a collective trauma, defined as a “group-level cataclysmic, tragic experience that is reproduced through co-constructed discourse” (Hirschberger, 2018), connecting people globally through experiences of helplessness, uncertainty, loss, and grief (Crosby et al., 2020; Stanley et al., 2021; Watson et al., 2020). Recent theoretical work has posited that COVID-19-related stressors, such as the outbreak itself and measures taken to bring it under control, could have the potential to trigger symptoms of post-traumatic stress disorder (PTSD) for many individuals due to feelings of helplessness and loss of control (Horesh & Brown, 2020). Stressors such as directly suffering from symptoms and traumatic treatment, witnessing the suffering of loved ones, fear of infection, isolation, and stigmatization have been ongoing traumatic experiences for many individuals (Kisely et al., 2020). For instance, individuals are encouraged by health professionals to stay alert and aware of their surroundings; however, the constant fear of contracting the virus could manifest as hypervigilance in vulnerable populations. Further, communities are encouraged to practice social distancing and avoid areas that increase the likelihood of contraction; however, this could also trigger avoidance behaviors such as isolation and detachment. However, research surrounding the prevalence of post-traumatic stress symptoms resulting from COVID-related stress is still very limited (Qiu et al., 2021). It is pivotal for researchers to focus efforts on investigating health disparities in trauma symptoms among oppressed communities who may be more likely to experience trauma symptoms and be exposed to COVID-19-related stress.

The Psychological Burden of the COVID-19 Pandemic for Black Americans

Black adults may be more likely to experience COVID-19-related distress due to disparities in infection and mortality rates (Thebault et al., 2020), socio-economic factors (Lubrano, 2020), and discrimination-related experiences (Lubrano, 2020). As of November 2021, the CDC has reported that Black Americans, who make up 12.1% of confirmed cases, are at least twice as likely to die from COVID-19 as their White counterpart (U.S. Centers for Disease Control and Prevention, 2021). Further, recent data on testing availability have demonstrated a lack of testing options in predominantly Black neighborhoods (Lubrano, 2020). Additionally, following the rollout of the COVID-19 vaccinations, some Black adults reported feeling fear and distrust of receiving COVID-19-related treatments, stemming from past experiences of discrimination and a historical legacy of exploitation and mistreatment within the U.S. health care system, which has affected generations of Black communities (Rusoja & Thomas, 2021).

Further, Black Americans are highly represented in essential, low-wage health care sectors, such as home health aides, nursing home staff, hospital janitorial, food service, laundry, and other sectors (U.S. Bureau of Labor Statistics, 2020). Many of these low-wage jobs do not provide adequate, if any, health insurance, sick leave, childcare, or other benefits, which protect higher-wage workers from COVID-19 exposures. Moreover, the surrounding environment magnifies risk. Black Americans are more likely to live in crowded settings such as public housing, where the ability to practice social distancing is quite limited, if not impossible (HUD, 2020). These factors demonstrate some of the prevalent stressors due to structural disadvantages that Black Americans face, particularly within the context of the COVID-19 pandemic.

COVID-related stress has also been associated with a decline in psychological well-being and mental health outcomes amongst Black communities in particular. It has been suggested that disruptions in social and cultural support caused by the pandemic, such as job loss, changes in family dynamics, death of family members, and increased isolation may have led to significant shifts in community support (Moore et al., 2020; Novacek et al., 2020). This support such as in the areas of community care of children and the elderly, financial support, gatherings at religious and spiritual institutions, and culturally affirming social support are likely to have been pivotal to the well-being of community members prior to the pandemic (Crooks et al., 2022).

A recent study by Villarroel and Terlizzi (2020) found that in 2019, 18.5% of adults had symptoms of mild depression, with Black adults (19.3%) being more likely to experience symptoms, compared to Latinx (16.9%) and Asian adults (10.2%). Concurrently, during the onset of the COVID-19 pandemic in 2020, Black communities within the United States and globally were exposed to the highly publicized murders of unarmed Black victims, such as George Floyd and Breonna Taylor (Shim & Starks, 2021). This increased vicarious exposure to racism and discrimination through videos of police killings and hate crimes created a broad context of threat and fear of racism for Black communities (Bird et al., 2021). The increased attention on racial disparities in both health outcomes and racial discrimination, such as increased attention to police brutality, were found to significantly influence the social environment and mental well-being on Black Americans within the United States (Witherspoon et al., 2023). Given these notable disparities in vicarious trauma, depression, and anxiety symptoms, more research is also needed to explore potential protective factors against COVID-related stress and trauma symptoms for Black adults specifically.

Resilience and Black Adults

Some individuals may respond to chronic traumatic stress differently based on their adaptation of positive psychosocial traits, such as resilience (Killgore et al., 2020). Resilience is defined as a process trait that aids in adaptation in the face of adversity, trauma, or a significant source of stress and is a crucial component of a strength-based approach to researching and treating traumatic stress exposure and post-traumatic stress symptoms (Liu et al., 2020). Resilience is a distinct process from psychosocial suppression of symptoms, which is often associated with PTSD following exposure to trauma. Resilience reflects positive adaptations to ongoing stress that individuals, families, and larger communities use to buffer against maladaptive thoughts, feelings, and behaviors (Nakkula et al., 2010). In the current study, we define “resilience” as the ability to “bounce back” following exposure to stressful events. While resilience has broadly been defined as “resistance to ailment,” “adaptation,” and “thriving,” “the ability to bounce back or recover from stress” is closest to its original meaning (Agnes, 2005; Smith et al., 2008). Specifically, the ability to bounce back can be particularly important for individuals already dealing with ongoing mental health-related stressors, such as Black Americans.

Findings suggest that amid experiencing concurrent forms of trauma symptoms, Black Americans can display remarkable resilience and maintain psychological and physical well-being that allows them to persist while facing ongoing adversity (Padesky & Mooney, 2012). In fact, previous researchers have hypothesized that Black Americans may be better prepared to respond to social and economic adversity than White communities due to experiencing more ongoing instances of adversity. As a result, Black adults may be more likely to be socialized to manage their harsh environments and to develop systematic resilience (Keyes, 2009). A recent study found that compared to White and Latinx adults, Black adults were more likely to report psychological resilience during the COVID-19 pandemic (Riehm et al., 2021). However, recent research focused on racial/ethnic disparities amongst groups has been critiqued for only utilizing race-comparative methodological approaches and has instead advocated for increased within-group designs that center the experiences of Black people participants independently. It is essential to acknowledge that the Black community is not homogenous, and their mental health experiences can vary broadly based on various factors such as gender, education, and socioeconomic status (Volpe et al., 2022).

It is essential to advance theory development in this specific domain to provide researchers and healthcare practitioners with much-needed insight on how to mitigate the mental-health impact of the pandemic and possible future community stressors on Black mental health. It is possible that some Black adults, who are at increased risk of facing adversities and trauma symptoms, may utilize resiliency by mobilizing their available assets and resources to protect individual and communal well-being. This resilience may influence their likelihood of experiencing post-traumatic stress symptoms. Therefore, research efforts are needed to evaluate resilience as a strength-based protective factor that may mitigate long-term health consequences of COVID-related stress and trauma symptoms in Black adults.

Current Study

The proposed study aims to expand upon existing literature by demonstrating the relationship between COVID-19 stress and post-traumatic stress symptoms (Aim 1) and examine if resiliency influences the association between COVID-19 stress and trauma symptoms in Black adults (Aim 2). We hypothesized that: (a) higher levels of COVID-related stress will be associated with higher post-traumatic stress symptoms, and (b) this association will be moderated by individual resilience (e.g., the ability to bounce back following traumatic stress). The proposed study has several implications, including illustrating the importance of considering the resiliency of Black adults when addressing COVID-19-related stress and post-traumatic stress symptoms in Black adults and providing implications for research and interventions for Black adults from varied economic classes. The current study is the first study, to our knowledge, to investigate the relationship between COVID-related stress and trauma symptoms experienced by Black adults and the potentially protective nature of resilience.

Method

Participants

The current study consists of 169 Black adults recruited over a 10-month period through email listservs, outreach to Black student organizations, targeted social media advertisements via Facebook and Twitter, and from a large public university in the Southern United States, which directed participants to the online survey on Qualtrics. Several questions were added to the screening methods of the platforms, including veracity checks, requests for best effort, and verification of racial identification before proceeding. Following completion of the survey, participants received compensation. Participants who were 18 years of age or older and identified as Black were considered eligible. The mean age for the total sample was 28.21 years (SD = 10.65 years) with an age range of 18 to 68 years. Slightly more than half of the sample identified as female (52.9%). Approximately 7% of the sample reported their highest educational level as high school, 28% reported having some college, 45% of participants reported having a bachelor’s degree, and approximately 19% of the sample reported advanced degrees (e.g., master’s, PhD, MD). The majority of participants (50.6%) reported an annual income of less than $25,000.

Measures

Demographics

The participants were asked comprehensive demographic items including age (measured continuously); gender (measured using the categories male, female, gender non-binary, with an additional write-in option); race (measured utilizing a number of non-exclusive categories, e.g., “Black”); ethnicity (measured utilizing a number of non-exclusive categories, e.g., “African American,” “West African”); and several indicators of socioeconomic status, including level of educational attainment (measured from “Junior High School” to “Graduate/Professional Degree”) and annual household income (measured in $25k increments from “$0–$24,999” to” “$100,000,” “$100,00 to $250,000,” and “more than $250,000”).

Epidemic-Pandemic Impacts Inventory

The Epidemic-Pandemic Impacts Inventory (EPII; Grasso et al., 2020) is a 92-item inventory of one’s exposure to pandemic-related experiences at various socioecological levels of influence that range across several life domains. Twenty-five items were used in the current study: “Infection History”—8 items (e.g., tested positive for COVID-19), “Economic”—5 items (e.g., unable to pay important bills), “Social Activities”—10 items (e.g., difficulty connecting with friends or family), and “Education and Training”—2 items (e.g., disruption to education or vocational program). Each item has the response options of “Yes[Me],” “Yes[Person in the Home],” “No,” and “Not Applicable.” Consistent with current literature that conceptualizes both individual and communal experiences as impacting the individual (Grasso et al., 2020), categories that indicated a positive response (i.e., Yes[Me] and Yes[Person in the Home]) were given a value of 1 and all other scores were given a value of 0. A total score was computed by summing the positive values of all survey items, with higher scores being indicative of worse pandemic-related stress experiences (Grasso et al., 2020). In the current study, this scale demonstrated good internal consistency (α = .85).

Brief Resilience Scale

The Brief Resilience Scale (BRS; Smith et al., 2008) is a 6-item unidimensional measure of one’s ability to bounce back or recover from stress (e.g., “I tend to bounce back quickly after hard times”). The response format is a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). A higher mean BRS score reflects higher levels of resilience and overall ability to bounce back from stressful events. The BRS demonstrates good internal consistency (α = .80–.91) and test–retest reliability (intraclass correlation coefficient, ICC = .62–.69). The reliability for this subscale (α = .80) was acceptable for the current study.

The Abbreviated Post-Traumatic Checklist—Civilian Version

The abbreviated Post-Traumatic Checklist—Civilian (PCL-C; Lang & Stein, 2005) is a 6-item self-administered questionnaire that assesses the severity of PTSD symptoms within the past month (e.g., “repeated, disturbing memories, thoughts, or images of a stressful experience from the past”). The abbreviated PCL-C is a shortened version of the PTSD Checklist (Weathers et al., 1993). Respondents’ scores are rated on a 1 (not at all) to 5 (extremely) scale, with higher scores indicating greater PTSD symptom severity. The abbreviated PCL-C is scored by summing the ratings; total scores range from 6 to 30. A prior validation study demonstrated that the abbreviated 6-item PCL-C can be used as a reliable screen for traumatic stress and potential PTSD among low-income, underserved populations (Han et al., 2016). In the current study, tests for internal consistency were similar to previous studies (α = .90).

Procedure

The present study was granted institutional review board approval. Each participant was informed that he/she/they would be administered a computerized set of questionnaires that included questions about beliefs, behavior, and thoughts related to their emotional and psychological well-being, particularly within the context of the recent COVID-19 pandemic. Individuals in the study first reviewed an informative cover letter that described the nature of the study. All participants were informed that their participation would be confidential, that participation in the study could cease at any time, and COVID-19 and mental health resources were provided at the conclusion of the survey. Approximately 45 to 60 min were required to complete the online survey. Each participant had the option to receive course extra credit or a $20 Walmart gift card, at their discretion, as incentive for participating in the study.

Results

Preliminary Analysis

All analyses were conducted using IBM SPSS version 27.0 (IBM Corp., 2020). First, the data was examined for normality and missingness. Little’s missing completely at random (MCAR) test was non-significant (c²(6) = 4.79, p = .442), suggesting it was reasonable to treat the data as MCAR. Therefore, list-wise deletion was employed for missing data (<1%). Examination of collinearity diagnostics did not reveal evidence of excess multicollinearity (variance inflation index [VIF] <1.1), as VIF values did not exceed 10.0 (Mason & Perreault, 1991). Distributions for study variables approximated normality (skewness < |2.25|; George & Mallery, 2003). Power analyses were computed to indicate that the participant sample size surpassed the minimum sample size required to achieve β = .80, given a medium effect size (Faul et al., 2007). Means, standard deviations, and intercorrelations for all measured variables are presented in Table 1. Importantly, Han et al. (2016) developed an ordinal decision rule to differentiate one’s risk of PTSD based on multiple PCL-C cutoff values. According to this scale, 48% of respondents demonstrated a pattern of responding consistent with high risk for PTSD (PCL-C scores 17–25), and an additional 14% of the sample were at very high risk for PTSD (PCL-C scores >26). The PCL-C mean score (M = 18.42, SD = 6.39) represents the overall level of traumatic stress in the current sample of Black adults and falls in the high-risk range (Table 2).

Table 1

Descriptive Statistics and Bivariate Correlations Between Study Variables for Black American Adults (N = 169)

Variable	1	2	3	4	5	6	M	SD
1. EPII	—						16.25	8.43
2. BRS	−.25**	—					3.19	0.86
3. PCL-C	.29**	−.36**	—				18.42	6.39
4. Age	−.14	.08	−.22**	—			28.21	10.65
5. Gender^a	.21**	−.11	.27**	−.23**	—		—	—
6. Education	.04	.11	.06	.23**	−.05	—	—	—
7. Income	−.04	.07	.08	.24**	.07	.47**	—	—

Note. EPII = Epidemic-Pandemic Impacts Inventory total score (Grasso et al., 2020); BRS = Brief Resilience Scale (Smith et al., 2008); PCL-C = The Abbreviated Post-Traumatic Checklist—Civilian Version (Lang & Stein, 2005).

Demographics questionnaire (0 = female; 1 = male; 2 = gender non-binary).

p < .01.

Table 2

Hierarchical Regression Analysis of COVID Stress and Resilience Predicting Trauma Symptoms Among Black American Adults (N = 169)

Model step and variable	β	R ²	ΔR²	t	p	Bootstrapped 95% CIs
Step 1		.11
Age	−.20			−2.58	.01*	−0.21	−0.03
Gender	.22			2.89	.004**	0.67	3.55
Education	.08			1.00	.32	−0.58	1.77
Income	.07			0.76	.45	−0.50	1.13
Step 2		.24	.13***
EPII	.14			1.96	.05	−0.001	0.22
BRS	−.30			−4.26	<.001***	−3.26	−1.19
Step 3		.25	.004
EPII × BRS	.23			0.93	.35	−0.06	0.17

Demographics questionnaire (0 = female; 1 = male; 2 = gender non-binary).

p < .05. **p < .01. ***p < .001.

As expected, bivariate correlation analyses revealed a significant positive association between COVID-related stress and traumatic stress (r = .29, p < .01), such that higher self-reported COVID-related stress was related to higher levels of traumatic stress symptoms. Furthermore, as indicated in Table 1, resilience was inversely associated with COVID-related stress (r = −.25, p < .01) and traumatic stress symptoms (r = −.36, p < .01), such that higher ratings of resilience related to lower COVID-related stress and lower traumatic stress.

Tests of Main Effects and Moderation

Main effects and moderation analyses were conducted to examine the moderating effect of resilience on the association between COVID-related stress and traumatic stress symptoms for Black adults. The order of entry in the hierarchical regression model was as follows: age, gender, education, and income were entered simultaneously as covariates in Step 1. To assess potential main effects of study variables, COVID-related stress and traumatic stress symptoms were entered simultaneously in Step 2. The interactive effect of COVID-related stress and traumatic stress symptoms was entered in Step 3.

Step 1 of the model with covariates was statistically significant (R² = .11, F[4, 164] = 5.18, p < .001). Step 2 of the model also was statistically significant (ΔR² = .13, p < .001), with resilience emerging as a statistically significant predictor of traumatic stress (β = −.30, p < .001). However, COVID-related stress did not emerge as a statistically significant predictor of traumatic stress, after accounting for the covariates in the model (β = .14, p = .05). Lastly, contrary to expectations, Step 3 of the model was not statistically significant (ΔR² = .004, p = .352).

Discussion

The overall aim of the current study was to assess the association between COVID-related stress and trauma symptoms in Black adults and to examine the moderating role of resilience. Consistent with our first hypotheses, our results found that participants who endorsed experiencing greater COVID-related stress also endorsed experiencing higher traumatic stress symptoms. This finding supports prior literature that suggests that individuals who report having high health concerns for contracting COVID-19, having loved ones who tested positive for COVID-19 or experienced lower quality of life in the context of COVID-19, tend to report higher trauma symptoms (Grasselli et al., 2020). Given that previous work has suggested that significant trauma symptoms can result in the later development of PTSD (Ozer et al., 2003) and that Black adults are at an increased risk of developing PTSD and experiencing more severe symptoms than their White counterparts (Bird et al., 2021), it is essential that future work in the area of COVID-related stress accounts for potential trauma symptoms amongst Black adults endorsing significant stressors.

Additionally, while COVID-related stress and post-traumatic stress symptoms were highly correlated, once we accounted for survey covariates (age, gender race, ethnicity, education, and annual household income), COVID-related stress was not significantly associated with traumatic stress. This finding calls for future research to further examine the underlying mechanisms of this association between COVID-related stress and traumatic stress. For instance, Black adults experiencing additional intersections of systemic oppressive systems such as financial hardships, acculturation stress, and gendered discrimination during the pandemic may be processing these ongoing significant chronic contributing factors to experiences of traumatic stress outside of the context of COVID-related stress. Further, our results demonstrated that resilience, or the ability to “bounce back” following significant stress, did not serve as a moderator of the association between COVID-related stress and trauma symptoms. To our knowledge, this is the first study to examine COVID-related stress in the context of trauma symptoms amongst Black adults and to examine resilience as a potential protective factor for this population. It is important to note that our preliminary analyses revealed that approximately 64% of respondents met the criteria for PTSD. It is pivotal to acknowledge that these prevalence rates are substantially higher than rates of PTSD in the general population (approximately 8%) (Kilpatrick et al., 2013). However, this finding is consistent with previous research demonstrating that African Americans tend to report having higher rates of PTSD overall (Roberts et al., 2011). These findings are likely partially explained by individuals experiencing dramatic changes in quality of life following the start of the COVID-19 pandemic, quarantine, instances of racial injustice in the media, and financial stress. Similar findings on stress during the COVID-19 pandemic have emerged from recent studies on general populations in Spain, Italy, China, and indigenous populations; however, trauma prevalence rates were not as high as in the current study (D’Amico et al., 2020; Huang & Zhao, 2020; Mazza et al., 2020; Ozamiz-Etxebarria et al., 2020).

Therefore, the finding that resilience did not serve as a significant moderator between COVID-related stress and trauma symptoms could be partially explained by the elevated reports of trauma symptoms amongst our population. These findings provide a more nuanced analysis than race-comparative findings of the functioning nature of resilience as a protective factor for Black adults during COVID-19 (Riehm et al., 2021). Further, as the first study to our knowledge to assess trauma symptoms amongst Black adults, these findings may highlight that resilience may not serve as a robust protective factor for trauma symptoms.

These findings also suggest a need to explore the unique cultural considerations of psychosocial resilience amongst Black communities and perhaps consider alternative definitions of resilience within these communities. For example, traditional Western conceptualizations of resiliency have historically focused on individualistic personality traits such as personal perseverance, optimism, and commitment to learning from hardship (Masten & Narayan, 2012; Shaw et al., 2016). Such individualistic traits may be demonstrated by those with successful educational, career, and social attainment (Patton, 2016). However, more recent work rooted in liberation psychology has expanded the lens to look beyond individual traits and include interactions of psychological, social, and cultural factors specific to affected groups (Bryant-Davis & Moore-Lobban, 2020; French et al., 2020). A recent systematic review by Jacob et al. (2023) highlighted that Black communities tend to report coping with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly).

Regarding problem-focused coping, resilience in the Black community can be further explained by the “high-effort” coping strategy, “John Henryism.” John Henryism is a behavioral predisposition to cope actively with psychosocial environmental stressors and happiness with three components including (a) mental and physical vigor, (b) commitment to hard work, and (c) determination to succeed (James, 1994). The origin of John Henryism stems from American folklore that centers on an African American steel driver named John Henry, who raced a steam-powered machine despite insurmountable odds. Although he wins the race, John dies shortly after (James et al., 1983). John Henry is revered for his bravery and willingness to pursue an enormous feat at the expense of his life. James argues that African Americans regularly exposed to psychosocial stressors may use high-effort coping (Hudson et al., 2016; James, 1994, 2002; James et al., 1983). According to James (1994), over time, high-effort coping may negatively impact their health because of the considerable energy required to cope with psychosocial stressors.

Alternatively, social support has been found to be one of the most beneficial and effective coping mechanisms for racial trauma (Gaylord-Harden et al., 2008). For Black Americans, developing personal resilience characteristics, such as “hardiness” may be tied to large communal experiences such as storytelling from elders regarding adaptations to discrimination within the family, conversations about community values such as perseverance and determination, and increased familial and community connectedness that can strengthen ethnic identity development, individual character traits, and communal resilience (Range et al., 2018). Therefore, several cultural and contextual factors may influence an individual’s level of resilience and future investigation evaluating underlying mechanisms of resilience is warranted.

Limitations

Due to the cross-sectional nature of the data, we could not delineate the temporal relationship between COVID-related stress and post-traumatic stress symptoms in this study. However, we asked participants to indicate how often they had been affected by trauma symptoms within the “past month” in response to stressful life experiences, which aligned with the pandemic’s start. Early work in this area across an array of diverse populations, including Lebanese citizens (Fawaz & Samaha, 2021), Italian populations (Grasselli et al., 2020), and Chinese populations (Jiang et al., 2020), have all found significant associations between COVID-related stress and post-traumatic stress symptoms during the pandemic, suggesting that the occurrence of a global, mass community trauma may be increasing post-traumatic stress symptoms across various populations. However, given the cross-sectional nature of this study, these conditions might have limited the prevalence of our results. Future work should investigate the linear pathway between COVID-related stress and post-traumatic stress symptoms longitudinally.

Future Directions

Future studies would benefit from continued monitoring of culturally responsive and communal-focused resiliency factors on the relationship between COVID-19 stress and trauma symptoms amongst Black adults. Gilbert et al.(2022) proposed an agenda for combatting racial trauma that includes an agenda focused on “communal restoration” that recognizes how social capital utilized by Black people in the United States can advance health equity and eliminate health disparities. Future research in this area must be inclusive of and guided by Black community members, leaders, and scholars to find effective ways and solutions for achieving social and health equity. For example, studies have suggested that participation in low-risk activism (e.g., donating funds or community organizing meetings) has been associated with resilience and positive outcomes among Black communities (Hope et al., 2019). Turner et al. (2022) created the “Black love, activism, and community (BLAC): The BLAC model of healing and resilience,” which provides a framework for understanding how Black communities’ engagement in activism may be pivotal in the fight against health inequity, and racial oppression and may serve as a protective factor against anti-Black racism and COVID-related stress. Therefore, future studies ought to incorporate measures of sociopolitical action as a potential contributing factor to resilience for Black communities.

Ungar (2011) proposed a socioecological model of resilience to focus beyond individual factors and emend to include contextual and cultural factors relative to positive functioning, survival, and development during traumatic stress. This theoretical model defines resilience as the capacity for individuals and their environments to interact to improve their outcomes following stress. Resilience can be observed in individuals when their socioecological networks have the capacity to provide them with culturally meaningful resources. Therefore, influencing factors including cultural norms, family structures, socioeconomic resources, and other life circumstances can affect an individual’s abilities to experience resilience following trauma symptoms. This socioecological focus aims to decenter individual Western healing models to avoid blaming individuals for not flourishing when they come from communities who experience systemic oppression and limit their ability to gain access to resources that buffer against trauma symptoms.

While the individual motivation to adapt is still a pivotal aspect of positive outcomes following trauma exposure, ecological lenses provide the structure necessary to process how members of larger oppressed communities can provide resources for trauma-exposed individuals to experience resilience, emphasizing cultural sensitivity, community-centered care, and influencing factors (Ungar, 2015; Utsey et al., 2007). These communal resilient factors may be particularly salient for Black Americans who also tend to value collectivist action and community care to strengthen community solidarity and to provide external protective factors during times of stress (Gooden & McMahon, 2016). Importantly, recent work by M. Williams & Zare (2022) found that among Black adults, higher reports of strong racial identity were associated with lower levels of risk for developing psychopathology as a result of racism. This suggests that ethnic identity development in particular may be vital for the well-being of Black communities in the face of traumatic stressors.

The study of resilience involves identifying and promoting positive aspects of adaptation that can improve trauma outcomes for individuals and their larger communities. In the current study, our definition of resilience focused on an ability to bounce back from challenges, which made the BRS particularly relevant. Previous work has clearly distinguished “resilience” as bouncing back or recovery and “thriving” as moving to a superior level of functioning following a stressful event. Further, the term “adaptation” has been used to describe the ability to change to adjust to a new situation. Finally, “resistance” refers to not displaying symptoms or showing a decrease in functioning during stress (Carver, 1998; Smith et al., 2008). Future work would benefit from exploring the relationship between COVID-related stress, post-traumatic stress symptoms, and other factors related to resilience, such as thriving, adaptation, and resistance.

Further, future research is needed to better understand the mechanistic association between COVID-related stress and trauma symptoms for Black adults. COVID-19 is clearly a collective trauma that has already been found to be associated with several factors that have the potential to lead to significant life changes, especially for individuals with limited resources. However, there is still uncertainty surrounding the variance in the recovery process for some individuals versus others after experiencing similarly distressing traumatic events. Previous research in this area has suggested that collective traumas have the potential to undermine individuals’ belief systems and prompt varying attempts to make sense of the event psychologically and emotionally (Maffly-Kipp et al., 2020). Future work would benefit from investigating the personal and environmental factors that may facilitate varying reactions to this shared traumatic stressor.

Finally, recent work has found that for many Black Americans during the pandemic, vicarious trauma has occurred as a result of hearing about racist acts committed against Black adults in the media (Chae et al., 2021). The simultaneous COVID-19 pandemic and racial injustice pandemic and their impact on health (specifically racial/ethnic inequities in mental health) have been referred to as “syndemic” (Gravlee, 2020; Poteat et al., 2020, Powell, 2021; Shim & Starks, 2021). According to the syndemic theory, two or more epidemics, such as COVID-19 stress and racial discrimination, can co-occur and exacerbate health and social disparity (Singer, 2006). The increased attention on racial disparities in both health outcomes and police brutality was found to significantly influence the social environment and mental well-being on Black Americans within the United States (Brower, 2021). Generally, Black Americans report experiencing disproportionately higher rates of discrimination and racism than their non-Black counterparts, and these experiences negatively impact various psychosocial outcomes (Witherspoon et al., 2023). Importantly, perceived discrimination can also perpetuate trauma and stress (Pieterse et al., 2023). Therefore, Black Americans navigating both COVID-19-related stress and concurrent concerns regarding racial discrimination may have been at increased likelihood of experiencing post-traumatic stress symptoms during the syndemic. Future studies would benefit from investigating the combined impact of both COVID-19-related stress and racial discrimination on trauma symptoms and resilience amongst Black Americans.

Implications and Conclusions

This study has several implications, including contributing theoretically to understanding the interactions between pandemic stressors and post-traumatic stress symptoms. Additionally, this work shows that it is possible to contribute to the scientific literature surrounding COVID-19 without relying solely on null hypothesis testing. Major reliance on tests of statistical significance, or rejecting the null, is neither necessary nor sufficient for acquiring new knowledge (Meehl, 1978). These findings may suggest that resilience, as defined as the individualized ability to “bounce back” following stressful events, may not be a robust enough protective factor to aid Black communities from experiencing trauma symptoms in the context of this community trauma. This provides us with a basis for examining these patterns across other populations, hypothesizing alternative protective factors, and serves as a call to action for increased resources for Black adults who may require additional tangible and psychological support during this time. This work additionally calls for increased theoretical work focused on redefining and conceptualizing resilience amongst Black communities from a communal lens. Further, this study illustrates the importance of having researchers, clinicians, and interventionists to identify appropriate cultural, and trauma-informed, strength-based approaches to mitigating the adverse mental health effects of COVID-related stress on Black adults.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research,authorship,and/or publication of this article: This study was supported by APA Division 56: Cultivating Healing,Advocacy,Nonviolence,Growth,and Equity (CHANGE) Grant and the APF/COGDOP Graduate Student Scholarship.

ORCID iD

Robyn D. Douglas

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Is Resilience Enough? COVID-Related Stress and Traumatic Stress for Black Adults

Abstract

Keywords

Post-Traumatic Stress and Black Americans

The Psychological Burden of the COVID-19 Pandemic for Black Americans

Resilience and Black Adults

Current Study

Method

Participants

Measures

Demographics

Epidemic-Pandemic Impacts Inventory

Brief Resilience Scale

The Abbreviated Post-Traumatic Checklist—Civilian Version

Procedure

Results

Preliminary Analysis

Tests of Main Effects and Moderation

Discussion

Limitations

Future Directions

Implications and Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

References