Abstract
BACKGROUND: Black individuals in the U.S. report experiencing the highest levels of racial discrimination in healthcare. Racial discrimination in healthcare contributes to mental health issues and has been shown to be associated with loneliness. Despite this, there is limited research on the role loneliness plays in the relationship between racial discrimination in healthcare settings and mental health outcomes. This study explored the relationship between racial discrimination in healthcare, loneliness, and mental health outcomes (depression and anxiety) among Black individuals. METHODS: This study was part of the PhillyCEAL (Community Engagement Alliance) initiative. Between February 2024 and April 2024, 327 Black Philadelphia residents completed online surveys. Multiple linear regression analyses examined the associations between racial discrimination in healthcare, loneliness, depression, and anxiety. Covariates included Hispanic ethnicity, age, insurance, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) status, sex assigned at birth, relationship status, employment, medical conditions, income, and education. RESULTS: Racial discrimination in healthcare was positively associated with loneliness (b = 0.66, 95% CI: 0.29 to 1.04), depression (b = 0.52, 95% CI: 0.19 to 0.86), and anxiety (b = 0.85, 95% CI: 0.50 to 1.19). When controlling for loneliness, the association between racial discrimination in healthcare and depression became non-significant (b = 0.29, 95% CI: -0.03 to 0.61), while the association between racial discrimination in healthcare and anxiety remained significant (b = 0.62, 95% CI: 0.29 to 0.94). CONCLUSION: Addressing racial discrimination within healthcare settings is crucial for improving mental health outcomes among Black populations. Given the significant role of loneliness in this relationship, interventions aimed at reducing loneliness may help mitigate the adverse mental health effects of racial discrimination in healthcare for Black populations.