Measurement of Intersectional Microaggressions: Conceptual Barriers and Recommendations.

Since Crenshaw coined the term "intersectionality" in 1989, researchers of bias have struggled with how to capture the complexity and intricacies of intersectional identities and microaggressions experienced by individuals holding these identities within the quantitative framework that dominates psychology. Although scholarship has grown in the exploration of experiences such as racialized sexual harassment, or sexual racism within queer and trans communities, there is no strong consensus on how this might be measured systematically in ways that allow for inferences regarding the experiences of populations of interest. With an emphasis on the experiences of queer and trans people of color, this article explores intersectional identities through three main points: First, we define what is meant by intersectionality and the real-world experiences that are important for advancing an understanding of microaggressions; second, we review the existing measures and their ability to capture the breadth and depth of the lived experience of those with intersectional identities; and third, we propose a framework for the development of a more accurate and comprehensive measure of microaggressions.

Rupture resolution strategies and the impact of rupture on the working alliance after racial microaggressions in therapy.

Despite a growing literature on racial microaggressions, little is known about the racial microaggression experiences of people of color in therapy, nor the effectiveness of strategies used by therapists to repair the harm of therapy racial microaggressions and cultural ruptures. This study used a mixed methodology to examine the occurrence of racial microaggressions in therapy and their potential impact on the participants' relationship with their therapist. Participants included 128 self-identified people of color who have had at least 1 counseling session and were recruited from across the United States. Results suggested that experiencing racial microaggressions negatively impacted the client-therapist relationship and that clients of color had more positive therapeutic alliances when their therapists engaged in active cultural repair strategies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Depression and perceived stress as mediators between racial microaggressions and somatic symptoms in college students of color.

The current study examined the ability of mental health indicators, namely depression and perceived stress, to mediate the relationship between racial microaggressions and health among a racially/ethnically diverse sample of 467 college students of color. Consistent with what was hypothesized, the main findings revealed that depression and perceived stress mediated the relationships between types of racial microaggressions, specifically low-achieving, invisibility, and criminality, and somatic symptoms. The study results suggest that there may be multiple pathways by which specific racial microaggressions might be associated with psychological and somatic health indicators. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Assessing Racial Microaggression Distress in a Diverse Sample.

Racial microaggressions are everyday subtle or ambiguous racially related insults, slights, mistreatment, or invalidations. Racial microaggressions are a type of perceived racism that may negatively impact the health and well-being of people of color in the United States. This study examined the reliability and validity of the Racial Microaggression Scale distress subscales, which measure the perceived stressfulness of six types of microaggression experiences in a racially and ethnically diverse sample. These subscales exhibited acceptable to good internal consistency. The distress subscales also evidenced good convergent validity; the distress subscales were positively correlated with additional measures of stressfulness due to experiencing microaggressions or everyday discrimination. When controlling for the frequency of one's exposure to microaggression incidents, some racial/ethnic group differences were found. Asian Americans reported comparatively lower distress and Latinos reporting comparatively higher distress in response to Foreigner, Low-Achieving, Invisibility, and Environmental microaggressions. African Americans reported higher distress than the other groups in response to Environmental microaggressions. Results suggest that the Racial Microaggressions Scale distress subscales may aid health professionals in assessing the distress elicited by different types of microaggressions. In turn, this may facilitate diagnosis and treatment planning in order to provide multiculturally competent care for African American, Latino, and Asian American clients.

Teaching for social justice and social action.

Social justice education involves promoting critical awareness of social inequalities and developing skills that work against these inequalities. This article describes a general theoretical framework for social justice education, describes general strategies for facilitating students' social justice awareness and engagement, identifies challenges to social education, and highlights articles in the special issue that address these themes.

Values and religiosity as predictors of engagement in social justice.

Some researchers have suggested that values, including religious values and motivations, might facilitate social justice work. Individuals might view social justice work as an expression of religious beliefs, values, and practices, or as an expression of their personal morals and values. The current study examined the role of religious variables and secular values to predict attitudes, intentions to engage in social justice, perceived norms around social justice, and perceived ability to engage in social justice within a culturally and religiously diverse student population. Implications of the study results for social justice education are presented and discussed.

The Racial Microaggressions Scale (RMAS): a new scale to measure experiences of racial microaggressions in people of color.

Racial microaggressions refer to the racial indignities, slights, mistreatment, or offenses that people of color may face on a recurrent or consistent basis. Racial microaggressions may represent a significant source of stress endured by people of color. The purpose of this study was to develop a scale to measure racial microaggressions. Exploratory factor analyses and confirmatory factor analyses were used to assess the dimensionality of the scale. The internal reliability, convergent validity, and concurrent validity of the scale were also explored. Results indicated that the Racial Microaggression Scale is a multidimensional tool to assess perceptions of racial microaggressions by people of color.

Development and psychometric evaluation of the Social Justice Scale (SJS).

The study describes the development of the Social Justice Scale (SJS). Practitioners, educators, students, and other members of the community differ on their attitudes and values regarding social justice. It is important to assess, not only individuals' attitudes and values around social values, but also other constructs that might be related to social justice behaviors. The implication of Ajzen in Organizational Behavior and Human Decision Processes 50:179-211, (1991) theory of planned behavior suggests that attitudes, perceived behavioral control, and social norms predict intentions, which then lead to behaviors. A scale was designed to measure social justice-related values, attitudes, perceived behavioral control, subjective norms, and intentions based on a four-factor conception of Ajzen's theory. Confirmatory factor analysis and analyses for reliability and validity were used to test the properties of the scale.

The "Virtual" Panel: A Computerized Model for LGBT Speaker Panels.

Recent societal trends indicate more tolerance for homosexuality, but prejudice remains on college campuses. Speaker panels are commonly used in classrooms as a way to educate students about sexual diversity and decrease negative attitudes toward sexual diversity. The advent of computer delivered instruction presents a unique opportunity to broaden the impact of traditional speaker panels. The current investigation examined the influence of an interactive "virtual" gay and lesbian speaker panel on cognitive, affective, and behavioral homonegativity. Findings suggest the computer-administered panel is lowers homonegativity, particularly for affective experiential homonegativity. The implications of these findings for research and practice are discussed.

The impact of energy modulation on physical functioning and fatigue severity among patients with ME/CFS.

OBJECTIVE: The energy envelope postulates that patients with Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS) will improve functioning when maintaining expended energy levels at the same level as available energy level. METHODS: Estimated weekly Energy Quotients were established by dividing expended energy level by perceived energy level and multiplying by 100. Two groups of patients were identified following participation in a non-pharmacologic intervention trial. Some were able to keep expended energy close to available energy and others were not successful at this task. RESULTS: Those who were able to stay within their energy envelope had significant improvements in physical functioning and fatigue severity. CONCLUSION: Findings suggest that helping patients with ME/CFS maintain appropriate energy expenditures in coordination with available energy reserves can help improve functioning over time. PRACTICE IMPLICATIONS: Health care professionals that treat patients with ME/CFS might incorporate strategies that help patients self-monitor and self-regulate energy expenditures.

Activity Logs as a Measure of Daily Activity Among Patients with Chronic Fatigue Syndrome.

BACKGROUND: Self-report data collected through interviews has been one of the primary ways of assessing symptoms of patients with chronic fatigue syndrome (CFS). An alternative way to collect data involves activity logs, which involves patients writing down the pattern, intensity, and qualitative nature of activity over several days. AIMS: We examined the associations between activity, evaluation of activity and symptoms. METHODS: Activity log data over a two day period of time were used in the present study using a sample of patients with diagnosed CFS. RESULTS: Findings indicated that the percent of time spent feeling fatigued was positively associated with a higher percent of time in pain and doing activities that were fatiguing. However, time spent in meaningful activities was associated with less fatigue. CONCLUSIONS: These findings and others suggest that activity logs can provide investigators and clinicians with valuable sources of data for understanding patterns of behavior and activity among patients with CFS.

The Energy Envelope Theory and myalgic encephalomyelitis/chronic fatigue syndrome.

Individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have little stamina and endurance, and pose a challenge for nursing professionals. The Energy Envelope Theory, which posits that maintaining expended energy levels consistent with available energy levels may reduce the frequency and severity of symptoms, is particularly useful when working with clients with ME/CFS. Anecdotal support from the client community for this theory supports its use as a management tool for ME/CFS, but little formal research has been done in this area. In this study, a daily energy quotient was established by dividing the expended energy level by the perceived energy level and multiplying by 100. It was predicted that those participants who expended energy beyond their level of perceived energy would have more severe fatigue and symptoms and lower levels of physical and mental functioning. Findings are congruent with the Energy Envelope Theory as they indicated that the daily energy quotient was related to several indices of functioning including depression, anxiety, fatigue, pain, quality of life, and disability. The overall results provide support for a strategy health care professionals can use when working with clients with ME/CFS.

Factors associated with early attrition from psychosocial rehabilitation programs.

This study aimed to identify characteristics associated with early dropout from a vocationally oriented psychosocial rehabilitation (PSR) program for clients with severe mental illness. The sample consisted of 194 individuals who participated in a study comparing a supported employment program to a stepwise vocational program. Study participants who dropped out of the PSR program within 6 months of study entry were compared to those who continued for at least 6 months. Dropouts had poorer competitive employment outcomes than those who continued. Participants with at least a high school diploma, never married, with a schizophrenia-spectrum diagnosis, and those assigned to a stepwise model of vocational rehabilitation were more likely to dropout. The implications of these findings are discussed.

The economic impact of ME/CFS: individual and societal costs.

BACKGROUND: ME/CFS is characterized by debilitating fatigue in addition to other physical and cognitive symptoms. It is estimated to affect over 800,000 adults in the U.S. ME/CFS often results in diminished functionality and increased economic impact. The economic impact of an illness is generally divided into two categories: direct and indirect costs. Despite high prevalence rates and the disabling nature of the illness, few studies have examined the costs of ME/CFS at the individual and societal level. In fact, of the four studies examining the economic impact of ME/ME/CFS only two used a U. S. sample. The current study used community and tertiary samples to examine the direct costs of ME/CFS. METHODS: Using archival data, Study 1 examined the direct cost of ME/CFS in a community-based sample in Chicago. Study 2 estimated the direct cost of ME/CFS in a tertiary sample in Chicago. Both Study 1 and Study 2 assessed direct costs using office visit costs, medical test costs, and medication costs. RESULTS: For Study 1, the annual direct total cost per ME/CFS patient was estimated to be $2,342, with the total annual direct cost of ME/CFS to society being approximately $2 billion. In Study 2, the annual direct was estimated to be $8,675 per ME/CFS patient, with the total annual direct cost of ME/CFS to society being approximately $7 billion. CONCLUSION: Using ME/CFS prevalence data of 0.42 and indirect costs estimates from Reynolds et al. (2004), the direct and indirect cost of ME/CFS to society was estimated to be $18,677,912,000 for the community sample and $23,972,300,000 for the tertiary sample. These findings indicate that whether or not individuals are recruited from a community or tertiary sample, ME/CFS imposes substantial economic costs.

Fatigue among Spanish- and English-speaking Latinos.

The present study investigated sociodemographic differences, fatigue severity, and the occurrence of prolonged or chronic fatigue reported by Spanish-speaking and English-speaking Latinos. The sample included 2,102 English-speaking Latinos and 1,348 Spanish-speaking Latinos interviewed as part of an epidemiological study of persons with chronic fatigue syndrome in the Chicago area. Results indicated that English-speaking Latinos scored higher on measure of fatigue than Spanish-speaking Latinos. Further, language status continued to be a predictor of fatigue level even when controlling for other sociodemographic differences found between the groups. Findings suggest that language spoken in Latino populations is important in predicting fatigue, and point to the potential importance of cultural factors such as acculturation or acculturative stresses.

Evidence for T-helper 2 shift and association with illness parameters in chronic fatigue syndrome (CFS).

Few immunological markers have been consistently reported in CFS. However, a shift to a T-helper 2 (Th2) type immune response has been hypothesized for individuals with CFS. The current study investigated whether individuals with CFS who exhibited a stronger shift towards a Th2 type of immune response would also exhibit more severe symptoms, poorer neurocognitive functioning, and poorer physical and psychosocial functioning. The current investigation measured the percentage of Th1-like and Th2-like memory cells using cell surface flow cytometry in 114 individuals with CFS. The associations between the ratio of Th1 and Th2 memory cells and various illness parameters measures were then examined, including symptom severity, psychiatric functioning, neurocognitive functioning, salivary cortisol levels, and chronic pain status. Results indicated that individuals who exhibited a more extreme shift towards a Th2 immune response also exhibited poorer sleep and high levels of basal salivary cortisol. The implications of these findings are discussed.

The associations between basal salivary cortisol and illness symptomatology in chronic fatigue syndrome.

Hypocortisolism has been reported in chronic fatigue syndrome (CFS), with the significance of this finding to disease etiology unclear. This study examined cortisol levels and their relationships with symptoms in a group of 108 individuals with CFS. CFS symptoms examined included fatigue, pain, sleep difficulties, neurocognitive functioning, and psychiatric status. Alterations in cortisol levels were examined by calculation of mean daily cortisol, while temporal variation in cortisol function was examined by means of a regression slope. Additionally, deviation from expected cortisol diurnal pattern was determined via clinical judgment. Results indicated that fatigue and pain were associated with salivary cortisol levels. In particular, variance from the expected pattern of cortisol was associated with increased levels of fatigue. The implications of these findings are discussed.

The prevalence of chronic fatigue syndrome in Nigeria.

The present study found adult rates of chronic fatigue syndrome (CFS) in Nigeria that were somewhat higher than rates from community-based CFS epidemiologic studies in the USA. The rates of chronic fatigue for both adults and children were also higher than in existing community-based studies. It is possible that the presence of several fatiguing illnesses such as malaria and typhoid, the lack of adequate healthcare resources and poverty in Nigeria, place individuals at greater risk for fatigue and its syndromes. There is a need for more epidemiologic studies on the prevalence and sociodemographic characteristics of CFS in developing countries.

Differential diagnosis of chronic fatigue syndrome and major depressive disorder.

The goal of this study was to identify variables that successfully differentiated patients with chronic fatigue syndrome, major depressive disorder, and controls. Fifteen participants were recruited for each of these three groups, and discriminant function analyses were conducted. Using symptom occurrence and severity data from the Fukuda et al. (1994) definitional criteria, the best predictors were postexertional malaise, unrefreshing sleep, and impaired memory-concentration. Symptom occurrence variables only correctly classified 84.4% of cases, whereas 91.1% were correctly classified when using symptom severity ratings. Finally, when using percentage of time fatigue reported, postexertional malaise severity, unrefreshing sleep severity, confusion-disorientation severity, shortness of breath severity, and self-reproach to predict group membership, 100% were classified correctly.

Causes of death among patients with chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a debilitating illness affecting thousands of individuals. At the present time, there are few studies that have investigated causes of death for those with this syndrome. The authors analyzed a memorial list tabulated by the National CFIDS Foundation of 166 deceased individuals who had had CFS. There were approximately three times more women than men on the list. The three most prevalent causes of death were heart failure, suicide, and cancer, which accounted for 59.6% of all deaths. The mean age of those who died from cancer and suicide was 47.8 and 39.3 years, respectively, which is considerably younger than those who died from cancer and suicide in the general population. The implications of these findings are discussed.