Racial Discrimination as a Traumatic Bedrock of Healthcare Avoidance: A Pathway Through Healthcare Institutional Betrayal and Mistrust

作者：Pedram Rastegar, Liming Cai, Jennifer Langhinrichsen‐Rohling · 发表于：Healthcare · 年份：2025 · DOI：10.3390/healthcare13050486 · 被引用次数：13 · 研究领域：Racial and Ethnic Identity Research、Migration, Health and Trauma、Race, History, and American Society

Objectives: Experiences of racial discrimination within the healthcare system are potentially traumatic events (PTEs) that have been associated with lowered perceived trust in healthcare providers, ongoing symptoms of PTSD and depression, and anticipated healthcare avoidance. Based on the BITTEN trauma impact model, we test a pathway such that greater past healthcare discrimination would be associated with anticipated future healthcare avoidance among BIPOC college students. We posited that this direct relationship would be sequentially mediated by healthcare institutional betrayal (HIB) during one’s worst healthcare event and subsequently reduced trust in healthcare. Methods: Our model was tested in a subsample of undergraduate students, all of whom self-identified with at least one minoritized racial or ethnic identity (n = 472). Participants reported on their past experiences with racial discrimination in healthcare. Each then chose and described their worst and/or most traumatic previous healthcare experience. Subsequently, they indicated if this experience included acts of HIB and/or led to medical mistrust. Finally, they reported on the degree to which they anticipated engaging in future healthcare avoidance. Results: Our model explained 31% of the variance in anticipated healthcare avoidance. As hypothesized via BITTEN, greater HIB during one’s worst or most traumatic healthcare experience and resulting mistrust in healthcare sequentially mediated the relationship betw...