Analyzing How the Pandemic's Financial, Psychological Impacts Differed by Race

Over recent years, conversations about inequity and social determinants of health have been brought to the forefront of the health care industry, as COVID-19 affected various communities differently across the United States.

In a cross-sectional, web-based study, Dr Carolyn Schwartz and coinvestigators analyzed race-related differences in how the pandemic impacted finances, psychological wellness, and health care access. In this interview with Integrated Healthcare Executive, Dr Schwartz reviews key findings from the study and offers insight into how health care professionals can support patient resilience and well-being.

What inspired your research into the race-related differences in the pandemic's impact?

Before we knew better, I thought COVID-19 would be a great equalizer. I was struck by how my colleagues all over the world were dealing with the same lockdown. Then, research started to emerge showing people of different races had very different experiences, especially non-White individuals.

We started a study on COVID-19 resilience in spring/summer 2020, and we have collected data 3 times so far. We worked with a panel research organization that helped to ensure we had a robust number of people who were not White. Most of the time, with survey research, if you ask a random sample of people to participate, you get a lot of White people and few non-White people participating. But in this case, we could over-sample, if you will, to reflect the general population.

Having more non-White participants allowed us to do this series of analyses.

Can you walk through how your study was designed, and any major findings that stood out?

We looked at the data 2 different ways, because it is important to know that what we were finding was true and not just a result of selection bias. One way was adjusting for covariates in the model, and another way was matching on those covariates in a different model. We found the results were consistent in both models, which was quite reassuring.

We studied the impact of different COVID-19-specific variables using items suggested by the National Institutes of Health (NIH). We evaluated health-enhancing behavioral strategies, which we referred to as coping with lockdown. This included positive coping behaviors like getting exercise every day, eating healthfully, etc. Positive emotional resources included social support and posttraumatic growth. Posttraumatic growth is the idea of looking at a challenge and trying to find a silver lining. It can include faith-based coping and involves reframing the experience into an opportunity for growth instead of only a negative.

Negative social and emotional resources included interpersonal conflict and worry about self. There were also several economic hardship variables, including financial impact on the family, lack of money, inadequate access to health care, and housing instability.

Our outcome was DeltaQuest's wellness measure, which is a 15-item measure, developed before COVID-19, that taps attitudes and perspectives related to wellness. We found wellness was below average across racial groups.

In coping with lockdown, White and Asian individuals were on the healthier side. These groups did more positive coping, whereas Black and American Indian individuals and those of multiple races did not have as many healthy coping behaviors.

Additionally, Black, Asian, and American Indian individuals and those of multiple races had much lower social support than White individuals.

We also found Hispanic individuals reported lower levels of positive behavioral strategies and higher levels of negative stressors or hardship-related variables.

The most interesting finding of this paper is that posttraumatic growth was much higher among non-White individuals. Non-White individuals reported lower levels of social and economic resources, but higher levels of posttraumatic growth compared to White individuals.

Also, because the relationships between COVID-19-specific stressors and wellness were similar across racial groups, this paper underscores that race is a social construct, not a biological construct. In other words, there is nothing about race that determines that people are going to have worse outcomes. Worse outcomes are because of the social context, which needs to change.

Our study has some advantages. We had a large sample size, and we collected a comprehensive set of variables. By using two models, we confirmed that the findings were robust to selection bias.

The limitations were that there were more White than non-White people, and the specific samples of racial groups were not large enough to do interaction analyses for specific race groups. It is possible, for example, that we missed some relationships that differed across non-White groups. Also, the NIH items we used for the COVID-19 specific variables are decently written but are not as reliable and valid as more formally developed scales.

The conclusions are as follows: race is a social construct, not a biological fact; there were race-related disparities in resources; and COVID-19 was a source of worry and even interpersonal conflict. But it also unlocked people's resources in terms of health-enhancing behavioral strategies, social support, and renewed gratitude.

How do you think these findings can inform health care professionals?

When I published this paper a few months ago, I did a quick search at the end to make sure I had not missed any recent scientific papers on this topic, and it seemed that while there is a large evidence base suggesting worse health outcomes and health care access during COVID-19 among people of color, there are very few examining the more psychosocial outcomes like what we studied. This body of research tells a consistent message, nonetheless: people who are not White have worse outcomes and experiences with COVID-19.

From my perspective, that means if you are a health care professional, go the extra mile with non-White individuals. Ask more questions, particularly about the psychosocial factors we addressed in our study: positive coping behaviors, social support resources, interpersonal conflict, economic hardship, and posttraumatic growth.

I believe it would be worthwhile to try to help everyone engage in posttraumatic growth. This would, for example, mean appreciating the value of one’s life, being aware of the people we can count on, recognizing the greater sense of closeness to others that came from the pandemic, and developing a stronger spiritual or religious faith. Maybe try to be  kinder to others. Maybe it would lead to less horrible divisiveness that we see in our culture right now. Trying to get more people to think about that silver lining would help.

Thank you. Do you intend to expand on this research?

I hope so. We have just finished a paper looking at depression over the course of the pandemic which used 18-months of follow-up data. We are also finishing a paper looking at how cancer survivors fared compared to people without cancer. We have one more data collection coming up, at which time we will look at Long COVID-19 effects. We hope to be able to expand on the race-related findings using the longitudinal data.

About Dr Schwartz

Carolyn Schwartz, ScD, is the President and Chief Scientist at DeltaQuest Foundation, Inc. She is also an Adjunct Research Professor at Tufts School of Medicine in the Departments of Medicine and Orthopedic Surgery.