Tag Archives: intersectionality

Finding Meaning in Life and in Death: A Call to Culturally Competent Action

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This is the second of three blog posts on grappling with end-of-life issues. Posts will go up for the next two Fridays. Subscribe to our Psychology Benefits Society blog to stay updated.

By Keisha Carden, MA (Doctoral Clinical Geropsychology Student, University of Alabama)

“Technically, I am still alive, but I’ve been dead for a long time. What was the meaning of it all?”

Elaina, seemed to be elsewhere as she shared this, her face void of affect. She was my 68-year-old in-home hospice patient suffering from a myriad of chronic health conditions with little time left to live. While I had used meaning-centered interventions with other clients, none had lived a life quite like this—a life peppered with physical, sexual, and emotional abuse, substantial self-harm, onerous failed attempts at healthy relationships and adaptive coping strategies, and an intimate familiarity with discrimination and prejudice. How could I help her make meaning of the senseless trauma, violence, and hate to which she had been subjected for so long? As a well-intentioned psychology scientist-practitioner, I looked to the evidence.

Like Elaina, many of our dying patients express the need for meaning—in life and in death. In palliative care, our primary goal is to facilitate comfort and maximize quality of life. We often employ interventions that emphasize the importance of meaning-making.

Unfortunately, these interventions seem to be overly individualistic and westernized, overlooking important aspects of intersectionality and cultural variations (e.g., Carden, Murry, Matthews, & Allen, in press). For example, Allen and colleagues (2016) reviewed the existing community-based interventions aimed at reducing the burden of palliative caregiving. Ten of the 17 interventions they identified were investigated among primarily (78% – 100%) non-Hispanic White participants and five studies did not report race. It is therefore conceivable that many palliative interventions fail to effectively assess and address the needs of many cultural groups.

So how do we move forward?


Back to the Basics

Meaning-based interventions are rooted in the teaching and writings of Viktor Frankl, founder of logotherapy and holocaust survivor. At their core, they assume:

  1. human beings consist of body, mind, and spirit
  2. life has meaning under all circumstances, even the most miserable
  3. people have a will to meaning
  4. people have freedom under all circumstances to activate the will to find meaning
  5. life has a demanding quality to which people must respond if decisions are to be meaningful
  6. the individual is unique


The individual is unique…

Have we lost sight of the individual in our efforts to be prescriptive and standardized in treatment development and delivery? It may be time to go back the basics and infuse our practice with more person-centeredness.


Promising beginnings

The scientific community seems to agree and is beginning to investigate innovative and creative solutions. These endeavors include utilizing culturally competent hospice educational materials (Enguidanos, Kogan, Lorenz, & Taylor, 2011), videos aimed at improving disparities in knowledge (Volandes, Ariza, Abbo, & Paasche-Orlow, 2008), employment of patient navigators (Fischer, Sauaia, & Kutner, 2007), and other peer support programs (Hanson et al., 2013).


What can you do?

It is time for researchers and providers to tackle this issue together. Research is needed that:

  1. explores factors contributing to differences and disparities in end-of-life and palliative care
  2. evaluates the effectiveness of current end-of-life interventions among diverse groups
  3. considers appropriate and ethical modifications to said interventions to enhance quality end-of-life care for all.

In the meantime, providers must go back to the basics and rely on ethical standards to facilitate quality care to diverse patients and their families.



Allen, R. S., Noh, H., Beck, L.N., Smith L. J. (2016). Caring for individuals near the end of life. In L.D. Burgio, J.E. Gaugler, & M.M. Hilgeman (Eds.), The spectrum of family caregiving for adults and elders with chronic illness (pp. 142-172). New York, NY: Oxford University Press.

Enguidanos, S., Kogan, A. C., Lorenz, K., & Taylor, G. (2011). Use of role model stories to overcome barriers to hospice among African Americans. Journal of Palliative Medicine, 14(2), 161-168. doi:10.1089/jpm.2010.0380.

Fischer, S. M., Sauaia, A., & Kutner, J. S. (2007). Patient navigation: A culturally competent strategy to address disparities in palliative care. Journal of Palliative Medicine, 10(5), 1023-1028. doi:10.1089/jpm.2007.0070.

Hanson, L. C., Armstrong, T. D., Green, M. A., Hayes, M., Peacock, S., Elliot-Bynum, S., Goldmon, M. V., Corbie-Smith, G., & Earp, J. A. (2013). Circles of care: Development and initial evaluation of a peer support model for African Americans with advanced cancer. Health Education & Behavior, 40(5), 536-543. doi:10.1177/1090198112461252.

Volandes, A. E., Ariza, M., Abbo, E. D., & Paasche-Orlow, M. (2008). Overcoming educational barriers for advance care planning in Latinos with video images. Journal of Palliative Medicine, 11(5), 700-706.



Keisha Carden is a fourth year graduate student in Clinical Geropsychology at The University of Alabama working under the mentorship of Dr. Rebecca S. Allen. Her primary clinical and research interests include: family caregiving for older adults (with and without cognitive impairment/Alzheimer’s disease and dementia); resilience; existential/death anxiety; childhood trauma; intergenerational relationships; and outcomes and treatment mechanisms of non-pharmacological interventions that incorporate aspects of positive psychology and meaning-making.

Image source: Photo by Jake Thacker on Unsplash

Filed under: Aging Tagged: end of life, existential, gender, intersectionality, meaning, minority, palliative care, sexuality

“I’m Not Just Black!”: Exploring Intersections of Identity

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By Faye Z. Belgrave, PhD (Professor, Virginia Commonwealth University) and Sarah J. Javier, MS (Doctoral Candidate, Virginia Commonwealth University)

Through a very complete body of research, the field of psychology has established that a person’s identity is composed of several different parts. However, psychological research projects often only focus on one or two aspects of identity. As we move towards a more complete picture of human behavior, we must remember to keep in mind that the intersections of identity are a vital piece of that picture.

“Intersectionality” is a term that is coming to the forefront in psychological research. It encompasses race, ethnicity, gender, socioeconomic status, sexual orientation, and other intersecting, categorical dimensions that describe groups of people. For example, think about different parts of your identity. You may describe yourself as a single, older, African American female who makes a modest income. Or perhaps you are a young, White male who identifies as gay. These different parts of our identities make us who we are, and professionals interested in intersectionality have come to understand that these different components of identity are integral to why individuals do the things they do.

Intersectionality in National Data Sets

Data collection on the intersections of identity and how they affect health is of utmost importance. By examining combinations of identities (e.g. Gender X Race, Race X Sexual Orientation, etc.), researchers can more completely understand why some groups do better on certain health outcomes than others.

For instance, research on the intersecting identities of Race X Gender yields findings that there are different outcomes among African American males compared to, not only White males, but also African American females, including lower levels of academic achievement and higher levels of incarceration. These data can then be used to create culturally and identity-appropriate programs to decrease disparities and promote wellness among African American males.

But data aren’t perfect. And often, these identities get lost, even in well-known national data sets. For example, because it is politically charged, sexual orientation may be omitted completely from national data sets, based on the idea that children and adolescents should be protected from this information. However, research indicates that sexual orientation may develop anywhere between middle childhood and early adolescence, and being a sexual minority is associated with a host of worsened physical and mental health disparities (e.g., higher levels of suicidality, depression, substance use, risk for sexually transmitted infections, etc.). What’s more, not asking these questions limits the amount of research that can be done in exploring how sexual orientation intersects with other identities.

Youth Risk Behavioral Surveillance Survey

On August 11, 2016 the Centers for Disease Control and Prevention released sexual minority youth data from the Youth Risk Behavioral Surveillance Survey (YRBSS). The YRBSS is a survey collected from millions of 9th through 12th grade students in the continental U.S. bi-annually. The survey asks questions about a diverse array of health behaviors, including violence, sexual activity, sexually transmitted infections including HIV infection, alcohol, tobacco, and other drug use, and physical activity.

One key feature of the YRBSS is its inclusion of identities in asking these questions. For instance, the survey asks items on race, gender, grade, and includes the following items on sexual orientation:

  1. “During your life with whom have you had sexual contact?” with response items being I have not had sexual contact, females, males, or females and males; and
  2. “Which of the following describes you?” with response items being heterosexual (straight), gay or lesbian, bisexual, or not sure.

The 2015 report yielded startling findings, including that more than 40% of LGB students seriously considered suicide, while 30% attempted suicide in the past year. According to the 2015 report, LGB students were more than five times more likely than individuals identifying as heterosexual to report using multiple illegal drugs.

Research that can come from this report includes how the intersection of sexual orientation and other identities (i.e., race/ethnicity) affect these outcomes, if at all. Individuals at intersections of identity in adolescence are especially at high risk for mental and physical consequences, and intersecting identities may be a vital component to risk for these consequences. Thus, the YRBSS is setting a precedent as one can now explore different aspects of identity and their relation to health outcomes in an adolescent population.

Data from the YRBSS may also help us understand whether certain intersections of identity act as protective factors that will help to combat negative health outcomes. Potential data analyses may in fact find that being at the intersection of a marginalized group may be correlated with being less likely to engage in certain negative health behaviors. For instance, African American adult females on the whole have been shown to smoke cigarettes at lower rates compared with both African men and White women. With the YRBSS, researchers can determine if this is true at a younger age, and whether this varies by grade, gender, sexual orientation, or any combination of these identities. 

What We Can Do

  • Acknowledge different parts of individuals’ identities. Too often, we make assumptions about individuals based on surface-level interactions. It is important to acknowledge that new individuals you may meet may have different parts of their identity that can’t just be seen on the surface.
  • Use existing resources from APA. APA recently released a Resolution on Data about Sexual Orientation and Gender Identity that speaks to the importance of collecting data from diverse groups in national surveys. Behavioral health professionals can use these tools, as well as others, to make the case for conducting research on underserved populations.
  • Fill in the gaps. One major limitation of the YRBSS is that it does not ask questions on gender identity. Researchers should examine these kinds of gaps in data collection so that yet another aspect of identity can be used in studies to improve the outcomes of people of different gender identities.
  • Be an advocate. Parents of underserved children, teachers, and allies of the LGBT community can help to advocate for these individuals and push their members of Congress to pass legislation that helps to improve the lives of the LGBT population.



American Psychological Association, Task Force on Resilience and Strength in Black Children and Adolescents. (2008). Resilience in African American children and adolescents: A vision for optimal development. Washington, DC: Author. Retrieved from http://www.apa.org/pi/cyf/resilience.html

American Psychological Association. (2008). Answers to your questions: For a better understanding of sexual orientation and homosexuality. Washington, DC: Author. Retrieved from www.apa.org/topics/lgbt/orientation.pdf

American Psychological Association, Presidential Task Force on Educational Disparities.(2012). Ethnic and racial disparities in education: Psychology’s contributions to understanding and reducing disparities. Retrieved from http://www.apa.org/ed/resources/racial-disparities.aspx

Centers for Disease Control and Prevention. (2011). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9–12 — youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR, 60. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss60e0606.pdf

Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170-180. Retrieved from: http://psycnet.apa.org/journals/amp/64/3/170.html

Jamal, A., Homa, D. M., O’Connor, E., Babb, S. D., Caraballo, R. S., …, & King, B. A. (2015). Current cigarette smoking among young adults – United States, 2005-2014. MMWR, 64(44), 1233-1240. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a2.htm

Kann, L., Olsen, E. O., McManus, T., et al. (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9–12 — United States and selected sites, 2015. MMWR Surveillance Summaries, 65(No. SS-9):1–202. DOI: http://dx.doi.org/10.15585/mmwr.ss6509a1

Neal, D., & Rick, A. (2014). The prison boom and the lack of Black progress after Smith and Welch. National Bureau of Economic Research. NBER Working Paper No. 20283. Retrieved from http://www.nber.org/papers/w20283



Faye Belgrave, PhD, is a professor in the Department of Psychology at Virginia Commonwealth University. Her work is focused on cultural factors (gender, ethnicity, age) that affect the health and wellbeing of African American youth and young adults.

Sarah Javier is a doctoral candidate in Health Psychology at Virginia Commonwealth University. Her research interests include developing culturally tailored prevention programs for underserved populations.

 Image source: iStockphoto.com


Filed under: Culture, Ethnicity and Race, Health Disparities, LGBT Issues Tagged: data collection, gender, health disparities, identity, intersectionality, race, research, sexual orientation, YRBS