Date of Award

Spring 5-13-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)

Department

Clinical Psychology

First Advisor/Committee Member

Keyne C. Law

Second Advisor/Committee Member

Jacob A. Bentley

Third Advisor/Committee Member

Sammuel B. Rennebohm

Abstract

There is a pressing need to address the significant health disparities of underrepresented groups such as racial and ethnic minorities (Mills et al., 2020). As of 2019, individuals identifying as a racial or ethnic minority make up 40% of the U.S population as of 2019, yet they fare significantly worse across many health-related measures (Hill et al., 2022). Given these disparities in healthcare and health outcomes, racial and ethnic minorities represent an important group to investigate somatization and health-related quality of life (HRQOL). Cognitive appraisals, such as perceived injustice and symptom catastrophizing, may mediate this relationship, influencing how somatization translates into reduced HRQOL given the association between maladaptive cognitive appraisals and physical and mental health outcomes (Seto & Nakao, 2017; Trost et al., 2018). Additionally, structural racism, discrimination, and lack of culturally competent care and resources perpetuates perceived injustice and the significant gap in healthcare outcomes among racial-ethnic minorities (Trost et al., 2018; van Ryn & Fu., 2003). Despite the large representation of racial-ethnic minorities within the U.S population, relatively little is known how somatization impacts HRQOL in racial-ethnic minorities and there remains a gap in understanding the processes occurring in the individual that impacts the relationship between somatization and HRQOL. This study sought to expand on the current understanding of somatization and healthcare disparities by investigating the mediating effects of symptom catastrophizing and perceived injustice on the relationship between somatization and HRQOL in racial-ethnic minorities.

Results indicated that higher somatization scores significantly predicted worse HRQOL outcomes, both physically and emotionally. Parallel mediation analyses demonstrated that somatization significantly predicted symptom catastrophizing (b=0.50, p< .001) and perceived injustice (b=1.48, p< .001). The total indirect effect of somatization on physical health through both mediators was significant (b=-1.05, 95% CI [-1.68, -0.51]), although neither mediator independently reached statistical significance. However, perceived injustice independently mediated the relationship between somatization and emotional health significantly (b=-0.81, 95% CI [-1.49, -0.16]), while symptom catastrophizing did not significantly mediate this relationship. This suggests external attributions of injustice may intensify emotional distress more broadly than symptom catastrophizing and further suggests the need for further exploration of factors impacting the relationship between somatization and HRQOL in racial-ethnic minorities.

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