Speaking of Psychology: Improving health care with psychology, with Elizabeth Brondolo, PhD

Where we live, work or socialize have an impact on our health. Poverty greatly increases the risk of heart disease, depression and stress, as do racism and ethnic discrimination, according to numerous psychological studies. In this episode, Elizabeth Brondolo, PhD, talks about how psychologists are taking the findings from those studies and using them in medical settings in an effort to improve patients’ quality of care.

Elizabeth Brondolo, PhD, is a professor of psychology at St. John’s University in New York, as well as a practicing psychologist. She is a nationally recognized researcher in stress and health and specializes in the treatment of bipolar disorder, post-traumatic stress disorder and obsessive compulsive disorder. Brondolo is also chair of the American Psychological Association’s Working Group on Stress and Health Disparities.

Since 2000, her work has focused on researching how racism and ethnic discrimination can affect people’s health, including their risk for heart disease. She has developed a community-based research program with Jamaica Hospital Medical Center and Flushing Hospital Medical Center, where her students share knowledge of research methods and behavioral science with the family medicine residents to improve patients’ quality of care.

Audrey Hamilton: Our environment – where we live, work, socialize – can actually have an effect on our health and well-being and those effects can be deadly. If people are stressed because they’re struggling to pay the bills or are facing ongoing aggression in the form of discrimination, research shows people’s health suffers. But how do we know this? How do we change it?

In this episode, we talk with one psychologist who takes the psychological research from the lab into medical settings – helping patients and their doctors improve their care and their quality of life.

I’m Audrey Hamilton and this is Speaking of Psychology.

Elizabeth Brondolo is a professor of psychology at St. John’s University in New York. She is also chair of the American Psychological Association’s working group on stress and health disparities. Her research on the health effects of racism and ethnic discrimination has led to efforts to improve the quality of care to ethnically and economically diverse communities in and around the New York area. Welcome, Dr. Brondolo.

Elizabeth Brondolo: Thank you very much for having me.

Audrey Hamilton: For most of your career, you’ve researched the health effects of stress, specifically heart disease and particularly in minorities and lower income populations. What differences did you find in how these populations experience stress?

Elizabeth Brondolo: There’s several differences. First, low income and many racial and ethnic minority individuals face more stress and they face more stress that they can report. They have more experiences of, for example, more severe, objectively severe daily hassles. They have more negative life events – things like divorce or problems in housing then people of higher socio-economic stress. And for many low income people and certain ethnic racial minorities, they’re also exposed to more trauma, including trauma that results from violent assault across their lifespan.

But they also have other kinds of stressors. So for example, people who have low SES are more likely to get divorced. People who live in very structurally disadvantaged communities may experience more child maltreatment. They’re exposed to more indoor pollution in their homes – things like lead and vermin and certain poor quality housing and in some cases but not in every part of the country, they’re exposed to more outdoor pollution and more crime and violence. So, they’re exposed overall to more stressors. Those stressors themselves change because they create a context that people live in and they change the way people think and feel about themselves, about other people and the world at large. So discrimination is a stressor that’s faced by many groups and racial or ethnic discrimination changes the way people think and feel about themselves, but most importantly, about other people. So when people face discrimination it changes the way their expectations about the way other people are going to treat them. So it may make them more concerned about being judged or being rejected or excluded because of their race or ethnicity. And those are the kinds of changes in thinking that effect people throughout the day and potentially change their relationships, their approach to other people, but also their physiological responses to those interchanges. Exchanges that they have with other people.

Audrey Hamilton: And what do you mean by physiological responses?

Elizabeth Brondolo: Well, one area of research that we’re currently exploring is the degree to which it changes, for example, blood pressure responses or inflammatory responses when people are engaging with other individuals. So it is the case actually that when you’re looking at individuals who are in sexual minority groups or racial or ethnic minority groups, there’s a consistent effect of discrimination on smoking, for example. And for African Americans, there’s increasing evidence that discrimination is related to changes in obesity over time. But not all groups are equally at risk for obesity or for smoking or for binge drinking, for example. But it is important to understand that discrimination itself has effects on the rates of smoking and how frequently people smoke and it has effects and potentially has some effects on changes in obesity over time.

Audrey Hamilton: There are also environmental stressors, particularly in lower income communities. Can you talk more about what those are and how they can impact people’s health?

Elizabeth Brondolo: This is a very interesting new line of research, which suggests that certain kinds of environmental threats, like lead exposure, may actually potentiate your reactivity – cardiovascular reactivity – to other kinds of stress. So, understanding the ways in which environmental exposures make changes maybe in the expression of our genes or the regulation of our autonomic nervous system, cardiovascular system, that’s an area of research that’s really important.

Audrey Hamilton: It sounds like you have a really interesting job where you’re able to sort of work on both sides of the psychological spectrum in the field and the research.

Elizabeth Brondolo: I really love working with the patients and testing different hypotheses and making relationships at the time. And I also really love working with the students, being able to generate new hypotheses and testing them out in the field.

And in fact, I’ll tell you about an exciting thing that we’re doing in collaboration -- that St. John’s University is doing in collaboration with Jamaica Hospital Medical Center. We’ve developed the collaborative health integration research program, which we call CHIRP and our logo is actually a little bird with a lab coat. But what’s really exciting about this program is that it’s a real integration of research and clinical practice. So we have family medicine residents participating. Clinical psychology graduate students and experimental psychology graduate students, undergraduates from the psychology program and even high school students from advanced high schools in the city all working together to do research on health disparities and they test their ideas in the field and in the lab. So that’s been a wonderful opportunity to do that kind of multidisciplinary research that is really necessary to reduce health disparities.

Audrey Hamilton: Well thank you so much for coming and talking with us today. I really, really appreciate it.

Elizabeth Brondolo: Okay. Thank you.

Audrey Hamilton: Thanks for listening. To hear more episodes, please go to our website. With the American Psychological Association’s Speaking of Psychology, I’m Audrey Hamilton.