Discrimination and the HPA axis: current evidence and future directions

David Busse, Ilona S. Yim, Belinda Campos, Christopher K. Marshburn

Research output: Contribution to journalReview articlepeer-review

77 Scopus citations


Numerous studies suggest that discrimination is associated with poor physical and mental health outcomes. Whereas the cardiovascular system has been extensively studied as a potential pathway linking discrimination with disease, the role of the hypothalamic–pituitary–adrenal (HPA) axis remains understudied. We conducted a systematic review of research on discrimination and related constructs as predictors and correlates of HPA axis activity. Twenty seven studies (10 experimental, 17 observational) met inclusion criteria. Studies suggest that discrimination is associated with alterations in HPA axis activity and that the direction of this association depends on the timing and chronicity of the discrimination experience. There is also evidence of important modulating variables (race, socioeconomic status) and contextual confounders (emotional, situational) that warrant further study. Accounting for the HPA axis in addition to the cardiovascular system will contribute to a more comprehensive understanding of the biobehavioral pathways contributing to physical and mental health inequities related to discrimination.

Original languageEnglish
Pages (from-to)539-552
Number of pages14
JournalJournal of Behavioral Medicine
Issue number4
StatePublished - Aug 1 2017

Bibliographical note

Publisher Copyright:
© 2017, Springer Science+Business Media New York.


  • Cortisol
  • Discrimination
  • Prejudice
  • Stigma
  • Stress

ASJC Scopus subject areas

  • General Psychology
  • Psychiatry and Mental health


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