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. 2026 Oct 20;17(1):2737042. doi: 10.1080/20008066.2026.2737042

The impact of racist events on post-trauma mental health symptoms among immigrants and refugees in Canada: the role of racial trauma

El impacto de eventos racistas sobre los síntomas de salud mental tras un trauma en inmigrantes y refugiados en Canadá: el papel del trauma racial

Ling Jin 1,CONTACT, Tina Nguyen 1
PMCID: PMC13693427  PMID: 42900598

ABSTRACT

Background: Immigrants and refugees are at greater risk of mental health symptoms, including elevated symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). For racialized immigrants and refugees, frequent exposure to racist events is one of several predictors of mental health outcomes. According to race-based traumatic stress theory, repeated exposure to racist events can undermine safety, belonging, and dignity, and may lead to racial trauma, referring to the psychological and physiological stress responses arising from such experiences. However, it remains unknown whether racial trauma plays a mediating role in the relationship between racist events and mental health symptoms. To address this gap, the present study aimed to examine racial trauma as a mediator of this relationship among racialized immigrants and refugees in Canada.

Methods: A sample of 182 immigrants and refugees in Canada (Mage = 30.76; 52.2% men; 52.7% of African descent) completed self-report measures. The mediating role of racial trauma in the relationship between racist events and mental health symptoms (PTSD, depression, anxiety) was examined using PROCESS Model 4.

Results: Results indicated that racial trauma significantly explained the relationship between racist events and mental health outcomes, including PTSD (B = 0.35, CI [0.20, 0.56]), depression (B = 0.11, CI [0.06, 0.18]), and anxiety (B = 0.12, CI [0.08, 0.17]). The model accounted for 34.02% to 46.21% of the variances in mental health outcomes.

Conclusions: Among racialized immigrants and refugees, greater exposure to racist events was associated with elevated racial trauma, which contributed to higher PTSD, depression, and anxiety symptoms. Clinicians, community organizations, and policymakers should integrate anti-racism strategies and racial trauma frameworks to support the mental health of immigrants and refugees.

KEYWORDS: Immigrants and refugees, racist events, racial trauma, PTSD, depression, anxiety

HIGHLIGHTS

  • Racialized immigrants and refugees in Canada with more exposure to racist events are more likely to show racial trauma, which may increase the risk of experiencing poor mental health.

  • Findings highlight the need to target racial trauma to reduce mental health issues when working with immigrants and refugees.

Immigrants and refugees constitute over 23% of Canada’s population (Statistics Canada, 2022). Within these communities, individuals who identify as visible minorities have long been subjected to racism and racial discrimination. Racist events share key features of Criterion A traumatic events, such as suddenness, uncontrollability, and a threatening nature (Bryant-Davis & Ocampo, 2005a; Carter, 2007). Importantly, unlike traumatic events that occur as isolated incidents, racism often manifests as frequent and cumulative exposures that include both overt and covert acts of violence (e.g. symbol, gestures, nonverbal cues, and images) as well as collective or cross-generational harms, rendering its impact both pervasive and insidious (e.g. Carter & Pieterse, 2020; Comas-Díaz et al., 2019). Despite the anti-Racism calls from Government of Canada and the Canadian tri-council call (e.g. Canadian Institutes of Health Research, 2025), the on-going racism has created perpetual foreignness and contributed to long-standing mental health challenges, such as depression, anxiety, and posttraumatic stress disorder (PTSD; Comas-Díaz et al., 2019; Jin et al., 2025). To our knowledge, no research has specifically focused on immigrants and refugees who identify as people of colour; this intersection of racialization and immigration-related marginalization warrants further attention. To this end, the current study examines the impact of experienced racism on mental health symptoms and explores emotional injury and racial trauma among this population in Canada.

Racist events and racial trauma

Racism is a structural and ideological force that operates across multiple dimensions, including individual, institutional, and cultural dimensions (Williams & Williams-Morris, 2000). Individual-level racism refers to the use of power by the dominant group to oppress marginalized groups such as people of colour (Williams et al., 2019). This form of racism manifests in everyday interactions, such as being targeted with racial slurs and racial attacks (Jones, 2000). Racialized refugees are forced to flee persecution, making resettlement the only viable path forward. When racism pervades this resettlement context, there is no safe home base to return to, making the experience of racism particularly inescapable (Williams et al., 2022). Systemic and institutional racism refers to policies, practices, and structures that advantage dominant groups while disadvantaging visible minorities (Jones, 2000; Williams, 2018). For instance, immigrants/refugees who are visible minorities often encounter heightened scrutiny, stigmatization, and structural barriers to resettlement in housing, education, healthcare, and employment (King et al., 2022; Williams, 2018c). Finally, cultural racism positions White, Euro-Canadian values and norms as superior and devalues non-Western norms while framing immigrants as ‘perpetual foreigners’ (e.g. Carter, 2008; Guo & Jin, 2025; Jones & Carter, 1996). This is pronounced for racialized refugees, whose visible minority status intersects with anti-refugee sentiment in Canada (King et al., 2022; Williams et al., 2022). Unfortunately, these multilevel and multifaceted forms of racism create a complex network and societal subsystems micro- and macro-levels, reinforcing and affecting family, friends, community, and broader social networks, resulting in cumulative negative impacts on mental health (Jin et al., 2025).

Racist events serve as stressors, referring to specific discriminatory incidents that individuals are exposed to with varying frequency (Landrine & Klonoff, 1996). According to the Race-based Traumatic Stress theory, chronic exposure to racial incidents can be traumatic in nature and produce psychological, emotional, and physical injury, known as racial trauma or race-based stress (e.g. Bryant-Davis & Ocampo, 2005a, 2005b; Butts, 2002; Carter, 2007). It is important to distinguish between racist events and racial trauma: racist events refer to the stressor (i.e. discriminatory incidents), whereas racial trauma refers to the stress response that develops from such events or cumulative exposure over time (Carter, 2007; Williams et al., 2022). Symptoms of racial trauma include a persistent sense of vulnerability, powerlessness, hopelessness, diminished self-worth, lowered energy, and low mood (Bryant-Davis & Ocampo, 2005a; Carter, 2007; Carter et al., 2013). Due to the nature that racist events elicit unwanted, uncontrollable, negative interpersonal interactions that threaten one’s sense of self, individuals may experience intrusive recollections or reliving of racist encounters, agitation, mistrust, and ongoing hypervigilance about potential harms (Pieterse et al., 2012; 2023). Racial trauma also manifests through somatic symptoms (e.g. heart palpitations, trembling, difficulty breathing), behavioural avoidance (disengagement, avoidance of reminders), and the suppression of painful memories (Carter, 2007; Carter & Pieterse, 2020). Together, these findings suggest that the frequency and severity of racist events influence the nature and intensity of racial trauma responses, as evidenced among individuals of Chinese heritage in Canada (Guo & Jin, 2025).

Racist events, racial trauma, and mental health

Racial trauma can serve as a mechanism that accounts for the link between racism and mental health symptoms such as depression, anxiety, and PTSD. PTSD develops following exposure to traumatic events, characterized by intrusions (e.g. flashbacks, nightmares), avoidance of trauma reminders, negative alterations in cognition and mood (NACM), and alterations in arousal and reactivity (AAR; hypervigilance, reckless behaviour; American Psychiatric Association, 2013). Systematic studies show that ongoing exposure to racist events can contribute to poor mental health symptoms, such as elevated symptoms of PTSD, depression, and anxiety (Kirkinis et al., 2018; Lee & Ahn, 2011; Paradies et al., 2015). More race-based traumatic stress has been linked to more PTSD (rs = .44–.53; Pieterse et al., 2024), depression, and anxiety (rs = .21–.24; Lee & Ahn, 2011; Paradies et al., 2015). Relevant to PTSD, chronic exposure to racist events can become a persistent stressor that threatens one’s dignity, safety, and self-worth, resulting in heightened racial trauma (Guo & Jin, 2025). Racial trauma, although distinct from PTSD due to its ongoing, collective, and emotional injurious nature (e.g. Comas-Díaz et al., 2019), can nonetheless contribute to more severe PTSD symptoms (Butts, 2002; Pieterse et al., 2024). This may further help explain why people of colour exhibit higher PTSD rates compared to White populations, even after accounting for general trauma exposure and other PTSD risk factors (Loo et al., 2001). As such, it is important to understand how racism and racial trauma function as unique and additive mechanisms underlying PTSD among these racialized groups (e.g. Bryant-Davis & Ocampo, 2005a, 2005b).

Relevant to depression and anxiety severity, evidence shows that people of colour who are classified as experiencing more racist events reported significantly greater depressive and anxiety symptoms (Jin et al., 2025). Immigrants and refugees exposed to more racist events may manifest racial trauma through heightened mistrust, diminished sense of belonging, negative help-seeking attitudes, and social withdrawal (Guo & Jin, 2025). These factors collectively increase the risk of depression (Mikrut et al., 2022; Pieterse et al., 2023). Regarding anxiety severity, the unpredictability and uncontrollability of racist encounters reinforce a sense of persistent threat and insecurity (Jin et al., 2025). These encounters can culminate in racial trauma, manifested through hypervigilance, intrusive recollections, persistent worry, and difficulty concentrating, which exacerbates anxiety symptoms (Carter et al., 2013; Carter & Pieterse, 2020). As such, racial trauma may serve as a pathway where repeated racist events condition individuals to anticipate threat, thereby generalizing worry, reinforcing avoidance, and perpetuating anxiety severity (Williams & Neighbors, 2001). Taken together, theories and empirical findings support that racial trauma can account for the relationship between racist events and depression/anxiety severity (e.g. Carter & Pieterse, 2020; Jin et al., 2025).

The present study

Racialized immigrants and refugees experience multiple levels of racism stemming from immigration, exclusion, and perceived foreignness, perpetuated by colourism, which further contributes to racial trauma and mental health symptoms. Prior research has documented associations between racist events and mental health outcomes among racialized populations (Jin et al., 2025), and racial trauma has been examined in relation to mental health outcomes among racialized communities in Canada (e.g. Butts, 2002; Pieterse et al., 2024). However, studies specifically examining racial trauma as a mediating mechanism among racialized immigrants and refugees in Canada remain limited. Among this population, trauma is often collective (vs. individualized), structural, and cumulative, especially given collectivist and family-oriented cultural values. The present study aimed to examine the mediating role of racial trauma in the association between racist events and mental health symptoms (i.e. PTSD, depression, and anxiety) among racialized immigrants and refugees living in Canada. Such research can inform the development of trauma-informed, culturally responsive treatments for this population. We hypothesized that more frequent racist events would be significantly and positively associated with PTSD symptom severity, depression symptom severity, and anxiety symptom severity (Hypothesis 1). We also hypothesized that racial trauma would be significantly and positively associated with PTSD symptom severity, depression symptom severity, and anxiety symptom severity (Hypothesis 2). Finally, we hypothesized that exposure to more racist events would indirectly associate with PTSD/depression/anxiety symptom severity through racial trauma (Hypothesis 3). See the proposed model displayed in Figure 1.

Figure 1.

Three diagrams showing racist events pointing to racial trauma, which in turn points to PTSD severity, depression severity, and anxiety severity. The figure shows three mediation diagrams arranged vertically and labeled with lowercase letters on the right: a, b, and c. Each diagram contains three rectangular boxes with text and directional arrows connecting them. In all three diagrams, a left box contains the text Racist Events, a centered upper box contains the text Racial Trauma, and a right box contains the name of a mental health outcome. In diagram a, the right box reads PTSD Severity. A straight horizontal arrow points from Racist Events to PTSD Severity. A diagonal arrow points up from Racist Events to Racial Trauma, and another diagonal arrow points down from Racial Trauma to PTSD Severity. In diagram b, the right box reads Depression Severity. The same three arrows appear: a horizontal arrow from Racist Events to Depression Severity, an upward diagonal arrow from Racist Events to Racial Trauma, and a downward diagonal arrow from Racial Trauma to Depression Severity. In diagram c, the right box reads Anxiety Severity, with the same arrangement of boxes and arrows linking Racist Events, Racial Trauma, and Anxiety Severity.

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Conceptual diagram for proposed mediation model.

Methods

Procedure and participants

The University of Calgary's Research Ethics Board approved this study. The research team collected data through: (1) reaching out to refugee organizations and resettlement services across Canada, such as the Calgary Catholic Immigration Society, the Centre for Newcomers in Calgary, Bow Valley Direction for Immigrants Calgary, Saskatoon Open Door Society, the Toronto Newcomer Office, and the Ottawa Community Immigrant Services Organization; (2) word of mouth and personal/professional contacts; and (3) the University of Calgary's recruitment research portal. The eligibility criteria for this study were: (a) 18–65 years of age, (b) self-identified as an immigrant or refugee, (c) identified as a visible minority (i.e. a person other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour), (d) a current resident of Canada, (e) able to provide informed consent, and (f) able to read and write English. Participants who were eligible and provided valid responses were compensated with a 15 Canadian dollar gift card.

Of the 406 responses, 89 were ineligible, 54 failed the attention-check questions, 25 showed duplicated responding, 54 had a response time shorter than 10 min (below 2 SD), and 2 participants had more than 30% missing on the racial trauma scale. The final sample included 182 immigrants and refugees (Mage = 30.76, SD = 5.59). The majority of the sample identified as men (n = 95, 52.2%) and are of African descent (n = 96, 52.7%). See Table 1 for detailed demographic information.

Table 1.

Information on sample characteristics (N = 182).

  M SD
Age 30.76 5.59
Length of Residency in Canada (Years) 7.22 4.33
  n %*
Gender    
 Women 82 45.1
 Men 95 52.2
 Trans/non-binary 4 2.1
 Do not wish to disclose 1 0.5
Sexual orientation    
 Straight/heterosexual 155 85.2
 Lesbian or Gay 11 6
 Bisexual 13 7.1
 Pansexual 1 0.5
 Do not wish to disclose 2 1.1
Education    
 High School 10 5.5
 Diploma 62 34.1
 Undergraduate University Degree 71 39
 Graduate Degree or Professional Designation 34 18.7
 Prefer not to respond 5 2.7
Current employment status    
 Part time 22 12.1
 Full time 146 80.2
 Unemployed 7 3.8
 Unemployed student 6 3.3
 Prefer not to respond 1 0.5
Annual household Income    
 Less than $15,000 12 6.6
 $15,000 to $44,999 111 61
 $45,000 to $74,999 41 22.5
 $75,000 to $99,999 10 5.5
 $100,000 to $149,999 4 2.2
 Prefer not to response 4 2.2
Religious background    
 Christianity 94 51.6
 Islam 34 18.7
 Hinduism 2 1.1
 Sikhism 1 0.5
 Buddhism 3 1.6
 Indigenous 20 11
 I have no religion 27 14.8
 Do not wish to disclose 1 0.5
Current immigration/citizenship status    
 Canadian citizen by naturalization 22 12.1
 Permanent resident 145 79.7
 Refugee 8 4.4
 Asylum seeker 6 3.3
 Do not wish to disclose 1 0.5
Cultural background    
 African (e.g. Ghana, Kenya, Somalia) 96 52.7
 Middle Eastern (e.g. Egypt, Iran, Israel, Saudia Arabia) 22 12.1
 European (e.g. England, Ireland, Sweden, Russia) 4 2.2
 South Asian (e.g. India, Pakistan, Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka) 12 6.6
 East Asian (e.g. China, Korea, Japan, Taiwan) 9 4.9
 South-east Asian (e.g. Brunei, Burma, Cambodia, Timor-Leste, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand, Vietnam) 7 3.8
 Hispanic or Latinx (e.g. Mexico, Argentina, Nicaragua) 21 11.5
 Other 8 4.4
 Prefer not to answer 4 2.2
Probable PTSD (≥ 31)a    
 Yes 46 25.30
 No 136 74.70
Probable Severe Depression (≥ 20)b    
 Yes 5 2.70
 No 177 97.30
Probable Severe Anxiety (≥ 15)c    
 Yes 8 4.40
 No 174 95.60
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Note: M is mean; SD is standard deviation; PTSD is posttraumatic stress disorder.

a

Scores > 31 are indicative of a probable PTSD diagnosis (Forkus et al., 2023).

b

Scores > 20 are indicative of probable severe depression (Kroenke et al., 2001).

c

Scores > 15 are indicative of a probable severe anxiety (Spitzer et al., 2006).

*Percentages are reported accounting for missing data.

Measures

Schedule of racist events (SRE; Landrine & Klonoff, 1996)

The SRE assesses the frequency of different types of racist events experienced over the past year and across one’s lifetime, along with the stress appraisal of each event. This self-report measure has 18 items, with the first 17 items measuring the frequency of different types of racist events, and the last item measuring how much individuals believe their lives would differ without these racist events. Data for the first 17 items (referencing the past year time frame) were used for this study. Items were rated from 1 (not at all) to 6 (extremely); higher scores indicate a higher frequency of different types of racist events. The SRE has demonstrated good psychometric properties (Jin et al., 2025; Landrine & Klonoff, 1996). In the current study, McDonald’s Omega was 0.91.

Race-based traumatic stress symptom scale (RBTSSS; Carter et al., 2013)

The RBTSSS assesses the seven domains of racial trauma: depression, anger, physical reactions, avoidance, intrusion, hypervigilance/arousal, and low self-esteem (Carter et al., 2013). Participants responded to the 52-item self-report measure using a 5-point Likert scale (0 = does not describe my reaction, 4 = this reaction would not go away). The scale has demonstrated good psychometric properties among immigrants in Canada (Guo & Jin, 2025). In the current study, McDonald’s Omega was 0.97.

Patient health questionnaire-9 (PHQ-9; Kroenke & Spitzer, 2002)

The PHQ-9 assesses depression severity over the past two weeks. Participants responded to the 9-item self-report measure using a scale of 0 (not at all) to 3 (nearly every day). A total score of ≥ 20 indicates probable severe depression (Kroenke et al., 2001). The PHQ-9 has demonstrated good psychometric properties (Kocalevent et al., 2013). In the current study, McDonald’s Omega was 0.84.

Generalized anxiety disorder-7 scale (GAD-7; Spitzer et al., 2006)

The GAD-7 assesses anxiety severity experienced over the past two weeks. Participants responded to the 7-item self-report measure using a scale from 0 (not at all) to 3 (nearly every day). A total score of ≥ 15 indicates probable severe anxiety (Spitzer et al., 2006). The GAD-7 has demonstrated good psychometric properties (Löwe et al., 2008; Spitzer et al., 2006). In the current study, McDonald’s Omega was 0.83.

PTSD checklist for DSM-5 (PCL-5; Weathers et al., 2013)

The PCL-5 assesses PTSD symptom severity, with four subscales: intrusion, avoidance, NACM, and AAR. Participants responded to a 20-item self-report measure using 0 (not at all) to 4 (extremely). A total score of ≥ 31 indicates a probable PTSD diagnosis (Forkus et al., 2023). The PCL-5 has demonstrated good psychometric properties (Forkus et al., 2023). In the current study, McDonald’s Omega coefficient was 0.92.

Data analytic plan

Data were normally distributed (skewness < 2 and kurtosis < 7; Curran et al., 1996). Missing data were minimal, with only one participant missing one item on the depression severity and one participant missing three items on the racial trauma scale. Consequently, missing data were handled through listwise deletion in SPSS PROCESS (Hayes, 2022). Mediation analyses were performed using PROCESS Model 4 (Hayes, 2022). The predictor was racist events (X), the dependent variable was each of the mental health symptoms (Y; PTSD severity, depression severity, anxiety severity), and the mediator was racial trauma (M). We also examined direct effects including the relationship between (1) racist events and mental health symptoms such as PTSD severity, depression severity, and anxiety severity; (2) racist events and racial trauma; and (3) racial trauma and each of the three mental health symptoms. Indirect effects included paths from racist event to each of the mental health symptoms (PTSD, depression, anxiety) separately, accounting for racial trauma. The significant mediating effects were examined using a bias-corrected bootstrap with 5,000 samples (Shrout & Bolger, 2002). We outlined conceptual models in Figure 1.

Results

The total mean score for PTSD severity was 25.22 (SD = 11.93), the mean depression severity total score was 8.19 (SD = 4.24), and the mean anxiety severity total score was 7.75 (SD = 3.65). In addition, 46 participants (25.3%) met criteria for a probable PTSD diagnosis, 5 participants (2.7%) met criteria for probable severe depression, and 8 participants (4.4%) met criteria for probable severe anxiety.

Salient post-migration demographic factors have an important impact on racial trauma. A one-way ANOVA revealed a significant effect of income on racial trauma, F(5,175) = 7.11, p < .001. Bonferroni post-hoc comparisons indicated that middle income groups ($45,000 – $74,999 and $75,000 – $99,999) reported significantly higher racial trauma than the highest income group ($100,000 – $149,999; ps = .002); the middle-income group ($45,000 – $74,999) also reported significantly higher racial trauma than the lowest income group ($15,000 – $44,999; p = .006). This suggests that middle-income immigrants and refugees may be particularly vulnerable to racial trauma. A one-way ANOVA also revealed a significant effect of immigration status on racial trauma, F(3,176) = 5.23, p = .002. Bonferroni post-hoc comparisons indicated that refugees reported significantly higher racial trauma than permanent residents (p = .001) as well as than naturalized citizens (p = .004); no other group differences were significant. Finally, there were no significant differences in racial trauma based on employment status, F(3, 177) = 1.52, p = .210, or length of stay in Canada, r = .11, p = .140.

See Table 2 for the results of the bivariate correlations. Racist events had significant positive correlations with racial trauma, PTSD symptom severity, depression symptom severity, and anxiety symptom severity (rs = .34 – .45, ps < .001). Further, racial trauma had a significant positive correlation with PTSD symptom severity, depression symptom severity, and anxiety symptom severity (rs = .55 – .68, ps < .001).

Table 2.

Descriptive statistics and bivariate correlations.

  M SD 1 2 3 4 5
1. Racist events
2. Racial trauma
3. PTSD severity
4. Anxiety severity
5. Depression severity		 42.80 9.22 - - - - -
117.78 34.48 .45*** - - - -
25.22 11.93 .44*** .67*** - - -
7.75 3.65 .34*** .68*** .69*** - -
8.19 4.24 .33*** .55*** .61*** .72*** –
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Note: M is mean; SD is standard deviation; *** p < .001.

See Table 3 for the results of the primary analyses. When PTSD symptom severity was the DV, results indicated that racial trauma significantly mediated the relationship between racist events and PTSD symptom severity (B = 0.35, 95% confidence interval [CI; 0.20, 0.55]). The model accounted for 46.21% of the variance in PTSD symptom severity (p < .001). Results indicated significant direct effects between racist events and PTSD symptom severity (B = 0.19, p = .018), between racist events and racial trauma (B = 1.71, p < .001), and between racial trauma and PTSD symptom severity (B = 0.20, p < .001).

Table 3.

Direct and indirect effect statistics.

  B SE β p LLCI ULCI
DV = PTSD Severity (R2 = 46.21%)
Direct Effects            
Racist Events → Racial Trauma 1.71 .25 .45 < .001 1.22 2.21
Racial Trauma → PTSD 0.20 .02 .15 < .001 0.16 0.25
Racist Events → PTSD 0.19 .08 .15 .018 0.03 0.35
Indirect Effects            
Racist Events → Racial Trauma → PTSD 0.35 .09 .27 < .001 0.20 0.55
DV = Depression Severity (R2 = 30.35%)
Direct Effects            
Racist Events → Racial Trauma 1.71 .25 .45 < .001 1.22 2.21
Racial Trauma → Depression 0.06 .01 .51 < .001 0.05 0.08
Racist Events → Depression 0.03 .03 .08 .276 −0.03 0.10
Indirect Effects            
Racist Events → Racial Trauma → Depression 0.11 .03 .23 < .001 0.06 0.18
DV = Anxiety Severity (R2 = 45.68%)
Direct Effects            
Racist Events → Racial Trauma 1.71 .25 .45 < .001 1.22 2.21
Racial Trauma → Anxiety 0.07 .01 .67 < .001 0.06 0.08
Racist Events → Anxiety 0.01 .02 .02 .780 −0.04 0.06
Indirect Effects            
Racist Events → Racial Trauma → Anxiety 0.12 .02 .30 < .001 0.08 0.17
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Note. B is unstandardized coefficients; SE is standard error; β is standardized coefficients; LLCI = Lower limit 95% confidence interval of unstandardized coefficients; ULCI = Upper limit 95% confidence interval of unstandardized coefficients; p values of indirect effect were generated via the Sobel Test and are provided for reference. Significance is determined by bootstrapped 95% confidence intervals excluding zero (Hayes, 2022).

When depression symptom severity was the DV, results indicated that racial trauma significantly mediated the relationship between racist events and depression symptom severity (B = 0.11, 95% CI [0.06, 0.18]). The model accounted for 30.35% of the variance in depression symptoms severity (p < .001). Results indicated significant direct effects between racist events and racial trauma (B = 1.71, p < .001) and between racial trauma and depression symptom severity (B = 0.06, p < .001), but a non-significant relationship between racist events and depression symptom severity (B = 0.03, p = .276).

When anxiety symptom severity was the DV, results indicated that racial trauma significantly mediated the relationship between racist events and anxiety symptom severity (B = 0.12, 95% CI [0.08, 0.17]). The model accounted for 45.68% of the variance in anxiety symptoms severity (p < .001). Results indicated significant direct effects between racist events and racial trauma (B = 1.71, p < .001) and between racial trauma and anxiety symptom severity (B = 0.07, p < .001), but a non-significant relationship between racist events and anxiety symptom severity (B = 0.01, p = .780).

Supplemental analyses were conducted to examine additional mediation models wherein the four PTSD symptom severity clusters were the DVs, racial trauma was the mediator, and the racist events was the IV. Results showed that racial trauma significantly mediated the associations between racist events and intrusions symptom severity (R2 = 39.71%, p < .001), between racist events and avoidance symptom severity (R2 = 18.60%, p < .001), between racist events and NACM symptom severity (R2 = 30.92%, p < .001), and between racist events and AAR symptom severity (R2 = 47.49%, p < .001; See Supplemental Table 1). We also conducted a secondary analysis by entering salient demographic factors such as gender, sexual orientation, education, income, length of stay, and immigration status as covariates in the mediation model. Controlling for these demographic variables increased the variance explained in mental health outcomes (R2 ranged from 39.14% to 52.91%) but did not change the pattern of findings. That is, racial trauma continued to significantly mediate the relationship between racist events and all three mental health outcomes.

Discussion

The current study is the first to examine racist events, racial trauma, and mental health symptoms among racialized immigrants and refugees in Canada. Consistent with race-based traumatic stress theory, the traumatization process of racism, and empirical studies on BIPOC individuals in Canada, our findings indicated significant direct effects between (1) racist events and PTSD severity (e.g. Loo et al., 2001); (2) racist events and racial trauma (Guo & Jin, 2025), and (3) racial trauma and depression severity, and anxiety severity, and PTSD severity (e.g. Pieterse et al., 2023). Distinct from prior work, our findings indicate that racialized immigrants and refugees who encounter more racist events tend to report higher levels of racial trauma, which increases the likelihood of experiencing mental health symptoms, particularly depression severity, anxiety severity, and PTSD symptom severity across all four symptom clusters. Together, these findings highlight racial trauma as a central mechanism linking racist events to mental health disparities among immigrants and refugees, as discussed in detail below.

First, our study indicates that racial trauma accounts for the association between racist events and depression symptom severity among immigrants and refugees, aligned with race-based traumatic stress theory (Carter, 2007). For immigrants and refugees, repeated experiences of racism, such as discrimination in employment, housing, or social interactions, combined with invalidation or lack of structural support, can undermine personal agency and foster feelings of helplessness (Williams et al., 2018a, 2018b). As these experiences accumulate into racial trauma, they can further impact one’s perceptions of self and others (e.g. Carter & Pieterse, 2020). Interpersonally, elevated racial trauma may manifest as heightened suspicion, alienation, and withdrawal from others (Mikrut et al., 2022). While a certain degree of skepticism can be adaptive in navigating racialized environments, at times, racial-trauma-related distrust may lead individuals to push others away indiscriminately or to perceive themselves as a burden to others, thereby intensifying feelings of isolation and depression (Guo & Jin, 2025; Pieterse et al., 2023). Intrapersonally, immigrants and refugees may experience more internalized racism, reflected in self-criticism, self-doubt (e.g. perceiving themselves as less capable than White non-immigrant peers), and self-devaluation (e.g. feeling ashamed of their racial identity or skin colour), which further contribute to greater depression severity (Guo & Jin, 2025).

Consistent with our hypothesis, immigrants and refugees with frequent exposure to racist events are more likely to develop racial trauma, which increases the possibility of experiencing more severe anxiety symptoms. Repeated exposure to these negative, uncontrollable experiences can contribute to greater race-based stress, such that they may show persistent worry about their accent, skin colour, cultural expression, and appearance. They may also avoid social gatherings or workplaces perceived as unwelcoming, hesitate to seek support due to fear of being dismissed, experience increased mistrust, and feel tense or guarded (Carter et al., 2013; Guo & Jin, 2025; Jin et al., 2025; Trawalter et al., 2009; Williams, 2018). For immigrants and refugees, the interplay between racial trauma responses and acculturative stressors (e.g. language adaptation, social adjustment) may exacerbate racial anxiety and contribute to greater anxiety symptom severity. Together, more racial trauma may erode social integration and reinforce isolation and withdrawal, contributing to heightened anxiety symptom severity.

Unique to this study, our findings suggest that immigrants and refugees who experience more frequent racist events tend to show heightened racial trauma, which increases the likelihood of experiencing all four PTSD symptom clusters. Racist events such as derogatory comments, stereotyping, and social exclusion can elicit feelings of helplessness and vulnerability as part of racial trauma (Carter, 2007; Guo & Jin, 2025). These experiences are likely to be compounded by systemic barriers in Canada; many immigrants/refugees who held professional careers (e.g. physicians, engineers, or professors) in their home countries face underemployment and loss of social status upon migration, evoking grief responses over disrupted life trajectories. As these race-based stressors accumulate, they can foster self-doubt and internalized inferiority, leading some to perceive their accent, cultural practices, or way of living as devalued (Guo & Jin, 2025; Yang et al., 2023). Such internalization can contribute to lower self-esteem and reinforce negative self-beliefs, manifesting as negative mood and anhedonia consistent with PTSD’s NACM symptoms. Additionally, greater racial trauma stemming from repeated exposure to racial attacks can undermine psychological and physical safety, which may be expressed as intrusive memories and distressing recollections of thoughts, indicative of PTSD’s intrusion symptoms. In response, some may deny the impact, avoid emotional pain, or even avoid interactions with mainstream society (Carter, 2007; Yang et al., 2023), contributing to more PTSD avoidance symptoms. Alternatively, some may develop vigilance, tension, and physiological arousal, mirroring PTSD’s AAR symptoms. Indeed, our model demonstrated the largest effect for AAR symptoms. Sadly, this sustained hyperarousal reflects the body’s continued anticipation of threat within a racially unsafe environment for immigrants/refugees.

Limitations, future directions, and implications

Several limitations are noted in the research. First, the survey was administered in English, which may have excluded some newcomers and refugees with limited English proficiency. This creates another layer of systemic barrier and may inadvertently privilege individuals who have higher language proficiency. Consequently, those experiencing more racial trauma or greater acculturative stress might have been underrepresented. Future research should aim to include participants across diverse language backgrounds by using translated measures, professional interpreters, or multilingual data collection approaches to ensure equitable access for linguistic minorities. Second, all measures relied on self-report surveys. Although self-report methods are advantageous for protecting privacy and anonymity for immigrants and refugees who may fear stigma or confidentiality breaches, they also pose risks of misinterpretation, especially when items do not fully align with participants’ cultural or linguistic contexts. Future research may combine self-report instruments with other modalities, such as clinician-administered interviews, behavioural tasks, or observational and nonverbal assessments, to capture a more nuanced understanding of distress expression. Third, the cross-sectional nature of this study precludes examination of causal or temporal relationships between racial trauma and mental health outcomes. Some mental health symptoms may be influenced by pre-migration trauma or early resettlement stressors that were not captured in this study. Future research should employ longitudinal designs to track trajectories of racist events, racial trauma, and psychological adjustment, ideally beginning upon arrival and continuing across different stages of resettlement. Fourth, the mental health measures used in this study (e.g. PCL, PHQ, GAD) were developed and validated primarily within Western populations. These instruments may not fully capture the idioms of distress or culturally specific expressions of mental health symptoms among immigrants and refugees, leading to potential underreporting or overreporting of symptoms. Future research should prioritize cultural adaptation and validation of trauma and mental health measures to ensure they reflect the lived experiences of diverse populations. Furthermore, this study focused only on post-migration factors (racist events, racial trauma) and their contributions to mental health. Future research should consider pre-, peri-, and post-migration trauma and stressors, especially as refugees often experience long-term mental health consequences associated with pre-migration trauma (e.g. war, genocide) and peri-migration trauma (e.g. transit trauma; Sangalang et al., 2019). Finally, this study did not conduct subgroup analyses based on country of origin due to limited sample size; this decision aligns with previous studies reporting no subgroup differences in racial trauma (e.g. Pieterse et al., 2023). Future studies should consider the heterogeneity within immigrant and refugee populations to examine potential subgroup differences.

Despite this, the current study is the first to examine mental health symptoms through the framework of racism and racial trauma among racialized immigrants and refugees in Canada. Previous research on racial trauma has predominantly focused on BIPOC individuals; immigrants and refugees who identify as visible minorities hold additional layers of marginalization due to their immigration status and systemic barriers. Our findings indicate that 25.3% of the racialized immigrants and refugees met the criteria for a probable PTSD diagnosis, which is higher than national estimates (Statistics Canada, 2024), underscoring the need to attend to racial trauma and its contribution to posttraumatic stress. Particularly, our results identified at-risk subgroups who may be particularly vulnerable to racial trauma and associated mental health, including those who identify as refugees (vs. permanent residents or naturalized citizens), middle-income class, and those with lower educational attainment. This calls for the need to develop a targeted preventative program for these at-risk subgroups. Furthermore, our findings highlight the importance of incorporating racism-related experiences into traditional trauma assessments when working with racialized immigrants and refugees (Carter, 2007; Guo & Jin, 2025) and recognizing the impact of post-trauma mental health beyond an individualized framework. Clinicians should adopt culturally responsive approaches that consider migration history, as well as historical and ongoing racial trauma. Trauma-informed interventions should move beyond traditional cognitive frameworks (e.g. challenge maladaptive thoughts) to emphasize empowerment, advocacy, and validation of clients’ lived experiences of racism. This may include integrating culturally meaningful narratives, fostering collective resilience, and promoting belongingness with ethnic communities (Guo & Jin, 2025). Broadly, in alignment with anti-racism strategies in Canada, our research calls for action from clinicians, researchers, and policymakers to recognize racial trauma as a public health concern and to advance efforts that reduce racial trauma and mental health inequities among racialized immigrants and refugees.

Supplementary Material

Supplemental Table 2.docx
ZEPT_A_2737042_SM6222.docx (24.1KB, docx)

Acknowledgements

We acknowledge Ms. Hawra Al-Khaz’Aly, Ms. Anjana Varadarajan, Ms. Zixin Guo, Mr. Mathew Vitale, and Mr. Craig Brown, for their help in data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

This work was supported by a grant from the SSHRC Insight Development Grant [# 430-2023-00218] awarded to L.J.

Data availability statement

Data available on request due to privacy/ethical restrictions.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2026.2737042.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplemental Table 2.docx
ZEPT_A_2737042_SM6222.docx (24.1KB, docx)

Data Availability Statement

Data available on request due to privacy/ethical restrictions.

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