A mixed methods study of the biopsychosocial and economic impacts of workplace racism among Black professionals in the United Kingdom

A mixed methods study of the biopsychosocial and economic impacts of workplace racism among Black professionals in the United Kingdom | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A mixed methods study of the biopsychosocial and economic impacts of workplace racism among Black professionals in the United Kingdom Anthony Isiwele, Funmi Adewole-Elliot, Aygun Badalova, Carol Rivas, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8671339/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Workplace racism is increasingly recognised as a social determinant of health, yet its interconnected psychological, social, and economic consequences for Black professionals in the UK remain underexplored. This study examines how workplace racism operates as a biopsychosocial-economic (BPSE) stressor, shaping mental health, organisational engagement, and career precarity, while identifying pathways of coping and resistance. Methods A convergent parallel mixed-methods design was employed. An exploratory online survey (n = 53) assessed experiences of workplace racism, reporting confidence, perceived inclusiveness, and policy effectiveness. Semi-structured interviews (n = 11) and focus groups (n = 12) explored lived experiences of racism, coping strategies, organisational responses, and economic impacts. Quantitative data were analysed descriptively and through group comparisons, while qualitative data were analysed thematically. Findings were integrated using a joint-display matrix. Results Most survey respondents reported experiencing (73.6%) or witnessing (69.8%) workplace racism, alongside low confidence in reporting mechanisms and low perceived policy effectiveness. Black and younger respondents reported significantly lower workplace inclusiveness. Qualitative analysis identified five interrelated themes: structural and institutional racism; psychological and health consequences; cultural stoicism and silenced resistance; economic exploitation and career precarity; and empowerment through solidarity, faith, and embodied coping practices. Integrated findings indicate cumulative biopsychosocial and economic harms, partially mitigated by alternative support networks in the absence of effective organisational responses. Conclusions Workplace racism functions as a structural determinant of health for Black professionals, operating through interconnected psychological, social, and economic pathways. Workplace racism Biopsychosocial-economic model Mental health inequalities Black professionals Mixed-methods research Introduction Racism is a systemic form of discrimination that sustains inequalities favouring White groups and operates across institutional, interpersonal, and structural levels ( 1 ). It is increasingly recognised as a critical social determinant of health, with significant consequences for mental, physical, and social well-being ( 1 – 3 ). In the United Kingdom (UK), approximately 1 in 3 ethnic minority employees report experiencing workplace discrimination ( 4 ). Sector-specific evidence reinforces these patterns. Data from the NHS England ( 5 ) Workforce Race Equality Standard (WRES) indicates that Black staff are disproportionately subjected to formal disciplinary processes and are less likely to benefit from informal resolution than White colleagues. These inequalities demonstrate how racism remains embedded within professional structures, shaping both occupational and health disparities. Empirical research consistently links exposure to workplace racism with elevated anxiety, depression, and burnout among racialised employees ( 6 , 7 ). Meta-analytic evidence confirms that perceived discrimination is strongly associated with adverse mental health outcomes, highlighting racism as a chronic psychosocial stressor rather than an isolated interpersonal experience ( 8 ). Beyond health impacts, racism produces measurable economic harm. According to the Office for National Statistics ( 9 ) report Ethnicity pay gaps, UK: 2012–2022 , median hourly pay in 2022 was £13.53 for Black employees compared with £14.35 for White employees, indicating racial pay disparities. Structural barriers to advancement are further evidenced by the Parker Review ( 10 ), which reported that Black professionals hold fewer than 1% of senior leadership roles in major UK companies, despite comprising approximately 3–4% of the working-age population. To examine these interconnected harms, this study adopts a Biopsychosocial-Economic (BPSE) framework, extending Engel’s ( 11 ) biopsychosocial model to explicitly incorporate economic precarity as a determinant of health. Intersectionality theory ( 12 ) is used here to illuminate how overlapping social positions shape differentiated experiences of racism and vulnerability. Critical Race Theory (CRT)) ( 13 ) frames racism as an enduring and systemic feature of institutional life, while the Racialised Organisations Framework (ROF) ( 14 ) provides an organisational lens for analysing how ostensibly neutral policies reproduce racial hierarchies and constrain progression. This mixed-methods study aims to: ( 1 ) quantify links between racism, psychological distress, and economic disadvantage; ( 2 ) explore lived experiences of coping, resistance, and resilience; and ( 3 ) integrate findings to inform intersectionality-based, culturally responsive policies promoting equity, accountability, and psychological safety at work. Methods Study design This study used a convergent parallel mixed-methods design ( 15 ) to examine the biopsychosocial-economic (BPSE) impact of workplace racism on Black professionals in the UK. Quantitative and qualitative data were collected concurrently, analysed separately, and integrated during interpretation to enable triangulation between prevalence patterns and lived experiences. Procedure Three complementary participant groups contributed data. Survey respondents (n = 53) were predominantly Black (79.6%), with smaller proportions identifying as Mixed, White, Asian, or Other; ages ranged from the 20s to the 60s, with most participants aged 40–59. Semi-structured interviews were conducted with 11 Black professionals (Table 1 ) who had experienced or witnessed workplace racism. Participants were purposively sampled to ensure variation in sector and career stage, though participation was predominantly female (9 women, 2 men). Two focus groups (n = 12; Table 1 ) were initially advertised as co-creative workshops but were restructured into facilitated discussion groups due to low attendance; both groups comprised women. Recruitment occurred across the UK (London, Milton Keynes, Manchester, Liverpool) through professional associations, university staff networks, community organisations, and targeted mailing lists. Flyers with QR codes directed participants to an online survey and a registration form for interviews and focus groups. Participation was voluntary, responses were anonymised, and optional demographic questions were included. Written informed consent was obtained from all interview and focus group participants, who received a £30 voucher. Participants Table 1 Qualitative Participants’ Characteristics (Interviews and Focus Groups) Participant ID Gender Role / Location in the UK Workplace Context / Sector Experience P1 Female Lecturer in Education. London High-rated Group of university, predominantly white, > 20 yrs, PhD P2 Female Primary School Teacher. Manchester Middle Leader / Coordinator > 20 yrs, qualified teacher P3 Female Consultant / Leicestershire Assessor in police custody > 15 years, Higher Education P4 Male Lecturer in Civil Engineering CConstruction sector > 20 yrs, master’s degree P5 Female Senior Lecturer in Policing. Liverpool University department (predominantly white) > 15 yrs, PhD P6 Female Civil servant. Berkshire. Central government office > 15 yrs, PhD P7 Male Software Engineer. London Public and private sectors > 25 yrs, master’s degree P8 Female Student Experience Advisor Milton Keynes Open University; prison education > 15 yrs, degree P9 Female Senior Manager (Student Casework) Northamptonshire Higher education (Open University) > 15 yrs, master’s degree P10 Female Nurse (Agency / NMC Referral) Manchester Health & Social Care sector > 20 yrs, PhD P11 Female Teaching Assistant in Special Needs School Kent Private special needs school > 3 yrs, degree FG1-1 Female Social Worker London Local Authority Social Services > 5 yrs, Master’s degrees FG1-2 Female Education Professional / Trainer London Primary & Secondary Education Leadership > 15 yrs, degree FG1-3 Female Researcher / Facilitator London Academic and Community Research > 10 yrs, PhD FG1-4 Female Mental Health Practitioner London Council / Community MH Services >>5 yrs, master’s degree FG1-5 Female Mental Health Support Worker Kent Supported Housing / MH > 5 yrs, degree FG1-6 Female Academic / Teacher London Higher Education & Primary Education > 20 + yrs, degree FG2-1 ( 7 ) Female Teaching Assistant (Special Needs) Kent Special Needs School > 5 yrs, degree FG2-2 ( 8 ) Female Parent Support Worker Kent School Setting > 10 yrs, degree FG2-3 ( 9 ) Female School Business Manager (Trainee) London Primary School > 15 yrs, master’s degree FG2-4 ( 10 ) Female Public Sector Support Staff London Public Sector Office > 10 yrs, degree FG2-5 ( 11 ) Female Teacher / Support Worker London Special Needs School / Hospitality > 10 yrs, MSc FG2-6 ( 12 ) Female Administrative Worker London Public Service > 5 yrs, degree Measures Survey instrument The questionnaire was not intended as a psychometric scale but as a context-specific instrument to capture workplace experiences relevant to the qualitative inquiry. A 15-item online questionnaire, co-designed with professionals, assessed experiences of workplace racism, reporting confidence, awareness and perceived effectiveness of anti-racism policies, training exposure, and managerial responses (Supplemental file 1). Two 5-point Likert-scale items measured perceived workplace inclusiveness and policy effectiveness. Demographic items were optional to protect anonymity. Semi-structured interviews and Focus group Interviews explored experiences of racism, coping strategies, reporting barriers, organisational responses, and perceived psychological and economic impacts. The interview guide is available on request. Interviews lasted 45–70 minutes and were conducted online between May and September 2025 with written and verbal consent. Two audio-recorded focus groups were held on 21 May and 20 June 2025. Each session began with a brief dance for health exercise to promote engagement and well-being, followed by a facilitated discussion. All recordings were destroyed following transcription. Analysis Quantitative analysis No a priori sample size calculation was conducted, as the survey component was designed to be exploratory and descriptive, intended to contextualise and triangulate qualitative findings rather than to generate population-level estimates or test causal hypotheses. The quantitative analysis, therefore, focuses on prevalence patterns and group comparisons to support integrated interpretation, consistent with mixed-methods guidance for exploratory health research ( 15 ) . Survey responses were analysed using IBM SPSS Statistics v28 , as detailed in supplemental file 2. Descriptive statistics summarised frequencies, percentages, means, and standard deviations. One-way analyses of variance (ANOVA) tested for group differences in inclusiveness ratings across ethnic and age categories, applying a significance threshold of p < .05. The ANOVA revealed significant differences in inclusiveness perceptions by ethnicity (F [3, 43] = 15.13, p < .001) and by age group (F [5, 35] = 32.95, p < .001). Black and younger respondents reported substantially lower inclusiveness compared with older or non-Black peers. Qualitative analysis. Interview and focus-group transcripts were analysed thematically using the six-phase approach of ( 16 ): familiarisation, initial coding, theme generation, review, definition, and reporting. Manual colour-coding facilitated systematic organisation and retrieval of data, detailed in supplemental file 3. A hybrid inductive-deductive strategy was employed. Codes were generated directly from participants’ language, guided by theoretical constructs of institutional racism and cultural stoicism. Triangulation across interviews and focus groups strengthened perceived credibility. Reflexive memos documented analytic decisions, and peer debriefing among researchers enhanced dependability. Ellipses (…) were used to improve readability and to shorten quotations without altering their original meaning. An audit trail documenting coding decisions, theme development, and integration steps was maintained to support transparency and analytic rigour (Supplementary file 3). Patient and Public Involvement Professionals and community members with lived experience of workplace racism contributed to the development and refinement of the survey instrument to ensure relevance, clarity, and sensitivity. Public contributors also informed the focus group format, including the incorporation of a brief dance-for-health activity to support well-being and engagement during discussions of potentially distressing experiences. Findings have been disseminated through professional and community networks to inform policy, practice, and advocacy on workplace racism and mental health. Participants were not involved in the final statistical analysis, but their lived experiences were central to the interpretation of the qualitative findings. Results Results are presented to illustrate patterns and lived experiences within this sample and are not intended to be generalised to all Black professionals in the UK. Quantitative Results Table 2 presents the quantitative results, summarising demographic characteristics and key workplace experiences related to racism, inclusiveness, and policy effectiveness. The data highlight prevalent experiences and observations of racism, low confidence in reporting mechanisms, limited anti-racism training, and significant disparities in inclusiveness perceptions across ethnic and age groups. Table 2 Quantitative Findings Summary Domain / Survey Item Variable Type Key Result(s) Interpretation / Insight Sample Profile (n = 53) Demographic summary 79.6% Black; 8% Mixed; 4% White; 2% Asian; 4% Other; ages 20s–60s (largest 40–59 yrs ≈ 48%) The majority of Black professionals are in mid-career stages Experience of Racism Yes/No 73.6% (39/53) reported personal experience of racism; 26.4% had not. Nearly three-quarters of respondents personally experienced racism at work. Witnessed Racism Yes/No 69.8% (37/53) had witnessed racist incidents; 30.2% had not. Indicates that racism is both experienced and observed by most staff. Comfort in Reporting Yes/No/Not sure 35.8% Yes; 43.4% No; 20.8% Not sure. Less than half feel safe reporting racism, Existence of Anti-Racism Policy Yes/No/Not sure 45.3% Yes; 18.9% No; 35.8% Not sure. Policies are unclear or poorly communicated in many organisations. Effectiveness of Anti-Racism Policies (1–5 Likert) Continuous Mean = 2.08 (SD = 1.21); 48% rated “1 = Not effective”; 4% rated “5 = Very effective.” Perceived policy effectiveness is very low. Participation in Anti-Racism Training Yes/No 41.5% Yes; 58.5% No. Fewer than ½ of employees have received any formal anti-racism training. Perceived Inclusiveness of Workplace (1–5 Likert) Continuous Mean = 2.63 (SD = 1.34); modal value = 3 (30.8%); 26.9% rated 1 = “Not inclusive.” Average inclusiveness rated below moderate; wide variation but skewed to negative perceptions. Observed Consequences for Racist Behaviour Yes/No/Not sure 18.9% Yes; 64.2% No; 15.1% Not sure. Visible accountability for racism is rare or inconsistent. Perception: “Management Takes Racism Seriously” Yes/Sometimes/No 21.6% Yes; 49.0% Sometimes; 29.4% No. ½ perceive only conditional or inconsistent management commitment. ANOVA: Inclusiveness by Ethnicity F(3, 43) = 15.13, p < .001 Mean scores: Black = 2.03; White = 4.00; Mixed ≈ 3.75; Other = 5.00. Black employees rated workplaces as significantly less inclusive than those rated by all other groups. ANOVA: Inclusiveness by Age F(5, 35) = 32.95, p < .001 Younger respondents (20s–30s) ≈ 1.0 = “Not inclusive”; older (50–59) ≈ 2.5; 60 + ≈ 3.1. Younger staff perceive markedly lower inclusiveness, suggesting generational disparities in racial climate. Qualitative Results Thematic analysis of 11 interviews and two focus groups identified five interrelated themes (Table 3 ; supplemental file 3) capturing the biopsychosocial and economic impacts of workplace racism on Black professionals. The themes represent distinct yet overlapping dimensions of harm and resilience shaped by structural inequities and align with the quantitative patterns. Table 3 Qualitative Themes Overview Theme Interpretive Summary (Biopsychosocial-Economic Link) 1. Structural and Institutional Racism Racism operates through policies and power structures that normalise exclusion and retaliatory risk, producing chronic mistrust and physiological stress responses. 2. Psychological and Health Consequences of Racism Continuous exposure to racial stress triggers psychological and physiological deterioration, manifesting as insomnia, depression, and burnout. 3. Cultural Stoicism, Internalised Racism & Silenced Resistance Stoicism and internalised restraint serve as culturally shaped survival tactics, maintaining composure but silencing resistance and compounding emotional distress. 4. Economic Exploitation and Career Precarity Racism generates economic losses through suspension, dismissal, and blocked advancement, reinforcing psychological and social disadvantage and creating an economic feedback loop. 5. Empowerment, Solidarity & Pathways for Reform Solidarity, faith, and structural reform transformed distress into agency. Dance and recreation eased stress and strengthened interaction under pressure, while rights awareness and collective advocacy functioned as protective, reform-driving forces within hostile systems. Integration of quantitative and qualitative strands. Integration was achieved through a joint display matrix in Table 4 , linking quantitative patterns with qualitative themes and participant narratives. Convergences strengthened the interpretation ( 15 ). For example, low confidence in reporting racism aligned with accounts that “the reporting system… doesn’t work” (P1, p. 11) and fear of being labelled “aggressive” (P1, p. 7) . Likewise, low policy-effectiveness scores matched experiences of inaction: “nothing was done, in fact, that person was promoted” (FG-7, p. 296) . This integration grounded statistical trends in lived experience, enhancing the study’s perceived meta-inferences. Table 4 Integrated Joint-Display Matrix Linking Quantitative and Qualitative Findings Quantitative Domain Key Quantitative Finding Linked Themes Sample profile Majority Black (79.6%), mid-career Structural Racism; Economic Precarity Personal experience of racism 73.6% experienced racism Psychological Harm; Structural Racism Witnessed racism 69.8% witnessed racism Silenced Resistance; Structural Racism Comfort in reporting Only 35.8% feel safe reporting Cultural Stoicism; Structural Racism Awareness of anti-racism policy 35.8% “Not sure” Empowerment & Reform; Structural Racism Effectiveness of anti-racism policies Mean = 2.08; almost half said “Not effective” Structural Racism; Psychological Harm Participation in anti-racism training Only 41.5% had training Reform Pathways; Structural Racism Perceived inclusiveness Mean 2.63; many rated workplaces “Not inclusive” Psychological Harm; Stoicism; Internalised Racism & Silenced Resistance Consequences for racist behaviour Only 18.9% saw consequences Structural Racism; Economic Harm Management takes racism seriously Only 21.6% agreed Psychological Harm; Structural Racism Inclusiveness by ethnicity (ANOVA) Black staff far lower than White staff Economic Precarity; Structural Racism; Psychological Harm Theme 1: Structural and Institutional Racism Participants’ accounts consistently framed racism as institutionally mediated, operating through organisational policies, procedures, and decision-making practices rather than through isolated interpersonal acts. This qualitative pattern converged with the quantitative findings, which showed high exposure to racism alongside low confidence in organisational responses, shaping a context in which institutional processes were experienced as uneven and, at times, unsafe. Survey results indicated that 73.6% of respondents reported personally experiencing racism at work, and 69.8% had witnessed racist incidents, suggesting that participants were situated within environments where racialised dynamics were recurrent rather than exceptional (supplemental files 2 & 3 and Table 4 ). Within this context, participants described how formal structures, such as grievance procedures, promotion pathways, and investigations, were perceived as neutral in principle but inconsistent in practice. One academic articulated racism as a structural condition, describing workplace racism as: “people and structures that create hostile environments in a workplace for those of us who are marginalised and minoritised. In predominantly white spaces, it means that you are either implicitly or explicitly always at a disadvantage” (P1, p. 16). She further emphasised that disadvantage emerged when those holding power did not “recognise, understand, or accept the difficulties that those of us who are marginalised…experience in those spaces” (P1, p. 16). Confidence in reporting mechanisms was a central institutional issue. Quantitatively, only 35.8% of respondents reported feeling comfortable reporting racist incidents, while 43.4% reported discomfort and 20.8% were unsure, indicating widespread uncertainty about procedural safety. Participants’ narratives illuminated how this uncertainty developed. One focus group participant reflected on racism as something “subtle, hidden within policies and practices ” (FG2-5, p. 295), making it difficult to challenge without risking misinterpretation or dismissal. Where participants did pursue formal complaints, experiences often reinforced scepticism about procedural fairness. One participant who submitted extensive evidence questioned the independence of the process: “The so-called “independent investigator” turned out to be one of the principals from their other schools. …So how is that independent? (FG2-3, p. 297). She described the outcome succinctly: “You didn’t follow processes. You didn’t follow policy. Nothing.” (FG2-3, p. 297) Such accounts align with survey findings showing that only 18.9% of respondents had ever seen a colleague face consequences for racist behaviour, suggesting limited visible accountability within organisations Participants also located institutional racism within career progression and recognition structures. Survey data revealed low perceived effectiveness of anti-racism policies (mean = 2.08 out of 5), alongside modest ratings of workplace inclusiveness (mean = 2.63 out of 5). Qualitative narratives contextualised these figures. P2, a teacher, stated: “The first one was applying for an assistant headteacher role four times at the same school. Despite being an experienced teacher, holding the right qualifications, having completed a management course, and leading departments without receiving additional pay—I was told I wasn’t successful each time…I was overlooked despite being qualified. That’s institutional racism” (p. 28) Others described being asked to undertake leadership or specialist responsibilities without commensurate title or pay, reinforcing perceptions of constrained advancement. Fear of negative repercussions shaped how participants navigated these structures. Several described informal warnings about the risks of speaking up. One focus group member captured this concern clearly: “Why are we blowing the whistle to the same people who are part of the problem?” (p. 244). This perceived risk helps explain the quantitative pattern of low reporting comfort and limited confidence in organisational responses. Largely, the integration of quantitative and qualitative findings indicates that structural and institutional racism was experienced not as an overt organisational stance, but as a patterned outcome of routine practices. High exposure to racism, low inclusiveness, limited accountability, and uncertain reporting pathways combined to produce environments in which participants managed risk carefully, often through silence or withdrawal. Participants’ narratives foreground how institutional arrangements shaped everyday experiences of work, influencing trust, safety, and engagement within organisational life. Theme 2: Psychological and Health Consequences of Racism Participants’ narratives showed that workplace racism was experienced as a chronic psychological and physiological stressor, with effects that accumulated over time rather than arising from single incidents. These qualitative accounts closely aligned with the quantitative findings, which indicated a high prevalence of racism exposure and low perceptions of organisational inclusiveness, conditions that form the backdrop to sustained psychological strain. Survey data indicated that 73.6% of respondents had personally experienced racism at work, and 69.8% had witnessed racist incidents, suggesting that many participants were operating in environments characterised by ongoing racial stress rather than isolated events (supplemental files 2 & 3 and Table 4 ) Within this context, participants described the embodied toll of prolonged exposure. One focus group participant stated: “I was so burnt out. I went off sick for two months because I just couldn’t take it anymore. My body was literally exhausted. I just wanted to get away” (p. 298). This account resonates with the broader pattern of low workplace inclusiveness reported in the survey (mean = 2.63 out of 5), indicating environments that many respondents experienced as psychologically unsupportive Anxiety emerged as a prominent consequence of racialised workplace stress. Participants described fear, hypervigilance, and emotional depletion that shaped everyday behaviour. One narrative captured this vividly: “She became so afraid and emotionally drained that she didn’t even want to see the person who was being racist toward her. She had reported it, but nothing was done, in fact, that person was promoted.” (FG2-7, p. 297) Quantitative findings help contextualise this response. Only 35.8% of survey respondents reported feeling comfortable reporting racist incidents, suggesting that many individuals manage distress internally rather than through formal support channels This lack of psychological safety appeared to intensify anxiety and withdrawal. Participants also described erosion of confidence and reduced psychological capacity, which affected engagement and performance. One academic reflected: “Because my confidence levels were so low…there were opportunities to collaborate on things…[that I just] didn’t feel confident enough to take” (P1, p. 15&16). Such accounts align with survey findings showing limited confidence in organisational responses, including low ratings of policy effectiveness (mean = 2.08 out of 5), reinforcing a context in which distress remains insufficiently addressed For some, the cumulative psychological impact manifested as disengagement from work itself: In the focus group narration, one participant said, “ When these issues were happening, people said they didn’t even want to go to work anymore. They couldn’t face getting up in the morning”. (p. 296) The integration of quantitative and qualitative data demonstrates how high exposure to racism, low inclusiveness, and limited reporting confidence coalesced into sustained psychological strain. Participants’ words illustrate that anxiety, exhaustion, and withdrawal were not individual pathologies, but understandable responses to prolonged racialised stress within workplace environments. Theme 3: Cultural Stoicism, Internalisation, and Silenced Resistance This theme captures how participants navigated workplace racism through culturally shaped strategies of endurance, restraint, and selective silence. Rather than indicating passivity or acceptance, these responses were described as protective adaptations developed within contexts where formal avenues of redress were perceived as risky or ineffective. The qualitative accounts converged with quantitative findings showing low confidence in reporting mechanisms, helping to explain why resistance was often internalised or displaced rather than openly articulated. (supplemental files 2 & 3 and Table 4 ) Participants described learning to manage racism through emotional containment. P9 reflected on how repeated exposure led to a default posture of endurance: “It’s exhausting after a while. You just get on with your job and ‘take it on the chin,’ even though that’s not healthy” (p. 190). Here, stoicism functioned as a survival strategy, enabling continued employment while simultaneously suppressing emotional expression. Several participants described withdrawal as a form of self-protection, particularly when reporting had previously resulted in dismissal or delay in addressing concerns. In focus group discussions, participants noted that when racism occurred, “we don’t go and report them to management. We speak amongst ourselves” (p. 298) . This intra-group sharing created informal spaces of validation, but also reinforced the absence of institutional accountability. Withdrawal was not only social but spatial and psychological, shaping how participants moved through workplaces and engaged with colleagues. Internalisation of racism was also discussed in relation to self-monitoring and emotional regulation. Participants described being cautious about tone, behaviour, and visibility, aware that emotional expression could be reinterpreted negatively. One participant noted that stereotypes such as being perceived as “too loud” or “too brash” made it difficult to just be themselves, leading to constant self-adjustment (P8, p. 175) . This vigilance contributed to emotional fatigue and reinforced silence as a safer option than confrontation. Quantitative findings further contextualise these narratives. Only 18.9% of respondents had ever seen a colleague face consequences for racist behaviour, suggesting limited visible accountability. In this environment, cultural stoicism and withdrawal emerged as rational responses to institutional uncertainty. This theme shows that silenced resistance was not an absence of agency, but a reconfiguration of agency under constraint. Participants’ narratives demonstrate how cultural expectations of strength, combined with organisational risk, shaped patterns of internalisation and withdrawal that protected livelihoods while exacting high emotional cost. Theme 4: Economic Exploitation and Career Precarity Participants’ narratives demonstrated that workplace racism was experienced not only as a psychological or social burden but as a material and economic force shaping career trajectories, income security, and long-term professional stability. These qualitative accounts converged with quantitative findings showing limited accountability and low confidence in organisational responses, conditions that rendered economic precarity a persistent risk rather than an exceptional outcome (supplemental files 3 and Table 4 ) Within this context, participants described how racism translated into stalled progression, loss of income, and blocked opportunity. Several accounts focused on repeated experiences of being overlooked for promotion despite qualifications and demonstrated competence. As noted earlier in Theme 1, P2 reflected on how she had applied multiple times for senior roles without success, despite undertaking leadership responsibilities without commensurate recognition or pay. These experiences were not framed as isolated disappointments, but as patterned outcomes that limited career mobility over time. Economic consequences also emerged from the withdrawal from opportunities due to diminished confidence and emotional depletion. P1 described how prolonged engagement with grievance processes undermined her capacity to pursue collaborative projects and external work, directly affecting her income. This illustrates how psychological harm and economic loss were intertwined, with racism constraining not only advancement within organisations but also engagement with supplementary professional opportunities. For others, precarity was more immediate and severe. Participants described suspension, dismissal, or contract termination after raising concerns, reinforcing the perception that economic security was conditional on silence. P11 recounted how, after formal complaints, processes were delayed in ways that foreclosed access to external remedies, leaving individuals without employment or recourse: “They made sure it took over three months to get back to me, so that I couldn’t even go to ACAS and claim anything. Everything they did went against their own policy” (p. 225). Such experiences shaped collective risk awareness, influencing how others navigated similar situations. Quantitative findings provide important context for these narratives. Less than half of respondents reported the presence of clear anti-racism policies, and policy effectiveness was rated very low overall (mean = 2.08 out of 5) In workplaces where protections were perceived as weak or inconsistently applied, economic vulnerability became an ever-present backdrop to daily decision-making. Participants described remaining in posts for financial reasons despite distress, or accepting additional responsibilities without advancement to maintain perceived indispensability. Overall, this theme highlights how racism operated as an economic mechanism, shaping who progressed, who remained precarious, and who exited organisations altogether. Participants’ accounts illustrate that career stagnation, income loss, and employment insecurity were not unintended side effects, but integral to how racism was experienced and managed in workplace contexts. 5. Empowerment, Solidarity, and Pathways for Reform While participants’ accounts detailed significant harm, they also articulated pathways of empowerment and collective resilience that transformed distress into agency. These pathways did not emerge primarily from formal organisational responses, but from peer solidarity, shared knowledge, faith, and embodied practices, which functioned as protective resources within challenging workplace environments. Quantitative findings showing low confidence in reporting and limited visible accountability provide important context for why these alternative sources of support became so salient (supplemental files 3 and Table 4 ). Against this backdrop, participants described turning toward collective spaces outside formal hierarchies. Informal peer networks, Black staff groups, unions, and community connections were repeatedly identified as places where experiences could be named, validated, and strategized around without fear of immediate reprisal. A focus group participant, FG2-3, narrates: “In my case, I found there was also an Association of Black Academics. If your line manager couldn’t help, you could go to them. They’d share their experiences and guide you: ‘This is what I did,…read this policy …That was really helpful.” (p. 302) She described how engagement with a Black academic network offered practical guidance, sharing policies, naming options, and modelling how others had navigated similar situations, thereby converting isolation into informed action. Solidarity was also described as emotionally restorative. Focus group discussions highlighted the importance of simply being heard by others with shared experiences. Participants noted that speaking openly within trusted groups countered the internalisation and self-doubt cultivated by racialised workplaces. These spaces did not eliminate harm, but they reduced its isolating effects and supported psychological endurance. Faith also serves as a critical reservoir of resilience for participants navigating workplace hostility, offering a "spiritual foundation" that precludes maladaptive coping mechanisms (p10, p. 208). For P10, faith provides a specific framework to contextualize suffering, removing self-blame by attributing events to a higher purpose: "My faith reminds me that God understands more than human understanding. If He allows certain situations to happen, then it must be for a reason. That belief is a consolation for me" (p. 208). Similarly, P3 describes her ordeal as a "spiritual journey" (p. 70) , using her relationship with God to regulate her emotions during periods of acute instability: "I literally had to say, ‘God, you’re going to have to carry us, because I don’t know how we’re going to cope'... I’ve learned over the years and I have my faith, I believe things will come—and they do". P. 71 Here, spiritual grounding acts not as denial, but as a stabilizing resource that fosters persistence and emotional regulation in hostile environments. For many participants, the body serves as a primary site of resistance and recovery when institutional support is absent. Rather than relying solely on cognitive strategies or medication, participants like P6 turn to "singing, dancing" (p. 140 ) as essential tools for managing the physiological toll of "work-related stress and burnout" (p. 139) . These embodied practices offer a safe outlet for emotions that might be unsafe to express verbally in hostile work environments. FG2-6 describes how movement provides a private, embodied release from workplace stress: "I watch movies, listen to music, dance—all of the above. Most times, when I’m stressed, I start cooking or cleaning while dancing. It really helps me." (p. 265) FG2-6 notes, dancing while cleaning becomes a private ritual to metabolize stress. This theme demonstrates that even within constrained conditions, participants cultivated forms of agency that transformed vulnerability into solidarity and reform-oriented insight. These pathways highlight how empowerment can coexist with harm, sustaining engagement while pointing toward more inclusive and responsive organisational practices. Discussion This study demonstrates that workplace racism functions as a multidimensional determinant of health, producing interconnected biological, psychological, social, and economic harms that accumulate over time. Participants’ accounts of physiological exhaustion, psychological distress, social exclusion, and financial strain reveal mutually reinforcing processes embedded within organisational life. Interpreted through a biopsychosocial-economic lens, informed by intersectionality, Critical Race Theory, and the Racialised Organisations Framework, these findings extend Engel’s ( 11 ) model and align with Clark et al.’s ( 17 ) conceptualisation of racism as a chronic stressor with cumulative effects on health. Biological The findings provide empirical support for Gravlee’s ( 18 ) concept of embodied inequality, illustrating how racism operates not only as a social insult but as a biological injury. Participants’ reports of insomnia, fatigue, and stress-related illness demonstrate how prolonged exposure to racialised organisational environments translates into physiological depletion. Within the UK context, these lived experiences help explain the persistent racial disparities in disciplinary action and staff well-being documented in NHS England’s ( 5 ) WRES data. The high prevalence of reported racism in this study (73.6%) and the qualitative data reinforce national evidence that such inequalities are systemic rather than exceptional. These patterns suggest that institutional inaction and procedural neglect function as mechanisms through which social disadvantage becomes biologically embodied, depleting health alongside career opportunity. Psychological Psychologically, workplace racism eroded confidence, motivation, and self-efficacy while intensifying hypervigilance and anxiety. These effects mirror meta-analytic evidence linking perceived discrimination to adverse mental-health outcomes ( 8 ), but the present study extends this literature by situating distress within organisational cultures that normalise silence and penalise resistance. The finding that only 35.8% of respondents felt safe reporting racism suggests the amplification of psychological harm by institutional betrayal, where formal processes exist but fail to provide protection. Interpreted through Critical Race Theory, this reflects the enduring normalisation of racism within bureaucratic systems that frame inequitable outcomes as procedural neutrality rather than injustice ( 13 ). The data therefore challenge individualised interpretations of distress, suggesting that psychological harm may be produced and sustained through organisational design. Social The social dimension of workplace racism was characterised by alienation, surveillance, and erosion of trust. Participants described organisational environments in which bystander silence, tokenism, and a lack of allyship perpetuated exclusion. This pattern aligns with Kyere and Fukui’s ( 19 ) analysis of racialised organisational cultures that normalise microaggressions while rendering Black professionals hyper-visible yet unheard. Such cultures suggest the persistence of discriminatory attitudes within institutional structures despite formal equality commitments, positioning racism as a systemic organisational practice rather than an isolated aberration. The resulting social fragmentation undermines the relational premise of the biopsychosocial model, which emphasises the role of supportive interpersonal and community networks in sustaining health. Within these contexts, participants described patterned withdrawal from organisational life, including reduced visibility, disengagement from shared spaces, and psychological distancing, as rational responses to racialised scrutiny. Consistent with evidence that unsupportive racial climates reduce engagement among racialised employees ( 20 ). Withdrawal in this study functioned ambivalently: it reduced immediate exposure to harm while simultaneously limiting access to informal support, mentoring, and advancement opportunities, thereby reinforcing longer-term disadvantage. Participants also highlighted Black peer solidarity, faith, and collective advocacy as important sources of resilience, consistent with community psychology perspectives ( 21 ). However, reliance on these informal networks exposed an institutional withdrawal from responsibility for inclusion and care. Rather than substituting for organisational support, such networks operated as compensatory mechanisms in response to persistent exclusion, aligning with analyses of institutional betrayal in which organisations espouse inclusion rhetorically while failing to protect those exposed to harm ( 22 ). Collectively, these dynamics illustrate how workplace racism fractures social belonging not only through exclusion, but through the routinisation of withdrawal as a rational survival strategy within organisational life. Economic Economic marginalisation emerged as a central mechanism linking all other domains of harm. Participants’ experiences of stalled progression, suspension, and exclusion from leadership mirror national labour-market data showing persistent racial pay gaps and under-representation of Black professionals in senior roles ( 23 ). Interpreted through the Racialised Organisations Framework, these outcomes reflect how organisational rules and reward systems allocate resources and status along racial hierarchies, often under the guise of neutrality ( 14 ). Economic insecurity compounded psychological distress and constrained biological recovery by limiting access to rest, therapy, and financial stability. These findings support evidence that economic precarity is both a cause and consequence of racialised health inequality ( 24 ), positioning income loss and blocked advancement as material expressions of institutional racism rather than incidental outcomes. Implications for Policy, Practice, and Research These findings call for an intersectional and culturally humble transformation of workplace equity policy, moving beyond compliance-based training toward approaches that explicitly address power, privilege, and institutional accountability. The Intersectionality-Based Cultural Humility Analysis (IBCHA) framework ( 25 ) offers a practical model for this shift, integrating reflexivity, lived experience, and structural analysis into leadership development, equity audits, and policy review. While the primary focus remains the UK context, insight can be drawn from international approaches that institutionalise accountability, such as the Government of Canada’s ( 26 ) Anti-Racism Strategy, which embeds equity audits and intersectional data within public-sector governance. Adapted through IBCHA, such mechanisms could strengthen UK workplace policies by moving from symbolic compliance toward participatory, evidence-informed reform. Further empirical evaluation of culturally responsive coping strategies, including participatory and movement-based approaches, is needed to strengthen the evidence base for organisational reform. Future studies should employ larger, more gender-balanced samples and longitudinal, purposive designs to examine variation across sectors, career stages, and organisational contexts. Gender Influence on Findings The predominance of female participants may have likely amplified gendered narratives of emotional labour, endurance, and intersectional burden commonly experienced by Black women in professional settings ( 7 , 12 , 27 ). Accounts of silence and resilience reflect the “strong Black woman” schema, which may obscure distress while enabling institutional neglect. Conversely, the limited representation of Black men may understate coping strategies shaped by masculine norms of stoicism and emotional suppression ( 28 , 29 ). Strengths and Limitations This study employed a convergent parallel mixed-methods design to integrate exploratory survey data with in-depth qualitative accounts, enabling a multidimensional analysis of workplace racism as a biopsychosocial and economic determinant of health. A key strength lies in integrating prevalence patterns with lived experience, providing analytic depth that large-scale datasets may not capture, including institutional processes and embodied impacts. Several limitations should be acknowledged. First, the survey component was exploratory and descriptive, and no a priori sample size calculation was conducted; findings are therefore not intended to be generalised to all Black professionals in the UK. Second, the overall sample size was modest and predominantly female, which may have amplified gendered narratives of emotional labour, endurance, and intersectional burden, while underrepresenting experiences shaped by masculine norms of coping. Third, participants were self-selected, which may have favoured individuals with prior experiences of workplace racism or heightened motivation to participate. Finally, the cross-sectional design precludes causal inference. These limitations are consistent with the study’s exploratory aims but should be considered when interpreting the findings. Conclusion This study demonstrates that workplace racism in the UK is a structural determinant of health rather than a series of isolated interpersonal incidents. Racism operates through interconnected biological, psychological, social, and economic pathways that existing organisational responses fail to address. A biopsychosocial-economic lens reveals the necessity of trauma-informed, accountable, and redistributive reforms if workplaces are to move beyond symbolic equality toward genuine racial equity and well-being. Declarations Acknowledgements We thank all Black professionals who participated in the survey, interviews, and focus groups for sharing their experiences. We also acknowledge professional networks and community organisations that supported recruitment and engagement. Author contributions: AI conceived and designed the study, led data collection and analysis, and drafted the manuscript. FA-E contributed to study design, qualitative interpretation, and critical revision of the manuscript. AB contributed to methodological input, data interpretation, and manuscript review. CR provided senior methodological oversight, theoretical guidance, and critical intellectual input. CC contributed to conceptual development Authorship The corresponding author confirms they have read the journal policies and are submitting their manuscript in accordance with those policies. Funding The study was funded by the University College London (UCL) Grand Challenge of Mental Health & Wellbeing Data availability To protect participant confidentiality, research data is not publicly available; however, anonymised data may be provided upon request. Ethics approval and concert for participation Ethical approval was obtained from the University College London Ethics Committee (Ref: Z6364106/2025/01/20; approved April 2025). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Participation was voluntary, with confidentiality assured and the right to withdraw at any time, including appropriately obtaining informed consent. Data were pseudonymised, securely stored, and all quotations were anonymised. Given the sensitive nature of the topic, participants received debrief information and signposting to mental health and occupational well-being support services. Competing interests: The authors have no relevant financial or non-financial interests to disclose. Dual publication Not applicable Clinical trial number Not applicable Consent to Publish declaration Not applicable References Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health 1971. 2000;90(8):1212–5. Hackett RA, Ronaldson A, Bhui K, Steptoe A, Jackson SE. Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC Public Health. 2020;20(1):1652. Williams DR, Lawrence J, Davis B. Racism and Health: Evidence and Needed Research. Annu Rev Public Health. 2019;40:105–25. Government UK. GOV.UK. 2025 [cited 2025 Oct 26]. Equality data Report 2024. Available from: https://www.gov.uk/government/publications/equality-data-and-gender-pay-gap-reports-2024/equality-data-report-2024 NHS England, England » NHS. NHS Workforce Race Equality Standard 2024 data analysis report for NHS trusts [Internet]. 2025 [cited 2025 Nov 16]. Available from: https://www.england.nhs.uk/long-read/nhs-workforce-race-equality-standard-wres-2024-data-analysis-report-for-nhs-trusts/ Hammond WP, Gillen M, Yen IH. Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees. Race Soc Probl. 2010;2(1):19–30. Showunmi V, Tomlin C. Understanding and Managing Sophisticated and Everyday Racism: Implications for Education and Work. Lanham: Lexington Books; 2022. (Race and Education in the Twenty-First Century). Pascoe EA, Richman LS. Perceived Discrimination and Health: A Meta-Analytic Review. Psychol Bull. 2009;135(4):531–54. ONS. Ethnicity pay gaps, UK - Office for National Statistics [Internet]. 2023 [cited 2025 Nov 6]. Available from: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/articles/ethnicitypaygapsingreatbritain/2012to2022?utm_source=chatgpt.com Parker Review. The-Parker-Review-March-2024 [Internet]. 2024 [cited 2025 Nov 6]. Available from: https://parkerreview.co.uk/wp-content/uploads/2024/03/The-Parker-Review-March-2024.pdf Engel GL. The Need for a New Medical Model: A Challenge for Biomedicine. Science. 1977;196(4286):129–36. Crenshaw K. Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. 1989;University Chic Legal Forum, 1989(1), 139–67. Delgado R, Stefancic J. Critical race theory: an introduction / Richard Delgado and Jean Stefancic; foreword by Angela Harris. Fourth edition. New York: University Press; 2023. (Critical America). Ray V. A Theory of Racialized Organizations. Am Sociol Rev. 2019;84(1):26–53. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research / John W. Creswell, Vicki L. Plano Clark. Third edition., International student edition. Thousand Oaks, California: SAGE Publications. Inc.; 2018. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. Clark R, Anderson NB, Clark VR, Williams DR. Racism as a Stressor for African Americans: A Biopsychosocial Model. Am Psychol. 1999;54(10):805–16. Gravlee CC. How race becomes biology: Embodiment of social inequality. Am J Phys Anthropol. 2009;139(1):47–57. Kyere E, Fukui S. Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review. J Racial Ethn Health Disparities. 2023;10(4):1985–96. Settles IH, Buchanan NT, Dotson K. Scrutinized but not recognized: (In)visibility and hypervisibility experiences of faculty of color. J Vocat Behav. 2019;113:62–74. Sarason SB. The psychological sense of community: Prospects for a community psychology. Oxford, England: Jossey-Bass; 1974. xii, 290 p. (The psychological sense of community: Prospects for a community psychology). Smith CP, Freyd JJ. Institutional Betrayal. Am Psychol. 2014;69(6):575–87. ONS, Ethnicity pay gaps UK. 2012 to 2022 - Office for National Statistics [Internet]. 2023 [cited 2025 Nov 17]. Available from: https://www.ons.gov.uk/releases/ethnicitypaygapsuk2012to2022 Nazroo JY, Bhui KS, Rhodes J. Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociol Health Illn. 2020;42(2):262–76. Isiwele AA. Multimethod Investigation into Nigerian and Ghanaian Young People’s Experiences of Care for Common Mental Disorders in Inner London [Internet] [Doctoral]. Doctoral thesis, UCL (University College London). UCL (University College London); 2025 [cited 2025 June 6]. pp. 1–385. Available from: https://discovery.ucl.ac.uk/id/eprint/10207452/ Government of Canada. S. Changing Systems, Transforming Lives: Canada’s Anti-Racism Strategy 2024–2028 [Internet]. 2024 [cited 2025 Nov 17]. Available from: https://www.canada.ca/en/canadian-heritage/services/combatting-racism-discrimination/canada-anti-racism-strategy.html Bhopal K. White Privilege: The Myth of a Post-Racial Society. 1st ed. Bristol: Policy; 2018. Hammond WP. Taking It Like a Man: Masculine Role Norms as Moderators of the Racial Discrimination–Depressive Symptoms Association Among African American Men. Am J Public Health 1971. 2012;102(S2):S232–41. Johnson A, Amonoo L, Lofton S, Powell-Roach KL. How Masculinity Impedes African American Men From Seeking Mental Health Treatment. Am J Mens Health 2024 Sept 17;18(5):15579883241278846. Additional Declarations No competing interests reported. Supplementary Files Supplementalfile1.pdf Supplementalfile2QuantitativeAnalysisofWorkplaceRacismSurveyResults1.docx Supplementaryfile3ThematicAnalysis.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8671339","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":597005901,"identity":"028b7cc7-40e8-482d-bf79-a7c742aca195","order_by":0,"name":"Anthony Isiwele","email":"data:image/png;base64,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","orcid":"","institution":"University College London","correspondingAuthor":true,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Isiwele","suffix":""},{"id":597005904,"identity":"3793ebf2-eb58-4196-9f58-29cc132a1fb6","order_by":1,"name":"Funmi Adewole-Elliot","email":"","orcid":"","institution":"Coventry University","correspondingAuthor":false,"prefix":"","firstName":"Funmi","middleName":"","lastName":"Adewole-Elliot","suffix":""},{"id":597005905,"identity":"c363fbb4-5110-4f3c-aaed-ee681600f38a","order_by":2,"name":"Aygun Badalova","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Aygun","middleName":"","lastName":"Badalova","suffix":""},{"id":597005906,"identity":"f8a349a4-19c4-407e-82fc-a1e5268bbc51","order_by":3,"name":"Carol Rivas","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Carol","middleName":"","lastName":"Rivas","suffix":""},{"id":597005907,"identity":"327fb2e9-19d0-48a5-9200-3741d10184c8","order_by":4,"name":"Christine Callender","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Callender","suffix":""}],"badges":[],"createdAt":"2026-01-22 15:23:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8671339/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8671339/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108085276,"identity":"196ef1aa-71fd-4204-a467-f48c0fab0483","added_by":"auto","created_at":"2026-04-29 08:26:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":411315,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8671339/v1/5ef04fb2-edb8-45e7-862a-f53947c32365.pdf"},{"id":103587731,"identity":"d85d678f-c470-4434-9118-f6c48170cc40","added_by":"auto","created_at":"2026-02-27 11:35:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":315876,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalfile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8671339/v1/2331963f7c6718accc95c6de.pdf"},{"id":103587729,"identity":"68767978-8a29-42d0-bfe2-9396a700c86d","added_by":"auto","created_at":"2026-02-27 11:35:43","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":180761,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalfile2QuantitativeAnalysisofWorkplaceRacismSurveyResults1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8671339/v1/5666965b1244abb6a7276951.docx"},{"id":103587730,"identity":"96bb6101-33f9-49c3-bd3c-13aeb4ffd15d","added_by":"auto","created_at":"2026-02-27 11:35:43","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":92848,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile3ThematicAnalysis.docx","url":"https://assets-eu.researchsquare.com/files/rs-8671339/v1/0527e51960c6bd62c4918c20.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A mixed methods study of the biopsychosocial and economic impacts of workplace racism among Black professionals in the United Kingdom","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRacism is a systemic form of discrimination that sustains inequalities favouring White groups and operates across institutional, interpersonal, and structural levels (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is increasingly recognised as a critical social determinant of health, with significant consequences for mental, physical, and social well-being (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In the United Kingdom (UK), approximately 1 in 3 ethnic minority employees report experiencing workplace discrimination (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Sector-specific evidence reinforces these patterns. Data from the NHS England (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Workforce Race Equality Standard (WRES) indicates that Black staff are disproportionately subjected to formal disciplinary processes and are less likely to benefit from informal resolution than White colleagues.\u003c/p\u003e \u003cp\u003eThese inequalities demonstrate how racism remains embedded within professional structures, shaping both occupational and health disparities. Empirical research consistently links exposure to workplace racism with elevated anxiety, depression, and burnout among racialised employees (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Meta-analytic evidence confirms that perceived discrimination is strongly associated with adverse mental health outcomes, highlighting racism as a chronic psychosocial stressor rather than an isolated interpersonal experience (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBeyond health impacts, racism produces measurable economic harm. According to the Office for National Statistics (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) report \u003cem\u003eEthnicity pay gaps, UK: 2012\u0026ndash;2022\u003c/em\u003e, median hourly pay in 2022 was \u0026pound;13.53 for Black employees compared with \u0026pound;14.35 for White employees, indicating racial pay disparities. Structural barriers to advancement are further evidenced by the Parker Review (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), which reported that Black professionals hold fewer than 1% of senior leadership roles in major UK companies, despite comprising approximately 3\u0026ndash;4% of the working-age population.\u003c/p\u003e \u003cp\u003eTo examine these interconnected harms, this study adopts a Biopsychosocial-Economic (BPSE) framework, extending Engel\u0026rsquo;s (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) biopsychosocial model to explicitly incorporate economic precarity as a determinant of health. Intersectionality theory (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) is used here to illuminate how overlapping social positions shape differentiated experiences of racism and vulnerability. Critical Race Theory (CRT)) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) frames racism as an enduring and systemic feature of institutional life, while the Racialised Organisations Framework (ROF) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) provides an organisational lens for analysing how ostensibly neutral policies reproduce racial hierarchies and constrain progression.\u003c/p\u003e \u003cp\u003eThis mixed-methods study aims to: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) quantify links between racism, psychological distress, and economic disadvantage; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) explore lived experiences of coping, resistance, and resilience; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) integrate findings to inform intersectionality-based, culturally responsive policies promoting equity, accountability, and psychological safety at work.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study used a convergent parallel mixed-methods design (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) to examine the biopsychosocial-economic (BPSE) impact of workplace racism on Black professionals in the UK. Quantitative and qualitative data were collected concurrently, analysed separately, and integrated during interpretation to enable triangulation between prevalence patterns and lived experiences.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThree complementary participant groups contributed data. Survey respondents (n\u0026thinsp;=\u0026thinsp;53) were predominantly Black (79.6%), with smaller proportions identifying as Mixed, White, Asian, or Other; ages ranged from the 20s to the 60s, with most participants aged 40\u0026ndash;59. Semi-structured interviews were conducted with 11 Black professionals (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) who had experienced or witnessed workplace racism. Participants were purposively sampled to ensure variation in sector and career stage, though participation was predominantly female (9 women, 2 men). Two focus groups (n\u0026thinsp;=\u0026thinsp;12; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) were initially advertised as co-creative workshops but were restructured into facilitated discussion groups due to low attendance; both groups comprised women.\u003c/p\u003e \u003cp\u003eRecruitment occurred across the UK (London, Milton Keynes, Manchester, Liverpool) through professional associations, university staff networks, community organisations, and targeted mailing lists. Flyers with QR codes directed participants to an online survey and a registration form for interviews and focus groups. Participation was voluntary, responses were anonymised, and optional demographic questions were included. Written informed consent was obtained from all interview and focus group participants, who received a \u0026pound;30 voucher.\u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative Participants\u0026rsquo; Characteristics (Interviews and Focus Groups)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant ID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRole / Location in the UK\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorkplace Context / Sector\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExperience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLecturer in Education.\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh-rated Group of university, predominantly white,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 yrs, PhD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimary School Teacher. Manchester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMiddle Leader / Coordinator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 yrs, qualified teacher\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConsultant / Leicestershire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessor in police custody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 years, Higher Education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLecturer in Civil Engineering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCConstruction sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 yrs, master\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Lecturer in Policing. Liverpool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUniversity department (predominantly white)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 yrs, PhD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCivil servant. Berkshire.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCentral government office\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 yrs, PhD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSoftware Engineer. London\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePublic and private sectors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25 yrs, master\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent Experience Advisor\u003c/p\u003e \u003cp\u003eMilton Keynes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOpen University; prison education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Manager (Student Casework)\u003c/p\u003e \u003cp\u003eNorthamptonshire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigher education (Open University)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 yrs, master\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNurse (Agency / NMC Referral)\u003c/p\u003e \u003cp\u003eManchester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth \u0026amp; Social Care sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 yrs, PhD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeaching Assistant in Special Needs School\u003c/p\u003e \u003cp\u003eKent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrivate special needs school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG1-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSocial Worker\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLocal Authority Social Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 yrs, Master\u0026rsquo;s degrees\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG1-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducation Professional / Trainer\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary \u0026amp; Secondary Education Leadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG1-3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResearcher / Facilitator\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAcademic and Community Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 yrs, PhD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG1-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMental Health Practitioner\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCouncil / Community MH Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026gt;5 yrs, master\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG1-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMental Health Support Worker\u003c/p\u003e \u003cp\u003eKent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupported Housing / MH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG1-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcademic / Teacher\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigher Education \u0026amp; Primary Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u0026thinsp;+\u0026thinsp;yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG2-1 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeaching Assistant (Special Needs)\u003c/p\u003e \u003cp\u003eKent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecial Needs School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG2-2 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParent Support Worker\u003c/p\u003e \u003cp\u003eKent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchool Setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG2-3 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchool Business Manager (Trainee)\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 yrs, master\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG2-4 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePublic Sector Support Staff\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePublic Sector Office\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG2-5 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeacher / Support Worker\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecial Needs School / Hospitality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 yrs, MSc\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFG2-6 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdministrative Worker\u003c/p\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePublic Service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 yrs, degree\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSurvey instrument\u003c/h2\u003e \u003cp\u003eThe questionnaire was not intended as a psychometric scale but as a context-specific instrument to capture workplace experiences relevant to the qualitative inquiry. A 15-item online questionnaire, co-designed with professionals, assessed experiences of workplace racism, reporting confidence, awareness and perceived effectiveness of anti-racism policies, training exposure, and managerial responses (Supplemental file 1). Two 5-point Likert-scale items measured perceived workplace inclusiveness and policy effectiveness. Demographic items were optional to protect anonymity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSemi-structured interviews and Focus group\u003c/h2\u003e \u003cp\u003eInterviews explored experiences of racism, coping strategies, reporting barriers, organisational responses, and perceived psychological and economic impacts. The interview guide is available on request. Interviews lasted 45\u0026ndash;70 minutes and were conducted online between May and September 2025 with written and verbal consent. Two audio-recorded focus groups were held on 21 May and 20 June 2025. Each session began with a brief dance for health exercise to promote engagement and well-being, followed by a facilitated discussion. All recordings were destroyed following transcription.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative analysis\u003c/h2\u003e \u003cp\u003eNo a priori sample size calculation was conducted, as the survey component was designed to be exploratory and descriptive, intended to contextualise and triangulate qualitative findings rather than to generate population-level estimates or test causal hypotheses. The quantitative analysis, therefore, focuses on prevalence patterns and group comparisons to support integrated interpretation, consistent with mixed-methods guidance for exploratory health research (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eSurvey responses were analysed using \u003cem\u003eIBM SPSS Statistics v28\u003c/em\u003e, as detailed in supplemental file 2. Descriptive statistics summarised frequencies, percentages, means, and standard deviations. One-way analyses of variance (ANOVA) tested for group differences in inclusiveness ratings across ethnic and age categories, applying a significance threshold of p \u0026lt; .05. The ANOVA revealed significant differences in inclusiveness perceptions by ethnicity (F [3, 43]\u0026thinsp;=\u0026thinsp;15.13, p \u0026lt; .001) and by age group (F [5, 35]\u0026thinsp;=\u0026thinsp;32.95, p \u0026lt; .001). Black and younger respondents reported substantially lower inclusiveness compared with older or non-Black peers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eQualitative analysis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInterview and focus-group transcripts were analysed thematically using the six-phase approach of (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e): familiarisation, initial coding, theme generation, review, definition, and reporting. Manual colour-coding facilitated systematic organisation and retrieval of data, detailed in supplemental file 3. A hybrid inductive-deductive strategy was employed. Codes were generated directly from participants\u0026rsquo; language, guided by theoretical constructs of institutional racism and cultural stoicism. Triangulation across interviews and focus groups strengthened perceived credibility. Reflexive memos documented analytic decisions, and peer debriefing among researchers enhanced dependability. Ellipses (\u0026hellip;) were used to improve readability and to shorten quotations without altering their original meaning. An audit trail documenting coding decisions, theme development, and integration steps was maintained to support transparency and analytic rigour (Supplementary file 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatient and Public Involvement\u003c/h2\u003e \u003cp\u003eProfessionals and community members with lived experience of workplace racism contributed to the development and refinement of the survey instrument to ensure relevance, clarity, and sensitivity. Public contributors also informed the focus group format, including the incorporation of a brief dance-for-health activity to support well-being and engagement during discussions of potentially distressing experiences. Findings have been disseminated through professional and community networks to inform policy, practice, and advocacy on workplace racism and mental health. Participants were not involved in the final statistical analysis, but their lived experiences were central to the interpretation of the qualitative findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e"},{"header":"Results","content":"\u003cp\u003eResults are presented to illustrate patterns and lived experiences within this sample and are not intended to be generalised to all Black professionals in the UK.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Results\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the quantitative results, summarising demographic characteristics and key workplace experiences related to racism, inclusiveness, and policy effectiveness. The data highlight prevalent experiences and observations of racism, low confidence in reporting mechanisms, limited anti-racism training, and significant disparities in inclusiveness perceptions across ethnic and age groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuantitative Findings Summary\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain / Survey Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKey Result(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInterpretation / Insight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample Profile (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemographic summary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.6% Black; 8% Mixed; 4% White; 2% Asian; 4% Other; ages 20s\u0026ndash;60s (largest 40\u0026ndash;59 yrs\u0026thinsp;\u0026asymp;\u0026thinsp;48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe majority of Black professionals are in mid-career stages\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience of Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.6% (39/53) reported personal experience of racism; 26.4% had not.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNearly three-quarters of respondents personally experienced racism at work.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWitnessed Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.8% (37/53) had witnessed racist incidents; 30.2% had not.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndicates that racism is both experienced and observed by most staff.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfort in Reporting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/No/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.8% Yes; 43.4% No; 20.8% Not sure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLess than half feel safe reporting racism,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExistence of Anti-Racism Policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/No/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.3% Yes; 18.9% No; 35.8% Not sure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePolicies are unclear or poorly communicated in many organisations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffectiveness of Anti-Racism Policies (1\u0026ndash;5 Likert)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;=\u0026thinsp;2.08 (SD\u0026thinsp;=\u0026thinsp;1.21); 48% rated \u0026ldquo;1\u0026thinsp;=\u0026thinsp;Not effective\u0026rdquo;; 4% rated \u0026ldquo;5\u0026thinsp;=\u0026thinsp;Very effective.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePerceived policy effectiveness is very low.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation in Anti-Racism Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.5% Yes; 58.5% No.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFewer than \u0026frac12; of employees have received any formal anti-racism training.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived Inclusiveness of Workplace (1\u0026ndash;5 Likert)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;=\u0026thinsp;2.63 (SD\u0026thinsp;=\u0026thinsp;1.34); modal value\u0026thinsp;=\u0026thinsp;3 (30.8%); 26.9% rated 1 = \u0026ldquo;Not inclusive.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage inclusiveness rated below moderate; wide variation but skewed to negative perceptions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObserved Consequences for Racist Behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/No/Not sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.9% Yes; 64.2% No; 15.1% Not sure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVisible accountability for racism is rare or inconsistent.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerception: \u0026ldquo;Management Takes Racism Seriously\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/Sometimes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.6% Yes; 49.0% Sometimes; 29.4% No.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026frac12; perceive only conditional or inconsistent management commitment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANOVA: Inclusiveness by Ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF(3, 43)\u0026thinsp;=\u0026thinsp;15.13, p \u0026lt; .001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean scores: Black\u0026thinsp;=\u0026thinsp;2.03; White\u0026thinsp;=\u0026thinsp;4.00; Mixed\u0026thinsp;\u0026asymp;\u0026thinsp;3.75; Other\u0026thinsp;=\u0026thinsp;5.00.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBlack employees rated workplaces as significantly less inclusive than those rated by all other groups.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANOVA: Inclusiveness by Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF(5, 35)\u0026thinsp;=\u0026thinsp;32.95, p \u0026lt; .001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYounger respondents (20s\u0026ndash;30s)\u0026thinsp;\u0026asymp;\u0026thinsp;1.0 = \u0026ldquo;Not inclusive\u0026rdquo;; older (50\u0026ndash;59)\u0026thinsp;\u0026asymp;\u0026thinsp;2.5; 60\u0026thinsp;+\u0026thinsp;\u0026asymp;\u0026thinsp;3.1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYounger staff perceive markedly lower inclusiveness, suggesting generational disparities in racial climate.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Results\u003c/h2\u003e \u003cp\u003eThematic analysis of 11 interviews and two focus groups identified five interrelated themes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; supplemental file 3) capturing the biopsychosocial and economic impacts of workplace racism on Black professionals. The themes represent distinct yet overlapping dimensions of harm and resilience shaped by structural inequities and align with the quantitative patterns.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative Themes Overview\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterpretive Summary (Biopsychosocial-Economic Link)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Structural and Institutional Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRacism operates through policies and power structures that normalise exclusion and retaliatory risk, producing chronic mistrust and physiological stress responses.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Psychological and Health Consequences of Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous exposure to racial stress triggers psychological and physiological deterioration, manifesting as insomnia, depression, and burnout.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Cultural Stoicism, Internalised Racism \u0026amp; Silenced Resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStoicism and internalised restraint serve as culturally shaped survival tactics, maintaining composure but silencing resistance and compounding emotional distress.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Economic Exploitation and Career Precarity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRacism generates economic losses through suspension, dismissal, and blocked advancement, reinforcing psychological and social disadvantage and creating an economic feedback loop.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Empowerment, Solidarity \u0026amp; Pathways for Reform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSolidarity, faith, and structural reform transformed distress into agency. Dance and recreation eased stress and strengthened interaction under pressure, while rights awareness and collective advocacy functioned as protective, reform-driving forces within hostile systems.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIntegration of quantitative and qualitative strands.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIntegration was achieved through a joint display matrix in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, linking quantitative patterns with qualitative themes and participant narratives. Convergences strengthened the interpretation (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For example, low confidence in reporting racism aligned with accounts that \u003cem\u003e\u0026ldquo;the reporting system\u0026hellip; doesn\u0026rsquo;t work\u0026rdquo; (P1, p. 11)\u003c/em\u003e and fear of being labelled \u003cem\u003e\u0026ldquo;aggressive\u0026rdquo; (P1, p. 7)\u003c/em\u003e. Likewise, low policy-effectiveness scores matched experiences of inaction: \u003cem\u003e\u0026ldquo;nothing was done, in fact, that person was promoted\u0026rdquo; (FG-7, p. 296)\u003c/em\u003e. This integration grounded statistical trends in lived experience, enhancing the study\u0026rsquo;s perceived meta-inferences.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntegrated Joint-Display Matrix Linking Quantitative and Qualitative Findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuantitative Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKey Quantitative Finding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLinked Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample profile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajority Black (79.6%), mid-career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStructural Racism; Economic Precarity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal experience of racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.6% experienced racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychological Harm; Structural Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWitnessed racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.8% witnessed racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSilenced Resistance; Structural Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComfort in reporting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly 35.8% feel safe reporting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCultural Stoicism; Structural Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness of anti-racism policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.8% \u0026ldquo;Not sure\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmpowerment \u0026amp; Reform; Structural Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffectiveness of anti-racism policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;=\u0026thinsp;2.08; almost half said \u0026ldquo;Not effective\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStructural Racism; Psychological Harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation in anti-racism training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly 41.5% had training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReform Pathways; Structural Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived inclusiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean 2.63; many rated workplaces \u0026ldquo;Not inclusive\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychological Harm; Stoicism;\u003c/p\u003e \u003cp\u003eInternalised Racism \u0026amp; Silenced Resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsequences for racist behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly 18.9% saw consequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStructural Racism; Economic Harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement takes racism seriously\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnly 21.6% agreed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychological Harm; Structural Racism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusiveness by ethnicity (ANOVA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack staff far lower than White staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEconomic Precarity; Structural Racism; Psychological Harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Structural and Institutional Racism\u003c/h2\u003e \u003cp\u003e Participants\u0026rsquo; accounts consistently framed racism as institutionally mediated, operating through organisational policies, procedures, and decision-making practices rather than through isolated interpersonal acts. This qualitative pattern converged with the quantitative findings, which showed high exposure to racism alongside low confidence in organisational responses, shaping a context in which institutional processes were experienced as uneven and, at times, unsafe. Survey results indicated that 73.6% of respondents reported personally experiencing racism at work, and 69.8% had witnessed racist incidents, suggesting that participants were situated within environments where racialised dynamics were recurrent rather than exceptional (supplemental files 2 \u0026amp; 3 and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Within this context, participants described how formal structures, such as grievance procedures, promotion pathways, and investigations, were perceived as neutral in principle but inconsistent in practice. One academic articulated racism as a structural condition, describing workplace racism as:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;people and structures that create hostile environments in a workplace for those of us who are marginalised and minoritised. In predominantly white spaces, it means that you are either implicitly or explicitly always at a disadvantage\u0026rdquo; (P1, p. 16).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eShe further emphasised that disadvantage emerged when those holding power did not \u0026ldquo;recognise, understand, or accept the difficulties that those of us who are marginalised\u0026hellip;experience in those spaces\u0026rdquo; \u003cem\u003e(P1, p. 16).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eConfidence in reporting mechanisms was a central institutional issue. Quantitatively, only 35.8% of respondents reported feeling comfortable reporting racist incidents, while 43.4% reported discomfort and 20.8% were unsure, indicating widespread uncertainty about procedural safety. Participants\u0026rsquo; narratives illuminated how this uncertainty developed. One focus group participant reflected on racism as something \u003cem\u003e\u0026ldquo;subtle, hidden within policies and practices\u003c/em\u003e\u0026rdquo; (FG2-5, p. 295), making it difficult to challenge without risking misinterpretation or dismissal.\u003c/p\u003e \u003cp\u003eWhere participants did pursue formal complaints, experiences often reinforced scepticism about procedural fairness. One participant who submitted extensive evidence questioned the independence of the process:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The so-called \u0026ldquo;independent investigator\u0026rdquo; turned out to be one of the principals from their other schools. \u0026hellip;So how is that independent? (FG2-3, p. 297).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eShe described the outcome succinctly:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You didn\u0026rsquo;t follow processes. You didn\u0026rsquo;t follow policy. Nothing.\u0026rdquo; (FG2-3, p. 297)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuch accounts align with survey findings showing that only 18.9% of respondents had ever seen a colleague face consequences for racist behaviour, suggesting limited visible accountability within organisations\u003c/p\u003e \u003cp\u003eParticipants also located institutional racism within career progression and recognition structures. Survey data revealed low perceived effectiveness of anti-racism policies (mean\u0026thinsp;=\u0026thinsp;2.08 out of 5), alongside modest ratings of workplace inclusiveness (mean\u0026thinsp;=\u0026thinsp;2.63 out of 5). Qualitative narratives contextualised these figures. P2, a teacher, stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The first one was applying for an assistant headteacher role four times at the same school. Despite being an experienced teacher, holding the right qualifications, having completed a management course, and leading departments without receiving additional pay\u0026mdash;I was told I wasn\u0026rsquo;t successful each time\u0026hellip;I was overlooked despite being qualified. That\u0026rsquo;s institutional racism\u0026rdquo; (p. 28)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOthers described being asked to undertake leadership or specialist responsibilities without commensurate title or pay, reinforcing perceptions of constrained advancement.\u003c/p\u003e \u003cp\u003eFear of negative repercussions shaped how participants navigated these structures. Several described informal warnings about the risks of speaking up. One focus group member captured this concern clearly: \u0026ldquo;Why are we blowing the whistle to the same people who are part of the problem?\u0026rdquo; (p. 244). This perceived risk helps explain the quantitative pattern of low reporting comfort and limited confidence in organisational responses.\u003c/p\u003e \u003cp\u003eLargely, the integration of quantitative and qualitative findings indicates that structural and institutional racism was experienced not as an overt organisational stance, but as a patterned outcome of routine practices. High exposure to racism, low inclusiveness, limited accountability, and uncertain reporting pathways combined to produce environments in which participants managed risk carefully, often through silence or withdrawal. Participants\u0026rsquo; narratives foreground how institutional arrangements shaped everyday experiences of work, influencing trust, safety, and engagement within organisational life.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Psychological and Health Consequences of Racism\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; narratives showed that workplace racism was experienced as a chronic psychological and physiological stressor, with effects that accumulated over time rather than arising from single incidents. These qualitative accounts closely aligned with the quantitative findings, which indicated a high prevalence of racism exposure and low perceptions of organisational inclusiveness, conditions that form the backdrop to sustained psychological strain. Survey data indicated that 73.6% of respondents had personally experienced racism at work, and 69.8% had witnessed racist incidents, suggesting that many participants were operating in environments characterised by ongoing racial stress rather than isolated events (supplemental files 2 \u0026amp; 3 and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWithin this context, participants described the embodied toll of prolonged exposure. One focus group participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I was so burnt out. I went off sick for two months because I just couldn\u0026rsquo;t take it anymore. My body was literally exhausted. I just wanted to get away\u0026rdquo; (p. 298).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis account resonates with the broader pattern of low workplace inclusiveness reported in the survey (mean\u0026thinsp;=\u0026thinsp;2.63 out of 5), indicating environments that many respondents experienced as psychologically unsupportive\u003c/p\u003e \u003cp\u003eAnxiety emerged as a prominent consequence of racialised workplace stress. Participants described fear, hypervigilance, and emotional depletion that shaped everyday behaviour. One narrative captured this vividly:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;She became so afraid and emotionally drained that she didn\u0026rsquo;t even want to see the person who was being racist toward her. She had reported it, but nothing was done, in fact, that person was promoted.\u0026rdquo; (FG2-7, p. 297)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eQuantitative findings help contextualise this response. Only 35.8% of survey respondents reported feeling comfortable reporting racist incidents, suggesting that many individuals manage distress internally rather than through formal support channels\u003c/p\u003e \u003cp\u003eThis lack of psychological safety appeared to intensify anxiety and withdrawal.\u003c/p\u003e \u003cp\u003eParticipants also described erosion of confidence and reduced psychological capacity, which affected engagement and performance. One academic reflected:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Because my confidence levels were so low\u0026hellip;there were opportunities to collaborate on things\u0026hellip;[that I just] didn\u0026rsquo;t feel confident enough to take\u0026rdquo; (P1, p. 15\u0026amp;16).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuch accounts align with survey findings showing limited confidence in organisational responses, including low ratings of policy effectiveness (mean\u0026thinsp;=\u0026thinsp;2.08 out of 5), reinforcing a context in which distress remains insufficiently addressed\u003c/p\u003e \u003cp\u003eFor some, the cumulative psychological impact manifested as disengagement from work itself: In the focus group narration, one participant said, \u0026ldquo;\u003cem\u003eWhen these issues were happening, people said they didn\u0026rsquo;t even want to go to work anymore. They couldn\u0026rsquo;t face getting up in the morning\u0026rdquo;. (p. 296)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe integration of quantitative and qualitative data demonstrates how high exposure to racism, low inclusiveness, and limited reporting confidence coalesced into sustained psychological strain. Participants\u0026rsquo; words illustrate that anxiety, exhaustion, and withdrawal were not individual pathologies, but understandable responses to prolonged racialised stress within workplace environments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Cultural Stoicism, Internalisation, and Silenced Resistance\u003c/h2\u003e \u003cp\u003eThis theme captures how participants navigated workplace racism through culturally shaped strategies of endurance, restraint, and selective silence. Rather than indicating passivity or acceptance, these responses were described as protective adaptations developed within contexts where formal avenues of redress were perceived as risky or ineffective. The qualitative accounts converged with quantitative findings showing low confidence in reporting mechanisms, helping to explain why resistance was often internalised or displaced rather than openly articulated. (supplemental files 2 \u0026amp; 3 and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e Participants described learning to manage racism through emotional containment. P9 reflected on how repeated exposure led to a default posture of endurance: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s exhausting after a while. You just get on with your job and \u0026lsquo;take it on the chin,\u0026rsquo; even though that\u0026rsquo;s not healthy\u0026rdquo; (p. 190).\u003c/em\u003e Here, stoicism functioned as a survival strategy, enabling continued employment while simultaneously suppressing emotional expression.\u003c/p\u003e \u003cp\u003e Several participants described withdrawal as a form of self-protection, particularly when reporting had previously resulted in dismissal or delay in addressing concerns. In focus group discussions, participants noted that when racism occurred, \u003cem\u003e\u0026ldquo;we don\u0026rsquo;t go and report them to management. We speak amongst ourselves\u0026rdquo; (p. 298)\u003c/em\u003e. This intra-group sharing created informal spaces of validation, but also reinforced the absence of institutional accountability. Withdrawal was not only social but spatial and psychological, shaping how participants moved through workplaces and engaged with colleagues.\u003c/p\u003e \u003cp\u003eInternalisation of racism was also discussed in relation to self-monitoring and emotional regulation. Participants described being cautious about tone, behaviour, and visibility, aware that emotional expression could be reinterpreted negatively. One participant noted that stereotypes such as being perceived as \u003cem\u003e\u0026ldquo;too loud\u0026rdquo;\u003c/em\u003e or \u003cem\u003e\u0026ldquo;too brash\u0026rdquo;\u003c/em\u003e made it difficult to just be themselves, leading to constant self-adjustment \u003cem\u003e(P8, p. 175)\u003c/em\u003e. This vigilance contributed to emotional fatigue and reinforced silence as a safer option than confrontation.\u003c/p\u003e \u003cp\u003eQuantitative findings further contextualise these narratives. Only 18.9% of respondents had ever seen a colleague face consequences for racist behaviour, suggesting limited visible accountability. In this environment, cultural stoicism and withdrawal emerged as rational responses to institutional uncertainty.\u003c/p\u003e \u003cp\u003eThis theme shows that silenced resistance was not an absence of agency, but a reconfiguration of agency under constraint. Participants\u0026rsquo; narratives demonstrate how cultural expectations of strength, combined with organisational risk, shaped patterns of internalisation and withdrawal that protected livelihoods while exacting high emotional cost.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Economic Exploitation and Career Precarity\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; narratives demonstrated that workplace racism was experienced not only as a psychological or social burden but as a \u003cb\u003ematerial and economic force\u003c/b\u003e shaping career trajectories, income security, and long-term professional stability. These qualitative accounts converged with quantitative findings showing limited accountability and low confidence in organisational responses, conditions that rendered economic precarity a persistent risk rather than an exceptional outcome (supplemental files 3 and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWithin this context, participants described how racism translated into stalled progression, loss of income, and blocked opportunity. Several accounts focused on repeated experiences of being overlooked for promotion despite qualifications and demonstrated competence. As noted earlier in Theme 1, P2 reflected on how she had applied multiple times for senior roles without success, despite undertaking leadership responsibilities without commensurate recognition or pay. These experiences were not framed as isolated disappointments, but as patterned outcomes that limited career mobility over time.\u003c/p\u003e \u003cp\u003eEconomic consequences also emerged from the withdrawal from opportunities due to diminished confidence and emotional depletion. P1 described how prolonged engagement with grievance processes undermined her capacity to pursue collaborative projects and external work, directly affecting her income. This illustrates how psychological harm and economic loss were intertwined, with racism constraining not only advancement within organisations but also engagement with supplementary professional opportunities.\u003c/p\u003e \u003cp\u003eFor others, precarity was more immediate and severe. Participants described suspension, dismissal, or contract termination after raising concerns, reinforcing the perception that economic security was conditional on silence. P11 recounted how, after formal complaints, processes were delayed in ways that foreclosed access to external remedies, leaving individuals without employment or recourse:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They made sure it took over three months to get back to me, so that I couldn\u0026rsquo;t even go to ACAS and claim anything. Everything they did went against their own policy\u0026rdquo; (p. 225).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuch experiences shaped collective risk awareness, influencing how others navigated similar situations. Quantitative findings provide important context for these narratives. Less than half of respondents reported the presence of clear anti-racism policies, and policy effectiveness was rated very low overall (mean\u0026thinsp;=\u0026thinsp;2.08 out of 5)\u003c/p\u003e \u003cp\u003eIn workplaces where protections were perceived as weak or inconsistently applied, economic vulnerability became an ever-present backdrop to daily decision-making. Participants described remaining in posts for financial reasons despite distress, or accepting additional responsibilities without advancement to maintain perceived indispensability.\u003c/p\u003e \u003cp\u003eOverall, this theme highlights how racism operated as an economic mechanism, shaping who progressed, who remained precarious, and who exited organisations altogether. Participants\u0026rsquo; accounts illustrate that career stagnation, income loss, and employment insecurity were not unintended side effects, but integral to how racism was experienced and managed in workplace contexts.\u003c/p\u003e \u003cp\u003e \u003cb\u003e5. Empowerment, Solidarity, and Pathways for Reform\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWhile participants\u0026rsquo; accounts detailed significant harm, they also articulated pathways of empowerment and collective resilience that transformed distress into agency. These pathways did not emerge primarily from formal organisational responses, but from peer solidarity, shared knowledge, faith, and embodied practices, which functioned as protective resources within challenging workplace environments. Quantitative findings showing low confidence in reporting and limited visible accountability provide important context for why these alternative sources of support became so salient (supplemental files 3 and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAgainst this backdrop, participants described turning toward collective spaces outside formal hierarchies. Informal peer networks, Black staff groups, unions, and community connections were repeatedly identified as places where experiences could be named, validated, and strategized around without fear of immediate reprisal. A focus group participant, FG2-3, narrates:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In my case, I found there was also an Association of Black Academics. If your line manager couldn\u0026rsquo;t help, you could go to them. They\u0026rsquo;d share their experiences and guide you: \u0026lsquo;This is what I did,\u0026hellip;read this policy \u0026hellip;That was really helpful.\u0026rdquo; (p. 302)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eShe described how engagement with a Black academic network offered practical guidance, sharing policies, naming options, and modelling how others had navigated similar situations, thereby converting isolation into informed action.\u003c/p\u003e \u003cp\u003eSolidarity was also described as emotionally restorative. Focus group discussions highlighted the importance of simply being heard by others with shared experiences. Participants noted that speaking openly within trusted groups countered the internalisation and self-doubt cultivated by racialised workplaces. These spaces did not eliminate harm, but they reduced its isolating effects and supported psychological endurance.\u003c/p\u003e \u003cp\u003eFaith also serves as a critical reservoir of resilience for participants navigating workplace hostility, offering a \u003cem\u003e\"spiritual foundation\"\u003c/em\u003e that precludes maladaptive coping mechanisms (p10, p. 208). For P10, faith provides a specific framework to contextualize suffering, removing self-blame by attributing events to a higher purpose:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My faith reminds me that God understands more than human understanding. If He allows certain situations to happen, then it must be for a reason. That belief is a consolation for me\" (p. 208).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSimilarly, P3 describes her ordeal as a \u003cem\u003e\"spiritual journey\" (p. 70)\u003c/em\u003e, using her relationship with God to regulate her emotions during periods of acute instability:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I literally had to say, \u0026lsquo;God, you\u0026rsquo;re going to have to carry us, because I don\u0026rsquo;t know how we\u0026rsquo;re going to cope'... I\u0026rsquo;ve learned over the years and I have my faith, I believe things will come\u0026mdash;and they do\". P. 71\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHere, spiritual grounding acts not as denial, but as a stabilizing resource that fosters persistence and emotional regulation in hostile environments.\u003c/p\u003e \u003cp\u003eFor many participants, the body serves as a primary site of resistance and recovery when institutional support is absent. Rather than relying solely on cognitive strategies or medication, participants like P6 turn to \u003cem\u003e\"singing, dancing\" (p. 140\u003c/em\u003e) as essential tools for managing the physiological toll of \u003cem\u003e\"work-related stress and burnout\" (p. 139)\u003c/em\u003e. These embodied practices offer a safe outlet for emotions that might be unsafe to express verbally in hostile work environments. FG2-6 describes how movement provides a private, embodied release from workplace stress:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I watch movies, listen to music, dance\u0026mdash;all of the above. Most times, when I\u0026rsquo;m stressed, I start cooking or cleaning while dancing. It really helps me.\" (p. 265)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFG2-6 notes, dancing while cleaning becomes a private ritual to metabolize stress.\u003c/p\u003e \u003cp\u003eThis theme demonstrates that even within constrained conditions, participants cultivated forms of agency that transformed vulnerability into solidarity and reform-oriented insight. These pathways highlight how empowerment can coexist with harm, sustaining engagement while pointing toward more inclusive and responsive organisational practices.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that workplace racism functions as a multidimensional determinant of health, producing interconnected biological, psychological, social, and economic harms that accumulate over time. Participants\u0026rsquo; accounts of physiological exhaustion, psychological distress, social exclusion, and financial strain reveal mutually reinforcing processes embedded within organisational life. Interpreted through a biopsychosocial-economic lens, informed by intersectionality, Critical Race Theory, and the Racialised Organisations Framework, these findings extend Engel\u0026rsquo;s (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) model and align with Clark et al.\u0026rsquo;s (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) conceptualisation of racism as a chronic stressor with cumulative effects on health.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eBiological\u003c/h2\u003e \u003cp\u003eThe findings provide empirical support for Gravlee\u0026rsquo;s (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) concept of embodied inequality, illustrating how racism operates not only as a social insult but as a biological injury. Participants\u0026rsquo; reports of insomnia, fatigue, and stress-related illness demonstrate how prolonged exposure to racialised organisational environments translates into physiological depletion. Within the UK context, these lived experiences help explain the persistent racial disparities in disciplinary action and staff well-being documented in NHS England\u0026rsquo;s (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) WRES data. The high prevalence of reported racism in this study (73.6%) and the qualitative data reinforce national evidence that such inequalities are systemic rather than exceptional. These patterns suggest that institutional inaction and procedural neglect function as mechanisms through which social disadvantage becomes biologically embodied, depleting health alongside career opportunity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePsychological\u003c/h2\u003e \u003cp\u003ePsychologically, workplace racism eroded confidence, motivation, and self-efficacy while intensifying hypervigilance and anxiety. These effects mirror meta-analytic evidence linking perceived discrimination to adverse mental-health outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), but the present study extends this literature by situating distress within organisational cultures that normalise silence and penalise resistance. The finding that only 35.8% of respondents felt safe reporting racism suggests the amplification of psychological harm by institutional betrayal, where formal processes exist but fail to provide protection. Interpreted through Critical Race Theory, this reflects the enduring normalisation of racism within bureaucratic systems that frame inequitable outcomes as procedural neutrality rather than injustice (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The data therefore challenge individualised interpretations of distress, suggesting that psychological harm may be produced and sustained through organisational design.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSocial\u003c/h2\u003e \u003cp\u003eThe social dimension of workplace racism was characterised by alienation, surveillance, and erosion of trust. Participants described organisational environments in which bystander silence, tokenism, and a lack of allyship perpetuated exclusion. This pattern aligns with Kyere and Fukui\u0026rsquo;s (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) analysis of racialised organisational cultures that normalise microaggressions while rendering Black professionals hyper-visible yet unheard. Such cultures suggest the persistence of discriminatory attitudes within institutional structures despite formal equality commitments, positioning racism as a systemic organisational practice rather than an isolated aberration. The resulting social fragmentation undermines the relational premise of the biopsychosocial model, which emphasises the role of supportive interpersonal and community networks in sustaining health.\u003c/p\u003e \u003cp\u003eWithin these contexts, participants described patterned withdrawal from organisational life, including reduced visibility, disengagement from shared spaces, and psychological distancing, as rational responses to racialised scrutiny. Consistent with evidence that unsupportive racial climates reduce engagement among racialised employees (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Withdrawal in this study functioned ambivalently: it reduced immediate exposure to harm while simultaneously limiting access to informal support, mentoring, and advancement opportunities, thereby reinforcing longer-term disadvantage.\u003c/p\u003e \u003cp\u003eParticipants also highlighted Black peer solidarity, faith, and collective advocacy as important sources of resilience, consistent with community psychology perspectives (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, reliance on these informal networks exposed an institutional withdrawal from responsibility for inclusion and care. Rather than substituting for organisational support, such networks operated as compensatory mechanisms in response to persistent exclusion, aligning with analyses of institutional betrayal in which organisations espouse inclusion rhetorically while failing to protect those exposed to harm (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Collectively, these dynamics illustrate how workplace racism fractures social belonging not only through exclusion, but through the routinisation of withdrawal as a rational survival strategy within organisational life.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eEconomic\u003c/h2\u003e \u003cp\u003eEconomic marginalisation emerged as a central mechanism linking all other domains of harm. Participants\u0026rsquo; experiences of stalled progression, suspension, and exclusion from leadership mirror national labour-market data showing persistent racial pay gaps and under-representation of Black professionals in senior roles (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Interpreted through the Racialised Organisations Framework, these outcomes reflect how organisational rules and reward systems allocate resources and status along racial hierarchies, often under the guise of neutrality (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Economic insecurity compounded psychological distress and constrained biological recovery by limiting access to rest, therapy, and financial stability. These findings support evidence that economic precarity is both a cause and consequence of racialised health inequality (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), positioning income loss and blocked advancement as material expressions of institutional racism rather than incidental outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Policy, Practice, and Research\u003c/h2\u003e \u003cp\u003eThese findings call for an intersectional and culturally humble transformation of workplace equity policy, moving beyond compliance-based training toward approaches that explicitly address power, privilege, and institutional accountability. The Intersectionality-Based Cultural Humility Analysis (IBCHA) framework (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) offers a practical model for this shift, integrating reflexivity, lived experience, and structural analysis into leadership development, equity audits, and policy review. While the primary focus remains the UK context, insight can be drawn from international approaches that institutionalise accountability, such as the Government of Canada\u0026rsquo;s (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) Anti-Racism Strategy, which embeds equity audits and intersectional data within public-sector governance. Adapted through IBCHA, such mechanisms could strengthen UK workplace policies by moving from symbolic compliance toward participatory, evidence-informed reform. Further empirical evaluation of culturally responsive coping strategies, including participatory and movement-based approaches, is needed to strengthen the evidence base for organisational reform. Future studies should employ larger, more gender-balanced samples and longitudinal, purposive designs to examine variation across sectors, career stages, and organisational contexts.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eGender Influence on Findings\u003c/h2\u003e \u003cp\u003eThe predominance of female participants may have likely amplified gendered narratives of emotional labour, endurance, and intersectional burden commonly experienced by Black women in professional settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Accounts of silence and resilience reflect the \u0026ldquo;strong Black woman\u0026rdquo; schema, which may obscure distress while enabling institutional neglect. Conversely, the limited representation of Black men may understate coping strategies shaped by masculine norms of stoicism and emotional suppression (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study employed a convergent parallel mixed-methods design to integrate exploratory survey data with in-depth qualitative accounts, enabling a multidimensional analysis of workplace racism as a biopsychosocial and economic determinant of health. A key strength lies in integrating prevalence patterns with lived experience, providing analytic depth that large-scale datasets may not capture, including institutional processes and embodied impacts.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the survey component was exploratory and descriptive, and no a priori sample size calculation was conducted; findings are therefore not intended to be generalised to all Black professionals in the UK. Second, the overall sample size was modest and predominantly female, which may have amplified gendered narratives of emotional labour, endurance, and intersectional burden, while underrepresenting experiences shaped by masculine norms of coping. Third, participants were self-selected, which may have favoured individuals with prior experiences of workplace racism or heightened motivation to participate. Finally, the cross-sectional design precludes causal inference. These limitations are consistent with the study\u0026rsquo;s exploratory aims but should be considered when interpreting the findings.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that workplace racism in the UK is a structural determinant of health rather than a series of isolated interpersonal incidents. Racism operates through interconnected biological, psychological, social, and economic pathways that existing organisational responses fail to address. A biopsychosocial-economic lens reveals the necessity of trauma-informed, accountable, and redistributive reforms if workplaces are to move beyond symbolic equality toward genuine racial equity and well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eAcknowledgements\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eWe thank all Black professionals who participated in the survey, interviews, and focus groups for sharing their experiences. We also acknowledge professional networks and community organisations that supported recruitment and engagement.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eAuthor contributions:\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAI conceived and designed the study, led data collection and analysis, and drafted the manuscript. FA-E contributed to study design, qualitative interpretation, and critical revision of the manuscript. AB contributed to methodological input, data interpretation, and manuscript review. CR provided senior methodological oversight, theoretical guidance, and critical intellectual input. CC contributed to conceptual development\u003c/p\u003e\n\u003ch3\u003eAuthorship\u003c/h3\u003e\n\u003cp\u003eThe corresponding author confirms they have read the journal policies and are submitting their manuscript in accordance with those policies.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThe study was funded by the University College London (UCL) Grand Challenge of Mental Health \u0026amp; Wellbeing\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eData availability\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eTo protect participant confidentiality, research data is not publicly available; however, anonymised data may be provided upon request.\u003c/p\u003e\n\u003ch3\u003eEthics approval and concert for participation\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from the University College London Ethics Committee (Ref: Z6364106/2025/01/20; approved April 2025). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Participation was voluntary, with confidentiality assured and the right to withdraw at any time, including appropriately obtaining informed consent. Data were pseudonymised, securely stored, and all quotations were anonymised. Given the sensitive nature of the topic, participants received debrief information and signposting to mental health and occupational well-being support services.\u003c/p\u003e\n\u003ch3\u003eCompeting interests:\u003c/h3\u003e\n\u003cp\u003e\u0026nbsp;The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eDual publication\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eClinical trial number\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eConsent to Publish declaration\u003c/h3\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJones CP. Levels of racism: a theoretic framework and a gardener\u0026rsquo;s tale. Am J Public Health 1971. 2000;90(8):1212\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHackett RA, Ronaldson A, Bhui K, Steptoe A, Jackson SE. Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC Public Health. 2020;20(1):1652.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams DR, Lawrence J, Davis B. Racism and Health: Evidence and Needed Research. Annu Rev Public Health. 2019;40:105\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGovernment UK. GOV.UK. 2025 [cited 2025 Oct 26]. Equality data Report 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/publications/equality-data-and-gender-pay-gap-reports-2024/equality-data-report-2024\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/publications/equality-data-and-gender-pay-gap-reports-2024/equality-data-report-2024\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNHS England, England \u0026raquo; NHS. NHS Workforce Race Equality Standard 2024 data analysis report for NHS trusts [Internet]. 2025 [cited 2025 Nov 16]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.england.nhs.uk/long-read/nhs-workforce-race-equality-standard-wres-2024-data-analysis-report-for-nhs-trusts/\u003c/span\u003e\u003cspan address=\"https://www.england.nhs.uk/long-read/nhs-workforce-race-equality-standard-wres-2024-data-analysis-report-for-nhs-trusts/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammond WP, Gillen M, Yen IH. Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees. Race Soc Probl. 2010;2(1):19\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShowunmi V, Tomlin C. Understanding and Managing Sophisticated and Everyday Racism: Implications for Education and Work. Lanham: Lexington Books; 2022. (Race and Education in the Twenty-First Century).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePascoe EA, Richman LS. Perceived Discrimination and Health: A Meta-Analytic Review. Psychol Bull. 2009;135(4):531\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eONS. Ethnicity pay gaps, UK - Office for National Statistics [Internet]. 2023 [cited 2025 Nov 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/articles/ethnicitypaygapsingreatbritain/2012to2022?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/articles/ethnicitypaygapsingreatbritain/2012to2022?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParker Review. The-Parker-Review-March-2024 [Internet]. 2024 [cited 2025 Nov 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://parkerreview.co.uk/wp-content/uploads/2024/03/The-Parker-Review-March-2024.pdf\u003c/span\u003e\u003cspan address=\"https://parkerreview.co.uk/wp-content/uploads/2024/03/The-Parker-Review-March-2024.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEngel GL. The Need for a New Medical Model: A Challenge for Biomedicine. Science. 1977;196(4286):129\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrenshaw K. Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. 1989;University Chic Legal Forum, 1989(1), 139\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelgado R, Stefancic J. Critical race theory: an introduction / Richard Delgado and Jean Stefancic; foreword by Angela Harris. Fourth edition. New York: University Press; 2023. (Critical America).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRay V. A Theory of Racialized Organizations. Am Sociol Rev. 2019;84(1):26\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Plano Clark VL. Designing and conducting mixed methods research / John W. Creswell, Vicki L. Plano Clark. Third edition., International student edition. Thousand Oaks, California: SAGE Publications. Inc.; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClark R, Anderson NB, Clark VR, Williams DR. Racism as a Stressor for African Americans: A Biopsychosocial Model. Am Psychol. 1999;54(10):805\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGravlee CC. How race becomes biology: Embodiment of social inequality. Am J Phys Anthropol. 2009;139(1):47\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKyere E, Fukui S. Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review. J Racial Ethn Health Disparities. 2023;10(4):1985\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSettles IH, Buchanan NT, Dotson K. Scrutinized but not recognized: (In)visibility and hypervisibility experiences of faculty of color. J Vocat Behav. 2019;113:62\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarason SB. The psychological sense of community: Prospects for a community psychology. Oxford, England: Jossey-Bass; 1974. xii, 290 p. (The psychological sense of community: Prospects for a community psychology).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith CP, Freyd JJ. Institutional Betrayal. Am Psychol. 2014;69(6):575\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eONS, Ethnicity pay gaps UK. 2012 to 2022 - Office for National Statistics [Internet]. 2023 [cited 2025 Nov 17]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ons.gov.uk/releases/ethnicitypaygapsuk2012to2022\u003c/span\u003e\u003cspan address=\"https://www.ons.gov.uk/releases/ethnicitypaygapsuk2012to2022\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNazroo JY, Bhui KS, Rhodes J. Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociol Health Illn. 2020;42(2):262\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsiwele AA. Multimethod Investigation into Nigerian and Ghanaian Young People\u0026rsquo;s Experiences of Care for Common Mental Disorders in Inner London [Internet] [Doctoral]. Doctoral thesis, UCL (University College London). UCL (University College London); 2025 [cited 2025 June 6]. pp. 1\u0026ndash;385. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://discovery.ucl.ac.uk/id/eprint/10207452/\u003c/span\u003e\u003cspan address=\"https://discovery.ucl.ac.uk/id/eprint/10207452/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGovernment of Canada. S. Changing Systems, Transforming Lives: Canada\u0026rsquo;s Anti-Racism Strategy 2024\u0026ndash;2028 [Internet]. 2024 [cited 2025 Nov 17]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.canada.ca/en/canadian-heritage/services/combatting-racism-discrimination/canada-anti-racism-strategy.html\u003c/span\u003e\u003cspan address=\"https://www.canada.ca/en/canadian-heritage/services/combatting-racism-discrimination/canada-anti-racism-strategy.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhopal K. White Privilege: The Myth of a Post-Racial Society. 1st ed. Bristol: Policy; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammond WP. Taking It Like a Man: Masculine Role Norms as Moderators of the Racial Discrimination\u0026ndash;Depressive Symptoms Association Among African American Men. Am J Public Health 1971. 2012;102(S2):S232\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson A, Amonoo L, Lofton S, Powell-Roach KL. How Masculinity Impedes African American Men From Seeking Mental Health Treatment. Am J Mens Health 2024 Sept 17;18(5):15579883241278846.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Workplace racism, Biopsychosocial-economic model, Mental health inequalities, Black professionals, Mixed-methods research","lastPublishedDoi":"10.21203/rs.3.rs-8671339/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8671339/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eWorkplace racism is increasingly recognised as a social determinant of health, yet its interconnected psychological, social, and economic consequences for Black professionals in the UK remain underexplored. This study examines how workplace racism operates as a biopsychosocial-economic (BPSE) stressor, shaping mental health, organisational engagement, and career precarity, while identifying pathways of coping and resistance.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA convergent parallel mixed-methods design was employed. An exploratory online survey (n\u0026thinsp;=\u0026thinsp;53) assessed experiences of workplace racism, reporting confidence, perceived inclusiveness, and policy effectiveness. Semi-structured interviews (n\u0026thinsp;=\u0026thinsp;11) and focus groups (n\u0026thinsp;=\u0026thinsp;12) explored lived experiences of racism, coping strategies, organisational responses, and economic impacts. Quantitative data were analysed descriptively and through group comparisons, while qualitative data were analysed thematically. Findings were integrated using a joint-display matrix.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost survey respondents reported experiencing (73.6%) or witnessing (69.8%) workplace racism, alongside low confidence in reporting mechanisms and low perceived policy effectiveness. Black and younger respondents reported significantly lower workplace inclusiveness. Qualitative analysis identified five interrelated themes: structural and institutional racism; psychological and health consequences; cultural stoicism and silenced resistance; economic exploitation and career precarity; and empowerment through solidarity, faith, and embodied coping practices. Integrated findings indicate cumulative biopsychosocial and economic harms, partially mitigated by alternative support networks in the absence of effective organisational responses.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWorkplace racism functions as a structural determinant of health for Black professionals, operating through interconnected psychological, social, and economic pathways.\u003c/p\u003e","manuscriptTitle":"A mixed methods study of the biopsychosocial and economic impacts of workplace racism among Black professionals in the United Kingdom","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 11:35:35","doi":"10.21203/rs.3.rs-8671339/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"578c9c87-13c5-4fd6-bd68-8bed6728765f","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-04-29T08:10:05+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T08:26:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 11:35:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8671339","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8671339","identity":"rs-8671339","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}