Racial microaggressions as perceived chronic stressors: self-reported physiological symptoms, mental health outcomes, and occupational wellbeing in Malawian workplaces.

Background: Racial microaggressions subtle, often unintentional acts of discrimination are linked to mental health challenges, yet their perceived physiological effects in African workplace contexts remain underexplored. Such chronic stressors may manifest as self-reported symptoms that are consistent with hypotheses about HPA axis strain. Methods: This cross-sectional mixed-methods study surveyed 384 Malawian employees (aged 18-60, ≥6 month's employment) in Asian-owned workplaces using a culturally adapted microaggressions scale and validated measures for anxiety (GAD-7), depression (PHQ-8), and distress (K-10). Linear regression and Pearson's correlations examined predictive relationships, while thematic analysis of semi-structured interviews (n = 50) explored lived experiences and somatic symptoms. Results: High microaggression frequency (≥3/week, 45% prevalence) was significantly associated with elevated anxiety (M = 4.12, SD = 0.87; r = 0.55), depression (M = 3.94, SD = 0.91; r = 0.53), and distress (M = 4.20, SD = 0.78; r = 0.56) scores (all p < 0.001; β = 0.62, R 2 = 0.38). Qualitative themes included micro-insults (35%) and stereotypes (28%), with reports of insomnia, headaches, and gastrointestinal distress aligning with chronic stress frameworks. Conclusion: Racial microaggressions are associated with biopsychosocial stress processes in Malawian workplaces. Although no biomarkers were collected, this study extends microaggression theory into an African workplace setting and proposes the BGM axis as a hypothetical, testable pathway that may help explain the reported somatic and psychological symptoms. Findings advocate for anti-discrimination policies to foster equity in diverse settings.