Exploring the Stress-Support-Distress Process Among Black Women

Abstract

Research on mental health inequalities typically focuses on variations in individuals’ stress exposure and coping strategies (i.e., perceptions of support adequacy). This study extends prior research by asking how the stress-support-distress process operates among Black w2omen. Data come from a 2003 survey by the Center for the Study of Public Health Impacts of Hurricanes at Louisiana State University (LSU). Our findings challenge the prototypic stress-health models that fail to acknowledge social group differences in the stress-support-distress process. More importantly, our research points to the need for health professionals to consider how formal support systems (i.e., health promotion programs) and internal resources (i.e., health education) can positively impact Black women’s mental health.

Keywords

mental health social support Black women stress

Stress research investigates the link between stress and psychological distress (Aneshensel, 2009; Kemeny, 2003; Thoits, 2010). Stress is activated by negative environmental, social, or internal demands that indicate that the individual should read just his or her usual activities (Holmes & Rahe, 1967; Thoits, 2010; Umberson & Montez, 2010). Cannon (1932) conducted extensive research on the relationship between stress and the “fight-or-flight” response in humans. The adaptive flight or flight reaction allows individuals to respond to threatening—or stressful situations. However, when the reaction to the “fight-or-flight” response is inadequate, exposure to continuous, negative stress can induce physiological effects and, in turn, produce poor mental health outcomes such as psychological distress. Although positive life events (i.e., birth of a child or starting a new job) also require individuals to readjust their usual activities, research suggests that exposure to undesirable or negative events (i.e., death, financial trouble, family problems) was more strongly correlated with poor health outcomes than desirable, positive events (Aneshensel, 2009; Pearlin, 1999; Thoits, 2010; Umberson & Montez, 2010). Therefore, throughout this study the terms stress or stressors refer to negative demands that create behavioral readjustments and, in turn, negatively impact psychological health.

Canon’s flight-or-flight framework is a prototypic model adopted by many health researchers to explain the human body’s responses to stress (Greenberg, Carr, & Summers, 2002). However, the majority of stress-health studies have been conducted on White males, despite the fact that women are more likely to report higher levels of psychological distress (Bauboeuf-Lafontant, 2007; Nolen-Hoeksema, 2001; Roxburgh, 2009). Scholars called for researchers to consider whether the flight-or-flight model adequately accounts for behavioral and cultural responses to stress for women (Bird & Harris, 1990). Taylor and her colleagues (2000) responded to that call by proposing that “tend and befriend” or the creation and maintenance of social relationships is a better-suited model to explain women’s response to stress. Although contemporary studies point to gender differences in how men and women respond to stress, social support theorists have long understood how supportive relationships can buffer the impact of stress on psychological distress (Thoits, 2010). However, the majority of studies focus on middle-class White women and men and fail to consider how the stress-support-distress process operates among less structurally empowered women (e.g., poor women, women of color, and single mothers)—even though studies consistently show a link between psychological distress symptoms and minority groups (Greer, Laseter, & Asiamah, 2009; Vega & Rumbaut, 1999; Walsemann, Gee, & Geronimus, 2009). Moreover, few studies empirically examined the stress-support-distress process for Black women. This research addresses that gap by asking how the stress-support-distress process functions among Black women.

Background Literature

Community studies in the 1950s and 1960s drew attention to how one’s social location in the social system is not extraneous to individuals’ stressful experiences, but rather the social structure has an influence on individuals’ stressful experiences and, in turn, mental health outcomes (Hollingshead & Redlich, 1958; Srole, Langner, Opler, & Rennie, 1960). From this line of work, Pearlin, Lieberman, Menaghan, and Mullan (1981) called researchers to understand stress as a “process” by emphasizing the interplay between (a) the source and the type of stress exposure (e.g., life events, chronic stress, and daily hassles); (b) the mediators of stress (e.g., social support); and (c) the manifestation of stress (e.g., psychological distress). For Pearlin (1989), then, it is critical to consider how systems of stratification influence social groups’ stress process. He argues that

. . . the most encompassing of these structures are the various systems of stratification that cut across societies, such as those based on socio-economic class, race and ethnicity, gender, and age. To the extent that these systems embody the unequal distributions of resources, opportunities . . . may itself be a source of stressful life conditions” (p. 242)

Our research responds to Pearlin’s call by systematically and empirically investigating the stress-support-distress process for Black women.

Stress and Health for Black Women

Two competing perspectives emerge as stress theorists explain mental health disparities: the exposure perspective and vulnerability perspective. The exposure perspective suggests that lower status groups (i.e., poor, women, minorities) are exposed to greater levels of stress because of their marginal position in the social structure (Bronder, Speight, Witherspoon, & Thomas, 2013; Lincoln, Chatters, & Taylor, 2003; Wilson, 1987, 1992). Although the exposure perspective can account for some group differences in the stress-health relationship, researchers note that while holding stress at equal levels, some groups (e.g., women, the poor, and racially underrepresented groups) still report higher levels of psychological distress (McLeod & Kessler, 1990; Thoits, 1984, 2010). Conversely, the vulnerability perspective begins with the assumption that stress alone cannot account for social group differences in psychological distress, but rather it is the mediators (e.g., mastery, self-esteem, and social support) that govern the effects of stressors (Kessler, 1979; Pieterse, Carter, & Ray, 2013; Thoits, 2010). Because our research is guided by Pearlin’s stress-support-distress framework, our conceptual model (see Figure 1) accounts for exposure to stress (i.e., the quantity and source of stress), vulnerability to stress (i.e., perceptions of social support adequacy), and the manifestation of stress (i.e., psychological distress).

Figure 1.

Conceptual model of the stress-support-distress process among Black Women.

Starting with the exposure hypothesis, studies consistently link economic hardship to stress exposure (Aneshensel, 1992; Everett, Hall, & Hamilton-Mason, 2010; Liem & Liem, 1978). That is, groups that are under economic strain tend to report greater exposure to stress. The stress-health literature recognizes three types of stress (or stressors): life events, chronic stressors, and hassles. Life events are negative events that require major behavioral readjustments within a relatively short period of time (e.g., death). Chronic stressors are the negative events that are reoccurring and require change over long periods of time (e.g., poverty). Life events and chronic stress require greater levels of adaptation. In contrast, hassles are harmful mini-events (e.g., traffic jam) that require small behavioral readjustments during the course of a day (Thoits, 1995). Because stress-health research primarily focuses on the relationships between chronic stressors and life events on mental health, we concentrate on these stressors.

Applying the exposure argument to women, recent data show that women, regardless of race, bear a disproportionate burden of the world’s poverty (DeNavas-Walt, Proctor, & Smith, 2012). In addition, because of women’s marginal position in the social structure, they bear a considerable amount of exposure to acute and chronic stressors compared with their male counterparts (Mullings, 2005). For Black women, however, they are twice as likely to live in poverty compared with their White counterparts (Dunlop, Song, Lyons, Manheim, & Chang, 2003; Mullings, 2005).

Therefore, it is important to consider the psychological implications of socioeconomic status for Black women. Wilson’s (1987, 1992) depiction of the “Black underclass” highlights the intersections of race and class on stress exposure. Wilson (1987, 1992) contends that the social conditions facing poor urban Blacks have deteriorated to the extent that rates of unemployment, out-of-wedlock births, households headed by females, and dependency on welfare have dramatically increased. The consequences of poverty for Black women increase their exposure to chronic stressors (i.e., work problems, family problems, and financial problems) and life events (e.g., poverty, joblessness, welfare dependency, and poor health), which subsequently make the day-to-day negotiations of life a demoralizing experience.

As previously noted, studies show that exposure alone cannot explain social group variation in psychological distress (Everett et al., 2010; Kessler & McLeod, 1984). Thus, the vulnerability perspective shifts attention from stress exposure to stress reactivity. Social support theorists see one stress-reactivity mechanism as activating one’s social support systems during times of adversity. Thus, groups that have coping resource deficits (i.e., inadequate social support systems) are more inclined to report higher levels of psychological distress. Although researchers have not reached a consensus on the conceptual definition of social support, they tend to emphasize its “social” dimension as a critical link in understanding its mediating effects on stress (Almedom, 2005). Thus, social support is defined as “a social network’s provision of psychological and material resources intended to benefit an individual’s ability to cope with stress” (Cohen, 2004). Social support theorists maintain that social support can serve as a “buffer” against the adverse psychological effects of stressors.

Research points to women-centered networks as instrumental in Black women’s day-to-day survival and as a vital element when faced with life’s stressors (Bauboeuf-Lafontant, 2007; Lincoln, Chatters, & Taylor, 2005; Stack, 1974). Because of Black women’s marginalized position in the social structure, they are exposed to many structural factors such as poverty, low education, racism, and violence (Bauboeuf-Lafontant, 2007; Pieterse et al., 2013; Terhune, 2008). Consequently, they often lack the economic and political personal resources that can mitigate many of the negative psychological effects of stress (Hine, 2007; Lincoln et al., 2005). Thus for Black women, one might expect informal networks to offer psychosocial resources that buffer the negative psychological impact of life’s stressors (Lincoln et al., 2003; McAdoo, 1982; Sherman, 2006, 2009; Stack, 1974). In fact, Stack (1974) described an elaborate system of supportive kinship transactions for Black families in lieu of personal coping resources. However, while these strong, homogeneous networks function as conduits for social resources to flow, these network structures are resource-poor and often do not offset the harmful consequences of stress exposure for Black women (Mullings, 2005). In addition, the high level of reciprocity within these network structures might nullify the positive effects of social support on psychological distress.

Data and Method

Hypotheses

Our primary research asks how the stress (i.e., stress exposure), support (i.e., stress vulnerability), and psychological distress (e.g., sadness) process operate for Black women. We expect for Black women increased exposure to negative life events, and chronic stressors will have a positive, direct relationship with psychological distress. We also expect women who report lower incomes to have higher levels of psychological distress than Black women with higher incomes.

Moving to stress vulnerability, research suggests that Black women are embedded in complex, informal network structures that are conducive for supportive transactions to flow. However, these structures have psychological and material demands that are burdened by obligations and high levels of reciprocity (Lincoln et al., 2005; McAdoo, 1982; Stack, 1974). Thus, we expect that perceptions of social support adequacy [instrumental support (e.g., tangible aid such as goods, services, and money) and expressive support (e.g., affective aid such as having someone to talk to) will have minimal or no effect on psychological distress for Black women.

Finally, we acknowledge that the stress-support-distress model does not operate as a stagnate process for Black women. Variables such as marital status and age can have an effect on Black women’s mental health. Thus, we control for age, income, and marital status in our analyses. Drawing on previous health literature, we expect age and marital status to have an impact on Black women’s psychological health (Mirowsky & Ross, 1992). We also expect married Black women to report lower levels of psychological distress than their unmarried counterparts. We also expect that as Black women age, they will have more social and economic stability, thereby decreasing their exposure and vulnerability to psychological distress (Mirowsky & Ross, 1992).

Data

The data used in this research paper come from a 2003 study by the Center for the Study of Public Health Impacts of Hurricanes at Louisiana State University (LSU). The data were collected through telephone interviews using random-digit-dialing. Interviews were conducted in February, March, and April of 2003. These data provide baseline measures for stress, perceptions of social support adequacy, and psychological distress levels of residents in the city of New Orleans, Orleans Parish, Louisiana. Researchers may access the entire data set by contacting the Center for the Study of Public Health Impacts of Hurricanes, located at the Department of Sociology at LSU.

Mental Health

Psychological distress

Psychological distress was constructed by using a modified seven-item version of the Center for Epidemiological Studies’ scale of Depression (CES-D; Ross & Mirowsky, 2002). Respondents were asked, “How many days during the past week have you (a) felt that you just could not get going, (b) felt sad, (c) had trouble getting to sleep or staying asleep, (d) felt that everything was an effort, (e) felt lonely, (f) felt that you could not shake the blues, and(g) had trouble keeping your mind on what you were doing.” To construct a psychological distress measure (scale), respondents’ answers were summed. This value reflects the number of psychologically distressing symptoms per week. Values ranged from 0 to 49, with higher values indexing higher levels of psychological distress. The α reliability of this scale is estimated at .83, indicating that it is internally consistent.

Stress

Stress indexes

To measure stress, we used a five-item index to assess respondent’s stressors. Chronic stressors are measured as the sum of responses (coded [1] yes and no [0]) to whether a respondent reports “had problems at work,” “had family problems,” and “had financial problems.” Values of this measure ranged from 0 to 3. Stressful life events are measured as the sum of responses (coded yes [1] and no [0]) to whether respondents report having “had serious injury” and/or “had a close friend or relative die.” Values of this measure ranged from 0 to 2. Because Cronbach’s α values are quite sensitive to short indexes or scales, it is more appropriate to report the mean inter-item correlation for both indexes. The mean inter-item correlation for chronic stressors (.32) and life events (.17) indicates that both indexes are internally consistent.

Social Support Adequacy

Perceived adequacy of social support

Because social support studies continuously demonstrate that perceived support is more effective in buffering the effects of stress than actual support received, this research project focuses on perceived support adequacy (Haines & Hurlbert, 1992; Thoits, 1995), rather than actual support transactions. We used two items to construct perceptions of expressive and instrumental support. The first item, which measured perceived expressive support, asked respondents “About how much of the time would you say you have enough people to talk to?” Responses ranged from (1) never to (4) a lot of time. The second item, which measured perceived instrumental support, asked respondents “About how much of the time would you say you have enough people to help you?” Responses ranged from (1) never to (4) a lot of time.

Control Variables

Individual characteristics

Because characteristics such as age, marital status, and income have shown to have effects on the stress-support-distress process (Pearlin, 1989; Thoits, 1995), this study accounted for the effects of these variables. We measured age in the number of a respondent’s years of life. Marital status was coded one (1) for married and zero (0) for unmarried. Family income is measured in thousands of U.S. dollars.¹

Analyses

This research paper utilizes ordinary least squares (OLS) regression to understand how the stress-support-distress process operates among Black women. To ensure that none of the independent variables were sufficiently correlated to cause problems in the estimation of regression coefficients, we performed multicollinearity tests with tolerance diagnostics. All computed tolerance values were above 0.4. These values are sufficient to exclude multicollinearity (O’Brien, 2007).

Results

Table 1 displays the means and standard deviations for the variables used in our analyses. One hundred sixty-nine respondents identified themselves as Black women. The average age of Black women in the sample was 44 years (M = 44.937; SD = 15.779) and the annual average income range was between US$24,999 and US$34,999 (SD = 2.065). Approximately 58% of the sample reported that they are employed, part-time or full-time. Thirty-seven percent of the respondents reported that they are married (M = 0.378; SD = 0.486). Results also showed that Black women consider themselves to have reasonable access to instrumental and expressive social support (M = 3.029; SD = 0.944; M = 3.449; SD = 0.811), but that they experienced chronic stressors and stressful events (M = 1.112; SD = 1.076; M = 0.745; SD = 0.690), respectively. The reported distress levels for all of the respondents averaged 10 symptoms a week (M = 10.721; SD = 11.825).

Table 1.

Demographic characteristics of the sample (N = 169).

Variable	Respondents mean	SD	n
Social support adequacy
Instrumental support	3.029	0.944	168
Expressive support	3.449	0.811	167
Stress
Chronic stress	1.112	1.076	169
Life events	0.745	0.900	150
Mental health
Distress	10.721	11.825	169
Individual characteristics
Age	44.937	15.779	160
Income	US$24,999-US$34,999	2.065	150
Marital status (married)	37%	0.486	169

Understanding the Stress-Support-Distress Process for Black Women

Table 2 shows stepwise OLS regression estimates of three multivariate models. In this analysis, we will only discuss the saturated models for Black women (see Model 3) for substantive interpretations and conclusions. Consistent with our expectations, Black women (see Model 3) who reported greater exposure to life events (i.e., death in the family and/or illness) also reported higher levels of psychological distress. Interestingly, however, we found that chronic stressors (i.e., work problems, family problems, and financial problems) had no effect on psychological distress for Black women.

Table 2.

Stepwise and Saturated Model Estimates of the Effects Perceptions of Social Support Adequacy, Stress, and Individual Characteristics on Psychological Distress for Black Women.

	Black women
	Model 1	Model 2	Model 3
	B	B	B
Variable	(SE)	(SE)	(SE)
Stress
Chronic stress	1.244	1.584*	1.246
Chronic stress	(0.895)	(0.782)	(0.825)
Life events	2.114	3.243**	3.996**
Life events	(1.397)	(1.232)	(1.327)
Social support adequacy
Instrumental support	—	−1.227	−0.884
Instrumental support	—	(0.914)	(0.959)
Expressive support	—	−1.255	−0.769
Expressive support	—	(1.066)	(1.188)
Individual characteristics
Married (yes)	—	—	2.551
Married (yes)	—	—	(1.855)
Age	—	—	−0.102*
Age	—	—	(0.055)
Income	—	—	−1.401***
Income	—	—	(0.445)
Intercept	7.761***	13.973***	21.955***
Intercept	(2.088)	(3.767)	(4.524)
R ²	.038	.113	.230
n	169	167	144

p ≤ .05. **p ≤ .01. ***p ≤ .001 (two-tailed test).

Our findings show that perceptions of instrumental support adequacy (i.e., enough people to help you) and expressive support adequacy (i.e., enough people to talk to) did not affect Black women’s psychological distress. But, consistent with the health literature, Black women who report lower levels of income tend to have significantly higher levels of psychological distress (Williams & Collins, 1995). Also, younger Black women tend to report higher levels of psychological distress than their older Black counterparts.

Discussion and Conclusion

This study investigated the stress process for Black women by creating a stress-support-distress model that examined the interplay among (a) source and type of stress exposure, (b) perceived social support, and (c) the resulting manifestation of psychological distress. Social support theory suggests that social support acts as a buffer to the adverse psychological effects of stress for individuals. Our analysis revealed that for Black women chronic stressors (i.e., family problems, work-related problems, and financial troubles) had no significant effect on their levels of psychological distress, whereas life events (i.e., illness or death in the family) significantly affected their levels of distress. Surprisingly, we also found that instrumental and expressive support had no effect on Black women’s psychological distress.

As previously mentioned, our findings revealed that chronic stressors had no psychological effects on Black women. Although this finding may seem counterintuitive, Geronimus’s (2001) weathering hypothesis suggests that repeated exposures to stressful encounters can have long-term pernicious physiological effects for Black women. In fact, Geronimus reports that Blacks tend to have higher mean allostatic load scores (or biological responses of stress-mediated wear and tear on the body), compared with their White counterparts. This raises important questions in regard to how psychological distress is conceptualized for Black women. Should depressive measures include items such as body mass index (BMI) scores, cholesterol levels, and eating habits? Future research should incorporate physiological along with psychological measures, to better understand the effects of stress on Black women.

Furthermore, although social support theorists argue that informal support systems (e.g., expressive and instrumental support) are critical mediators in buffering the deleterious effects of stress, we found that perceived instrumental and expressive support adequacy did not have an effect on psychological distress for Black women. One plausible explanation for these findings is that because Black women occupy lower positions in the social structure they are embedded in social circles that have inadequate informal resources (e.g., expressive and instrumental support) that do not effectively counterbalance their exposure to stress. Furthermore, mobilized social support systems, which serve as problem-focused coping mechanisms to buffer the impact of stress, may work best when we actually have the capacity to shield individuals against stressful encounters. However for Black women who tend to be embedded in tight-knit, homophilous social circles, their resource pool may only temporarily buffer their stressful experiences—which may have minimal or no effects on psychological distress.

Considering our suppositions, we propose that health promoters target two areas to decrease stress exposure and vulnerability to stress for Black women: strengthen personal coping skills and highlight formalized sources of support that are accessible and can be activated during times of need. We contend that if Black women mobilize their personal and social coping strategies in tandem, they will decrease their exposure and vulnerability to stress and, in turn, produce better mental health outcomes.

Starting with personal coping skills, our findings indicate that attention needs to be given to the development of culture- and gender-appropriate health promotion and disease prevention interventions aimed at improving self-efficacy (e.g., teaching emotion-focused strategies such as acceptance, increasing self-esteem, and mediation) for the purpose of reducing stress and, in turn, psychological distress for Black women. Hall, Everett, and Hamilton-Mason (2012) argued, for Black women, that emotion-focused strategies may be more culturally appropriate when stressful circumstances are likely unalterable. Although much of the network literature points to women-centered networks serving to alleviate stress exposure and lessen vulnerability to stress for Black women, scholars also note that these network systems also serve as sources of stress. Thus, the “cost of caring” in Black women-centered network structures often outweighs the perceived benefits. Thus, promoting those populations that are embedded in resource-poor informal networks to draw on internal factors, such as self-efficacy, is essential. Individuals with high levels of self-efficacy in times of distress are more likely to remain more problem-focused and be more persistent over time.

Although personal coping strategies are essential in times of adversity, social resources are also critical during times of adversity. However, as previously mentioned, our findings suggest that informal support systems that offer expressive and instrumental support have no effect on Black women’s psychological distress. Thus, we argue that more formalized social support systems offer resources that are more permanent and consistent, which may be more effective than drawing on one’s immediate social circles. Thus, comprehensive, coordinated, community-based health promotion programs that utilize health education and mobilize community leaders can have an effect on social systems by influencing cultural norms within a community. These approaches can be more successful in achieving long-term behavioral changes because they affect the culture in which people live, work, and socialize. We acknowledge that for racially underrepresented groups, trusting and relying on medical or governmental agencies for formalized support may be challenging. Furthermore, if health professionals are culturally insensitive and unaware of certain social groups’ needs, their practices may further marginalize groups of lower statuses. Thus, we encourage usage of community-based health centers that tend to be more aware of community members needs and, in turn, promote culturally effective health strategies that can reduce poor mental health outcomes for Black women.

While this study contributes to the existing stress-health literature, it is not without limitations. This research utilizes a secondary data set, which limited this study in three significant ways: (a) control of what the data set contains, (b) breadth of research questions the researchers could ask, and (c) data were not collected in the most desirable years—those prior to Hurricane Katrina. Moreover, the data used in this study pertain to the population of Orleans Parish, Louisiana, which has a distinct interracial history that is, in many ways, radically different from that of many other U.S. populations. As such, the findings of this study could only be generalized to areas and social groups of similar socioeconomic and cultural histories.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biographies

Claire M. Norris, PhD is an Assistant Professor at Xavier University. Her research interests include mental health, social support, and depression.

Flint D. Mitchell, PhD is an Adjunct Assistant Professor in the undergraduate studies program at Tulane University in the School of Public Health and Tropical Medicine. His research interests include health education and exercise psychology.

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