Abstract
Objectives
African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population.
Methods
Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults.
Results
Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress.
Discussion
Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal.
Introduction
Past research regularly finds that Black Americans have lower rates of mental disorder than Whites (Breslau et al., 2006, 2005; Himle et al., 2009; Levine et al., 2013; Williams et al., 2007), a conclusion that remains robust across different types of disorder, by nativity status (Alvarez et al., 2019), for men and women (Tobin et al., 2020), and for both African Americans and Afro-Caribbeans (Himle et al., 2009; Williams et al., 2007). With regard to mental disorders, the Black-White paradox in mental health is also found among older adults (Taylor & Chatters, 2020; Tobin et al., 2020). Older Black Americans also experience lower rates of mental disorder than younger Black Americans (see (Taylor & Chatters (2020) for a review), further compounding the mental health advantage of this group. The Black-White mental health paradox is striking given Whites’ privileged socioeconomic standing (factors known to be associated with good mental health) and given Black Americans’ greater rates of morbidity and mortality (factors known to be associated with poor mental health). It is imperative to investigate mechanisms that contribute to this trend, as they can yield important solutions for populations at greater risk of mental disorders.
One understudied area of research to explain the mental health advantage among Black Americans is coping, further defined as “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” (Lazarus & Folkman, 1984:141). Coping is primarily studied in the psychology literature and tends to rely on the use of small, non-representative samples. Studies of Black Americans often focus on coping within the context of racial discrimination, an important determinant of mental health (Lewis et al., 2015; Mouzon et al., 2017; Williams & Mohammed, 2013; Mouzon & Brock 2022). To the best of my knowledge, no research investigates coping in a population-based sample of African Americans within the context of general (non-racial) chronic stress. This study will address these gaps, with a focus on older African Americans.
This paper is motivated by one of the most important legacies set forth by James S. Jackson, PhD, longtime director of the Program for Research on Black Americans at the University of Michigan and one of the lead investigators on the National Survey of American Life (NSAL). Throughout his long career, Dr. Jackson rejected the idea that research on Black Americans is only worthwhile in the context of racial comparison with Whites. He fervently believed that inquiry into Black American life was a field wholly worthy and valid on its accord. In his own words, one of Dr. Jackson’s main endeavors was “giving voice to the African American population” (Kraut, 2014). He “challenged the implicit and sometimes explicit bias… that Euro-American norms were the standard against which Black people should be measured and compared” and strived to “create a more self-determined body of research on African American people, independent of their white counterparts” (Parham, 2020). Through continued work that centers the lived experiences of Black Americans, Dr. Jackson’s legacy will undoubtedly live on.
Stress Exposure and Appraisal
The present inquiry is guided by the Stress Process Model or SPM (Pearlin, 1989; Pearlin & Bierman, 2013), a theoretical framework that links individuals’ positions in various social stratification systems (e.g., race/ethnicity and gender) to physical and mental health outcomes through an array of protective and risk-conferring mechanisms. Their lower positioning in the American racial and socioeconomic hierarchy should systematically predict high rates of mental disorder among Black Americans yet the opposite pattern is observed. The SPM proposes that people vary in terms of their response to stress exposures based on the presence or absence of various psychosocial resources. Of these, social support, mastery, and self-esteem are the most commonly studied mechanisms linking social characteristics to stress exposure and health but coping can also help explain certain groups’ greater or lesser risk of poor health outcomes (Pearlin & Schooler, 1978).
Early stress research measured stress burden as an objective count of life events or chronic stressors. A small but burgeoning area of research extends conventional stress research by incorporating the subjective meaning of stressors. Stress appraisal is typically measured as the extent to which an experienced stressor is upsetting to the individual. Consistent with theoretical framework of Lazarus and Folkman (described below; (Lazarus & Folkman, 1984)), a particular stress exposure does not equally impact all individuals; therefore, a sole focus on count measures cannot provide a comprehensive understanding of the stress process. Two recent analyses using the Health and Retirement Study found that, as expected, older Black adults reported greater exposure to chronic stressors than older White adults across five domains (health, financial, relationships, residential, and caregiving). Yet despite greater stress exposure, older Black adults appraise these stressors as less upsetting than older White adults (Brown et al., 2020a, 2020b). Given this theoretical and empirical work, using both objective and subjective measures of health is imperative to better understand how Black people experience, interpret, and respond to stressors.
Coping and Mental Health
The Transactional Theory of Stress and Coping (Lazarus, 1966; Lazarus & Folkman, 1984) emphasizes the dynamic relationship between an individual and the social environment. During the primary appraisal stage, an environmental stressor is either assessed as a threat, challenge, or non-threat. During secondary appraisal, one considers the range of potential coping responses they have available to address the stressor and coping is the cognitive and/or behavioral outcome of the primary and secondary appraisal processes. Depending on the coping response used within a specific social context, an environmental stressor may or may not lead to distress.
A common distinction made in the literature is the difference between problem-focused coping and emotion-focused coping (Folkman & Lazarus, 1980). Problem-focused coping focuses on addressing the stressor itself, taking action to either remove the stressor or reduce its impact. Emotion-focused coping, on the other hand, does not aim to directly act upon the stressor but instead intends to reduce the emotional distress caused by the stressor. It has been suggested that emotion-focused coping is most often employed when the secondary appraisal process determines that a stressor is of an uncontrollable nature, whereas problem-focused coping is utilized when, during secondary appraisal, an individual deems the stressor to be modifiable (Folkman & Lazarus, 1980).
Most of the coping research on African Americans examines mental health related to discrimination. This is a reasonable focus given the frequency with which African Americans experience discrimination but this emphasis leaves a dearth of literature regarding how African Americans cope with non-racial stressors. The lack of research on general chronic stress is important because research finds that African Americans use different coping strategies when dealing with racial versus non-racial stressors (Bey et al., 2019; Brown et al., 2011; Hoggard et al., 2012). Using the theoretical framework of Carver and colleagues (Carver, 1997; Carver et al., 1989), I will review past literature on the coping dimensions that are central to the present study. Where possible, I will highlight findings based on Black American samples.
Literature Review
Problem-Focused Coping
Social Support
Social support is a diverse construct, encompassing dimensions such as instrumental (i.e., tangible) support, emotional support, and support that is informational or financial in nature. An abundance of research on Black Americans links social support to an array of positive mental health outcomes (Ajrouch et al., 2010; Chatters et al., 2015; Levine et al., 2015; Lincoln & Chae, 2012; Nguyen et al., 2018; Taylor et al., 2015; Warren-Findlow et al., 2011).
In addition to the documented direct effects of social support on the mental health of Black Americans, social support can also buffer or protect against the health-damaging consequences of stressors. Most research on the stress-buffering function of social support among Black Americans focuses on discrimination. For example, using data from middle-aged and older African Americans within the Milwaukee sample of the Midlife Development in the United States (MIDUS) study, Warren-Findlow and colleagues (2011) found that both friend and family support dampened the effect of everyday discrimination on self-reported mental health. Similarly, data from a sample of church members in Texas found that a scale of general social support weakened the association between everyday discrimination and psychological distress such that those who experienced high discrimination but reported high levels of general social support had fewer distress symptoms than those who experienced high discrimination and had low social support (Steers et al., 2019). One unique study using a general sample of adults found that both instrumental support and emotional support during the early stages of the COVID-19 pandemic were associated with lower levels of depressive symptoms (Park et al., 2021).
Literature is scarce, however, on the utility of social support as a coping mechanism for African Americans under general (e.g., non-racial) stress. Additionally, most past research focuses on emotional support rather than instrumental support. One exception was a study using data from the Nashville Stress and Health Study, which found that instrumental social support from church members weakened the impact of major discrimination on past month depressive symptoms (Ellison et al., 2017). Similarly, another study found that instrumental support—but not emotional support—buffered the association between everyday discrimination and psychological distress in a sample of African American caregivers in Detroit (Ajrouch et al., 2010).
Problem-Focused Coping
Past literature finds that problem-focused coping tends to be protective for health. For example, active coping during COVID-19 has been linked to fewer depression and anxiety symptoms within a diverse adult sample (Park et al., 2021). In addition, two early studies found that Black women who reported that they “did something about” discrimination exhibited lower risk of hypertension than those who did not (Krieger, 1990; Krieger & Sidney, 1996). Active coping has also been linked to fewer anxiety symptoms and internalizing symptoms of distress among African American adolescents, although it did not moderate the association between discrimination and either mental health outcome (Gaylord-Harden & Cunningham, 2009). In another diverse sample of young adults, more active coping in the face of racial discrimination protected against dissociative symptoms (Polanco-Roman et al., 2016).
Perhaps the most common measure of problem-focused coping among African Americans is John Henryism. According to the folktale, John Henry was a steel-driving Black man who, in a competition of “man versus machine,” manually competed against a mechanical steel drill. Although John Henry won the race, he collapsed and died shortly after, suggesting that although high effort coping in the face of seemingly insurmountable odds may lead to success, there may be grave health costs associated with this coping strategy (James, 1994). The initial iteration of the John Henryism hypothesis was that low-SES Black adults would be most harmed by high levels of active coping, a theory that was confirmed in early studies focusing on hypertension in samples of Black men (James et al., 1983) and Black men and women (James et al., 1987)
Despite multiple studies on John Henryism and physical health, until recently, few studies have studied John Henryism and mental health, yielding mixed results. For example, one recent study using data from the Nashville Stress and Health Study found that higher John Henryism was associated with fewer depressive symptoms among Black adults (Robinson & Thomas Tobin, 2021), a result echoed in a similar regional study of Black women (Bronder et al., 2014). However, one NSAL study found that John Henryism predicted higher odds of depression among African American men and women (Hudson et al., 2016) while yet another study using data from the National Comorbidity Survey found that John Henryism was associated with lower psychological distress, lower odds of any psychiatric disorder, and lower odds of substance use disorder among African Americans (Kiecolt et al., 2009).
There is a small body of work examining John Henryism within the context of discrimination and mental health. Findings in this area are inconclusive. For example, although one NSAL study found that John Henryism did not moderate the association between racial discrimination and depression among African Americans (Hudson et al., 2016), another found that high levels of John Henryism exacerbated the association between race-related stress and rumination symptoms (i.e. continuous or obsessive thinking) among African American women (Hill & Hoggard, 2018). Another set of researchers found that John Henryism protects against depressive symptoms related to high levels of racial discrimination among African American men (Matthews et al., 2013). Overall, while the literature confirms an inverse association between John Henryism and physical health, findings on the impact of John Henryism on mental health among African Americans, especially within the context of psychosocial stressors, is more varied.
Emotion-Focused Coping
Acceptance
Emotion-focused coping is a passive coping strategy that can be considered the opposite of problem-focused coping in that there is no attempt to change or eliminate the stressor, only to reduce one’s emotional response to it. One study of primarily minority young adults found that those who used a combination of acceptance and keeping it to oneself in response to racial discrimination experienced fewer dissociative symptoms than those who did not (Polanco-Roman et al., 2016). Acceptance—much like emotion-focused coping as a whole (Folkman & Lazarus, 1980)—may be especially useful in the face of uncontrollable stressors. For example, one important study found that acceptance of racial discrimination dampened the impact of perceived racism on blood pressure among Black adults (Clark & Gochett, 2006).
Positive Reframing
Positive reframing is a cognitive strategy for emotion regulation that seeks to change the way in which a stressor is interpreted, with a focus on its positive aspects (Lazarus & Folkman, 1984). For example, one study found that positive reappraisal mitigates the association between childhood emotional abuse and negative affect in midlife adults (Jung, 2021). Importantly, a review of the literature finds this coping mechanism to be more common among older than younger adults (Nowlan et al., 2015). Positive reappraisal is associated with a wide range of psychological well-being measures among older adults (Danhauer et al., 2005; Schanowitz & Nicassio, 2006). In terms of stress-buffering, positive reappraisal has also been tied to less suicidal ideation and emotional distress among older adults with HIV/AIDS (Kalichman et al., 2000).
Religion
Religious involvement is a multidimensional concept encompassing domains such as organizational involvement (e.g., attendance at religious services), non-organizational involvement (e.g., frequency of prayer), and subjective religiosity (e.g., how one rates their religious convictions). Although research links all of these domains to favorable health outcomes among Black adults (Nguyen, 2020), prayer is an especially important factor to study within the context of stress, coping, and health. Religious coping through prayer is thought to be an especially important coping strategy for African Americans, given their greater use of: prayer (Mouzon, 2017; Taylor et al., 2007), turning to prayer during stressful times (Chatters et al., 2008), and requesting prayer from others (Chatters et al., 2009). Despite the lack of literature on general (non-racial) stress, both qualitative and quantitative research documents the utility of prayer as a coping strategy against discrimination among Black Americans (Ellison et al., 2017; Shorter-Gooden, 2004).
Maladaptive Coping Strategies
Behavioral Disengagement
Behavioral disengagement occurs when an individual decreases their efforts toward addressing a stressor (Carver et al., 1989) and is most often operationalized as “giving up” in the face of stress. Related concepts include mental disengagement (often in the form of distraction) and denial, or refusing to accept the reality of the situation. Disengagement is related to worse mental health among Black women (Lewis et al., 2017; Williams & Lewis, 2019), rural Native Hawaiians (Kaholokula et al., 2017), and adults in California (Aldao & Nolen-Hoeksema, 2012). A study of Black women college students found that avoidant coping—measured as a composite measure of behavioral disengagement, mental disengagement, and denial—was associated with more frequent depressive symptoms. Moreover, avoidant coping exacerbated the link between racial discrimination and depressive symptoms for these young Black women (West et al., 2010), highlighting its maladaptive nature.
Substance Use and Stress Eating
Although stress eating and the use of alcohol or other drugs may be considered a maladaptive response to stress, other work suggests otherwise. For example, the Environmental Affordances (EA) Model proposes that the use of unhealthy behaviors (e.g., substance use, stress eating, and smoking), although associated with higher risk of morbidity and mortality, can interrupt the stress-distress link through physiological changes in the hypothalamic-pituitary-adrenalcortical axis (Jackson et al., 2010; Jackson & Knight, 2006). Therefore, coping through stress eating or drug/alcohol use is theorized to enact a stress-buffering effect, protecting against poor mental health despite harming physical health. With some exceptions (e.g., Keyes et al., 2011), the Environmental Affordances Model has been confirmed empirically (Jackson et al., 2010; Mezuk et al., 2010).
Current Study
Most past research on stress-related coping is limited to small samples or samples of people experiencing very unique circumstances (e.g., breast cancer, kidney disease, homelessness, natural disasters, and undergraduate students). Although this research has been influential, the knowledge base regarding the general African American population has not yet reached its full potential. Additionally, past research shows that African Americans tend to use different coping strategies for racial discrimination compared to general, non-racial stress. For example, one unique study noted that active coping, positive reframing, and acceptance were the most common forms of coping with general stress while active coping, emotional support, and instrumental support were most commonly used for racism-related stress (Brown et al., 2011). In this study, I investigate the direct and stress-buffering effects of 11 coping strategies on mental health among a sample of older African Americans within a nationally representative dataset.
Methods
I used secondary data from the National Survey of American Life Reinterview (NSAL RIW), a multistage national probability study conducted to investigate racial and ethnic differences in mental disorders, both formal and informal use of mental health services, and a wide array of risk and protective factors for health (Heeringa et al., 2004; Jackson et al., 2004). Collected between 2001 and 2003, the NSAL was conducted as part of the Collaborative Psychiatric Epidemiology Surveys. NSAL used face-to-face interviews and interviewers were matched to the racial/ethnic background of participants. The NSAL included a nationally representative sample of African Americans (i.e., those who do not report Caribbean ancestry; N = 3570), from which the present analytic sample was drawn. In this study, I limited the sample to older African Americans ages 55 and older. NSAL provided sampling weights designed to adjust for disproportionate sampling, non-response bias, and population representation.
Dependent Variable
The primary outcome for the present investigation was the K6, a six-item index of psychological distress (Kessler et al., 2003). Participants were asked how often they experienced the following six symptoms during the past 30 days: so sad nothing could cheer [you] up; nervous; restless or fidgety; hopeless; that everything was an effort; and worthless. Response categories for all items included: all of the time, most of the time, some of the time, a little of the time, or none of the time. Items were summed into a scale ranging from 0/least distress to 24/most distress (α = 0.8471).
Key Independent Variables
NSAL included a ten-item scale of chronic stress, which asked respondents whether, in the past month or so, they: had health problems; had money problems; had job problems; had problems with children; had family or marriage problems; had (or a family member had) been the victim of a crime; had problems with the police; had problems with [their] love life; had (or a family member had) been treated badly because of [their] race; and had difficulty with gambling. Each item was coded as 1/yes and 0/no and summed into a count measure of chronic stressors. Those who answered affirmatively to any question were asked a follow-up question asking, “How much did that upset you?” (1 = not at all; 2 = only a little; and 3 = a great deal), a measure tapping stress appraisal. In response to the Transactional Model of Theory and Coping’s emphasis on both primary and secondary appraisal (Lazarus, 1966; Lazarus & Folkman, 1984), I then multiplied each dummy measure of chronic stress exposure by its corresponding measure of stress appraisal and subsequently summed these values into a weighted scale of chronic stress/appraisal (range: 0/low to 30/high).
Nine coping measures were adapted from the Coping with Problems Experienced Scale (COPE; (Carver et al., 1989)) and the Brief COPE (Carver, 1997). Respondents were asked, “How often do you generally do any of these things to make your problems easier to bear?” The following nine coping strategies were queried: just give up; take action to try to make the situation better; get help and advice from other people; use alcohol or drugs to help [me] get through it; try to see it in a different light, to make it seem more positive; look for something good in what is happening; accept the fact that it has happened; try to learn to live with it; and pray or get someone to pray for me. One additional coping response not derived from COPE/Brief COPE was added to the NSAL questionnaire (“I eat more than I usually do”). These 10 items shared five response categories of very often, fairly often, not too often, hardly ever, or ever. Depending on the measure, either the top two or bottom two categories were combined due to small cell sizes. With the exception of behavioral disengagement, substance use, and stress eating, the remaining coping responses are theorized to be adaptive for mental health (Carver et al., 1989).
I also used a measure of John Henryism, based on the 12-item John Henryism Scale of Active Coping (James et al., 1983; Neighbors et al., 2007). Respondents were asked, “How true is each statement about how you feel about your efforts in life?” Example questions included “Once I make up my mind to do something, I stay with it until the job is completely done” and “It’s not always easy, but I manage to find a way to do the things I really need to get done.” All questions shared response categories of completely true, somewhat true, somewhat false, and completely false. All items were summed into a scale ranging from 0/lowest John Henryism through 36/highest John Henryism (α = 0.8400). Consistent with past research, I recoded this scale into three categories for low, medium, and high, based on the 25th and 75th percentile (Kiecolt et al., 2009; Robinson & Thomas Tobin, 2021). A summary of all 11 coping measures can be found in Appendix 1.
Control Variables
Gender was measured using categories for men and women and age was measured in years. Educational attainment was measured using categories for less than high school, high school graduate, some college, and bachelor’s degree or more and marital status was measured as married/cohabiting, divorced/separated/widowed, and never married. Self-rated health was originally measured using categories for excellent, very good, good, and poor/fair; the latter two categories were combined due to small cell size. Region had four categories for South, Northeast, Midwest, and West.
Analytic Strategy
After running univariate statistics to describe the analytic sample, I conducted a series of multivariate regression models using each coping strategy to predict psychological distress. I used negative binomial regression because the outcome variable in this analysis, psychological distress, is overdispersed (when the variance exceeds the mean). In the third stage of analysis, I re-ran the original multivariate models while including an interaction term for chronic stress/appraisal * each specific coping response, to test whether the response buffers against or exacerbates the association between chronic stress and psychological distress. I present incidence rate ratios and 95% confidence intervals for all models. All analyses were conducted in Stata 17.0 and are weighted and adjusted for complex survey design.
Results
Sociodemographic Characteristics of African Americans Age 55 and Older, National Survey of American Life (N = 601).
Note. Data are weighted and adjusted for complex sampling design.
aTen-item chronic stress/appraisal scale ranges from 0/low to 30/high.
bSix-item psychological distress symptoms scale ranges from 0/low to 24/high.
Prevalence of Coping Strategies Among African Americans Age 55 and Older, National Survey of American Life (N=601)
Taking action to try to make the situation better was the most commonly reported problem-focused coping strategy among older African Americans; 86.9% reported using this coping strategy either very often or fairly often. Almost 55% reported getting help or advice from other people very often or fairly often and 79.8% reported medium or high levels of John Henryism. In terms of religious coping, almost seven in 10 respondents (69.5%) reported praying or getting someone to pray for them very often or fairly often.
Patterns were a bit more varied for maladaptive coping. Roughly 78.3% of older African Americans reported never or hardly ever just giving up; 16.4% reported giving up not too often and only 5.3% reported giving up fairly or very often. Using alcohol or drugs was the least commonly used coping response. When asked whether they use alcohol or other drugs in response to stress, 91.2% of respondents reported never or hardly ever doing so, 5% reported not so often doing so and only 3.8% reported very often using alcohol or other drugs in response to stress. Finally, when asked whether they eat more than usual when under stress, 57.8% of older African Americans reported that they never or hardly ever did so, one-quarter (25.3%) reported eating more than usual not too often and 16.9% reported doing so fairly or very often.
Multivariate Negative Binomial Regression Models Predicting Psychological Distress Based on Coping Strategies Among African Americans Age 55 and Older, National Survey of American Life (N = 601).
Note. Data are weighted and adjusted for complex sampling design. All models adjust for the weighted chronic stress scale and sociodemographic characteristics (gender, age, marital status, region, self-rated health, and educational attainment). IRR = incident rate ratio.
Three of the four emotion-focused coping strategies were predictive of distress among older African Americans. Looking for something good in what has happened was generally an adaptive coping strategy. Compared to older African Americans who frequently (“very often”) looked for something good in what has happened, those who used this strategy fairly often and not too often had an elevated rate of psychological distress symptoms (IRR = 1.59 and 2.57, respectively; p < .001 for both). Likewise, those who not too often (IRR = 2.22; p = .001) or fairly often (IRR = 1.51; p = .01) accepted the fact that it happened experienced greater distress symptoms than those who very often accepted the fact that it happened. A less consistent pattern was found for the coping strategy of learning to live with it. Compared to those who used this coping strategy very often, those who learned to live with it fairly often had 47% increased rate of distress symptoms but those who never/hardly ever learned to live with it had a 71% decreased rate of distress symptoms, suggesting that the most adaptive pattern was to either rarely or frequently learn to live with it. Trying to see the situation in a different light was not predictive of psychological distress among older African Americans.
Two of the three problem-focused strategies were associated with psychological distress among older African Americans. Those who took action not too often had an 81% increased rate of distress symptoms compared to those who took action very often (p = .004). Older African Americans who exhibited moderate levels of John Henryism had a rate of distress symptoms that was 25% lower than those with low John Henryism (p = .035) while getting help or advice from other people was not predictive of psychological distress. Religious coping was protective against distress; those who prayed or requested prayer from others fairly often had an 55% increased rate of distress symptoms than those who did so very often (p = .012).
All three maladaptive coping strategies were predictive of high psychological distress. For example, older African Americans who never (IRR=0.37; p < .001) or hardly ever (IRR=0.65; p = .001) just gave up had a reduced rate of distress symptoms compared to those who fairly/very often just gave up. Likewise, those who never used alcohol or other drugs had a 70% lower rate of distress symptoms than those who fairly/very often used substances in response to stress (p < .001). The same pattern was found for eating more than usual in response to stress. Those who never (IRR=0.39; p < .001), hardly ever (IRR=0.66; p = .024), or not too often (IRR=0.59; p < .001) ate more than usual had significantly lower rates of distress than those who very often ate more than usual.
In the final stage of analysis, I re-ran the multivariate models presented in Table 3 but included an interaction term for each coping strategy * chronic stress/appraisal. There were significant interactions for five of the 11 coping strategies.
The results for two emotion-focused coping strategies—accepting the fact that it has happened and learning to live with it—are graphed in Figure 1. For all levels of both coping strategies, psychological distress rose as chronic stress increased. However, the increased rate of distress symptoms was much more rapid among older African Americans who never/hardly ever accepted the fact that a stressful event has happened (Panel A). An identical but even more pronounced pattern was found for the coping strategy of learning to live with it, such that never/hardly ever learning to live with it was associated with an extremely accelerated increase in psychological distress symptoms while a greater tendency to learn to live with it was associated with a far more modest increase in distress symptoms (Panel B). Taken together, these findings suggest that acceptance and learning to live with it are adaptive coping strategies for older African Americans under high levels of chronic, non-racial stress. Predicted mean psychological distress symptomsa based on the interaction of chronic stress exposure/appraisalb and emotion-focused coping among African Americans age 55 and older, National Survey of American Life (N = 601). Note. Data are weighted and adjusted for complex sampling design. All models adjust for sociodemographic characteristics (gender, age, marital status, region, self-rated health, and educational attainment).
There was one significant interaction for problem-focused coping. Figure 2 presents the results for John Henryism. As expected, for all levels of John Henryism, distress symptoms increased as non-racialized chronic stress increased. In addition, a dose-response relationship emerged such that as chronic stress increased, there was a minimal rise in the rate of distress symptoms for those with low John Henryism, a moderate rise for those with moderate levels of John Henryism, but those with high rates of John Henryism experienced the steepest increase in the rate of psychological distress symptoms at higher levels of stress. This finding suggests that active striving in the face of high levels of chronic, non-racial stress is especially detrimental to older African Americans’ mental health. Predicted mean psychological distress symptomsa based on the interaction of chronic stress exposure/appraisalb and John Henryism among African Americans age 55 and older, National Survey of American Life (N = 601). Note. Data are weighted and adjusted for complex sampling design. All models adjust for sociodemographic characteristics (gender, age, marital status, region, self-rated health, educational attainment, occupational status, and household income).
I also found a significant interaction between religious coping and chronic stress/appraisal (Figure 3). A bifurcated relationship emerged such that older African Americans who fairly often or very often prayed or asked others to pray for them in the response for stress experienced a very modest increase in the rate of distress symptoms but those who engaged in religious coping less frequently (never/hardly ever or not too often) experienced a sharp increase in the rate of distress symptoms. These findings are very clear; for older African Americans, religious coping serves as an important buffer against the mental health consequences of high levels of chronic, non-racial stress. Predicted mean psychological distress symptomsa based on the interaction of chronic stress exposure/appraisalb and religious coping among African Americans age 55 and older, National Survey of American Life (N = 601). Note. Data are weighted and adjusted for complex sampling design. All models adjust for sociodemographic characteristics (gender, age, marital status, region, self-rated health, educational attainment, occupational status, and household income).
There was one significant interaction for maladaptive coping, for the use of alcohol or drugs in response to stress (Figure 4). These patterns were extremely varied. For example, older African Americans who never/hardly ever engaged in substance use in response to chronic stress experienced a shallow increase in the rate of distress symptoms as chronic stress increased and there was virtually no association between chronic stress/appraisal and psychological distress for those who used substances not too often. Using substances fairly often in response to stress was associated with a rapid increase in the rate of distress symptoms; however, the frequent use of substances (“very often”) in response to stress exhibited the opposite pattern. At low levels of chronic stress, frequently using alcohol or drugs was associated with the highest level of psychological distress but a strong buffering effect emerged at increasing levels of chronic stress such that the combination of frequent substance and high chronic stress was associated with a reduced rate of psychological distress. Predicted mean psychological distress symptomsa based on the interaction of chronic stress exposure/appraisal and using alcohol or drugs, among African Americans age 55 and older, National Survey of American Life (N = 601). Note. Data are weighted and adjusted for complex sampling design. All models adjust for sociodemographic characteristics (gender, age, marital status, region, self-rated health, and educational attainment).
Discussion
Despite consistent documentation of the Black-White mental health paradox, surprisingly little is known about the specific factors that confer mental health resilience among African Americans. In this study, I focused on the role of coping, a cognitive or behavioral response to a stressor that aims to prevent or dim its impact. I sought to fill certain gaps in the literature (the use of small, non-representative samples, the almost exclusive focus on coping as a buffer against racial discrimination rather than non-racialized stress) by using a sample of older African Americans within a nationally representative dataset in order to study the utility of various coping responses, both in direct relation to mental health and also how they shape the association between general, non-racial chronic stress and mental health.
I focused on four emotion-focused coping strategies, three problem-focused strategies, one religious coping strategy, and three maladaptive coping strategies. Overall, the present findings support the Stress Process Model (Pearlin, 1989; Pearlin & Bierman, 2013), both in terms of the direct impacts of stress exposure and personal resources (e.g., coping) on mental health and the buffering impact of personal resources in the stress-mental health relationship. For example, chronic stress was also consistently associated with heightened distress throughout the analysis and of the 11 coping strategies considered, there were nine direct effects on mental health. In addition, I found significant buffering effects for five of the 11 coping strategies considered, consistent with hypothesized role of personal resources in the stress process framework. This analysis also supports the Transactional Model of Stress and Coping (Lazarus, 1966; Lazarus & Folkman, 1984), which implicitly incorporates the subjective meaning of stressors, operationalized in this study as the extent to which an environmental stressor is upsetting, or perceived to be a threat. Recent studies confirm that a singular focus on stress exposure (without the inclusion of subjective measures of stress appraisal) provides an incomplete picture of the stress process among African Americans (Brown et al., 2020a, 2020b).
The Transaction Model of Stress and Coping differentiates between emotion-focused coping and problem-focused coping (Lazarus, 1966; Lazarus & Folkman, 1984). Two of the four emotion-focused strategies (looking for something good and accepting the fact that it happened) were associated with reduced distress symptoms. Findings were more mixed for the coping strategy of learning to live with it, whereby infrequent use of learning to live with it was more protective against distress and fairly often learning to live with it was associated with more distress than frequently learning to live with it. When assessing the utility of emotion-focused coping in the face of chronic stress, two significant interactions were found. Failing to accept the fact that it has happened and resistance in learning to live with it were detrimental to mental health under high levels of chronic stress while conversely, both measures of acceptance buffered against the mental health consequences of chronic (non-racial) stress. The Transactional Model of Stress and Coping posits that emotion-focused coping, or a cognitive appraisal process that seeks to change one’s emotions surrounding a stressor, is more often employed when a stressor is perceived to be uncontrollable in nature. The aging process is characterized by many health and psychosocial challenges, especially for African Americans who are multiply and uniquely disadvantaged by accelerated aging, financial hardship, and discrimination (Mutchler et al., 2019; Thorpe et al., 2016; Whitfield & Baker, 2013). Emotion-focused coping was the most prevalent and most efficacious type of coping among older African Americans, consistent with other research in aging populations (Chen et al., 2018; Folkman et al., 1987). Future research should take a deeper dive into the specific psychological mechanisms through which emotion-based coping influences mental health among older African Americans.
Of the three problem-focused coping strategies, the direct effect of taking action was largely beneficial for mental health while John Henryism was most adaptive at moderate, rather than high or low, levels. The latter finding echoes a threshold effect highlighted in previous work (Wheaton, 1985), suggesting that at its extremes, some coping resources may be associated with poor mental health. This result runs somewhat counter to past research finding the fewest depressive symptoms among African Americans with the highest levels of John Henryism, both using the NSAL (Robinson & Thomas Tobin, 2021) and other regional samples of Black women (Bronder et al., 2014) and Black men (Matthews et al., 2013). A highly plausible explanation for these discrepant findings is that the present study focused on older African Americans (55 and older) while the other studies were based on general samples of adults ages 18 and older. While increasing levels of John Henryism may be adaptive in general adult populations, older adults often face an emerging loss of control as the aging process unfolds (Lachman et al., 2011). It could be that the specific combination of high John Henryism and low levels of personal control that many older adults face in later life may negatively impact their mental health, a question that should be addressed in future research.
Despite the threshold effect found for John Henryism in the general multivariate models, a different (dose-response) pattern emerged when considering chronic stress/appraisal in the interaction analysis. At the highest levels of chronic stress, having low John Henryism was most adaptive for mental health, followed by moderate John Henryism, while the combination of high chronic stress and high John Henryism was most damaging for the mental health of older African Americans. These results suggest that when faced with chronic, non-racial stress, the mental health of older African Americans is most protected when they exhibit low levels of striving and self-determination.
Religious coping (measured as the frequency with which one prays or requests prayer from others in response to stress) was also an important protective factor in the stress, coping, and mental health relationship for older African Americans, in both additive and interaction models. Despite little difference in distress symptoms based on religious coping at low and moderate levels of chronic stress, under greater levels of chronic stress, more frequent religious coping buffered against poor mental health symptoms. Conversely, those infrequently coped with high chronic stress through the use of prayer were at risk of an increased rate of distress symptoms. These results are very consistent with past research finding the ongoing utility of prayer in the lives of African Americans (Ellison et al., 2017; Nguyen, 2020; Shorter-Gooden, 2004).
There were also important findings regarding maladaptive coping. When considering the direct associations between maladaptive coping and psychological distress, the coping responses of just giving up, using alcohol or drugs to get through it, and eating more than usual were harmful to mental health. Yet a more nuanced relationship emerged when considering the role of chronic stress/appraisal. Specifically, I found that frequent alcohol and substance use buffered against psychological distress symptoms associated with high levels of chronic stress, a result that fits squarely with predictions of the Environmental Affordances (EA) Model articulated by Jackson and colleagues (Jackson et al., 2010; Jackson & Knight, 2006; Mezuk et al., 2010, 2013). The EA Model theorizes that coping with stress through unhealthy behaviors (e.g., smoking, drinking, and overeating or unhealthy eating) can, through various biochemical processes relating to the hypothalamic-pituitary-adrenalcortical axis, mute the impact of stress on mental health, despite raising the risk of physical health problems associated with unhealthy behaviors. Because the focal point of the Environmental Affordances Model is Black-White differences in physical and mental health, the present study’s focus on within-group differences among African Americans did not permit a direct test of the EA model. Nonetheless, the findings are instructive and strongly support the EA model’s theorized positive impact of unhealthy coping behaviors on mental health among African Americans.
There are important limitations to consider, which can serve as directions for future research. First, although respondents were able to report whether they tended to use each coping response, there was no way to ascertain their primary coping response to stress. Moreover, I was unable to investigate various combinations of coping responses in the present investigation. Given the complex nature of stress in the real world, it is highly plausible that individuals do not rely solely on one coping strategy in a specific situation, nor do they solely use adaptive or maladaptive strategies within one context (Aldao & Nolen-Hoeksema, 2012) or the same strategy in different contexts (Lazarus & Folkman, 1984). Third, despite the distinction I draw between racial and non-racial stressors, some of the chronic stress items could in fact be racialized in nature. For example, money problems could be tied to discriminatory exclusion from the labor market and problems with police are clearly a racialized phenomenon. I was also unable to study individual perceptions regarding the controllability of stressors, an important factor in the study of stress, coping, and mental health (Folkman, 1984; Taylor and Stanton, 2007). One recent study found important gender differences in discrimination-related coping among African Americans (Sullivan et al., 2021). Although beyond the scope of the present analysis, future research should further investigate how gender shapes coping and mental health among African Americans.
One final consideration is that the Black-White paradox is strongest for psychiatric disorders rather than general measures of distress. For example, an important meta-analysis found that Black adults had significantly lower prevalence of major depression than Whites in six out of nine studies while Blacks had significantly higher prevalence of various measures of distress in 16 out of 25 studies under consideration (Barnes & Bates, 2017). Given the low prevalence of disorders in the present age-restricted sample, I was unable to examine mental disorders as an outcome. Future research in larger and younger samples should assess these patterns in relationship to mental disorders, as they can directly inform research on the causes of the mental health paradox.
This investigation focused on within-group differences among older African Americans, consistent with Dr. James Jackson’s call for non-comparative research that centers that experience of Black American populations. Therefore, this paper did not directly test the Black-White mental health paradox. Nonetheless, the present findings regarding the mental health benefits and drawbacks of specific coping strategies among older African Americans are instructive given that psychological distress measures appear to be more sensitive to Black suffering than measures of psychiatric disorders (Barnes & Bates, 2017).
Despite these limitations and considerations, the present study can inform clinical and public health practice for older African Americans. The results suggest that interventions and clinical approaches that focus on acceptance of stressors and the use of prayer can be especially protective for the health of older African Americans, findings that make sense given certain uncontrollable aspects of aging (e.g., health decline). Healthcare providers should also remain attentive to the role of coping through alcohol/substance use, which may help mitigate mental health symptoms in the short term but carries long-term risk for the physical health of older African Americans. Mental health interventions that employ these strategies will likely have the added benefit of improving physical health of older African Americans as well.
Footnotes
Note. With the exception of the John Henryism Scale of Active Coping and stress eating, all items were adapted from the Coping with Problems Experienced Scale (COPE; Carver and colleagues (1989)) and the Brief COPE Scale (Carver 1997).
Category
NSAL Survey Question
Emotion-focused coping
Positive reinterpretation and growth
“Look for something good in what is happening”
“Try to see it in a different light, to make it seem more positive”
Acceptance
“Accept the fact that it has happened”
“Learn to live with it”
Problem-focused coping
Active coping
“Take action to try to make the situation better”
Use of instrumental social support
“Get help or advice from other people”
John Henryism Scale of Active Coping
12-item scale (e.g., “Once I make up my mind to do something, I stay with it until the job is completely done”)
Religious coping
“Pray or get someone to pray for me”
Maladaptive coping
Behavioral disengagement
“Just give up”
Substance use
“Use alcohol or other drugs to help me get through it”
Stress eating
“Eat more than I usually do”
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The preparation of this manuscript was supported by a grant from the National Institute on Aging (grant number P30AG015281).
