Psychologically Resilient,but Physically Vulnerable? Exploring the Psychosocial Determinants of African American Women’s Mental and Physical Health

Abstract

Integrating the intersectionality framework and stress theory, this study identifies the stressors and psychosocial resources contributing to the physical and psychological health status of African American women. Using the National Survey of American Life (N = 2,077), the authors examine the relationship between stress exposures, psychological resources, and health among African American women. The results show that not all psychological resources buffered the deleterious health effects of multiple stress exposures and that the effects of stress and psychological resources differ by health domain. One important finding is that chronic stress negatively affects both mental and physical health, even after adjusting for other stress exposures and psychological resources. Traditional forms of psychological resources, such as social support, mastery, and self-esteem, do not completely ameliorate the negative effects of stress and, in some cases, amplify the negative effects of stress on health. The findings demonstrate the need to disentangle the differential impact of psychosocial factors on African American women’s health.

Keywords

African American women intersectionality stress theory health disparities National Survey of American Life

For centuries, Black women¹ have remained at the margins of both public policy efforts and social science research alike. Offering a glimmer of hope, on March 22, 2016, Congress announced the creation of the Congressional Caucus on Black Women and Girls, the first caucus devoted exclusively to public policy efforts that eliminate barriers and disparities experienced by Black women and girls (Coleman, Kelley, and Clarke 2016; Workneh 2016). Its goal is to “give Black women a seat at the table for the crucial discussion on the policies that impact them while also providing a framework for creating opportunities and eliminating barriers to success for Black women” (Coleman et al. 2016). Amid progress on the policy front, the impact of structural disadvantage and stress exposure on human life persists, as recently personified in the untimely death of Erica Garner, a young activist who worked tirelessly to combat racial injustice after the death of her father, Eric Garner, an unarmed Black man killed by New York Police Department officers in 2014. Erica Garner died from a heart attack stemming from asthma and a subsequent coma (Wang 2017). By her own admission, stress exposure took a psychological and, ultimately, physical toll (Dixon 2017). These events, along with the millions of untold stories of Black women’s triumphs and struggles, inspired the present study, which centers Black women by elucidating the variety of stressors and psychosocial resources affecting their health.

African American women experience relative worse physical health (e.g., chronic health problems, functional limitations) vis-à-vis their White female and African American male peers (Erving 2011; Etherington 2015; Lincoln 2019; Read and Gorman 2006; Umberson et al. 2014; Williams 2002). Conversely, African American women report relatively lower rates of mental disorder (e.g., major depression, substance abuse) relative to White women and, in some cases, African American men (Barnes, Keyes, and Bates 2013; Greer, Laseter, and Asiamah 2009; Neighbors and Williams 2001). These “paradoxical” (Barnes et al. 2013) racialized and gendered epidemiological patterns demonstrate the need for further Black women–centered research that clarifies how social factors may be physically damaging yet psychologically protective.² In this article, we address the following question: What stress exposures and psychosocial resources contribute to the physical and psychological health profiles of African American women? Our study extends previous research by integrating intersectionality and stress theory to elucidate how African American women’s unique social position is stressfully burdensome and psychosocially resource rich, both of which having implications for health. We also advance African American women’s health research by using a nationally representative sample, providing a comprehensive depiction at the national level.

Background

The barrage of health problems African American women experience at disproportionately high rates provide justification for studying the specific factors undergirding their health (Umberson et al. 2014; Williams 2002). Furthermore, focusing on African American women unveils the social determinants of health for a specific gendered and racialized group. Here, we draw from intersectionality and stress theory: intersectionality highlights why there may be heterogeneous health effects among African American women, while the stress process model (SPM) focuses on what potential mechanisms contribute to African American women’s health.

Attending to the unique social location of individuals at the intersection of multiple stratification systems, the intersectionality framework emphasizes the interlocking and mutually reinforcing relationships among multiple systems of oppression (Collins 1990, 2015; Crenshaw 1991; Grollman 2014). One form of stratification (e.g., racism) cannot be fully understood without considering how it works in tandem with other forms of stratification (e.g., sexism) (Collins 2015; Cummings and Jackson 2008; Harnois and Ifatunji 2011). Furthermore, López’s (2013) call for health disparities researchers to anchor empirical studies in a racialized-gendered social determinants of health framework suggests that race and gender must be taken seriously.

Stress theory more broadly and the SPM in the sociology of mental health research tradition in particular offer explanatory mechanisms for understanding African American women’s health. The SPM proposes that lower social status is associated with higher exposure to stressors that produce elevated risk for mental and physical health problems (Pearlin and Bierman 2013; Pearlin et al. 1981; Turner 2013; Williams et al. 1997), while psychosocial resources mediate and/or moderate the association between stress and health (Pearlin 1999; Pearlin and Bierman 2013). A growing body of research has examined the specific stressors and resources affecting African American women’s physical and psychological health (Donovan and West 2015; Evans, Bell, and Burton 2017; Greer 2011; Holden et al. 2012, 2013; Jones et al. 2007; McKnight-Eily et al. 2009; Perry, Harp, and Oser 2012; Perry, Pullen, and Oser 2013; Rosenthal and Lobel 2011; Schulz et al. 2000; Stevens-Watkins et al. 2012, 2014). Very few studies, however, have used nationally representative samples, hindering us from understanding the scale of impact of stressors on health. Accordingly, using national data, we assess how stress exposures and personal resources impact African American women’s well-being.

Stress Exposure and Health

The SPM proposes that stress exposure is associated with poor physical and mental health (Pearlin 1999; Pearlin and Bierman 2013) and can develop across different contexts (e.g., workplace, home) and social relationships (e.g., with children, romantic partners) (Pearlin and Bierman 2013; Thoits 2010). Because African American women navigate their social lives via the lens of their racialized and gendered experiences, some stressors are more likely to affect their health (Beauboeuf-Lafontant 2009). Relatedly, the SPM engages the possibility that the stress-health association may differ by social status (e.g., race, gender) (Assari and Lankarani 2015; Greer et al. 2009; Guyll, Matthews, and Bromberger 2001; Umberson et al. 2014). Although the goal of the present study is not to assess status differences in the stress-health association, the stressors affecting the well-being of African American women specifically are worth independent study. Below we review the stress-health literature focused on African American women.

Racism involves belief in an inherent inferiority of racial groups that is used to justify unequal treatment (i.e., discrimination against members of racial groups designated as inferior by both individuals and institutions) (Williams 1999). Similarly, ideology about the inherent inferiority of gender groups (sexism) is also often used to justify discrimination against women. The impact of both race- and gender-based discrimination on the physical and mental health of racial minorities and women is well documented (Doyal 1995; Jackson et al. 1996; Krieger 1990; Lincoln 2019; Sellers and Shelton 2003; Soto, Dawson-Andoh, and BeLue 2011; Tull et al. 1999; Zucker and Landry 2007). Consequently, African American women’s social location at the nexus of both racialized and gendered marginalization forecasts a greater likelihood to be exposed to both forms of discrimination; in fact, the compound effect of both race- and gender-based discrimination increases susceptibility to other life stressors for African American women, which diminishes health (Perry et al. 2013; Stevens-Watkins et al. 2014; Thomas, Witherspoon, and Speight 2008). Moreover, discriminatory experiences rooted in racism and sexism are associated with psychological distress, anxiety, mental disorders, negative health behaviors, poor self-rated health (SRH), and physical illness (Brown et al. 2003; Kwate et al 2003; Lacey et al. 2015; Perry et al. 2013; Thomas et al. 2008).

Although a few studies of African American women’s health used the SPM as a basis for investigating the health effects of racial discrimination (Keith et al. 2010; Perry et al. 2013; Stevens-Watkins et al. 2012), African American women are also exposed to other chronic stressors in the domains of the workplace, financial matters, and the family at disproportionately higher rates (Everett, Hall, and Hamilton-Mason 2010; Lincoln 2019). This chronic stress exposure (e.g., workplace stress, financial strain, family conflict) is associated with higher depressive symptomatology, diminished psychological well-being, and accelerated biological aging (Beauboeuf-Lafontant 2009; Lincoln 2019; Simons et al. 2016; Woods-Giscombé 2010). In sum, African American women are exposed to various stressors, and in our study we comprehensively assess the health effects of stress by examining exposure across social contexts. Specifically, we assess the relative health impact of five stress exposures: major discrimination, everyday discrimination, chronic stress, financial strain, and family conflict.

Psychological Resources and Health

Despite the harsh reality of stress exposure, African American women also have access to psychological resources, which are generally health protective (Pearlin 1999; Turner, Lloyd, and Roszell 1999). In the SPM, the most commonly studied psychosocial resources include social support, mastery, and self-esteem (Pearlin and Bierman 2013; Turner et al. 1999; Turner and Roszell 1994). Not only does African American women’s social location reflect unique stressors that differentially affect their health, but they also adopt culturally specific psychological resources and coping strategies (Krieger 1990; Thomas et al. 2008). Religiosity in general and participation in formal religious organizations in particular remain crucial for African American women (Lincoln and Chatters 2003; van Olphen et al. 2003). Accordingly, we integrate psychological resources in the broader literature (i.e., social support, mastery, and self-esteem) with more culturally specific resources (i.e., religious involvement and coping) that could be particularly crucial for African American women.

Research on psychosocial resources and health among African American women yields encouraging findings. Social support from family members is associated with lower levels of depressive symptoms (Baldwin-Clark, Ofahengaue, and Anderson 2016; Brown and Cochran 2003; Gray and Keith 2003; Tucker 2003). Also, African American women report relatively higher levels of mastery and self-esteem in comparison with their White female counterparts (Etherington 2015; Milkie 1999), and mastery serves as a health protective factor against discrimination (Keith et al. 2010; Uzogara and Jackson 2016), while self-esteem and health are positively associated (Etherington 2015; Tucker 2003). Additionally, African American women report high levels of organizational (e.g., church attendance) and nonorganizational (e.g., prayer) religious involvement, as well as spirituality and religiosity (Lincoln and Chatters 2003; van Olphen et al. 2003); religious involvement serves as both a coping mechanism and a positive predictor of mental health (Jarvis and Northcutt 1987; Levin, Markides, and Ray 1996; Lincoln and Chatters 2003; Mattis 2002; Tucker 2003).

Stress Exposure, Psychological Resources, and Health

In addition to the independent negative effect of stress and positive impact of personal resources on health, the SPM proposes complex interrelationships among stress exposure, psychological resources, and health (Pearlin 1999; Pearlin and Bierman 2013). Previous research, however, has not adequately tested these interrelationships for African American women. We integrate research from sociology of mental health and intersectionality to describe four hypotheses elucidating how interrelationships among stress, resources, and health could operate among African American women. Drawing from these two theoretical traditions allows us to develop testable hypotheses that will clarify our understanding of the complex associations among harmful and beneficial health determinants for one of the most marginalized demographic groups in the United States.

Mediation Hypothesis

Much of the SPM research suggests that personal resources can lessen, or even eliminate, the negative impact of stressors on physical and psychological well-being (Pearlin and Bierman 2013; Pearlin et al. 1981). Some past research showed that psychosocial resources mediate the stress-health association (e.g., Keith et al. 2010), while other work demonstrated that these resources are not consequential (e.g., Thomas et al. 2008). In a qualitative study, Everett et al. (2010) showed that African American women often depend on family and friend social support as well as religious involvement as psychosocial resources to manage stress in the domains of work, family, and finances. Using National Survey of American Life (NSAL) data, Keith et al. (2010) reported that mastery mediated the relationship between discrimination and depressive symptoms among African American women. Despite evidence that psychological resources are mediators, Thomas et al. (2008) found that spiritual-centered coping styles did not mediate the association between discrimination and psychological distress. These findings underscore the possibility that empirical support for the mediation hypothesis is contingent on the stressors and psychological resources under study.

Suppressor Hypothesis

Individuals facing personal crises such as illness, accidents, and other stressors may be more likely to use certain psychological resources (e.g., prayer) (Ellison et al. 2001). Accordingly, the association between resources and health may emerge only under the condition of stress exposure. Statistically speaking, the positive psychological resources-health association would be minimal in the absence of adjustments for stressors. After adjusting for stress exposure, however, a positive association between psychological resources and health would emerge. This would indicate evidence of a suppression effect. We test the possibility that suppression effects could operate among African American women.

Stress-Buffering Hypothesis

The stress buffering perspective suggests that psychosocial resources moderate the stress-health association (as evidenced by a statistically significant interaction between a stressor and a resource) and can be interpreted in two ways. First, psychological resources have a stronger positive effect on mental health among people who face high stress levels but little to no effect among those with low stress levels. Second, the association between stress and health is weaker among individuals who possess high levels of psychological resources, while the stress-health association is stronger for individuals with few psychological resources. There is empirical support for stress buffering in the general mental health literature (Gayman et al. 2014; Thoits 2011) and for African American women in particular (Perry et al. 2012; Ulbrich and Bradsher 1993). However, research on African American women has been less consistent in finding evidence of psychological resources serving as stress buffers.

Stress-Exacerbating Hypothesis

The negative effects of stressors on mental health could be larger among individuals with high levels of psychological resources than among those with low levels of resources. Used in various studies of Black women’s unique experiences related to health and well-being, the strong Black woman archetype reflects society’s demands on Black women to be psychologically resilient, physically strong, and selfless in the face of misogynoir and other forms of stress (Abrams, Hill, and Maxwell 2019; Baker et al. 2015; Beauboeuf-Lafontant 2003; Wallace 1979). Grounded in Black feminist theory, Woods-Giscombé (2010) explored the roots of the strong black Woman archetype and the superwoman myth (Wallace 1979) to develop the super woman schema (SWS) framework in an effort to link controlling images and stress-related health outcomes for Black women. Importantly, the SWS framework elucidates the seemingly counterintuitive ways psychological and coping resources may intensify the impact of stress on health. Specifically, the SWS framework highlights how Black women are expected to be “the strong ones,” to suppress their emotions, to be resistant to vulnerability, to succeed despite limited resources, and to help others at their own expense. Although this framework highlights some perceived benefits of endorsed SWS, such as the preservation of the self, family, and community, the SWS can have negative implications, including creating strain in interpersonal relationships and contributing to stress-related health behaviors. This duality of having high levels of psychological resources and stress could cause psychological resources to be ineffective as stress buffers (Donovan and West 2015). Our study highlights the possibility of a stress-exacerbation effect amid high levels of psychological resources.

In sum, our work extends previous research by drawing from the intersectionality framework and stress theory to uncover how African American women’s unique social position burdens them with certain stressors while extending psychosocial resources. In particular, in this study we ask the following research question: What stress exposures and psychological resources contribute to the physical and psychological health profiles of African American women?

Data and Methods

We use the NSAL, a nationally representative data set of U.S. Blacks (Jackson et al. 2004). The sample is composed of African American, Caribbean Black, and non-Hispanic White adults age 18 years and older residing in U.S. households. African Americans self-identify as Black but do not report Caribbean ancestry. The sampling design and method have been described elsewhere (Heeringa et al. 2004). Face-to-face interviews were completed with 3,570 African Americans, 1,621 Caribbean Blacks, and 891 non-Hispanic Whites. For this analysis, we confined the sample to U.S.-born African American women (n = 2,242). After conducting listwise deletion, we retain 90 percent of the sample (n = 2,077).

Measures

Dependent Measures

Depressive symptoms is a 12-item version of the Center for Epidemiological Studies Depression Scale (Radloff 1977). Respondents were asked, “Please tell me how often you have felt this way during the past week.” Examples of scale items include “I felt depressed” and “My sleep was restless.” Response categories range from “rarely or none of the time (less than 1 day)” to “most or all of the time (5–7 days).” We created an additive scale for the Center for Epidemiological Studies Depression Scale 12 (range = 0–33), with lower values indicating fewer depressive symptoms. SRH queried respondents to rate their current physical health from poor (1) to excellent (5). Although SRH is a subjective assessment of health, it is associated with morbidity (Ferraro, Farmer, and Wybraniec 1997) and mortality (Idler and Benyamini 1997).

Independent Measures

We include the following stress exposure measures: major discrimination, everyday discrimination, past-month chronic stress, financial strain, and family conflict. The major discrimination scale includes nine items (e.g., “unfairly fired,” “prevented from moving into a neighborhood”). We developed a count variable to assess the number of discriminatory events, ranging from zero to nine events. Although respondents are asked to identify one main reason for their mistreatment, scholars have noted that this does not allow respondents to report multiple explanations for why they were discriminated against (e.g., because of their race and gender; Grollman and Hagiwara 2017; Harnois 2014; Harnois and Ifatunji 2011). Because respondents were able to report only one reason for discrimination, we did not limit the analysis to race- or ethnicity-related discrimination. Instead, we include all reports of unfair treatment in the aggregate to capture discrimination as a general stress exposure. Everyday discrimination assesses the more routine and (arguably) relatively minor experiences. Ten items capture the frequency of experiences such as “being treated with less courtesy than others.” The everyday discrimination scale has a theoretical range of 0 to 50, with items ranging from “never” (0) to “almost every day” (5). Both discrimination measures have been validated and used in prior research (Williams et al. 1997).

Past-month chronic stress includes 10 questions assessing if respondents experienced stress across various social domains and contexts, including health problems, family or marriage problems, or problems with the police. We develop an index of chronic stress with a theoretical range of 0 to 10. We assess financial strain with the item “How much do you worry that your total (family) income will not be enough to meet your (family’s) expenses and bills?” Response options range from “not at all” (0) to “a great deal” (3). Family conflict is measured using three items: “family makes too many demands of you,” “criticizes you and the things you do,” and “takes advantage of you.” The response options included “never” (0) to “very often” (3). We created an index of the three items, which has a theoretical range of 0 to 9.

We include the following measures of psychosocial resources: social support, mastery, self-esteem, religious involvement, and religious coping. Social support is a multidimensional concept that encompasses a variety of sources (e.g., family, friends) and types (e.g., instrumental, socioemotional) (Thoits 2011). To develop a parsimonious measure of social support, we include an index of social support based on the following items: being married or cohabiting, frequent family contact (at least once a month), closeness to family (fairly or very close), feel loved and cared for by family (fairly or very often), frequent friend contact (at least once a month), and closeness to friends (fairly or very close). We created an additive index, ranging from 0 to 6; higher values indicate greater social support. Mastery is measured using Pearlin and Schooler’s (1978) 7-item scale to assess perception of control over one’s life. The scale includes items such as “feeling helpless in dealing with the problems of life” and “hav[ing] control over things that happen” to respondents. Response categories range from “strongly agree” (0) to “strongly disagree” (3). The scale has a theoretical range of 0 to 21, and we recoded the appropriate items such that a higher score reflects higher mastery. Self-esteem is measured using Rosenberg’s (1986) 10-item scale. The scale includes items such as “I feel that I am a failure” and “I take a positive (good) attitude toward myself.” Response categories mimic those for the mastery items. We recoded the appropriate items such that higher scores indicate higher self-esteem (theoretical range = 0–30).

We include four religious involvement measures: church attendance, nonorganizational religious participation, religiosity, and spirituality. For church attendance, we combined two measures: frequency of church attendance and whether respondents have attended service since the age of 18 (Taylor, Chatters, and Abelson 2012). The resulting categories are “never attended services since the age of 18” (1), “less than once a year” (2), “a few times a year” (3), “a few times a month” (4), “at least once a week” (5), and “nearly every day” (6). We constructed an index of non-organizational religious participation using five items: “reading religious books or other religious materials,” “watching religious television programs,” “listening to religious radio programs on the road,” “praying,” and “asking others to pray for [you]” (Lincoln and Chatters 2003). Response options for each item ranged from “never” (0) to “nearly every day” (5). The index ranges from 0 to 25, with higher values reflecting higher participation. Religiosity was assessed by asking respondents, “How religious would you say you are?” Response options include “not religious at all” (1) to “very religious” (4). The same question was asked for overall spirituality, with the same response options.

We include two measures of religious coping. First, look to God for strength is assessed using the following statement: “I look to God for strength, support, and guidance.” Response options range from “strongly disagree” (1) to “strongly agree” (4). Second, prayer in stressful situations was assessed by asking, “How important is prayer when you deal with stressful situations?” Response options range from “not important at all” (1) to “very important” (4). The religious involvement and religious coping measures are consistent with prior research (Chatters et al. 2008; Lincoln and Chatters 2003; Taylor et al. 2012; van Olphen et al. 2003).

Controls

We include factors associated with physical and mental health for controls: annual household income ($0–$200,000 or more measured in $10,000 increments), education (less than high school, high school/some college, and college educated), employment status (employed, not in the labor force, unemployed), age (18–93 years), and region (South, Northeast, Midwest, and West).

Analysis Plan

First, we provide descriptive statistics for the key dependent and independent measures (Table 1). Next, we use ordinary least squares (OLS) regression to analyze depressive symptoms and ordered logistic regression for SRH. All regressions are standardized to compare the magnitude of coefficients across models. The regression analysis proceeds as follows: each measure is entered in a separate regression model to assess its individual effects (column 1 in Tables 2 and 3). To assess the collective effects of stress exposure, column 2 includes stress exposure measures and controls in one model. In column 3, all psychological resources and controls are entered in one model. Last, column 4 includes all stress exposure and psychosocial resources in one model. To test the stress-buffering and stress-exacerbating hypotheses, we conducted statistical interactions between each stress exposure and psychological resource measure for the final models (column 4 in Supplemental Figures 1–4). All analyses incorporate sampling weights and are conducted using Stata 14.2. Bivariate correlations for the key measures are available in Appendix A.

Table 1.

Descriptive Sample Characteristics (n = 2,077).

	M	SD	Range	Proportion
Health outcomes
Depressive symptoms	7.09	6.08	0–33
Self-rated physical health	3.34	1.07	1–5
Stress exposure
Major discrimination	1.15	1.45	0–8
Everyday discrimination	10.59	7.82	0–43
Chronic stress	1.98	1.61	0–9
Financial strain	.96	1.00	0–3
Family conflict	2.73	2.44	0–9
Psychological resources
Social support	4.88	1.01	0–6
Mastery	11.51	1.56	3–16
Self-esteem	26.14	4.31	2–30
Religious involvement
Church attendance	3.97	1.29	1–6
Nonorganizational religious involvement	17.12	5.07	0–25
Religiosity	3.20	.71	1–4
Spirituality	3.38	.66	1–4
Religious coping
Look to God for strength	3.92	.36	1–4
Prayer in stressful situations	3.93	.31	1–4
Controls
Annual household income (×$10,000)	3.19	2.61	0–20
Education
Less than high school				.25
High school/some college				.61
College graduate				.14
Employment status
Employed				.63
Unemployed				.11
Not in the labor force				.25
Age	41.98	16.01	18–93
Region
South				.56
Midwest				.19
Northeast				.16
West				.09

Source: National Survey of American Life, 2001 to 2003.

Table 2.

Standardized Weighted Ordinary Least Squares Regression of Depressive Symptoms (n = 2,077).

	Column 1^a	Column 2^b	Column 3^c	Column 4^d
Stress exposure
Major discrimination	.145*** (6.04)	−.054 (–2.00)		−.023 (–.95)
Everyday discrimination	.328*** (10.23)	.216*** (6.94)		.168*** (6.16)
Chronic stress	.370*** (12.97)	.247*** (7.37)		.197*** (6.51)
Financial strain	.355*** (14.73)	.229*** (10.41)		.151*** (8.25)
Family conflict	.216*** (7.35)	.064* (2.48)		.024 (1.00)
Psychological resources
Social support	−.151*** (–5.85)		−.061 (–2.00)	−.029 (–1.11)
Mastery	−.210*** (–8.53)		.005 (.17)	−.011 (–.41)
Self-esteem	−.468*** (–19.56)		−.455*** (–13.30)	−.316*** (–8.90)
Religious involvement
Church attendance	−.101*** (–4.39)		−.072*** (–3.86)	−.049** (–2.90)
Nonorganizational religiosity	−.006 (–.29)		.099** (3.45)	.055* (2.26)
Religiosity	−.060* (–2.13)		.025 (.83)	.045 (1.52)
Spirituality	−.103*** (–3.56)		−.046 (–1.66)	−.052* (–2.17)
Religious coping
Look to God for strength	−.072* (–2.41)		−.029 (–1.47)	−.040* (–2.44)
Prayer in stressful situations	−.044 (–1.78)		.003 (.12)	.014 (.72)
R ²	—	.365	.351	.454

Source: National Survey of American Life, 2001 to 2003.

Note: Values are standardized β coefficients; t statistics are in parentheses. All models control for household income, education, employment status, age, and region.

Separate models for each stressor and psychological resource.

Single model including stressors.

Single model including psychological resources.

Full model of the collective effects of all stressors and psychological resources.

p < .05. **p < .01. ***p < .001.

Table 3.

Standardized Weighted Ordered Logistic Regression of Self-Rated Physical Health (n = 2,077).

	Column 1^a	Column 2^b	Column 3^c	Column 4^d
Stress exposure
Major discrimination	.818*** (.03)	.957 (.03)		.913* (.03)
Everyday discrimination	.864** (.01)	1.019 (.01)		1.100 (.01)
Chronic stress	.592*** (.03)	.626*** (.03)		.660*** (.04)
Financial strain	.791*** (.06)	.917 (.07)		1.000 (.06)
Family conflict	.806*** (.02)	.935 (.02)		.985 (.02)
Psychological resources
Social support	1.157* (.04)		1.058 (.05)	1.020 (.05)
Mastery	1.067 (.03)		.828** (.04)	.850* (.04)
Self-esteem	1.620*** (.01)		1.748*** (.02)	1.607*** (.02)
Religious involvement
Church attendance	1.053 (.05)		1.036 (.05)	1.027 (.05)
Nonorganizational religiosity	.934 (.01)		.820*** (.01)	.836*** (.01)
Religiosity	1.087 (.07)		1.004 (.07)	1.002 (.08)
Spirituality	1.153** (.07)		1.121* (.07)	1.138* (.08)
Religious coping
Look to God for strength	1.079 (.15)		1.067 (.14)	1.083 (.14)
Prayer in stressful situations	1.037 (.17)		.975 (.22)	.981 (.21)

Source: National Survey of American Life, 2001 to 2003.

Note: Exponentiated coefficients (odds ratios) are shown in the table. Standard errors are in parentheses. All models control for household income, education, employment status, age, and region.

Separate models for each stressor and psychological resource.

Single model including stressors.

Single model including psychological resources.

Full model of the collective effects of all stressors and psychological resources.

p < .05. **p < .01. ***p < .001.

Results

Descriptive Statistics

Table 1 provides descriptive statistics for the health outcomes, independent measures, and controls. Average depressive symptoms is low (7.09, SD = 6.08) and SRH is 3.34, relatively close to the “good” category. In terms of stress exposure, the mean number of acts of major discrimination is 1.15 (SD = 1.45), and the average score for everyday discrimination is 10.59 (SD = 7.82). The mean number of chronic stressors is 1.98 (SD = 1.61), the average for financial strain is .96 (close to the “a little” response category), and family conflict is 2.73 (SD = 2.44). With regard to psychological resources, social support, mastery, and self-esteem levels are high. For religious involvement, the church attendance mean is 3.97, indicating that average attendance is “a few times a month.” Consistent with prior research on African American women (Lincoln and Chatters 2003), nonorganizational religious involvement, religiosity, and spirituality are high in this sample. In terms of religious coping, looking to God for strength and prayer in stressful situations have means aligned with the “strongly agree” and “very important” response categories, respectively. Mean household income is $31,900 (SD = $26,100). Although one fourth have less than a high school degree, the majority of the sample (61 percent) have a high school diploma, and 14 percent are college-educated. Sixty-three percent are employed, and one fourth are not in the labor force, while 11 percent are unemployed. The average age is 41.98 years (range = 18–93 years). A little over half of the sample live in the South, nearly one fifth reside in the Midwest, 16 percent in the Northeast, and 9 percent in the West.

Depressive Symptoms

Table 2, column 1 shows estimates from the separate models for the individual effects of each stressor and psychological resource. When examined individually, stress exposure (i.e., major discrimination, everyday discrimination, chronic stress, financial strain, and family conflict) is associated with higher depressive symptoms. In terms of psychological resources, high levels of all but two indicators (nonorganizational religiosity and prayer in stressful situations) are associated with fewer depressive symptoms. To assess the collective effects of stress exposure, column 2 includes all stress exposures in the same model. Four stress exposures are associated with higher depressive symptoms: everyday discrimination, chronic stress, financial strain, and family conflict. Column 3 includes the collective effects of psychological resources on depressive symptoms. When entered into the same model, only two psychological resources are associated with fewer depressive symptoms: self-esteem (b = −.455, p < .001) and church attendance (b = −.072, p < .001). Nonorganizational religiosity is associated with higher depressive symptoms (b = .099, p < .01).

Column 4 includes stress exposures and psychological resources. There are three notable results. First, everyday discrimination, chronic stress, and financial strain remain associated with higher depressive symptoms; however, the effect sizes are smaller compared with those in column 2. The coefficients for everyday discrimination, chronic stress, and financial strain are reduced by 22 percent, 20 percent, and 34 percent, respectively. This suggests that psychosocial resources partially, but do not fully, mediate the effects of everyday discrimination, chronic stress, or financial strain on depressive symptoms. Second, family conflict is no longer statistically significant, suggesting that self-esteem, church attendance, spirituality, and looking to God for strength mediate the negative effect of family conflict on depressive symptoms. Third, spirituality and looking to God for strength are associated with fewer depressive symptoms, but these psychological resources were not associated with depressive symptoms in column 3. Thus, we find evidence in support of the mediation and suppression hypotheses. To test the stress-buffering and stress-exacerbating hypotheses, we ran interactions between each stressor and psychological resource, and there were no statistically significant interactions. Of note, stress exposure and psychological resources collectively explain a substantial portion of the variation in depressive symptomatology: the R² value for the full model (column 4) shows that stress exposure and psychological resources explain 45.4 percent of the variation in depressive symptoms.

SRH

The individual effects in Table 3, column 1, show that all stress exposures are inversely associated with SRH. In addition, three psychological resources are associated with higher SRH: social support, self-esteem, and spirituality. In the stress exposure model (column 2), only chronic stress is associated with poorer SRH (odds ratio = .626, p < .001). In the psychological resources model (column 3), two psychosocial resources are associated with better SRH: self-esteem and spirituality. However, counterintuitively, two resources, mastery and nonorganizational religiosity, are associated with lower SRH. In the full model shown in column 4, chronic stress remains associated with lower SRH. In addition, Although psychosocial resources remain statistically significant, they do not act as mediators; in fact, after including stress and resources in model 4, major discrimination is also inversely associated with SRH (odds ratio = .913, p < .05).

To assess the stress-buffering and stress-exacerbating hypotheses, we ran interactions between each stressor and each psychological resource. There were four statistically significant interactions. The coefficients for the statistically significant interactions are shown in Table 4. To facilitate interpretation of interaction terms, predicted probabilities are presented in Supplemental Figures 1 to 4.

Table 4.

Interaction Effects of Stress Exposure and Psychological Resources on Self-Rated Physical Health (n = 2,077).

Stressor × Psychological Resource	Main Effect: Stressor	Main Effect: Psychological Resource	Interaction Term
Major discrimination × Church attendance	.162	.087	−.055*
Major discrimination × Look to God for strength	1.035*	.446**	−.278**
Everyday discrimination × Religiosity	.049*	.213	−.012*
Financial strain × Social support	−.481*	−.090	.102*

Source: National Survey of American Life, 2001 to 2003.

Note: Coefficients are shown in the table. All models control for all covariates included in the full model (Table 3, column 4).

p < .05. **p < .01.

First, for the significant interaction between major discrimination and church attendance, we find evidence of an exacerbation effect. That is, high levels of discrimination and church attendance are associated with a higher predicted probability of fair or poor health (42 percent), while high discrimination and no church attendance are associated with a lower predicted probability of fair or poor health (11 percent) (Supplemental Figure 1). Second, the interaction between major discrimination and looking to God for strength is perplexing: on one hand, individuals with high stress and low coping (high discrimination, no looking to God for strength) have the highest predicted probability of excellent health (94 percent). On the other hand, individuals with no major discrimination and low coping have the highest predicted probability of fair or poor health (44.9 percent), followed by high major discrimination and high God strength (28.7 percent). Thus, this form of religious coping (looking to God for strength) coupled with high major discrimination is associated with poor SRH, thereby lending support to the exacerbation hypothesis (Supplemental Figure 2).

Third, the interaction between everyday discrimination and religiosity shows that low everyday discrimination and low religiosity have the highest probability of fair or poor health (48.5 percent) (Supplemental Figure 3). This suggests that low stress exposure in the form of everyday discrimination and few psychological resources in the form of religiosity are associated with the worst physical health. This is not consistent with the stress-buffering and stress-exacerbation hypotheses.

Fourth, for the interaction between financial strain and social support, we find evidence of stress buffering. This is especially pronounced in the comparison of the SRH predicted probabilities for high financial strain and high social support versus high financial strain and no social support. For example, individuals with high financial strain and no social support have a predicted probability of 34.3 percent for reporting fair or poor health, while African American women with similarly high financial strain and high levels of social support have a predicted probability of 15.1 percent for fair or poor health (Supplemental Figure 4).

Discussion

We assessed the associations among stress exposure, psychological resources, and health for African American women. Because of limited nationally representative studies, less is known about African American women’s experiences with various stressors, their “toolkit” of coping strategies, and psychosocial resources that might mitigate the negative effects of stressors on health. Thus, we contribute to a small, but growing, body of research on African American women’s health by using a nationally representative sample and integrating two theoretical perspectives: intersectionality and stress theory. Findings were both consistent and inconsistent with past research.

Independent Effect of Stress Exposure

Of the stress exposures examined, past-month chronic stress is the most insidious, as it is the only stressor associated with both mental and physical health, even after adjusting for the other stress exposures and psychological resources. Given the ongoing nature of chronic stress exposure (Lincoln 2019; Turner and Turner 2005), future intervention programs focused on improving African American women’s health should prioritize the mitigation of chronic stress in their lives. In addition to the negative effect of chronic stress, three other stressors also negatively affected mental health: everyday discrimination, financial strain, and family conflict. Therefore, other key stress exposures should be addressed in programs designed to counteract depressive symptoms among African American women. Overall, we find that stress exposure has a stronger effect on mental health than physical health. Thus, further research should elucidate the unique pathways linking specific stress exposures to particular health outcomes.

Independent Effect of Psychological Resources

Regarding the impact of psychological resources on health, self-esteem appears to be the “most valuable player”: self-esteem was associated with fewer depressive symptoms and higher SRH. Self-esteem also had the largest relative effect of the psychological resources examined here. African American women and girls tend to have higher self-esteem compared with their White counterparts (Etherington 2015; Milkie 1999). Thus, it is insightful that self-esteem is also health protective for African American women. Despite the substantial impact of self-esteem on the psychological and, to some extent, physical well-being of African American women, it should not be viewed as a panacea. Self-esteem is but one psychological resource linked to health; furthermore, stress exposure is often anathema to psychological resources (Pearlin and Bierman 2013; Wheaton 1985).

Nonorganizational religious involvement (e.g., “praying,” “asking others to pray for [you]”) was associated with worse mental and physical health. Although seemingly counterintuitive, this finding is consistent with prior work showing that prayer frequency was associated with higher distress (Ellison et al. 2001). Individuals facing personal crises such as illness and accidents may be more likely to pray and engage in other forms of nonorganizational religious practices (Ellison et al. 2001). Our findings for nonorganizational religious participation support this logic, as the effect of nonorganizational religious participation was not associated with physical or mental health when in the depressive symptoms and SRH regression models alone. Other religion-based psychological resources affect either mental health or physical health, but not both. For example, consistent with past research, church attendance was associated with fewer depressive symptoms (van Olphen et al. 2003), while spirituality was associated with better SRH (Zullig, Ward, and Horn 2006). Thus, religious involvement in general, and church attendance as well as spirituality in particular, is salubrious for African American women.

Counterintuitively, high levels of mastery were associated with lower SRH. Despite feeling masterful, this self-perception may create a false sense of security for African American women, who often face structural barriers and interpersonal conflict that impede their ability to protect their own physical health. Perceiving that one is powerful and in control when reality suggests otherwise could elicit cognitive dissonance and have grave implications for physical health. Although mastery can serve as a health-protective factor (Keith et al. 2010; Uzogara and Jackson 2016), even among African American women who have relatively high levels of mastery, discrimination can undermine mastery and ultimately worsen health (Keith et al. 2010).

Interrelationships among Stress, Resources, and Health

Research in the SPM tradition suggests four hypotheses regarding the associations among stress exposure, psychological resources, and health: mediation, suppression, stress buffering, and stress exacerbation. Among African American women, support for these hypotheses was contingent on the specific health outcome, stress exposure, and psychological resource. Results for mental health lend support to the mediation and suppression hypotheses, while results for physical health lend support to the suppression, stress-buffering, and stress-exacerbation hypotheses.

Regarding mental health, we find partial support for the mediation hypothesis: psychological resources partially mediated the stress–depressive symptoms association. First, psychological resources reduced the negative effect of everyday discrimination, chronic stress, and financial strain on depressive symptoms. Second, the negative mental health effects of family conflict lessened by including psychological resources. Thus, psychological resources (e.g., self-esteem, church attendance) appear to be most effective in counteracting the negative mental health effects of family conflict. Although these resources can powerfully counteract the negative mental health effects of familial problems and demands, they are less effective in reducing stressors outside the family context. This finding is both encouraging and disheartening, as stressors occurring within the family context is an important domain of intervention but is only one of the numerous other life domains where African American women experience stress exposure.

Our findings for depressive symptoms also support the suppression hypothesis. Specifically, spirituality and looking to God for strength were associated with fewer depressive symptoms, but only after adjusting for stress exposures. In other words, high use of spirituality and religious coping (looking to God for strength in particular) are associated with better mental health, but only when called upon to counteract stressful life circumstances (Ellison et al. 2001; Wheaton 1985). Although suppression effects are less commonly emphasized in the extant literature, future work is needed to better understand the implications of statistical suppression effects for the complexities and exigencies of social life (Schieman 2010).

The results for physical health, as measured by SRH, supported three of the four hypotheses: suppression, stress buffering, and stress exacerbation. First, major discrimination negatively affects SRH, but only after accounting for psychological resources. Although this suppression effect is not commonly found in the literature, it speaks to the deleterious impact of major discrimination on health amid the presence of psychological resources. Perhaps those with psychological resources (e.g., high self-esteem, high spirituality) are more likely to perceive major discrimination, which in turn intensifies the effects of such discrimination on SRH. Future work should further examine suppression effects, as they may illuminate our understanding of the interrelationships among psychological resources, discrimination, and physical health. Second, we find one instance of stress buffering: high levels of social support buffer the effect of financial strain on physical health. This finding demonstrates the powerful ability of social support to reduce the health-harmful effects of financial instability not just for the broader population (Thoits 2011) but particularly for African American women.

Third, we find evidence of stress exacerbation: high church attendance intensifies the association between major discrimination and SRH. Also, religious coping (looking to God for strength) combined with high major discrimination is associated with poor SRH. Both findings suggest that high levels of some psychological resources are not health protective when stress is present. In fact, high levels of psychological resources can be so ineffective that they induce physical health problems. As it relates to African American women, the stress-exacerbation evidence aligns with the SWS that African American women often adopt (because of societal pressures and constraints), which can render high psychological resources but does not protect African American women from the assault of stress exposure and its health consequences. Furthermore, the SWS simultaneously operates as both a source of motivation and encouragement for African American women to “push through” difficult times and challenging circumstances and a rationalization for African American women’s overwork, overburden, and overextension (Baker et al. 2014; Woods-Giscombé 2010).

Last, one physical health finding did not align with any of the four hypotheses. Low everyday discrimination and low religiosity were associated with poor physical health, suggesting that even when stress exposure is nearly nonexistent, when psychological resources are also lacking, poor health can ensue. Similarly, Krieger (1990) found that African American women who recounted no instances of race- or gender-based discrimination were more likely to internalize their responses to unfair treatment and had higher risk for hypertension than African American women who talked to others. Moreover, this finding suggests that African American women’s psychological resources might not only be effective as stress buffers but also independently health promoting to the extent that even in the absence of stressors like discrimination, the absence of necessary psychological resources bear costly physical health consequences.

Given the distinct findings for depressive symptoms and SRH, our study provides further evidence that the effects of stress exposure and psychological resources differ by health domain (i.e., physical vs. mental health). Overall, the results suggest that African American women are “psychologically resilient” and simultaneously “physically vulnerable.” On one hand, African American women are in relatively good mental health, with overall low depressive symptoms. On the other hand, African American women’s self-rated physical health is relatively lower compared with other race and gender groups (Read and Gorman 2006; Umberson et al. 2014).

Although our study further elucidates our understanding of how stress exposure and psychological resources affect African American women’s health, more work is needed to confirm and clarify these results. Particularly, stress exposures specific to African American women’s racialized and gendered identities would propel the literature forward. Harnois (2014) and Harnois and Ifatunji (2011) drew attention to male bias in extant discrimination scales often used in health research; more specifically, this body of work astutely notes that although some forms of discrimination are directed at both black men and women, other manifestations of discrimination affect women more than men, and vice versa.³ Future work should include measures that assess discriminatory practices that disproportionately target African American women. Measures that tap into gendered racism or racialized sexism are needed to comprehensively capture African American women’s experiences. For example, Thomas et al. (2008) found that African American women reported experiencing gendered racism with employers, supervisors, and coworkers, as well as sexual harassment, being called names, and hearing jokes targeted at African American women.

Last, there is a need to examine ethnic distinctions among Black women. This will not only contribute to our knowledge of the health of diverse groups in the United States but will also aid in dismantling the notion that Black women are a monolith. Also, the changing demographic composition of the Black population due to increasing immigration from the Caribbean and sub-Saharan Africa is further justification for research to examine ethnic and nativity heterogeneity among Black Americans (Erving 2011; Hamilton and Hummer 2011).

In sum, our study advances research by centering African American women, who have been historically marginalized and understudied. We provide a national snapshot of Black women’s health from their own perspectives. Furthermore, we uncover numerous stress exposures and psychosocial resources that both provoke and prevent health problems. As noted by Audre Lorde (1985), “I recognize that my power as well as my primary oppressions come as a result of my blackness as well as my woman-ness, and therefore my struggles on both of these fronts are inseparable.” Black women, located at the intersections of both their racialized and gendered identities, were the original focus of the intersectionality framework in its first articulation (Crenshaw 1991). Hence, our study contributes to a growing empirical base in which African American women are repositioned from the margins to the center.

Supplemental Material

Supplemental_Files_-_CLEAN – Supplemental material for Psychologically Resilient, but Physically Vulnerable? Exploring the Psychosocial Determinants of African American Women’s Mental and Physical Health

Supplemental material, Supplemental_Files_-_CLEAN for Psychologically Resilient, but Physically Vulnerable? Exploring the Psychosocial Determinants of African American Women’s Mental and Physical Health by Christy L. Erving, Lacee A. Satcher and Yvonne Chen in Sociology of Race and Ethnicity

Footnotes

Acknowledgements

We thank Deadric Williams and Evelyn Patterson for helpful comments and feedback. An earlier draft of this article was presented at the 2018 International Conference on Social Stress Research in Athens, Greece.

Notes

Author Biographies

Christy L. Erving is an assistant professor in the Department of Sociology at Vanderbilt University. Using theories, concepts, and perspectives from several research areas, her program of research focuses on clarifying and explaining status distinctions in health. Her primary research areas explore (1) how race, ethnicity, gender, and immigrant status intersect to produce health differentials; (2) the relationship between physical and mental health; (3) psychosocial determinants of Black women’s health; and (4) the Black-White mental health paradox.

Lacee A. Satcher is a PhD candidate in the Department of Sociology at Vanderbilt University. Her research interests include race, place, and inequality; the social psychology of health and inequality; health policy; environmental justice; and urban sociology. Her recent research focuses on the race-environment-health connection, specifically how various individual social identities and social locations structure our relations with and within space and place to shape health outcomes and health experiences.

Yvonne Chen is currently a PhD student at Vanderbilt University. Her research areas include medical sociology, mental health, race/ethnicity, and social networks. Her current work focuses on racial/ethnic disparities in health and access to care. Specifically, she examines how discrimination and racialization of Asians in the United States shape health disparities and health care utilization. Moreover, she examines how Asian Americans navigate care and well-being from a social networks perspective.

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