Pushing Past Limits: How Efficacious Is High-Effort Coping for Self-Rated Health among African American and Caribbean Black Women?

Abstract: Due to systemic oppression, Black women experience distinct risks across the life course, such as exposure to various stressors that shape lower ratings of self-rated health. This is important given that self-rated health is a stronger indicator of current morbidity and subsequent mortality than physician assessments. However, there has been limited consideration of the role of coping in shaping self-rated health among this group. John Henryism, or high-effort coping, is a culturally relevant coping style that reflects the broader societal, cultural, and historical context that shapes lived experiences of Black populations navigating racism and capitalism in the U.S., and has received limited consideration in health research among Black women. Additionally, less is known regarding how ethnicity shapes John Henryism and health processes among Black women specifically. Therefore, the present study examined the association between John Henryism and self-rated health among African American and Caribbean Black women (n = 1580) collectively, and explored this association among Caribbean Black women specifically, utilizing the National Survey of American Life (NSAL 2001–2003). Findings show that while John Henryism was not directly associated with self-rated health among either group, once sociodemographic characteristics and stress exposure were accounted for, John Henryism was associated with lower odds of fair or poor self-rated health among both groups.

Robinson, M.N. (2022). “Pushing Past Limits: How Efficacious is High-Effort Coping for Self-Rated Health among African American and Caribbean Black Women?” International Journal of Environmental Research and Public Health-Special Issue. 19(20):13460.

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Are Distressed Black Women Also Depressed? Implications for a Mental Health Paradox.

Abstract: Purpose: Recent research suggests the determinants of and links between psychological distress and psychiatric disorder are distinct among Black Americans. Yet, these associations have not been explored among Black women, despite the unique social experiences, risks, and mental health patterns they face. The present study assessed the sociodemographic and psychosocial determinants of distress and disorder and evaluated the distress–disorder association, including whether it was conditional on sociodemographic and psychosocial characteristics among Black women. Methods: Data were from 328 Black women in the Nashville Stress and Health Study, a cross-sectional community epidemiologic survey of Blacks and Whites in Nashville, Tennessee, and was used to assess the correlates of distress (CES-D depressive symptoms scale) and major depressive disorder (MDD; based on the CIDI). Multinomial logistic regression models estimated the extent to which greater distress was associated with higher risk of “chronic” or “resolved MDD”. Results: Stress exposure and marital status were associated with greater distress, while stress exposure and childhood SES were associated with elevated disorder risk. Although increased distress was associated with greater disorder risk, significant interactions indicated these associations depend on differences in age and adult socioeconomic status within this population. Conclusions: This study identifies distinct correlates of distress and disorder and shows that the distress–disorder association varies among subgroups of Black women. Results have important implications for public health research and practice, as they highlight the factors that matter most for the mental health outcomes of Black women.

Robinson, M.N., Erving, C.L. & Thomas Tobin, C.S. Are Distressed Black Women Also Depressed? Implications for a Mental Health Paradox. J. Racial and Ethnic Health Disparities (2022).

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Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources.

Abstract: Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22–35), middle-aged (ages 36–49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.

Thomas Tobin, C. S., Huynh, J., Farmer, H. R., Israel Cross, R., Barve, A., Robinson, M., Leslie, E. P., & Thorpe, R. J. (2022). Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources. Journal of Aging and Health, 0(0).

Lifetime Major Discrimination Experiences Moderate the Impact of Depressive Symptoms on Chronic Conditions among Black Americans.

Abstract: To clarify the ways in which Black Americans’ experiences of structural racism may influence their mental and physical health in distinct ways, the present study evaluated whether major discrimination moderates the association between depressive symptoms and chronic physical health conditions among this population. t-tests and chi-squared tests of significance were used to determine significant differences between women and men. The association between major discrimination and depressive symptoms was examined by assessing mean depressive symptoms scores across levels of major discrimination. ANOVA tests indicated whether there were significant differences in symptom scores across each discrimination category. Additional t-tests determined significant gender differences within each level of discrimination. Gender-stratified negative binomial models were used, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the relationship between depressive symptoms, major discrimination, and chronic conditions. Our findings indicated that the association between depressive symptoms and chronic conditions depends on lifetime experiences of major discrimination among Black Americans and varies significantly between women and men. Considering that major discrimination conditioned the depressive symptom-chronic conditions association among our sample, this provides insight into potential pathways for intervention in efforts to offset the detrimental mental and physical consequences of experiencing racism.

Skrine Jeffers, K., Walton, Q. L., Robinson, M. N., & Thomas Tobin, C. S. (2021). Lifetime Major Discrimination Experiences Moderate the Impact of Depressive Symptoms on Chronic Conditions among Black Americans. Healthcare (Basel, Switzerland), 9(11), 1528.

Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans.

Abstract: Research shows that John Henryism, a high-effort, active coping style, is associated with poor physical health, whereas others suggest it may be psychologically beneficial. As such, it is unclear whether John Henryism represents a health risk or resource for Black Americans and whether its impact varies across sociodemographic and gender groups. The present study used data from a representative community sample of black Americans (n = 627) from the Nashville Stress and Health Study (2011–2014) to clarify the physical and mental health consequences of John Henryism by assessing its relationship with depressive symptoms and allostatic load (AL). Results indicate that John Henryism is associated with increased AL scores and fewer depressive symptoms. Additionally, the association between John Henryism and AL is conditional on socioeconomic status. Study results underscore the importance of evaluating both physical and mental health to clarify the health significance of John Henryism among Black Americans.

Robinson, M.N., &. Thomas Tobin, C.S. (2021). “Is John Henryism a Health Risk or Resource?: Exploring the Role of Culturally Relevant Coping for Physical and Mental Health among Black Americans .” Journal of Health and Social Behavior. 62(2):136–151.

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Does marriage matter? Racial differences in allostatic load among women.

Abstract: Prior research suggests that there are health benefits associated with marriage, although the physiological implications of marital status for women’s health is less clear. Given that recent trends indicate that Black women are less likely to marry than White women, the goal of this study was to evaluate whether marital status accounts for racial differences in women’s physical health. Using data from the Nashville Stress and Health Study (2011–2014), we estimated the probability of high allostatic load (AL), a biological indicator of physiological dysregulation, among women aged 18–69. We examined AL scores by race and marital status, evaluated the extent to which Black-White differences persisted after accounting for marital status, and assessed whether the racial disparity in AL varied across marital status groups. Results indicated that Black women had higher AL than White women, although racial differences in AL were not explained by marital status. In addition, marital status was a significant predictor of AL among Black, but not White women. Moreover, the racial disparity in AL was smallest among never married women and largest among currently and formally married women. Taken together, these findings suggest that Black-White inequalities in women’s physical health are not explained by racial differences in marital status, despite the widening racial gap in marriage. Nevertheless, marital status may be an influential factor in shaping outcomes among Black women.

Thomas Tobin, C. S., Robinson, M. N., & Stanifer, K. (2019). Does marriage matter? Racial differences in allostatic load among women. Preventive Medicine Reports, 15(100948), 1-6.

Superwoman Schema, stigma, spirituality, and (culturally) sensitive providers: Factors influencing mental health service utilization in African American women.

Abstract: Many African American women are heavily burdened by unmet mental health needs yet underuse mental health services. The superwoman schema (SWS) conceptual framework provides a new culturally sensitive framework to enhance researchers’, providers’, and educators’ understanding of the barriers to mental health service use among this group. The “superwoman” role involves perceived obligations to (1) project strength, (2) suppress emotions, (3) resist feelings of vulnerability and dependence, (4) succeed despite limited resources, and (5) prioritize caregiving over self-care. In this study, the SWS framework guided a secondary qualitative analysis of data from eight focus groups comprised of 48 African American women from the southeastern United States and a broad range of age and educational backgrounds. Results suggest that the major components of SWS, as well as perceived stigma, religious and spiritual concerns, and the desire for culturally sensitive providers, influenced participants’ perceptions and use of mental healthcare. Understanding how SWS operates in African American women may (1) enable researchers to better understand and develop interventions to mitigate disparities in mental health service use; (2) help healthcare professionals to engage and treat this population more effectively; and (3) equip health professions educators to improve the cultural sensitivity of the next generation of providers.

Woods-Giscombe, C. L., Robinson, M.N., Carthron, D. & Devane-Johnson, S. & Corbie-Smith, G. (2016). Superwoman Schema, stigma, spirituality, and (culturally) sensitive providers: Factors influencing mental health service utilization in African American women. Journal of Best Practices in Health Professions Diversity: Research, Education, and Policy. 9(1): 1124-1144.