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. Author manuscript; available in PMC: 2020 May 13.
Published in final edited form as: Issues Ment Health Nurs. 2015;36(9):710–717. doi: 10.3109/01612840.2015.1011759

Whose Stress is Making Me Sick? Network-stress and Emotional Distress in African-American Women

Cheryl L Woods-Giscombé 1, Marci Lobel 2, Catherine Zimmer 3, Crystal Wiley-Cene 4, Giselle Corbie-Smith 5
PMCID: PMC7220100  NIHMSID: NIHMS761106  PMID: 26440874

Abstract

Research on stress-related health outcomes in African American women often neglects “network-stress:” stress related to events that occur to family, friends, or loved ones. Data from the African American Women’s Well-Being Study were analyzed to examine self-stress and network-stress for occurrence, perceived stressfulness, and association with symptoms of psychological distress. Women reported a higher number of network-stress events compared to self-stress events. Occurrences of network-stress were perceived as undesirable and bothersome as self-stress. Both types of stress were significantly associated with psychological distress symptoms. Including network-stress may provide a more complete picture of the stress experiences of African American women.

Keywords: African American women, Stress, Social Network, Network Stress, Health Disparities

Stress, including discrimination or racism-related stress, has been identified as one of the most important social determinants of health and health inequities across populations and across health outcomes (Braveman et al., 2011; Jones, 2002; Marmot, 2005; Wilkinson & Marmot, 2003; Williams & Mohammed, 2009; Williams, Neighbors, & Jackson, 2003). The National Institutes of Health has prioritized research to better understand the social determinants of health disparities, including research on psychological stress (Boyce & Olster, 2011). It is critical to incorporate accurate and comprehensive definitions and measures of stress in the lives of African American women. African American women are exposed to disproportionately high levels of stress as a result of their race/ethnicity, gender, and socioeconomic position (Cole, 2009; Jackson, Hogue, & Phillips, 2005; Moradi & Subich, 2003; Nuru-Jeter et al., 2009; Rosenthal & Lobel, 2011; Woods-Giscombé & Lobel, 2008). Physiological responses to life stressors contribute to cardiovascular, immune, and neuroendocrine responses that, when experienced chronically, adversely influence health outcomes in African American women, including hypertension, obesity, diabetes, untreated mental health conditions, and adverse birth outcomes such as preterm birth and low birth weight (American Psychiatric Association, 2015; Dominguez, 2011; Geronimus, Hicken, Keene, & Bound, 2006; Krieger, 2005; McEwen, 2012; Williams, 2009).

A growing body of literature suggests that such health disparities are related to the specific ways in which African American women experience and respond to life stressors (Giscombé & Lobel, 2005; Woods-Giscombé & Lobel, 2008; Rosenthal & Lobel, 2011).For the purpose of this paper, “stressors” are operationalized as demands, threats, stimuli, or other events in the environment to which an individual is exposed (Lazarus & Folkman, 1984). Stressors that are inadequately managed by intrapersonal, interpersonal or tangible resources may result in “distress,” which is characterized as an aversive state that may include physical or psychological symptoms (e.g., tension, worry, weakness, or headaches) (Dohrenwend & Dohrenwend, 1974). There is evidence that increased psychological distress in African American women is influenced by the intersection of race- and gender-related stress, in addition to factors such as social status, increase psychological distress in this group (Berger & Guidroz, 2010; Geronimus et al., 2006; Jackson, Rowley, & Owens, 2012; Hamilton-Mason, Hall, & Everett; 2009; Krieger, 2012; Mullings, 2006; Perry, Harp, & Oser, 2013; Thomas, Hacker, & Hoxha; 2011; Woods-Giscombé & Lobel, 2008). Research findings indicate that stress-related health outcomes in African American women might be influenced by perceived obligations to family members, friends, and community members to present an image of strength, even in the face of stressors that are race- or gender-related, or generic (Black & Peacock, 2011; Woods-Giscombé, 2010). Generic stressors are events or conditions including accidents, financial strain, or other crises or critical events that are not a direct result of one’s race or gender (Woods-Giscombe, 2008). African American women have often adopted a behavioral script of “strength,” encompassing self-reliance, self-sacrifice, and self-silence, to enhance survival in racist and sexist contexts that have existed over generations in the United States (Black & Peacock, 2011). The caregiving roles of many African American women can result in complex patterns of adaptation whereby they take on the needs of others while minimizing, neglecting, or postponing personal needs and self-care (Black & Peacock, 2011; Black & Woods-Giscombe, 2012; Carthron, Bailey, & Anderson, 2014; Carthron, Johnson, Hubbart, Strickland, & Nance, 2010; Samuel-Hodge, Skelly, Headen, Carter-Edwards, 2005; Woods-Giscombé, 2010).

Social networks and health among African American women

Researchers have documented the positive effects of social networks on a variety of health outcomes (Barefoot, Gronbaeck, Jensen, Schnohr, & Prescott, 2005; Rutledge et al., 2008; Seeman, 2000; Thoits, 2011; Troxel et al., 2010). Social networks have been found to represent a key resource, a form of “social capital,” that may provide various forms of emotional, informational, or tangible support (Coleman, 1988). Both the structural features of social networks (e.g., size, composition) and the availability or lack of network-based resources in turn influence physical and mental health outcomes (Berkman & Glass, 2000). Compared to Whites, African Americans tend to have broader social networks that are more likely to include extended family, fictive kin (individuals unrelated by either blood or marriage who, nevertheless, have strong emotional and family-like ties), friends, or church members (George, 1988; Johnson & Barer, 1990).It may useful to examine and understand how, for African American women, a broad social network might not only provide greater potential sources of support, social capitol, and eustress, but also how it might provide greater sources of indirectly experienced stress exposure, crises, or other critical and potentially distressing life events. The research evidence on African American women’s caregiving roles within their families and communities and their potential for prioritizing caregiving over self-care may place them at greater risk for detrimental health effects related to the life experiences of members of their social network (Black & Peacock, 2011; Samuel-Hodge et al., 2005; Woods-Giscombe, 2010).

The case for examining network events in stress research

Kessler and McLeod (1984, p. 620) defined “network events” as “life events that do not occur to the focal respondent but to someone deemed ‘important’” in his or her social network. “Network-stress” then refers to perceived stress related to stressors in the lives of family members, friends, or other loved ones. This is in contrast to what could be termed “self-stress,” or stress related to life events that occur directly to an individual. Thoits seminal work (1991) also suggested that assessment of psychological distress would benefit from a deeper understanding of role identity; that is, stressful life events related to the roles with which individuals most identify may have a stronger impact on psychological distress. According to these researchers, women might experience more network events than men because their social roles lend themselves to greater emotional involvement with people in their lives. To support this line of reasoning, Kessler and McLeod (1984) drew upon the classic work of Dohrenwend (1977), who showed that women (unlike men) were more likely to report among their most distressing life events crises experienced by members of their social networks, including friends, family, and neighbors. This foundational research suggested that network-stress should be integrated with traditional stress measures to provide a more contextualized perspective on life stress, especially among women. Kessler and McLeod (1984) made a strong argument for including network-stress when measuring stress, particularly in women.

Network-Stress and African American women

The classic, foundational, theoretical work on roles, networks stress and distress (Dohrenwend, 1977; Kessler & McLeod, 1984; Thoits, 1991) can be used to guide and enhance research on stress and health in African American women. As posited by theoretical frameworks such as the Superwoman Schema (Woods-Giscombé, 2010), the Strong Black Woman Script (Black & Peacock, 2011), and the Weathering Hypothesis (Geronimus et al., 2006), African American women’s stress experiences encompass their roles as nurturers, caregivers, mothers, and community activists. Therefore, operationalizing and assessing network-stress may be an important key to understanding how their stress experiences contribute to their emotional and physical well-being, as well as stress-related health disparities. The purpose of the current study was to examine the experience of network stress in African American women. The following research questions were addressed: (1) What are the most common types of network events experienced by the African American women sampled in this study? (2) Do African American women report a greater number of network-stress events compared to self-stress events? (3) Is the perceived stressfulness of network-stress events similar to the perceived stressfulness of self-stress events? (4) Are self-stress and network-stress eventssignificantly associated with symptoms of psychological distress? (5) Is the perceived stressfulness of self-stress and network-stress significantly associated with symptoms of psychological distress?

Methods

The current study involves secondary analyses of data from the African American Women’s Well-Being Study. The original study aimed to examine how psychological distress in African American women is influenced by race-related, gender-related, and generic stress, which are events or conditions including accidents, financial strain, or other crises or critical events that are not a direct result of one’s race or gender (Woods-Giscombe, 2008). The original study did not examine network stress events, the differences between self-stress and network stress experiences, or their contributions to psychological distress.A full description of methods from this study was published previously (Woods-Giscombé & Lobel, 2008). The focus of the current study is on distinct concepts of self- and network-stress and how they contribute to distress in this population.

Participants

The data analyzed in this study come from the sample reported in Woods-Giscombé and Lobel (2008). The women (N = 189) all self-identified as Black or African American and ranged in age from 21 to 78 years (M = 41.5, SD = 14.3). A subset of women also self-identified as West Indian or Caribbean (3.7%), Latino (0.5%), African (0.5%), or a combination of African American/Black, West Indian/Caribbean, Latino, or African (7.4%). Approximately 80% resided in the Southeast of the United States at the time of data collection, while 20% lived in the Northeastern region of the United States. Approximately 37% were married, 23.8% single, 21.7% in a committed relationship but unmarried, 11.6% divorced, and 5.3% widowed. Approximately 54% had at least a bachelor’s degree as their highest educational credential; 23% of those held a degree: master’s, law, MD, or PhD. Nine percent identified themselves as full-time students and 7.9% as part-time students. Median household income was between $26,000 and $50,000 annually with 37% reporting earning more than $50,000 and 25% earning less than $26,000. African American women with college education were intentionally oversampled in the original study to facilitate investigation of stress in African American women across ranges of low, median, and high income and education status. On average, women’s psychological distress scores (M = 0.63, SD = 0.44) were lower than published norms for community samples. Sample descriptive statistics are presented in Table 1 and correlations among key variables are presented in Table 2.

Table 1.

Sample Description

N %
Age
  21–30 56 29.6
  31–40 36 19
  41–50 39 20.6
  51–60 41 21.7
  61–70 13 6.9
  71–80 4 2.1
Marital Status
  Married 70 37.0
  Committed relationship 41 21.7
  Single, not in a committed relationship 45 23.8
  Divorced 22 11.6
  Widowed 10 5.3
  Other 1 0.5
Education
  <11 years 5 2.6
  High school diploma 16 8.5
  Trade school/Associates degree 20 10.6
  4-Year College, did not complete 37 19.6
  College, graduated 67 35.4
  Master’s or Terminal degree 44 23.3
Household income
  Less than 15K 23 12.2
  15K–25K 25 13.2
  26K–50K 70 37
  51K–75K 32 16.9
  76K–100K 24 12.7
  More than 100K 15 7.9
Income
  Less than 15K 23 12.2
  15K–25K 25 13.2
  26K–50K 70 37
  51K–75K 32 16.9
  76K–100K 24 12.7
  More than 100K 15 7.9
Student status
  Not a student 156 82.5
  Student 33 17.5
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Table 2.

Correlations of Key Variables

1 2 3 4 5 6 7 8
1. Self-stress Events -
2. Network-stress Events −.09
3. Self-stress Appraisal .94*** −.07 -
4. Network-stress Appraisal −.11 .94*** −.09 -
5. Distress .23** .17* .24** .17* -
6. Age −.18* −.17* −.18* −.20** −.15* -
7. Education −.17* .06 −.15* .07 −.11 .11
8. Income −.20** .07 −.17* .05 −.13 .22** .58**
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*

p < .05.

**

p < .01.

***

p < .001.

Measures

Self- and network-stress

Self-stress includes events that happen directly to the individual. Network-stress includes events that happen to a loved one, family member, or friend that have the potential for being an indirect stressor for the individual. For the current study, 10 items from a measure of stressful life events used in previous research (Lobel, DeVincent, Kaminer, & Meyer, 2000; Woods-Giscombé & Lobel, 2008) were used to measure self-stress and network-stress. Women indicated whether these 10 events happened to them directly or to a close friend or family member in the past year (e.g., got arrested, physical injury, illness, or hospitalization, trouble with alcohol or drugs). If the event did occur, the participant indicated if the event happened to “self” or to someone in their network: “other.” For every “self-stress” item endorsed, participants provided an appraisal or rating regarding how stressful (“undesirable or negative”) the event was on a 4-point scale ranging from 0 = not at all to 3 = very much. Similarly, for every “network-stress” item endorsed, participants provided an appraisal on the same 4-point scale. Four indices were created: total number of self-stress events, total number of network-stress events, average self-stress appraisal (average appraisal of all 10 self-stress events) and average network-stress appraisal (average appraisal of all 10 network-stress events).

Distress

The measure of distress was the Hopkins Symptom Checklist (HSCL-58; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974), a brief version of the Symptom Checklist-90 that is a reliable and valid measure of psychological and physical distress symptoms that has been used in key studies of race and gender-related stress in African American women (see Klonoff, Landrine, & Ullman, 1999; Kwate et al., 2003). Five types of distress are assessed and included in a total symptom score: anxiety, depression, obsession-compulsion, interpersonal sensitivity, and somatization. Participants rate how much a “problem has bothered or distressed you” using a scale from 0 (not at all) to 4 (extremely) to represent the intensity of distress symptoms. The HSCL-58 exhibited high internal consistency in this study (alpha = .96).

Analysis plan

Descriptive statistics were used to identify the frequency with which network-stress events were experienced by the African American women sampled in this study. A paired-samples t test was conducted to determine if women report a greater number of network-stress events compared to self-stress events and if women would report greater average perceived stressfulness of network-stress events compared to the average perceived stressfulness of self-stress events. Ordinary least squares (OLS) regression analyses were used to determine if network-stress events’ occurrence and average perceived stressfulness and self-stress events’ occurrence and average perceived stressfulness are significantly associated with symptoms of psychological distress. Demographic variables that had statistically significant associations with distress were included as covariates in the regression analyses.

Results

Correlations among key variables are presented in Table 2. The African American women who participated in this study experienced a range of 0–6 network events. Fifty-six percent of the sample (n = 106) reported experiencing at least one network-stress event. Of those who experienced at least one network-stress event, 37% (n = 40) experienced just one event; 24.5% (n = 26) experienced two network-stress events. First, we examined the first research question, “What are the most common types of network events experienced by the African American women sampled in this study?” The most commonly experienced network stress events included having a loved one who experienced being fired or laid off from work (n = 42); a serious illness, injury, or hospitalization (n = 39); problems with alcohol or drugs (n = 33); or an arrest or trouble with the law (n = 21). The least commonly experienced network-stress events included having a loved one who experienced divorce (n = 6), mugging or personal assault (N = 8), or separation from spouse or partner (n = 12). Next, we examined the second and third research questions, “Do African American women report a greater number of network-stress events compared to self-stress events?” and “Is the perceived stressfulness of network-stress events similar to the perceived stressfulness of self-stress events?” Overall, women in the sample reported significantly more network-stress events in the past year (M = 1.25, SD = 1.45) compared to self-stress events (M = .76, SD = 1.07); mean difference = −0.50, t = −3.64, df = 188, p = .000. In addition, the perceived stressfulness of network events (M = 1.99, SD = 1.00) was not significantly different from the average perceived stressfulness of self-stress events (M = 1.92, SD = .71); t = −.365, df = 43, p = .72.

Finally, we examined the fourth and fifth research questions, “Are self-stress and network-stress events significantly associated with symptoms of psychological distress?” and “Is the perceived stressfulness of self-stress and network-stress significantly associated with symptoms of psychological distress?” Before conducting the regression analyses to examine these final research questions, we examined correlations of demographic variables (age, income, and education) with distress. Age was the only demographic variable significantly associated with distress and was therefore included in the regression models (Table 2).

We used OLS regression analyses to determine if self-stress and network-stress events were significantly associated with symptoms of psychological distress. First, a model was estimated with only the number of self-stress events predicting distress. The number of self-stress events was significantly associated with distress: β = .21, t = 2.89, p < .01. Self-stress also explained a significant proportion of variance in distress scores, R2 = .064, F(2, 186) = 6.35, p = .002. A second model was examined with only number of network-stress events and distress. Number of network-stress was significantly associated with distress: β = .15, t = 2.13, p < .05. Network stress also explained a significant proportion of variance in distress scores, R2 = .045, F(2, 186) = 4.41, p = .013. Next, network-stress was added to the regression model with self-stress; adding number of network events to the model with number of self-stress events explained an additional 3.2% of variance in distress symptoms: R2 = .096, F(1, 185) = 6.53, p = .011; R2 Change = .032. Both number of self-stress events (β = .23 t = 3.23, p = .001 and number of network-stress events (β = .18, t = 2.57, p = .011) were similarly associated with distress symptoms.

Finally, we used OLS regression analyses to examine if the average perceived stressfulness of self-stress and network-stress are significantly associated with symptoms of psychological distress. A regression model was estimated with only average perceived stressfulness of self-stress events. Average perceived stressfulness of self-stress events was not significantly associated with distress: B = .12, t = 1.11, p =.27, and it did not explain a significant proportion of variance in distress: R2 = .016, F(2, 79) = .625, p = .538. A second model was estimated with only average perceived stressfulness of network-stress events and distress. Average perceived stressfulness of network-stress events was not significantly associated with distress: B = −.06, t = −.62, p =.54, and it did not explain a significant proportion of variance in distress: R2 = .036, F(2, 103) = 1.92, p = .152. We did not examine a model including both perceived stressfulness of self- and network-stress because neither variable was significantly associated with distress.

Discussion

The purpose of the current study was to examine network-stress in the lives of African American women and, more specifically, to determine if there was a difference between reports of self-stress and network-stress and their association with symptoms of psychological distress. Our results indicated that African American women were exposed to a greater number of network-stress events than self-stress events. In addition, occurrences of network-stress were perceived as undesirable and bothersome as self-stress. Both self-stress and network-stress were significantly and positively associated with distress symptoms.

These findings corroborate the work of Kessler and McLeod (1984) who posited that network events are important to explore in women. Women’s social roles and emotional connections with people from various aspects of their lives may expose them to a greater number of network stressors than the stressors that their experience directly. The distress related to helping their loved ones through hardships or difficulties appear to be just as distressing as their own personal stressors (Nuru-Jeter et al., 2009). In the current study, appraisal or perceived stressfulness of self- and network-stress events were not related to distress; only the frequency of self- and network-stress events predicted distress. Previous research has revealed similar findings (Kwate, Valdimarsdottir, Guevarra, & Bovbjerg, 2003); the occurrence of stress events may influence outcomes even when the subjective appraisal of these events does not.

Overall, the results from this study indicate that stress related to network events is important to assess in addition to self-stress related to directly experienced events. This finding has particular validity when contextualized within a framework for how social networks of African Americans influence health (e.g., Berkman & Glass, 2000; George, 1988). These findings also adds to the growing body of research on the importance of using race- and gender-relevant conceptualizations of stress to understand stress-related health outcomes for African American women (Jackson et al., 2005; Perry et al., 2013; Thomas et al., 2011; Woods-Giscombe & Lobel, 2008; Woods-Giscombe, 2010).

As stated earlier, the most commonly reported network-stress events included having a loved one who experienced being fired or laid off from work, a serious illness, injury, or hospitalization, problems with alcohol or drugs, or an arrest or trouble with the law. Although a small body of research has explored the impact of loved ones’ stressful life events on the physical and mental health of African American women (Williams & Lawler, 2001), most of this research has examined the burden of family member incarceration (Lee, Wildeman, Want, Matusko, & Jackson, 2014; Wildeman, Lee, & Comfort, 2013). African American men are incarcerated at a rate more than six times higher than non-Hispanic European American men (U.S. Department of Justice, 2010). In addition, African Americans disproportionally experience chronic disease morbidity (including heart disease, cancer, stroke, and diabetes), and are less likely to receive treatment for substance abuse conditions compared to their European American counterparts when adjusted for criminal history and Medicaid enrollment (Lê Cook & Alegria, 2011). These facts illustrate the potential sources of network-stress exposure among African American women.

Limitations and Future Directions

The findings of this study provide information regarding the value of assessing network events when examining stress in African American women. However, it is possible that African American women might be less comfortable reporting feeling bothered or upset by events that happened to them because—as posited in the Superwoman Schema framework (Woods-Giscombé, 2010)—they may feel obligated to present an image of strength or to suppress their emotions. They might also consider it as less sociably acceptable to report feeling overwhelmed or bothered by their own life experiences (Black & Peacock, 2011) and more sociably acceptable to report stress experienced by loved ones. This may be especially true if they perceive that prioritizing the well-being of others before their own is a requirement of their role as a caretaker, mother, sister, partner, or friend (Black & Peacock, 2011). These possibilities may have influenced the data collected in the study whose data set was used for this secondary analysis. Future studies might explore alternate methods for posing questions to participants to help women feel as comfortable as possible sharing personal experiences with stress. In addition, only 10 potential self-stress and network-stress events were assessed in this study. Future research on self- and network-stress may benefit from the inclusion of additional stressors to more comprehensively assess stress in this population.

Findings from this study illustrate the importance of conceptually and operationally differentiating direct self-stress experiences from network-stress experiences in research with African American women. Assessments of stress that include only measurements of self-stress (directly experienced life events) will likely provide an incomplete picture. This is particularly relevant given the many potential sources of network-stress (e.g., family members, friends, church or religious family, co-workers) and how they could affect the potential risk for stress-related disparities in this population. It is also possible that a woman’s network’s characteristics (e.g., size, composition, percentage of kin, availability) could affect her risk for experiencing network-stress, particularly if the network is deficient in positive or health-promoting resources (e.g., positive support) that can buffer experienced or perceived stress. Also, individual characteristics and role identities should be studied further for their associations with life stress.

It is interesting to note that, on average, participants in the current study were well-educated and reported a moderately high income. This suggests that relationships’ psychological stress is an important phenomenon to explore even in relatively advantaged, well-educated samples. Previous research reveals that higher socioeconomic status (e.g., education attainment) does not necessarily translate into higher levels of emotional well-being for African American women (Jackson, 2003). There may be particular ways that demographic factors such as education, household income, and marital status or relationship quality interact with exposure to workplace discrimination, job satisfaction, and household role responsibilities to influence psychological well-being (Jackson, 2003). It may be important to also examine whether African American women with moderately high economic means and levels of education are particularly identified by their friends and family as sources of economic support and other resources and how related obligations may increase risk for stress and stress-related health conditions. Future research with African American women from various demographic strata would help to elucidate some of these relationships.

The findings from this study have implications also for stress management interventions for African American women. Strategies that encourage women to manage exposure and reactivity to their personal life-stress might be inadequate if network-stress similarly affects their overall well-being. Modifications to stress management interventions can be made to help women identify and develop healthy coping strategies for network-stress (e.g., Woods-Giscombe & Black, 2010). A growing body of evidence demonstrates the significant impact that stress can have on African American women’s health, morbidity, and mortality (e.g., Geronimus et al., 2006); research on network-stress will be key to ensuring a culturally relevant, comprehensive, and effective approach to advancing mental and physical well-being in this population.

The findings suggest that investigations of stress should include both occurrence of events and perceived stressfulness of those events because one and not the other may be associated with outcomes. Further research could also examine how phenomena, such as Superwoman Schema and specifically perceived obligations to present an image of strength, influence African American women’s report of perceived stressfulness of life events.

Qualitative research investigating women’s perceptions of network-stress may be a valuable approach to further conceptualizing and operationalizing this concept. In addition, participants in this study provided information about stressors that occurred over the past year and distress symptoms that they experienced over the past month. Of great value would be research using a prospective, longitudinal design to better understand how self- and network-stress predict distress and other potential outcome variables (e.g., smoking or overeating) in this population. Future research may also include a wider range of demographic status as well as greater representation from women who self-identify as African or Caribbean to enhance the generalizability of the study’s results.

Future investigations of network-stress may further illuminate the importance of including this concept in standard investigations of stress in this population.

Contributor Information

Cheryl L Woods-Giscombé, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA.

Marci Lobel, Stony Brook University, Department of Psychology, Stony Brook, New York, USA</affiliations.

Catherine Zimmer, University of North Carolina at Chapel Hill, Odum Institute for Research in Social Science, Chapel Hill, North Carolina, USA and University of North Carolina at Chapel Hill, Sociology, Chapel Hill, North Carolina, USA.

Crystal Wiley-Cene, University of North Carolina at Chapel Hill, Department of General Medicine, Chapel Hill, North Carolina, USA.

Giselle Corbie-Smith, University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina, USA.

References

  1. American Psychiatric Association. ((2015) Fact sheet: Health disparities and stress. Retrieved from http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx
  2. Barefoot JC, Gronbaek M, Jensen G, Schnohr P, & Prescott E. (2005). Social network diversity and risks of ischemic heart disease and total mortality: Findings from the Copenhagen City Heart Study. American Journal of Epidemiology, 161, 960–967. [DOI] [PubMed] [Google Scholar]
  3. Berger MT, & Guidroz K. (2010). The intersectional approach: Transforming the academy through race, class, and gender. Chapel Hill, NC: University of North Carolina Press. [Google Scholar]
  4. Berkman LF, & Glass T. (2000). Social integration, social networks, social support, and health In Berkman LF, & Kawachi I. (Eds.), Social epidemiology (pp. 137–173). New York, NY: Oxford University Press. [Google Scholar]
  5. Berkman LF, & Syme SL (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109(2), 186–204. [DOI] [PubMed] [Google Scholar]
  6. Black AR, & Peacock N. (2011). Pleasing the masses: Messages for daily life management in African American women’s popular media sources. American Journal of Public Health, 101(1), 144–150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Black AR, & Woods-Giscombe. (2012). Applying the stress and ‘strength’ hypothesis to Black women’s breast cancer screening delays. Stress & Health, 28, 389–396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bosworth HB, & Schaie KW (1997). The relationship of social environment, social networks, and health outcomes in the Seattle Longitudinal study: Two analytical approaches. Journal of Gerontology B Psychology Science and Sociology Science, 52(5), 197–205 [DOI] [PubMed] [Google Scholar]
  9. Boyce CA, & Olster DH (2011). Strengthening the public research agenda for social determinants of health. American Journal of Preventive Medicine, 40(1 Suppl 1), S86–8. doi:10.1016/j.amepre.2010.10.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Braveman P, Egerter S, & Williams DR (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32, 381–98. [DOI] [PubMed] [Google Scholar]
  11. Carthron DL, Bailey DE, & Anderson RA (2014). The “invisible caregiver”: Multicaregiving among diabetic African-American grandmothers. Geriatric Nursing, 35, S32–S36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Carthron DL, Johnson TM, Hubbart TD, Strickland C, & Nance K. (2010). “Give me some sugar!” The diabetes self-management activities of African American primary caregiving grandmothers. Journal of Nursing Scholarship, 42, 330–337. [DOI] [PubMed] [Google Scholar]
  13. Cole ER (2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170–180. [DOI] [PubMed] [Google Scholar]
  14. Coleman JS (1988). Social capital in the creation of human capital. American Journal of Sociology, 94(Supplement: Organizations and Institutions: Sociological and Economic Approaches to the Analysis of Social Structure), S95–S120. Retrieved from http://www.jstor.org/stable/2780243 [Google Scholar]
  15. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, & Covi L. (1974). The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19(1), 1–15. [DOI] [PubMed] [Google Scholar]
  16. Dohrenwend BS (1977). Anticipation and control of stressful life events: An exploratory analysis In Strauss JS, Babigian HM, & Rolf M. (Eds.), The origins and course of psychopathology (pp. 135–186). New York, NY: Plenum. [Google Scholar]
  17. Dohrenwend BS, & Dohrenwend BP (1974). Stressful life events: Their nature and effects. Oxford, England: Wiley. [Google Scholar]
  18. Dominguez TP (2011). Adverse birth outcomes in African American women: The social context of persistent reproductive disadvantage. Social Work in Public Health, 26(1), 3–16. [DOI] [PubMed] [Google Scholar]
  19. George LK (1988). Social participation in later life: Black-White differences In Jackson JS (Ed.), The Black American elderly: Research on physical and psychosocial health (pp. 99–126). New York, NY: Springer. [Google Scholar]
  20. Geronimus AT, Hicken M, Keene D, & Bound J. (2006). “Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. American Journal of Public Health, 96(5), 826–833. doi:10.2105/AJPH.2004.060749 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Giscombe CL, & Lobel M. (2005). Explaining disproportionately high rates of adverse birth outcomes among African Americans: The impact of stress, racism, and related factors in pregnancy. Psychological Bulletin, 131(5), 662–683. doi:10.1037/0033–2909.131.5.662 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hamilton-Mason J, Hall JC, & Everett JE (2009). And some of us are braver: Stress and coping among African American women. Journal of Human Behavior in the Social Environment, 19, 463–482. [Google Scholar]
  23. Jackson FM, Hogue CR, & Phillips MT (2005). The development of a race and gender-specific stress measure for African-American women: Jackson, Hogue, Phillips contextualized stress measure. Ethnicity and Disease, 15(4), 594–600. [PubMed] [Google Scholar]
  24. Jackson FM, Rowley DL, & Owens TC (2012). Contextualized stress, global stress, and depression in well-educated, pregnant African American women. Women’s Health Issues, 23(3), 329–336. [DOI] [PubMed] [Google Scholar]
  25. Jackson PB (2003). Sho’ me the money: The relationship between social class and mental health among married women In Brown D. and Keith V. (Eds.), In & out of our right minds (pp. 173–198). New York: Columbia University Press. [Google Scholar]
  26. Johnson CL, & Barer BM (1990). Families and networks among older inner-city Blacks. The Gerontologist, 30(6), 726–733. [DOI] [PubMed] [Google Scholar]
  27. Jones CP (2000). Levels of racism: A theoretic framework and a gardener’s tale. American Journal of Public Health, 90(8), 1212–1215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kessler RC, & McLeod JD (1984). Sex differences in vulnerability to undesirable events. American Sociological Review, 49, 620–631. [Google Scholar]
  29. Klonoff EA, Landrine H, & Ullman JB (1999). Racial discrimination and psychiatric symptoms among blacks. Cultural Diversity and Ethnic Minority Psychology, 5(4), 329–339. [Google Scholar]
  30. Krieger N. (2005). Embodiment: A conceptual glossary for epidemiology. Journal of Epidemiology and Community Health, 59(5), 350–355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Krieger N. (2012). Methods for the scientific study of discrimination and health: An ecosocial approach. American Journal of Public Health, 102(5), 936–944. doi:10.2105/AJPH.2011.300544; 10.2105/AJPH.2011.300544 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Kwate NA, Valdimarsdottir HB, Guevarra JS, & Bovbjerg DH (2003). Experiences of racist events are associated with negative health consequences for African American women. Journal of the National Medical Association, 95, 450–460. [PMC free article] [PubMed] [Google Scholar]
  33. Lazarus RS, & Folkman S. (1984). Stress, appraisal, and coping. New York: Springer. [Google Scholar]
  34. Lê Cook B, & Alegria M. (2011). Racial-ethnic disparities in substance abuse treatment: The role of criminal history and socioeconomic status. Psychiatric Services, 62(11), 1273–1281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Lee H, Wildeman C, Wang EA, Matusko N, & Jackson JS (2014). A heavy burden: The cardiovascular health consequences of having a family member incarcerated. American Journal of Public Health, 104, 421–427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Lobel M, DeVincent CJ, Kaminer A, & Meyer BA (2000). The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychology, 19, 544–553. [DOI] [PubMed] [Google Scholar]
  37. Marmot M. (2005). Social determinants of health inequalities. Lancet, 365(9464), 1099–1104. doi:10.1016/S0140–6736(05)71146–6. [DOI] [PubMed] [Google Scholar]
  38. McEwen BS (2012). Brain on stress: How the social environment gets under the skin. Proceedings of the National Academy of Sciences of the United States of America, 109(Suppl 2), 17180–17185. doi:10.1073/pnas.1121254109; 10.1073/pnas.1121254109 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Mindel CH, Wright R Jr., & Starrett R. (1986). Informal and formal health and social support systems of Black and White elderly: A comparative cost approach. The Gerontologist, 26(3), 279–285. [DOI] [PubMed] [Google Scholar]
  40. Moradi B, & Subich LM (2003). A concomitant examination of the relations of perceived racist and sexist events to psychological distress for African American women. The Counseling Psychologist, 31, 451–469. [Google Scholar]
  41. Mullings L. (2006). Resistance and resilience: The Sojourner Syndrome and the social context of reproduction in Central Harlem In Schulz AJ & Mullings L. (Eds.), Gender, race, class, and health (pp. 345–370). San Francisco, CA: Jossey-Bass. [Google Scholar]
  42. National Poverty Center. (n.d.). Poverty facts. Retrieved from http://npc.umich.edu/poverty/
  43. Nuru-Jeter A, Dominguez TP, Hammond WP, Leu J, Skaff M, Egerter S, … Braveman P. (2009). “It’s the skin you’re in”: African-American women talk about their experiences of racism. An exploratory study to develop measures of racism for birth outcome studies. Maternal and Child Health Journal, 13(1), 29–39. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Perry BL Harp KLH., & Oser CB. (2013). Racial and gender discrimination in the stress process: Implications for African American women’s health and well-being. Sociological Perspectives, 56(1), 25–48. [PMC free article] [PubMed] [Google Scholar]
  45. Putnam RD (1995). Bowling alone: America’s declining social capital. Journal of Democracy, 6(1), 65–78. [Google Scholar]
  46. Rosenthal L, & Lobel M. (2011). Explaining racial disparities in adverse birth outcomes: Unique sources of stress for Black American women. Social Science & Medicine (1982), 72(6), 977–983. doi:10.1016/j.socscimed.2011.01.013; 10.1016/j.socscimed.2011.01.013 [DOI] [PubMed] [Google Scholar]
  47. Rutledge T, Linke SE, Olson MB, Francis J, Johnson D, Bittner V, … Merz NB. (2008). Social networks and incident stroke among women with suspected myocardial ischemia. Psychosomatic Medicine, 70, 282–287. [DOI] [PubMed] [Google Scholar]
  48. Samuel-Hodge CD, Skelly AH, Headen S, & Carter-Edwards L. Familial roles of older African-American women with type 2 diabetes: Testing of a new multiple caregiving measure. Ethnicity & Disease, 15, 436–443. [PubMed] [Google Scholar]
  49. Thoits PA (1991). On merging identity theory and stress research. Social Psychology Quarterly, 54(2), 101–112. [Google Scholar]
  50. Thoits PA (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52, 134–161. [DOI] [PubMed] [Google Scholar]
  51. Thomas AJ, Hacker JD, Hoxha D. (2011). Gendered racial identity of Black young women. Sex Roles, 64, 530–542. [Google Scholar]
  52. Troxel WM, Buysse DJ, Hall M, Kamarck T, Owens JF, Strollo PJ, Reis SE, Matthews KA Social integration, social contacts, and nocturnal blood pressure in African Americans and Caucasians. Journal of Hypertension, 28, 265–271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. U.S. Department of Justice (2010). Prison inmates at midyear 2009- statistical tables. Retrieved from http://www.bjs.gov/content/pub/pdf/pim09st.pdf
  54. U.S. Department of Labor, Bureau of Labor Statistics. (2014). Employment status of the civilian population by race, sex, and age. Retrieved from http://www.bls.gov/news.release/empsit.t02.htm
  55. Wildeman C, Lee H, & Comfort M. (2013). A new vulnerable population? The health of female partners of men recently released from prison. Women’s Health Issues, 23(6), e335–E340. doi:10.1016/j.whi.2013.07.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Wilkinson RG & Marmot M. (Eds.). (2003). Social determinants of health: The solid facts (2nd ed). Geneva: WHO; retrieved from www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf [Google Scholar]
  57. Williams RA (2009). Cardiovascular disease in African American women: A health care disparities issue. Journal of the National Medical Association, 101(6), 536–540. [DOI] [PubMed] [Google Scholar]
  58. Williams D, & Lawler KA (2001). Stress and illness in low-income women: The roles of hardiness, John Henryism, and race. Women & Health, 32,(4), 61–75. doi:10.1300/J013v32n04_04 [DOI] [PubMed] [Google Scholar]
  59. Williams DR, & Mohammed SA (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20–47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Williams DR, Neighbors HW, & Jackson JS (2003). Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93(2), 200–208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Woods-Giscombe CL (2010). Superwoman schema: African American women’s views on stress, strength, and health. Qualitative Health Research, 20(5), 668–683. doi:10.1177/1049732310361892; 10.1177/1049732310361892 [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Woods-Giscombé CL, & Black AR (2010). Mind-body interventions to reduce risk for health disparities related to stress and “strength” among African American women: The potential of mindfulness-based stress reduction, loving kindness, and the NTU therapeutic framework. Complementary Health Practice Review, 15, 115–131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Woods-Giscombe CL, & Lobel M. (2008). Race and gender matter: A multidimensional approach to conceptualizing and measuring stress in African American women. Cultural Diversity & Ethnic Minority Psychology, 14(3), 173–182. doi:10.1037/1099–9809.14.3.173; 10.1037/1099–9809.14.3.173 [DOI] [PMC free article] [PubMed] [Google Scholar]

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