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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences logoLink to The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
. 2022 Aug 17;77(11):2026–2037. doi: 10.1093/geronb/gbac115

How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans

Tyrone C Hamler 1,✉, Ann W Nguyen 2, Verna Keith 3, Weidi Qin 4, Fei Wang 5
Editor: Tamara Baker
PMCID: PMC9683503  PMID: 35976084

Abstract

Objectives

As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans.

Methods

Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims.

Results

Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women.

Discussion

This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the “why” is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.

Keywords: Diversity in aging, Gender, Health disparities, Minority aging

Researchers have long documented the many ways that skin tone gradations impact the lives of African Americans. A preponderance of studies find darker complexion among African Americans are linked to disadvantages in socioeconomic position (Goldsmith et al., 2007; Monk, 2014), poorer physical health and mortality (Cobb et al., 2016; Hargrove, 2019; Laidley et al., 2019; Stewart et al., 2018), greater exposure to discrimination and unfair treatment (Keith et al., 2017; Klonoff & Landrine, 2000), and harsher treatment in the criminal justice system (Monk, 2019; White, 2015). Taken together, these studies reflect the impact of colorism, a term conceived in 1982 by Pulitzer Prize winner Alice Walker and defined as “prejudicial or preferential treatment of same-race people based solely on their color” (Norwood, 2015). Mental health also follows a complexion gradient with dark-skinned African Americans reporting higher psychological distress and poorer self-rated mental health than their lighter-skinned counterparts (Louie, 2020; Monk, 2015). Prior work has suggested that these patterns remain because some believe that darker-skinned African Americans more closely embody negative stereotypes applied to Blacks as a racial group (Maddox, 2004; Mitchell et al., 2021). Complexion differences may be even more consequential for women than men given that lighter-skinned women are perceived as being more attractive than darker-skinned women (Hill, 2000) and can attract males of higher socioeconomic standing (Hargrove, 2019; Monk, 2014). Skin tone remains a key contextualizing factor that influences how being Black is experienced and may be viewed as an additional status marker that exposes African Americans to differing life chances. There is evidence that there are generational differences in how skin tone is perceived among African Americans. For example, older African Americans who came of age during the Civil Rights movement may perceive skin tone differently than their younger and older counterparts due to the Black pride movement that coincided with the Civil Rights movement, which celebrated darker skin and a collective racial identity (Gullickson, 2005). Thus, this study is focused on older African Americans and seeks to examine the moderating role of skin tone in the relationship between discrimination mental health and whether this moderating effect differs between men and women.

The Stress Process Framework

The current analysis is guided by the Stress Process Framework, which contends that stressors and life adversities provoke physiological or emotional reactions that may overwhelm an individual’s ability to cope, undermining physical and mental health (Aneshensel, 1992; Pearlin, 1989). Stressors arise out of interpersonal interactions, social roles, and unexpected and often uncontrollable events. Over the life course, individuals are at risk of experiencing a range of stressful life circumstances, including discrete life events (e.g., involuntary retirement), traumatic events (e.g., violent victimization), and enduring chronic strains such as discrimination, long-term financial hardship, or permanent disability (Wheaton & Montazer, 2010).

A central feature of this framework is that stressors are tied to social inequality such that stressors are more prevalent (the differential exposure hypothesis) among socially disadvantaged groups, including racial-ethnic minorities, women, and those occupying lower socioeconomic positions (Turner et al., 1995). As a minoritized racial group in the United States, African Americans are more likely to experience discrimination, a chronic stressor, than Whites (Brondolo et al., 2011). In particular, older African Americans are likely to have experienced many adverse stressors, including discrimination, over the lifetime, which can lead to long-term chronic strain and compromised mental and physical health. Furthermore, prior research has shown that discrimination is more prevalent among darker-skinned African Americans than those with lighter skin (Hughes & Hertel, 1990; Klonoff & Landrine, 2000), which points to differential exposure within this population based on skin tone. How skin tone interacts with chronic stressors to impact an individual’s life and opportunities remains a critically important, yet understudied, area of inquiry regarding within-group health disparities in the African American community.

Mental Health and Discrimination Among Older African Americans

Few studies have examined the mental health effects of discrimination specifically among older African Americans; however, the general body of research available indicates that older African Americans have a lower prevalence of mood and anxiety disorders than their younger counterparts (Taylor & Chatters, 2020). Despite this finding researchers have found a relationship between mental health and discrimination. Cross-sectional studies focused on depressive symptoms found that more frequent experiences of discrimination were associated with elevated depressive symptoms (Nadimpalli et al., 2015; Wheaton et al., 2018). Two prior longitudinal studies indicated indicate a similar association between discrimination and depressive symptoms (Qin et al., 2020; White et al., 2020).

Additionally, several studies have examined the relationship between discrimination and other mental health outcomes. These studies have found evidence of associations between discrimination, psychological distress (Mouzon et al., 2016; Nguyen et al., 2018; Steers et al., 2019), and hopelessness (Mitchell et al., 2020). Research on psychiatric disorders has also demonstrated a connection between discrimination and psychiatric vulnerabilities among older African Americans (Mouzon et al., 2016; Nguyen et al., 2018). Together these examinations provide ample evidence that discrimination has an adverse effect on the mental health of older African Americans.

Skin Tone and Discrimination

Overall, research on the relationship between skin tone and discrimination among African Americans has asserted that individuals with darker skin tones are more likely to experience discrimination. Darker skin tone has been connected to disadvantage due to persistent discrimination (Keith & Herring, 1991), perceived discrimination (Monk, 2015), and in-group discrimination (Uzogara et al., 2019). Darker skin tone has been significantly associated with the likelihood of experiencing racial discrimination, with darker-skinned African American individuals being up to 11 times more likely to experience frequent racial discrimination than African American individuals who were lighter-skinned (Klonoff & Landrine, 2000). Keith et al. (2017) found respondents with darker skin were more likely to experience discrimination related to disrespect/condescension and overall higher levels of microaggressions than respondents with lighter skin.

Several studies have investigated the connection between lighter complexions and discrimination among African American men and women. Generally, individuals with lighter skin tones experience less out-group discrimination than those with darker skin tones (Hersch, 2011; Uzogara et al., 2019), but the available research has produced mixed results. In a prospective cohort study among African Americans, men who reported discrimination were slightly more likely to have lighter complexions than those who did not (Borrell et al., 2006). There have been fewer studies focused on discrimination and skin tone among African American women (Keith et al., 2010). Keith and colleagues (2010) found that discriminatory experiences were equally prevalent among lighter- and darker-skinned African American women.

Although colorism and its negative impact among African American women have been well documented (Monk, 2015; Thompson & Keith, 2001), few studies have set out to examine gender differences in skin tone and discrimination. Of the studies we were able to identify one focused on younger adults (ages 24–42 years old) and another examined a sample of adolescents. Krieger and colleagues (1998) reported that among men only, lighter skin color was associated with reporting having experienced racial discrimination. However, there were no gender differences in other areas of self-reported discrimination (i.e., getting a job, getting housing, medical care). The only identified study that has examined gender differences was focused on adolescents. In a sample of 360 Caribbean Black adolescents, darker skin tone was associated with more perceived discrimination for males but not females (Assari & Caldwell, 2017). Taken together, these studies indicate that darker skin tone is associated with more experiences of discrimination; however, more research is necessary in this area.

Skin Tone and Mental Health

Despite the documented social and economic disadvantages associated with skin tone, few studies have focused on skin tone and mental health outcomes. Darker skin tone was associated with adverse mental health outcomes among African Americans. Monk (2015) found that with each incremental increase in the darkness of a respondent’s skin tone, there was an increase in the likelihood of reporting worse self-rated mental health, while (Thompson & Keith, 2001) found that lighter skin tone was associated with higher feelings of mastery, self-efficacy, and self-esteem (for African American women only). Additionally, in this study, dark-skinned women from working-class backgrounds had the lowest self-esteem scores and the impact of skin tone on self-esteem was weaker among women from higher socioeconomic classes (Thompson & Keith, 2001). Lastly, among a sample of Black women, Hall (2017) found that colorism was a source of psychological distress for all of the women surveyed, and that dark-skinned women in particular expressed feelings of helplessness when reflecting on differential opportunities based on skin color.

Several studies found no relationship between skin tone and mental health-related outcomes. These studies were unable to identify associations between skin tone and psychological distress (McCleary-Gaddy & James, 2022), self-esteem (Mathews & Johnson, 2015), and self-rated mental health (Dent et al., 2020). Null findings have also been reported for depressive symptoms. Using structural equation modeling, Keith and colleagues (2010) found that skin tone had neither a direct nor indirect association with depressive symptoms in a sample of African American women from the National Survey of American Life. Overall, the findings from these studies have been mixed. This indicates that the research on skin tone and mental health is inconclusive, and there has been no empirical work, to our knowledge, that has focused specifically on older African American adults in this area. Together, this evidence highlights a need for further investigation.

The Moderating Role of Skin Tone in the Association Between Discrimination and Mental Health

Given that skin tone is related to both discrimination and mental health, it is plausible that the relationship between discrimination and mental health may vary by skin tone, yet there have been limited inquiries in this area. In a sample of urban Brazilian women (categorized as Black, Brown, and White) exposed to high levels of discrimination, the prevalence of common mental disorders (defined as a group of distress states characterized by mood disorders, symptoms of depression, anxiety, and psychosomatic complaints) were higher for women who had brown skin tone than for women who had black skin tone (Fattore et al., 2018). While Perry et al. (2013) found that gendered racism (i.e., concurrent sexism and racism experiences) was positively associated with suicidality among African American women and skin tone moderated this association (stronger for women with medium to dark color compared to women with light skin color). Overall, these results point to how impactful skin tone may be in the relationship between discrimination and health, yet few studies have set out to explore this specifically.

Focus of the Study

Research on African Americans has now begun to focus on within-group differences that contribute to health disparities within this population. Empirical evidence indicates that skin tone may be an important determinant of these health disparities. To date, few studies have examined the moderating effect of skin tone on the relationship between discrimination and mental health among African Americans, and, to our knowledge, no studies have examined this specifically among older African Americans. Also, there is limited information on how the moderating effect of skin tone may differ between men and women. This is important because previous research has asserted that skin tone may have differential impacts in the lives of African American women versus African American men. The purpose of the current investigation is to examine the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress and if this moderating effect differs between older African American men and women.

Method

Sample

The analytic sample for this analysis was drawn from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), which was collected by the Program for Research on Black Americans at the University of Michigan’s Institute for Social Research.

A total of 6,082 interviews were conducted with persons aged 18 years or older, including 3,570 African Americans, 891 non-Hispanic Whites, and 1,621 Blacks of Caribbean descent. Fourteen percent of the interviews were completed over the phone, and 86% were administered face-to-face in respondents’ homes. Respondents were compensated for their time. The data collection was conducted from February 2001 to June 2003. The African American sample is the core sample of the NSAL. Sixty-four primary sampling units comprised the core sample. The remaining eight primary areas were selected from the South to ensure representation of African Americans in the proportion in which they are nationally distributed. The African American sample is a nationally representative sample of households located in the 48 coterminous states with at least one Black adult aged 18 years or older who did not identify ancestral ties in the Caribbean. The overall response rate was 72.3%. Final response rates for the NSAL two-phase sample designs were computed using the American Association of Public Opinion Research (AAPOR) guidelines (for Response Rate 3 samples) (American Association of Public Opinion Research, 2006) (see Jackson et al. [2004] for a more detailed discussion of the NSAL sample). The NSAL data collection was approved by the University of Michigan Institutional Review Board. Of the total 3,570 African American respondents, those under the age of 55 were excluded, resulting in an analytic sample of 837 respondents in the current analysis.

Measures

Independent variables

Discrimination was measured with a summary score of the 10-item Everyday Discrimination Scale developed by Williams et al. (1997) that assesses episodes of unfair treatment experienced during the past 12 months. Response categories ranged from never (0) to almost everyday (5). Higher discrimination scores represented more frequent experiences of discrimination (Cronbach’s α = 0.90 for the total sample, 0.91 for men, and 0.90 for women). Skin tone was assessed with the question, “Compared to most Black people, what shade of skin color do you have? Would you say very dark brown (5), dark brown (4), medium brown (3), light brown (2), or very light brown (1)?”

Dependent Variables

Serious psychological distress (SPD) was assessed by the Kessler 6 (K6), which is a six-item scale designed to assess nonspecific psychological distress including symptoms of depression and anxiety in the past 30 days (Kessler et al., 2002, 2003). The K6 includes items designed to identify individuals: (a) with a high likelihood of having a diagnosable mental illness and associated limitations and (b) who have mental health problems severe enough to cause moderate to serious impairment in social and occupational functioning and to require treatment. The six items of the K6 assess (over the past 30 days) how often the respondent felt: (a) nervous; (b) hopeless; (c) restless or fidgety; (d) so depressed that nothing could cheer you up; (e) that everything was an effort; and (f) worthless. Each item was measured on a 5-point Likert scale ranging from 0 (none of the time) to 4 (all of the time). Items were summed, and scores ranged from 0 to 24, with higher scores reflecting higher levels of SPD (Cronbach’s α = 0.83 for the total sample, 0.82 for men, and 0.84 for women). Self-rated mental health was assessed with the following question, “How would you rate your overall mental health at the present time? Would you say it is excellent, very good, good, fair or poor?” Possible ratings ranged from 1 to 5, with higher ratings representing better self-rated mental health.

Covariates

Multivariable analyses accounted for sociodemographic differences and health status. Age and education, measured in years, were assessed as continuous variables. Home ownership was coded dichotomously (yes/no). Chronic health conditions were measured by reports from respondents of the number of physician-diagnosed physical conditions. Preliminary analyses indicated that region and marital status were not associated with the outcome variables, so they were omitted from the final analyses.

Analysis Strategy

Multiple linear regressions were conducted to test the associations between discrimination, skin tone, SPD, and self-rated mental health. An interaction term between discrimination and skin tone was created to test for the moderating effect of skin tone on the association between discrimination and the mental health variables (SPD, self-rated mental health). These relationships were tested in nested regression models. In the first model, mental health variables were regressed on discrimination, skin tone, and covariates. In the second model, the discrimination × skin tone interaction term was added. Separate regression analyses were conducted for the total sample, men, and women. We also tested the interaction terms using formula by Jaccard et al. (1990). To illustrate significant interactions, we plotted the estimated value of SPD and self-rated mental health (Figures 1 and 2). All multivariable analyses took into account the complex multistage clustered design of the NSAL sample, unequal probabilities of selection, nonresponse, and poststratification.

Figure 1.

Figure 1.

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Skin tone, discrimination, and serious psychological distress among older African American men and women. SPD = serious psychological distress.

Figure 2.

Figure 2.

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Skin tone, discrimination, and self-rated mental health among older African American men.

Results

Table 1 presents the characteristics of the sample and distribution of the study variables. The mean age of respondents was 67 years. On average, respondents had just over 11 years of formal education, and the majority of respondents were homeowners (69%). The mean score for discrimination was 8.74. Respondents reported a mean of 2.64 chronic health conditions. On average, respondents reported low levels of SPD and rated their mental health as good to very good. Turning to skin tone, approximately close to half of the sample (46%) indicated that they had medium brown skin, and slightly less than one third (29%) of respondents reported that they had dark brown skin. Very small proportions of respondents reported having either very light brown (4%) or very dark brown (7%) skin tones.

Table 1.

Bivariate Relationships Between Gender and Study Variables

Total sample Men Women
(N = 837) (n = 300) (n = 537) Test
Skin tone χ 2 = 6.94***
 Very light brown 30 (4.24) 11 (5.32) 19 (3.51)
 Light brown 118 (14.54) 26 (7.72) 92 (19.13)
 Medium brown 361 (45.87) 125 (42.63) 236 (48.04)
 Dark brown 244 (28.60) 107 (37.64) 137 (22.52)
 Very dark brown 59 (6.75) 20 (6.69) 39 (6.79)
Home ownership χ 2 = 0.07
 No 272 (30.61) 101 (30.06) 171 (30.98)
 Yes 541 (69.39) 191 (69.94) 350 (69.02)
Age 66.77 (8.60) 66.45 (8.56) 66.95 (8.63) t = −0.80
Education 11.21 (3.50) 10.98 (3.76) 11.34 (3.34) t = −1.41
Discrimination 8.74 (8.51) 10.33 (9.48) 7.84 (7.77) t = 4.04***
Chronic health conditions 2.64 (1.90) 2.47 (1.91) 2.74 (1.90) t = −1.88
SPD 2.89 (3.89) 2.98 (4.08) 2.84 (3.78) t = 0.49
Self-rated mental health 3.56 (1.04) 3.62 (1.04) 3.53 (1.05) t = 1.13
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Notes: Ns and percentages, presented within parentheses, are presented for categorical variables. Means and standard deviations, presented within parentheses, are presented for continuous variables. Percentages are weighted and frequencies are unweighted.

SPD = serious psychological distress.

*** p < .001.

The bivariate analyses indicated that male and female respondents differed from each other on skin tone and discrimination (Table 1). Compared to men, a greater proportion of women self-identified as having light brown skin tone and a smaller proportion of women than men reported dark brown skin tone. Compared to men, women reported significantly less frequent experiences of discrimination.

The multiple linear regression analysis for SPD (Table 2) indicated that more frequent experiences of discrimination were associated with higher levels of SPD in the total sample (Model 1a) and among women (Model 3a). The inclusion of the interaction terms significantly improved the model significance. Significant interactions between discrimination and skin tone indicated that skin tone moderated the effects of discrimination on SPD in the total sample and among men and women. Figure 1 depicts these interactions for men and women. Simple slopes analysis indicated discrimination was not associated with SPD among men who self-identified as having very light, light, or medium brown skin and among women who self-identified as having very light or light brown skin (Supplementary Table 1). However, discrimination was associated with higher SPD among men who self-identified as dark brown or very dark brown in complexion and among women who self-identified as medium brown or darker in complexion. Further, among respondents with darker complexions, the positive association between discrimination and SPD increased in magnitude as complexion became darker. Consequently, while respondents across the entire complexion spectrum had similar SPD scores at the lowest level of discrimination, at the highest level of discrimination, respondents with darker skin tones had higher SPD scores than respondents with lighter skin tones.

Table 2.

Multiple Linear Regression Analyses of Discrimination, Skin Tone, and SPD Among Older African Americans

B (SE)
Total sample Men Women
Model 1a Model 1b Model 2a Model 2b Model 3a Model 3b
Discrimination .10 (.02)*** −.09 (.06) .07 (.04) −.14 (.09) .12 (.02)*** −.05 (.08)
Skin tone .05 (.15) −.47 (.18)* −.33 (.26) −.99 (.38)* .32 (.20) −.11 (.20)
Discrimination × skin tone — .06 (.02)** — .06 (.03)* — .05 (.02)*
Age −.03 (.02)* −.03 (.02) −.03 (.02) −.03 (.02) −.04 (.02) −.04 (.02)
Gender
 Mena — — — — — —
 Women .21 (.27) .14 (.27) — — — —
Education −.20 (.04)*** −.21 (.04)*** −.11 (.05)* −.12 (.04)** −.28 (.06)*** −.29 (.06)***
Home ownership
 Noa — — — — — —
 Yes −.61 (.42) −.56 (.41) −.87 (.56) −.73 (.56) −.43 (.47) −.41 (.47)
Chronic health conditions .43 (.09)*** .44 (.09)*** .57 (.14)*** .56 (.14)*** .32 (.10)** .34 (.09)***
Intercept 5.22 (1.78) 6.99 (1.77) 5.59 (2.25) 7.94 (2.18) 6.33 (2.13) 7.60 (2.14)
N 763 763 273 273 490 490
R 2 .17 .18 .15 .17 .21 .22
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Notes: B = regression coefficient; SE = standard error; SPD = serious psychological distress.

aReference category.

*p < .05;

**p < .01;

***p < .001.

Turning to self-rated mental health (Table 3), the data indicated a significant interaction between skin tone and discrimination among men (Model 3b; Figure 2). The inclusion of the interaction term did not significantly change the model significance. However, simple slopes analysis indicated that discrimination was inversely associated with self-rated mental health only among men who reported very dark brown complexion. Among men who reported dark brown or lighter complexions, discrimination was not associated with self-rated mental health.

Table 3.

Multiple Linear Regression Analyses of Discrimination, Skin Tone, and Self-Rated Mental Health Among Older African Americans

B (SE)
Total Sample Men Women
Model 1a Model 1b Model 2a Model 2b Model 3a Model 3b
Discrimination −.01 (.00) .02 (.02) −.01 (.01) .03 (.02) −.01 (.01) .01 (.02)
Skin tone −.02 (.04) .04 (.05) −.02 (.05) .10 (.08) −.01 (.05) .01 (.06)
Discrimination × skin tone — −.01 (.00) — −.01 (.01)* — −.01 (.01)
Age −.01 (.01) −.01 (.01) .01 (.01) .01 (.01) −.01 (.01) −.01 (.01)
Gender
 Mena — — — — — —
 Women −.09 (.08) −.09 (.07) — — — —
Education .04 (.01)** .04 (.01)** .05 (.02)*** .06 (.02)*** .02 (.02) .02 (.02)
Home ownership
 Noa — — — — — —
 Yes −.11 (.09) −.12 (.09) .05 (.09) .02 (.09) −.21 (.12) −.21 (.12)
Chronic health conditions −.09 (.02)*** −.09 (.02)*** −.12 (.04)** −.12 (.04)** −.07 (.02)** −.07 (.02)***
SPD −.09 (.01)*** −.09 (.01)*** −.08 (.02)*** −.08 (.02)*** −.11 (.01)*** −.10 (.02)***
Intercept 4.30 (.43) 4.10 (.47) 3.54 (.63) 3.12 (.68) 4.72 (.49) 4.66 (.54)
N 763 763 273 273 490 490
R 2 .23 .23 .27 .27 .21 .21
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Notes: B = regression coefficient; SE = standard error; SPD = serious psychological distress.

aReference category.

*p < .05;

**p < .01;

***p < .001.

Discussion

The findings of this investigation build on prior research on within-group differences among African Americans. This study underscores the importance of self-reported skin tone and its impact on the reporting of experiences of discrimination and mental health among older African Americans. The adverse influence of discrimination on the mental health of African Americans continues to be a growing area of inquiry. Attention to skin tone remains limited in health research, but recognition of its importance for understanding racial health disparities is emerging. Although the National Survey of Black Americans (Jackson & Gurin, 2005) and several other surveys in the 1960s and 1970s included interviewer-rated skin tone measures, the NSAL is one of the first national surveys to include a self-reported measure of skin tone. Skin tone measures are now included in several national surveys, such as the National Social Life, Health, and Aging Project and the General Social Survey. Thus, the present research is an early step that interrogates the role of skin tone in the lives of older African Americans and how it may influence their mental health.

The data indicated that more frequent experiences of discrimination were associated with higher SPD in the total sample and among women, which is empirically consistent with previous work that has examined the connection between discrimination and mental health among older African Americans (Nguyen, 2018; Qin et al., 2020). This finding is in line with the Stress Process Framework, which asserts that stressors, such as discrimination, are tied to social inequities and are commonplace among minoritized groups. In turn, stress exposure can result in compromised mental health.

Additionally, we found that skin tone moderated the association between discrimination and SPD in the total sample as well as among both men and women. In our analysis of self-rated mental health, we found that skin tone only moderated the association between discrimination and self-rated mental health among men but not among women or the total sample. Our findings showed that the relationship between discrimination and SPD increased in magnitude as skin tone became darker. Thus, SPD scores were similar across all skin tone categories at the lowest levels of discrimination. However, at the highest level of discrimination, those with darker skin tones had substantially higher levels of SPD than those with lighter skin tones. Discrimination was associated with worse self-rated mental health only among African American men who self-identified as having very dark brown skin. These moderation findings indicate increased vulnerability to the effects of discrimination among people with darker complexions. These results were consistent with previous research evidence that individuals with darker skin tone bear a greater burden of the mental health consequences of discrimination than individuals with lighter skin tone (Keith & Herring, 1991; Monk, 2015; Uzogara et al., 2019). Research has indicated that African Americans with darker complexions are more likely to experience discrimination, socioeconomic disadvantage, and other forms of chronic stressors than African Americans with lighter complexions (Keith et al., 2017; Monk, 2014). This disproportionate exposure to chronic stressors can erode effective stress coping resources and exacerbate the mental health consequences of discrimination among African Americans with darker skin tones. The current findings support the notion that colorism can lead to differential vulnerability to the psychological toll of discrimination. The fact that the moderating effect of skin tone was identified among both genders speaks to the ubiquity of colorism for both older African American men and women.

Surprisingly, skin tone did not moderate the association between discrimination and self-rated mental health among women. This result was unexpected as prior work (Hill, 2000) has pointed to the importance of skin tone and complexion for African American women. Skin tone in African American women has been connected to higher self-esteem, partner selection, and perceived attractiveness (Hill, 2000; Hargrove, 2019). This result could indicate that there are differences in mechanisms producing SPD and self-rated mental health.

An intersectional perspective could be particularly relevant to understanding how discrimination may impact and be perceived among older African American men. As it pertains to discrimination, previous work has found that African American men may appraise discrimination qualitatively differently than African American women (Lewis & Dyke, 2018). Also, older African American men may experience what Crenshaw (1989) describes as double discrimination—with an underrepresentation of African American men in studies of discrimination and physical health and overall gender differences in vulnerability to stress (Lewis & Dyke, 2018).

Another possible explanation for our null moderation finding for self-rated mental health among women may be the important distinction between general mental health measures (i.e., self-rated mental health) and specific mental health measures (SPD). Prior research has found a moderate correlation (.49) between self-rated mental health and SPD (McAlpine et al., 2018), yet researchers seem to have differing opinions about what exactly self-rated mental health represents to those who appraise their own mental health. Scholars have said that self-rated mental health represents how well individuals recognize their own symptoms as being signs of a mental illness, while SPD is assumed to correlate with symptoms associated with common DSM disorders (e.g., depressive and anxiety disorders). We also acknowledge that there are inherent differences between the measurement of self-rated health (one’s own perception of health and well-being) versus psychological distress, which is based on a scale that assesses clinical symptoms. Self-rated mental health and its relationship to psychological distress is a particularly interesting area that we endeavor to continue exploring, especially in this population.

Given the ambiguity in this area, more studies are needed to clarify how skin tone may function differently between African American men and women in the relationship between discrimination and self-rated mental health.

Research on the direct association between skin tone and mental health across the adult life span has been mixed, with some studies demonstrating an association between skin tone and mental health (e.g., Diette et al., 2015; Monk, 2015), while other studies do not find a significant relationship between skin tone and mental health (e.g., Keith et al., 2010). In our analysis of older African American men and women, we did not find a direct association between skin tone and the two mental health outcomes (SPD, self-rated mental health). Our null findings are consistent with those from Keith et al.’s (2010) study, which, in part, examined skin tone and depressive symptoms among African American adults across the life span using data from the NSAL.

However, the significant interactive effects between skin tone and discrimination in the current analysis suggest that the effects of skin tone on mental health are more complex and may be better understood through its conditional effects rather than its direct effects on mental health. We are aware of only one study that has examined the conditional effects of skin tone in the relationship between discrimination and mental health among African Americans. Using a community sample of African American women with low income in Kentucky, Perry et al. (2013) found that the positive association between gendered racism (i.e., concurrent sexism and racism experiences) and suicidality was significantly stronger among women with medium to dark skin color than among women with light skin color (Perry et al., 2013). Our findings align with those of Perry et al.’s study and underscore the enduring effects of colorism in relation to the psychological sequelae of discrimination throughout the life course. Additionally, our analysis extends research in this area by confirming the conditional effects of skin tone in the discrimination–mental health connection in a nationally representative sample of older African Americans. This represents an important empirical contribution by investigating these relationships among older African Americans. While there is limited knowledge regarding the relationships between skin tone, discrimination, and mental health among African Americans across the adult life span, there are no studies that have investigated these relationships among older African Americans. A better understanding of these relationships among older African Americans is critical, as this population has endured a lifetime of discrimination and colorism and their cumulative effects on health. This analysis is the first study, to our knowledge, to examine these relationships among older African Americans. Moreover, the use of a nationally representative sample of older African Americans allows for population-level inferences from the study findings.

Strengths and Limitations

The current analysis has several notable strengths. Although previous research has reported associations between discrimination and mental health in older African Americans, the present study extends this body of research by documenting the moderating effects of skin tone in this association and demonstrating that the moderating effects of skin tone differ by gender for self-rated mental health. Focusing on gender differences allows for a more in-depth examination of the distinctiveness in how skin tone affects mental health outcomes between older African American men and women. Additionally, the use of SPD and self-rated mental health captures both objective and subjective aspects of mental health, providing a more complete understanding of how skin tone and discrimination interactively affect mental health among older African Americans.

Despite the strengths of the study, the findings should be interpreted in light of its limitations. First, the generalization of study findings is limited due to the sample characteristics. On average, the sample reported low SPD and good self-rated mental health; thus, the study findings may not be generalizable to older African Americans with clinically significant distress. Second, because the NSAL respondents are community-dwelling individuals, the findings cannot be generalized to institutionalized and homeless populations. Third, all measures in the study were self-reported, which are subject to recall bias and social desirability. Fourth, because the data for the study are cross-sectional, we are not able to draw causal inferences from the findings. For example, it remains unclear whether experiences of discrimination lead to worse mental health outcomes, or, alternatively, individuals with poorer mental health tend to perceive more everyday discrimination. Similarly, the exact causal pathways among skin tone, discrimination, and mental health cannot be determined conclusively. However, prospective research demonstrates that people who reported higher levels of discrimination at the outset of the study experienced declining mental health (i.e., SPD, depressive symptoms) at later time points (Brown et al., 2000; Hackett et al., 2020; Jackson et al., 1996; Qin et al., 2020). Moreover, Schulz et al. (2006) show that increasing levels of discrimination over time are associated with increasing depressive symptoms. Neuroimaging studies provide further evidence in the temporal ordering of discrimination and mental health. Neuroimaging evidence indicates that participants who were exposed to discrimination during functional magnetic resonance imaging (fMRI) scanning had decreased activity in the nucleus accumbens (an area of the brain associated with reward processing and which is affected by depression) compared to participants who were not exposed to discrimination (Welborn et al., 2020); also, participants who appeared more distressed by the discrimination episode demonstrated greater social pain-related neural activity and reduced emotion regulatory neural activity (Masten et al., 2011). Together, these prospective and neuroimaging studies strongly suggest that discrimination can lead to mental health problems.

Future Directions

To clarify the issue of temporal ordering and causality, we recommend that future research examine the relationships between discrimination, skin tone, and mental health using longitudinal data. Some research indicates that depression and depressive symptoms explain the relationship between discrimination and poor health outcomes, including physical and cognitive health (Barnes et al., 2012; Lewis et al., 2015; Zahodne et al., 2019). That is, individuals who experience discrimination, especially chronic forms of discrimination such as everyday discrimination, are at greater risk for developing depressive symptoms and depression. In turn, depression is both directly and indirectly linked to a broad range of morbidities that are also related to discrimination. Given this causal mechanism and the fact that SPD is also linked to morbidities related to discrimination, we suggest that future research evaluate the role of SPD as a mediator in the discrimination–physical health connection. Lastly, we acknowledge that the U.S. Black population is increasing in diversity and that the term Black is no longer synonymous with African American. While we have no doubts that colorism is salient for all Black people in the United States, previous research suggests that the response to racism, and theoretically colorism, may differ for African Americans and other Black people (e.g., Caribbean Black Americans). Thus, future work should address ethnic distinctions in colorism and its relationship to mental health.

Conclusions

Racism and discrimination often manifest in ways that are insidious and impact how the targeted group is viewed and how the targeted group views themselves. This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. The findings provide evidence that darker skin tone may amplify the risk of adverse mental health in the face of discrimination. Uncovering the mechanisms behind the “why” is an important next step in understanding how skin tone influences the relationship between discrimination and mental health and why this relationship is stronger among darker-skinned individuals compared to those with lighter complexions. Additionally, more research is needed to understand how the moderating role of skin tone differ between African American men and women.

Contributor Information

Tyrone C Hamler, Graduate School of Social Work, University of Denver, Denver, Colorado, USA.

Ann W Nguyen, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA.

Verna Keith, Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Weidi Qin, Center for Social Epidemiology and Public Health, University of Michigan, Ann Arbor, Michigan, USA.

Fei Wang, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA.

Funding

The preparation of this article was supported by a grant from the National Heart, Lung, and Blood Institute to A. W. Nguyen (5R25HL105444-11) and a grant from the National Institute on Aging to A. W. Nguyen (P30AG072959).

Conflict of Interest

None declared.

Author Contributions

T. C. Hamler supervised the data analysis, wrote the paper, and contributed to revising the paper. A. W. Nguyen and W. Qin performed all statistical analyses, wrote the paper, and contributed to revising the paper. V. Keith wrote the paper and contributed to revising the paper. F. Wang contributed to revising the paper and wrote the paper.

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