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Triple jeopardy: Race-related stress, racial identity, coping patterns, and psychological distress among elderly African American women

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Kisha Nicole Bazelais
Abstract:
The extant theory and research on race-related stress and coping has not adequately examined how internalized racial and gender socialization factors influence levels of stress and coping strategies of elderly African American women. Consequently, little is known about how to address their mental health concerns effectively. Therefore, the purpose of the present study was to investigate the complex relationships among racial identity attitudes, culture and gender specific coping strategies, and race-related stressors that have been hypothesized to affect psychological distress among elderly African American women. Elderly African American women (N = 125), who were at least 65 years old, completed a demographic questionnaire and measures of Black racial identity (Helms, 2003), race-related stress (Utsey, 1999), Black women's coping strategies (Phields, 2002), and a mental health inventory (Veit & Ware, 1983). Three canonical correlation analyses were used to investigate how the women's appraisal of race-related stress, use of prototypical Black women coping strategies, and psychological distress were interrelated. Results of the analyses revealed four statistically significant patterns: (a) "Self-Reliant Internalization," women described by this pattern endorsed Internalization (transcendent identity) as a primary appraisal strategy, self-reliance as a coping strategy, and less psychological distress; (b) "High SES," women defined by this pattern used education, social class, and self-reliance as buffers against institutional race-related stress and psychological distress; (c) "Self-Reliant, Multiply Distressed," a pattern in which greater individual and cultural race-related stress, were associated with use of self-reliance as a coping strategy and greater psychological distress; and (d) "Internalized Individual Racism as Stressors," a pattern in which endorsement of the Preencounter (pro-White/anti-Black) and Immersion (pro-Black/anti-White) racial identity statuses as appraisal strategies were related to higher levels of individual race-related stress and psychological distress. Results were used to speculate about how the factors investigated might be integrated to form a model for addressing research and practice for elderly African American women. Limitations of this study and implications for research and practice, and future research are discussed.

TABLE OF CONTENTS

List of Tables ix

List of Figures x

Chapter 1 Introduction 1

Chapter 2 Review of Literature 11

Experiences of Elderly African American Women as Racial Stressors 12 Sociocultural Stressors and Coping Strategies 16 Consequences of Stressors 19 Psychological Distress 20 Empirical Studies of Psychological Distress 21 Race-Related Stress 22 Empirical Studies on Race-Related Stress 23 Racial Identity as a Form of Stress Appraisal 26 Empirical Studies on Racial Identity Statuses 28 Coping Strategies 33 Empirical Studies on Coping Strategies 34 Empirical Studies on Gender/Cultural Specific Coping Strategies 36 Statement of Problem 41 Hypotheses 49

vii

Chapter 3 Method 53

Participants 53 Measures 55 Procedure 64 Chapter 4 Results 69 Preliminary Analyses 69 Primary Analyses 72 Post-Hoc Analyses 92 Chapter 5 Discussion 94

Implications for Practice 106 Implications for Research 108 Limitations 110 Future Research 114 References 115 Appendix A: Recruitment Letter 129

Appendix B: Recruitment Flyer 131

Appendix C: Informed Consent Form 132

Appendix D: Raffle Page 135

Appendix E: Demographic Questionnaire 136

Appendix F: Phenomenal Womanism Inventory 137

Appendix G: Mental Health Inventory 139

viii

Appendix H: Black Racial Identity Attitudes Scale 146

Appendix I: Index of Race-Related Stress Brief 151

ix

List of Tables

Table 1: Self-Reported Characteristics of Participants 54

Table 2: Means, Standard Deviations, and Cronbach Alphas for the Black Racial Identity Attitudes Scale, Index of Race-Related Stress-Brief, Phenomenal Womanism Inventory, and Mental Health Inventory 70

Table 3: Pearson Product Moment Intercorrelations Among Educational Level, Socioeconomic Status and the Predictor and Criteria Variables 72

Table 4: Summary of Canonical Correlations Using Racial Identity Statuses, Educational Level, and Socioeconomic Status, to Predict Black Women Coping Strategies, and Psychological Distress 76

Table 5: Summary of Canonical Correlations Using Types of Race-Related Stress, Educational Level, Socioeconomic Status, to Predict Black Women Coping Strategies, and Psychological Distress 81

Table 6: Summary of Canonical Correlations Using Racial Identity Statuses, Black Women Coping Strategies, Educational Level, Socioeconomic Status, to Predict Types of Race-Related Stress, and Psychological Distress 88

x

List of Figures

Figure 1: Model of the effects of racial and gender factors that influence levels of psychological distress among elderly African American women 52

Figure 2: Model of the effects of socio-demographic, racial and gender factors that influence levels of psychological distress among elderly African American women 105

1

Chapter 1

Introduction

Racial discrimination is among the foremost societal issues that racial minorities in the United States continue to face in their daily lives despite federal laws such as the Civil Rights Acts of 1964, 1968, and 1991 laws that were established to prohibit racial and other forms of discrimination in employment, education, and use of public accommodations and facilities (Davis, Johnson, & Martinez, 2001). African American elderly women, ages 65 years and older, potentially have experienced life-long exposure to racism in the United States. Elderly African American women have unique experiences and mental health concerns, such as high rates of depression and anxiety (Barbee, 1992; Mills, 2000; Warren, 1994), which might be attributable to the chronic stress induced by experiences of race-based discriminatory practices. Yet little is known about the impact of race-related stress on their psychological functioning, nor is there much known about the protective factors that have helped many elderly African American women to cope with experiences of racial discrimination throughout their lifetimes. According to US Census Bureau Statistics, the elderly population, which includes individuals 65 years and older, generally is increasing more rapidly than other age populations; yet it still remains one of the most underserved populations in the mental health field (Gatz & Symer, 2001). Recent census data reveal that in 2007 the African

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American elderly population comprised about 8.3% of the older adult population in the United States (Administration on Aging, 2009). Elderly African American women comprise more than half of the African American elderly population due to having longer life expectancy rates than African American men. In fact in 2006, the average life expectancy rates for African American women at age 65 years was an additional 19.1 years, whereas African American men had an average life expectancy at age 65 of an additional 15.5 years (Administration on Aging, 2009). Despite US Census Bureau (2008) statistics that suggest that by the year 2050, older African Americans, in particular elderly African American women, will constitute the largest racial/ethnic minority elderly population in the US, there are very few studies that focus specifically on the issues and experiences of elderly African American women. Some scholars have suggested that elderly African Americans experience “double jeopardy” due to their marginalized status as both a minority and an aged individual (Dowd & Bengston, 1978). However, for elderly African American women, who have multiple memberships in groups that have been traditionally marginalized, one could argue that they experience “triple jeopardy.” Elderly African American women are not only confronted with racial and age discrimination, but they are also subjected to gender discrimination, or gendered racism, which is defined as “negative White reactions, individual and institutionalized, to Black female characteristics” (Essed, 1991; p.31). The concept of gendered racism provides a more comprehensive conceptualization of the unique ways in which African American women experience oppression based on both

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their gender and race. Clark, Anderson, Clark, and Williams (1999) provided a conceptual definition of racism as “the beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or their ethnic group affiliation” (p. 805). As posited by Jones (1997), racial discrimination is multidimensional and can occur on three different levels: individual, institutional, and cultural. Individual racism refers to racial discrimination that is experienced on a personal level by African American women. Several examples of gender-focused individual racism include being labeled and treated as exotic, stereotyped as promiscuous African American women, or being sexually assaulted and harassed because of one‟s race and gender. Institutional racism refers to institutional and social policies that deny or exclude African American women from opportunities that are offered to White American women. Examples of gender-focused institutional racism include being denied a job or being given menial jobs, poor housing, and lack of access to quality health care. Cultural racism can be experienced when notable contributions made by racial minority groups are ignored or regarded as inferior compared to the contributions of the White Americans. Some examples of gender-focused cultural racism include the exclusion of historical contributions made by women of Color in school curriculums and textbooks, and a lack of positive representation of racial and ethnic women in the media (Jones, 1997; Utsey, Ponterotto, Reynolds, & Cancelli, 2000). Elderly African American women may have been exposed to these various forms of racism throughout the course of their lifetimes; yet even though racism is potentially a chronic source of stress that might adversely

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affect the well-being of African Americans generally, the greater longevity of African American women relative to their male counterparts suggests that it may not affect them in the same ways. It appears that elderly African American women may be at a higher risk of experiencing race-related stress and poor psychological and/or physical outcomes as compared to women from other racial and ethnic groups. In fact, studies examining the relationship between racism and physical health have demonstrated that African American women experience a disproportionately high rate of stress-induced physical health problems, such as hypertension, cardiovascular disease, and cerebrovascular disease relative to White women (Office on Women‟s Health, 2006). The higher incidence of stress-related health concerns among African American women may in fact be masking underlying emotional and psychological concerns related to chronic experiences of race-related stress. Although Black women have seldom been the primary focus of racism and mental health research, several researchers have found that being the target of a racially motivated act, whether it is overt or subtle, chronic or acute, tends to have an adverse effect on the mental health of its victims (Clark et. al., 1999; Fernando, 1984; Thompson Sanders, 1996; Utsey & Ponterotto, 1996; Utsey et. al., 2000). Reported mental health effects include the onset of psychological disorders such as depression, anxiety, hopelessness-helplessness, (Clark et al., 1999; Fernando, 1984; Jackson, Brown, William, Torres, Sellers, & Brown, 1996; Thompson Sanders, 1996). It is plausible that race-

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related stress is as much an underlying catalyst for each of these disorders in elderly African American women as it seems to be for other types of samples. In Utsey, Payne, Jackson, and Jones‟s (2002) study of race-related stress, quality of life, and life satisfaction among elderly African Americans, an aggregated sample of African American elderly women and men reported experiencing poorer psychological health related to institutional racism-related stress, such as policies and practices that restricted opportunities or access to resources. Additional empirical research has also demonstrated a link between institutional racism (e.g., lack of preventative health services, lack of quality health care, poor delivery of health services, and lack of insurance coverage), and poor physical health status of elderly African American women (Brotman 2003; Shellman, 2004; Sullivan-Bolyai, Bova, & Harper, 2005; Utsey et al., 2002). For example, elderly African American women have reported frequently being treated dismissively by service providers, not receiving the same care and respect provided to their White counterparts, and often being subjected to racist assumptions and comments from health care providers (Barbee, 2002; Brotman, 2003; Shellman, 2004). It seems likely that institutional racism in health care facilities might contribute to increased race-related stress for African American women who seek services from such institutions. Unfortunately, the effects of race-related stress on the mental health of elderly African American women has yet to be adequately addressed by mental health professionals or researchers, although scholars and researchers have developed a variety of models to potentially account for the associations between racism and mental or

6

physical health outcomes. The focus of the present study is the integration of three conceptual approaches that have been used to consider factors that contribute to health concerns or psychological distress for African Americans generally, but for elderly African American women very little if at all. The theoretical or conceptual approaches are racial identity (Helms, 1985), racism-related stress theory (Harrell, 2000) and stress- and-coping approaches (Outlaw, 1993; Slavin, Rainer, McCreary, Gowda, 1991; Woods- Giscombe & Lobel, 2008). Racial identity theory proposes that elderly African American women (in this case) have developed and internalized different strategies for appraising or making sense of racism in their lives. The basic premise of the racism-related stress models is that experiences of racism can occur at multiple levels, and can adversely affect the mental health of elderly African American women through the experience of stress, and through its‟ influence on mediators of stress (e.g., coping strategies). Coping strategies perspectives assume that certain coping strategies reduce stress, whereas others aggravate it (Outlaw, 1993; Slavin et al., 1991; Woods-Giscombe & Lobel, 2008). While previous research has found that certain racial identity attitudes are predictors of psychological outcomes and use of various coping strategies (Neville, Heppner, & Wang, 1997). Only a few empirical studies have actually examined how racial identity statuses are related to experiences of race-related stress, psychological well-being or coping (e.g., Caldwell et. al, 2004; Franklin-Jackson & Carter, 2007) but to date, no study has examined whether Black racial identity statuses interact with coping strategies, race-related stress, and psychological functioning. Examining how Black

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racial identity statuses influence the stress and coping process may help to provide a comprehensive understanding of the within-group differences that exist among African American elderly women, as well as the internal factors that may serve as buffers against psychological distress. Consequently, many unanswered questions remain with respect to what factors help or have helped to protect African American elderly women against the adverse effects of racial discrimination. Most research that has assessed African American women‟s stress has used Harrell‟s (2000) race-related stress model to examine the impact of racism on the women‟s physical health and mental health without examining appraisal strategies or mediating effects. Other scholars have used specific gender-related stress models to examine experiences of gender discrimination or sexism in African American women without considering racism as a correlate or aggravating factor (Moradi & Subich, 2003). According to Woods-Giscombe and Lobel (2008), the stressors to which African American women are exposed and their manner of appraising the stressors is reflective of the women‟s histories, their marginalized position in society, and their racial and gender socialization experiences. Therefore, Woods-Giscombe and Lobel argue that models used to conceptualize stress of African American women should take into account both race and gender-specific experiences, instead of one or the other. Race and gender seem to be salient factors for African American women, each of which contributes to how they experience and cope with racism. Yet, little is currently known about the race-related stressors experienced by this population, thus it is important to gain a clearer

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understanding of the stress and coping processes of elderly African American women who potentially have been exposed to lifelong racial discrimination. An essential question to address is how the women cope with potential racial stressors. Several theorists have posited that the strategies African American women use to help them cope effectively with racism are often passed down from generation to generation and are essential components of their cultural socialization experiences (Bell & Nkomo, 1998; Greene, 1994; Jackson & Sears, 1992). For example, it has been argued that many African American women are socialized to be “phenomenal women,” who are self-reliant and embody a sense of tenacity which includes being persistent, tough, and maintaining emotional strength in order to deal with the stressors or challenges that come their way (Bell & Nkomo, 1998; Phields, 2002). Although it has been argued that these are adaptive coping strategies, Phields contends that overreliance on oneself to overcome racism in its various forms may contribute to psychological distress. Most of the literature on the coping strategies of African American women has not focused on elderly women or the culture-specific coping strategies hypothesized to characterize them (e.g., self-reliance or tenacity). Therefore, it is not clear whether they alleviate stress over time or aggravate it. As a first step in determining the long-term health consequences on African American women of race-related stress, it is important to examine which strategies seem to have been most effective in helping them to manage stress. The purpose of the present study was to investigate how racial identity statuses, racism stressors, and culture-specific coping strategies interact to either reduce or

9

contribute to psychological distress among elderly African American women. Specifically, I examined the relationships among Black racial identity statuses as appraisal strategies, the use of prototypical Black women coping strategies (e.g., tenacity and self-reliance) and how the coping strategies, in turn, affected psychological outcomes in elderly African American women. Additionally, I examined how different forms of race-related stress e.g. individual, institutional, cultural) were associated with the coping strategies used by elderly African American women, and its relationship to their psychological distress. Lastly, I examined the association between Black racial identity statuses as appraisal strategies, the use of coping strategies, and its relationship to experiences of race-related stress and psychological distress in elderly African American women. Ideally, the present study was intended to provide an integrated model for addressing elderly African American women‟s mental health concerns. Elderly African American women fill important roles within the African American community which often extend beyond their roles as grandparents. For example, in addition to being care-takers for their own grandchildren, many African American elderly women often take on the important role of maintaining structure within their community by disciplining and passing down cultural traditions and wisdom to African Americans youths within their neighborhoods and churches (Coke & Twaite, 1995; Collins, 1991). Thus, research aimed at understanding the mental health concerns of this population is of the utmost importance given the significant role that African American elderly women play in the lives of younger generations of African Americans

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and within society. Through better understanding of the stressors affecting elderly African American women and the factors that help protect them against adverse psychological outcomes, service providers working with this population will be able to provide them with more effective services that may help elderly African American women to achieve a greater sense of well-being, and perhaps promote positive health outcomes. Additionally, it may help elderly African American women to be able to continue their efforts in sustaining their African American communities. Elderly African American women will also likely benefit from improved interventions that incorporate methods that help strengthen their existing effective coping strategies and reduce any potentially harmful strategies that may be exacerbating their mental health issues.

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Chapter 2 Review of Literature Elderly African American women may be more prone to health and mental health issues because they potentially have been subjected to discrimination due to racism and sexism throughout their lifetimes (Barbee, 1992; Mills, 2000; Office on Women‟s Health, 2006; Warren, 1994). Moreover, living long enough to become “elderly” adds another possible focus of discrimination to their lives (Dowd & Bengston, 1978; Gatz & Symer, 2001). However, the theory and limited research that have focused on this population have not considered the within-group diversity that exists among elderly African American women or the factors that might have helped some elderly African American women cope more effectively with racism than others. In this literature review, elderly African American women refers to women of Color, ages 65 and older, who were born and raised in the United States and who report having some African ancestry. Efforts to understand how race and gender influence the mental health issues of African Americans have generally focused on either racism (Utsey et. al, 2002), racial identity (Neville et al., 1997), or coping strategies (Pillay, 2005) as contributors to psychological distress. However, none has attempted to integrate these components in a manner that addresses the mental health issues of elderly African American women. With respect to mental health issues, some factors that have been suggested as having some effects on these women‟s capacity to cope effectively with race-related

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stress are (a) the diversity of their racial experiences, (b) the nature of the coping strategies that they have developed in response to such experiences, and (c) the manners in which they appraise or make sense of racial events or stressors. The first section of the present literature review focuses on historical life experiences of elderly African American women and racial socialization experiences that might contribute to development of race-related stress in their lives and perhaps mental health concerns more generally. Two subsequent sections focus on stress- and-coping models for the purpose of identifying coping strategies that have been considered prototypical of African American women and Helms‟s Black racial identity development model, which has been used in previous research to describe within-group differences in women‟s manner of appraising race-related stressors (Franklin-Jackson & Carter, 2007; Moradi & Subich, 2003; Warren, 2004). Experiences of Elderly African American Women as Racial Stressors From a historical perspective, elderly African American women allegedly have had uniquely stressful historical and sociocultural experiences in U.S. society. Their experiences define the stressors that they are exposed to, their interpretation of those stressors, and the stressors‟ subsequent psychological impact (Brown, Parker-Dominguez, & Sorey, 2000; Jackson, Hogue, & Phillips, 2005; Jackson, Phillips, Hogue, & Curry Owens, 2001). The stressful experiences related to limited educational access and work- related discrimination that African American women deal with (i.e., institutional stressors)

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may be life-long experiences that possibly contribute directly to elderly African American women‟s experiences of race-related stress. Historical Experiences Proponents of racism and/or gender discrimination as the source of African Americans‟ psychological distress locate its origins in historical events (Chatters & Jackson, 1989; Harrell, 2000; Shenk, 2000). Throughout the years, African American elderly women may have witnessed and/or have been a part of sociopolitical movements that have led to many positive and negative variations in race relations and social policies that may have directly affected the social status of African Americans and other racial and ethnic minority groups collectively, but may have also affected them as individuals. Elderly African American women may have experienced living through positive historical events, such as the Civil Rights Movement, the Brown vs. The Board of Education Supreme Court decision, the passing of the Voter Registration Act (Gilmore, 1966), and the rise of the Black Panther Party, as well as negative events, such as the era of Jim Crow laws, the numerous lynchings of African Americans, rape and sexual assault of African American women, and the assassinations of activists, such as Malcolm X and Martin Luther King, Jr. (Chatters & Jackson, 1989). Additionally, some elderly African American women may be members of a generation that perhaps grew up listening to their parents‟ and grandparents‟ stories of having lived through the period of Jim Crow laws and slavery (Shenk, 2000). Not all elderly African American women have experienced all of these race-related sociopolitical events in the same manner or to the same extent; so

Full document contains 168 pages
Abstract: The extant theory and research on race-related stress and coping has not adequately examined how internalized racial and gender socialization factors influence levels of stress and coping strategies of elderly African American women. Consequently, little is known about how to address their mental health concerns effectively. Therefore, the purpose of the present study was to investigate the complex relationships among racial identity attitudes, culture and gender specific coping strategies, and race-related stressors that have been hypothesized to affect psychological distress among elderly African American women. Elderly African American women (N = 125), who were at least 65 years old, completed a demographic questionnaire and measures of Black racial identity (Helms, 2003), race-related stress (Utsey, 1999), Black women's coping strategies (Phields, 2002), and a mental health inventory (Veit & Ware, 1983). Three canonical correlation analyses were used to investigate how the women's appraisal of race-related stress, use of prototypical Black women coping strategies, and psychological distress were interrelated. Results of the analyses revealed four statistically significant patterns: (a) "Self-Reliant Internalization," women described by this pattern endorsed Internalization (transcendent identity) as a primary appraisal strategy, self-reliance as a coping strategy, and less psychological distress; (b) "High SES," women defined by this pattern used education, social class, and self-reliance as buffers against institutional race-related stress and psychological distress; (c) "Self-Reliant, Multiply Distressed," a pattern in which greater individual and cultural race-related stress, were associated with use of self-reliance as a coping strategy and greater psychological distress; and (d) "Internalized Individual Racism as Stressors," a pattern in which endorsement of the Preencounter (pro-White/anti-Black) and Immersion (pro-Black/anti-White) racial identity statuses as appraisal strategies were related to higher levels of individual race-related stress and psychological distress. Results were used to speculate about how the factors investigated might be integrated to form a model for addressing research and practice for elderly African American women. Limitations of this study and implications for research and practice, and future research are discussed.