Racial Differences in Arthritis-Related Stress, Chronic
Life Stress, and Depressive Symptoms Among
Women With Arthritis: A Contextual Perspective
Jessica M. McIlvane, Tamara A. Baker, and Chivon A. Mingo
School of Aging Studies, University of South Florida, Tampa.
Objectives. This study examined the effects of arthritis-related stress and chronic life stress on depressive symptoms
among African Americans and Whites with arthritis.
Methods. Participants included 175 African American and White women (aged 45–90) who completed structured
questionnaires assessing arthritis-related stress (i.e., pain, functional impairment, perceived stress), chronic life stress (i.e.,
discrimination, financial stress, life stressors), and well-being (i.e., depressive symptoms).
Results. African Americans reported more functional impairment and lower perceived arthritis stress, but more life
stressors, financial stress, and discrimination, than Whites. Arthritis-related stress accounted for similar proportions of
variance in depressive symptoms across African Americans (?R2¼ .16, p < .001) and Whites (?R2¼ .24, p < .001).
However, chronic life stressors explained significantly more variance among African Americans (?R2¼.20, p < .001, vs
?R2¼ .06, p < .05).
Discussion. Findings demonstrate the importance of considering contextual factors influencing women’s health and
well-being, particularly for those women with a chronic illness, including arthritis. Although arthritis-related stressors may
be the predominant factors affecting well-being for Whites with arthritis, well-being in African Americans with arthritis is
also closely tied to broader life stressors. Results suggest the importance of looking beyond illness-specific stressors when
studying aging and health.
Key Words: Arthritis-related Stress—Chronic Life Stress—Racial Differences—Depressive Symptoms.
(Ferraro & Farmer, 1996). However, the reasons for these
racial differences are complex and remain unclear. It is well
established that members of minority populations in general,
and African Americans in particular, are disproportionately
diagnosed with more severe and debilitating illnesses, are likely
to be diagnosed at a younger age with a medical disorder,
and are more incapacitated from similar diseases than Whites
(Bazargan & Hamm-Baugh, 1995). Explanations for these
disparate rates in diagnosis and symptom management may
range from institutional racism and discrimination to fewer
socioeconomic resources. Documenting these sources of
disparities is critical given that health disparities are embedded
in larger historical, geographic, cultural, social, and economic
milieus (Williams & Jackson, 2005).
An accumulating body of research on health disparities
focuses on socioeconomic factors (e.g., income, education).
Although socioeconomic status (SES) appears to partially
explain these racial differences in health, there are cases in
which racial differences persist even after controlling for SES
(Williams, Yu, Jackson, & Anderson, 1997), suggesting that
other factors, such as stress, may be important to consider.
Chronic stressors (e.g., discrimination, financial stress), in
general, are important contextual factors that may potentially
have an explanatory contribution to racial differences in health
and well-being, particularly stressors that may be more salient
among diverse racial populations.
ACIAL health disparities in health status and chronic
disease persist throughout much of the life course
In the current study, we focused on arthritis, one of the most
common chronic conditions in middle-aged and older women
(National Academy on an Aging Society, 1999). In light of
various theoretical perspectives emphasizing the importance of
considering multiple chronic stressors (Antonucci & McIlvane,
2003; Moos, 2002; Pearlin, 1989), we examined the effects of
both arthritis-related stressors and chronic life stressors on
well-being for African American and White women. Guiding
our conceptualization of stress was Lazarus and Folkman’s
(1984) definition, where stress involves person–environment
demands that exceed an individual’s resources, requires
adjustments be made by the individual, and may lead to
distress. Also guiding the study was Pearlin’s (1989) assertion
that multiple chronic stressors should be considered to capture
a broader picture of the stress process. Not only are women
with arthritis coping with pain and functional limitations, but
they are also likely to experience other stressors in their daily
lives, such as interpersonal stress and work-/home-related
stress (Gignac et al., 2006). Thus, examining stress associated
with chronic illness alone is not sufficient. A chronic illness,
such as arthritis, does not occur in a vacuum, and it is
important to consider the context in which women cope with
chronic illness, which may differ based on race. However, the
majority of studies on coping with arthritis have used
predominantly White samples, and we are unaware of any
studiesthathave specifically compared
stressors and broader chronic life stressors in African
American and White samples.
Journal of Gerontology: SOCIAL SCIENCES
2008, Vol. 63B, No. 5, S320–S327
Copyright 2008 by The Gerontological Society of America
Racial Differences in Arthritis-Related Stressors
Recent evidence shows that African Americans face higher
levels of arthritis-related stressors. African Americans report
a higher prevalence of activity and work limitations, and severe
pain due to arthritis (Centers for Disease Control and
Prevention, 2005). They also experience more functional
impairment (Kington & Smith, 1997) and lower perceived
quality of life (Ibrahim, Burant, Siminoff, Stoller, & Kwoh,
2002) compared to Whites. These findings are particularly
important given that arthritis-related stressors such as pain and
functional limitations are related to poor psychological well-
being and depression (e.g., Williamson & Schulz, 1992; Zeiss,
Lewinsohn, Rohde, & Seeley, 1996).
A less studied factor, the appraisal of arthritis as stressful or
not, may also be an important factor for well-being. It is well
established that both the presence of stress and the perception of
stress may influence one’s well-being (Lazarus & Folkman,
1984). For example, when encountering a stressful situation,
primary appraisal involves assessing one’s risk or stake in
a situation (Folkman, Lazarus, Dunkel-Schetter, DeLongis, &
Gruen, 1986). The extent to which an individual perceives
a stressor, such as arthritis, as harmful, threatening, challenging,
or causing loss may be particularly important in terms of well-
being (Folkman & Lazarus, 1985; Folkman et al., 1986).
However, racial differences in primary appraisal, or the
perception, of arthritis-related stress and effects on well-being
among African Americans are not clear.
Racial Differences in Broader Chronic Life Stressors
African Americans, in particular, are more likely to be
exposed to a variety of unique stressors, such as discrimination,
low SES, and financial stress, than Whites (Anderson &
that these factors are related to higher levels of depressive
symptoms in African Americans (Barnes et al., 2004; Schulz,
Gravlee, et al., 2006; Schulz, Israel, et al., 2006). Moreover,
there is a growing interest in examining the extent to which
perceptions of discrimination and personal experiences of racial
bias adversely affect health (Williams, Neighbors, & Jackson,
2003; Williams & Williams-Morris, 2000). The extant literature
has shown that discrimination based on race and/or ethnicity
leads to experienced physical and mental perturbations among
diverse racial populations (Jackson, 2002). In particular, Barnes
et al. found that everyday discrimination, categorized into
perceptions of unfair treatment and personal rejection, was
related to more depressive symptoms in both African American
and White older adults.
Although the relationship between discrimination and
psychological well-being (e.g., depression; Barnes et al.,
2004; Schulz, Gravlee, et al., 2006) and physical health (e.g.,
hypertension, heart disease, diabetes; Guyll, Matthews, &
Bromberger, 2001; Krieger & Sidney, 1996; Moody-Ayers,
Stewart, Covinsky, & Inouye, 2005; Troxel, Matthews,
Bromberger, & Sutton-Tyrrell, 2003) has been well docu-
mented, the impact of discrimination on health and psycholog-
ical well-being among those with arthritis remains unclear. In
the current study, we focused on everyday discrimination,
which involves perceptions of unfair treatment in everyday life,
such as being treated with less courtesy or respect than others.
Purpose and Hypotheses
The current study examined the effects of arthritis-related
stress (i.e., pain, functional impairment, perceived stress) and
chronic life stress (i.e., everyday discrimination, count of life
stressors, financial stress) on depressive symptoms in African
American and White women with arthritis. The primary
objectives of this study were to (a) examine racial differences
in levels of arthritis-related and chronic life stress, (b) assess
whether the amount of variance in depressive symptoms
accounted for by arthritis-related stressors is different for
African Americans and Whites, and (c) assess whether the
amount of variance accounted for by chronic life stressors is
different for African Americans and Whites. To do this, we
statistically tested whether the R2s for arthritis-related stressors
and for chronic life stressors were different in African
Americans compared to Whites.
Participants (N¼175) included 77 African American and 98
White women with arthritis ranging in age from 45 to 90 (M¼
66.57, SD¼10.74). We recruited participants from a variety of
community sites, including clinics, senior centers, church
groups, and other community groups (e.g., Foster Grand-
parents, the Black Nurses Association of Tampa). We recruited
approximately 25% of participants from clinics: one rheuma-
tology clinic (22%), and two community clinics that serve
individuals with low SES (3%). The remainder (75%) were
from community and church groups. In the rheumatology
clinic, we recruited participants with the assistance of nurses
and rheumatologists who introduced the study to patients with
osteoarthritis (OA) during a clinic visit. We recruited partici-
pants from community groups and clinics through flyers, com-
munity contacts, and presentations in the community.
We screened potential participants for eligibility either in
person or by phone, and we scheduled an interview for all
eligible participants. All potential participants, including both
clinic and community participants, responded to the following
questions in the initial screening: ‘‘What is the main kind of
arthritis that you have?’’ ‘‘Do you have any other kinds of
arthritis such as rheumatoid arthritis, psoriatic arthritis, or
lupus?’’ and ‘‘Are you age 45 or older?’’ Eligibility criteria
included having self-reported OA, being ?45 years of age,
being female, and being cognitively intact. If a potential
participant did not report having OA, then we did not include
her in the study. In the clinic, we only approached patients if the
doctor or nurse confirmed the OA diagnosis. In the community,
we attempted to confirm the OA diagnosis by contacting each
participant’s doctor. Including both clinic and community
participants, we were able to contact participants’ rheumatol-
ogists or physicians for confirmation of their diagnosis for the
majority of the sample (63%). However, for the remainder of
participants, who were recruited from the community, we were
not able to contact their doctor for OA diagnosis confirmation.
Interviews lasted approximately 1 hr. We obtained informed
consent from all participants, and respondents received $20 for
their participation. Trained interviewers conducted the majority
(96%) of the interviews at the rheumatology clinic, community
RACIAL DIFFERENCES IN STRESS
site (e.g., senior center), or the participant’s home. In the
remaining 4% of cases (n ¼ 7), participants were not able to
participate in the study due to time constraints unless they self-
administered the questionnaire at home and mailed it back to
the research office. In these situations, we included a letter with
instructions for filling out the questionnaire. Upon receiving
completed questionnaires, we made follow-up phone calls with
these participants, if necessary, to clarify any unclear answers.
The seven self-administered interviews were evenly distributed
across the two racial groups (four Whites, three African
Americans). We examined all analyses with and without these
seven participants, and the results were unchanged.
Demographic variables.—We measured age as a continuous
variable. We assessed education by asking participants to report
the highest level of education completed. We determined race
by asking participants if they considered themselves to be
White/Caucasian, Black/African American, Latina/Hispanic,
Asian/Pacific Islander, Native American, or other.
Depressive symptoms.—We measured depressive symptoms
with the Center for Epidemiologic Studies–Depression scale
(Radloff, 1977), a 20-item self-report scale that measures
frequency of mood and behavioral symptoms occurring in the
previous week. Example items include ‘‘I felt depressed’’ and
‘‘I enjoyed life.’’ We reverse coded positively worded items.
Items are scored on a 4-point scale ranging from 0 to 3 (rarely/
none of the time, some of the time, occasionally, most of the
time), scores range from 0 to 60, and high scores indicate high
depressive symptoms. Reliability for the Center for Epidemi-
ologic Studies–Depression scale was acceptable for both the
African American and White samples (as ¼ .90 and .90,
Arthritis-related symptoms.—We measured functional im-
pairment with the Arthritis Impact Measurement Scale 2
(AIMS2; Meenan, Mason, Anderson, Guccione, & Kazis,
1992). The AIMS2 functional impairment scale is a 28-item
measure with six subscales, including mobility, walking and
bending, hand and finger function, arm function, self-care, and
household tasks. Possible scores range from 0 to 60, with high
scores indicating poor functional status. We assessed pain with
the AIMS2 5-item scale, which asks respondents to rate
severity of pain, pain in two or more joints, morning stiffness,
and interference with sleep. Scores range from 0 to 10, with
high scores indicating greater pain. The AIMS2 assesses
functional impairment and pain in the past month. Reliability
was acceptable for both functional impairment (as¼.92 and .91
for African Americans and Whites) and pain (as ¼ .77 and .79
for African Americans and Whites).
Perceived arthritis stress.—Four questions assessed primary
appraisal (i.e., harm, threat, challenge, loss) of stress related to
pain from arthritis (based on Folkman & Lazarus, 1980, as used
by Schiaffino & Revenson, 1995). We asked participants to
think about a time when your pain was a moderate level of
intensity or greater. When you had this pain, did you feel: 1)
Harmed because it had occurred? 2) Threatened by something
that might occur in the future? 3) Challenged by the situation?
4) Did you feel that something had been lost or taken away?
Responses ranged from not at all (1) to a great deal (5). Possible
scores ranged from 4 to 20, with a high score indicating more
perceived stress. The primary appraisal scale demonstrated
acceptable reliability (as ¼ .73 and .78 for African Americans
Chronic Life Stressors
Everyday discrimination.—We measured perceptions of
everyday discrimination by using a 10-item scale that assesses
discrimination without any reference to race (Williams et al.,
1997). Example items include ‘‘You are treated with less
courtesy than other people’’ and ‘‘You receive poorer service
than other people at restaurants or stores.’’ Respondents rated
whether these events happened to them in their daily lives
almost everyday, at least once a week, a few times a months,
a few times a year, less than once a year, or never. We
combined never and less than once a year and recoded the items
so that scores for each item ranged from 0 to 4. Scores for the
total scale ranged from 0 to 40, with a high score indicating
greater perceived discrimination. After responding to the 10
questions, respondents stated if these experiences were mainly
due to ancestry or national origins, gender, race, age, height or
weight, shade of skin color, or other. We grouped race, ancestry
or national origins, and shade of skin color together into one
category. The perceived discrimination scale was reliable for
both groups (as ¼ .87 and .82 for African Americans and
Life stress.—We assessed life stress by using a list of 11 life
stressors taken from the National Survey of American Life
(Jackson et al., 2004). Respondents indicated whether the
following events had occurred during the past month (yes or
no): problems with health (other than arthritis), money, job,
children, family, friends, marriage, love life, police; victim of
a crime; treated badly based on race. We summed items for
a total count of life stressors ranging from 0 to 11.
Financial stress.—A 1-item question determined financial
stress: ‘‘How difficult is it for (you/your family) to meet the
monthly payments on your (family’s) bills?’’ Responses ranged
from extremely difficult (5) to not difficult at all (1).
First, we calculated descriptive statistics for the sample’s
demographic characteristics (age, education), arthritis-related
stressors (i.e., pain, functional impairment, perceived arthritis
stress), chronic life stressors (i.e., everyday discrimination,
number of life stressors, financial stress), and depressive
symptoms. We used t-test and chi-square analyses to determine
racial differences between African Americans and Whites
among the study variables.
Next, we used hierarchical regression models to examine the
pattern of relationships between the predictor variables and
MCILVANE ET AL.
depressive symptoms and to determine the amount of variance
in depressive symptoms accounted for by arthritis-related
stressors versus chronic life stressors, separately by race. The
regression procedure involved entering the predictor variables
in three models. We first entered demographic variables (Model
I), followed by arthritis-related stressors (Model II) and chronic
life stressors (Model III). We report unstandardized beta
coefficients to describe the relative importance of the predictor
variables within the regression model. To assess the relative
percentage of variance explained in depressive symptoms
across race, we calculated the confidence interval (CI) for R2for
the White sample as described in Cohen, Cohen, West, and
Aiken (2003) and then examined whether the R2for African
Americans fell outside of the CI, indicating a statistical
difference in the two R2s (i.e., the proportion of variance
accounted for by arthritis-related stressors or by chronic life
stressors was statistically different across the two racial groups).
The total sample (N ¼ 175) included 77 African American
in age between the two groups (see Table 1). However, African
Americans had lower educational attainment than Whites.
Table 1 shows that African Americans reported having sig-
nificantly more functional impairment and lower perceived
arthritis stress than Whites. There was no significant difference
Americans reported significantly more life stressors, more
financial stress, and more everyday discrimination than Whites.
that African Americans were more likely than Whites to report
problems due to money (55% African Americans, 26% Whites;
v2¼ 16.00***) and children (30% African Americans, 16%
Whites; v2¼ 4.57*), however there were no significant racial
differences in reporting of any other individual life stressor.
The majority of African Americans (82%) reported experi-
encing everyday discrimination at least a few times a year,
compared to 63% of Whites (see Table 1). Of those reporting
discrimination, African Americans were more likely to report
that race was the main reason for these events, whereas Whites
were more likely to choose age or other reasons. The other
reasons stated by White women included (a) other people’s bad
attitudes (e.g., ‘‘They just had a bad day probably’’), (b) job-/
family-related issues (e.g., ‘‘My kids don’t respect me as they
should’’), (c) bad customer service (e.g., ‘‘Bad customer service
in stores’’), and (d) own personality (e.g., ‘‘I’m assertive and
people just don’t know how to deal with that’’).
of arthritis-related stressors and chronic life stressors on
depressive symptoms, and the unique variance accounted for
by the two groups of stress variables, separately for each racial
group (see Table 2). First, we entered the demographic variables
(i.e., age, education) for the African American sample in Model
I. Younger age (b ¼?0.25, p , .05) and lower education (b ¼
?1.07, p , .001) were significantly related to higher levels of
the total variance. We entered the arthritis-related stress
indicators (i.e., pain, functional impairment, perceived arthritis
stress)inModelII.Higher levelsofperceivedarthritis stress (b¼
0.89, p , .01) were significantly related to more depressive
symptoms, and the arthritis-related stress variables together
accounted for 16% of the variance in Model II. We entered the
chronic life stress variables (i.e., number of life stressors,
financial stress, everyday discrimination) in Model III. Higher
levels of financial stress (b¼2.55, p , .001) and more everyday
discrimination (b ¼ 0.51, p , .01) were significantly related to
higher levels of depressive symptoms. Chronic life stressors
accounted for an additional 20% of the variance in depressive
symptoms. In the final model, when we took all of the variables
strain, and more everyday discrimination were related to higher
accounted for 53% of the total variance in depressive symptoms.
Table 1. Descriptive Statistics for Study Variables
(n ¼ 77)
11.5 (10.0) 11.7 (9.6)
66.1 (11.1) 66.9 (10.5)
(n ¼ 98)
Age (M in years)
Education (M in years) 12.5 (3.4) 14.1 (2.1)3.73***
High school or less (%)
More than high school (%)
Perceived arthritis stress
Chronic life stressors
No. of life stressors
Financial stress (high ¼ high stress)
Any discrimination in previous
year? (% yes)82 63(7.01)**
Main reason for discrimination
(if yes; %)
Racea(þ skin color, nation
Life stressors (%)
Health problems (other than arthritis)
Problems with children
Problems with family
Problems with a friend
Problems with love life
Treated badly because of race
Victim of a crime
Problems with police
aIncludes participants who chose race, shade of skin color, or
ancestry/national origins as the reason for discrimination.
bIncludes participants who chose ‘‘other’’ or height/weight as the reason for
*p ? .05; **p ? .01; ***p ? .001.
RACIAL DIFFERENCES IN STRESS
Next, for the White sample, in Model I the demographic
variables accounted for 11% of the variance, with younger age
(b¼?0.26, p , .01) and lower education (b¼?1.13, p , .01)
both significantly related to more depressive symptoms (see
Table 2). In Model II, higher levels of functional impairment
(b¼ 0.48, p , .001) were significantly related to more depres-
sive symptoms, and the arthritis-related stress variables together
accounted for an additional 24% of the variance in depressive
symptoms. Model III included chronic life stress indicators.
Higher levels of everyday discrimination (b ¼ 0.55, p , .05)
were significantly related to higher levels of depressive
symptoms and accounted for an additional 6% of the variance.
In the full model, which took all variables into account, higher
levels of functional impairment and more everyday discrimi-
nation were related to higher levels of depressive symptoms
for White women and accounted for 41% of the variance in
In order to compare the variance explained by arthritis-
related stressors among the two racial groups, we first
calculated the 95% CI for the R2for the White sample (R2¼
.24, CI ¼ .09, .38). The R2for arthritis-related stressors for the
African American sample was .16, which overlapped with the
CI for Whites, indicating that the variance explained for the two
groups was not statistically different. We next calculated the
95% CI for chronic life stressors for the White sample (R2¼
.06, CI ¼ ?.03, .16). In this case, the R2for the African
American sample, which was .20, did not overlap with the CI
for the White sample. This indicates that chronic life stressors
accounted for more variance in depressive symptoms for
African Americans compared to Whites.
In the current study, we sought to examine racial differences
in arthritis-related stress and chronic life stress as well as the
relationship between these stressors and well-being for African
American and White women. The results suggest that African
American women experienced more functional impairment but
had lower perceptions of arthritis stress than their White
counterparts. Additionally, African American women reported
higher levels of chronic life stress (i.e., everyday discrimina-
tion, financial stress, and number of other life stressors).
For well-being, the findings suggest a different pattern of
relationships for African American and White women among
the arthritis stress and chronic life stress variables. Perceptions
of greater stress due to arthritis, financial stress, and everyday
discrimination were related to higher levels of depressive
symptoms for African Americans, whereas more functional
impairment and everyday discrimination were related to higher
depressive symptoms for Whites. Moreover, chronic life stress
accounted for more variance in depressive symptoms for
African American women, whereas arthritis-related stressors
accounted for similar proportions of variance across the two
Racial Differences in Perceptions of Arthritis-Related
Stress and Life Stress
Prior research has demonstrated that African Americans
experience more severe arthritis-related symptoms, including
more activity limitations and pain, compared to Whites (Centers
for Disease Control and Prevention, 2005; Kington & Smith,
1997). However, findings are mixed, with some studies failing
to find racial differences in arthritis-related symptoms (Ang,
Ibrahim, Burant, & Kwoh, 2003). Accordingly, the findings
from the current study reveal racial differences in functional
impairment and perceived arthritis stress, but not pain. African
American women reported more functional impairment com-
pared to White women; however, we should note that in
a previous analysis of these data, the racial difference in
functional impairment was no longer significant when we
accounted for SES (McIlvane, 2007).
In terms of perceptions of arthritis stress as being harmful,
challenging, threatening, or causing loss, African American
women had lower perceptions of arthritis stress compared to
White women. Here we emphasize that context matters;
although these findings are preliminary, it is possible that
Table 2. Effects of Arthritis-Related Stress and Chronic Life Stress on Depressive Symptoms for African Americans and Whites
African Americans (n ¼ 75)
Whites (n ¼ 96)
Model II Variable Model IModel IIIModel I Model III
Perceived arthritis stress
No. of life stressors
Notes: Data are unstandardized betas (SE).
*p ? .05; **p ? .01; ***p ? .001.
MCILVANE ET AL.
African American women have different perceptions and
experiences regarding arthritis-related stress and other chronic
life stressors (e.g., discrimination, financial stress) compared to
To that end, African American women reported more chronic
life stress than White women for every indicator, suggesting
that African American women may be dealing with more
outside stressors (e.g., financial stress) in addition to arthritis.
Consideration of chronic life stressors that may be more salient
for diverse racial groups with arthritis is particularly important,
yet not often considered. Nonetheless, health reflects a social
and historical pattern of differential treatment, rights, privileges,
and unequal social status based on race and SES (King &
Williams, 1995). For instance, the finding that African
American women reported more everyday discrimination is
consistent with past research (Barnes et al., 2004). However,
African American women and White women attributed these
events to different reasons. African American women were
more likely to attribute these events to race (56% compared
to 2% of White women), whereas White women were likely
to attribute these events primarily to age and other reasons.
Similarly, African American women reported experiencing
more financial stress and other life stressors, particularly money
problems and problems with children, compared to White
women. Although the current study provides preliminary infor-
mation on potential racial differences in perceptions of arthritis-
related stress and broader chronic life stressors among women,
future research should continue to focus on the relationship
among these stressors and how it impacts well-being across
different racial and gender groups.
Racial Differences in the Relationship Between
Stress and Well-Being
A different pattern of relationships emerged between stress
and well-being for African Americans compared to Whites,
underscoring the importance of considering relationships
among health, stress, and well-being separately for diverse
racial groups (Dilworth-Anderson, Williams, & Gibson, 2002).
For White women, functional impairment and everyday
discrimination were related to depressive symptoms. For
African American women, perceived arthritis stress, financial
stress, and everyday discrimination were related to depressive
symptoms. The findings also demonstrate that chronic life
stressors accounted for more of the variance in depressive
symptoms for African Americans than Whites, whereas
arthritis-related stressors accounted for similar proportions of
the variance across the two groups.
The finding that functional impairment is related to well-
being for White women confirms prior research (e.g.,
Williamson & Schulz, 1992; Zeiss et al., 1996). Yet the ques-
tion remains as to why functional impairment was not signifi-
cantly related to depressive symptoms for African American
women. A recent longitudinal study demonstrated that for low-
SES older adults, increases in functional impairment were
related to increases in depression for Whites but not for African
Americans (Schieman & Plickert, 2007). To explain this
finding, Schieman and Plickert suggested that African Amer-
icans are more likely to have lifetime experiences with illness
and disability, whereas White women do not expect to have
functional limitations. It may be that African Americans have
more experience with illness, find it less distressing, and are
better able to cope than Whites. This is important, considering
that African Americans are disproportionately diagnosed with
more severe and debilitating illnesses (Bazargan & Hamm-
Baugh, 1995; Feldman & Fulwood, 1996; Gibson & Jackson,
Alternatively, African American women are more likely to
be coping with multiple chronic life stressors, which may cause
more distress. This is not to suggest that pain and functional
impairment are unrelated to well-being in African American
women; arthritis-related symptoms were related to depressive
symptoms in bivariate analyses (not shown) and accounted for
a similar amount of depressive symptoms among African
Americans and Whites. However, it may be that other factors,
such as perceptions of arthritis stress and other life stressors,
need to be considered. Overall, our findings suggest that
arthritis-related stressors may be the predominant factors
explaining well-being for White women, whereas well-being
in African American women may also be closely linked to
exposure to broader chronic life stressors.
Future Research and Conclusions
The results from the current study provide preliminary
highlighting the importance of contextual factors in health and
aging. However, we should note several limitations. The results
need to be replicated using larger, more representative samples.
Specifically, the use of community- and clinic-based samples
of women suggests that the results cannot be generalized to
all African Americans, to all Whites, or to men. Additionally,
participantsself-reported havingarthritis, andself-reports can be
prone to bias. However, we were able to access participants’
rheumatologists or physicians for further confirmation of their
offers a snapshot view of stress and illness at one point in time,
and the cross-sectional design limits the conclusions that can be
Somehaveemphasizedthe importanceof incorporating alife-
Williams, 2002). In particular, older African American women
are likely to have experienced a lifetime of discrimination, and
it is important to take this into consideration in studies on health
and well-being (Becker & Newsom, 2005). Racial differences
in exposure to stress across the life course signify critical
differences in access to care, utilization, proper diagnosis, and
treatment, all of which have implications for health and well-
being (Jackson, 2002). Future research needs to take a more
detailed look at the accumulation of stress, complex interplay
among stressors across a lifetime, and especially those stressors
that may be unique to diverse racial groups and to women.
The current study highlights the complexity of capturing the
chronic life stressors was unrelated to depressive symptoms for
didnotfully capturethe day-to-dayexperience of stress forthese
two groups of women. In addition, we used a measure that
assessed discrimination regardless of the cause, and, not
surprisingly, the perceived reason for these events appears to
RACIAL DIFFERENCES IN STRESS
be different for the two racial groups. The discrimination
measure may be capturing ageism and daily hassles rather than
racial discrimination for White women, because the majority
attributed these events to age or other reasons.
These issues highlight an additional study limitation re-
garding measurement equivalence across the two racial groups.
Establishing measurement equivalency is always a difficult
issue requiring the use of very large sample sizes to determine if
the measure is equivalent or measuring the same construct
across racial groups. The small sample size in this study limits
our ability to establish measurement equivalency. We also
recognize that cultural differences in the interpretation of
measures used in the study may contribute to our findings.
However, few studies have examined the impact of perceived
(or experienced) discrimination on arthritis-related symptoms,
pain management, or quality of life in older patients in general,
and older women with arthritis in particular. Future research
efforts should continue to examine the role of discrimination
and social structure in the general health and well-being of
diverse racial populations with arthritis; however, studies with
larger samples across racial groups will be necessary to fully
address this issue.
The results from the current study have implications for
future research as well as for service providers working with an
increasingly diverse aging population. When considering how
people adapt to arthritis, it is important not only to focus on
arthritis-related symptoms but also to be aware of the impact of
broader chronic life stressors. Arthritis, as well as other types
of chronic illness, does not occur in a vacuum, and it is
important to consider the broader social context in which
people are living with chronic illness. This may be especially
true for African Americans, who are more likely to experience
other chronic life stressors such as discrimination and financial
stress. Research on health and aging, as well as health
disparities, should consider chronic life stress and the context
in which women from diverse racial backgrounds are living
with chronic illness.
We would like to gratefully acknowledge Dr. Mihaela Popa for
assistance with participant recruitment, data collection, and data cleaning;
and Mary Ann Watson, the Black Nurses Association of Tampa,
Evangeline Best, Elizabeth Bergman, Ronna Metcalf, Dr. Roy Kaplan,
and Mary Kaplan for their assistance with recruiting participants for the
study. We would also like to thank Dr. Bill Haley and Dr. Brent Small for
their invaluable feedback on the paper. Lastly, we would like to thank our
study participants. This research was supported by Pilot Grant RO3
AG22652-01 from the National Institute on Aging.
J. M. McIlvane planned the study, analyzed the data, and contributed to
writing and revising the paper. T. A. Baker contributed to writing and
revising the paper. C. A. Mingo wrote the Results section and contributed
to revising the paper.
Address correspondence to Jessica M. McIlvane, PhD, School of Aging
Studies, University of South Florida, 4202 East Fowler Avenue, MHC1318,
Tampa, FL 33620. E-mail: firstname.lastname@example.org
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Received February 12, 2008
Accepted June 5, 2008
Decision Editor: Kenneth F. Ferraro, PhD
RACIAL DIFFERENCES IN STRESS