Research Paper - Archives of General Internal Medicine (2019) Volume 3, Issue 1
High Sense of Mastery Reduces Psychological Distress for African-American Women but not African-American MenShervin Assari1,2,3*
- *Corresponding Author:
- Shervin Assari
Department of Family Medicine
Charles R Drew University of Medicine and Science
Los Angeles, CA,USA
E-mail: [email protected]
Accepted date: February 15, 2019
Citation: Assari S. High sense of mastery reduces psychological distress for African-American women but not African-American men. Arch Gen Intern Med. 2019; 3(1):01-04. DOI: 10.4066/2591-7951.100066
Recent research has suggested that relative to Whites, African Americans (AAs) may be at a systemic disadvantage regarding the health effects of socioeconomic position (SEP) indicators as well as psychological assets (e.g., sense of mastery). However, less is known about how these diminished returns differ between AA men and women. This study tested whether AA men and women differ in the mental health effects of high sense of mastery. The National Survey of American Life (NSAL, 2003) recruited 3570 AA adults who were either female (n = 2299) or male (n = 1271). Dependent variable was psychological distress. Independent variable was sense of mastery. Gender was the focal moderator. Age and educational attainment were the covariates. Multiple linear regression model was applied for statistical analysis. Overall, high sense of mastery was associated with lower psychological distress. Significant interaction was found between gender and sense of mastery on psychological distress suggestive of a stronger association for AA women compared to men. A smaller mental health gain of high sense of mastery for AA men compared to AA women is indicative of within race heterogeneity regarding diminished returns. Racism and discrimination may be why high sense of mastery does not translate to mental health gain for AA men.
African-Americans, Blacks, Socioeconomic status (SES), Socioeconomic position (SEP), Racism, Distress, Mastery
Both high socioeconomic position (SEP) [1-3] and psychological assets [4,5] are protective against undesired mental health outcomes. For example, educational attainment and income [6,7] as well as high sense of mastery  are protective against depression and distress. These protective effects, however, are unequal across race and ethnic groups [9-19].
As argued by the Minorities’ Diminished Return (MDR) theory [20,21], SEP indicators [22,23] and personal assets [24-26] have weaker effects on mental and physical health of African American (AA) and other race/ethnic groups compared to Whites. An extensive body of research has shown that SEP has weaker effects on diet , obesity [13,19], alcohol use , smoking , impulse control , chronic disease [14,22], suicidal ideation , anxiety , depression [20,29], selfrated health , and life expectancy  for AA individuals compared to White Americans.
There are, however, studies suggesting that even within AAs, men may be at a relative disadvantage compared to women. In a 25-year follow up study of White and AA men and women, AA men were the only group in which a high level of educational attainment was linked to an increase in depressive symptoms over time . Another study showed that high-SEP youth, particularly males and those who were living in predominantly White neighborhoods, experienced more depressive symptoms over time, an effect which is probably due to discrimination [29,31]. In another national study, AA boys from wealthy families showed higher risk of clinical depression compared to their low SEP counterparts .
As some research built on MDR theory has shown [20,21], SEP resources and psychological assets generate smaller protective effects on the mental health of AA individuals, particularly AA males [10,11,20]. It is, however, still unclear why this pattern is worse for males than females. To respond to this gap in the literature, this study aimed to explore gender differences in the association between sense of mastery and psychological distress among AA adults in the United States. To generate generalizable results, we used a nationally representative sample.
This secondary analysis used data from the National Survey of American Life (NSAL 2003). NSAL is a cross-sectional survey of non-Hispanic Black/AA adults in the US [32-34]. We briefly describe the overview of the study design, sampling, and methods here. More details on the NSAL methods and sampling is published elsewhere [32-34].
The NSAL enrolled a household probability sample. In the NSAL, AAs were selected from rural and urban areas [32-34]. Using a multi-stage sampling design, the NSAL followed the core sampling that the National Survey of Black Americans (NSBA) applied.
Eligibility and sampling
The NSAL participants were eligible only if they were adult (age 18 years or older), were residing in the coterminous US, were non-institutionalized, and could perform an interview in English. Any individual who was residing in a nursing home, a long-term medical care setting, or a prison/jail was excluded . Race/ethnicity in the NSAL was measured using selfidentified response. All participants in this analysis selfidentified as non-Hispanic AA, defined as being black with no ties to Caribbean countries.
The analytical sample in this study composed of 3570 AA adults who were either female (n=2299) or male (n=1271).
The variables entered in this study were gender, age, educational attainment, sense of mastery, and psychological distress.
Educational attainment: Educational attainment was selfreported and treated as an interval variable (years of schooling). A higher score was indicative of higher SEP.
Sense of mastery: Sense of mastery was measured using the scale developed by Pearlin. This questionnaire measures how much a person feels that he/she has control over events in his/ her life . Example item is “What happens to me in the future mostly depends on me” The responses ranges from (1) strongly disagree to (4) strongly agree. This variable was treated as a continuous measure. All items were reverse-coded so the higher score would indicate higher sense of mastery .
Psychological distress: To measure psychological distress, K6 was used. K6, developed by Ronald Kessler , is a six-item scale that is designed to evaluate nonspecific psychological symptoms such as anxiety and depression in the past month. Participants report how frequent they felt 1) sad, 2) hopeless, 3) worthless, 4) nervous, 5) restless, and 6) no interest over the past 30 days. The K6 has the potential to identify individuals who are at an increased risk for mental health problems and may require treatment . Response item is on a 5-scale ranging from 1 (none of the time) to 5 (all the time), with a total score ranging from 6 to 30. Higher scores reflect more psychological distress [40,41] (Alpha=0.84).
As the NSAL is a survey with a complex sampling design, Stata 15.0 (Stata Corp., College Station, TX, USA) was used to perform the data analysis. Standard Errors (design-based SEs) were estimated using Taylor series approximation. Thus, all inferences, means, and proportions are generalizable to the US AA population. Using Svy commands with sub-pop options, we used survey linear regression models for multivariable analysis. Sense of mastery was the main independent variable, psychological distress was the dependent variable, gender was the moderator, and age and educational attainment (SEP) were covariates. First, we ran two linear regressions in the pooled sample that included both men and women. Model 1 did not include any interaction term. Model 2, however, included an interaction term between sense of mastery and gender. Then we ran two gender- stratified models, one for AA females and one for AA males (Models 3 and Model 4). Adjusted b, SE, Confidence Interval (CI), and p-values were reported.
From the participating 3570 AA adults, 2299 were women and 1271 were men. Table 1 describes age, SEP (educational attainment), sense of mastery, and psychological distress overall, as well as by gender.
|Sense of Mastery||27.2||0.1||26.98||27.41|
|Psychological Distress (K-6)||4.81||0.13||4.54||5.08|
|Sense of Mastery||27.04||0.12||26.8||27.27|
|Psychological Distress (K-6)*||5.17||0.14||4.88||5.45|
|Sense of Mastery||27.4||0.15||27.1||27.71|
|Psychological Distress (K-6)||4.36||0.18||3.99||4.72|
Table 1. Descriptive characteristics in the overall sample. * p<0.05 for a comparison of men and women.
Multiple linear regressions in the overall sample
Table 2 depicts the summary of the results of multiple linear regression models in the pooled sample. In the pooled sample, high sense of mastery was associated with lower levels of psychological distress beyond confounders. In the pooled sample, we found a significant interaction between gender and sense of mastery on psychological distress. This suggests that high sense of mastery is more strongly associated with low psychological distress for AA women than AA men (Table 2).
|Model 1 (All)|
|Sense of Mastery||-0.44||0.02||-0.49||-0.39||-19.2||<0.001|
|Model 2 (All)|
|Sense of Mastery||-0.48||0.02||-0.53||-0.44||-20.41||<0.001|
|Sense of Mastery * Gender (Men)||0.1||0.04||0.02||0.19||2.43||0.02|
Table 2. Multiple linear regressions in the overall sample of African American adults. Standard Errors (SE), 95% Confidence Interval (CI).
Gender-stratified multiple linear regression models
Table 3 presents the results of our gender-stratified linear regression models. In AA women (Models 3) but not AA men (Models 4), high sense of mastery was correlated with less psychological distress (Table 3).
|Model 3 (Women)|
|Sense of Mastery||-0.48||0.02||-0.53||-0.43||-19.28||<0.001|
|Model 4 (Men)|
|Sense of Mastery||-0.39||0.04||-0.47||-0.31||-9.81||<0.001|
Table 3. Multiple linear regressions for African American men and women. Standard Errors (SE), 95% Confidence Interval (CI).
This study found that in a nationally representative sample, high sense of mastery is associated with lower psychological distress for AA women but not AA men. That is, AA men are at a relative disadvantage compared to AA women in gaining mental health from their sense of mastery. Although this study did not measure racism, we attribute this finding to the stronger effect of structural racism facing AA men than AA women.
The findings can be interpreted with the MDR theory in mind [14,15]. According to this theory, AAs gain less health from their available resources than Whites. Across age groups including children , youth [43,44], adults , and older adults , SEP and personal assets better improve health for whites than non-whites.
This study suggests that even within various social identities such as race and ethnicity, other social identities shape advantage or disadvantage. The intersection of multiple social identities such as gender and race determine how much health follows from SEP resources and psychological assets. Among AA individuals, males are at a dual disadvantage as they do not gain mental health from the very same SEP and psychological resources. Most of the papers built on the MDR theory, however, have merely compared race/ethnic groups [14,15], with less information being available on the nuances such as gender differences within race.
The weak effect of SEP resources such as educational attainment and psychological assets in lowering psychological distress among AA men is in line with previous research [9,20]. Similarly, there is some research suggesting that SEP and psychological assets have smaller effects on chronic disease , health behaviors [15,16], obesity , and mortality  for AA individuals, particularly males [10,11,46]. More research is needed on the interplay of race/ethnicity, SEP, and gender on health.
Discrimination, which is probably responsible for reduced health gains of SEP resources and psychological assets,  is more common in male than female AA individuals [31,46]. In addition, AA men are considerably more sensitive to the effects of discrimination and related stressors on psychological distress [41,47,48].
The results suggest that AA men with high sense of mastery still report high levels of psychological distress. High-mastery AA women, however, report lower psychological distress. Thus, while AA men with high mastery still need screening, diagnosis, and treatment of mental problems, however, a high sense of mastery is protective for AA women. As mental health protection that follows a high sense of mastery differs for AA men and women, AA men and women with psychological distress may have very different needs. High sense of mastery is linked to better mental health . That means, AA men need other support in addition to their individual sense of mastery to overcome racism. Personal factors such as sense of mastery convey less information regarding psychological distress for AA men than other groups. This is another reason interventions and programs benefit from tailored design based on the intersections of race/ethnicity, gender/sex, and SEP/class. Such approach may be superior to universal programs that do not take into account specific needs of each subsection of the society .
The current study is not without limitations. First, with a crosssectional design, this study is limited in making any causal inferences. While sense of mastery impacts psychological distress, psychopathology also reduces sense of mastery. Whether there is causal association, reverse causality, or confounding due a third factor, sense of mastery and distress seem to differently correlate in AA men and women. Second, sample size was larger for females than males. Given that we did not find an association in the group with lower sample size, differential statistical power may have biased our results. However, there are always fewer AA men than AA women in national surveys. Although differential statistical power may have affected our gender-stratified models, sample size would not be a source of bias in our pooled sample model with an interaction term. Third, the main outcome here was symptoms of distress rather than a clinical disorder (e.g., diagnosed by a psychiatrist). Fourth, very limited number of potential confounders was controlled. A wide range of individual and contextual factors may be associated with both sense of mastery and psychological distress . Fifth, psychological distress and sense of mastery may be differently prone to measurement bias in AA men and women. Overall, women better disclose their emotional symptoms, while men tend to hide them. Sixth, we argue that the reason AA men and women differ in these associations is structural racism, oppression, injustice, and discrimination [51-53]. We, however, did not measure any explanatory factor that could potentially explain our gender differences. Finally, as there are more AA men who are institutionalized (e.g., imprisoned) than AA women, selection bias may be a more severe source of bias for AA men than AA women in national surveys. There is a need to replicate our findings using newer, longitudinal data, with more comprehensive list of confounders. Also, there is a need to extend the MDR to within race comparison of diminished returns [54-58].
To conclude, a higher sense of mastery is associated with lower psychological distress for AA women but not AA men. This observation extends the MDR theory by documenting within-race heterogeneity in the diminished returns by gender. Diminished returns may be worse for AA men compared to AA women. This finding has implications for practice and policy concerning mental health and well-being of AA men.
The NSAL is mainly supported by the National Institute of Mental Health, with grant U01-MH57716. Support from the Office of Behavioral and Social Science Research at the National Institutes of Health and the University of Michigan is also acknowledged. Shervin Assari is partly supported by the Center for Medicare and Medicaid Services (CMS, 1H0CMS331621, PI=Mohsen Bazargan), National Institute on Minority Health and Health Disparities (NIMHD, 4P60MD006923-05; PI=Vickie Mays), the National Institute of Child Health and Human Development (NICHD, D084526-03), the National Cancer Institute (CA201415 02; Co-PI=Ritesh Mistry), and the National Institute on Drug Abuse (NIDA; DA035811-05; PI=Marc Zimmerman). Special thanks to Hamid Helmi, Wayne State University, for his contribution to this paper.
Conflicts of Interest
The author declares no conflicts of interest.
- Mirowsky J, Ross CE. Education, health, and the default American lifestyle. J Health Soc Behav. 2015;56(3):297-306.
- Ross CE, Mirowsky J. Refining the association between education and health: The effects of quantity, credential, and selectivity. Demography. 1999;36(4):445-60.
- Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. J Health Soc Behav. 2010;51:S28-40.
- Surtees PG, Wainwright NW, Luben R, et al. Mastery, sense of coherence, and mortality: Evidence of independent associations from the EPIC-Norfolk prospective cohort study. Health Psychol. 2006;25:102-10.
- Surtees PG, Wainwright NW, Luben R, et al. Mastery is associated with cardiovascular disease mortality in men and women at apparently low risk. Health Psychol. 2010;29(4):412-20.
- Herd P, Goesling B, House JS. Socioeconomic position and health: The differential effects of education versus income on the onset versus progression of health problems. J Health Soc Behav. 2007;48:223–38.
- Leopold L, Engelhardt H. Education and physical health trajectories in old age. Evidence from the Survey of Health, Ageing and Retirement in Europe (SHARE). Int J Public Health. 2013;58:23–31.
- Bennetter KE, Clench-Aas J, Raanaas RK. Sense of mastery as mediator buffering psychological distress among people with diabetes. J Diabetes Complications. 2016;30(5):839-44.
- Assari S. High income protects whites but not African Americans against risk of depression. Healthcare. 2018;6:37.
- Assari S, Caldwell CH. High risk of depression in high-income African American Boys. J Racial Ethn Health Disparities. 2018;5:808-19.
- Assari S, Lankarani MM, Caldwell CH. Does discrimination explain high risk of depression among high-income African American Men?. Behav Sci. 2018;8:40.
- Fuller-Rowell TE, Curtis DS, Doan SN, et al. Racial disparities in the health benefits of educational attainment: A study of inflammatory trajectories among African American and white adults. Psychosom Med. 2015;77:33–40.
- Assari S, Thomas A, Caldwell CH, et al. Blacks' diminished health return of family structure and socioeconomic status: 15 years of follow-up of a National Urban Sample of Youth. J Urban Health. 2018;95:21-35.
- Assari S. Unequal gain of equal resources across racial groups. Int J Health Policy Manag. 2017;7:1-9.
- Assari S, Lankarani M. Educational attainment promotes fruit and vegetable intake for whites but not blacks. 2018;1:29-41.
- Assari S, Mistry R. Educational attainment and smoking status in a national sample of American adults: Evidence for the blacks' diminished return. Int J Environ Res Public Health. 2018;15:763.
- Assari S, Lankarani MM. Education and alcohol consumption among older Americans; Black-white differences. Front Public Health. 2016;4:67.
- Assari S, Caldwell CH, Mincy R. Family socioeconomic status at birth and youth impulsivity at age 15: Blacks' diminished return. Children (Basel). 2018;5:58.
- Assari S. Family income reduces risk of obesity for white but not black children. Children. 2018;5:73.
- Assari S. Combined racial and gender differences in the long-term predictive role of education on depressive symptoms and chronic medical conditions. J Racial Ethn Health Disparities. 2017;4:385-96.
- Assari S. Health disparities due to diminished return among black americans: Public policy solutions. Soc Issues Policy Rev. 2018;12:112-45.
- Assari S, Lankarani M. Poverty status and childhood asthma in white and black families: National survey of children's health. Healthcare. 2018;6:62.
- Assari S, Lankarani MM. Race and urbanity alter the protective effect of education but not income on mortality. Front Public Health. 2016;4:100.
- Assari S. General self-efficacy and mortality in the USA: Racial differences. J Racial Ethn Health Disparities. 2017;4(4):746-57.
- Assari S. Association between self-esteem and depressive symptoms is stronger among black than white older adults. J Racial Ethn Health Disparities. 2017;4(4):687-95.
- Assari S. Race, sense of control over life, and short-term risk of mortality among older adults in the United States. Arch Med Sci. 2017;13(5):1233-40.
- Assari S. Ethnic and gender differences in additive effects of socio-economics, psychiatric disorders, and subjective religiosity on suicidal ideation among blacks. Int J Prev Med. 2015;6:53.
- Assari S, Caldwell CH, Zimmerman MA. Family structure and subsequent anxiety symptoms: Minorities' diminished return. Brain Sci. 2018;8:97.
- Assari S, Gibbons FX, Simons R. Depression among black youth: Interaction of class and place. Brain Sci. 2018;8:108.
- Assari S, Lapeyrouse LM, Neighbors HW. Income and self-rated mental health: Diminished returns for high income black Americans. Behav Sci. 2018;8:50.
- Assari S, Gibbons FX, Simons RL. Perceived discrimination among black youth: An 18-year longitudinal study. Behav Sci. 2018;8:44.
- Jackson JS, Torres M, Caldwell CH, et al. The national survey of american life: A study of racial, ethnic, and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res. 2004;13:196-207.
- Jackson JS, Neighbors HW, Nesse RM, et al. Methodological innovations in the National Survey of American Life. Int J Methods Psychiatr Res. 2004;13:289-98.
- Heeringa S, Wagner J, Torres M, et al. Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES). Int J Methods Psychiatr Res. 2004;13:221-39.
- Jackson JS, Torres M, Caldwell CH, et al. The National Survey of American Life: A study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res. 2004;13:196-207.
- Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav. 1978;19:2-21.
- Assari S, Caldwell CH. The link between mastery and depression among black adolescents: Ethnic and gender differences. Behav Sci (Basel). 2017;7(2).
- Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32:959-76.
- Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60:184-9.
- Lincoln KD, Chatters LM, Taylor RJ. Psychological distress among black and white Americans: Differential effects of social support, negative interaction and personal control. J Health Soc Behav. 2003;44:390-407.
- Assari S, Lankarani MM. Discrimination and psychological distress: Gender differences among Arab Americans. Front Psychiatry. 2017;8:23.
- Assari S, Hani N. Household income and children's unmet dental care need: Blacks' diminished return. Dent J. 2018;6:17.
- Assari S, Caldwell CH. Low family support and risk of obesity among black youth: Role of gender and ethnicity. Children. 2017;4:36.
- Assari S, Caldwell CH, Mincy RB. Maternal educational attainment at birth promotes future self-rated health of white but not black youth: A 15-year cohort of a national sample. J Clin Med. 2018;7:93.
- Assari S, Nikahd A, Malekahmadi MR, et al. Race by gender group differences in the protective effects of socioeconomic factors against sustained health problems across five domains. J Racial Ethn Health Disparities. 2017;4:884-894.
- Assari S, Caldwell CH. Social determinants of perceived discrimination among black youth: Intersection of ethnicity and gender. Children. 2018;5:24.
- Hudson DL, Bullard KM, Neighbors HW. Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?. J Men’s Health. 2012;9:127-36.
- Assari S, Mistry R, Caldwell CH. Perceived discrimination and substance use among caribbean black youth: Gender differences. Brain Sci. 2018;8:131.
- Barrera M, Castro FG Jr, Strycker LA, et al. Cultural adaptations of behavioral health interventions: A progress report. J Consult Clin Psychol. 2013;81:196-205.
- McKinney CM, Chartier KG, Caetano R, et al. Alcohol availability and neighborhood poverty and their relationship to binge drinking and related problems among drinkers in committed relationships. J Interpers Violence. 2012;27:2703-27.
- Lucas T, Woerner J, Pierce J, et al. Justice for all? Beliefs about justice for self and others and telomere length in African Americans. Cultur Divers Ethnic Minor Psychol. 2018.
- Lucas T, Lumley MA, Flack JM, et al. A preliminary experimental examination of worldview verification, perceived racism, and stress reactivity in African Americans. Health Psychol. 2016;35:366-75.
- Lucas T, Alexander S, Firestone I, et al. Just world beliefs, perceived stress, and health behavior: The impact of a procedurally just world. Psychol Health. 2008;23:849-65.
- Assari S. Life expectancy gain due to employment status depends on race, gender, education, and their intersections. J Racial Ethn Health Disparities. 2018;5:375-86.
- Assari S. Does school racial composition explain why high income black youth perceive more discrimination? A gender analysis. Brain Sci. 2018;8:140.
- Assari S, Preiser B, Kelly M. Education and income predict future emotional well-being of whites but not blacks: A ten-year cohort. Brain Sci. 2018;8:122.
- Assari S, Moghani Lankarani M. Workplace racial composition explains high perceived discrimination of high socioeconomic status African American men. Brain Sci. 2018;8:139.
- Assari S. Educational attainment better protects African American women than African American men against depressive symptoms and psychological distress. Brain Sci. 2018;8:182.