The Heart of Strength: The Strong Black Woman Schema and Cardiovascular Disease Risk

Black women are disproportionately affected by cardiovascular disease (CVD). While chronic stress has been identified as a key contributor to CVD risk, research has not identified the specific mechanisms through which stress influences CVD risk among Black women. Research suggests that in response to stress, Black women who internalize the SBW Schema engage in high effort coping, avoidant coping, postponement of self-care, and other maladaptive health behaviors and experience premature health deterioration. However, it is important to consider that internalization of the SBW Schema may exert differential effects on the physiological profiles of Black women due to varied interpretations of experiences filtered through the Schema and differences in emotion regulation. As emotion regulation has a robust impact on cardiovascular outcomes, individual differences in internalization of the SBW Schema may be explained by this related construct. Given that limited research has examined the impact of psychological factors associated with CVD risk in Black women, the current study examined relations between CVD risk, chronic stress, emotion regulation, and the Strong Black Woman (SBW) Schema. Hypotheses were: 1) internalization of the SBW Schema (i.e., higher levels of endorsement) and chronic stress are unique predictors of CVD risk, 2) the relation between internalization of the SBW Schema and CVD risk will be partially mediated by emotion regulation, and 3) the effect of chronic stress on CVD risk will be moderated by internalization of the SBW Schema. Results provided partial support for the first hypothesis and did not support the second and third hypotheses. Results of exploratory analyses revealed relationships among psychological variables, such that greater endorsement of SBW Schema characteristics (obligation to manifest strength, dedication to care, independence, and emotion suppression) was related to greater overall difficulties with emotion regulation. Additionally, greater dedication to care predicted lower CVD risk and greater emotional suppression predicted higher CVD risk. The relationship between emotional suppression and CVD risk was mediated by emotion regulation. Results stand to inform future research and culturally specific prevention strategies to decrease CVD risk in Black women.