The seemingly ‘protective’ effect of internalised racism on overall health among 780 Black/African Americans: the serial mediation of stigma consciousness and locus of control

Objective: Internalised racism (IR) is associated with better and worse health outcomes among racial/ethnic minorities. However, the underlying mechanisms associating IR with either positive or negative health outcomes are not well understood. Design & main outcomes measures: To address this gap, this study investigated two pathways that associate increased IR with better self-reported overall health (OH; i.e. dental, mental, physical and vision health) among 780 Black/African American adults (mean age 37.68 years, 57.6% female): (1) via stigma consciousness and (2) via stigma consciousness and locus of control beliefs. Results: Consistent with predictions, stigma consciousness mediated the indirect effect of IR on OH, such that higher IR was associated with lower stigma consciousness, which was associated with better self-reported OH. Confirming predictions, this indirect effect was also carried through locus of control beliefs, such that higher IR was associated with lower stigma consciousness; lower stigma consciousness was also associated with internal locus of control beliefs, which were associated with better self-reported OH. Conclusions: Although seemingly protective, this adaptive, strategic and short-term response to race-based threat in which group stereotypes are internalised can lead to negative health outcomes over time. These findings have implications for understanding IR and associated health disparities.