Social Science & Medicine 74 (2012) 1791e1801

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Social Science & Medicine

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Triple jeopardy? Mental health at the intersection of gender, race, and class
Sarah Rosenfield*
Department of Sociology, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 134 Davison Hall, Douglass Campus, New Brunswick, NJ 08901, USA

a r t i c l e i n f o a b s t r a c t

Article history: Structural theories of stratification predict that groups with low positions in social hierarchies experience
Available online 5 January 2012 high rates of mental health problems. Extensions of this approach such as a triple jeopardy hypotheses
claim that groups that are subordinate in multiple stratification systems such as gender, race and class
Keywords: are at especially high risk. Multiple minority statuses affect mental health in paradoxical ways, however,
Gender that refute triple jeopardy approaches. This paper presents a theoretical perspective based in cultural as
Race
well as structural theories that offers an alternative to triple jeopardy. I predict that certain relational
Class
schemas are jointly shaped by gender, race, and class and help explain their anomalous effects on mental
Mental health
USA
health. These schemas of self-salience refer to beliefs about the relative importance of the self and others
Intersectionality in social relations; they affect mental health by forming subjective alternative hierarchies to larger
Stratification societal stratification systems. I use secondary analyses of two U.S. data sets to investigate this
perspective. Results of regression analysis show that self-salience helps explain the paradoxical patterns
of mental health by gender, race, and social class. The findings underscore the importance of using an
intersectional approach and integrating cultural and structural factors to understand how stratification
shapes mental health.
Ó 2011 Published by Elsevier Ltd.

Structural approaches to stratification and mental health argue
that groups who are lower in social hierarchies suffer from greater
psychological problems. Extensions such as a double jeopardy
hypothesis claim that groups who are subordinate in dual stratifi-
cation systems such as race and gender are at especially high risk. A
triple jeopardy approach warns that low positions in multiple
hierarchies such as gender, race, and class are particularly lethal.
Contrary to these approaches, disadvantaged statuses affect
mental health in paradoxical ways. For example, research in the
United States shows that blacks possess similar or better mental
health than whites in most major psychiatric problems, despite
economic disadvantages and discrimination (Breslau, Kendler,
Maxwell, Aguilar-Gaxiola, & Kessler, 2005; Breslau, Aguilar-
Gaxiola et al., 2005; McGuire & Miranda, 2008; Rosenfield, Phil-
lips, & White, 2006; Williams, Costa, & Leavell, 2009). In addition,
women equal rather than exceed men in mental health: while
women predominate in internalizing problems like depression that
are more destructive to the self, men surpass women in external-
izing problems like anti-social behavior that are more destructive
for others. Perhaps the greatest paradox comes at the intersection
of race and gender. Despite their presumed double disadvantage of
* Tel.: þ1 732 932 6636; fax: þ1 732 932 6872.
E-mail address: slrosen@rci.rutgers.edu.
being both black and female, black women actually experience the
best overall rates of mental health, low in both internalizing and
externalizing problems.
In sum, this research on stratification and mental health chal-
lenges theories of double jeopardy. Few studies test triple jeopardy,
however. A triple jeopardy hypothesis on gender, race, and class
claims that black females in lower social classes would suffer the
worst mental health, while white males in higher social positions
experience the best. In contrast, work that exists suggests disputes
triple jeopardy. For example, black men are less depressed than
white men in lower education groups (Roxborough, 2009). These
findings suggest the need for alternative perspectives.
This paper further examines tests a triple jeopardy hypothesis
and proposes an alternative theoretical approach based in cultural
and social psychological as well as structural approaches. I argue
that certain cultural schemas help explain the paradoxical effects
on mental health. Self-salience refers to beliefs and values about
the relative importance of the self and others in social relations.
These schemas are problematic for mental health at the extremes:
under-privileging the self increases the risk of internalizing prob-
lems; over-privileging the self facilitates externalizing problems
(Rosenfield, Lennon, & White, 2005; Rosenfield et al., 2006).
Social statuses such as gender, race, and class shape schemas of
self-salience. For example, conceptions of gender vary by race and
by class in ways that are relevant to self-salience, as does racial

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doi:10.1016/j.socscimed.2011.11.010
1792 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
socialization. I contend that these schemas affect mental health by
forming subjective status hierarchies that operate as alternatives to
larger societal stratification systems.
Prior work finds that self-salience helps explain gender differ-
ences in mental health and disparities by gender and race, but has
not been tested in relation to social class (Rosenfield et al., 2005,
2006). The present research provides a test of this perspective as
an explanation for the intersection of gender, race, and class.
This research underscores the importance of intersectionality in
theories of stratification and mental health (Anderson, 2006;
Browne & Misra, 2003; Carter, Sellers, & Squires, 2002; Jackson,
2005; Kohn & Hudson, 2002). Intersectional approaches partly
come from black feminist critiques of single status analyses and
accumulated disadvantage models such as double and triple jeop-
ardy (Cole, 2009; Mullings, 2006; Nakano Glenn, 1999). In contrast,
intersectional perspectives argue that separate analysis of race,
class, or gender cannot fully describe individuals’ experiences
(Constantine, 2001; Salazar 2005; Shields, 2008; Syed, 2010).
Combinations of statuses such as gender, race, and class have
unique rather than additive effects on outcomes, which account for
the seemingly paradoxical effects of stratification on mental health
(Jackson, 2005; Mullings & Schulz, 2006; Salazar & Abrams, 2005).
Self-salience and mental health
Schemas of self-salience
Schemas are our basic assumptions about the self, other people,
and the world that are part of the gut reactions we have auto-
matically, especially in new situations. Relational schemas concern
our assumptions about the nature of social relationships and our
place in them. Within these, schemas of self-salience refer to the
relative importance of the self versus others in social relationships.
Self-salience ranges from high levels that privilege the self over
others to low levels that privilege others above the self. These
schemas basically involve who individuals put first, themselves or
other people. People can privilege others far above themselves,
privilege themselves above others, or privilege both equally.
There are three components of self-salience. First, the worth
component concerns the value and esteem we give to ourselves
versus others. This aspect includes direct comparisons of the self
and others in esteem, competence, and mastery. The boundaries
component refers to the degree to which the individual is subor-
dinated to or elevated above the group. This dimension involves the
lines people draw between themselves and others and the varying
degrees of independence or connectedness in social relations. The
ranking component concerns the degree of dominance or subor-
dination in relationships. This aspect addresses whose interests and
desires people view as more important, their own or those of others.
Self-salience differs from other conceptions and perspectives on
the self. For example, schemas of self-salience differ from the
concept of self-esteem, which concerns self-liking or acceptance
but not superiority or inferiority (Rosenberg, 1989a, b). These
schemas also differ from independent and interdependent self-
construals by focusing on their relative balance rather than indi-
viduals’ levels of each one separately (Gudykunst et al., 1996).
Finally, most approaches to the self and mental health focus on one
extreme such as low self-esteem as problematic, which implies that
extremely high self-esteem is positive (Crocker & Park, 2004). The
perspective on self-salience argues that the high extreme of self-
salience is also destructive by increasing the risk of externalizing
types of problems.
The concept of self-salience fits within a larger body of theory
and research on relational selves. This includes work on interper-
sonal forms of cognition and relational schemas, which include
self-salience (Baldwin, 2003, 2005). Other research examines
individualistic versus collectivist, altruistic versus egoistic, and
sociotropic versus autonomous behavior and orientations (Clark,
Beck, and Brown 1992; Oyserman, Coon, & Kemmelmeier, 2002;
Shweder, 1991; Simpson & Willer, 2008). Additional lines of work in
both the United States and Asia focus on interdependent versus
independent self-construals (Chen, Boucher, & Tapias, 2006;
Markus & Kitayama, 1991). Still others examine relational-
interdependent self-construals (Cross, Bacon, & Morris, 2000), the
relational self (Andersen & Chen, 2002; Brewer & Gardner, 1996),
and the interpersonal self (Markus & Cross, 1990).
Self-salience schemas and mental health
I argue that self-salience is problematic for mental health at
both extremes. Schemas that put others first give rise to internal-
izing problems. People are more self-critical if they think that
others are more valuable, desirable, or fortunate. Negative self-
evaluations are exaggerated when individuals think that there is
something fundamentally wrong with them that others do not have
to endure. Also, if people are overly connected to and reliant on
others, they experience an extreme sense of responsibility for
others’ welfare and take more blame for their problems. To the
extent that people give more in relationships and put others’ needs
first, they deny their own interests and desires, as well as lose
a sense of control over their lives and what happens to them. Each
of these is a symptom of depression.
At the opposite extreme, schemas that put the self first give rise
to externalizing problems. A sense of superiority over others allows
individuals to deny others’ rights. A lack of empathy and detach-
ment from others makes it easier to act against their interests.
People are also more likely to blame others for difficulties when
they devalue the importance of others and elevate their own.
This approach fits with cognitive theories of psychopathology
that emphasize the importance of schemas for mental health
problems (Beck, 1967; Dodge, 1993; Epstein, 1991; Harter, 1999;
Hoyle, Kernis, Leary, & Baldwin, 1999; Seligman, 1975). Schemas
shape the information people selectively attend to, the attributions
they make, and their mental representations of current
situationseall of which affect mental health (Dodge, 1993;
Menaghan, 1999). Certain schemas predispose people to particular
types of problems (Beck, 2005; Dodge, 2006). Applied to this
research, self-salience schemas bias individuals’ interpretation of
experience in ways that generate cognitions associated with
internalizing and externalizing problems. I build on cognitive
approaches by emphasizing the social foundations of self-salience
schemas, specifically, the influence of gender, race, and class.
Gender, race, and class
Conceptions of gender vary by race and social class. Although
gender conceptions also differ within these groups, I focus on the
divergence between them in the present research. Dominant
conceptions of gender, which are held by groups in positions of
power, are primarily white and middle-class (Connell, 1995).
Gender conceptions and practices consist of the division of labor
between men and women in and outside the home, the power
relations between men and women, and differences in the self.
Femininities
With roots in industrialization and the enlightenment, dominant
gender conceptions split the public sphere of productive work,
associated with males and masculinity, from the private sphere of
domestic labor and socioemotional work, linked to females and
 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
femininity (Connell, 1995; Flax, 1993). These differences in
responsibilities translate into lower economic resources and thus
less power for women than men (Cohen & Huffman, 2003);
Kilbourne, Stanek, Farkas, Brown, & Weir, 1994). This dominant
form, referred to as emphasized femininity, holds personal char-
acteristics of submissiveness, nurturance, sensitivity, and emotional
expressiveness as ideals (De Coster & Heimer, 2006; Hagan, 1991;
Heimer, 1995; Heimer & De Coster, 1999; Heimer and Miedzian,
1991; Schippers, 2007; Simon, 2002; Steffensmeier & Allan, 1991).
Blacks’ conceptions of gender and gender practices differ from
whites’ in many ways (Anderson, 1999; Billingsley, 1992; Connell,
1995; Duneier, 1992; Harris, Torres, & Allender, 1994; Hunter &
Davis, 1992; Lamont, 1999; Patterson, 1998).Black conceptions of
femininity less strongly divide the private sphere of the family and
the public sphere of the workplace by gender. Definitions of femi-
ninity incorporate paid work and achievement (Giddings, 1984).
For example, black conceptions of motherhood encompass
economic provision along with caretaking, with responsibilities for
children’s material as well as emotional well-being. Compared to
whites, blacks conceptualize gender as more flexible and inter-
changeable, with greater gender role equality (Hill & Sprague,
1999). Black women generally hold less traditional attitudes
toward women’s roles than white women, although this gap has
narrowed over time (Carter, Corra, and Carter, 2009).
Black women and men are also more equal in power relations. This
stems in part from the higher levels of education that black women
attain compared to men (Patterson, 1998). Also, due to high rates of
poverty, incarceration, and unemployment among black men, greater
economic equality exists between black men and women than their
white counterparts, which also provides more power than white
women (Lennon & Rosenfield, 1995; Shelton & Daphne, 1993).
Dimensions of the self associated with femininity vary between
blacks and whites. Connectedness comes at the expense of
autonomy in white femininity, but are more equally valued and
encouraged in black conceptions (Nobles, 1980; Pasteur and
Toldson, 1982). Larger spiritual values underscore the emphasis
on caring and community as well as on equality. Given these egal-
itarian beliefs, black parents socialize their daughters to be strong,
self-reliant, intelligent, and resourceful (Collins, 1997; Wallace,
2007). Also, given males’ restricted resources, independence and
self-sufficiency are seen as essential for women (Hill, 2002). While
both black and white women see gentleness and sensitivity to
others’ needs as central to femininity, the emphasis on self-
sufficiency and inner strength in black femininity contrasts with
the more submissive and subordinate stance in white feminine
conceptions (Cole & Zucker, 2007; Settles, Pratt-Hyatt, & Buchanan,
2008). In addition, the high regard for individuals’ uniqueness and
expression among blacks affirms the worth of females as well as
males. As evidence, a meta-analysis finds that blacks report higher
self-esteem than whites (Twenge & Crocker, 2002).
Racial socialization builds resilience and the deflective coping
strategies that help neutralize the negative assessments from the
external world (Billingsley, 1992; Collins, 1997; Constantine,
Alleyne, Wallace, & Franklin-Jackson, 2006; Kohn & Hudson,
2002; Miller, 1999). Income inequality is attributed to structural
rather than personal characteristics, which helps preserve the
worth of the individual. Also, blacks often view their own cultural
values, including ethics of caring, sincerity, and civility, as superior
to the more competitive and materialistic values of white culture
and as grounds for personal pride.
I argue that varying conceptions of femininity and racial sociali-
zation give rise to different schemas of self-salience in black and
white women. While white versions privilege others over the self to
a high degree, black femininity privileges the self and others more
equally. On this basis, I propose that black women possess greater
1793
self-salience than white women. I also hold that this difference is
stronger when social position, particularly education, is high. In
addition to directly positive effects on mental health, greater
education is associated with more egalitarian conceptions of gender,
which would raise self-salience (Peterson et al., 2000). Black women
in higher social positions thus receive multiple sources of high self-
salienceegender, race, and class-basederelative to white women. On
this basis, I predict that highly educated black women suffer from
fewer internalizing problems than their white counterparts. I also
propose that the differences in self-salience help explain these
patterns in internalizing problems.
Masculinities
Dominant white, middle-class conceptions of masculinity
associate males with primary responsibilities in the public sphere,
greater power in gendered relationships, and character traits of
assertiveness, competitiveness, independence, and control (De
Coster & Heimer, 2006). Connell refers to these conceptions as
hegemonic masculinity, the "culturally idealized form of masculine
character" among males in positions of the greatest power in
a society (Connell, 1990: 83). This middle-class ideal involves
professional or managerial work, an emphasis on competition in
terms of expertise, and success in work (De Coster & Heimer, 2006).
There are other versions of dominant masculinity. For example,
dominant masculinity in business rests on “the aggressive market
exploits of men” (Coles, 2009: 42).
Masculinities in other social groups are formed in relation to this
dominant model. There are overlaps and contrasts between these
dominant and subordinate forms. Black and white men share
fundamental commonalities in their conceptions of maleness
(Harris, 1996; Haynes, 1998; Hunter & Davis, 1992; Hunter & Sellers,
1998). Both define ambition, economic viability and responsibility,
as well as an independent sense of self, as core components of
masculinity. Black and white men also define similar character
traits as masculine.
In contrast, black men are less conventional in gender roles than
white men, although the evidence is somewhat mixed (Blee, 1995;
Hunter & Davis, 1992; Kane, 2000; Rowley, Kurtz-Costes, Mistry, &
Feagans, 2007; Wilkie, 1993). They hold more egalitarian views in
the family and participate more often in childrearing. In personal
traits, black men describe themselves as more androgynous than
white men.
Dominant and marginalized masculinities also vary by social
position (Blee, 1995; Cooper, 2000; Shows & Gerstel, 2009).In
general, oppressed groups are blocked from the resources to
accomplish dominant masculine ideals of success in the workplace
and economic responsibility for the family (De Coster & Heimer,
2006). Protest masculinities form in response to economic power-
lessness as well as barriers to the jobs and education that underlie
hegemonic masculinity (Connell, 1995). These marginalized mascu-
linities contain themes of dominant masculinity that are recast in the
context of poverty and discrimination (Connell, 1995). Because of the
limited access to conventional means for establishing masculine
identity, they exaggerate claims to masculine position and empha-
size physical power and prowess more than middle-class forms
(Benson, Wooldredge & Thistlethwaite, 2004; Hill & Zimmerman,
1995; Hunter & Davis, 1992; Levant & Richmond, 2007; Majors &
Billson, 1992; Pyke Karen, 1996; Schrock & Schwalbe, 2009).
These forms are particularly strong among black males, given
the additional obstacles due to racism. As witnessed in the
threatening facades necessary to maintain status and avoid
victimization in some peer groups, the claims to masculine position
stress purely gendered positions of power (Anderson, 1990, 1999;
Connell, 1995; Majors & Billson, 1992; Patterson, 1998). Fighting
1794 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
and sexual conquests become strong bases of maleness (Morgan,
2004; Anderson, 1999).
As a result, black and white masculinities appear to differ more
in lower classes than in middle-class groups. These differences
suggest that black masculinity privileges the self more than white
masculinity in lower social positions but resembles white mascu-
linity in higher socioeconomic groups. I thus predict that black
males possess higher self-salience than white males in lower social
classes but similar self-salience at higher class levels. As a result, I
propose that black males exceed white males in externalizing
problems in lower class groups, which produces greater gender
differences among blacks than whites. In higher social classes, black
and white males as well as gender differences are more equal.
Finally, I argue that the differences in self-salience help explain
these patterns in externalizing problems by race, gender, and class.
In sum, I hold that black women and men are relatively more
advantaged in mental health than their white counterparts in
higher class positions. Education in particular contributes to this
advantage through the effects on masculinities and femininities.
Gender socialization conveys these conceptions of gender and thus
schemas of self-salience in a process that intensifies over the course
of adolescence. Mental health disparities by gender, race, and class
emerge at the same time. These overlapping changes further
suggest the importance of self-salience schemas for mental health
patterns (Barrett & White, 2002; Basow, 1992; Brown & Gilligan,
1992; Chodorow, 1978; Galambos, Almeida, & Petersen, 1990;
Gove & Herb, 1974; Nolan-Hoeksema 1990). I provide a test of the
predictions above using two data sets, including a large national
survey and a smaller survey of adolescents.
The perspective on self-salience highlights the importance of
cultural and social psychological approaches to stratification and
mental health. These approaches hold that individuals’ subjective
interpretations of their social standing can counteract the impact of
low positions in stratification systems. The interpretations are
based on individuals’ positions within their local, proximal refer-
ence groups as well as the groups’ ability to resist negative evalu-
ations and offer positive alternatives (Schnittker & McLeod, 2005).
Previous research on subjective status supports this argument.
Defined as “the individual’s perception of his own position in the
social hierarchy,” subjective status influences mental health more
than objective status, especially when individuals compare them-
selves to others in their local environment (Demakakos, Nazroo,
Breeze, & Marmot, 2008; Goodman et al., 2001; Jackman &
Jackman, 1973; Muntaner, Eaton, Miech, & O’Campo, 2004;
Schnittker & McLeod, 2005; Singh-Manoux, Marmot, & Adler,
2005; Wolff, 2007). Blacks exceed whites in subjective status when
based on reference group comparisons (Wolff, 2007). Consistent
with this, strong racial socialization, racial identity, and Afrocentic
values enhance blacks’ sense of self and life satisfaction
(Constantine et al., 2006; Miller, 1999).
Because self-salience concerns the relative importance of the
self versus others, these schemas function as a form of subjective
status that offers alternative hierarchies to societal stratification
systems. In this way, self-salience schemas help explain how groups
can experience better mental health than would be expected from
their positions in larger social hierarchies.
Methods
I use data from the baseline National Comorbidity Survey (NCS)
and the Rutgers Health and Human Development Survey (HHDP) to
investigate the predictions. These were chosen because they
contain information on self-salience and address different aspects
of the perspective above (all measures described below are avail-
able upon request).
Baseline national comorbidity survey
Sample
Funded by the National Institute of Mental Health, the National
Institute on Drug Abuse, and the William T. Grant Foundation, the
National Comorbidity Survey was the first survey to administer
a structured psychiatric interview to a nationally representative
sample of the United States. The baseline data were collected in
1990e1991 on a stratified, multistage area probability sample. I use
the baseline survey because it contains a substantial number of
items bearing on self-salience. A subsample of 5877 completed part
II of the survey, which includes these items. To describe this
subsample, the age range is 15e54 years old. Eleven percent is
black, 79 percent is white, 8 percent is Hispanic, and 2 percent
other race/ethnicities. Fifty percent are males and females. Twenty-
two percent did not graduate high school, 35 percent are high
school graduates, and 43 percent continued their education past
high school.
Measures
The Baseline National Comorbidity Survey was designed to
study the prevalence and correlates of psychiatric disorders based
on the Diagnostic and Statistical Manual of Mental Disorders
(DSM), which is the official listing of what psychiatry defines as
mental illness. The diagnoses were made on the basis of the
Composite International Diagnostic Interview (CIDI). In these
analyses, I combine diagnoses of depression, which include major
depression and dysthymia, the milder form, over the lifetime. I
combine diagnoses of anti-social personality disorder and conduct
disorder as a measure of anti-social problems.
I combine a number of items to construct a scale of self-salience.
As an example, measures of worth include, “Sometimes I think that
I have an inferiority complex.” Examples of ranking are, “I would
rather be a follower than a leader,” “I find it difficult to say ‘no’ to
people, and “In an argument, I give in easily.” Items on boundaries
include, “It is important for me to be able to do things the way I
want to do them rather than the way other people want me to do
them,” and “I have a lot of trouble making decisions by myself.” The
alpha coefficient of this scale of self-salience is .72. Most of these
items measure low self-salience, however, rather than range from
one extreme to the other. As a result, this scale relates to inter-
nalizing problems more than externalizing problems and is used
only in analyses of depression.
I code gender as 0 for males and 1 for females, and code race as
0 for black and 1 for whites. I use questions on total family income
and total years of education as measures of social class. I note,
however, that there are multiple definitions and debates over the
meaning and measures of class and related terms. For example,
some distinguish social class from socioeconomic status as separate
aspects of socioeconomic position (e.g., Muntaner et al., 2004;
Schnittker & McLeod, 2005). Socioeconomic status is defined as
the hierarchical dimensions of education, income, and occupational
status, while social class involves relations of production such as
owner, manager, and worker (Muntaner et al., 2004). Other
conceptions of class center on authority and control in the work-
place as the defining characteristics (Wright, 2000). I chose
measures of income and education because they are in line with
much of the research on stratification and mental health.
Rutgers Health and Human Development Project
Sample
The second data set for this research comes from the Rutgers
Health and Human Development Project, a longitudinal study of
adolescent development (Pandina, Labouvie, & White, 1984).
 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
Contacted through random telephone calls, the sample comes from
a statewide survey of New Jersey. Field staff conducted home
interviews with volunteering respondents and their parents.
Respondents for the present analysis total 1308 and were inter-
viewed in 1982e84 at the ages of 15, 18, and 21. They have been
interviewed on four or five subsequent occasions until the ages of
28 and 31. I used the earlier wave because it contains items on self-
salience, and because race, class, and gender differences in self-
salience and mental health arise during adolescence. The sample
for this research includes respondents who described themselves
as white (n ¼ 1227) or as black (n ¼ 106).
Overall, participants were comparable to refusers on selected
demographic characteristics and behaviors that were assessed
during an initial anonymous telephone interview, except that
participants displayed slightly higher levels of parental income and
education. Yet, both of these variables exhibited heterogeneity in
the sample. A comparison of central variables at Time 1 between
those subjects who were retested and those who dropped out
further indicated high comparability (Pandina et al., 1984). I also
tested for the possibility that outliers may affect the results of
analyses, especially for blacks. However, the findings are similar to
those reported below when I omit extreme cases and when I
transform variables using logarithmic or square root trans-
formations. As further evidence against selection bias, in these data
the race differences in internalizing and externalizing problems
replicate those found in previous research with larger samples.
Measures
The data include the Johns Hopkins Symptom Checklist (SCL-
90R), which has been shown to be a reliable indicator of psycho-
logical symptoms (Derogatis & Cleary, 1977). The depression
subscale includes symptoms such as feeling lonely, blue, or
worthless, feeling hopeless about the future, and having thoughts
of suicide. Responses range from zero to four, which corresponds to
experiencing symptoms very little to very much. The alpha coeffi-
cient is above .80 for the scale.
The survey also includes questions on delinquency. Respondents
are asked the number of timesdwhether not at all, 1e2 times, 3e5
times, 6e10 times, or more than 10 timesdin the last three years
they avoided paying for such things as movies, bus or subway rides,
and food; broke into a building to look for something to steal or to
steal something; stole (or tried to steal) a motor vehicle, such as
a car or motorcycle; stole things worth less than $50.00; and stole
things worth more than $50.00. Possible scores on the delinquency
scale range from 5 to 25. Because the scale is composed of behaviors
that would not necessarily occur together, I did not compute
a reliability coefficient.
As measures of self-salience, respondents were questioned
about how much self-confidence they have. I use this item as an
indicator of the worth component of self-salience. Possible
responses range from a low of 1 to a high of 5. The Personality
Research Form (PRF) included in the interview measures other
aspects of self-salience (Jackson, 1974). Respondents answered true
or false to questions on these scales. High levels of internal
consistency and reliability have been reported for the scales
(Stricker, 1974). I use scales of autonomy and nurturance as indi-
cators of the boundary component. For example, the autonomy
scale includes items about whether respondents are independent
of the opinions of others, whether they like to be alone, and
whether they like feeling unattached. Examples of items on the
nurturance scale, which measures the connectivity dimension of
boundaries, are whether it is very important to respondents that
they demonstrate that they are interested in others’ problems,
whether they feel most worthwhile when helping someone, and
whether they are highly disturbed when a friend is in trouble. I
1795
subtract scores on nurturance from scores on autonomy for an
indicator of boundary schemas.
Scales of dominance and abasement indicate schemas about
ranking. The dominance scale includes questions on whether
respondents desire positions of power over other people, whether
they are comfortable telling others what to do, and whether they
try to control others rather than permitting others to have control
over them. The scale of abasement includes items asking whether
respondents tend to apologize when someone bumps into them,
whether they are uncomfortable when others try to make them feel
important, and whether they try to be a good sport when they think
people are taking advantage of them. I subtract scores on abase-
ment from scores on dominance for the measure of the ranking
component.
I combine the separate measures for a general indicator of self-
salience schemas. I sum scores on self-worth, autonomy, and
dominance to indicate high self-salience. I add scores on nurtur-
ance and abasement to measure low self-salience. I subtract the
second score from the first for an indicator of overall self-salience
(see Rosenfield et al., 2005, 2006 for more details about the
measures).
Gender is coded 0 for males and 1 for females. I categorize race
into black (coded 0) and white (coded 1). I use family income and
the highest educational level attained by either parent as measures
of social class.
These data sets have different weaknesses and strengths for
addressing the perspective above. The measure of self-salience in
National Comorbidity Survey is only useful for examining outcomes
of depression, while the HHDP measure relates to both depression
and anti-social problems. In addition, while the HHDP data set is
limited in sample size, the National Comorbidity Survey offers
a large, nationally representative sample that is advantageous for
testing three-way interactions between race, class, and gender and
for its generalizability. The latter is particularly relevant since social
class in adolescents is more changeable and thus less generalizable
than class positions among adults. Finally, both surveys were
collected some time ago, especially the HHDP. I note, however, that
the National Comorbity Surveys in the 1990’s and 2000’s are similar
in their distribution of outcomes.
Results
Tests for interactions between class, race, and gender
I first test for three-way interactions between gender, race, and
education in relation to depression and anti-social problems. I
present interactions of gender and race with education as the
measure of social class, because of the small interaction effects
found with income (not shown). Table 1 shows results of regression
analyses with diagnoses of depression in the National Comorbidity
Survey (logistic regression) and depressive symptoms the Health
and Human Development Survey.
Consistent with previous research, gender is significantly
related to depression: females exceed males in both surveys.
Depression also differs by race in the National Comorbity Survey. In
line with prior studies, blacks experience lower rates of depression
than whites. Blacks are also lower in the Health and Human
Development Survey, although the differences do not reach
significance.
There are no significant two-way interactions in these data sets.
However, the patterns suggest three-way relationships between
gender, race, and education. These relationships do not reach
significance but are trends in both data sets that are close to
marginally significant: p ¼ .14 in the National Comorbidity Survey
and .15 in the Health and Human Development Study. The
1796 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801

Table 1
Interactions of gender, race, education in diagnoses and symptoms of depression.

National Comorbidity Survey Health and Human Development

b se(b) exp(b) b se(b) Beta

Race .467 .124 .627*** .080 .064 .036
Gender .792 .078 2.208*** .118 .033 .102***
Education .015 .016 1.015 .034 .037 .027

Race .971 .841 .379 .016 .134 .007

Gender .917 .436 2.501* .179 .145 .155
Education .028 .054 1.028 .023 .061 .018
Gender by race .032 .273 1.033 .091 .132 .079
Race by education .035 .058 1.036 .012 .019 .043
Gender by education .010 .033 .990 .030 .019 .138

Race 2.768 2.595 15.920 .043 .140 .019

Gender 1.101 .454 3.006* .438 .230 .379þ
Education .050 .056 1.051 .007 .065 .005
Gender by race 2.225 1.530 .108 .228 .257 .197
Race by education .267 .210 .766 .001 .021 .002þ
Gender by education .024 .034 .976 .098 .051 .459
Gender by race by education .181 .122 1.198a .080 .056 .377b

þ p < .10, *p < .05, **p < .01, ***p < .001.
a
p ¼ .14.
b
p ¼ .15.

consistency of these trends across the surveys suggests further
exploration of these patterns.
Findings on anti-social behavior are similar. Table 2 presents
relationships between gender, race, and education in relation to
anti-social diagnoses and behavior. As in depression, anti-social
problems differ by gender in both surveys. Along with girls’ and
women’s preponderance in depression, men’s excess of anti-social
problems concurs with previous research. These problems also vary
strongly by education in the National Comorbidity Survey, which
fits with existing work on social class. Although nonsignificant,
those from more highly educated backgrounds also commit fewer
delinquent acts in the Health and Human Development Survey.
In tests of two-way interactions, gender interacts with race and
with education only in the National Comorbidity Survey. However,
both data sets show trends toward three-way interactions of
gender, race, and education. These relationships are somewhat
stronger than those for depression: p ¼ .11 in the National
Comorbidity Survey and .12 in the Health and Human Development
Study. The consistency of these patterns across outcomes also
points to further investigation.
Differences in mental health problems by race, class and gender
What are the specific differences in mental health problems by
race, class, and gender that underlie these three-way relationships?
Table 3 presents the mean scores on depressive symptoms in the
HHDP and the rates of depressive diagnoses in the NCS. Because of
the small sample in the HHDP, I divide education into two cate-
gories in the data sets: high school graduate or below, and above
high school.
Both surveys show that race differences in depression occur only
among females, who predominate in internalizing problems in

Table 2
Interactions of gender, race, education in anti-social problems.

National Comorbidity Survey Health and Human Development

b se(b) Exp(b) b se(b) Beta

Race .219 .135 .804þ .021 .210 .003
Gender 1.128 .094 .324*** .708 .107 .185***
Education .164 .018 .848*** .155 .120 .036

Race 1.853 .808 .157* .217 .398 .029

Gender .098 .531 .906 .613 .426 .160
Education .056 .056 .945 .791 .426 .186þ
Gender by race .704 .271 2.021** .167 .427 .043
Race by education .057 .060 1.058 .657 .421 .160
Gender by education .093 .043 .911* .078 .241 .020

Race 1.404 2.186 4.071 .639 .482 .086

Gender .249 .575 1.282 1.215 .576 .317*
Education .021 .061 .979 1.511 .629 .355*
Gender by race 1.651 1.508 .192 .521 .615 .135
Race by education .216 .181 .806 1.434 .654 .348*
Gender by education .122 .047 .885* 1.290 .816 .322
Gender by race by education .196 .123 1.216a 1.327 .855 .327b

þp < .10, *p < .05, **p < .01, ***p < .001.
a
p ¼ .11.
b
p ¼ .12.
 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801 1797

Table 3
Diagnoses and symptoms of depression by class, race, and gender.

Lower education: high school graduate and below Higher education: above high school

White males White females Black males Black females White males White females Black males Black females
National Comorbidity Survey: Percent (N) 11.4 (1234) 22.9g* (1212) 7.2 (195) 15.2r*,g* (191) 13.0 (913) 23.7g* (869) 8.7 (85) 17.1r*,g* (168)
Health and Human Development: Means (N) .671 (153) .849g* (148) .689 (16) .820 (29) .687 (425) .789g* (408) .603 (19) .583rþ (24)
r*
Significant difference by race within same gender and education level.
rþ
Marginally significant difference by race within same gender and education level.
g*
Significant difference by gender within same race and education level.

Table 4
Anti-Social behavior and diagnoses by class, race, and gender.

Lower education: high school graduate and below Higher education: above high school

White males White females Black males Black females White males White females Black males Black females
National Comorbidity Survey: Percent (N) 23.0 (1233) 8.7g* (1213) 17.4rþ (195) 10.5g* (191) 14.2 (1024) 3.8g* (971) 7.7rþ (104) 5.7 (192)
Health and Human Development: Means (N) 6.714 (154) 6.020g* (149) 7.353 (17) 6.138gþ (29) 6.637 (430) 5.906g* (413) 5.842 (19) 5.917 (24)
rþ
Marginally significant difference by race within same gender and education level.
g*
Significant difference by gender within same race and education level.
gþ
Marginally significant difference by gender within same race and education level.

general. These differences vary by education in the HHDP. In
a marginally significant relationship, black girls experience lower
depressive symptoms than white girls only when educational
backgrounds are high, exceeding high school. Little differences
exist at the lower education level. In contrast, black women suffer
from significantly less depression at both educational levels in the
NCS. To further investigate these differences, I divided the low
education group into those who graduated from high school versus
those with less education (not shown). Black and white women are
equal in depression among high school graduates, which consti-
tutes the vast majority of those with lower educational back-
grounds and which is consistent with the HHDP.
Gender differences in depression vary by race and education in
both data sets. White girls and women suffer more from depression
than white boys and men, regardless of their educational back-
ground. These differences also hold among blacks in the NCS: black
women suffer from greater depression than black men across
educational groups. The trend in the HHDP is the same at lower
education levels, while in higher levels black women are slightly
below black men.
Race and education differences in anti-social problems vary by
gender, as Table 4 reports. These differences occur only among
males, who generally predominate in externalizing problems. In
marginally significant relationships, black men are lower than
white men in the NCS at both educational levels. Although
nonsignificant in the HHDP, black boys also exhibit fewer delin-
quent acts than white boys in high educational backgrounds, but
more delinquent behavior when educational backgrounds are low.
Similar to depression, gender differences in anti-social problems
hold across educational levels for whites. Among blacks, however,
gender differences vary by education. As a result of their
particularly high level of anti-social behavior, black boys and men
exceed black girls and women only when educational attainment is
low. No gender differences exist at the higher education level due to
low rates in women but especially in men.
In sum, the specific differences that underlie the three-way
relationships between race, gender, and class vary by outcome.
For depression, race differences depend on gender and education.
Consistent with the predictions above, black girls and women
gain more mental health advantage in higher educational back-
grounds, particularly comparing high school graduates and post-
graduates. In anti-social behavior, gender differences vary by race
and class. Also consistent with the predictions, white males
exceed white females in lower and higher education groups,
while black boys surpass black girls only in lower educational
backgrounds.
Self-salience and mental health
Turning to self-salience and mental health, I first examine
whether patterns of schemas parallel those of depression and anti-
social problems. I report the means on self-salience as well as the
rates of mental health problems for comparison. Table 5 presents
differences by race, class, and gender in the National Comorbidity
Survey. I show results for self-salience and depression only, since
this measure of self-salience focuses on the low extreme related to
internalizing problems.
Patterns of self-salience mirror the differences in depression in
the NCS, as expected. Race differences in schemas and diagnoses of
depression hold across education levels. Black women experience
more self-salience and less depression than white women. Black
men also possess higher self-salience and lower depression than

Table 5
Means on self-salience and depression by gender race and class: The National Comorbidity Survey.

Lower education: high school graduate and below Higher education: above high school

White males White females Black males Black females White males White females Black males Black females
Self-salience (means) 3.067 2.890g* 3.251r* 3.086r*,g* 3.104 2.961g* 3.403r* 3.158r*,g*
(N) (1172) (1138) (186) (172) (1024) (971) (104) (192)
Depression (percent) 11.4 22.9g* 7.2rþ 15.2r*,g* 13.0 23.7g* 8.7 17.1r*,g*
(N) (1234) (1212) (195) (191) (913) (869) (85) (168)
r*
Significant difference by race within same gender and education level.
rþ
Marginally significant difference by race within same gender and education level.
g*
Significant difference by gender within same race and education level.
1798 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801

Table 6
Means on self-salience, depressive symptoms, and anti-social behavior by gender race and class: The Health and Human Development Project.

Lower education: high school graduate and below Higher education: above high school

White Males White Females Black Males Black Females White Males White Females Black Males Black Females
Self-salience .869 1.630g* 1.513 .631r* 1.166 1.104g* .830 .999r*
(N) (154) (149) (17) (29) (430) (413) (19) (24)
Depressive Symptoms .671 .849g* .689 .820 .687 .789g* .603 .583rþ
(N) (153) (148) (16) (29) (425) (408) (19) (24)
Delinquency 6.714 6.020g* 7.353 6.138gþ 6.637 5.906g* 5.842 5.917
(N) (154) (149) (17) (29) (430) (413) (19) (24)
r*
Significant difference by race within same gender and education level.
rþ
Marginally significant difference by race within same gender and education level.
g*
Significant difference by gender within same race and education level.
gþ
Marginally significant difference by gender within same race and education level.

Table 7
Differences in mental health problems, controlling for self-salience.

Controlling for Self-Salience

b se(b) exp(b)/Beta b se(b) exp(b)/Beta

Depression
Race differences among highly educated females:
NCS .427 .210 .652* .120 .260 .887
HHDP .185 .120 .074a .108 .120 .043

Anti-social problems
Gender differences among less educated Blacks 1.148 .710 .251b .817 .715 .178

*p < .05.
a
p ¼ .12.
b
p ¼ .11.

white men, although the differences only approach significance in
the lower education group.
Turning to gender differences, black and white women fall
below their male counterparts in self-salience and exceed them in
depression at both educational levels. These disparities are similar
within each race but occur at different levels, with black males and
females at higher levels of self-salience and lower levels of
depression than corresponding whites.
Table 6 presents results from the Health and Human Develop-
ment Project, which include both depressive symptoms and anti-
social problems, both of which are related to this measure of self-
salience (Rosenfield et al., 2005). As in the NCS, self-salience
generally corresponds to depressive symptoms, in opposite ways.
Examining race differences, black girls possess significantly greater
self-salience and lower symptoms of depression than white girls
across education backgrounds.
Gender differences are significant among whites in both self-
salience and symptoms of depression. White girls are lower than
white boys in self-salience and surpass them in depressive symptoms
at both educational levels. Although nonsignificant, the gender
differences in self-salience among blacks also correspond to depres-
sive symptoms. Black girls possess lower self-salience and greater
symptoms than black boys in lower educational backgrounds, and
greater self-salience and lesser symptoms at higher education levels.
Patterns of self-salience also correspond to the differences in anti-
social behavior. Gender differences among whites are significant: boys
are higher than girls in both self-salience and anti-social behavior
across educational backgrounds. Black boys surpass black girls in
delinquency only in lower educational groups; although the differ-
ences in self-salience are nonsignificant, the patterns are similar.
Gender differences in both self-salience and anti-social behavior are
nonsignificant at the higher education level, which result from low
self-salience and less anti-social behavior among black men.
Having established a correspondence between self-salience and
mental health problems, the final analyses explore whether
patterns of self-salience help explain configurations of depression
and anti-social behavior. Table 7 presents these results. The upper
panel examines depression, specifically, whether self-salience
contributes to the advantage of black women in higher educa-
tional levels. When schemas of self-salience are controlled, these
race differences decline by about 30 percent in the NCS and by 42
percent in the HHDP.
The lower panel shows results for anti-social problems. Self-
salience helps explain the greater delinquent behavior among
black boys versus girls in lower educational backgrounds. When
self-salience is controlled, these gender differences diminish by
about 30 percent. Thus, schemas of self-salience help explain the
three-way relationships between race, class, and gender in both
internalizing and externalizing problems.
Discussion and conclusion
Multiple disadvantaged statuses affect mental health in para-
doxical ways that challenge existing approaches to stratification
and mental health. I propose that certain relational schemas at the
intersection of gender, race, and class help explain the anomalous
effects on mental health. I argue that self-salience schemas about
the importance of the self and others arise from multiple sources
such as gender and racial socialization, which affect mental health
by forming subjective status hierarchies that are alternatives to
larger societal stratification systems.
Analyses of two data sets provide some support for this
perspective. In spite of the differences in samples and measures, the
surveys suggest that black girls and women privilege the self more
strongly than white girls and women especially in higher class
groups. These differences in self-salience help explain the lower
rates of depressive symptoms in black girls that are more
pronounced in higher social positions. Differences in self-salience
also help explain disparities in delinquency, specifically, the
 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
greater rates among black men and resulting gender differences
that exist in lower educational backgrounds.
These findings challenge triple jeopardy approaches. Instead,
they suggest the integration of structural with cultural and social
psychological approaches to stratification and mental health. To
recall, structural approaches propose that individuals who are
lower in societal systems of stratification suffer from greater
psychiatric problems than those in more privileged positions.
Cultural and social psychological approaches hold that individuals’
subjective perceptions of their standing relative to others, which
depends on their power or status within reference groups and the
ability of these groups to offer positive alternatives, affect mental
health.
This study shows the importance of such multiple sources of
self-salience and mental health problems, including both cultural
and structural dimensions of race, class, and gender. Of these
sources, the cultural and structural aspects of gender figure
prominently. Gender is among the first distinctions that children
learn and gender socialization starts particularly early in a child’s
life. Race and class influence self-salience partly through the
conceptions of gender that differ across subcultural groups. In
addition to these cultural conceptions, structural aspects of gender
are also critical: the degree of economic equality between men and
women strongly shapes self-salience and problems in mental
health.
As noted earlier, intersectional perspectives underlie and figure
prominently in this work. Results suggest that gender and race have
different effects on self-salience and mental health when the
intersection with social class is also considered. Otherwise, the mix
of classes in samples can influence overall results in conflicting
ways. For example, the numbers of black women from lower versus
higher classes affects whether their mental health is similar to or
better than their white counterparts. These different class mixes
may help account for this very inconsistency in studies focused
only on gender and race.
Also discussed above, this research is limited in several ways,
each of which suggests future work. Large, recent samples are
needed for further investigating gender, race, and class. Other racial
and ethnic groups such as Hispanics and Asian Americans should be
included in these analyses. Hispanics and Asian Americans differ
from other groups in conceptions of gender and in mental health
problems (Harris & Firestone, 1998; Ho, 2001; Pyke & Johnson,
2003; Strong, McQuillen, & Hughey, 1994). For example, Hispanic
women have lower than expected rates of depression that match
whites, while Asian American women exceed other groups
(Breslau, Aguilar-Gaxiola et al., 2005a; Breslau, Kendler, Maxwell,
Aguilar-Gaxiola, & Kessler, 2005b; Harris, Edlund, & Larson, 2005;
Kohn & Hudson, 2002; Lee, Lei, & Sue, 2001; Norasakkunkit &
Kalick, 2002; Turner and Gil 2002; Williams, Takeuchi, & Adair,
1992). Self-salience across different relationships and situations
should also be investigated. Further research should examine other
internalizing problems such as anxiety and other externalizing
problems such as aggressive behavior and substance abuse. Other
sources of stratification such as age and sexual orientation should
also be considered in intersectional analyses (Carter et al., 2002). In
addition, this perspective should be tested in other cultures and in
cross-cultural comparisons. The data for this research come solely
from the United States. However, schemas about the importance of
the self versus others are relevant across different cultures and
subcultures, which suggest further analyses.
Despite the limitations, this study indicates that subjective,
hierarchical representations of the self versus others warrant
continued investigation for explaining the impact of stratification
on mental health. Given the relative dearth of explanations for the
intersections of gender, race, and class, it is important to examine
1799
perspectives on these complex interactions. These perspectives
could guide interventions to reduce the excess of internalizing and
externalizing problems suffered by men and women in different
classes and races. This research takes one step toward that goal.
Acknowledgments
I am grateful to James Jasper, Mary Clare Lennon, Kristen
Springer, and other members of the Robert Wood Johnson Foun-
dation Health & Society Scholars Program Working Group on
Gender and Health at Columbia University. I especially thank Hel-
ene White for her helpful comments and her permission to use the
data, which were collected with a grant from the National Institute
on Drug Abuse (DA/AA 03395).
References
Anderson, E. (1990). Streetwise. New York: W. W. Norton.
Andersen, S. M., & Chen, S. (2002). The relational self: an interpersonal social-
cognitive theory. Psychological Review, 109, 619e645.
Anderson, E. (1999). Code of the street: Decency, violence, and the moral life of the
inner city. New York: W. W. Norton.
Baldwin, M. (2003). Cued activation of relational schemas: self-evaluation and
gender effects. Canadian Journal of Behavioural Science, 35, 153e163.
Baldwin, M. (2005). Interpersonal cognition. New York: Guilford Press.
Barrett, A. E., & White, H. R. (2002). Trajectories of gender role orientations in
adolescence and early adulthood: a prospective study of the mental health effects
of masculinity and femininity. Journal of Health and Social Behavior, 43, 451e468.
Basow, S. A. (1992). Gender: Stereotypes and roles. Pacific Grove: Brooks/Cole
Publishing.
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New
York: Harper and Row.
Beck, A. T. (2005). The current state of cognitive therapy: a 40-year retrospective.
Archives of General Psychiatry, 62, 953e959.
Benson, M., Wooldredge, J., Thistlethwaite, A., & Fox, G. (2004). The correlation
between race and domestic violence is confounded with community context.
Social Problems, 51, 326e342.
Billingsley, A. (1992). Climbing Jacob's ladder. New York: Simon and Schuster.
Blee, K. M. (1995). Racial differences in men's attitudes about women's gender roles.
Journal of Marriage and the Family, 57, 21e30.
Breslau, J., Aguilar-Gaxiola, S., Kendler, K. S., Maxwell, S., Williams, D., & Kessler, R. C.
(2005a). Specifying race-ethnic differences in risk for psychiatric disorder in
a USA national sample. Psychological Medicine, 36, 57e68.
Breslau, J., Kendler, K. S., Maxwell, S., Aguilar-Gaxiola, S., & Kessler, R. C. (2005b).
Lifetime risk and persistence of psychiatric disorders across ethnic groups in
the United States. Psychological Medicine, 35, 317e327.
Brewer, M. B., & Gardner, W. (1996). Who is this “We”? Levels of collective identity
and self representations. Journal of Personality and Social Psychology, 71, 83e93.
Brown, L., & Gilligan, C. (1992). Meeting at the crossroads. Boston: Harvard University
Press.
Browne, I., & Misra, J. (2003). The intersection of gender and race in the labor
market. Annual Review of Sociology, 29, 487e513.
Carter, P., Sellers, S., & Squires, C. (2002). Reflections on race/ethnicity, class and
gender inclusive research. African American Research Perspectives, 8, 111e124.
Chen, S., Boucher, H. C., & Tapias, M. P. (2006). The relational self revealed: inte-
grative conceptualization and implications for interpersonal life. Psychological
Bulletin, 132, 151e179.
Chodorow, N. (1978). The reproduction of mothering. Berkeley: University of Cal-
ifornia Press.
Clark, D. A., Beck, A. T., & Brown, G. K. (1992). Sociotropy, autonomy and life event
perceptions in dysphoric and nondysphoric individuals. Cognitive Therapy and
Research, 16, 635e652.
Cohen, P., & Huffman, L. (2003). Individuals, jobs, and labor markets: the devalu-
ation of women's work. American Sociological Review, 68, 443e463.
Cole, E. R., & Zucker, A. N. (2007). Black and white women's perspectives on
femininity. Cultural Diversity and Ethnic Minority Psychology, 13, 1e9.
Cole, E. R. (2009). Intersectionality and research in psychology. American Psychol-
ogist, 64, 170e180.
Coles, T. (2009). Negotiating the field of masculinity: the production and repro-
duction of multiple dominant masculinities. Men and Masculinities, 12, 30e44.
Collins, P. H. (1997). Shifting the center: race, class, and feminist theorizing about
motherhood. In Evelyn Glenn, Grace Chang, & Linda Forcey (Eds.), Mothering:
Ideology, experience, and agency. New York: Routledge Press.
Connell, R. W. (1990). An iron man: The body and some contradictions of hege-
monic masculinity. In M. A. Messner, & D. F. Sabo (Eds.), Sport, men, and the
gender order: Critical feminist perspectives (pp. 83e95). Champaign, IL: Human
Kinetics.
Connell, R. W. (1995). Masculinities. Berkeley: University of California Press.
Constantine, M. G. (2001). Addressing racial, ethnic, gender, and social class issues
in counselor training and practice. In D. B. Pope-Davis, & H. L. K. Coleman (Eds.),
1800 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
The intersection of race, class, and gender in multicultural counseling (pp.
341e350). Thousand Oaks, CA: Sage.
Constantine, M., Alleyne, V., Wallace, B., & Franklin-Jackson, D. (2006). Africentric
cultural values: their relation to positive mental health in African American
adolescent girls. Journal of Black Psychology, 32, 141e154.
Cooper, M. (2000). Being the ‘Go-To Guy’: fatherhood and masculinity and the
organization of work in Silicon Valley. Qualitative Sociology, 23, 379e405.
Crocker, J., & Park, L. (2004). The costly pursuit of self-esteem. Psychological Bulletin,
130, 392e414.
Cross, S. E., Bacon, P. L., & Morris, M. L. (2000). The relational-interdependent self-
construal and relationships. Journal of Personality and Social Psychology, 78,
791e808.
De Coster, S., & Heimer, K. (2006). Crime at the intersections: race, class, gender, and
violent offending. In R. D. Peterson, L. J. Krivo, & J. Hagan (Eds.), The many colors
of crime: Inequalities of race, ethnicity, and crime in America. New York: New York
University Press.
Demakakos, P., Nazroo, J., Breeze, E., & Marmot, M. (2008). Socioeconomic status
and health: The role of subjective social status. Social Science and Medicine, 67,
330e340.
Derogatis, L., & Cleary, P. (1977). Configuration of the dimensional structure of the
scl-90: a study in construct validation. Journal of Clinical Psychology, 33,
981e989.
Dodge, K. A. (1993). Social-cognitive mechanisms in the development of conduct
disorder and depression. Annual Review of Psychology, 44, 559e584.
Dodge, K. A. (2006). Translational science in action: hostile attributional style and
the development of aggressive behavior problems. Development and Psycho-
pathology, 18, 791e814.
Duneier, M. (1992). Slim’s table. Chicago: University of Chicago Press.
Epstein, S. (1991). Cognitive-experiential self-theory: an integrative theory of
personality. In R. Curtis (Ed.), The relational self (pp. 11 1e1137). New York:
Guilford Press.
Flax, J. (1993). Disputed subjects: Essays on psychoanalysis, politics, and philosophy.
New York: Routledge.
Galambos, N. L., Almeida, D. M., & Petersen, A. C. (1990). Masculinity, femininity,
and sex role attitudes in early adolescence: exploring gender intensification.
Child Development, 61, 1905e1914.
Giddings, P. J. (1984). When and where I enter: The impact of black women on race and
sex in America. New York: Bantam Books.
Goodman, E., Adler, N. E., Kawachi, I., Frazier, A. L., Huang, B., & Colditz, G. A. (2001).
Adolescents’ perceptions of social status: development and evaluation of a new
indicator. Pediatrics, 108, e31.
Gove, W., & Herb, T. (1974). Stress and mental illness among the young: a compar-
ison of the sexes. Social Forces, 53, 256e265.
Gudykunst, W. B., Matsumoto, Y., Ting-Toomey, S., Nishida, T., Kim, K., & Heyman, S.
(1996). The influence of cultural individualism-collectivism, self construals, and
individual values on communication styles across cultures. Human Communi-
cation Research, 22, 510e543.
Hagan, J. (1991). Destiny and drift: subcultural preferences, status attainments,
and the risks and rewards of Youth. American Sociological Review, 56,
567e582.
Harris, R. J., & Firestone, J. M. (1998). Changes in predictors of gender role ideologies
among women: a multivariate analysis. Sex Roles: A Journal of Research, 38,
239e252.
Harris, A. C. (1996). African American and Anglo-American gender identities: an
empirical study. Journal of Black Psychology, 22, 182e194.
Harris, K. M., Edlund, M. J., & Larson, S. (2005). Racial and ethnic differences in the
mental health problems and use of mental health Care. Medical Care, 43,
775e784.
Harris, I., Torres, J. B., & Allender, D. (1994). The responses of African American men
to dominant norms of masculinity within the United States. Sex Roles, 31,
703e719.
Harter, S. (1999). The construction of the self. New York: Guilford Press.
Haynes, F. (1998). Exploring gender and family ideals: an exploratory study of black
middle class Americans. American Sociological Association Meetings.
Heimer, K. (1995). Gender, race and the pathways to delinquency: an interactionist
explanation. In J. Hagan, & R. D. Peterson (Eds.), Crime and inequality (pp.
140e173). Stanford, CA: StanfordUniversity Press.
Heimer, K., & De Coster, S. (1999). The gendering of violent delinquency. Crimi-
nology, 37, 277e317.
Hill, S. A., & Sprague, J. (1999). Parenting in black and white families: the interaction
of gender with race and class. Gender and Society, 13, 480e502.
Hill, S. A., & Zimmerman, M. K. (1995). Valiant girls and vulnerable boys: the impact
of gender and race on mother’s caregiving for chronically-ill children. Journal Of
Marriage and Family, 57, 43e53.
Hill, S. A. (2002). Teaching and doing gender in African American families. Sex Roles,
47, 493e506.
Ho, J. (2001). Depression: The silent epidemic among Asian American women. Hard-
boiled: The Asian Pacific American Newsmagazine. Issue 4.5.
Hoyle, R., Kernis, M., Leary, M., & Baldwin, M. (1999). Selfhood: Identity, esteem,
regulation. New York: Westview Press.
Hunter, A. G., & Davis, J. E. (1992). Constructing gender: an exploration of Afro-
American men's conceptualization of manhood. Gender and Society, 6, 464e479.
Hunter, A. G., & Sellers, S. L. (1998). Feminist attitudes among African American
women and men. Gender and Society, 12, 81e99.
Jackman, M. R., & Jackman, R. W. (1973). An interpretation of the relation between
objective and subjective social status. American Sociological Review, 38, 569e582.
Jackson, D. N. (1974). Personality Research Form Manual. Goshen, NY: Research
Psychologists Press.
Jackson, P. (2005). Health inequalities among minority populations. Journal of
Gerontology, 60, 63e67.
Kane, E. W. (2000). Racial and ethnic variations in gender-related attitudes. Annual
Review of Sociology, 26, 419e439.
Kilbourne, B., Stanek, P. E., Farkas, G., Brown, K., & Weir, D. (1994). Returns to skill,
compensating differentials, and gender bias: effects of white women and men.
American Journal of Sociology, 100, 689e719.
Kohn, L. P., & Hudson, K. M. (2002). Gender, ethnicity and depression: inter-
sectionality and context in mental health research with African American
women. African American Research Perspectives, 174e184.
Lamont, M. (1999). Above people above? Status and worth among white and black
Workers. In M. Lamont. (Ed.), The cultural territories of race - Black and white
boundaries. Chicago: University of Chicago Press and New York: Russell Sage
Foundation.
Lee, J., Lei, A., & Sue, S. (2001). The current state of mental health research on Asian
Americans. Journal of Human Behavior in the Social Environment, 3, 159e178.
Lennon, M. C, & Rosenfield, S. (1995). Relative fairness and the division of household
work. American Journal of Sociology, 100, 506e531.
Levant, R. F., & Richmond, K. (2007). A review of research on masculinity ideologies
using the male role norms inventory. The Journal of Men’s Studies, 15, 130e146.
Majors, R., & Billson, J. (1992). Cool pose. The dilemmas of black manhood in America.
New York: Simon and Schuster.
Markus, H., & Cross, S. (1990). The interpersonal self. In L. A. Pervin (Ed.), Handbook
of personality: Theory and research (pp. 576e608). New York: Guilford.
Markus, H., & Kitayama, S. (1991). Culture and the self: implications for cognition,
emotion and motivation. Psychological Review, 98, 224e253.
McGuire, T. G., & Miranda, J. (2008). New evidence regarding racial and ethnic
disparities in mental health: policy Implications. Health Affairs, 27, 393e403.
Menaghan, E. (2009). Stress and distress in childhood and adolescence. In
T. L. Scheid, & T. N. Brown (Eds.), A handbook for the study of mental health: Social
contexts, theories, and systems (pp. 321e334). New York: Cambridge University
Press.
Miller, D. (1999). Racial socialization and racial identity: Can they promote resil-
iency for African American adolescents? Adolescence, 34, 493e501.
Morgan, D. (2004). Class and masculinity. In M. Kimmel, J. Hearn, & R. Connell.
(Eds.), Handbook of studies on men and masculinities (pp. 165e177). Thousand
Oaks: Sage Publications.
Mullings, L., & Schulz, A. J. (2006). Intersectionality and health: an introduction. In
A. J. Schulz, & L. Mullings (Eds.), Gender, race, class and health: Intersectional
approaches (pp. 3e16). San Francisco: Jossey-Bass.
Muntaner, C., Eaton, W., Miech, R., & O’Campo, P. (2004). Socioeconomic position
and major mental disorders. Epidemiologic Reviews, 26, 53e62.
Nakano Glenn, E. (1999). The social construction and Institutionalization of gender
and race: an integrative framework. In M. M. Feree, J. Lorber, & B. B. Hess (Eds.),
Revisioning gender (pp. 3e43). Thousand Oaks, CA: Sage.
Nobles, W. W. (1980). The psychology of Black Americans: An historical perspective.
In R. L. Jones (Ed.), Black Psychology. New York: Harper & Row.
Nolen-Hoeksema, S. (1990). Sex differences in depression. Stanford: Stanford
University Press.
Norasakkunkit, V., & Kalick, M. S. (2002). Culture, ethnicity, and emotional distress
measures: the role of self-construal and self-enhancement. Journal of Cross-
Cultural Psychology, 33, 56e70.
Oyserman, D., Coon, H. M., & Kemmelmeier, M. (2002). Rethinking individualism
and collectivism: evaluation of theoretical assumptions and meta-analyses.
Psychological Bulletin, 128, 3e72.
Pandina, R., Labouvie, E., & White, H. (1984). Potential contributions of the life span
developmental approach to the study of adolescent alcohol and drug use: The
Rutgers Health and Human Development project. Journal of Drug Issues, 14,
253e268.
Pasteur, A., & Toldson, I. (1982). Roots of Soul: The psychology of black expressiveness.
Garden City, NY: Doubleday.
Patterson, O. (1998). Rituals of blood. Washington, D.C.: Civitas/Counterpoint.
Pyke, K. D., & Johnson, D. L. (2003). Asian American women and racialized femi-
ninities: “doing” gender across cultural Worlds. Gender and Society, 17, 33e53.
Pyke Karen, D. (1996). Class-based masculinities: the interdependence of gender,
class, and interpersonal power. Gender and Society, 10, 527e549.
Rosenberg, M. (1989a). Society and the adolescent self-Image. Middletown, CT:
WesleyanUniversity Press.
Rosenberg, M. (1989b). Self-concept research: a historical overview. Social Forces,
68, 34e44.
Rosenfield, S., Clare Lennon, M., & White, H. (2005). Mental health and the self: self-
salience and the emergence of internalizing and externalizing problems. Journal
of Health and Social Behavior, 46, 326e340.
Rosenfield, S., Phillips, J., & White, H. R. (2006). Gender, race, and the self in mental
health and crime. Social Problems, 53, 161e185.
Rowley, S. J., Kurtz-Costes, B., Mistry, R., & Feagans, L. (2007). Social status as
a predictor of race and gender stereotypes in late childhood and early adoles-
cence. Social Development, 16, 150e168.
Roxburgh, S. (2009). Untangling inequalities: gender, race, and socioeconomic
differences in depression. Sociological Forum, 24, 357e381.
 S. Rosenfield / Social Science & Medicine 74 (2012) 1791e1801
Salazar, C. F., & Abrams, L. P. (2005). Conceptualizing identity development in
members of marginalized groups. Journal of Professional Counseling: Practice,
Theory, and Research, 33, 47e59.
Schippers, M. (2007). Recovering the feminine other: masculinity, femininity, and
gender hegemony. Theory and Society, 36, 85e102.
Schnittker, J., & McLeod, J. D. (2005). The social psychology of health disparities.
Annual Review of Sociology, 31, 75e103.
Schrock, D., & Schwalbe, M. (2009). Men, masculinity, and manhood acts. Annual
Review of Sociology, 35, 277e295.
Scott, C. J., Corra, M.i, & Carter, S. K. (2009). The interaction of race and gender:
changing gender-role attitudes, 1974e2006. Social Science Quarterly, 90,
196e211.
Seligman, M. E. P. (1975). Helplessness. San Francisco: Freeman.
Settles, I., Pratt-Hyatt, J., & Buchanan, N. (2008). Through the lens of race: black and
white women's perceptions of womanhood. Psychology of Women Quarterly, 32,
454e468.
Shelton, B., & Daphne, J. (1993). Race, ethnicity and difference: A comparison of
white, black and hispanic men’s household labor. In J. Hood, (Ed.), Men, work
and family (pp. 131e150). Newbury Park, CA: Sage.
Shields, S. A. (2008). Gender: an intersectionality perspective. Sex Roles, 59,
301e311.
Shows, C., & Gerstel, N. (2009). Fathering, class, and gender: a comparison of
Physicians and Emergency Medical Technicians. Gender and Society 23, 161e187.
Shweder, R. (1991). Thinking through cultures. Cambridge: Harvard University Press.
Simon, R. (2002). Revisiting the relationships among gender, marital status, and
mental health. American Journal of Sociology, 107, 1065e1096.
Simpson, B., & Willer, R. (2008). Altruism and indirect reciprocity: the interaction of
person and situation in prosocial behavior. Social Psychology Quarterly, 71,
37e52.
Singh-Manoux, A., Marmot, M., & Adler, N. (2005). Does subjective social status
predict health and change in health status better than objective status?
Psychosomatic Medicine, 67, 855e886.
1801
Steffensmeier, D., & Allan, E. (1991). Gender, age, and crime. In J. F. Sheley (Ed.),
Criminology: A contemporary handbook (pp. 67e93). Belmont, CA: Wadsworth.
Stricker, L. J. (1974). Personality research form: factor structure and response style
involvement. Journal of Consulting and Clinical Psychology, 42, 529e537.
Strong, W. F., McQuillen, J. S., & Hughey, J. D. (1994). En el laberinto de Machismo:
a comparative analysis of macho attitudes among hispanic and anglo college
students. The Howard Journal of Communications, 5, 18e35.
Syed, M. (2010). Disciplinarity and methodology in intersectionality theory and
research. American Psychologist, 65, 61e62.
Turner, R. J., & Gil, A. G. (2002). Psychiatric and substance use disorder in south
florida: racial/ethnic and gender contrasts in a young adult cohort. Archives of
General Psychiatry, 59, 43e50.
Twenge, J. M., & Crocker, J. (2002). Race and self-esteem revisited: reply to Hafdahl
and Gray-Little. Psychological Bulletin, 128, 417e420.
Wallace, D. M. (2007). It’s a M-A-N Thang: black male gender role socialization and
the performance of masculinity in love relationships. The Journal of Pan African
Studies, 1, 11e22.
Wilkie, J. R. (1993). Changes in U.S. men’s attitudes toward the family provider role
1972e1989. Gender and Society, 7, 261e279.
Williams,, D. R., Costa, M., & Leavell, J. (2009). Race and mental health: Patterns and
challenges. In T. L. Scheid, & T. N. Brown (Eds.), A handbook for the study of
mental health: Social contexts, theories, and systems (pp. 268e291). New York:
Cambridge University Press.
Williams, D., Takeuchi, D., & Adair, R. K. (1992). Marital status and psychiatric
disorders among blacks and whites. Journal of Health and Social Behavior, 33,
140e157.
Wolff, L., Acevedo-Garcia, D., Subramanian, S. V., Weber, D., & Kawachi, I. (2007).
Subjective social status, a new measure in health disparities research: do race/
ethnicity and choice of referent group matter? Journal of Adolescent Health, 41,
479e487.
Wright, E. O. (2000). Class counts. Cambridge, United Kingdom: Cambridge
University Press.