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. 2025 Aug;44(8):800-809.
doi: 10.1037/hea0001469. Epub 2025 Apr 7.

Skin-deep resilience in the Black women's experiences living with lupus study

Kara W Chung  1 , Connor D Martz  2 , Brendan Lutz  3 , Natalie Slopen  4 , Bridget J Goosby  2 , Tamika Webb-Detiege  5 , David H Chae  1
Affiliations

Skin-deep resilience in the Black women's experiences living with lupus study

Kara W Chung et al. Health Psychol. 2025 Aug.

Abstract
in English, Spanish

Objective: The skin-deep resilience hypothesis suggests that Black Americans from disadvantaged backgrounds who attain academic or professional success despite social obstacles may paradoxically experience adverse physical health outcomes. This study examined skin-deep resilience among a sample of Black women with systemic lupus erythematosus (SLE), a disease sensitive to psychosocial stress.

Method: Data were from 426 Black women with SLE from metropolitan Atlanta, Georgia, United States, recruited to the Black Women's Experiences Living with Lupus (BeWELL) Study. Multivariable linear regression models examined cross-sectional associations between adverse childhood experiences (ACEs) and SLE disease activity, and whether educational attainment and racial discrimination moderated this relationship.

Results: There was a significant three-way interaction between educational attainment, ACEs, and racial discrimination, F(26, 399) = 2.92, p = .02. Racial discrimination was positively associated with disease activity; however, the relationship between discrimination and disease activity was the strongest among those who displayed high "resilience," indicated by those attaining a graduate degree despite experiencing high childhood adversity (≥ 3 ACEs). There was no interaction between educational attainment and discrimination among those who experienced low childhood adversity (< 3 ACEs).

Conclusion: Findings indicate that among Black women living with SLE, resilience to childhood adversity conferred worse physical health resulting from greater exposure to racial discrimination. Although educational attainment is traditionally conceptualized as protective for health, it may come with unintended physiological tolls for high-achieving Black women with SLE from disadvantaged backgrounds. Interventions aimed at "building resilience" without addressing underlying structural and social inequities could exacerbate racial health inequities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objetivo:: La hipótesis de la resiliencia superficial sugiere que los Estadounidenses Negros de entornos desfavorecidos que logran éxito académico o profesional a pesar de los obstáculos sociales pueden, paradójicamente, experimentar resultados adversos en su salud física. Este estudio examinó la resiliencia superficial entre una muestra de mujeres Negras con lupus eritematoso sistémico (SLE, por sus siglas en inglés), una enfermedad sensible al estrés psicosocial.

Métodos:: Los datos procedieron de 426 mujeres Negras con SLE de la zona metropolitana de Atlanta, GA, reclutadas para el estudio “Black Women’s Experiences Living with Lupus” (BeWELL, por sus siglas en inglés). Los modelos de regresión lineal multivariable examinaron las asociaciones transversales entre las Experiencias Infantiles Adversas (ACE, por sus siglas en inglés) y la actividad de la enfermedad SLE, y si el nivel educativo y la discriminación racial moderaron esta relación.

Resultados:: Hubo una interacción triple significativa entre el nivel educativo, las ACEs y la discriminación racial (F(26,399) = 2.92, p = .02). La discriminación racial se asoció positivamente con la actividad de la enfermedad; sin embargo, la relación entre la discriminación y la actividad de la enfermedad fue más fuerte entre aquellos que mostraron alta ‘resiliencia’, indicada por aquellos que obtuvieron un título de posgrado a pesar de experimentar una gran adversidad infantil (≥3 ACEs). No hubo interacción entre el nivel educativo y la discriminación entre aquellos que experimentaron baja adversidad infantil (<3 ACEs).

Conclusiones:: Los hallazgos indican que entre las mujeres Negras que viven con SLE, la resiliencia a la adversidad infantil confirió una peor salud física como resultado de una mayor exposición a la discriminación racial. Aunque el logro educativo se conceptualiza tradicionalmente como protector de la salud, puede tener consecuencias fisiológicas no deseadas para las mujeres Negras con SLE de alto rendimiento provenientes de entornos desfavorecidos. Las intervenciones destinadas a “crear resiliencia” sin abordar las desigualdades estructurales y sociales subyacentes podrían exacerbar las desigualdades raciales en salud.

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Conflict of interest statement

We have no known conflicts of interest to disclose.

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