Internalized Racism, Stress, and Health: A Comprehensive Meta-Analytic Structural Equation Model Test of the Internalized Racism Framework

Internalized racism (IR) among ethnoracial minorities refers to the internalization of prejudiced beliefs, stereotypes, and attitudes that devalue their group while upholding the superiority of dominant ethnoracial groups. Previous research suggests a positive association between IR and poor health. We used meta-analytic structural equation modeling analyses to test assumptions of the Internalized Racism Framework (IRF), which posits that IR-poor health associations are explained by stress processes and engagement in health-compromising behaviors. We synthesized correlation effects from 174 independent studies (45,483 participants) between 1982–2024. Results showed that IR was positively associated with (a) psychological stress (k = 198), (b) biophysiological stress (k = 18), (c) engagement in health-compromising behaviors (k = 52), and (d) negative mental (k = 324) and (e) physical health (k = 41). Conversely, IR was negatively associated with (a) positive mental (k = 45) and (b) physical health (k = 14). The positive mental and physical health associations were no longer significant after accounting for covariates, including gender, age, ethnoracial group, publication year, peer-review status, and the form and evaluative focus of IR. The IR-negative mental health association was partially explained by engagement in health-compromising behaviors. Robustness analyses found no evidence of publication bias, and evidence that study quality only moderated the IR-positive mental health relationship. These findings support an expansion of the IRF to include the IR-Stress-Vulnerability Model, which highlights bidirectional relationships between IR, stress, engagement in health-compromising behavior, and health. This expanded model has implications for understanding and addressing IR among ethnoracial minoritized groups.