TUESDAY, Feb. 11, 2020 (American Heart Association News) -- The image of the strong African American woman – resilient, driven to succeed, devoted to those around her – is rooted in generations of history. Many women see it as a proud legacy that helps shield them from the insults of entrenched discrimination.

But health-wise, that shield might be a double-edged sword.

As part of the African American Women's Heart and Health Study, which has been examining links between racism and health since 2012, researchers talked to 208 African American San Francisco Bay Area women, ages 30 to 50, about the racism they've faced and how they cope. They also measured physical responses to stress, such as blood pressure and certain hormone levels.

This newest work built off studies that defined what's known as the "superwoman schema." Its aspects include feeling obligated to appear strong and suppress emotions; resistance to being vulnerable or dependent on others; determination to succeed; and feeling obligated to help others.

For the recent study, published last year in the Annals of the New York Academy of Sciences, researchers compared those physical responses to stress to aspects of being a superwoman.

The results? Some of those aspects – having an intense motivation to succeed and feeling an obligation to help others – seemed to worsen the physical harm from racism-induced stress.

The need to appear strong and suppress emotions seemed to protect women's health in the face of racism – but with an asterisk.

The pressure to be a superwoman starts early, lead author Amani M. Allen said.

"It's something that black girls and then teenagers and then women tend to carry with them throughout their life," said Allen, associate professor of community health sciences and epidemiology at the University of California-Berkeley School of Public Health. It's more than just "'I'm black, so I'm dealing with racism,' or 'I'm a woman, and I'm dealing with sexism.' It's both of those things."

And each amplifies the other.

Some of Allen's earlier work associated the pressures of being a superwoman with harmful habits: smoking, physical inactivity, using food to cope with stress, and more.

But when she gives talks about the potential harm from trying to be a superwoman, she said, "I invariably get someone in the audience that stands up and says, 'How can you tell me that this is bad for my health? This is my armor. This is what I put on as a form of protection so that I can deal with the day-to-day stressors – the darts, the arrows that I know are going to come my way simply because I'm an African American woman.'"

Karen Patricia Williams, a distinguished professor of nursing at The Ohio State University in Columbus, said stress from the "drip, drip, drip" of constant exposure to racism adds up over time.

Her 2019 study in Circulation: Cardiovascular Quality and Outcomes suggests the stresses of trying to be a superwoman aren't connected to specific diseases but to several risk factors that could leave women more susceptible to health problems, including heart disease. Williams praised Allen's research for getting beneath the surface of how environment, mental health and physical health overlap.

Those interactions are complex.

For example, some research shows caregiving can boost health and longevity. But it seemed to hurt the women in Allen's study.

This might be a result of women ignoring their own health, Allen said. Many of the women described how their concerns about others, particularly their children and loved ones, can result in them neglecting their own self-care. "They're so busy taking care and looking after others, they're not eating right, they're not exercising, they're not doing all the things that they know would be helpful for themselves," she said.

Similarly, Allen's data showed projecting an image of strength protected women. But women also said that left them "utterly exhausted."

And while the data found suppressing emotions was helpful, most research shows emotional suppression is "really bad for health," Allen said. "Kind of like a time bomb waiting to go off."

She thinks women who suppress emotions might see a short-term benefit from limiting the effects of anger, which she said is both the most commonly reported emotional response to racism and one that is particularly damaging to health. But her study didn't measure anger – or consider long-term health effects. So, more research will be needed, she said.

What should an African American woman who faces these pressures do?

Everyone is different, Allen said, and they should decide for themselves if their style of coping is harmful or helpful. She suggested women be mindful – take the time to stop and think about how they're reacting, and why. Being around supportive people can be powerful.

"Social support is associated with a hormone called oxytocin," she said. "And oxytocin has been associated with positive health outcomes."

Allen and Williams both emphasized the importance of self-care.

"I think we've been taught not to be self-indulgent," Williams said. "But I think that we can do a little bit for ourselves. … Maybe it's just having a day for yourself. Or maybe it's not a full day. Maybe it's, 'You know, I'm going to let somebody else pick up the kids today from school, and I'm going to do something by myself.'"