Internalized racism, stress, and health: A comprehensive meta-analytic structural equation model test of the internalized racism framework.

We used meta-analytic structural equation modeling to test the internalized racism framework, which posits that internalized racism (IR) is associated with poor health directly and indirectly via stress processes and engagement in health-compromising behaviors. We synthesized correlation effects from 149 studies (141 reports, 38,650 participants, 1982-2024). IR was significantly (p < .05) positively associated with (a) psychological stress (k = 64, r = .18), (b) biophysiological stress (k = 18, r = .10), (c) engagement in health-compromising behaviors (k = 52, r = .16), (d) negative mental health (k = 330, r = .23), and (e) negative physical health (k = 31, r = .09) and significantly negatively associated with (f) positive mental health (k = 50, r = -.19) and (g) positive physical health (k = 14, r = -.08). IR was not associated with (h) overall health (k = 5, r = -.06). After adjusting for covariates (gender, age, ethnoracial group, publication year, peer-review status, and form and evaluative focus of IR), only the associations between IR with psychological stress and with negative mental health remained significant. The association between IR and negative mental health was partially explained by health-compromising behaviors, but not by psychological stress. There was mixed evidence of publication bias, and study quality only moderated the association between IR and positive mental health. Findings support an expanded internalized racism framework, the IR-stress-vulnerability model, which highlights bidirectional relationships among IR, stress, health-compromising behaviors, and health, with implications for addressing IR among minoritized ethnoracial groups. (PsycInfo Database Record (c) 2025 APA, all rights reserved).