"I Wouldn't Be Here Without Her": Chosen Sisters as a Social Determinant of Mental Health

ObjectiveIn recent years, more attention has been given to the unique challenges Black women in the U.S. face as it pertains to mental health and psychological distress. Research has consistently shown that close relationships among this demographic can be emotionally supportive, stigma-reducing, serve as isolation buffers, and are positively correlated with reduced rates of depression. Despite a growing body of literature on the benefits of social ties, chosen sister relationships, a subsystem within adaptive family structures, have received limited research in the public health sector, particularly regarding their impact on mental and physical well-being. This study will investigate the often-overlooked yet historically beneficial chosen sisterhoods among Black women. Despite an evolved definition of family, chosen family (also known as voluntary kin and fictive family) relationships need to be justified for legitimacy.MethodsGrounded in the social determinants of health (SDoH) framework, focusing especially on social and community contexts, and utilizing minority stress theory, this study sought to understand why individuals establish such relationships and how they are associated with positive health outcomes. Furthermore, we sought to understand how these negotiated relationships fulfill emotional and material needs, supplementing or replacing those met through bio-legal family ties. Interpretative phenomenological analysis (IPA) of 23 semi-structured in-depth interviews was used to identify emergent personal and group experiential themes.ResultsThe four themes that emerged were 1) Emotional witnesses and interpreters, 2) Reliable crisis kin and containers of care, 3) Grounding, accountability, and cognitive reorientation, and 4) Protection against racialized distress. Using a family impact lens in tandem with the SDoH framework, we analyzed how these chosen sister relationships serve as protective factors against psychological distress and other internal and external stressors.ConclusionFindings will inform the development of a survey instrument to examine the benefits of these relationships on health outcomes at the population level. Implications are twofold. We will utilize the findings to help inform family- and community-based interventions by recognizing the often-central role of chosen sisters in the lives of Black women. Secondly, healthcare systems may become more patient-centered by recognizing these unique assets as vital aspects of collective well-being.