{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:40:18Z","timestamp":1792669218876,"version":"4.5.0"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Grounded 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319261501256","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:57:46Z","timestamp":1792519066000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cI Wouldn\u2019t Be Here Without Her\u201d: Chosen Sisters as a Social Determinant of Mental Health"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5489-4394","authenticated-orcid":false,"given":"Genese","family":"Clark","sequence":"first","affiliation":[{"name":"Department of Public and Allied Health, Morgan State University, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7310-5573","authenticated-orcid":false,"given":"Keisha","family":"Clark","sequence":"additional","affiliation":[{"name":"Kansas State University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_3_7_2_2","unstructured":"Mental Illness - National Institute of Mental Health (NIMH). Accessed August 12 2026.https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness"},{"key":"e_1_3_7_3_2","unstructured":"National Center for Health Statistics. Interactive Summary Health Statistics for Adults. 2024. Published online. https:\/\/wwwn.cdc.gov\/NHISDataQueryTool\/SHS_adult\/index.html"},{"key":"e_1_3_7_4_2","unstructured":"Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. Table 6.88B. Serious psychological distress in past year: Among people aged 18 or older; by age group and demographic and socioeconomic characteristics Percentages 2023 and 2024. Published online 2025. https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/reports\/rpt56484\/NSDUHDetailedTabs2024\/NSDUHDetailedTabs2024\/2024-nsduh-detailed-tables-sect6pe.htm#tab6.88b"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-022-01313-7"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2025.101027"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/08982643221086065"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/soc4.12919"},{"key":"e_1_3_7_9_2","volume-title":"Black Americans and mistrust of the U.S. health care system and medical research","author":"Cox K","year":"2024","unstructured":"Cox K. Black Americans and mistrust of the U.S. health care system and medical research. Pew Research Center; 2024. https:\/\/www.pewresearch.org\/race-and-ethnicity\/2024\/06\/15\/black-americans-and-mistrust-of-the-u-s-health-care-system-and-medical-research\/. 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Superwoman Schema, Stigma, Spirituality, and Culturally Sensitive Providers: Factors Influencing African American Women\u2019s Use of Mental Health Services. J Best Pract Health Prof Divers. 2016;9(9):1124-1144.","journal-title":"J Best Pract Health Prof Divers"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/fare.12215"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/jftr.12019"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1741-3737.2006.00330.x"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/jftr.12472"},{"key":"e_1_3_7_21_2","article-title":"The black family in the age of mass incarceration","author":"Coates T","unstructured":"Coates T. The black family in the age of mass incarceration. The Atlantic. 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