Triple jeopardy? Mental health at the intersection of gender, race, and class.

Structural theories of stratification predict that groups with low positions in social hierarchies experience high rates of mental health problems. Extensions of this approach such as a triple jeopardy hypotheses claim that groups that are subordinate in multiple stratification systems such as gender, race and class are at especially high risk. Multiple minority statuses affect mental health in paradoxical ways, however, that refute triple jeopardy approaches. This paper presents a theoretical perspective based in cultural as well as structural theories that offers an alternative to triple jeopardy. I predict that certain relational schemas are jointly shaped by gender, race, and class and help explain their anomalous effects on mental health. These schemas of self-salience refer to beliefs about the relative importance of the self and others in social relations; they affect mental health by forming subjective alternative hierarchies to larger societal stratification systems. I use secondary analyses of two U.S. data sets to investigate this perspective. Results of regression analysis show that self-salience helps explain the paradoxical patterns of mental health by gender, race, and social class. The findings underscore the importance of using an intersectional approach and integrating cultural and structural factors to understand how stratification shapes mental health.