The extant theory and research on race-related stress and coping has not adequately examined how internalized racial and gender socialization factors influence levels of stress and coping strategies of elderly African American women. Consequently, little is known about how to address their mental health concerns effectively. Therefore, the purpose of the present study was to investigate the complex relationships among racial identity attitudes, culture and gender specific coping strategies, and race-related stressors that have been hypothesized to affect psychological distress among elderly African American women. Elderly African American women (N = 125), who were at least 65 years old, completed a demographic questionnaire and measures of Black racial identity (Helms, 2003), race-related stress (Utsey, 1999), Black women's coping strategies (Phields, 2002), and a mental health inventory (Veit & Ware, 1983). Three canonical correlation analyses were used to investigate how the women's appraisal of race-related stress, use of prototypical Black women coping strategies, and psychological distress were interrelated. Results of the analyses revealed four statistically significant patterns: (a) "Self-Reliant Internalization," women described by this pattern endorsed Internalization (transcendent identity) as a primary appraisal strategy, self-reliance as a coping strategy, and less psychological distress; (b) "High SES," women defined by this pattern used education, social class, and self-reliance as buffers against institutional race-related stress and psychological distress; (c) "Self-Reliant, Multiply Distressed," a pattern in which greater individual and cultural race-related stress, were associated with use of self-reliance as a coping strategy and greater psychological distress; and (d) "Internalized Individual Racism as Stressors," a pattern in which endorsement of the Preencounter (pro-White/anti-Black) and Immersion (pro-Black/anti-White) racial identity statuses as appraisal strategies were related to higher levels of individual race-related stress and psychological distress. Results were used to speculate about how the factors investigated might be integrated to form a model for addressing research and practice for elderly African American women. Limitations of this study and implications for research and practice, and future research are discussed.