Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships (original) (raw)
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Minority stress and physical health among sexual minority individuals
Journal of Behavioral Medicine, 2013
This study examined the effects of minority stress on the physical health of lesbians, gay men, and bisexuals (LGBs). Participants (N = 396) completed baseline and one year follow-up interviews. Exposure to stress and health outcomes were assessed with two methods: a subjective self-appraisal method and a method whereby two independent judges externally rated event narratives using standardized criteria. The odds of experiencing a physical health problem at follow-up were significantly higher among LGBs who experienced an externally rated prejudice event during the follow-up period compared to those who did not. This association persisted after adjusting for experiences of general stressful life events that were not related to prejudice. Self-appraised minority stress exposures were not associated with poorer physical health at 1-year follow-up. Prejudice-related stressful life events have a unique deleterious impact on health that persists above and beyond the effect of stressful life events unrelated to prejudice.
Accepted Manuscript Structural Stigma and All-Cause Mortality in Sexual Minority Populations
Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in lowprejudice communities (Hazard Ratio [HR] =3.03, 95% Confidence Interval [CI]=1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and lowprejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations.
Stigma, Mental Health, and Dyadic Coping for Sexual Minority Persons in the United States
2018
There is increasing evidence that sexual minority individuals experience high levels of stigma associated with their sexuality, and this stigma is detrimental to the health of sexual and gender minority persons. However, the majority of this research has involved indivudals in urban settings. The overall aim of this work is to examine these knowledge gaps for these dyads and rural individuals, understudied subpopulations about whom there has been a paucity of research. This dissertation included three separate but highly related studies, each with its own specific aim. The first study examined the association between self-reported sexuality-based stigma and self-reported depression among a nationally representative online sample of 771 rural sexual minority persons. Using multiple and binary regression modeling, significant associations were demonstrated between three types of stigma (internalized, enacted, and anticipated) and clinically significant depression for this population. The second study used a multilevel modeling technique known as actor partner interdependence modeling (APIM) to examine aspects of dyadic functioning that contribute to the maintenance of health behaviors that prevent new HIV infection. Among a sample of 270 partnerships, hypothesized associations between stigma and adverse outcomes were not demonstrated. However, relationship satisfaction was significantly associated with three communal coping outcome scales (planning and decision-making, communication, and joint effort) as antecedents to the maintenance of health-enhancing behaviors. The third study also involved male couples, but utilized qualitative thematic analysis to explore how individuals in 30 same-sex male partnerships describe their experiences of coping with sexuality-based stigma, as well as the meaning they ascribe to those experiences. This was viii accomplished by analyzing transcribed interviews of male couples discussing stigmatizing events during their relationships and coping strategies used to manage those events. Results from this study indicated same-sex male couples utilize a number of both adapative and maladaptive coping mechanisms, though adaptive strategies were more commonly reported. Couples placed particular emphasis on the importance of social support, as well as specific stigma management strategies such as avoidance, concealment, anticipating stigma, and purposefully living as openly gay men. Results indicated the need to tailor existing theory to address this population. Despite recent gains made in human rights and social justice for sexual minority persons, what has already been done is not enough. LGBT persons still endure an unfair distribution of decreased benefits and increased burdens in both healthcare and research. This dissertation work aims to establish equity for this disadvantaged population by increasing their representation in research. These results address gaps in knowledge and inform recommendations for future research, interventions, laws, policies, and clinical practice to address these health disparities and protect the health of this vulnerable population. Future research and interventions that are evidence-based, theoretically driven, and formed with the help of the community they serve will have the greatest capacity for improving the health of LGBT persons, both for individuals and for couples. National policy changes must be made to prohibit stigma and discrimination in all domains that might impact social determinants of health, including housing, employment, and healthcare to create comprehensive protections. With changes made informed by this research, the social benefit of this work lies in potential disparity reduction, establishing equity for this disadvantaged population. risk and protective factors, health services, and contextual influences" (IOM report, 2011, p. 23). Broadly stated, the health of LGBT individuals is poorer compared to heterosexual persons (Conron et al., 2010; Wallace et al., 2011; Fredriksen-Goldsen et al., 2014). Sexual and gender minority persons suffer from poorer mental health, depression, anxiety, and suicide ideation at higher rates that heterosexual persons (Diamant & Wold,
2020
Background: Compared to heterosexual individuals, sexual minorities (e.g., those identifying as gay, lesbian, or bisexual) are at higher risk of several mental health problems, including suicidality, substance abuse, depression, and anxiety. Research has attributed much of these elevated risks to unique and chronic stress experiences, so-called minority stress, relating to the stigma and prejudice that many sexual minorities face. Less is known about how sexual minority stigma may function as a multilevel socio-ecological system that includes stigma-related risk factors at various levels, such as the structural (e.g., negative population attitudes and discriminatory laws and policies), interpersonal (e.g., victimization and harassment), and individual level (e.g., internalization of negative societal attitudes and concealment of sexual identity), to drive poor mental health among sexual minorities. Such a socio-ecological system of sexual minority stigma may feature unique character...
Psychology of Sexual Orientation and Gender Diversity
Sexual and gender diverse (SGD) and Black, Indigenous, and People of Color (BIPOC) live at the intersection of statuses that create unique experiences of marginalization. Minority stress theory is often utilized to examine how distal and proximal minority stressors contribute to mental health disparities among SGD communities. However, existing minority stress scholarship often relies on single-axis (e.g., SGD or BIPOC) frameworks or modifies SGD measures to map onto SGD-BIPOC populations, missing opportunities to capture the unique intersectional experiences of SGD-BIPOC. Further, research continues to not center the voices of plurisexual BIPOC within research. Utilizing a sample of 418 SGD-BIPOC (M age = 36.09, SD = 13.71), the present study tested a preliminary model of intersectional minority stress among SGD-BIPOC exploring the moderating effects of plurisexual identity on the association between intersectional distal stress and depression. Results from mediation analysis found that a significant relation between intersectional microaggressions (intersectional distal stressor-predictor) and depression (mental health outcome) was best explained by its relation with conflict in allegiances (intersectional proximal stressor-mediator). Furthermore, moderated meditation findings reveal specific differences where plurisexual identity moderated these effects. Findings point to the expansion of minority stress theory to attend to the unique intersectional experiences of SGD-BIPOC communities, with specific attention to the experiences of plurisexual BIPOC. Implications for clinical practice, outreach, and the expansion of intersectional minority stress research are discussed. Public Significance Statement The present study quantitatively tested a model of intersectional minority stress among sexual and gender diverse Black, Indigenous, and People of Color. Our study allows researchers to expand minority stress to understand the multiple and interlocking systems of oppression that perpetuate mental health disparities for sexual and gender diverse Black, Indigenous, and People of Color.
Journal of Gay & Lesbian Mental Health, 2019
There is minimal research addressing the mental health outcomes of lesbian, gay, and bisexual people of color (LGB-POC). Meyer's (2003; 2015) minority stress theory posits that the manifestation of depression and anxiety symptomology is due to the excess distal and proximal stress that minority groups face because of their societal marginalization. The purpose of this study was to determine the predictive value of distal stress measures (e.g. LGBT-POC microaggressions and daily heterosexist/racist experiences) and proximal identity concepts (e.g., self-stigma, identity salience, and sexual orientation rumination) for self-reported depression/anxiety symptoms among LGB-POC. Data were collected via an online survey involving a sample of 88 LGB-POC. Plurisexual participants reported higher rates of negative mental health outcomes in comparison to monosexual participants. Regression analyses suggested that proximal stressors accounted for 15% more of variance in reported mental health outcomes than distal stress factors, alone. Distal and proximal minority stressors, together, accounted for 33% of the variance in participants' responses of mental health symptoms. Implications regarding mental health outcomes for LGB-POC are discussed.
Journal of Counseling Psychology, 2014
Understanding and intervening to address health disparities is part of the expanding role of psychologists (Johnson, 2013). We drew on Hatzenbuehler's (2009) psychological mediation framework and Lick, Durso, and Johnson's (2013) conceptual pathways to lesbian, gay, and bisexual (LGB) physical health disparities to test a serial mediation model in which 2 types of cognitive appraisals (proximal minority stressors and coping self-efficacy) partially account for the association between perceived discrimination and prejudice (distal minority stressor) and self-reported physical health symptoms in a nationally recruited sample of 564 LGB individuals (270 women, 294 men) who participated in a web-based survey. Results indicated that perceived experiences of discrimination and prejudice were associated with expectations of rejection and internalized homonegativity. These 2 proximal stressors were associated with lower coping self-efficacy, and the combined cognitive appraisal pathways were associated with higher levels of self-reported physical symptom severity. The pathway through emotion-focused coping self-efficacy was particularly salient in accounting for the overall mediation. Interventions to address distal and proximal minority stressors and improve emotion-focused coping self-efficacy may be particularly helpful in reducing the negative effects of stigma on physical health.
Mental Health Disparities by Identity Among Gender and Sexual Minorities
One of the major obstacles faced by the queer and trans community is the poorer mental health outcomes this group tends to have. There is a disparity in mental health between people who are part of gender and sexual minority groups, and those who are not. Due to the connection between mental health, marginalization, and stigma in society, this disparity may weigh more heavily on people whose identities are especially marginalized, such as bisexuals, asexuals, trans people in general, and non-binary trans people even more so. It is difficult to determine how exactly mental health disparities impact people with these identities because of the lack of psychological literature about these groups. Further, gender and sexual identities are complex and fluid, and therefore can be hard to define, and although people with some identities tend to experience more stigma than others, whether this correlation can be attributed to the identity itself or to other factors is undetermined. The lack of representation of gender and sexual minorities in literature demonstrates that these marginalized groups are historically ignored in research as well as in broader society.
DISCRIMINATION, MINORITY STRESS, AND COPING MECHANISMS IN THE LGBTQ+ COMMUNITY
International Journal of Progressive Research In Engineering Management and Science , 2024
This study explores the intricate relationship between discrimination, minority stress, and coping mechanisms within the LGBTQ+ community. Discrimination, both structural and interpersonal, significantly contributes to the unique stressors faced by LGBTQ+ individuals, leading to increased experiences of minority stress. This form of stress, characterized by chronic anxiety, social isolation, and internalized stigma, adversely affects mental health outcomes, including depression and anxiety disorders. The research employs a mixed-methods approach, incorporating quantitative surveys and qualitative interviews, to capture the lived experiences of LGBTQ+ individuals regarding discrimination and its psychological impacts. Findings indicate that those who experience higher levels of discrimination report elevated levels of minority stress, which in turn correlates with poorer mental health outcomes. Additionally, the study highlights the diversity within the LGBTQ+ community, revealing that intersectional factors-such as race, gender identity, and socioeconomic statusfurther complicate the experiences of discrimination and minority stress. Coping mechanisms employed by participants range from social support networks to adaptive strategies such as mindfulness and community engagement. These coping strategies are critical for mitigating the negative effects of minority stress and enhancing overall well-being. The study underscores the importance of promoting inclusive environments that foster acceptance and support for LGBTQ+ individuals. It also emphasizes the need for targeted mental health interventions that address the specific stressors faced by diverse groups within the LGBTQ+ community. Ultimately, this research contributes to a deeper understanding of the complex interplay between discrimination, minority stress, and coping mechanisms, offering insights for mental health practitioners, policymakers, and advocates working to improve the lives of LGBTQ+ individuals.
Gender Minority Stress: A Critical Review
Journal of Homosexuality, 2019
Past studies that compare cisgender to transgender (or trans) and gender diverse people have found a higher prevalence of mental health problems among the latter groups. This paper utilises Testa's Gender Minority Stress Framework, which is an expansion of Minority Stress Theory to assess minority stressors that are specific to the experiences of trans and gender diverse people. The concept of cisnormativity, an ideology that positions cisgender identities as a norm, is used in relation to the Gender Minority Stress Framework to describe the marginalising nature of social environments for trans and gender diverse people. This paper provides a critical review that integrates and expands upon past theoretical perspectives on gender minority stressors and protective factors. Specifically, this paper demonstrates the relevance of cultural and ethnic backgrounds to complement the application of intersectionality in research on health disparities experienced by trans and gender diverse people.