Sexual Minority Stress and Social Support Explain the Association between Sexual Identity with Physical and Mental Health Problems among Young Lesbian and Bisexual Women

Bisexual women report more physical and psychological health problems than lesbian women do, which may be attributed to greater sexual minority stress and less social support. However, many studies combine lesbian and bisexual women into a single group. The current study examined if sexual minority stress and social support mediated the association between women’s sexual identity (lesbian or bisexual) and health-related outcomes. A total of 650 U.S. young adult lesbian (n?=?227) and bisexual (n?=?423) women completed an online survey about sexual minority stress, social support, and physical and mental health problems. Bisexual women reported more physical and mental health problems. A sequential mediation model showed that bisexual women reported greater sexual minority stress than lesbian women, which in turn was associated with less social support, which was associated with more physical and mental health problems. Greater sexual minority stress and lower social support may help explain why bisexual women report more health-related problems than lesbian women. The results of the present study support the importance of examining risk and protective factors for health problems separately for lesbian and bisexual women. Health-related intervention programs that target sexual minority women may need to be tailored differently for lesbian and bisexual women.

     

Sexual Debut Ages in Heterosexual,Lesbian, Gay,and Bisexual Young Adults in Norway

This study estimates sexual debut ages in young heterosexual, lesbian, gay, and bisexual men and women in Norway. A questionnaire survey was completed online by 27.2 % of a representative national web sample of 2090 persons aged 18–29 years. Three self-selected samples of 924 respondents completed an extended version of the survey online. Lesbian and bisexual women reported earlier experience of orgasm through masturbation than heterosexual women (median 13.1 vs. 15.2 years), and heterosexual men (median 13.5) reported earlier debut than heterosexual women. There was a statistically significant difference between heterosexual and lesbian and bisexual women’s age at the first experience of receptive vaginal sex (median 16.8 vs. 15.4 years). As regards experience of insertive vaginal sex, a significantly higher percentage of heterosexual men than women, and of heterosexual and lesbian and bisexual women, reported experience. It was more common among lesbian and bisexual women than heterosexual women to have had oral sex with another woman, but in neither group did the cumulative percent reach 50 % by the age of 29 years and the median could not be estimated. Gay and bisexual men reported earlier receptive anal sex debut than heterosexual men. With regard to insertive anal sex, gay and bisexual men accumulated experience earlier than heterosexual men, and lesbian and bisexual women acquired this experience earlier than heterosexual women. Compared to heterosexuals, LGB persons of both genders engage in more varied sexual activities. Lesbian and gay persons have same-sex experiences at an earlier age than bisexuals.     

Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths

Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families' reactions to youths' sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.     

Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family

Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings.     

A Preliminary Investigation of Body Dissatisfaction and Eating Disorder Symptomatology with Bisexual Individuals

Body dissatisfaction and eating disorder symptomatology were examined in bisexual individuals (n?=?139 women, n?=?37 men) and compared to lesbian/gay (n?=?51 women, n?=?96 men) and heterosexual individuals (n?=?82 women, n?=?34 men) in a U.S. online sample. Age, body mass index (BMI), income, and exercise frequency served as covariates. MANCOVA results showed a significant gender by sexual orientation interaction and significant main effects of gender and sexuality. Univariate tests were used to explore multivariate results. ANCOVA results for body dissatisfaction showed a significant gender by sexual orientation interaction. Post-hoc comparisons revealed higher levels of body dissatisfaction among all groups compared to heterosexual men. ANCOVA results for eating disorder symptomatology showed a significant main effect of sexual orientation. Post-hoc comparisons revealed higher levels of eating disorder symptoms among bisexual compared to heterosexual individuals. For bisexual men, gay community involvement, maladaptive social comparison, drive for muscularity, self-esteem, gender role orientation, and body dissatisfaction were explored as predictors of eating disorder symptomatology while controlling for age, BMI, exercise frequency, and income in a hierarchical regression analysis. The same factors, minus body dissatisfaction, were explored as predictors of body dissatisfaction in bisexual men. For bisexual women, similar factors, with the exception of drive for muscularity, were explored. Drive for muscularity predicted body dissatisfaction and exercise frequency predicted eating disorder symptomatology in bisexual men. BMI and self-esteem predicted body dissatisfaction in bisexual women; gay community involvement and body dissatisfaction predicted eating disorder symptomatology.     

Factors influencing therapist selection among gays,lesbians and bisexuals

For this study 609 gay, lesbian and bisexual individuals were surveyed with respect to openness about sexual orientation and preference for a therapist with a particular sexual orientation. Other factors considered important in selecting a therapist such as licensure, referral source, gender, cost and specialty were also examined. Data for this study was collected using two different methods. In the first method, data was collected from respondents subscribing to internet listervers serving gay, lesbian and bisexual subscribers. In the second, more traditional method, surveys were distributed by mail or hand delivered to various organizations serving gay, lesbian, and bisexual communities in two southwestern states. Findings suggest that significantly more lesbians than gay men and bisexuals in the e-mail sample prefer a therapist of the same sexual orientation. No significant relationships were found between degree of openness and importance of the therapist's sexual orientation. Other factors related to therapist preference were explored, and results are discussed.     

The Impact of Cumulative Minority Stress on Cognitive Behavioral Treatment With Gender Minority Individuals: Case Study and Clinical Recommendations

For sexual minority individuals (i.e., lesbian, gay, and bisexual [LGB] persons), minority stress includes experiences of discrimination, expectations of rejection, internalized negativity, and concealment of identity. Sexual minority stress has been linked to various negative mental health outcomes (e.g., depression, anxiety), and levels of psychiatric comorbidity are high among LGB people. However, little is known about the extension of minority stress models to gender minority individuals (i.e., transgender and gender nonconforming persons) and its impact on mental health in this particular group. Further, the influence of gender minority stress on the delivery and outcome of traditional cognitive behavioral therapy (CBT) approaches is unclear. A case study of CBT for chronic depression with a young, transgender individual is presented. This case study highlights potential barriers that may arise with gender minority clients when implementing evidence-based clinical interventions in the context of an individual’s minority stress history. Implications for cognitive-behavioral treatments with gender minority individuals and recommendations for clinicians and researchers are discussed.     

Was it a phase? Young women's relinquishment of lesbian/bisexual identities over a 5-year period

There have been many anecdotal accounts of individuals who self-identify as lesbian, gay, or bisexual only to relinquish these identities later. The current study examines this phenomenon among a sample of young nonheterosexual women who underwent 3 interviews over a 5-year period. Over a quarter of these women relinquished their lesbian/bisexual identities during this period: half reclaimed heterosexual identities and half gave up all identity labels. These women did not differ from those who maintained lesbian/bisexual identities regarding the age at which they underwent sexual identity milestones, the factors that precipitated their sexual questioning, or their recollection of childhood "indicators" of same-sex sexuality. Women who relinquished their identities for heterosexual identities had smaller ratios of same-sex to other-sex attractions across the 5-year assessment period, but their attractions did not significantly change. Only 1 woman described her previous same-sex identification as a phase; the rest emphasized changes in how they interpreted or acted on their attractions.     

Perceived cultural attitudes toward homosexuality and their effects on Iranian and American sexual minorities

This study examined the relationship between three mental health constructs and perceived cultural attitudes toward homosexuality among lesbian, gay, and bisexual individuals. Specifically, differences in perceived cultural attitudes and depression, self-esteem, and perceived stress between 49 Iranians and 47 Americans were compared. It was hypothesized that (a) perceived cultural attitudes toward homosexuality would be more negative among Iranians than Americans; (b) perceived cultural attitudes would be related to depression, self-esteem, and perceived stress; and (c) that Iranian participants' scores on the depression, self-esteem, and perceived stress measures would reflect poorer mental health than that of their American counterparts. Results indicated more negative perceptions of cultural attitudes toward homosexuality among Iranians. Contrary to prediction, however, no difference was found in levels of depression, self-esteem, and perceived stress among American and Iranian participants. Findings are discussed in terms of cultural and familial differences with regard to sexual orientation disclosure.     

Sexual identity development in the context of compulsory heterosexuality

This study analyzed the implications of sexual identity development for global, political, religious, and occupational identity development in 358 college students. Participants completed a written survey packet including the Extended Objective Measure of Ego Identity Status (EOM-EIS) and measures of sexual identity, physical/sexual preference, and emotional/affective preference. Data from the EOM-EIS suggest that having a sexual minority identity (lesbian, gay, bisexual, or "other" nonheterosexual identity) and reporting strong same-sex sexual or physical preferences are linked with more advanced global, political, religious, and occupational identity development. Heterosexual-identified participants were more likely to score high on identity foreclosure, moratorium, and diffusion, while sexual-minority-identified individuals scored higher on identity achievement. Individuals with strong same-sex physical/sexual preferences showed a pattern of results similar to those of sexual-minority-identified participants. Themes coded from a free-response question highlighted the finding that sexual-minority-identified participants more often viewed their sexual identity as salient and involving an effortful process. These individuals also stressed the importance of having support or modeling for their sexual identity.     

Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population

Past and future suicide attempt rates among gay, lesbian, and bisexual (GLB) young people were compared with those of heterosexual young people. A sample of Norwegian students (N = 2.924; grades 7-12) was followed in 3 data collection waves. Risk factors included previous suicide attempt,depressed mood, eating problems, conduct problems, early sexual debut, number of sexual partners, pubertal timing, self-concept, alcohol and drug use, atypical gender roles, loneliness, peer relations, social support, parental attachment, parental monitoring, and suicidal behavior among family and friends. When homosexual attraction, homosexual identity, and same-sex sexual behavior were entered to predict suicide attempt, only same-sex sexual behavior was significantly predictive. The increased odds could not be attributed to GLB students' greater exposure to risk factors for suicide attempt.     

A Phenomenological Study of Identifying as Lesbian,Gay and Bisexual in an Islamic Country

Ten adult Kuwaitis (four women and six men) who self-identified as being gay, lesbian, or bisexual (GLB) participated in in-depth semi-structured interviews examining their experience of being a sexual minority and living in a socially conservative Islamic country. The data were analyzed using interpretive phenomenology and yielded four primary themes including the role of religion and culture, risks, coping, and influential political factors. These themes help understand the ways in which LGB individuals in Kuwait integrate their sexual identity with religious and cultural factors and navigate a socially conservative society. The results of the study have implications for political and social policies in Kuwait, and for more culturally-sensitive models of sexual identity development among Arab populations.     

Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.     

Sex differences in the events that elicit jealousy among homosexuals

When individuals are asked which event would upset them more—a partner's emotional infidelity or a partner's sexual infidelity—among heterosexuals more men than women select a partner's sexual infidelity as the most distressing event, whereas more women than men select a partner's emotional infidelity as the most upsetting event. Because homosexuals’mating psychology is unlike that of heterosexuals, the present study examined which of these two events is more upsetting in a sample of 237 Dutch homosexuals. In support of our hypothesis it was found that, whereas gay men more often than lesbian women chose a mate's emotional infidelity as the most upsetting event, lesbians more often than gay men chose a mate's sexual infidelity as the most upsetting event. In addition, analyses showed that the effect of participant sex on infidelity choice was mediated by beliefs with regard to the co‐occurrence of sexual and emotional infidelity. Apparently, with respect to choosing the most upsetting type of infidelity of their partner, homosexuals resemble heterosexuals of the opposite sex. Several explanations are discussed for this finding.     

Psychological aggression in lesbian,gay, and bisexual individuals' intimate relationships: A review of prevalence,correlates, and measurement issues

Psychological Aggression (PA) is a common and serious problem in the relationships of lesbian, gay, and bisexual (LGB) individuals. It includes a range of behaviors that are used to hurt, coerce, control, and intimidate intimate partners. This paper reviewed the conceptualizations of PA, summarized the extant literature on PA among LGB women and men, and offered recommendations to improve the investigation of PA among LGB individuals. The conceptualization, definition, measurement, and prevalence of PA perpetration and victimization vary widely across studies. Different definitions and methods of assessing PA, a lack of consistency in examining and reporting psychometric information on measures used to assess PA among LGB samples, and varying sample characteristics make it difficult to compare results across studies. As a result, we know relatively little about the antecedents and consequences of PA among LGB individuals. In order to advance research in this area and increase understanding of this serious public health problem, it is necessary to: (1) clarify what constitutes PA; (2) specify the psychometric aspects of measures used to assess PA; (3) report details about sexual minority participants' sexual orientation/identity; (4) examine LGB-specific variables; and (5) utilize advanced methodological and statistical approaches to studying PA.     

The importance of feeling sexually attractive: Can it predict an individual's experience of their sexuality and sexual relationships across gender and sexual orientation?

Limited research exists on the implications of feeling sexually attractive for various aspects of sexuality and sexual relationships. This article examined associations between self‐perceived sexual attractiveness and sexual esteem, sexual satisfaction and amount of sexual experience, among both men and women who identified as heterosexual (n = 1017), gay or lesbian (n = 1225) or bisexual (n = 651). Results of the study demonstrated that positive self‐perceptions of sexual attractiveness predicted greater sexual esteem, greater sexual satisfaction, a higher frequency of sexual activity with others and a larger number of sexual partners among both men and women who identified as heterosexual, gay, lesbian or bisexual. The findings suggest that feeling sexually attractive may have implications for how an individual experiences their sexuality and sexual relationships regardless of their gender or sexual orientation. The importance of considering an individual's self‐perceptions of sexual attractiveness when they present with concerns related to their sexual experiences or relationships, and the potential benefits of educational and therapeutic interventions designed to enhance self‐perceptions of sexual attractiveness are discussed.     

Religion and Suicide Risk in Lesbian,Gay and Bisexual Austrians

Religion is known to be a protective factor against suicide. However, religiously affiliated sexual minority individuals often report a conflict between religion and sexual identity. Therefore, the protective role of religion against suicide in sexual minority people is unclear. We investigated the effect of religion on suicide risk in a sample of 358 lesbian, gay and bisexual Austrians. Religion was associated with higher scores of internalized homophobia, but with fewer suicide attempts. Our data indicate that religion might be both a risk and a protective factor against suicidality in religiously affiliated sexual minority individuals.     

The Intersection of Gender and Sexuality: Sexism Shapes Men’s Same-Sex Sexuality in Terms of Self-Label Identification and Partner Choice in China

We examined how sexism related to gay and bisexual men’s preferences for same-sex top (dominant) or bottom (submissive) sexuality in China. Specifically, we determined the impacts of sexism on sexual self-label identification and requirements for a romantic partner’s sexual role among 507 Chinese gay and bisexual men. Sexism was found to significantly predict top/bottom sexual self-label: gay and bisexual men endorsing benevolent sexism (BS; ideation of women who conform to traditional gender roles) were more likely to identify as tops than as bottoms. We also noted a significant prediction of hostile sexism (HS; hostility toward women who oppose traditional roles) on partner choice: Tops and bottoms endorsing HS were more likely to require a complementary partner rather than to have no requirements. Moreover, sexism was related to sexual role prejudice, a concept derived from sexism that we defined as holding attitudes toward the gender roles of “bottoms” among gay and bisexual men that indicate inequality of sexual self-labels. In a mediation analysis of these relationships, we noted significant indirect effects of BS and HS on sexual self-label via both benevolent and hostile sexual role prejudice, as well as on requirements for a romantic partner’s sexual role via benevolent (but not hostile) sexual role prejudice. Our results suggest that traditional gender beliefs may influence negative beliefs toward other sexual roles and that both sets of beliefs, although not always consistent with each other, relate to gay and bisexual men’s sexual self-labels and requirements for a romantic partner’s sexual role.     

A computer-based intervention to reduce internalized heterosexism in men

Internalized heterosexism (IH) is a strong predictor of the psychological well-being of lesbian, gay, bisexual (LGB), or other same-sex attracted individuals. To respond to the call for interventions to address IH, the current study developed and tested an online intervention to reduce IH among gay, bisexual, and other same-sex attracted men. A total of 367 self-identified same-sex attracted adult males were recruited through various nationwide LGB-related sources and were assigned by birth month to either the experimental condition (focusing on IH reduction) or the control condition (a similarly structured invention focusing on stress management); 290 of these participants completed the intervention and all post-intervention measures. Mean levels of IH were compared by condition, indicating significant differences on the IH global score and 2 of the 3 IH subscale scores between the participants in the 2 conditions. The study findings support the promise of using the Internet to deliver IH interventions. Implications for research and practice are discussed.     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.