Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the "gay-friendly" Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed.     

Clustered Patterns of Behavioral and Health-Related Variables Among Young Lesbian Women

Lesbian women are at increased risk for a variety of mental and physical health problems compared to heterosexual women. In order to inform treatment and prevention, the purpose of this study was to examine behavioral and health-related patterns among lesbian women and elucidate how these patterns are associated with general discrimination, sexual minority stress, affect, and social support. A sample of self-identified lesbian women (N = 436) completed an online survey from August 2014–March 2015. A latent profile analysis was conducted using measures of body mass index, hazardous alcohol use, binge eating, eating disorder risk, and exercise as indicators. A 5-class solution best fit the data and included two healthy groups: (a) low health risk, moderate exercise (54%), (b) low health risk + high exercise (22%); and three unhealthy risk groups: (c) obese + binge eating (14%); (d) disordered eating + hazardous alcohol use (5%); (e) disordered eating + high exercise (5%). The three unhealthy classes generally reported more general discrimination, sexual minority stress, social anxiety, negative affect, and lower social support compared to the healthy classes. These findings show that behavioral and health-related variables cluster together in several distinct patterns among lesbian women. In addition, general discrimination and sexual minority stress and associated psychosocial functioning may be related to these maladaptive behavioral and health-related patterns and may be important to consider in behavioral interventions.     

A New Paradigm for Women's Sexual Orientation

Abstract

This paper critiques old models of women's sexual orientation that viewed heterosexuality as the norm for mental health, characterized lesbians as masculinized sexual “inverts,” and looked to biology to explain the development of homosexuality. A new paradigm for women's sexual orientation is presented. This paradigm emphasizes the importance of the social context and recognizes the multiple pathways that can lead a woman to identify as lesbian, bisexual or heterosexual. In addition, the main components of sexual orientation are considered as is the potential fluidity of women's sexuality. Throughout, implications of the new paradigm for psychotherapy with women are considered.     

Disclosure Experiences of Sexual Minority College Student Victims of Intimate Partner Violence

Although research on disclosure following intimate partner violence (IPV) victimization is burgeoning, sexual minority young adults’ (lesbian, gay, bisexual, queer, questioning, etc.; LGBQ+) experiences have not received equal attention. The current study employed the minority stress framework to examine disclosure experiences of LGBQ+ college students across the United States reporting physical IPV victimization within their current relationship (n = 77). Participants completed measures assessing minority stress and IPV disclosure, and answered open‐ended questions regarding the most and least helpful persons/responses to disclosure or reasons for non‐disclosure. Results indicated that approximately one‐third (35 %) of victims disclosed to at least one person, with friends being the most common recipients. Thematic analyses indicated that talking or listening to the victim was considered the most helpful response and not understanding the situation least helpful. Reasons for non‐disclosure centered on themes of the victims’ perception that the IPV was not a big deal. Quantitative findings regarding physical IPV disclosure indicated that non‐disclosers experienced greater minority stress than disclosers. The current study suggests the presence of differences between sexual minority (i.e., LGBQ +persons) and non‐sexual minority persons, as well as between LGBQ+ young adults/college students and older adults and presents a theoretical structure (i.e., minority stress framework) through which these differences may be understood.     

Sexual Minority Stress,Coping, and Physical Health Indicators

Sexual minorities experience higher rates of several physical health problems compared to their heterosexual counterparts. The present study uses Meyer's Minority Stress Model (Psychological Bulletin, 129(5): 674-697, 2003) to examine physical health indicators among 250 adults who identified as sexual minorities. Study hypotheses include that sexual minority stress is predictive of two physical health indicators (i.e., engagement in a health-promoting lifestyle and number of physical health problems) and that planning (i.e., problem-focused) and social support coping will partially mediate the relationship between sexual minority stress and each physical health indicator. Results showed that as level of sexual minority stress increased, engagement in a health-promoting lifestyle decreased and the number of physical health problems increased. Planning and social support coping did not mediate these relationships; however, as levels of coping increased, engagement in a health-promoting lifestyle increased. These findings have implications for researchers and healthcare professionals in their efforts to promote the physical health of sexual minorities.     

Mental health of the bisexual Veteran

Despite evidence showing that bisexual individuals may be at greater risk for mental health issues than lesbian and gay individuals, they are often combined into a single group, with lesbian and gay individuals the actual focus of the research. This study aims to address this gap in the literature among US Veterans. Using data collected from a multicity purposive sample (N = 4,493), logistic regression was used to analyze whether the following groups differ in current posttraumatic stress disorder (PTSD) and depression: (a) bisexual (n = 101) vs. heterosexual Veterans (n = 4,271); (b) bisexual vs. lesbian/gay Veterans (n = 121); (c) lesbian/gay vs. heterosexual Veterans; and (d) combined group of lesbian, gay, and bisexual (LGB; n = 222) vs. heterosexual Veterans. Controlling for significant covariates, bisexual Veterans had 2.5 times the risk of severe depression (95% confidence interval [CI] = 1.34–4.67; p = 0.004) and 2.3 times the odds of PTSD (95% CI = 1.40–3.77; p = 0.001) relative to heterosexual Veterans. Bisexual Veterans had 3 times the risk of severe depression (95% CI = 1.22–7.44; p = 0.017) and 1.9 times the risk of PTSD (95% CI = 1.02–3.70; p = 0.045) compared to lesbian/gay Veterans. Lesbian/gay Veterans had no significant difference in risk for depression compared to heterosexual Veterans. However, the combined group of LGB Veterans had 1.6 times the odds of PTSD (95% CI = 1.12–2.15; p = 0.008) compared to heterosexual Veterans. These findings suggest that past research showing mental health disparities between LGB and heterosexual individuals may be driven by the inclusion of bisexual individuals. Research should assess bisexual individuals as a distinct group, and future studies should explore factors leading to depression and PTSD among bisexual Veterans.     

Academic and Social Integration on Campus Among Sexual Minority Students: The Impacts of Psychological and Experiential Campus Climate

A heterosexist campus climate can increase risk for mental health problems for sexual minority students; however, the relationship between campus climate for sexual minorities and academic outcomes remains understudied. Using a sample of sexual minority respondents extracted from a campus climate survey conducted at a large university in the Midwest, we examine relationships between multiple dimensions of psychological and experiential campus climate for sexual minorities with academic integration (academic disengagement, grade‐point average [GPA]) and social integration (institutional satisfaction, acceptance on campus). We also investigate the protective role of engagement with informal academic and peer‐group systems. Findings suggest campus climate affects sexual minority students’ integration. In multivariate analyses, perceptions of whether lesbian, gay, and bisexual (LGB) people could be open about their sexual identity was positively associated with acceptance on campus; personal heterosexist harassment was positively associated with academic disengagement and negatively with GPA. Students’ informal academic integration (instructor relations) and informal social integration (LGB friends) demonstrated influential main effects but did not moderate any of the climate‐outcome relationships. Researchers should further explore the relationships between climate and academic outcomes among sexual minority students, both collectively and among specific sub‐groups, and address the role of other protective factors.     

Minority Stress and the Risk of Unwanted Sexual Experiences in LGBQ Undergraduates

Sexual assault is prevalent among lesbian, gay, bisexual, and queer (LGBQ) college students, but its relationship to anti-LGBQ stigma has not been established. The goal of the present study was to determine whether minority stress, specifically internalized homophobia, predicted unwanted sexual experiences among LGBQ undergraduates (N = 763), whether routine behaviors (number of consensual sexual partners and alcohol use) mediated this relationship, and whether sense of LGBTQ community was a protective factor. Significant proportions of sexual minority men (10 %), women (18 %), and non-binary or transitioning students (19 %) reported an unwanted sexual experience since entering college. Internalized homophobia was associated with greater risk of unwanted sexual experiences. It also had a negative indirect effect on unwanted sexual experience risk through a negative association with number of sexual partners. Alcohol use did not mediate the relationship between internalized homophobia and unwanted sexual experiences. Sense of LGBTQ community was associated with lower risk, mediated by lower levels of internalized homophobia. The relationships between internalized homophobia and unwanted sexual experience risk were similar for women and men. These findings demonstrate that minority stress increases LGBQ students’ risk of sexual victimization and that in-group social relationships can mitigate this risk. We argue that minority stress is an important risk factor for sexual violence. Violence prevention interventions should attempt to reduce internalized homophobia, and colleges and high schools should establish LGBQ-affirming social climates and provide resources for LGBQ students, including targeted violence prevention efforts and programs that foster a sense of supportive community.     

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.     

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.     

Dual Marginality: The Impact of Auditory Status and Sexual Orientation on Abuse in a College Sample of Women and Men

This exploratory study examined the relationship between the combination of auditory status and sexual orientation, and experiencing interpersonal violence, as measured by sexual, physical, and psychological abuse. A cross-sectional examination of 1,023 undergraduate students including 222 Deaf and hard-of-hearing students provided the data. Findings revealed that gay, lesbian, and bisexual students who also were Deaf or hard of hearing were more likely to experience sexual, physical, and psychological abuse than those in mainstream majority groups. The combination of auditory minority with sexual minority status for students had the strongest effect for physical and psychological abuse. Implications for policy and future research are provided.     

Childhood Trauma, Adult Sexual Assault, and Adult Gender Expression among Lesbian and Bisexual Women

Several studies have demonstrated that lesbian and bisexual women are more likely than heterosexual women to report childhood abuse and adult sexual assault. It is unknown, however, which sexual minority women are most likely to experience such abuse. We recruited adult sexual minority women living in the US through electronic fliers sent to listservs and website groups inviting them to complete an online survey (N?=?1,243). We examined differences in both childhood abuse and adult sexual assault by women’s current gender identity (i.e., butch, femme, androgynous, or other) and a continuous measure of gender expression (from butch/masculine to femme/feminine), adjusting for sexual orientation identity, age, education, and income. Results indicated that a more butch/masculine current self-assessment of gender expression, but not gender identity, was associated with more overall reported childhood trauma. Although one aspect of gender expression, a more butch/masculine gender role, was associated with adult sexual assault, feminine appearance and a femme gender identity also significantly predicted adult sexual assault. These findings highlight the significance of gender identity and expression in identifying women at greater risk for various abuse experiences.     

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.     

Sexual Minority Youth,Social Change,and Health: A Developmental Collision

Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people—perhaps particularly for youth—has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. The authors suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility.     

DO COPING STYLES MODERATE OR MEDIATE THE RELATIONSHIP BETWEEN INTERNALIZED HETEROSEXISM AND SEXUAL MINORITY WOMEN'S PSYCHOLOGICAL DISTRESS?

The purpose of this study was to test tenets of both minority stress and lesbian feminist/sexual identity development theories by examining the potential moderating and mediating roles of individual coping styles (i.e., problem-solving and avoidant coping) in the relationship between internalized heterosexism and lesbian and bisexual (sexual minority) women's psychological distress. Participants included 323 sexual minority women who completed an Internet survey. Results revealed that avoidant coping partially mediated the relationship between internalized heterosexism and psychological distress. No support was found for the mediating role of problem-solving coping or for the moderating roles of problem-solving and avoidant coping in the link between internalized heterosexism and psychological distress. Feminist strategies that may be useful for clinicians working with clients to reduce internalized heterosexism are provided.     

Female bisexuality from adolescence to adulthood: results from a 10-year longitudinal study

Debates persist over whether bisexuality is a temporary stage of denial or transition, a stable "3rd type" of sexual orientation, or a heightened capacity for sexual fluidity. The present study uses 5 waves of longitudinal data collected from 79 lesbian, bisexual, and "unlabeled" women to evaluate these models. Both the "3rd orientation" and "fluidity" models had support, but the "transitional stage" model did not. Over 10 years, 2/3 of women changed the identity labels they had claimed at the beginning of the study, and 1/3 changed labels 2 or more times. Yet, contrary to the "transitional stage" model, more women adopted bisexual/unlabeled identities than relinquished these identities; few bisexual/unlabeled women ended up identifying as lesbian or heterosexual. Overall, the most commonly adopted identity was "unlabeled." Bisexual/unlabeled women had stable overall distributions of same-sex/other-sex attractions but greater absolute fluctuations in attractions from assessment to assessment than lesbians. All women reported declines in their ratio of same-sex to other-sex behavior over time. These findings demonstrate that the distinction between lesbianism and bisexuality is a matter of degree rather than kind.     

Psychological Well-Being of Sexual Minority Young Adults in Iceland: Assessing Differences by Sexual Attraction and Gender

The literature on sexual minority adolescents and young adults has highlighted a poor mental status among those groups compared to their heterosexual peers. Sexual minorities are also more likely to experience stress factors such as bullying and physical violence. However, sexual minority young adults have not been studied much in Iceland, a Nordic country renowned for a high degree of sexual equality. Given what the literature has shown to date, a noteworthy question is whether patterns of mental well-being of sexual minority adolescents and young adults in Iceland are comparable to other countries. The aim of the present study was to provide an assessment of mental well-being in sexual minority young adults in Iceland. We used population data to examine a selection of mental well-being indicators in 16–20 year-olds, both-sex-attracted and same-sex-attracted participants, and compared them to other-sex-attracted peers. Findings indicated that sexual minority young adults exhibited significantly greater levels of depressed mood, anger, and perceived stress than other-sex-attracted young adults. However, when stratified by gender and sexual attraction pattern, the analyses revealed that both-sex-attracted young women scored significantly higher on all indicators than any other group. We conclude that studies in this area should strive to distinguish between same-sex and both-sex attraction as well as to stratify analyses by gender. The well-being of both-sex-attracted young women is a compelling topic for future research.     

Sexual quality of life in patients undergoing coronary artery bypass graft surgery

Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.

Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3–5-day post-surgery; n?=?60) and 2-month post-surgery (n?=?42).

Results: Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values ≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values ≤0.03) and greater sexual satisfaction and interest (p values ≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p?=?0.05).

Conclusions: Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients’ motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.     

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.     

Predictors of Sexual Consent Attitudes,Beliefs, and Behaviors Among Sexual Minority Cisgender and Nonbinary Young Adults

Sexual assault is a major public health concern in the United States that disproportionately affects sexual minority cisgender and nonbinary young adults. Although sexual assault is influenced by a myriad of societal and interpersonal factors, misunderstandings during the communication and interpretation of sexual consent signals likely contribute to this public health crisis. Unfortunately, research on sexual consent miscommunication has been heavily informed by heteronormative theories and conducted primarily with cisgender heterosexual men and women. The present study attempted to help address this gap in the literature by exploring factors that contribute to sexual consent attitudes, beliefs, and behaviors in a sample of 251 cisgender and nonbinary sexual minority young adults. Nonbinary participants reported more proactive sexual consent attitudes, beliefs, and behaviors than cisgender participants. Sexual assertiveness was also a robust and unique predictor of adaptive sexual consent, particularly among those who identified as more traditionally masculine. Findings from the current study may help guide the development of more inclusive, research-informed sexual consent and sexual violence prevention programs.