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.     

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.     

LGBTQ Adolescents’ Positive and Negative Emotions and Experiences in U.S. High Schools

In a national survey of more than 19,000 U.S. high school students, we compared how LGBTQ youth and their non-LGBTQ peers felt at school and how they perceived social and academic experiences. We examined differences in emotions and school experiences across gender identities, sexual identities, and their intersections. LGBTQ adolescents reported significantly more frequent negative emotions and bullying, consistent with previous research. LGBTQ students also reported less frequent experiences of positive emotions at school and less frequent positive school experiences (i.e., positive peer and teacher relationships, subjective task value, and persistence support). Students who were both gender and sexual identity minority reported the most frequent negative and least frequent positive experiences at school, compared to students who were neither a gender or sexual identity minority. Analyses of the intersection of gender and sexual identity showed that heterosexual male students experienced more frequent positive emotions and school experiences, and fewer negative emotions and bullying, compared to all other groups. We discuss how these differences might be addressed through school interventions and future research.     

Associations of LGBTQ+ Identities With Acceptability and Efficacy of Online Single-Session Youth Mental Health Interventions

Barriers such as stigma, financial costs, and provider shortages prevent large portions of youth with depression and related difficulties from accessing treatment; lesbian, gay, bisexual, transgender, queer/questioning sexual orientation, or other non-heterosexual identity (LGBTQ+) youth are burdened with additional barriers related to minority stress. Single-session interventions (SSIs) have been found to benefit youth and help reduce depression symptoms, and since many SSIs are brief, cost-free, and accessible online, they may circumvent several access barriers. However, prior to recommending non-community-tailored SSIs as a useful resource for minoritized youths, we first assessed whether LGBTQ+ youth respond as positively to SSIs as do cisgender heterosexual youth. In a subsample of youths recruited via online advertisements from September 2019 to August 2020 (N = 258, 81.4% female-assigned sex at birth, 60.5% LGBTQ+, 47.3% youth of color), we investigated whether changes in hopelessness, agency, and self-hate from before to after completing online self-directed SSIs differed as a function of LGBTQ+ identity. We also quantitatively and qualitatively compared intervention acceptability ratings and feedback across LGBTQ+ and cisgender heterosexual youths. Analyses revealed no significant differences between cisgender LGBQ+, trans and gender diverse, and cisgender heterosexual youths for any intervention outcomes. Likewise, no group differences emerged in intervention acceptability ratings or written program feedback. Self-selection bias and underrepresentation of certain populations, such as American Indian and Alaskan Native youths, may limit generalizability of results. Results suggest that online mental health SSIs are equally acceptable and useful to LGBTQ+ and cisgender heterosexual youth alike, even prior to culturally specific tailoring.     

College Campus Community Readiness to Address Intimate Partner Violence Among LGBTQ+ Young Adults: A Conceptual and Empirical Examination

This paper provides an overview of a conceptual model that integrates theories of social ecology, minority stress, and community readiness to better understand risk for and outcomes of intimate partner violence (IPV) among LGBTQ+ college students. Additionally, online survey data was collected from a sample of 202 LGBTQ+ students enrolled in 119 colleges across the United States to provide preliminary data on some aspects of the proposed model. Results suggested that students generally thought their campuses were low in readiness to address IPV; that is, students felt that their campuses could do more to address IPV and provide IPV services specific to LGBTQ+ college students. Perceptions of greater campus readiness to address IPV among LGBTQ+ college students was significantly and positively related to a more favorable LGBTQ+ campus climate and a greater sense of campus community. Additionally, IPV victims were more likely to perceive higher levels of campus community readiness than non‐IPV victims. There was no association between IPV perpetration and perceptions of campus community readiness. Greater sense of community was marginally and inversely related to IPV victimization and perpetration. Sense of community and LGBTQ+ campus climate also varied to some extent as a function of region of the country and type of institution. Implications for further development and refinement of the conceptual model, as well as future research applying this model to better understand IPV among sexual minority students are discussed.     

Assessing Sexual Orientation Symptoms in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT)

Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one’s sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current paper details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure’s 12 items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears; Factor 2: Somatic Checking) and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.     

Minority Stress,Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian,Gay, Bisexual,Transgender, Queer,and Gender Non‐Conforming Youth

Lesbian, gay, bisexual, transgender, queer, and gender non‐conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14–24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.     

Coming Out Growth: Conceptualizing and Measuring Stress-Related Growth Associated with Coming Out to Others as a Sexual Minority

Coming out has long been depicted as a process that is conducive to personal growth. However, LGBTQ psychology has yet to conduct systematic, theoretically informed research to study how individuals experience coming out growth (COG) and the impact of such experiences on the lives of sexual minorities. The present investigation seeks to address these gaps in the literature through an examination of stress-related growth within the context of coming out as a sexual minority. Findings from a preliminary investigation of COG in a sample of 418 gay and lesbian adults are presented, including the development and initial validation of the coming out growth scale (COGS), and data addressing the relationship between COG and relevant constructs found in the literature on identity development and stress-related growth.     

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.

     

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans

Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.     

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.     

Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.     

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.     

Resilience in Community: A Social Ecological Development Model for Young Adult Sexual Minority Women

Family support and rejection are associated with health outcomes among sexual minority women (SMW). We examined a social ecological development model among young adult SMW, testing whether identity risk factors or outness to family interacted with family rejection to predict community connectedness and collective self‐esteem. Lesbian and bisexual women (N = 843; 57 % bisexual) between the ages of 18–25 (M = 21.4; SD = 2.1) completed baseline and 12‐month online surveys. The sample identified as White (54.2 %), multiple racial backgrounds (16.6 %), African American (9.6 %) and Asian/Asian American (3.1 %); 10.2 % endorsed a Hispanic/Latina ethnicity. Rejection ranged from 18 to 41 % across family relationships. Longitudinal regression indicated that when outness to family increased, SMW in highly rejecting families demonstrated resilience by finding connections and esteem in sexual minority communities to a greater extent than did non‐rejected peers. But, when stigma concerns, concealment motivation, and other identity risk factors increased over the year, high family rejection did not impact community connectedness and SMW reported lower collective self‐esteem. Racial minority SMW reported lower community connectedness, but not lower collective self‐esteem. Families likely buffer or exacerbate societal risks for ill health. Findings highlight the protective role of LGBTQ communities and normative resilience among SMW and their families.     

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.     

Adaptability of Family Therapy Modalities in the Treatment of Lesbian and Gay Clients with Bulimia Nervosa

Bulimia nervosa (BN) has becoming an increasingly common form of eating disorder, particularly with gay and lesbian populations. The lack of current literature on this particular topic, as well as the limited resources for recommendations of treatment adaptations for this population is evident by the disproportionate number of sexual minorities that present for treatment. This paper discusses the possible reasons for the lack of literature and resources, and provides clinicians with the adaptations of Emotion Focused Therapy, Cognitive Behavioral Therapy, Structural Family Therapy, and Internal Family Systems when working with lesbian and gay populations who are suffering from BN. This paper aims to contribute more to the limited research in the area of sexual minorities in hopes to broaden the understanding of the treatment of individuals, as well as family functioning. We attempt to adapt these therapy modalities to be more inclusive of these nuanced presenting concerns, and to provide clinicians from all scopes of practice a thorough look into the treatment of a sexual minority population.     

Effects of Minority Stress on Group Identification and Collective Action among Sexual Minorities: A Longitudinal Test of the Rejection-Identification Model

Minority stress remains pervasive in various aspects of life among sexual minorities. Driven by the awareness of social injustice, some sexual minority individuals may undertake collective action to counteract discrimination, but this does not apply to all members of sexual minorities. The present study used a prospective, longitudinal research design to examine how different dimensions of minority stress (i.e., perceived discrimination and internalized stigma) interact to affect group identification and collective action. A total of 628 sexual minority individuals in Hong Kong were involved in the study. The results showed that prior discriminatory experiences were positively associated with collective action at follow-up through increased levels of group identification and commitment to social justice. The moderating effect of internalized stigma was found in which perceived discrimination was not significantly related to group identification and collective action among those with high levels of internalized stigma. The study extends the literature on the rejection-identification model by understanding collective action as a form of group-level coping in the face of discrimination. It highlights the importance of fostering group identification, strengthening collective action, and mitigating internalized stigma among sexual minorities in psychological practice.

     

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.     

Organizational efforts to affirm sexual diversity: a cross-level examination

A growing number of organizations have enacted policies intended to recognize and affirm sexual diversity in the workforce. This research demonstrates that the more prevalent these policies, the less likely sexual minority members are to experience treatment discrimination. Further, as expected, more equitable treatment was associated with higher levels of satisfaction and commitment among lesbian and gay employees. Treatment discrimination was also systematically related to the use of 3 identity management strategies (i.e., counterfeiting, avoiding, integrating). Findings also illustrate the importance of considering individual attributes in diversity research. In particular, group identity attitudes were associated with work-related attitudes and identity management. Overall, the research demonstrates the importance of organizational efforts to affirm sexual diversity and highlights the need for future research in this area.