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.

     

The Affective Consequences of Minority Stress Among Bisexual,Pansexual, and Queer (Bi+) Adults: A Daily Diary Study

Bisexual, pansexual, and queer (bi+) individuals are at increased risk for depression and anxiety. These disparities are hypothesized to be due to the unique, minority-specific stressors that they experience. Prior research supports that bi+ stressors are associated with depression and anxiety, but nearly all studies have been cross-sectional, limiting our understanding of how experiencing bi+ stress influences individuals’ levels of depression and anxiety as they occur in their day-to-day lives. To address this gap, we examined the daily associations between bi+ stressors (discrimination, internalized stigma, rejection sensitivity, and identity concealment) and depressed/anxious mood in a 28-day diary study. Participants were 208 bi+ individuals who completed daily measures of bi+ stressors and depressed/anxious mood. We tested unlagged (same-day) and lagged (next-day) associations, and we also tested whether internalized stigma, rejection sensitivity, and identity concealment functioned as mechanisms underlying the daily associations between discrimination and depressed/anxious mood. Participants reported higher depressed/anxious mood on days when they reported higher discrimination, internalized stigma, rejection sensitivity, and identity concealment. There were significant unlagged indirect effects of discrimination on depressed and anxious mood via internalized stigma and rejection sensitivity, and there was also a significant unlagged indirect effect of discrimination on anxiety via identity concealment. However, none of the lagged associations were significant. Results suggest that bi+ stress is related to same-day, but not next-day, depressed/anxious mood. The nonsignificant lagged associations could reflect that bi+ individuals are using adaptive coping skills in response to bi+ stress, or that other experiences throughout the day have stronger influences on next-day mood.     

The Psychological and Physical Health Effects of Stigma: The Role of Self‐threats

Being a member of a group that is stigmatized (i.e., low status, devalued, negatively stereotyped, and victimized by prejudice and discrimination) can affect health. In this paper, I consider threats to the social self as a mediator in the relationship between stigmatizing experiences and health. I discuss experiences associated with stigmatization that can pose a potential threat to the sense of self and how each of these aspects of stigma relates to health. Our current knowledge is heavily centered on how discrimination experiences relate to health. More research is needed on how other aspects of stigma affect health. In addition, research addressing coping strategies, and especially how they influence health behaviors, will be useful in gaining a better understanding of the mechanisms through which stigma affects health.     

Effect of perceived public stigma on internalized homophobia,anticipated stigma,shame, and guilt: Outness as a moderator

Although previous studies found that distal minority stress contributes to proximal minority stress and shame/guilt among the lesbian, gay, and bisexual (LGB) population, it is unclear whether the extent to which LGB individuals' open display and discussion their sexual orientation moderates these relationships. A total of 1,452 Chinese LGB adults provided demographic information and completed measures of outness, perceived public stigma, internalized homophobia, anticipated stigma, shame, and guilt. Structural equation modelling was conducted to test the hypothesized moderation analyses. Perceived public stigma had positive associations with internalized homophobia, anticipated stigma, shame, and guilt. Outness played a moderating role in the associations of perceived public stigma with internalized homophobia, anticipated stigma, shame, and guilt. Specifically, when LGB individuals had higher levels of outness, the effects of perceived public stigma on internalized homophobia, anticipated stigma, shame, and guilt were lower. Moreover, such moderating effect did not differ by sexual orientation. The degree to which sexual minority individuals' sexual orientation is known by and openly discussed with others may lower the extent to which LGB individuals internalize sexual stigma, expect rejection after coming out, and develop shame and guilt as a result of perceived social prejudice and discrimination.     

The effect of personal and group discrimination on the subjective well-being of people with mental illness: the role of internalized stigma and collective action intention

The goal of this study is to test a model in which personal discrimination predicts internalized stigma, while group discrimination predicts a greater willingness to engage in collective action. Internalized stigma and collective action, in turn, are associated to positive and negative affect. A cross-sectional study with 213 people with mental illness was conducted. The model was tested using path analysis. Although the data supported the model, its fit was not sufficiently good. A respecified model, in which a direct path from collective action to internalized stigma was added, showed a good fit. Personal and group discrimination appear to impact subjective well-being through two different paths: the internalization of stigma and collective action intentions, respectively. These two paths, however, are not completely independent, as collective action predicts a lower internalization of stigma. Thus, collective action appears as an important tool to reduce internalized stigma and improve subjective well-being. Future interventions to reduce the impact of stigma should fight the internalization of stigma and promote collective action are suggested.     

Prejudice,social stress,and mental health in lesbian,gay, and bisexual populations: conceptual issues and research evidence

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.     

Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India

Previous research has shown that HIV stigma in India can be characterized by a framework dividing manifestations into enacted (discrimination), vicarious (hearing stories of discrimination), felt normative (perceptions of stigma's prevalence), and internalized stigma (personal endorsement of stigma beliefs). We examined whether this framework could explain associations among stigma, efforts to avoid HIV serostatus disclosure, and depression symptoms in a cohort of 198 HIV-infected individuals from Southern India who were followed up for one year as part of a study of antiretroviral adherence. Prior studies had suggested that disclosure avoidance was a primary outcome of stigma and that impaired well-being was a primary outcome of disclosure avoidance. Analyses from our longitudinal research revealed that the pattern of associations among stigma, disclosure avoidance, and depression symptoms remained consistent over time. Enacted and vicarious stigmas were correlated with felt normative stigma beliefs. In turn, felt normative stigma was correlated with disclosure avoidance. And, enacted stigma, internalized stigma, and disclosure avoidance were all associated with depression symptoms. However, even though the overall framework held together, internalized stigma and depression symptoms dropped significantly over time while other components remained unchanged. These findings suggest that, although HIV stigma may limit disclosure, it does not invariably lead to psychological maladjustment. Amidst ongoing perceptions and experiences of stigma, HIV-positive individuals can achieve significant improvements in their acceptance of the disease and in mental well-being.     

HIV/AIDS and the family: a review of research in the first decade

Most studies of the psychosocial implications of HIV/AIDS have been focused on the individual. This paper reviews the small but growing body of research into the impact of HIV/AIDS on the family system. Special reference is made to definitions of the family, same-sex relationships and the African family. The impact of HIV/AIDS on the family is discussed in terms of social stigma, isolation and secrecy, stress and coping, social support, communication and disclosure, responses to illness, and changing structure and roles in families. It is anticipated that in the 1990s, the study of the family will become a dominant topic in HIV/AIDS-related research.     

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study

This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.     

Infant feeding and internalized stigma: The role of guilt and shame

Globally the rates of breastfeeding duration are extremely low and postnatal mental health issues are common. As a result, it is important to examine the emotions that underlie these matters. Across two studies (one correlational study N = 160 and one experimental study N = 118), we examined participants’ experiences of shame and guilt when feeding their baby, and the relationship between these emotions with breastfeeding behaviors and internalized stigma. We also examined the psychosocial factors that predict internalized stigma, and whether shame and guilt mediate these relationships. We focused on three factors that have been shown to be associated with internalized stigma in other domains: self-esteem and social support (Study 1), as well as self-efficacy (Study 2). Multiple regression revealed that experienced guilt uniquely predicted a shorter duration of exclusive breastfeeding (Study 1). Higher self-efficacy (Study 2), self-esteem, and perceived social support (Study 1) predicted lower internalized stigma of feeding choice. We found that shame was a mediator for the self-esteem and internalized stigma relationship (Study 1), while guilt was a mediator for the self-efficacy and internalized stigma relationship (Study 2). Our findings highlight the importance of experienced shame and guilt in mothers’ infant feeding experiences. The current results can inform future research and the design of interventions to improve breastfeeding rates and reduce feelings of stigma.     

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples’ adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross‐sectional study, a total of 134 participants (67 couples with infertility) completed self‐report questionnaires assessing infertility‐related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.     

Perceived Stigma of Postpartum Depression Symptoms in Low-Risk First-Time Parents: Gender Differences in a Dual-Pathway Model

Although postpartum depression (PPD) symptoms are fairly common among new mothers and fathers, new parents still perceive a stigma associated with having the “baby blues.” Research has extensively examined the role of perceived stigma on help-seeking for clinical PPD, but little is known about the process of perceived stigma in new parents. We examined the role of perceived stigma in postpartum depressive symptoms using the dual-pathway model (Mickelson and Williams 2008). Specifically, we tested whether internalized stigma would influence PPD symptoms through parenting efficacy, whereas experienced stigma would influence PPD symptoms through indirect support-seeking. We also examined whether the internalized pathway was stronger for fathers while mothers would utilize both pathways. Using longitudinal data from a community sample of first-time parents in the United States, we found parenting efficacy was a mediator between internalized stigma and PPD symptoms for mothers and experienced stigma and PPD symptoms for fathers; indirect support-seeking was only a cross-sectional mediator for mothers between internalized stigma and PPD symptoms. Understanding how new mothers and fathers perceive the stigma attached to PPD symptoms and the process by which it impacts symptom reporting can help to improve interventions aimed at new parents.     

A paradox of support seeking and rejection among the stigmatized

Individuals perceiving stigma may be unwilling to seek support directly. Instead, they may use indirect strategies due to fear of rejection. Ironically, indirect seeking leads to unsupportive network responses (i.e., rejection). In Study 1, data collected from structured interviews of a sample of U.S. women in poverty (N= 116) showed that perceived poverty‐related stigma was related to increased fear of rejection, which in turn partially mediated perceived stigma and indirect seeking. In Study 2, data gathered from structured interviews of a sample of U.S. abused women (N= 177) revealed that perceived abuse‐related stigma was linked to increased indirect seeking, which in turn related to increased unsupportive network responses. By contrast, direct support seeking was related to increased supportive and decreased unsupportive responses.     

Children's coping with peer rejection: the role of depressive symptoms,social competence,and gender

The present study investigated children's anticipated emotional response and anticipated coping in response to peer rejection, as well as the qualifying effects of gender, depressive symptoms, and perceived social competence. Participants (N = 234), ranging in age between 10 and 13 years, were presented with two written vignettes depicting peer rejection. The most highly endorsed coping strategies were behavioural distraction, problem‐focused behaviour, and positive reappraisal. Results indicate that children higher in depressive symptoms reported a more negative anticipated mood impact. Moreover, children higher in depressive symptoms were less inclined to endorse behavioural and cognitive coping strategies typically associated with mood improvement (e.g., behavioural distraction, positive reappraisal). Independent of depression, children scoring higher on perceived social competence reported more active, problem‐oriented coping behaviour in response to the stressors. Types of coping were largely unaffected by gender, however girls reported higher levels of anticipated sadness than boys in response to the rejection vignettes. Theoretical and clinical implications are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Mentoring as a Mediator or Moderator of the Association between Racial Discrimination and Coping Efficacy in Urban,Low‐Income Latina/o Youth

The aim of this study was to examine the associations among mentoring relationship quality (i.e., relational and instrumental quality), racial discrimination and coping efficacy with racial discrimination. Three social support models were tested, including the stress buffering, support mobilization, and support deterioration models. Participants were 257 urban, low‐income Latina/o high school students, who completed surveys in both 9th and 10th grades. While controlling for gender and coping efficacy with discrimination in 9th grade, results supported the social support deterioration model. Specifically, there was a significant indirect effect of racial discrimination in 9th grade on coping efficacy in 10th grade through instrumental mentoring quality. As racial discrimination increased, mentoring quality decreased and then coping efficacy decreased. We also found that more racial discrimination in 9th grade was significantly associated with lower coping efficacy in 10th grade, and higher instrumental mentoring quality in 9th grade was significantly associated with higher coping efficacy in 10th grade, while controlling for gender and coping efficacy in 9th grade. Implications and recommendations for future research are discussed.     

流动儿童歧视知觉与社会文化适应：社会支持和社会认同的作用

采用整群取样方法对选自北京市的1164名流动儿童进行问卷调查, 考察社会支持、社会认同在歧视知觉与社会文化适应关系中的作用。结果表明, 流动儿童的歧视知觉整体上并不明显, 其社会文化适应状况整体良好; 歧视知觉对社会文化适应有显著负向预测性(β=-0.39, p<0.001); 在歧视知觉与社会文化适应的负向预测关系中, 社会支持起部分中介作用, 城市认同有增强作用, 老家认同有缓冲作用; 社会支持的中介作用受到城市认同、老家认同的调节。     

Psychological stigma costs as barriers to healthcare use in former soldiers of the German Armed Forces: A qualitative analysis

Individuals decide to use healthcare when the expected benefits outweigh the perceived costs. One of these cost factors in this decision can be stigma. So far, it has not been researched how former soldiers of the German Armed Forces with a service-induced mental illness perceive stigma and how it influences their healthcare use. As stigma is shaped by the socio-cultural context, the setting of the potential healthcare use must be considered. Narrative interviews were conducted with 33 former soldiers with mental health problems. The data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. The relationship between stigma and healthcare use was analyzed. Occupational discrimination and social exclusion were experienced in both in the military and civilian context, but stigma functioned differently in each context. In the military context, former soldiers’ self-stigma of mentally ill individuals being weak was in stark contrast to their internalized military standards. This contrast let them avoid disclosure and subsequent healthcare use. In civilian context, the participants perceived 2 different stigma costs: mental illness stigma and former soldier stigma (i.e., stigmatization because of their military past). Both were perceived as barriers to healthcare use. A model, illustrating these different stigma costs in the different contexts, was developed. Further research on the link between stigma and healthcare use of this group is urgently needed.     

Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: personal accounts of South African individuals

The purpose of the study was to investigate the life experiences of a group of South African adults who stutter and the impact of stuttering on their quality of life. Participants were 16 adults with a mean age of 28.9 and ranging from 20 to 59 years. Methods involved individual interviews designed to explore the life domains of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues. Main findings of the study indicated that the majority of participants perceived their stuttering to have impacted on their academic performance at school, and relationships with teachers and classmates. Although their stuttering was not perceived to adversely influence their ability to establish friendships, people generally reacted negatively to their stuttering. Many felt that their stuttering did not have an adverse effect on their choice of occupation, ability to obtain work, and relationships with managers and co-workers, although it was perceived to influence their work performance and hamper their chances for promotion. Although the majority viewed their speech therapy experiences as being negative; more than half the sample believed that speech therapy had, nevertheless exerted a positive effect on their quality of life. Overall, stuttering did not appear to have influenced participants’ family and marital life. Most participants felt that stuttering had affected their self-esteem and self-image, and had evoked strong emotions within them. Findings are taken to suggest the need to incorporate subjective feelings about stuttering into the clinical practice of speech-language therapy; to provide information and coping strategies for teachers and employers; and for further research.

Educational objectives: After completing this activity, the reader will be able to: (1) describe and explain the perceived impact of stuttering on quality of life in terms of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues; (2) to interpret and utilize the subjective meanings that individuals attach to their stuttering to improve stuttering treatment, counseling and research.     

Heterosexist discrimination and relational sacrifice of same-sex couples

Drawing on the family stress process model and using data from 141 same-sex couples (N = 282 partners), we examined associations between heterosexist discrimination and relational sacrifices (i.e., willingness and behaviors). We also examined the moderating roles of both partners' internalized homophobia and state-level liberalism on same-sex marriage legalization. Actor-partner interdependence moderation models were conducted. Most of our findings supported hypotheses from the family stress process model. One individual's experiences of greater heterosexist discrimination were related to the partner's higher levels of sacrifice willingness and the individual's own higher frequency of sacrifice behaviors. Such associations emerged (a) among couples living in more liberal states that legalized same-sex marriage earlier, and (b) when the individual's partner reported lower levels of internalized homophobia. Yet the moderating role of an individual's internalized homophobia was the opposite of our hypothesis. When individuals reported high (versus low) internalized homophobia, individuals' experiences of more discriminative events were related to partners' higher levels of sacrifice willingness. Collectively, our study findings highlight that—when investigating how same-sex couples forge and maintain romantic bonds—researchers should consider their experiences in the social cultural context of heteronormativity, which includes the focus on discrimination, stigma, and affirmative laws and policies.