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Internalized Homophobia and Suicidal Ideation among LGB Youth

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Objective: The objectives of this study are to evaluate the relation between internalized homophobia and suicidal ideation in young lesbians, gays, bisexuals and heterosexuals; and also assess the influence of gender, discrimination experiences and disclosure of sexual orientation on suicidal ideation. Method: Participants- the sample consists of 389 participants, with a mean age of 19 years old. 51.9% were men and 48.1% were women. Regarding sexual orientation 36.0% were gay, 25.2% bisexual, 21.9% lesbian and17.0% heterosexual. The majority assume having already come out (61.4%). Most of the participants were in high school (51.4%).Instruments-we used a Demographic Questionnaire, the Suicide Ideation Questionnaire (SIQ) (Cronbach's alpha=0,975), and the Internalized Homophobia Questionnaire (Cronbach's alpha=0.81).Procedure - the data collection was done using the Internet. The questionnaires were available on a website built solely for this study. Publicity to this website was done through virtual communities, e-mail and several youth forums. Results: The results support the idea that there is a positive and statistically significant correlation between internalized homophobia and suicidal ideation. In addition, it was found that gay youngsters are the ones who have a stronger internalized homophobia, while young bisexuals are the ones who have higher levels of suicidal ideation. The teenagers who have not, yet, made their disclosure of sexual orientation and those who experienced discrimination, due to their sexual orientation, are those who had higher levels of suicidal ideation. Conclusion: More emphasis should be placed on suicide prevention for younger LGB individuals, in addition to the current emphasis on suicide prevention for adults. Future research should continue to examine unique, understudied LGB communities.
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Internalized Homophobia and Suicidal Ideation among LGB Youth
Henrique Pereira
1*
and Patrícia Rodrigues
2
1
University of Beira Interior & Research Unit of Psychology and Health (UIPES/ISPA-IU), Portugal
2
Institute of Applied Psychology, Portugal
*
Corresponding author: Henrique Pereira, University
of Beira Interior & Research Unit of Psychology and Health (UIPES/ISPA-IU), Portugal, Tel: 35127531970; E-mail:
hpereira@ubi.pt
Received Date: November 10, 2014, Accepted Date: December 15, 2014, Published Date: December 23, 2014
Copyright: © 2015, Henrique Pereira, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: The objectives of
this study are to evaluate the relation between internalized homophobia and suicidal
ideation in young lesbians, gays, bisexuals and heterosexuals; and also assess the influence of gender,
discrimination experiences and disclosure of sexual orientation on suicidal ideation.
Method: Participants- the sample consists of 389 participants, with a mean age of 19 years old. 51.9% were men
and 48.1% were women. Regarding sexual orientation 36.0% were gay, 25.2% bisexual, 21.9% lesbian and17.0%
heterosexual. The majority assume having already come out (61.4%). Most of the participants were in high school
(51.4%).Instruments-we used a Demographic Questionnaire, the Suicide Ideation Questionnaire (SIQ) (Cronbach’s
alpha=0,975), and the Internalized Homophobia Questionnaire (Cronbach’s alpha=0.81).Procedure – the data
collection was done using the Internet. The questionnaires were available on a website built solely for this study.
Publicity to this website was done through virtual communities, e-mail and several youth forums.
Results: The results support the idea that there is a positive and statistically significant correlation between
internalized homophobia and suicidal ideation. In addition, it was found that gay youngsters are the ones who have
a stronger internalized homophobia, while young bisexuals are the ones who have higher levels of suicidal ideation.
The teenagers who have not, yet, made their disclosure of sexual orientation and those who experienced
discrimination, due to their sexual orientation, are those who had higher levels of suicidal ideation.
Conclusion: More emphasis should be placed on suicide prevention for younger LGB individuals, in addition to
the current emphasis on suicide prevention for adults. Future research should continue to examine unique,
understudied LGB communities.
Keywords: Internalized homophobia; suicidal ideation; LGB Youth
Introduction
Several studies have
shown that the suicide rate is high among
Lesbian, Gay and Bisexual (LGB) teenagers. Prevalence rates of suicide
ideation have been estimated at 37% to as high as 50% for LGB
populations [1-8]. There are a number of known risk factors for LGB
suicidal behavior, including age (both young and older persons),
sexual orientation, gender identity, gender, mental disorders, and
stress [9]. The bulk of suicide research among LGB populations have
been limited to adolescent and young adult samples, with the belief
that after young adulthood, the risk of suicidal thinking or behavior
decreases. There are also studies that find suicide behaviors across the
lifespan for sexual minority persons [10,11]. This confirms that sexual
minorities are confronting specific challenges related to their sexual
minority status, such as acquiring a positive identity while
experiencing social stigma and exclusion. Internalized homophobia
(IH), defined as “the application of anti-LGB stigma to the self” [12], is
one possible consequence of intimidation based on non-exclusive
heterosexuality. There are few studies that have assessed the impact of
peer bullying on IH among youths, demonstrating that homophobic
bullying among teenagers with a negative LGB identity, a concept
reflecting IH, accentuates difficulties in accepting one’s sexual
orientation [9,13]. Furthermore, recent studies have revealed that
heterosexist harassment, rejection and discrimination is related to IH
among young LGB
individuals, and have shown that both factors
increased psychological distress, depression and anxiety [3,14,15].
Lower self-esteem has also been associated to suicidal ideation [16],
and suicidal attempt [17]. Finally, recent studies show that past
victimization experiences and IH have a significant direct effect on
suicide ideation [18], indicating that when compared with non-LGB
youth, LGB youth had increased odds of suicide ideation [19].
Thus, considering the lack of literature and information regarding
LGB youth in Portugal, and specially information that corroborates
the link between internalized homophobia and suicide, this study was
developed with the following aims: (a) assess internalized homophobia
and suicidality in LGB and non-LGB teenagers and young adults; (b)
assess internalized homophobia and suicidal ideation on related
variables, such as gender, discrimination, disclosure of sexual
orientation, and sexual orientation; and (c) establish the relationship
between internalized homophobia and suicidal ideation. To this end
we established the following hypothesis:
H1: There are different levels of internalized homophobia when
comparing different sexual orientations (lesbian, gay or bisexual).
H2: Gay and bisexual young men present higher levels of
internalized homophobia than lesbian or bisexual young women.
Journal of Psychiatry
Pereira et al., J Psychiatry 2015, 18:2
http://dx.doi.org/10.4172/Psychiatry.1000229
Short Communication Open Access
J Psychiatry
Journal of Psychiatry, an open access
Volume 18 • Issue 2 • Psychiatry-14-168
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H3: There are different levels of suicide ideation when comparing
different sexual orientations (lesbian, gay, bisexual or heterosexual).
H4: Gay and bisexual young men present higher levels of suicide
ideation than lesbian or bisexual young women.
H5: Suicide ideation varies among LBG youths when comparing
different circumstances such as being out of the closet or having been
exposed to discrimination experiences.
H6: There is a positive and strong correlation between internalized
homophobia and suicide ideation.
Independent variables in this study were: sexual orientation (H1
and H3), gender (H2 and H4), significant experiences (H5), and levels
of internalized homophobia (H6).Dependent variables were:
internalized homophobia (H1 and H2) and suicide ideation (H5 and
H6).
Methods
Participants
This cross-sectional study used a non-probabilistic convenience
sample of 389 participants from the population of young Portuguese
individuals (N=1500000). The inclusion criteria for participation in
the study were: (1) being lesbian, gay, bisexual or heterosexual self-
identified, (2) being over 13 years of age, (3) being Portuguese (either
national or legal resident/citizen) and living in Portugal, and (4)
willingness to participate voluntarily in the study after knowing its
objectives. This sample included all the participants who completed
successfully all the instruments, and the ages ranged between 13 and
32 years old, being that 18% were 19 years old and 16.5% were 20, and
the average age was 21 years (SD=5,14). Regarding gender, 51.9% were
men and 48.1% were women.
Concerning (self-defined) sexual orientation, 36% were gay, 25.2%
were bisexual, 21.9% were lesbian and, finally, 17% were heterosexual.
As for assuming their sexual orientation, 61.4% had already come out.
As for their educational attainment, 51.4% had a secondary education,
42.4% had tertiary education, 4.4% had a primary education and 1.8%
and an undergraduate degree. Regarding the marital status, 67.9%
were single and 32.1% had a partner.44% of the LGB participants, in
this study, consider being discriminated frequently, where as 39.1% do
not feel discriminated because of their sexual orientation. In relation
to other life aspects, 64.5% consider being happy and 17.5% consider
not being very happy.
Instruments
The investigation protocol used in this study consisted of three
instruments: a) a Demographic Questionnaire (developed solely for
this study); b) Reactions to Homosexuality Scale (RHS) [20]
Portuguese version [21]; c) Suicide Ideation Questionnaire (SIQ) [22].
The Demographic Questionnaire was developed to gather specific
(socio-demographic and personal) information about the participants.
This questionnaire included three groupsof questions: socio-
demographic questions, which included age, gender, sexual
orientation, and educational attainment; questions about clinical
information, to assess the existence (or not) of a mental disorder and
possible medication (exclusion criterion); and finally questions about
discrimination (specifically sexual discrimination).
The Portuguese version of the Reactions to Homosexuality Scale
(RHS) was translated and validated (for the Portuguese population) by
Pereira and Leal [21], from the original Ross and Rosser’s scale (
Ross
&
Rosser
) [20]. The RHA is a 26-item questionnaire, being the answers
given using 5-point Likert scale (I strongly agree, I agree, I don’t agree
nor disagree, I disagree, strongly disagree). The answers given had a
good internal consistency (Cronbach’s alpha=0.81). According to the
Portuguese version and factorial analysis, this scale assesses the
internalized homophobia based on two different dimensions: the
internal perception of stigma related to homosexuality (α=0.818), and
the external perception of stigma related to homosexuality (α=0.606).
The Suicide Ideation Questionnaire (SIQ), developed by Ferreira
and Castela [22], assesses the seriousness of suicide thoughts in
teenagers and adults. The SIQ has a total of 30 items, each one with
seven response alternatives (never, almost never, rarely, sometimes,
frequently, almost always, always). The results obtained can vary
between 0-180 points, indicating the frequency of suicidal thoughts
(higher scores correspond to higher frequency in suicidal thoughts).
This questionnaire has an excellent internal consistency (Cronbach’s
alpha=0.975)
Procedures
For the purpose of data gathering, all the instruments were made
available on the internet, in a website built specifically for this study.
The advertising of this website was made by sending e-mails to
potential participants using mailing lists, and joining Internet-based
communities and several forums (school, religious, political).To
participate in the study the users just had to select the link and access
the webpage.
A short presentation of the study, listing the objectives and
purposes, was given together with the participation request. The
anonymity of the participants was always ensured. All the individuals
that participated in this study gave their informed consent.
Data analysis
Data analysis was performed with SPSS Statistics 21.0. Basic
descriptive analysis and the internal consistency by Cronbach's alpha
coefficient for the SIQ were made. T-test and One-way ANOVA
significant at p<0.05 were used to compare differences in the mean
frequency of different scores. All tests were two-tailed.
Ethical approval
This study was approved by the scientific and ethical committees of
the Research Unit of Health and Psychology (UIPES/ISPA-IU,
Institute of Applied Psychology in Portugal).
Results
The results we obtained demonstrate statistically significant
differences, regarding the levels of internalized homophobia, among
different sexual orientations (gay, lesbian and bisexual), except for
heterosexuals, who were not included in this comparison; and genders.
Based on H1 we can observe that these differences are significant
(F(3;385)=7.918; p<0.001), being that gay teenagers were the ones with
the highest levels of internalized homophobia, although the difference
between these and bisexual teenagers is not very significant. The
lesbian teenagers were the ones with the lowest levels of internalized
homophobia.
Based on H2we also studied Internalized homophobia considering
the differences in the “gender” variable. According to the results,
Citation: Henrique Pereira, Patrícia Rodrigues (2015) Internalized Homophobia and Suicidal Ideation among LGB Youth. J Psychiatry 18: 229.
doi:10.4172/Psychiatry
.1000229
Page 2 of 6
J Psychiatry
Journal of Psychiatry, an open access
Volume 18 • Issue 2 • Psychiatry-14-168
statistically significant differences were found between genders, when
regarding
internalized homophobia (t (387)=-5.256; p<0.001),
indicating that men have higher levels of homophobia than women.
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With regard to the experience of discrimination (H5), there are also
significant differences when comparing individuals that had been
discriminated to the ones who had no discriminating experiences (t
(387)=2.934; p=0.004). The youngsters that had been discriminated
present higher levels of suicidal ideation. All these results can be seen
on Table 1.
N Mean Standard Deviation F/t p
Sexual Orientation Internalized homophobia
Gay 140 71.98 12.70 F(3;385)=7.918 0.000**
Lesbian 85 66.54 11.32
Bisexual 98 71.21 11.73
Suicidal Ideation
Gay 140 71.04 38.00 F(3;385)=2.501 0.049*
Lesbian 85 68.45 36.65
Bisexual 98 80.56 37.03
Heterosexual 66 66.77 34.02
Gender Internalized homophobia
Women 187 68.02 11.56 t(387)=-5.256 0.001**
Men 202 74.15 11.44
Suicidal Ideation
Women 187 75.15 37.59 t(387)=1.543 p=0.124
Men 202 69.37 26.37
Disclosure of sexual
orientation
Suicidal Ideation
Yes 298 69.66 34.53 t(387)=-2.410 0.016*
No 91 80.29 43.47
Discrimination Suicidal Ideation
Yes 187 77.82 40.65 (387)=2.934 0.004*
No 202 66.90 32.56
Table1: Results of the comparison between the levels of internalized homophobia and suicidal ideation and sexual orientations, gender,
disclosure of sexual orientation and discrimination, *<0.05 **<0.001
Suicidal ideation was studied considering different variables:
“sexual orientation”, “gender”, “(non) disclosure of sexual orientation”
and “discrimination”. Based on H3, statistically significant differences
were found (F(3;385)=2.501; p=0.049), regarding suicidal ideation
Citation: Henrique Pereira, Patrícia Rodrigues (2015) Internalized Homophobia and Suicidal Ideation among LGB Youth. J Psychiatry 18: 229.
doi:10.4172/Psychiatry
.1000229
Page 3 of 6
J Psychiatry
Journal of Psychiatry, an open access
Volume 18 • Issue 2 • Psychiatry-14-168
among teenagers with different sexual orientations (gay, lesbian,
bisexual,
heterosexual). Bisexual teenagers were the ones with the
highest levels of suicidal ideation, when compared to gays and
lesbians. Heterosexuals were the ones that had lower suicidal ideation.
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Concerning the suicidal ideation levels in different genders (H4) no
statistically significant differences were found (t (387)=1.543;
p=0.124), although women present higher levels.
As to the disclosure of sexual orientation process (H5), the results
show significant statistical differences (t (387)=-2.410; p=0.016). The
LGB teenagers that had not “come out” yet were the ones with highest
levels of suicidal ideation, when compared to the ones that had already
gone through the disclosure of sexual orientation process.
Finally, in the attempt to ascertain the relation between the levels of
internalized homophobia and suicidal ideation (H6), we did a
correlation between these variables, having obtained a positive and
statistically significant result (r=0.320; p<0.001) as can be seen in
Figure 1. These results lead us to believe that the more homophobia is
internalized in young LGB, the higher the levels of suicidal ideation
will be.
Discussion
The aim of this study was to verify the relation between internalized
homophobia and suicidal ideation, among LGB teenagers and young
adults, as well as to explore the eventual relations between these two
variables and gender, discrimination and disclosure of sexual
orientation.
Consistent with prior studies [18,23,24], we confirmed the
hypothesis of finding a higher level of internalized homophobia in gay
participants compared to lesbian ones. In the Portuguese context,
sexism plays a dominant role in the social pressure to conform to
heteronormative gender roles. In these contexts, gay men are more
visible targets than lesbian women and thus are more ostracized by
heteronormative pressures [23]. Moreover, social changes in Portugal
brought about new challenges as same-sex marriage created visibility
for LGB rights. The concrete political demands for LGB rights could
probably make the homophobic attitudes against the most visible
targets in the sexual minorities-the gay men-more critical, especially in
contexts where traditional gender roles and religious beliefs against
homosexual orientation are dominant [24].
Figure 1:
Results for the correlation between total levels of
internalized homophobia (QHI_total) and total levels of suicidal
ideation (QIS_total) (r = 0.320; p<0.001)
The results scored by self-identified bisexual teenagers and young
adults may fit into the classical view of bisexuality as a transitive
phenomenon. Teenagers, who perceive themselves as bisexual,
accommodate two types of feelings: one of a heterosexuality, that is
socially valued, and another of isolation from an eventual homosexual
identity. These opposite feelings, during adolescence, may lead the
appearance of suicidal thoughts; confusion and not being able belong
to any of these "two worlds".
The gender variable was also evaluated, and the results showed
differences between men and women, when regarding suicidal
ideation. As expected, these differences were not statistically
significant. Nevertheless, women had slightly higher levels of suicidal
ideation that are possibly due to social values which determine that
women can suffer more and, thus, trigger self-destruction thoughts
(Allison, Roeger, Martin & Keeves). In spite of these results, we cannot
conclude that they are a tendency, since we did not obtain statistically
significant differences, as mentioned above.
Concerning the association between discrimination and suicidal
ideation, consistent with previous research [25,26] the results suggest
that discrimination experiences (whether these are direct or indirect),
may actually work as a confirmation of internalized homo-negativity,
especially when there are no effective sources of social support. Gays,
lesbians and bisexuals represent a sexual minority and as such, they
face discrimination situations, stigma and violence by society. The
most common manifestation of the internalization of that stigma is the
sense of shame at the identification as LGB. This may have occurred in
our sample and these negative feelings may have, once again,
influenced the occurrence of suicidal ideation.
In the relationship between disclosure of sexual orientation (or not)
and suicidal ideation, we observed that a non-disclosure of their sexual
Citation: Henrique Pereira, Patrícia Rodrigues (2015) Internalized Homophobia and Suicidal Ideation among LGB Youth. J Psychiatry 18: 229.
doi:10.4172/Psychiatry
.1000229
Page 4 of 6
J Psychiatry
Journal of Psychiatry, an open access
Volume 18 • Issue 2 • Psychiatry-14-168
orientation can have negative effects on the lives of LGB teenagers. As
the coming out process is of the outmost importance in the life of
these teenagers and young adults, many decide to reveal their sexual
orientation to friends, family and even to society, in order to find a
sense of honesty, self-esteem, towards themselves and others.
Nevertheless, this process is still difficult, mostly due to the
anticipation of rejection, thus it may be accompanied by great anxiety,
depression and/or behavioral problems and even substance use [27].
The data that we obtained supports the idea that the young LGB, who
do not come out, are those that are likely to anticipate the negative
impact, of such disclosure, and have higher levels of internalized
homophobia.
This study focuses on a public health problem (the suicidality),
particularly among LGB adolescents, and its relationship to
internalized homophobia. According to the literature [3,28], the
hypothesis about a direct association of internalized homophobia and
suicidal ideation was confirmed. Also, concealing one’s sexual
orientation, and past experiences of victimization plays an important
role on suicidal attitudes.
When finding a positive, and statistically significant, correlation
between internalized homophobia and suicidal ideation, we are
contributing to a better understanding of this problem and offering
clues on how to change both intervention in mental health, and social
behaviors. This study also contributes for an enrichment if the
literature regarding homophobia and suicidal ideation, in both LGB
and non-LGB teenagers. We hope it generate new ideas for relevant
research on health of sexual minorities. This study is not without
limitations. First, internet recruitment could have differentially
affected the associated variables to attitude towards life and death.
Second, the surveys focused on unspecific urban areas of Portugal are
not generalized able to all regions of the country. Third, the relation to
suicidal ideation of only a limited number of variables was tested.
Personality factors, social support, satisfaction with life, purpose in
life, and cognitive were not examined. Fourth, concerns are raised over
the reliability (test-retest, alternate-form and internal consistency) as
well as validity (face, construct, content and criterion) of the
demographic questionnaire developed solely for this study.
A number of implications can be drawn from the present research.
In line with the literature [29], there is evidence that even in today’s
potentially more accepting culture, gay and lesbian persons are still at
risk for internalized homophobia and suicidality. The role of
internalized sexual stigma should be taken into consideration when
working with sexual minorities. Additionally, the present research
suggests potentially important implications for health professionals
working with non-disclosing lesbian or gay people [27,30]. The finding
that concealment is associated with suicidal ideation by way of greater
internalized homophobia may suggest that the risk for suicide in non-
disclosing gay and lesbian persons may be facilitated by helping them
to accept themselves, reduce the hyper vigilance associated with the
fear of being identified as gay or lesbian, and realistically assess the
consequences of disclosure to family or friends.
Promoting accepting environments is necessary to improve the
adjustment of sexual minorities. Therefore, it is important to work to
educate teachers and other school personnel in creating supportive
and welcoming environments where homophobic victimization is not
tolerated.
Conclusion
This article is important for understanding suicidality among
understudied LGB young populations. As the first known LGB study
of Portuguese youth, these data help illuminate important realities for
LGB individuals that are distinct in comparison to heterosexual
individuals. While research consistently shows LGB individuals to be
at heightened risk for suicidal behaviors, those concerns may be
greater if they don’t disclose their sexual orientation and are exposed
to discrimination experiences. Further, more emphasis may need to be
placed on suicide prevention for younger LGB adults, in addition to
the current emphasis on suicide prevention for adults. Future research
should continue to examine unique, understudied LGB communities.
Also, qualitative investigations regarding the nature, context, and
complexities of LGB suicidal behaviors would likely yield important
findings to be incorporated into quantitative studies and mass
marketing campaigns to address mental health, stigma, and LGB
identity.
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Citation: Henrique Pereira, Patrícia Rodrigues (2015) Internalized Homophobia and Suicidal Ideation among LGB Youth. J Psychiatry 18: 229.
doi:10.4172/Psychiatry
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J Psychiatry
Journal of Psychiatry, an open access
Volume 18 • Issue 2 • Psychiatry-14-168
... Estudios más específicos sobre la situación de estos colectivos en la escuela, como el llevado a cabo por la European Union Agency for Fundamental Rights (2014), destacan que el 70% de las personas españolas entrevistadas ha sufrido comentarios o comportamientos negativos en la escuela por su identidad sexual, y en torno al 60% ha escondido o disfrazado su identidad durante su escolaridad. En la misma línea, estudios realizados en España y Portugal señalan que alrededor del 50% de lxs adolescentes y jóvenes LGBTIQQ han sufrido bullying sistemáticamente La ideación suicida y el intento de suicidio en adolescentes y jóvenes se ha relacionado consistentemente con estas situaciones (Baiocco et al., 2014;Pereira y Rodrigues, 2015), así como la homofobia internalizada (Pereira y Rodrigues, 2015). ...
... Estudios más específicos sobre la situación de estos colectivos en la escuela, como el llevado a cabo por la European Union Agency for Fundamental Rights (2014), destacan que el 70% de las personas españolas entrevistadas ha sufrido comentarios o comportamientos negativos en la escuela por su identidad sexual, y en torno al 60% ha escondido o disfrazado su identidad durante su escolaridad. En la misma línea, estudios realizados en España y Portugal señalan que alrededor del 50% de lxs adolescentes y jóvenes LGBTIQQ han sufrido bullying sistemáticamente La ideación suicida y el intento de suicidio en adolescentes y jóvenes se ha relacionado consistentemente con estas situaciones (Baiocco et al., 2014;Pereira y Rodrigues, 2015), así como la homofobia internalizada (Pereira y Rodrigues, 2015). ...
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Livro CELEI - Chile. Artigos com temática da Pedagogía Queer.
... La internalización del estigma sexual -homolesbobitransfobia internalizada-, consiste en la interiorización del estigma por parte del individuo perteneciente a una minoría sexual, como parte de su sistema de valores, implicando la adaptación y conformidad del concepto de sí a las estigmatizaciones sociales. Esta puede manifestarse "hacia afuera", por ejemplo, a través de actitudes globales y lenguaje negativos hacia otras personas LGBT, o puede ser expresada "hacia adentro", produciendo malestar con la revelación de la orientación sexual a otros, autoexclusión y desconexión con otros individuos LGBT, malestar con la actividad sexual del mismo sexo, conflictos internos, disminución de la autoestima y autodesprecio y violencia auto-inflingida (Austin & Goodman, 2016;Martínez et al., 2018;Newcomb & Mustanski, 2001Pereira & Rodrigues, 2015, Tomicic et al., 2016. ...
... (Pereira & Rodrigues, 2015;Tomicic et al., 2016;Walls, Freedenthal, & Wisneski, 2008).La asociación entre indicadores negativos de salud mental e identificarse como personaLGBT ha sido estudiada desde el punto de vista de los determinantes sociales de salud(Logie, 2012). En este sentido, se ha enfatizado que las y los jóvenes LGBT constituyen un grupo de alto riesgo en problemáticas de salud mental, ya que a menudo se ven enfrentadas/os a discriminación, violencia y humillación por su orientación sexual o identidad de género(Cáceres & Salazar, 2013;Pineda, 2013; Puckett et al., 2016). ...
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Las altas prevalencias de problemas de salud mental en personas LGBT han sido explicadas desde el modelo de estrés de minorías. La homolesbobitransfobia y la internalización del estigma, constituyen procesos de estrés que impactan la salud mental. Por su parte, la internalización e hipervigilancia del estigma y, el ocultamiento de la identidad sexual diversa, pueden constituir barreras para la provisión de una atención de calidad. Con el objetivo de identificar aspectos que constituyen barreras y facilitadores para la ayuda en salud mental, se re-analizaron 30 entrevistas de un estudio previo con adolescentes y jóvenes LGBT sobrevivientes de procesos de suicidio. Se empleó la codificación focalizada de la Teoría Fundamentada, desarrollando tres categorías centrales: La hipervigilancia en la ayuda psicológica, La necesidad de ayuda en el estigma internalizado, y el lugar de la orientación sexual y la identidad de género en la ayuda psicológica. Del análisis emergió el fenómeno “Tan cerca pero tan lejos”, que engloba las barreras para la provisión de ayuda psicológica y psicoterapéutica sensible a las necesidades de adolescentes y jóvenes LGBT.
... While research among sexual minority youth has supported general risk factors, such as self-criticism, depression, low self-esteem, and body image concerns Smith et al., 2020), GSMspeci c or -related risk factors have also been identi ed. Minority-speci c factors, such as internalized stigma (known as internalized sexual stigma in sexual minority populations and internalized transphobia in TGNC populations) and perceptions that one's sexual and gender identity development process was dif cult, have been shown to be predictive of NSSI among GSM youth Pereira, 2015;Smith et al., 2020;Taliaferro et al., 2019). Internalized stigma is a complex constellation of emotions involving shame, fear, and discomfort regarding one's sexual or gender identity; studies examining internalized stigma have identi ed its importance in the development of psychological distress in sexual minority individuals (McLaren, 2016;Newcomb & Mustanski, 2010). ...
Chapter
Nonsuicidal self-injury (NSSI) is an important transdiagnostic behavior prevalent among youth and young adults. In addition, NSSI is a risk factor for suicidal behaviors. Research on NSSI among underserved Black, Indigenous, People of Color (BIPOC) and gender and sexual minority (GSM) youth is limited; however, NSSI is prevalent among these groups. In particular, prevalence rates of NSSI are greater among GSM youth and young adults when compared with their cisgender, heterosexual counterparts. Research indicates that specific risk factors for NSSI may exist among these groups, such as factors related to systemic minority stressors. In this chapter, we review the association between NSSI and suicide, as well as general risk factors for NSSI. Then, we review research on NSSI among BIPOC and GSM youth and young adults, including specific risk factors and correlates for these populations.
... This consists of the internalization of stigma by the individual belonging to a sexual or gender minority as part of their value system, involving adaptation to normative gender expectations and a conformity of self-concept to social stigmatization. In the Trans* population, this internalization of stigma can be manifested "outwardly," also called internalized horizontal transphobia, for example, through negative global attitudes and language towards other LGBT people, which implies alienation from one's own community and group identity; or it can be expressed "inward," called vertical transphobia, producing discomfort with disclosure of sexual orientation to others, self-exclusion and shame about oneself, discomfort with same-sex sexual activity, diminished self-esteem, self-hatred, and self-inflicted violence (Austin & Goodman, 2017;WO Bockting, 2015;Pereira, 2015;Tomicic et al., 2016). In the transgender identity development model, Lev (Lev, 2004) asserts that TGNC individuals may experience shame and self-loathing in their early stage of transgender identity, when they become aware of living an incongruence between gender identity and sex assigned at birth. ...
Chapter
The neurobiological theories of depression find their main pitfall when searching associations between specific pathophysiological mechanisms and a clinical syndrome with diffuse limits and high heterogeneity, such as depressive syndrome. In order to improve treatment effectiveness, recent studies have focused on identification of intermediate phenotypes (quantifiable physiological traits or processes that are interposed between gene and clinical phenotype) that could identify the subgroup of patients with depression with more homogeneous symptoms, similar physiological features, and consistent responses to treatment. This chapter will provide a critical review of neurobiological studies with a dimensional approach in patients with mood disorders. Focusing on neurobiological evidence about intermediate phenotypes, such as cognitive functioning in patients with depression, it emphasizes the relevance of building bridges between neuroscience research and clinical field to lead to greater understanding of the causes of depressive illness.
... This consists of the internalization of stigma by the individual belonging to a sexual or gender minority as part of their value system, involving adaptation to normative gender expectations and a conformity of self-concept to social stigmatization. In the Trans* population, this internalization of stigma can be manifested "outwardly," also called internalized horizontal transphobia, for example, through negative global attitudes and language towards other LGBT people, which implies alienation from one's own community and group identity; or it can be expressed "inward," called vertical transphobia, producing discomfort with disclosure of sexual orientation to others, self-exclusion and shame about oneself, discomfort with same-sex sexual activity, diminished self-esteem, self-hatred, and self-inflicted violence (Austin & Goodman, 2017;WO Bockting, 2015;Pereira, 2015;Tomicic et al., 2016). In the transgender identity development model, Lev (Lev, 2004) asserts that TGNC individuals may experience shame and self-loathing in their early stage of transgender identity, when they become aware of living an incongruence between gender identity and sex assigned at birth. ...
Chapter
Contributing factors to major depressive disorder (MDD) onset are highly heterogeneous, hindering a precise understanding about its etiology and pathophysiology. Although epidemiological studies have established that depression heritability can get to approximately 40%, only a small number of transporters, neurotransmitters, and neurotrophin genes – representing an overall minor contribution – have been identified, and genome-wide association studies have not been able to consistently reproduce significant MDD-associated loci, until very recently. This partial success at the genome level could point toward a more integrative approach, such as epigenetic research, which bridges the interplay between both genetic and environmental influences. Epigenetics refers to alterations in gene expression without affecting the DNA sequence, and thus, epigenetic regulation and its promising applications could provide relevant information to better handle diagnosis and treatment. Here, we review the state of the art of the genetic and epigenetic architecture of MDD.
... In Portugal, the current political achievements of support and inclusion collaborate so that the country is one of seven European countries with the greatest respect for equality for LGBT people [45]. Measures such as the legalization of same-sex marriage and the adoption of children by same-sex couples, in addition to specific legislation to combat discrimination against people on the basis of sexual orientation, aim to accelerate the inclusion of these people into the society they live in [37,46]. ...
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The aim of this study was to assess the relationship between social support, positive identity , and resilience and the successful aging of older sexual minority men. The study involved having 210 self-identified gay and bisexual men aged between 50 and 80 years complete a cross-sectional online survey comprised of sociodemographic information; the Portuguese version of the Multidimensional Scale of Perceived Social Support; the Lesbian, Gay, and multifactor Bisexual Positive Identity Measure; the Connor-Davidson Resilience Scale 10; and the Successful Aging Perceptions Scale. The results showed that self-identified gay participants showed higher levels of positive identity, while bisexual participants scored higher for resilience, mental health, and successful aging. Higher levels of social support, resilience, and positive identity were significant predictors of mental health (28%), physical health (18%), and successful aging (10%) in our sample. These results offer similarities with the growing body of literature on the positive factors of successful aging in the gay and bisexual men communities, which is an important step in the development of aging and health preventive initiatives among this population.
... 17 These individuals were already at a social disadvantage due to sexual stigma, prejudice, and society's discrimination against their sexual orientation, 43 which negatively impacts their mental health. 35,36 Moreover, LGBTQI individuals have a higher prevalence of problems related to mental health functioning, 25 including higher levels of depression, anxiety, and suicidal ideation, 44,45 compared to their heterosexual peers. 46 Thus, our study results are in line with the existing literature that shows that the emergence of the COVID-19 pandemic and the adoption of lockdown measures to contain it has aggravated LGBTQI individuals' mental health. ...
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Introduction: Not many studies have been reported from Portugal or Brazil to date, reading the psychosocial impacts of COVID-19 on lesbian, gay, and bisexual (LGB) people, especially from a qualitative perspective. Materials and Methods: A convenience sample of 65 self-identified LGB individuals from Portugal and Brazil participated in this study. Thirty-two participants were from Portugal and 33 from Brazil. The average age was 34.48 years (standard deviation = 11.66), ranging from 19 to 67. We used an online interview approach in an asynchronous format. All study respondents completed a structured inquiry consisting of a short section of sociodemographic questions and a single openended question: “As a lesbian, gay, bisexual (or other) self-identified person, please elaborate on how the COVID-19 pandemic has impacted your life.” Results: The thematic analysis of participants’ responses revealed 9 recurring themes, encompassing 18 subcategories to occur: mental health (depression, anxiety, fear, anger, and loneliness), isolation (social distancing and leisure impediments), relationships (family and friends), work-related problems, education-related problems, financial problems, changes (behavioral changes and opportunity to grow), coping (seeking support, accessing information and physical activities), and LGBTQI topics (health barriers, going back into the closet, pride celebration events, and online dating). Conclusions: Our results provide voice to LGB Portuguese and Brazilian people during the COVID-19 pandemic demonstrating specific challenges exacerbated by stigma and sexual discrimination amplified by preexistent social inequalities.
Article
Antecedentes Estudios señalan que la internalización de creencias, prejuicios y actitudes existentes en la sociedad sobre las personas de la diversidad sexual afectan fuertemente su salud mental y podrían constituirse en una barrera de acceso a la ayuda psicológica y terapéutica en personas LGB. Objetivo Determinar la asociación entre los niveles de internalización de estigma sexual (ESI) en personas autoidentificadas como lesbianas, gay y bisexuales (LGB) con la presencia de malestar subjetivo, sintomatología depresiva y ansiosa, suicidalidad, y asistencia a psicoterapia. Método Un cuestionario aplicado de manera online que incluía preguntas sobre haber asistido o estar asistiendo a psicoterapia, además de escalas que evaluaban estigma sexual internalizado, malestar-bienestar subjetivo, depresión y suicidalidad fue respondido por 669 personas cisgenero autoidentificadas como lesbianas, gay y bisexuales. Resultados Los resultados muestran una asociación positiva entre el nivel de ESI en personas LGB con sus niveles de malestar subjetivo, sintomatología depresiva y ansiosa, y suicidalidad, y una asociación negativa con estar asistiendo o haber asistido a psicoterapia. Conclusiones Se discuten las implicancias de los resultados presentados para el desarrollo de intervenciones psicoterapéuticas culturalmente competentes para pacientes pertenecientes a la diversidad sexual y de género.
Chapter
This chapter will address both depressive disorders associated with women’s life cycle and those associated with transgender and gender nonconforming (TGNC) people. They both share the higher prevalence of mood disorders. Depressive disorders are common mental disorders, occurring as early as 3 years of age and across all world regions. Major depression is a serious, recurrent disorder linked to diminished role functioning and quality of life, medical morbidity, and mortality. We discuss them separately, women and TGNC depression, in order to examine specific aspects and the various explanatory theories of this phenomenon. First, we will talk about the phenomenon and some definitions, to further try to explain why differences in depression prevalence arise with different gender. In its this section, the chapter reviews the empirical research on the prevalence of women’s depression, which is greater than in men, and the relevant factors that contribute to this difference. The traditional components of femininity (gender stereotypes) predisposing women to depression are examined: the importance of maintaining intimate relationships, anxiety over the possible loss of relationships, aggression inhibition, scarcity of resources for action, and culturally imposed gender roles. The last part of the chapter will review depression in trans and gender nonconforming people, focusing on the explanations of the minority model. Minority stress model (MEM) has been one of the most important and useful theories for understanding social processes – such as discrimination – that underlie negative mental health indicators in sexual and gender minority populations.
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