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Minority Stress and Lesbian Women.
... In recent decades, there has been an increase in research examining the social experiences of minoritized groups, including queer adults, transgender individuals, and people of color (Brooks, 1981;Flanders et al., 2019;Meyer, 2003;Testa et al., 2015). These studies have highlighted substantial disparities in mental health and well-being among these populations, often linked to experiences of discrimination and marginalization. ...
... The theoretical framework for this study is grounded in Minority Stress Theory (MST; Brooks, 1981;Meyer, 2003) and Rolón-Dow and Davison's (2021) typology of microaffirmations. MST posits that the stress experienced by individuals with stigmatized identities is not due to the identity itself but arises from external prejudice and discrimination, as well as internalized stigma (Brooks, 1981;Meyer, 2003). ...
... The theoretical framework for this study is grounded in Minority Stress Theory (MST; Brooks, 1981;Meyer, 2003) and Rolón-Dow and Davison's (2021) typology of microaffirmations. MST posits that the stress experienced by individuals with stigmatized identities is not due to the identity itself but arises from external prejudice and discrimination, as well as internalized stigma (Brooks, 1981;Meyer, 2003). For QTPOC, these stressors are compounded by intersecting forms of racism, heterosexism, and transphobia. ...
Queer and transgender people of color (QTPOC) face unique mental health challenges because of intersecting forms of discrimination that place them at higher risk for adverse mental health outcomes. Emerging research has begun to explore the concept of microaffirmations—small verbal or nonverbal forms of communication that signal support, encouragement, or validation—as a protective factor for marginalized populations. This study highlights how QTPOC experience and perceive microaffirmations and explores the role microaffirmations play in their mental health and well-being. Utilizing an interpretive phenomenological analysis, qualitative data were obtained from 14 QTPOC participants through semi-structured interviews. Analyses identified five superordinate themes: influence of identity development, safety with others, envisioning policy changes, representation, and internalization of perceived worth. This study demonstrates the role microaffirmations play in mitigating the negative impacts of discrimination and enhancing the well-being of QTPOC. Implications for counselors include suggestions for providing QTPOC clients with more affirming care on the micro and macro levels.
... The current study was informed by minority stress and demandresource theories. Scholars have used minority stress theory to contextualize the development of mental health vulnerabilities of individuals with minoritized sexual and gender identities (Brooks, 1981;Meyer, 2003). The theory posits that in addition to general life stressors young people of all sexual and gender identities may encounter (e.g., stressful school transitions), SGDY experience additional unique stressors specific to their minoritized sexual and gender identities (e.g., disclosing their identities to others). ...
... Unique minority stressors can be characterized along a continuum of distal (e.g., discrimination) and proximal (e.g., internalized stigma) forms and, with chronic exposure, can deplete SGDY's preemptive coping resources and self-regulative capabilities to manage future stressors (Hatzenbuehler, 2009). The resulting and repeated exposure to these compounding stressors directly contributes to SGDY's disproportionate mental health vulnerabilities relative to their cisgenderheterosexual peers (Brooks, 1981;Meyer, 2003). ...
... Emerging research has also found that sexual minority youth may tend to ingratiate, or attempt to win back acceptance from their peers to a greater extent than their heterosexual counterparts following rejection (Clark et al., 2024). Thus, it could be that SGDY who experience frequent harassment in otherwise "healthier" contexts may further benefit from peer and/or support from school personnel in the form of defending behaviors that show clear intolerance to identity-based harassment; indeed, theoretically, these SGDY who experience persistent peer harassment in contexts with multiple in-school support systems may be more socially isolated relative to their other sexual and/or gender diverse and cisgender-heterosexual peers (Garandeau & Salmivalli, 2019;Pan et al., 2021), at a time when peer affiliation is critical (Brown & Larson, 2009). Other scholars have used person-centered approaches to identify unique school profiles based on the integration of multiple LGBTQ in-school resources (Mann et al., 2024). ...
A growing body of research has found that perceptions of social–emotional support from school personnel and lesbian, gay, bisexual, transgender, and queer (LGBTQ) in-school resources (e.g., gender and sexuality alliances, inclusive curricula, inclusive sexual education, presence of affirming adults) contribute to sexual and gender diverse youth’s (SGDY) positive development. However, no research has investigated how support from school personnel and LGBTQ in-school resources might jointly modify the associations between SGDY’s experiences with sexual orientation and gender identity (identity)-based harassment and mental health outcomes. Thus, the current study examined how school personnel support and LGBTQ in-school resources, together, moderated the association between identity-based harassment, depressive symptoms, and anxiety symptoms among a national sample of SGDY (N = 13,500, Mage = 15.50, SD = 1.34). Multigroup path analysis revealed that for SGDY in middle school (i.e., 6–8) and high school grade levels (i.e., 9–12), school personnel support and LGBTQ in-school resources jointly moderated the association between identity-based harassment and depressive symptoms. Among SGDY who reported high levels of harassment, support from school personnel buffered the association between identity-based harassment and depressive symptoms. However, at low levels of harassment, it was a combination of high support from school personnel and LGBTQ in-school resources that was linked to the lowest levels of depressive symptoms. SGDY reported more depressive symptoms when they perceived low levels of support from school personnel, regardless of the concentration of LGBTQ in-school resources.
... Leading theoretical models, such as the minority stress model, sexual stigma theory, the psychological mediation framework, and the oppression-based framework, posit that exposure to oppressionbased stressors, such as interpersonal heterosexism-based stressors (e.g., heterosexist discrimination, rejection, and microaggressions), leads to intrapersonal or internalized oppression-related processes among sexual minority individuals (Brooks, 1981;Hatzenbuehler, 2009;Herek et al., 2009;Mereish, 2024;Meyer, 2003). These internalized or intrapersonal oppression-based processes, which involve adopting negative views about one's sexual orientation and encompass a host of self-stigmatizing and shaming beliefs (e.g., internalized heterosexism, heterosexism-based rejection sensitivity, and sexual orientation rumination), confer risk for myriad poor mental health outcomes among sexual minority populations (Kiekens & Mereish, 2022;Newcomb & Mustanski, 2010;Pachankis et al., 2020;Williams et al., 2023). ...
... internalized heterosexism-based processes (Dyar et al., 2018;Szymanski et al., 2014;Timmins et al., 2020), our findings provide more robust support for several theoretical models, including the minority stress model, sexual stigma theory, the psychological mediation framework, and the oppression-based stress framework (Brooks, 1981;Hatzenbuehler, 2009;Herek et al., 2009;Mereish, 2024;Meyer, 2003). These models posit that heterosexism can be internalized and lead to poor health outcomes and well-being. ...
Leveraging a novel experimental heterosexism mood induction paradigm, this study tested the effects of vicarious exposure to heterosexism on internalized oppression-based processes (i.e., internalized heterosexism, heterosexism-specific rejection sensitivity, and sexual orientation rumination) among a sample of sexual minority young adults. Participants were 101 sexual minority young adults, aged 20–35 (M = 26.46 years old; SD = 3.49), who engaged in recent heavy drinking and were recruited from the community (51.5% female sex assigned at birth, 76.3% cisgender, 51.5% plurisexual, and 42.6% racial and ethnic minorities). They completed three experimental mood induction trials counterbalanced over three laboratory visits on different days: heterosexism stress, general stress, and neutral. The results indicated that the heterosexism stress condition produced more internalized heterosexism, heterosexism-specific rejection sensitivity, and sexual orientation rumination than the general stress and neutral conditions while controlling for demographic variables and exposure to structural heterosexism during adolescence. These effects were small to medium in their magnitude. Moreover, exploratory analyses indicated that these effects were somewhat larger among participants who resided in states with high structural heterosexism during adolescence. As further specificity, we documented no statistically significant differences between the general stress and neutral conditions. This study provides the first experimental evidence that exposure to vicarious heterosexism elicits internalized oppression-specific processes among sexual minority young adults. These novel findings extend and have implications for oppression-based stress and stigma models.
... Mental distress in LGBTQ+ people has been theorized as arising from minority stress (Brooks, 1981;Frost & Meyer, 2023;Meyer, 1995Meyer, , 2003. Brooks (1981) first developed sexual minority stress theory, conceptualizing a relationship between sociocultural stressors and psychological stressors in sexuality diverse people (Rich et al., 2020). ...
... Mental distress in LGBTQ+ people has been theorized as arising from minority stress (Brooks, 1981;Frost & Meyer, 2023;Meyer, 1995Meyer, , 2003. Brooks (1981) first developed sexual minority stress theory, conceptualizing a relationship between sociocultural stressors and psychological stressors in sexuality diverse people (Rich et al., 2020). Later, Meyer (2003) theorized that stigma, discrimination, and alienation create a burden of stress for sexuality diverse people compared to the general population, contributing to mental health challenges. ...
High rates of co-occurring mental health and substance use issues in the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) population are well documented; yet, no reviews exist that investigate LGBTQ+ peoples’ heterogeneous and intersectional experiences in mental health and substance use services. To address this gap, this lived experience-informed systematic review examines the experiences, including intersectional experiences, of LGBTQ+ people in mental health and substance use services. A search of MEDLINE, CINAHL, PsycINFO, Scopus, Sociological Abstracts, and Embase was completed, and a thematic synthesis of 35 qualitative and mixed-methods studies was undertaken in partnership with LGBTQ+ people with a lived experience of mental health and/or substance use issues. Included studies highlighted inconsistent and negative experiences of LGBTQ+ people in mental health and/or substance use services. Negative experiences included general service stressors, which occurred irrespective of participants gender or sexuality; minority service stressors that were specific to LGBTQ+ people; and intersectional service stressors related to intersections of gender and sexuality with other social structures, including race and class. Review data also indicated that experiences in mental health and substance use services could have an ameliorating or exacerbating impact on mental health and substance use issues. Drawing on the analytical themes of the review, as well as existing research and intersectional minority stress theory, we propose a model of the impacts of societal and service stressors on LGBTQ+ people’s mental health and substance use, which may serve as a framework for future research.
... One recent study on emotional distress disparities among adolescents found race and ethnicity to be less salient differentiators relative to sexual orientation or gender identity; the youth with the highest prevalence of emotional distress were often lesbian, gay, bisexual, and queer and/or transgender, gender diverse, and questioning identities, but differences by race and ethnicity rarely emerged . Minority stress theory posits that disparities faced by SGDY and other socially marginalized youth do not result directly from holding a socially minoritized identity but rather from the negative social, interpersonal, and psychological experiences related to their stigmatized identities (Brooks, 1981;Meyer, 2003). In addition to general stressors, SGDY must contend with minority stressors associated with their sexual and gender identities-exposure which can place SGDY at an increased risk for negative life outcomes and psychological distress (e.g., Eisenberg et al., 2024) relative to cisgender heterosexual individuals. ...
... Stated another way, it is possible that an untreated or unaccommodated disability could result in an increased level of stress, as one may not have access to helpful strategies or treatment that could make stress more manageable. This is in line with minority stress theory, which suggests that youth with minoritized identities experience more stress as they must contend with both general stressors and minority stressors (Brooks, 1981;Meyer, 2003); in this case, these youth face intersectional stress related to their sexual and/or gender diverse identities and disability, which in turn may overwhelm their ability to cope. Because uncertainty intolerance may vary across SGDY who do not know their disability status, future research should assess the extent to which not knowing is distressing for SGDY to better understand intragroup variation in mental health outcomes. ...
Emerging research on sexual and gender diverse youth (SGDY) with disabilities (e.g., developmental or learning disabilities and physical disabilities) has begun to document the social- and health-related disparities that this population faces because of holding multiple marginalized identities. However, not all SGDY know their disability status, and those who are not aware of their disability status represent a unique group who might differently experience mental health challenges. Thus, the current exploratory study examined mental health differences among youth with diverse sexual and gender identities (n = 10,505) across three disability statuses: youth with disabilities, those without disabilities, and those who did not know their disability status. Compared to SGDY with and without disabilities, SGDY who did not know their disability status were younger, less able to cope with stress, and less likely to identify as asexual. When considering anxiety and depressive symptoms, SGDY who did not know their disability status reported similar levels of anxiety/depression as their counterparts who reported having a disability, though effect sizes were very small. These exploratory findings have implications for how we measure and understand the experiences of SGDY who are not aware of their disability status; stakeholders should consider continuing to work to remove barriers that may thwart SGDY’s ability to be diagnosed and offered support for disabilities.
... As a stigmatized group, people who identify as an SGM face the threat of discrimination and violence from members of the non-SGM (i.e., heterosexual and cisgender) majority. As several scholars have noted, belonging to a stigmatized group has significant cognitive, affective, and behavioral implications that appear to contribute to mental health issues (Brooks, 1981;Crocker & Quinn, 2000;Goffman, 1963;Meyer, 2003;Pachankis, 2007;Riggle et al., 2017). Consequently, it is perhaps unsurprising that SGMs have higher rates of depression, anxiety, and other psychological disorders than do their non-SGM peers (Borgogna et al., 2019;Chakraborty et al., 2011;Wittgens et al., 2022). ...
... In his seminal paper, Meyer (2003) argued that individuals who belonged to a stigmatized group are chronically exposed to social stressors that the non-stigmatized are not, extending the theory of minority stress as initially conceptualized by Brooks (1981). Meyer (2003) maintained that social and institutional structures that are prejudicial or discriminatory against members of minority groups are chronic stressors that negatively impact their mental health. ...
Introduction
People who identify as Sexual or Gender Minorities (SGMs) tend to report more symptoms of depression and anxiety relative to those who identify as cisgender heterosexuals (non-SGMs). According to the minority stress model, these elevated rates are due to exposure to distal stressors that are disproportionately experienced by SGMs relative to non-SGMs and the proximal manifestations of such exposure.
Methods
We test this model with an online survey sample of 447 SGM and 171 non-SGM adults. Data were collected June of 2023.
Results
Consistent with the model (a) SGMs report significantly more symptoms of anxiety and depression than do non-SGMs, (b) distal forms of stress account for this difference, and (c) distal stressors appear to promote concealment, which in turn is associated with proximal stress, anxiety, and depression in the SGM sample.
Conclusions
SGM identity concealment appears to play a more pivotal role in the mechanisms by which environmental stressors lead to anxiety and depression symptoms than previously established.
Policy Implications
These findings highlight the importance of policies that reduce environmental stressors and, in turn, reduce the necessity for identity concealment among SGMs. Public education initiatives should prioritize reducing stigmatization and creating supportive communities. Efforts to create safe spaces, such as community centers, and to ensure access to relevant healthcare, including gender-affirming care, are important steps in fostering supportive communities.
... LGBTQ+ students may have been at particular risk for the negative influence of campus closures because, as delineated by Minority Stress Theory, they experience unique stressors as members of a marginalized community [14,15], which might negatively impact their academic performance [5,16]. The pandemic displaced many LGBTQ+ students from potentially supportive campus environments in which students have access to greater resources and a strong sense of community to off-campus housing with potentially less supportive individuals [17]. ...
... Guided by Minority Stress Theory [14,15], we examined LGBTQ+ college students' perceived changes in academic-related challenges and their association with perceived social support from family and friends and parent-child relationship quality. Our findings indicate that during the first months of the pandemic, when universities were still in session but had closed their physical campuses, LGBTQ+ college students experienced increased academic challenges at rates comparable to or higher than those in students' retrospective reports from summer 2020 in other published work (e.g., [33]). ...
The COVID-19 pandemic disrupted the living arrangements of many college students in the United States, potentially impacting their academic development, which plays a critical role in their mental health. At the start of the pandemic, university closures led to an abrupt transition from face-to-face instruction to online instruction, which may have caused significant challenges for college students, particularly lesbian, gay, bisexual, transgender, queer, and others who identify as having a minority sexual orientation and/or gender identity (LGBTQ+). To identify academic challenges and associated protective factors, we examined LGBTQ+ college students’ social support from family and friends, the parent–child relationship quality, and their associations with academic challenges during the first months of the pandemic. The results of online surveys indicated that LGBTQ+ college students (N = 408; Mean Age = 20.4 yrs) who reported less family support and worse relationship quality with their parents perceived that academics had become relatively harder than before the pandemic. In contrast, friend support was unrelated to perceived academic challenges. These findings underscore the potentially protective role of supportive and high-quality relationships with family. The findings also provide insight into how universities could support students’ academic success during other temporary academic breaks and sudden, unplanned disruptions, such as hurricanes or other weather-related events, which is essential in promoting LGBTQ+ college students’ mental health and academic success.
... People from marginalized social groups, such as LGBTQ+ people, were vulnerable to adverse pandemic-related outcomes due to deeply embedded social inequalities [14] and the minority stress stemming from anti-LGBTQ+ sentiment tied to both gender and sexual discrimination [15][16][17]. In general, LGBTQ+ people face elevated mental health inequalities due to minority stress processes [18], including disproportionately declining wellbeing in the pandemic compared to non-LGBTQ+ people [19]. ...
... Specifically, LGBTQ+ people were especially vulnerable to pandemic-related stressors based on their derogated social status [27] that can shape minority stress [16,17]. Further, LGBTQ+ people were more vulnerable to COVID-related health outcomes based on their higher prevalence of various health challenges and social marginalization [28]. ...
The coronavirus pandemic shaped challenges for marginalized groups. Specifically, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) people experienced community-building constraints, notably in predominantly rural regions. People are also navigating digital geographies, or online social environments, in novel ways to develop virtual communities in the face of prejudice, discrimination, and potential trauma. Through a minority coping approach, the present study explored LGBTQ+ people’s experiences navigating the dynamics of digital geographies during the pandemic while residing in socially conservative, highly rural physical spaces where they may be exposed to vicarious trauma. Using qualitative semi-structured interviews, data were gathered from 43 LGBTQ+ identifying individuals between 19 and 59 years old (M/SD = 27.7/9.2) between October 2020 and January 2021. Nearly 14% identified as transgender, nonbinary, or queer individuals, 35% as bisexual individuals, and 21% as people of color including Hispanic/Latina/o. Thematic analysis of the narratives described participants’ exposures to online discrimination and stigmatization of minority groups (racial and/or sexual/gender minority groups) during the COVID-19 pandemic, institutional constraints to identity expression, utilizing social technologies to manage their identities, and negotiating digital strategies to promote social ties. Findings emphasize improving marginalized people’s experiences with digital geographies through identity affirmation and community relationship-building to offset potentially traumatic experiences. Furthermore, service providers can utilize the findings to tailor effective virtual LGBTQ+ community programming to support underserved, marginalized populations.
... Minority Stress Theory (Brooks, 1981) is a useful framework for conceptualizing elevated rates of STBs among TGNB people. This theory considers the historical context of antitrans sentiment and the sociocultural prejudice against TGNB people, which may manifest through discriminatory public attitudes, laws, and policies that marginalize TGNB people (Tebbe & Moradi, 2016). ...
... This theory considers the historical context of antitrans sentiment and the sociocultural prejudice against TGNB people, which may manifest through discriminatory public attitudes, laws, and policies that marginalize TGNB people (Tebbe & Moradi, 2016). The theory posits that perceived experiences of discrimination, internalized prejudice, limited access to economic opportunities, and fear of stigmatization are risk factors for poor mental health outcomes (Brooks, 1981;Meyer, 1995Meyer, , 2003. An adapted version of the framework, the Gender Minority Stress and Resilience model (GMSR; , describes sources of stress and resiliency proposed to be central to mental health outcomes among TGNB people. ...
Suicidal thoughts and behaviors are more common among transgender and nonbinary (TGNB) people relative to the general population. Nonetheless, research on correlates and predictors of STBs among TGNB people is lacking. This Canadian study used a mixed-methods design to examine whether negative health care experiences (NHEs) concurrently and prospectively predicted suicide ideation (SI) among 182 TGNB adults aged 18–55 (M = 25.64, SD = 6.63). Participants could complete the study online worldwide, although 84% resided in North America. At baseline (November 2019–May 2020), participants completed questionnaire measures of NHEs, SI, depression symptoms, social support, and TGNB community connectedness. The NHE questionnaire included open textboxes, and data from 20 respondents were analyzed in a descriptive qualitative content analysis. Participants were recontacted 4 months later (March 2020–October 2020), and STBs experienced since baseline were recorded. Participants frequently experienced NHEs; 169 (93%) reported at least one. Further, experiencing more NHEs was significantly associated with more frequent SI concurrently (ρ = .61, p < .01) and prospectively (ρ = .56, p < .01) but not when depression was included as a covariate. Community connectedness was associated with SI at baseline, even when controlling for social support and NHEs (p = .007) but not when controlling for depression. Contrary to hypotheses, social support and community connectedness generally did not moderate the relationship between NHEs and SI. In qualitative analyses, we identified five thematic categories that added context regarding participants’ adverse experiences in health care settings. Our results highlight contributors to suicide risk among TGNB people. Systematically improving health care experiences (access and care received) for these groups may ultimately contribute to suicide prevention efforts.
... Minority stress theory, the primary framework to explain these persistent mental health-related inequalities for LGBTQ+ populations, considers internalized stigma to be a proximal (i.e., intrapersonal) stressor (Brooks, 1981;Frost & Meyer, 2023;Hendricks & Testa, 2012;Meyer, 2003). It is created through experiencing or witnessing victimization, discrimination, harassment, or other forms of verbal or physical violence, together termed distal minority stress within the model (Brooks, 1981;Frost & Meyer, 2023;Hendricks & Testa, 2012;Meyer, 2003). ...
... Minority stress theory, the primary framework to explain these persistent mental health-related inequalities for LGBTQ+ populations, considers internalized stigma to be a proximal (i.e., intrapersonal) stressor (Brooks, 1981;Frost & Meyer, 2023;Hendricks & Testa, 2012;Meyer, 2003). It is created through experiencing or witnessing victimization, discrimination, harassment, or other forms of verbal or physical violence, together termed distal minority stress within the model (Brooks, 1981;Frost & Meyer, 2023;Hendricks & Testa, 2012;Meyer, 2003). Advancements of this theory also propose that enduring structurally stigmatizing environments (e.g., lack of legal protection, prejudicial societal attitudes), a concept known as structural stigma (Hatzenbuehler & Link, 2014), creates and perpetuates internalized stigma, partially through elevations in experiences of (distal) minority stress (Hatzenbuehler et al., 2024). ...
Internalized stigma within lesbian, gay, bisexual, transgender (trans), and queer populations (LGBTQ+) refers to the internalization of societal prejudices about one's sexual orientation or gender identity. It is commonly considered to be a form of minority stress, which, in turn, is thought to be created and perpetuated through stigmatizing structural conditions (i.e., structural stigma). Here, we present a study protocol for a cross-temporal meta-analytic systematic review on internalized stigma in LGBTQ+ populations and its associations with structural stigma. Specifically, we hypothesize that sample mean levels of internalized stigma have decreased over time for LG populations (directed hypotheses) and that they are associated with year of data collection for BTQ+ populations (no direction specified). We also hypothesize that lower sample mean levels of internalized stigma are associated with lower levels of country-level structural stigma (directed hypotheses). We will conduct forward searches (citationchaser, Google Scholar, Scopus, Web of Science, PsycInfo) of five popular, population-specific scales to assess internalized stigma within lesbian, gay, bisexual and other plurisexual, and trans and non-binary (TNB) populations that have been in longstanding use. We will extract data via standardized, piloted coding sheets for every scale. Analyses will include three-level meta-regressions (year of data collection and structural stigma as moderators of interest, additional covariates in adjusted models) via correlated, hierarchical effects models. We will conduct a series of sensitivity analyses within a descriptive, multiverse-based approach and test for reporting bias using a multilevel variant of Egger's test, using publication status as a moderator, as well as via power-enhanced funnel plots. We will assess study risk of bias via an adapted version of the critical appraisal tool for analytical cross-sectional studies by the Joanna Briggs Institute. Exploratorily, we will test for differences in effect strength for lesbian vs. gay populations and run a series of machine learning-based meta-regressions using gradient boosted decision tree models.
... An analysis by Downing and Przedworski revealed that transgender individuals were more likely to report worse mental health, and that gender minorities had higher odds of reporting poor quality of life compared to cisgender males or females [19]. The minority stress model offers valuable insights into understanding the disparities gender minorities face [20]. According to this model, marginalized groups face unique internal and external stressors, such as internalized negative attitudes, prejudice, and discrimination related to their socially stigmatized minority status [21]. ...
... Weighted % refers to the Weighted Percentage, and 95% CI denotes the 95% Confidence Interval the proportion of younger age groups(18)(19)(20)(21)(22)(23)(24) declined. Non-Hispanic White participants were the largest group, with their percentage peaking at 67.74% in 2021. ...
Background
With the proliferation of anti-transgender policies in some U.S. jurisdictions, this study examines the general, mental, and physical health of transgender and cisgender populations.
Methods
Data from the 2020–2023 Behavioral Risk Factor Surveillance System were analyzed to examine associations between gender identity and health outcomes. Propensity score weighting was used to address potential imbalances among group characteristics. We conducted logistic regression for the binary outcome of self-rated health and quasi-Poisson regression for the number of days reporting poor mental and physical health.
Results
Results reveal significant disparities in health outcomes, with transgender individuals reporting lower proportions of good general health and more days of poor mental and physical health compared to cisgender individuals. In the adjusted analyses, transgender individuals were significantly less likely to report good general health compared to cisgender peers (OR = 0.60, 95% CI = 0.52–0.69). Gender nonconforming (GNC), male-to-female (MTF), and female-to-male (FTM) individuals had lower odds of reporting good general health compared to cisgender individuals (GNC, OR = 0.46, 95% CI = 0.35–0.61; MTF, OR = 0.67, 95% CI = 0.53–0.85; FTM, OR = 0.71, 95% CI = 0.57–0.87). GNC individuals had an 86% higher frequency of poor mental health days (IRR = 1.86, 95% CI = 1.57–2.21) and a 37% higher frequency of poor physical health days (IRR = 1.37, 95% CI = 1.15–1.63) compared to cisgender counterparts. Similarly, MTF and FTM individuals had significantly higher frequencies of poor mental and physical health days.
Conclusions
The study highlights significant health disparities faced by transgender individuals, who report poorer general, mental, and physical health. These findings underscore the need to address the unique challenges and improve health outcomes within the transgender community.
... Cultural dynamics within rural communities often reinforce cisnormative and heteronormative hierarchies and policies, increasing anti-LGBTQ attitudes and further marginalizing LGBTQ individuals [5]. According to Meyer's minority stress model [6,7], the mental and physical health disparities LGBTQ populations experience can be explained by the stigma that LGBTQ people face daily [8]. Given that stigma can be embodied and directly impact health, it is plausible that there may be nonverbal signs of experienced stigma that predict health outcomes for LGBTQ individuals. ...
... Self-reported state shame did not uniquely predict suicidal ideation among rural or urban LGBTQ people. These findings are consistent with the minority stress model [6][7][8] and prior research that links shame to psychological distress [55] and suicide risk [56] and extends this literature by documenting the unique predictive power of nonverbal expressions of shame, especially among populations who experience structural level stigma. The results of this study highlight the importance of considering cultural and social contexts when assessing the impact of shame on mental health outcomes within LGBTQ PLOS MENTAL HEALTH communities. ...
In the United States (US), lesbian, gay, bisexual, transgender, and queer (LGBTQ) people experience disproportionate rates of suicidality associated with minority stress. This study aimed to investigate whether nonverbal expressions of experienced stigma (i.e., shame) predicted suicidal ideation among LGBTQ individuals with a focus on location-based disparities (comparing those living in a more rural setting to those living in a more urban setting). More specifically, we examined whether nonverbal expressions of shame predicted suicidal ideation three months later and whether this relationship was moderated by region. LGBTQ individuals (N = 133) from one rurally-situated and one urban location were videorecorded while talking about a time they felt bad about their LGBTQ identity in an observational, prospective (two-time point) design. Recordings were coded for the intensity of nonverbal expressions of shame (shoulders slumped, chest narrowed). Participants also completed several self-report measures including state shame and suicidal ideation at both the time of the recording and three months later. Moderation analyses revealed that for LGBTQ adults living in more rural settings, nonverbal shame, predicted increased suicidal ideation three months later (Bstd = 0.64, p = .005), and this was not the case for those living in more urban settings (Bstd = -0.08, p = 0.70). Self-reported shame did not predict suicidal ideation for LGBTQ adults from more rural or urban locations. These findings highlight the importance of recognizing nonverbal cues in context (i.e., in locations with more structural stigma) when assessing mental health risks and when shaping interventions for LGBTQ populations.
... One common theory used to explain differences between cisgender and TNB people is gender minority stress theory. Minority stress theory was originally applied to the specific additional stressors that LGB people faced as a result of having a marginalized sexual orientation (Brooks, 1981;Meyer, 1995Meyer, , 2003Meyer, , 2015 as a way to explain health disparities. The gender minority stress model (Hendricks & Testa, 2012;Testa et al., 2015) expands this model by identifying specific stressors that TNB people face as a result of having a stigmatized gender identity. ...
This paper describes an aspect of a larger research project using mixed methods to develop a transgender resilience measure. We highlight how our approach “queers” mixed methods research. We center transgender and nonbinary (TNB) voices throughout our research process, disrupting conventional scale development methods and ultimately (trans)forming traditional conceptualizations of resilience, which emphasize individual recovery from adversity. Historically, TNB research has perpetuated marginalization and is rooted in cisnormativity. By understanding resilience from the theoretical frameworks of gender minority stress, the transgender resilience intervention model, and intersectionality, our conceptualization of TNB resilience rejects assumptions of cisnormativity, binary normativity, and ultimately transforms our understanding of resilience. This case study exemplifies one way to queer mixed methods research to reflect TNB people’s experiences.
... From 2018 to 2022, 48 laws restricting the rights of transgender and nonbinary individuals were enacted across the United States; in the states that enacted those laws, reports of past-year suicide attempts among TGD youth increased by 7% to 72% [23]. Minority stress theory suggests that individuals who hold stigmatized identities, across domains, experience disproportionately high stress that results from that stigma [11,24,25]. Within this framework, stigma-related stressors may be external to the self (eg, harassment) or experienced internally because of consistent exposure to societal stigma (eg, negative attitudes toward the self). ...
Background
Transgender and gender diverse (TGD) individuals are disproportionately impacted by suicidal thoughts and behaviors (STBs), and intersecting demographic and psychosocial factors may contribute to STB disparities.
Objective
We aimed to identify intersecting factors associated with increased risk for suicidal ideation, intent, plan, and attempts in the US transgender population health survey (N=274), and determine age of onset for each outcome using conditional inference trees (CITs), which iteratively partitions subgroups of greater homogeneity with respect to a specific outcome.
Methods
In separate analyses, we restricted variables to those typically available within electronic medical records (EMRs) and then included variables not typically within EMRs. We also compared the results of the CIT analyses with logistic regressions and Cox proportional hazards models.
Results
In restricted analyses, younger adults endorsed more frequent ideation and planning. Adults aged ≤26 years who identified as Black or with another race not listed had the highest risk for ideation, followed by White, Latine, or multiracial adults aged ≤39 years who identified as sexual minority individuals. Adults aged ≤39 years who identified as sexual minority individuals had the highest risk for suicide planning. Increased risk for suicidal intent was observed among those who identified as multiracial, whereas no variables were associated with previous suicide attempts. In EMR-specific analyses, age of onset for ideation and attempts were associated with gender identity, such that transgender women were older compared to transgender men and nonbinary adults when they first experienced ideation; for attempts, transgender women and nonbinary adults were older than transgender men. In expanded analyses, including additional psychosocial variables, psychiatric distress was associated with increased risk for ideation, intent, and planning. High distress combined with high health care stereotype threat was linked to increased risk for intent and for suicide planning. Only high everyday discrimination was associated with increased risk for lifetime attempts. Ages of onset were associated with gender identity for ideation, the intersection of psychiatric distress and drug use for suicide planning, and gender identity alone for suicide attempts. No factors were associated with age of onset for suicide intent in the expanded variable set. The results of the CIT analysis and the traditional regressions were comparable for ordinal outcomes, but CITs substantially outperformed the regressions for the age of onset outcomes.
Conclusions
In this preliminary test of the CIT approach to identify subgroups of TGD adults with increased STB risk, the risk was primarily influenced by age, racial identity, and sexual minority identity, as well as psychiatric distress, health care stereotype threat, and discrimination. Identifying intersecting factors linked to STBs is vital for early risk detection among TGD individuals. This approach should be tested on a larger scale using EMR data to facilitate service provision to TGD individuals at increased risk for STBs.
... In the creation of the intervention, two leading models of suicidal behavior were considered. Minority stress theory (Brooks 1981;Hendricks and Testa 2012;Meyer 1995Meyer , 2003Tebbe and Moradi 2016) is the leading theoretical model explaining health disparities, including suicide attempts, among SGM. Minority stress theory posits that in addition to general stressors, SGM individuals also experience distal minority stressors (e.g., prejudice, discrimination, and victimization) and proximal minority stressors (e.g., internalization of stigmatizing messaging, concealment of one's identity, expectations of rejection), the combination of which leads to poorer mental health outcomes and increased risk for suicide attempts compared to their cisgender, heterosexual counterparts. ...
Background
Patient navigation (PN), paired with the safety planning intervention (SPI), may allay mechanisms that theoretically underlie suicide among sexual and gender minorities (SGM). This paper describes (a) the iterative development of a theory‐informed PN + SPI intervention (QueerCare) to prevent suicide among at‐risk SGM youth and young adults and (b) a case series examining the feasibility and acceptability of study procedures, measures, and QueerCare.
Methods
Seven initial QueerCare modules and a glossary of terms were drafted. Seven participants completed the case series. Feasibility and acceptability over 3 months were examined by triangulating multi‐method data.
Results
The study procedures and measures in the at‐risk population were feasible and sensitive, provided that remote safety monitoring and parental consent waivers were in place. QueerCare was feasible, helpful, and appropriate based on satisfaction ratings and four emerging themes: matched identity care, internalized barriers, support, and flexibility valued. Two additional modules and guardian materials were created. Suicidal crisis management protocols were continuously refined.
Conclusion
QueerCare was developed as a highly flexible modular intervention to meet the needs of SGM youth and young adults and prevent repeat suicide attempts in this population. Findings indicate study procedures, measures, and QueerCare were feasible and acceptable based on triangulated data.
Trial Registration
This study was registered under ClinicalTrials.gov identifier NCT04757649
... Additional clinical practice frameworks developed with and for 2STNB individuals have highlighted strategies particularly related to reducing internalized antitransgender and nonbinary (TNB) stigma (also referred to as internalized transnegativity in the literature) to decrease mental health symptoms and promote wellbeing (Israel et al., 2021;Matsuno, 2019;Matsuno & Israel, 2018). Internalized anti-TNB stigma has been theorized to be one of the major underlying proximal factors that contribute to minority stress (see Brooks, 1981;Hendricks & Testa, 2012;Meyer, 2003). Research demonstrates that internalized anti-TNB stigma is positively related to psychological distress (e.g., depression, anxiety, stress, suicide risk; Chodzen et al., 2019;Staples et al., 2018;Tebbe & Moradi, 2016;Testa et al., 2015) and mediates and moderates external stress (e.g., discrimination) and suicide risk (e.g., Inderbinen et al., 2021;Staples et al., 2018;Testa et al., 2017). ...
This article reports program evaluation findings of the effectiveness of a pilot training program integrating key principles from the psychological framework for radical healing (French et al., 2020) and models aimed at decreasing internalized stigma (Israel et al., 2021). Our main goal of the training program was to increase psychotherapists’ knowledge and skills related to competent and affirming practice with two-spirit, transgender, and nonbinary clients who are Black, Brown, and people of color adults. Pre- and posttraining qualitative and quantitative data were collected from 82 psychotherapist attendees to assess the acceptability of the training for learning goals and to provide preliminary evidence of training effectiveness for the training’s learning objectives. Descriptive content analysis of qualitative data was used to assess the degree to which the training addressed psychotherapists’ goals and increased knowledge and skills. Regression analyses of quantitative data found significant increases in psychotherapists’ self-reported knowledge of key concepts and frameworks and confidence to apply new learning to psychotherapy practice. Program evaluation results largely support the acceptability and effectiveness of this training for increasing self-rated competency for psychotherapy practice with two-spirit transgender, and nonbinary Black, Brown, and people of color adult clients. Implications are discussed.
... The minority stress model posits that belonging to a minority group inherently presents unique social challenges, leading to elevated stress responses and adverse health outcomes [1,2]. With regards to health disparities across sexual orientation, the model specifically highlights how clashes with heteronormative culture can engender environments where sexual minorities face distinctive stressors such as internalisation of negative societal attitudes, anticipation of rejection, and experiences of discrimination [3]. ...
Background
While prior studies have shown LGB individuals have elevated risk of poor mental health, poor physical health, and substance use, existing study designs may be improved by using representative samples, wider ranges of health outcomes, heterosexual comparison groups, and disaggregated data. The goal of this study is to provide estimates of multiple health disparities across sexual orientations in Canada based on these principles.
Methods
Using data from 2009-2014 Canadian Community Health Surveys, a sample of 19,980,000 weighted individuals was created. Outcomes included mental health, physical health, binge drinking, illicit drug use, and cannabis use. The study used logistic regression models adjusted by covariates, stratified by sex, to estimate health disparities across sexual orientations over time.
Results
Among LGB individuals, there was evidence for elevated risk of poor mental health (i.e. gay men, bisexual men, bisexual women), poor physical health (i.e. bisexual men, bisexual women), binge drinking (i.e. lesbians, bisexual women), illicit drug use (i.e. lesbians, bisexual women), and cannabis use (i.e. lesbians, bisexual women) relative to their heterosexual counterparts. Those identifying as ‘don’t know’ or ‘refuse’ showed reduced odds of substance use. Bisexual women exhibited highest disparities in health outcomes, e.g. OR=3.3, 95% 2.58 to 4.22 for poor mental health. Trends over time showed worsening mental health among bisexual women (relative to changes in heterosexual women), and decreasing substance use in gay and bisexual men, and lesbians.
Conclusion
This study highlights health disparities across sexual orientations in Canada, especially bisexual women, calling for targeted interventions (e.g. increased training of service providers in working with bisexual women and community outreach against biphobia). Future research should aim to explore these disparities longitudinally while also including the use of administrative-linked health data to reduce potential bias in self-reported data.
... Our findings supported previous evidence that suggest a relation between oppressive experiences, often internalized, and mental health (Baiocco et al. 2010;Baiocco and Pistella 2018;Gower et al. 2018;Meyer 2003) and expand the literature addressing how these effects take place for intersectional bullying among Latinx and Black LGBTQ+ youth. Minority stress theory (Brooks 1981;Meyer 2003) highlights the cumulative impact from both distal (bullying) and proximal (internalization) stress observed in our models . Furthermore, by assessing multiple forms of bullying, all based on systems of power that influence various based-identify forms of biases and stigma, we incorporated an intersectional lens to capture the combined impact from these experiences for Latinx and Black LGBTQ+ youth. ...
Research on bullying and LGBTQ+ Black and Latinx youth is limited, yet findings suggest experiencing bullying is associated with high levels of psychological distress, which can be internalized. Similarly, research on aspects such as parental acceptance and informed therapy suggest these can operate as protective factors when experiencing oppression. Yet, these relations are often tested individually. Thus, using an intersectional approach, we explore the cumulative effect of these variables using a sample of LGBTQ+ Black and Latinx youth to highlight specific mental health disparities among these groups. Using a national online cross‐sectional survey with LGBTQ+ Black and Latinx youth (N = 2414), we assessed the relation between school bullying (predictor), internalized LGBTQ+ stigma (mediator), and psychological distress (outcome) and tested the influence of access to therapy (moderator 1) and parental acceptance (moderator 2) in a moderated mediation analysis. Additionally, a second moderated mediation analysis tested among participants who have access to therapy if LGBTQ+ informed therapy (moderator 1) and parental acceptance (moderator 2) influenced the relation between our main variables. Using a moderated mediation analysis PROCESS Model 11 for two models, results suggested in model 1 that internalized stigma mediated the relation between school bullying and psychological distress. Furthermore, both parental acceptance and access to therapy moderated the association between school bullying and internalized LGBTQ+ stigma. The second model found that for those with access to therapy, receiving LGBTQ+ ‐informed therapy and high parental acceptance disrupted the relationship between school bullying and internalized LGBTQ+ stigma. Our findings suggested that LGBTQ+ Black and Latinx youth receiving LGBTQ+ informed therapy reported less internalized LGBTQ+ stigma, particularly when parental acceptance is high. Implications and limitations are discussed.
... Thus, it is important to identify whether salient sociocultural factors (e.g., ethnic identity acceptance and internalized racism) serve as protective factors or exacerbate the effects of internalized homophobia on cigarette use. The minority stress model (Brooks, 1981;Meyer, 2003;Rich et al., 2020) posits that sexual minority individuals are at heightened risk of adverse psychological and behavioral conditions due to the compounded effect of proximal and distal stressors present in their environments. Proximal stressors include internalized homophobia, concealment, and expectation of rejection. ...
Latino and Black sexual minority men (SMM) are at elevated risk of cigarette use compared to their heterosexual and White SMM counterparts. Internalized homophobia may affect substance use disparities. However, the research linking internalized homophobia and substance use has been inconsistent. The purpose of the present study was to clarify the association between internalized homophobia and daily cigarette use by testing the roles of internalized racism and ethnic identity acceptance as potential moderators of this link. This study collected data from 165 Black and/or Latino SMMs across the United States (Mage = 23.72, SD = 3.85) as part of a larger study. Data were collected from December 2020 to February 2021 via Qualtrics Panels. Zero-inflated Poisson regression was conducted to examine the association between internalized homophobia and daily cigarette use and whether internalized racism and/or ethnic identity acceptance would moderate the association between internalized homophobia and daily cigarette use. Internalized homophobia was negatively associated with daily cigarette use; however, this association was significantly moderated by internalized racism and ethnic identity acceptance. Simple slope analyses revealed that low levels of internalized racism and high levels of ethnic identity acceptance attenuated the positive association between internalized homophobia and daily cigarette use. At low levels of ethnic identity acceptance, the positive association between internalized homophobia and daily cigarette use was strengthened. This research aids in contextualizing the association between internalized homophobia and daily cigarette use among Latino and Black SMM. Implications for smoking treatment and prevention programs are discussed.
... SGM people are subject to many stressors. Some of these are normal life stresses experienced by most people (e.g., starting a new school or job) while others-termed minority stresses-are more often encountered by SGM people (Brooks, 1981;Frost & Meyer, 2023;Meyer, 2003). One example of minority stress is that SGM people are more likely than others to have negative and/or conflicted relationships with their parents and with other members of their families of origin, which can cause numerous problems (Chum et al., 2021;Patterson et al., 2018). ...
Está bien documentado que las personas de minorías sexuales y de género enfrentan experiencias estresantes, como problemas en las relaciones familiares e incluso violencia física, con más frecuencia que las personas heterosexuales. En adición, está bien documentado el papel causal de estas experiencias estresantes en la deficiencia de sueño y el rol causal de la deficiencia de sueño en la salud física y mental. También se ha establecido que las personas de minorías sexuales y de género sufren múltiples disparidades de salud. Lo que aún no se comprende bien es cómo podrían vincularse estas variables. Este manuscrito explora lo que se llama la “vía de la deficiencia del sueño,” es decir, que las deficiencias de sueño que pueden ser causadas y/o exacerbadas por experiencias estresantes pueden a su vez contribuir a importantes disparidades de salud que experimentan las personas de minorías sexuales y de género. Si la deficiencia de sueño es una vía importante que va desde experiencias adversas hasta disparidades de salud, el uso de tratamientos efectivos para las deficiencias de sueño podría mejorar la cantidad y/o calidad del sueño y, de esta manera, permitir una mejor salud entre las personas de minorías sexuales.
... Minority stress theory, originally conceived by Brooks and then popularized by Meyer, considers the relationship between minority group members, the dominant culture, and their interactions within the larger social environment; minority stressors are unique (i.e., not experienced by individuals in the dominant culture), socially constructed (i.e., reinforced by social processes, structures, and institutions), and chronic (Brooks, 1981;Meyer, 1995). The lived experiences of prejudice, discrimination, internalized queerphobia, stigma, and expectations of rejection that LGBTQI+ cancer survivors must navigate in society are collectively known as minority stressors (Diamond & Alley, 2022;Meyer, 1995). ...
Objetivo: Las lesbianas, gays, bisexuales, transgénero, queer, intersexuales y las personas con otras orientaciones sexuales e identidades de género diversas (LGBTQI+) experimentan niveles más altos de aislamiento social y retrasos en las pruebas de detección, el diagnóstico y el tratamiento del cáncer en comparación con sus contrapartes no LGBTQI+. El propósito de este estudio fue examinar la asociación entre el aislamiento social percibido (PSI, por sus siglas en inglés) y el retraso en las pruebas de detección, el seguimiento o el tratamiento del cáncer durante la pandemia de COVID-19 entre los sobrevivientes de cáncer LGBTQI+, y determinar si esta asociación variaba según la raza y etnicidad. Métodos: Se utilizaron datos de la Red Nacional de Cáncer LGBT OUT: La Encuesta Nacional de Cáncer. Se encuestó a adultos LGBTQI+ sobrevivientes de cáncer (N = 3,023) en los EE. UU. entre septiembre de 2020 y marzo de 2021 utilizando medidas auto informadas de PSI y retraso en la atención del cáncer desde el inicio de la pandemia de COVID-19. El análisis de datos incluyó estadística descriptiva y regresión logística. Resultados: Los sobrevivientes de cáncer LGBTQI+ con niveles altos de PSI tuvieron más probabilidades de retrasar la atención del cáncer que aquellos con niveles bajos de PSI (OR ajustado = 1.29; IC del 95% = 1.06, 1.57). Los sobrevivientes de cáncer LGBTQI+ birraciales/multirraciales tenían más probabilidades de retrasarse que sus pares Blancos (OR ajustado = 3.65; IC del 95% = 1.58, 8.41). El envejecimiento, la variación intersexual, la pérdida de empleo y el peor estado de salud actual también se asociaron con un retraso significativo en la atención del cáncer. Conclusiones: El aislamiento social y otros determinantes sociales de la salud son objetivos importantes para la evaluación clínica y las intervenciones de salud pública destinadas a abordar las disparidades de salud relacionadas con el cáncer en las personas LGBTQI+, particularmente aquellas con identidades marginadas que se cruzan.
... 67,68 Higher rates of smoking and alcohol use are often attributed to minority stressors that then elevate psychological distress, phenomenon explained by gender minority stress theory. 9,[69][70][71][72][73] Smoking among transgender folks is often used as a coping mechanism against stigma, making screening for lung cancer particularly important. 74,75 Interestingly, increased uptake of smoking cessation have been observed in transgender women receiving GAHT, suggesting that genderaffirming medical care leads to a reduction in behaviors that contribute to cancer risk. ...
Transgender and gender‐diverse (TGD) populations experience health disparities across all areas of health care due to issues of bias, discrimination, and structural barriers to care. Existing literature on cancer screening in TGD populations demonstrates significant gaps in care; for example, transgender men receive Pap smears at lower rates than cisgender women. Because of known disparities in cancer screening, and gaps in our understanding in terms of diagnosis, treatment, and survivorship, the authors conducted a rapid review of the literature to examine cancer care continuum (screening, treatment, and survivorship) disparities among TGD persons. The results reported disparities across the cancer care continuum. Although there is currently limited research on cancer diagnosis, treatment, and survivorship, the available evidence indicates TGD patients are diagnosed with cancer at later stages than cisgender patients. TGD patients were also less likely than cisgender patients to receive treatment for some types of cancer. The results of this rapid review demonstrate the need for more research across the cancer care continuum for TGD patients with significant gaps in knowledge for cancer treatment and survivorship.
... Gay, bisexual, and other men who have sex with men (GBM) experience significant mental, social, and sexual health disparities compared to their heterosexual peers (e.g., Frost & Meyer, 2009;Hsieh, 2014;Nouri et al., 2022;Perales & Plage, 2020). These disparities are due in part to the unique minority stressors faced by GBM (Brooks, 1981;Meyer, 2003), which stem from the identity-related stigma these men face due to their sexual orientation. GBM can experience identity-related stigma from multiple sources (e.g., mainstream media, family, peers, and school or workplace settings) and this can negatively impact access to social support networks, which are vitally important for health and wellbeing (e.g., Skakoon-Sparling, Berlin, et al., 2022;Skakoon-Sparling, Cox, et al., 2022;Weisz et al., 2016). ...
Objetivo: Entre los hombres gays, bisexuales y otros hombres que tienen sexo con hombres (GBM, por sus siglas en inglés), los pensamientos/comportamientos sexuales intrusivos (es decir, angustia por los propios impulsos o comportamientos sexuales) se asocian con la depresión y la participación en comportamientos que aumentan el riesgo de infecciones de transmisión sexual. (STI, por sus siglas en inglés). El presente estudio examina la asociación entre la homonegatividad internalizada y los pensamientos/comportamientos sexuales intrusivos, el efecto intermedio de los síntomas de depresión y el posible efecto amortiguador del apoyo social. Además, establecemos el vínculo posterior con los resultados de salud física al examinar la asociación entre pensamientos/comportamientos sexuales intrusivos y un diagnóstico reciente de STI bacterianas. Métodos: Utilizando datos de los participantes (n = 1,046) de tres momentos temporales, realizamos un análisis de mediación moderada y regresión logística. Resultados: Las puntuaciones más altas de homonegatividad internalizada predijeron condicionalmente mayores pensamientos/comportamientos sexuales intrusivos un año después: los participantes con puntuaciones más altas de homonegatividad internalizada informaron pensamientos/comportamientos sexuales intrusivos más severos si también tenían un menor apoyo social (β = .08, SE = .02, p < .001, IC95%: 0.04, 0.13). Los síntomas de depresión más graves también se asociaron directamente con mayores pensamientos/comportamientos sexuales intrusivos (β = .02, SE = .01, p = .011, IC del 95%: 0.01, 0.03). Finalmente, hubo una asociación significativa entre pensamientos/comportamientos sexuales intrusivos y diagnóstico reciente de STI bacteriana (OR = 1.68, p < .001, IC95%: 1.30, 2.16). Conclusiones: Dado que el apoyo social mitigó el impacto de la homonegatividad internalizada en los pensamientos/comportamientos sexuales intrusivos y, en última instancia, redujo indirectamente la aparición de STI bacterianas en esta población, estos hallazgos demuestran la utilidad de los factores psicosociales como posibles objetivos de intervención para mejorar la salud de GBMs.
... The increased burden of OCD among sexual minority people can be conceptualized through the minority stress model (Brooks, 1981;I. H. Meyer, 2003), which posits that sexual minority people face unique stressors associated with their marginalized identity (e.g., discrimination, internalized stigma, expectations of rejection). ...
Sexual minority people are at increased risk of psychopathology, including obsessive–compulsive disorder (OCD), compared with heterosexual people. Prior research has found that sexual minority people are more likely to be diagnosed with or treated for OCD compared with their heterosexual peers, and sexual minority people represent a substantial portion of those in OCD treatment. As such, it is critical to examine potential sexual orientation differences in clinical presentation and treatment outcomes among people with OCD. Among 437 patients in treatment for OCD, we examined OCD severity and related constructs (depression, worry, and quality of life) over treatment as a function of sexual orientation (bi+, gay/lesbian, and heterosexual). At admission, there were no significant differences in clinical presentation between bi+, gay/lesbian, and heterosexual people. Treatment resulted in significantly reduced symptoms across all groups. However, depression was more severe across treatment for bi+ versus heterosexual people, improvements in quality of life were quicker for heterosexual and bi+ versus gay/lesbian people, and bi+ people reported quicker improvements in OCD versus heterosexual people. Clinical implications are discussed.
... Minority stress theory was initially developed as a multilevel theory to explain health inequities experienced by gay, lesbian, bisexual, queer, and other sexual minority groups (Brooks, 1981;Meyer, 2003;Rich et al., 2020). Minority stress theory articulates the role of cumulative exposure to systems of oppression in the development of mental health issues, including body image concerns and eating pathology. ...
... Minority Stress Theory posits that such stigma contributes to disparities in the well-being of stigmatized groups (V. R. Brooks, 1981;Meyer, 2003). Consequently, LGBTQ+ adolescents frequently grapple with heightened depression, anxiety, suicidality, and substance use compared to their cisgender, heterosexual peers (The Trevor Project, 2022). ...
... Informed by minority stress (Brooks, 1981;Meyer, 2003) and social safety (Diamond & Alley, 2022;Slavich et al., 2023) theories, concealing stigmatized yet indiscernible identities may serve as a strategy to avoid future stigma and to reaffiliate with majority groups (Livingston et al., 2020;Pachankis, Mahon, et al., 2020). This desire to prevent future stigma and seek reaffiliation could explain why concealment often enhances perceived safety in hostile environments (Slavich et al., 2023). ...
Recent calls have been made to decolonize White-dominated, Western narratives around concealment (e.g., that disclosure should be prioritized) and instead to examine psychosocial factors associated with concealment. Existing literature lacks exploration into daily variations of sexual or gender identity concealment (hereafter, “concealment”) among sexual and gender minority people, especially sexual minority women (SMW) and transgender and gender-diverse (TGD) individuals who have experienced trauma. Additionally, there is little research delving into individual characteristics, such as trait-based avoidance coping, and specific contexts, including daily minority stressors and threat appraisal, prompting trauma-exposed SMW and TGD people to conceal their identities. Addressing these gaps, we aimed to develop and test an innovative model that advances stress and coping frameworks by integrating minority stress and social safety theories. We used data from a 14-day intensive longitudinal study among 57 trauma-exposed SMW and TGD people. Minority stressors and threat appraisal were associated with concealment at both the within- and between-person levels, respectively. Trait-based general avoidance coping predicted identity concealment and moderated the link between daily minority stressors and concealment. Daily minority stressors were associated with greater concealment only among those who reported lower avoidance coping. Concealment may operate as an experiential avoidance behavior among those who habitually cope by using avoidance and as a goal-directed coping response among trauma-exposed SMW and TGD people who face acute minority stressors and report less avoidance coping. Counseling psychologists exploring the function of concealment with trauma-exposed SMW and TGD people should attend to stigma exposure, threat appraisal, and avoidance coping.
... We also recognize that the experiences of LGB+ people are heterogeneous and require an intersectional approach that considers how multiple social identities interact to produce distinct experiences (as per Bowleg, 2012;Crenshaw, 1997). For instance, research suggests that LGB+ women are more susceptible to psychological distress than GB+ men (Velez et al., 2013), largely because of the unique intersections between discrimination based on gender and sexuality (Brooks, 1981;Meyer, 2003). Well-being trends may also differ as a function of normative life experiences (i.e., age; Blanchflower & Oswald, 2008;Fredriksen-Goldsen et al., 2015;Lilly et al., 2023) and the sociopolitical environment in which one was born, raised, and reached maturity (Botha & Vera-Toscano, 2022;Frost et al., 2022;La Roi et al., 2022;Meyer et al., 2021). ...
Minority stress theory suggests that shifts toward egalitarianism should reduce well-being disparities between heterosexual people and lesbian, gay, bisexual, and other sexual minorities (LGB+ people). However, few studies have examined well-being trends in these groups over periods of social change. We addressed this issue directly using a large nationwide random sample of New Zealand adults over thirteen years (from 2009 to 2022; Ntotal = 72,790; LGB+ n = 7,677). In doing so, we tracked people’s well-being both before and in the years following major legal changes that increased LGB+ rights. Multigroup latent growth curve models revealed stable well-being differences between LGB+ and heterosexual participants across five domains of well-being, with little evidence of disparities reducing over time. Differences were most pronounced between younger LGB+ and heterosexual groups, with young LGB+ women and men reporting the lowest psychological and social well-being, respectively. These results highlight the need to further examine the impact of minority stress, as well as intersectional identities, on well-being among LGB+ populations.
... Minority stress theory (Brooks, 1981;Meyer, 2003) posits that discrimination, stigma, and rejection on the basis of being a member of a minoritized community contribute to hostile and stressful social environments that cause heightened stress (referred to as minority stress). The accumulation of this stress over time may then increase the risk of psychopathology and worse health outcomes. ...
Latine sexual minority adults report discrimination related to their minoritized identities (racism, heterosexism) and at the intersection of those identities (racism in the lesbian, gay, bisexual, transgender, and queer community, heterosexism in one’s racial/ethnic community). Much research has supported the additive effects of single-identity discrimination (racism and heterosexism) on mental health problems; however, less research has examined the role of intersectional discrimination in physical health symptoms and how psychological distress may account for that association. The present study examined the associations between intersectional discrimination with physical symptom severity (PSS) and tested psychological distress as a potential underlying mechanism. Using cross-sectional data from 320 Latine sexual minority adults (age range 18–70; M = 30.5, SD = 9.6), a structural equation model estimated the association between two intersectional discrimination variables (i.e., racism in the lesbian, gay, bisexual, transgender, and queer community and heterosexism in one’s racial/ethnic community) with PSS and tested their indirect effects via psychological distress. Results revealed that greater heterosexism in one’s racial/ethnic community was associated with higher PSS; there was a significant indirect effect via psychological distress. Racism in the lesbian, gay, bisexual, transgender, and queer community was not a significant predictor in the model. These results highlight the importance of applying an intersectional framework to measuring stigma and discrimination. Findings also provide initial support for psychological distress as a potential underlying mechanism through which discrimination contributes to poorer physical health among Latine sexual minority adults. These results can inform interventions that aim to promote psychological and physical health among this population by mitigating the detrimental effects of intersectional discrimination.
... [6][7][8][9][10] The 2003 Minority Stress Model hypothesis states that there exists a complex connection between the prevalence of mental health issues within LGBTQI+ populations and the experience of discrimination. [11,12] Based on the concept, minority communities face persistent discrimination and victimization on a daily basis. This leads to higher levels of stress compared to the mainstream population and increases their chances of developing various mental health issues later in life. ...
Background
Stressors from discrimination (lifetime and day-to-day) can be precipitated as mental health problems particularly substance use among marginalized subjects including LGBTQI+ community. The study assessed substance use among LGBTQI+ adults and its association with lifetime and day-to-day discrimination.
Materials and Methods
The study was performed as a cross-sectional design among 254 LGBTQI+ adults above the age of 18 years where substance use was measured using WHO – ASSIST V.3 questionnaire and discrimination was evaluated using a lifetime and day-to-day assessing questionnaire. The analysis of risk of substance use amid discrimination was measured using logistic regression.
Results
Among the subjects 64.2% were Gay men with a mean (SD) age of 30.67 (6.05) years. In lifetime discrimination, experience of discrimination was found to be always present during the enquiries for any housing among 11 (4.3%) while in day-to-day discrimination, the experience was always present in public places among 11 (4.3%) and public transport 13 (5.1%). In substance use risk score, 169 (66.5%) subjects showed a moderate risk for using any alcohol beverages and 135 (53.1%) showed a moderate risk in using any tobacco related products. The analysis showed a significant positive association between the discrimination and substance use (alcohol and tobacco related) among LGBTQI+ adults.
Conclusion
The increased proportion of substance use among the LGBTQI+ community is linked with the discrimination suffered by the individuals, which is to be addressed by society in a deeper and specific manner.
... While the suboptimal mental health and suicidal behaviors experienced by SGM persons are well-documented, the upstream determinants of these disparities have not been extensively studied [12]. The Minority Stress Model suggests that societal marginalization of SGM persons results in specific distal stressors (i.e., external stressors such as discrimination, violence, and harassment) and proximal stressors (i.e., internal stressors such as internalized homophobia or transphobia, anticipated rejection, and identity concealment) which may be responsible for driving the relatively higher prevalence of poor mental health outcomes compared to the general population [13][14][15]. These stressors are reflective of stigma, a complex social process in which an individual is labeled based on a specific characteristic, linked to a negative stereotype, and set apart from others based on perceived differences, resulting in experiences of discrimination, marginalization, and devaluation [16]. ...
Background
Sexual and gender minority (SGM) persons experience substantial mental health disparities throughout the life course, including increased vulnerability to depression and suicide. Few existing studies, however, have explored how pervasive experiences of SGM-related stigma, discrimination, and trauma (i.e., minority stress) contribute to adverse mental health outcomes among diverse sub-populations of SGM adults living in rural areas of the United States. This paper describes the protocol for a prospective cohort study, “Rural Exploration and Approaches for LGBTQ + Mental Health (REALM),” that will explore minority stress in relation to mental health conditions and suicidal behaviors among rural SGM adults.
Methods
Online processes will be used to recruit and enroll a diverse sample of up to 2,500 SGM adults aged 18 + living in rural counties and small metropolitan areas in the United States to complete an online baseline survey. This will include: up to 1,000 cisgender sexual minority persons (up to n = 500 each cisgender women and cisgender men); and up to 1,500 gender minority persons (up to n = 500 persons who were assigned male at birth and identify as a woman, female, and/or transfeminine; up to n = 500 persons who were assigned female at birth and identify as a man, male, and/or transmasculine; and up to n = 500 persons who identify as some other gender, including non-binary, gender non-conforming, and/or agender regardless of sex assigned at birth). All enrolled participants will subsequently be followed over a 12-month period, with repeated surveys at three-month intervals. Included survey measures will focus on sociodemographic information, mental health, substance use, suicidal behaviors, minority stressors, psychological processes, and other related risk and protective factors.
Discussion
This study presents a critical opportunity to better understand how minority stress contributes to adverse mental health outcomes among populations that remain underrepresented in research and programs in 2024. Results will be used to create more targeted, acceptable, and impactful intervention content and strategies that mitigate stigma, promote mental health, and prevent suicidal behaviors among rural SGM adults.
... These inequalities are particularly entrenched in non-WEIRD (Western, Educated, Industrialized, Rich, and Democratic) societies like Brazil, where efforts to recognize and support minority sexual groups often face resistance (Figueiredo & Pereira, 2021;Terra et al., 2022;Torres et al., 2021). Consequently, belonging to a social minority can engender stress due to a heightened awareness of being devalued and marginalized (Brooks, 1981;Meyer, 2003;Meyer & Frost, 2013), detrimentally affecting one's overall health. These stressors, known as minority stressors (Frost & Meyer, 2023), stem from processes of exclusion and devaluation of minority social identity, including microaggressions (Smith et al., 2023). ...
Apesar dos avanços nos direitos e na visibilidade de pessoas lésbicas, gays e bissexuais (LGB+), ainda existe uma lacuna significativa na compreensão das experiências sutis de discriminação enfrentadas por minorias sexuais no Brasil, especialmente no que diz respeito ao impacto na sua saúde mental. Esta pesquisa examina o papel das microagressões relacionadas à orientação sexual na determinação dos desfechos de saúde mental entre indivíduos LGB+ brasileiros. Especificamente, investigamos a associação entre as experiências de microagressões e sintomas de depressão, ansiedade e estresse dentro dessa comunidade. Ao longo de quatro estudos (N = 678), examinamos a associação entre microagressões relacionadas à orientação sexual e os sintomas de depressão, ansiedade e estresse em indivíduos LGB+ brasileiros, garantindo primeiro a validade de conteúdo, fatorial, convergente-discriminante e a consistência interna da versão em português brasileiro da Sexual Orientation Microaggression Scale (SOMS-br). Os resultados mostram que as experiências de microagressões baseadas na orientação sexual estão associadas à piora da saúde mental em indivíduos LGB+ brasileiros. Além disso, os itens adaptados da SOMS-br apresentaram propriedades psicométricas adequadas para avaliar as diferenças individuais nas microagressões vividas pela comunidade LGB+ brasileira. Em conjunto, esses resultados ressaltam a validade psicométrica da SOMS-br na mensuração de microagressões no contexto brasileiro. Além disso, fornecem as primeiras evidências de que as microagressões sexuais impactam indicadores de saúde mental na comunidade LGB+ do Brasil. As implicações teóricas e práticas para a literatura são discutidas.
Palavras-chave: minorias sexuais e de gênero, microagressões, psicometria, desigualdades em saúde mental
... In studies worldwide, minority stress has been used to explain the impacts of social stress experienced by people with stigmatized identities (e.g., SGM identities) [8][9][10][11]. Research on health disparities among SGM people has identified Minority Stress as a risk factor for many precursors to mortality, including suicidal ideation and attempts [12]. In addition to experiencing Minority Stress, which itself has been described as a social determinant of health for SGM people [13], SGM individuals are more likely than their non-SGM peers to report exposure to other harmful social determinants such as adverse childhood experiences [14], housing instability and homelessness [15], violent victimization [16], food insecurity [17], unemployment, and living in poverty [18]. ...
Sexual and gender minority (SGM) populations experience elevated rates of negative health outcomes (e.g., suicidality) and social determinants (e.g., poverty), which have been associated with general population mortality risk. Despite evidence of disparities in threats to well-being, it remains unclear whether SGM individuals have greater risk of mortality. This systematic review synthesized evidence on mortality among studies that included information about SGM. Three independent coders examined 6,255 abstracts, full-text reviewed 107 articles, and determined that 38 met inclusion criteria: 1) contained a sexual orientation or gender identity (SOGI) measure; 2) focused on a mortality outcome; 3) provided SGM vs non-SGM (i.e., exclusively heterosexual and cisgender) or general population comparisons of mortality outcomes; 4) were peer-reviewed; and 5) were available in English. A search of included articles’ references yielded 5 additional studies (total n = 43). The authors used the NIH’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess included studies. Mortality outcomes included all-cause (n = 27), suicide/intentional self harm (n = 23), homicide (n = 7), and causes related to drug use (n = 3). Compared to non-SGM people, 14 studies (32.6%) supported higher mortality for SGM, 28 studies (65.1%) provided partial support of higher mortality for SGM (e.g., greater mortality from one cause but not another), one study (2.3%) found no evidence of higher mortality for SGM. There was considerable heterogeneity in operational definitions of SGM populations across studies. Although mixed, findings suggest elevated mortality for SGM versus non-SGM populations. Integrating SOGI measures into mortality surveillance would enhance understanding of disparities by standardizing data collection, thereby reducing heterogeneity and increasing capacity to aggregate results (e.g., meta-analyses).
... Minority Stress Theory posits that such stigma contributes to disparities in the well-being of stigmatized groups (V. R. Brooks, 1981;Meyer, 2003). Consequently, LGBTQ+ adolescents frequently grapple with heightened depression, anxiety, suicidality, and substance use compared to their cisgender, heterosexual peers (The Trevor Project, 2022). ...
In the United States, the experience of minority stress among LGBTQ+ youth varies across regions with high and low levels of stigma (e.g., laws, policies and cultural norms that limit the lives of individuals with stigmatized identities). Some evidence suggests that stigma can undermine response to individual-level psychosocial interventions among youth, creating a need to identify factors that may buffer against minority stressors’ effects in high-stigma contexts. Social support may be one such factor. Therefore, among LGBTQ+ youth who received a digital, single-session intervention (SSI) focused on minority stress, we investigated whether structural and internalized stigma and social support predicted intervention response, independently or interactively. Specifically, we predicted that LGBTQ+ youth in environments characterized by high stigma would report weaker SSI responses. Further, we predicted that LGBTQ+ youth who perceived higher social support would report stronger SSI responses. We also tested structural stigma and social support as moderators. Using data from a previously-completed randomized evaluation, we analyzed data from 244 LGBTQ+ adolescents, aged 13 to 16 years, across 181 counties in 46 U.S. states, who engaged with the SSI. We created a factor representing structural stigma using confirmatory factor analysis at the county level. No evidence emerged for structural stigma or social support as a moderator of intervention effects on internalized stigma, identity pride, or mental health-related outcomes, either at post-intervention or at two-week follow up. Results speak to the potentially broad utility of the SSI tested in this trial for LGBTQ+ youth with limited access to mental health support.
... LGBTQ college students are also at an increased risk of substance misuse compared to their heterosexual peers (e.g., Brittain & Dinger, 2015) and tend to experience more serious consequences from substance use than heterosexual students (Kerr et al., 2014;Reed et al., 2010). The high prevalence of mental health disorders among LGBTQ college students can be attributed in part to experiences of heterosexism, cissexism, and minority stress (Brooks, 1981;Meyer, 2003;Rich et al., 2020), highlighting the need for a nuanced understanding of targetable factors to tailored prevention and intervention efforts with LGBTQ young adults. ...
Body image disturbance is pervasive among young adults and linked with adverse health outcomes. This preregistered study examined longitudinal associations between body image and eating disturbance, psychological distress, and substance use over one year among 365 diverse young adults (54% BIPOC, Mean age= 20.77) using structural equation modeling. Higher body image disturbance and substance misuse at Time 1 were associated with increased psychological distress at Time 2, with no significant bidirectional relationships found. Body image disturbance did not predict subsequent alcohol use or substance misuse. LGBQ+ young adults reported higher levels of psychological distress and substance misuse compared to heterosexual peers at Time 1, and women reported higher levels of body image and eating disturbance and psychological distress compared to men at Time 1. This research addresses the gap in empirical understanding of longitudinal associations between body image and eating disturbance, psychological distress, and substance use to inform targeted interventions. Implications for prevention, clinical practice, and advocacy in promoting mental health and well-being are discussed.
Background: Research on LGBTQ+ parent families is evolving to include a growing range of family systems, identities, methodologies, and topics. However, studies that examine minority-specific risk and resilience factors and their associations with within-family processes remain scarce, particularly outside a US-American context. Addressing these research gaps quantitatively poses challenges for researchers, because traditional modelling techniques based on (generalized) linear models are not ideally suited to capture the complexity and intersectionality of family experiences. Within this study protocol, we introduce the Rainbow Austrian Longitudinal Family (RALF) study. Its main goal is to comprehensively investigate general and minority-specific factors that affect the well-being of LGBTQ+ parent family members in Austria.Methods: RALF is a three-wave, longitudinal study over two years that examines risk and resilience factors at the individual, couple, and family level using a multi-method, multi-rater approach. We will assess child adjustment outcomes across three child cohorts, parental mental health, and family processes across three annual data waves through online questionnaires. We aim to recruit N = 150 LGBTQ+ parent families from a variety of family forms and with various identities residing in Austria. A focal sample (target n = 60) will additionally participate in observational, video-based assessments. Our participatory research approach aims to actively engage community members and stakeholders throughout the study. A community advisory board ensures that the study reflects the lived experiences of LGBTQ+ parent families adequately, while community events and accessible dissemination strategies for study results, such as the open access data explorer ExploRALF, support community engagement and facilitate the dissemination and discussion of results. Data will be analyzed using machine learning-based approaches designed to capture complex, non-linear interactions, which are ideally suited to model intersectional experiences of LGBTQ+ parent families.Discussion: The RALF study is the first prospective study to comprehensively investigate minority-specific risk and resilience factors in Austrian LGBTQ+ parent families. Findings have the potential to fill key research gaps, inform policy, and guide clinical practices that support LGBTQ+ parent families.
Mental health disparities have been reported among sexual minority individuals; minority stress theory posits that such disparities are a result of stigma and discrimination. We estimated the prevalence of mental disorders across sexual orientation groups among first-year college students and whether differences across sexual orientation groups varied by gender and country-level LGBTQ+ (lesbian, gay, bisexual, transgender, queer) social acceptance. Using data (N = 53,175; 13 countries) from the World Mental Health Surveys International College Surveys, we performed multilevel logistic regressions to estimate the associations between sexual orientation (i.e., heterosexual, heterosexual with same-gender attraction [SGA], gay/lesbian, bisexual, asexual, questioning, and other) and five twelve-month DSM-5 disorders (major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Heterosexual students with SGA (AORs 1.30–2.15), gay/lesbian (AORs 1.49–2.70), bisexual (AORs 2.26–3.49), questioning (AORs 1.38–2.04), and “other” (AORs 1.76–2.94) students had higher odds of all disorders compared to heterosexual students with no SGA; asexual students did not. Significant interactions with gender show that the gender difference in prevalence was greater among bisexual individuals for most disorders and among all sexual minorities (except “other”) for drug use disorder. Significant interactions with country level LGBT+ social acceptance showed some sexual minority groups had lower odds (AORs 0.83–0.95) of disorder as country-level acceptance increased. These findings provide further evidence of mental disorder disparities across a wide range of sexual orientations and how these disparities vary by gender and societal LGBTQ+ acceptance in students from diverse countries.
The Double Jeopardy Hypothesis posits that sexual minority people of color may have a greater risk of substance use because of dealing with heterosexism and racism. We sought to test this hypothesis by examining whether appraisal of intersectional forms of discrimination predict greater cigarette dependence and whether acculturation attenuates that relationship among Latinx sexual minority men (SMM) who smoke.
Participants were 258 Latinx SMM who identified as current smokers recruited via Amazon Mechanical Turk (MTurk). OLS regressions tested (1) the relationship between appraisal of intersectional forms of discrimination (total and subscales) and Hispanic/non-Hispanic acculturation on cigarette dependence, and (2) the moderating effects of appraisal of intersectional discrimination (total and subscales) on the relationship between Hispanic/non-Hispanic acculturation and cigarette dependence.
In line with our hypotheses, non-Hispanic acculturation was associated with lower cigarette dependence. Appraisal of intersectional discrimination and subscales moderated the relationship between non-Hispanic acculturation and cigarette dependence. Simple slopes tests showed that the effects of non-Hispanic acculturation on cigarette dependence were strongest for those who experience lower intersectional discrimination.
Our findings suggest that Latinx SMM may have resilience that helps them deal with the negative effects of discrimination on cigarette dependence, especially for those who are more acculturated to the U.S. These findings may point to Latinx SMM taking on U.S. negative views towards smoking. However, future studies should use a more nuanced assessment of acculturation that does not rely on a language-based acculturation measure.
BACKGROUND
Health inequities among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+) are driven by anti-LGBTQ+ stigma and discrimination. However, there is limited research on the manifestations of stigma and discrimination among LGBTQ+ cancer survivors.
METHODS
Data were collected by the North Carolina Department of Health and Human Services via the 2023 North Carolina LGBTQ+ Health Needs Assessment. Differences in outcomes (i.e., discrimination, violence, homelessness, mental health, substance use, and overdose) between LGBTQ+ individuals by cancer history were assessed using Chi-squared tests. Further, multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals (CI) of the association of cancer with each outcome.
RESULTS
A total of N = 3170 LGBTQ+ individuals (n = 200 cancer survivors) took part in the survey. In adjusted analyses, cancer history was associated with an 8.1 to 19.1 percentage point increase in the probability of all discrimination, violence, and homelessness outcomes. The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2–29.8), followed by homelessness (AME: 19.1; 95% CI, 11.6–26.6), spouse or family violence (AME: 16.7; 95% CI, 9.3–24.1), LGBTQ+ violence (AME: 15.1; 95% CI, 7.8–22.5), sexual assault (AME: 14.1; 95% CI, 6.0–22.2), as well as nicotine product (AME: 9.0; 95%CI, 1.6–16.5) and cocaine use (AME: 8.9; 95% CI, 3.8–14.1). The most common barriers to mental health services were cost (36.0%) and health insurance (33.5%).
LIMITATIONS
The needs assessment was a convenience-based study, which limits the generalizability of our findings.
CONCLUSIONS
LGBTQ+ cancer survivors in North Carolina experience an elevated burden of discrimination, violence, suicide attempt, substance use, and accidental overdose in comparison to LGBTQ+ individuals without a cancer history.
The lived experiences of sexual minority and gender diverse (SMGD) people in romantic relationships remain relatively understudied compared to their heterosexual and cisgender counterparts. Existing research has predominantly focused on cisgender gay or lesbian individuals, particularly those who identify as White, resulting in significant gaps in our understanding of diverse SMGD experiences. This volume pioneers an effort to address this gap by uniting interdisciplinary researchers to examine key aspects of SMGD individuals' lives and relationships across 12 countries. Specifically, this book focuses on the individual well-being, relational well-being, social support, and dyadic coping of SMGD people. The book's insightful findings are invaluable to researchers, practitioners, policymakers, and anyone striving for a more equitable global society.
The lived experiences of sexual minority and gender diverse (SMGD) people in romantic relationships remain relatively understudied compared to their heterosexual and cisgender counterparts. Existing research has predominantly focused on cisgender gay or lesbian individuals, particularly those who identify as White, resulting in significant gaps in our understanding of diverse SMGD experiences. This volume pioneers an effort to address this gap by uniting interdisciplinary researchers to examine key aspects of SMGD individuals' lives and relationships across 12 countries. Specifically, this book focuses on the individual well-being, relational well-being, social support, and dyadic coping of SMGD people. The book's insightful findings are invaluable to researchers, practitioners, policymakers, and anyone striving for a more equitable global society.
The lived experiences of sexual minority and gender diverse (SMGD) people in romantic relationships remain relatively understudied compared to their heterosexual and cisgender counterparts. Existing research has predominantly focused on cisgender gay or lesbian individuals, particularly those who identify as White, resulting in significant gaps in our understanding of diverse SMGD experiences. This volume pioneers an effort to address this gap by uniting interdisciplinary researchers to examine key aspects of SMGD individuals' lives and relationships across 12 countries. Specifically, this book focuses on the individual well-being, relational well-being, social support, and dyadic coping of SMGD people. The book's insightful findings are invaluable to researchers, practitioners, policymakers, and anyone striving for a more equitable global society.
Este estudo, fundamentado na Teoria do Estresse de Minorias (EM), investiga as experiências biopsicossociais de vulnerabilidade vividas pelos participantes do projeto SUPRIMIDO, um grupo de acolhimento psicológico para a comunidade LGBTQIAPN+. Com foco em processos como o estigma imposto, a homonegatividade internalizada e a ocultação da identidade, a pesquisa busca compreender como essas experiências afetam a saúde mental dessa população. Para isso, através de uma abordagem qualitativa e descritiva, cinco sujeitos LGBTQIAPN+ participantes do projeto foram selecionados para entrevistas semiestruturadas. A análise dos dados, realizada a partir da análise temática das entrevistas, revelou quatro temas principais: A violência expressiva e simbólica do estigma, as configurações opressoras que LGBTfobia internalizada pode exercer, a redefinição de territorialidades LGBTQIAPN+ frente à ocultação da identidade e a importância de uma rede afirmativa como zona de resistência coletiva e apoio mútuo. Dessa forma, a pesquisa oferece novas perspectivas sobre como as vulnerabilidades operam entre minorias de gênero e sexualidade, trazendo à tona relatos diretos dessas experiências, frequentemente sub-representados nas pesquisas brasileiras sobre EM, bem como pode contribuir no fortalecimento de práticas de acolhimento em serviços de saúde mental, a partir de estratégias de cuidado afirmativas que considerem as especificidades dessas minorias.
This is an introduction to the special issue "Sexual and Gender Minority Health Inequities: A Focus on Mechanisms, Interventions, and Implementation." The article addresses current challenges and knowledge gaps, methodological approaches to SGM health research, developing and implementing effective interventions, and future directions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Individuals with diverse sexual orientations face discrimination, stigma, victimization, concealment, etc., which tend to have a negative impact on their psychological and social functioning. Research indicates that self-acceptance is the psychological armor that has a major impact in alleviating social-emotional issues and promoting life satisfaction and well-being. Thus, the present study is an attempt to assess self-acceptance, self-acceptance of sexuality and mental health among lesbian, gay, and bisexual (LGB), and heterosexual young adults. It was hypothesized that individuals identifying as LGB would have lower general self-acceptance, lower self-acceptance of sexuality, and poorer mental health compared to heterosexual individuals. The sample of LGB adults (L (N = 45) G (N = 45) and B (N = 46)) and heterosexual adults (men = 45 and women = 47) with total N = 228 in the age range of 18–35 years (M = 25.12, SD = 4.86) were assessed using Berger’s Self-Acceptance Scale (Berger in J Abnorm Soc Psychol 47:778–782, 1952), the Self-Acceptance of Sexuality Inventory (Camp et al. in Psychol Sex Orient Gender Divers 9:92–109, 2022) and Keyes’ Mental Health Continuum (Keyes in J Consult Clin Psychol 73:539–548, 2005). The obtained data were subjected to One Way Analysis of Variance (ANOVA). The findings revealed significant differences on Self-acceptance (SA) (F = 89.84; p < 0.01), Self-acceptance of Sexuality (SAS) (F = 17.64; p < 0.01), and Mental Health (MH) (F = 51.53; p < 0.01). It is revealed that LGB adults had lower general self-acceptance, lower self-acceptance of sexuality, and poorer mental health in comparison to heterosexual adults. Significant implications can be observed from the results for mental health practitioners, healthcare practitioners, and the general public alike.
Purpose: Although several studies have shown a relationship between anti-transgender experiences and binge drinking and/or hazardous drinking, very little research has examined how these experiences relate to heavy drinking. That is the focus of this study. Methods: This paper uses data from the 2015 National Transgender Survey, and is based on a sample of 17,367 transgender adults residing in the United States. Analyses compare three groups: current “regular” drinkers (drank at least some alcohol during the previous month but no days consuming five or more drinks) (n = 10,496), binge drinkers (consumption of five or more drinks on at least one occasion during the previous month) (n = 4977), and heavy drinkers (five or more drinks per day on five or more days during the previous month) (n = 1894). The paper focuses on how anti-transgender experiences with harassment, discrimination, and/or violence (a 20-item scale measure, Cronbach’s alpha = 0.76) are related to people’s classification as current drinkers versus binge drinkers versus heavy drinkers. Results: 13.8% of the participants met the criteria for heavy drinking; 26.4% more were classified as binge drinkers. The more anti-transgender experiences people had, the more likely they were to engage in heavy drinking. Multivariate analyses revealed that this relationship was a robust one, holding up even when numerous other potentially confounding control measures were included in the analyses. Conclusions: Anti-transgender experiences are a strong predictor of heavy drinking. This type of minority stressor is an important consideration when understanding what leads many transgender individuals to become heavy drinkers.
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