An Application of the Minority Stress Model in a Non-Western Context: Discrimination and Mental Health Among Sexual and Gender Minorities in Macedonia

Abstract

We examined an application of the minority stress model to the experiences of sexual and gender minorities in Macedonia. We conducted a cross-sectional online national survey among 18–30-year-old participants in Macedonia. We facilitated two focus groups with a subset of sexual and gender minority participants to gain an additional context about their everyday lives and experiences of discrimination. We performed unadjusted and adjusted linear regression models between sexual and gender identity and discrimination scales, as well as rumination and social anxiety. We calculated indirect effects using the Judd and Kenny difference of coefficients approach and used framework analysis to analyze the focus groups. Overall, 396 persons completed the survey, 178 identified as cisgender male and 200 identified as cisgender female. Sexual and gender minorities had higher scores on the rumination scale, 48.6 vs. 45.6 (p = 0.039), as compared to non-sexual and gender minorities. Sexual and gender minority persons had scores on the social anxiety that were higher than those of non-sexual and gender minority persons, 17.7 vs. 12.9 (p = 0.000). Experiences of discrimination due to one’s sexual orientation and gender identity accounted for a substantial portion of the increased anxiety and rumination. Focus groups confirmed the quantitative findings. Sexual and gender minority persons in Macedonia have poorer mental health outcomes as compared to non-sexual and gender minority persons, with discrimination being a major factor. Policies are needed to safeguard their rights, and interventions are also needed to provide mental health support and services to the population in an identity-friendly and affirming manner.