Minority Stress Experiences Research Articles

Intersections of Institutional Racism, Racial Microaggressions, and Minority Stress in the Lived Experiences of Black People

Macro-level institutional racism and micro-level racial microaggressions have an insidious effect on the social experience and, consequently, mental health of Black people. The purposes of this study were to compare the differential experiences of structural uncertainties, racial microaggressions, and minority stress between a nation-wide sample of people who are Black and people who are White as well as to understand the impact of racial stressors on minority stress among people who are Black, specifically. It is argued that minority stress among people who are Black is a central process that inherently connects institutional elements and the lived experience and, ultimately, provides a context for a deeper understanding of the connection between racism and mental health among people who are Black. A secondary data analysis of survey data from the “2016 Racial Attitudes in America II” was conducted by the Pew Research Center in which perceptions and experiences of people who are Black and White (Weighted n=3,036) and, subsequently, patterns among a subsample of people who are Black (Weighted n=480) were examined. The study found that larger percentages of people who are Black in the U.S. experience structural uncertainties and racial microaggressions than people who are White. Among people who are Black, as the intensity of racial stressors increases, the level of minority stress increases. Ultimately, the study substantiates the structural uncertainties, racial microaggressions, and minority stress experienced among people who are Black and suggests that minority stress among people who are Black is a psychosocial response to everyday structural uncertainties and racial microaggressions. Based on the results, it is recommended that on a macro-level, healthcare policy acknowledges minority stress among people who are Black and, on a micro-level, that addressing minority stress be incorporated into therapeutic interventions by social workers and other helping professionals as an important component of cultural competency.

External Minority Stress, Gender Dysphoria, and Capability for Suicide Among Transgender Adults: A Daily Diary Study.

This study analyzed whether external gender-related minority stress (i.e., discrimination, rejection, and violence) and gender dysphoria contribute to same-day and next-day acquired capability for suicide (ACS) in a sample of transgender adults residing in the southeastern United States. A sample of transgender participants (n = 38, 84.2% White, average age = 28.6 years) residing in the southeastern United States completed daily surveys on discrimination, rejection, violence, gender dysphoria, and ACS over 30 days (n = 836 of the 1,140 surveys sent out were completed). External minority stress (i.e., rejection, discrimination, and violence) was very common in this sample. External minority stress experiences were reported on 16% of the completed daily surveys, and 68% of the sample reported experiencing such stress at least once over the 30-day study period. Similarly, gender dysphoria occurred on 37.2% of the completed days and was experienced on at least 1 day by 78.9% of the participants over the 30-day survey period. Multilevel modeling showed daily experiences of discrimination and rejection, but not gender dysphoria, were positively associated with same-day ACS. Violence trended toward significance in correlating with same-day capability for suicide. Neither external minority stress nor gender dysphoria were associated with next-day ACS while controlling for acquired capability reported on the previous day. These preliminary data support proximal associations of external gender minority stress with same-day, but not next-day, ACS. Findings from this study advance understanding of how anti-transgender discrimination and violence contribute to increased capability for suicide in a population at increased risk for suicide.

The effects of sexual and gender minority stress on relationship functioning: A meta‐analysis

AbstractTheory and research indicate that experiences of sexual and gender minority (SGM) stress among Lesbian, Gay, Bisexual, Transgender, Queer, plus (LGBTQ+) individuals are related to a variety of negative health outcomes. Because positive romantic relationships promote better physical and mental health outcomes, understanding factors that contribute positively or negatively to relationship functioning is necessary to improve relationships and promote physical and mental health. As such, the primary goals of the present study were to conduct a meta‐analysis on the association between SGM stress and (1) relationship functioning and (2) substance use, a well‐established predictor of relationship functioning. We used multivariate meta‐analysis with robust variance estimation to summarize the effects. Across 304 effects from 73 studies, we found a significant negative association between SGM stress and relationship functioning, r = −.13, 95% CI [−0.16, −0.10]. We also found significant positive associations between SGM stress and alcohol use r = .08, 95% CI [0.06, 0.11], and drug use r = .09, 95% CI [0.05, 0.13]. These small, but significant, relations are interpreted to indicate that SGM stress could erode relationship functioning and, in turn, weaken its potential protective effects against negative health outcomes, although longitudinal studies are needed.

Promoting Wellness at the Intersections of Gender, Race and Ethnicity, and Sexual–Affectional Orientation Identities

Gender identity intersects with racial and ethnic identities, sexual–affectional identities, and other salient aspects of personal identity to create distinct experiences of health and well-being. Gender identity minorities experience minority stress across the life span that results in persistent health and wellness disparities exacerbated by hostile social and political environments. Strategies for achieving wellness are impacted by intersecting minority stress factors, often resulting in diminished likelihood of multiple-minority populations receiving wellness-based health promotion and intervention. This article presents an overview of wellness informed by intersectional gender, racial and ethnic, and sexual–affectional identity considerations based on critical synthesis of the literature. A case scenario is presented to demonstrate how to conduct wellness-oriented assessment and treatment through an intersectional gender identity lens.

The impacts of hate violence on the adrenocortical functioning, psychosocial adjustment, and mental health of ethnically/racially diverse LGBQ young adults

Experiences of heterosexist and racist discrimination, sexuality-based victimization, and vicarious exposure to hate violence constitute pervasive and severe sources of social stress that adversely impact diurnal patterns of adrenocortical functioning (via salivary cortisol) and have enduring effects on the mental health of ethnically/racially diverse lesbian, gay, bisexual, and queer (LGBQ) young adults. Yet, little is known about how these experiences of minority stress are associated with diurnal adrenocortical and psychological functioning among ethnically/racially diverse LGBQ young adults. In three unique studies guided through the application of the intersectionality, minority stress, and allostatic load frameworks, we examined 1) whether sexuality-based peer victimization and diurnal adrenocortical patterns predicted contemporaneous depressive symptoms and trajectories of depressive symptoms; 2) whether experiences of heterosexist and racist discrimination were associated with disruptions to diurnal adrenocortical patterns and challenges to identity integration; and 3) whether diurnal adrenocortical responses in the days following the Pulse nightclub massacre on June 12, 2016 varied in a time-dependent manner. Data used in these studies were from the the Sexual Orientation and Psychosocial Adjustment Study, collected in Northern California. Overall, the findings suggested that direct and indirect experiences of hate violence adversely impacted diurnal adrenocortical functioning, psychosocial processes related multiply marginalized identity integration, and mental health. These physiological responses to discrimination, victimization, and violent crimes support policy efforts to protect vulnerable communities, including violence prevention, gun control, and community-based trauma response services for those directly and indirectly affected by hate violence and gun violence.

Piloting a Flexible Solicited Diary Study With Marginalized Latina Women During the COVID-19 Pandemic.

Little is known about the experiences of minority stress among Latina women who have sex with both women and men (WSWM), a sexual and gender minority group situated at the intersection of multiple marginalized identities. The current article presents an exploratory study aimed at addressing this knowledge gap. The research utilized a flexible diary-interview method (DIM) to investigate stress-related experiences among Mexican American WSWM residing in an economically disadvantaged community in the U.S. during the third wave of the COVID-19 pandemic. A detailed description of the study is provided, including information on the background, methodology, participants' experiences, and how the project was managed remotely by a virtual research team. Twenty-one participants were asked to maintain a diary for a 6-week period spanning from March to September 2021. They submitted weekly entries in diverse formats (visual, audio, typed, and handwritten) through a user-friendly website or via mail while communicating regularly with researchers over the phone. Following the diarizing period, in-depth semi-structured interviews were conducted to clarify pertinent information within the entries and validate researchers' preliminary interpretations. Out of the initial 21 enrollees, 14 participants stopped diarizing at different stages, and nine completed the entire study. Despite facing challenges exacerbated by the pandemic, participants reported the diary-keeping process as a positive experience that offered an authentic outlet to share parts of their lives they seldom reveal. The implementation of this study highlights two significant methodological insights. Firstly, it emphasizes the value of employing a DIM to explore intersectional narratives. Secondly, it underscores the importance of adopting a flexible and sensitive approach in qualitative health research, particularly when engaging individuals from minoritized groups.

Raising voices of 2SLGBTQIA+ patients: The intersection of minority stress and systemic oppression in pharmacy practice

BackgroundTwo-spirit, lesbian, gay, bisexual, trans, queer, intersex, asexual, and other sex, sexual, and gender identities (2SLGBTQIA+) experience minority stress processes in pharmacy settings. Processes may be distal (objective prejudicial events) or proximal (subjective internalized feelings) and lead to delay or avoidance of care. The nature of these experiences in pharmacies and ways to reduce occurrence is largely unknown. ObjectivesThis study aimed to characterize 2SLGBTQIA+ individuals’ perceived experiences in pharmacies according to the minority stress model (MSM) and to elicit patient-identified individual, interpersonal, and systemic strategies for reducing systemic oppression of 2SLGBTQIA+ individuals in pharmacy practice. MethodsThis was a qualitative phenomenological study using semistructured interviews. Thirty-one 2SLGBTQIA+ individuals from the Canadian Maritime provinces completed the study. Transcripts were coded according to domains of the MSM (distal and proximal processes) and the lens of systemic oppression (LOSO) (individual, interpersonal, and systemic factors). Framework analysis was used to identify themes within each theoretical domain. ResultsDistal and proximal minority stress processes were described by 2SLGBTQIA+ individuals in pharmacy settings. Distal processes included direct and indirect perceived discrimination and microaggressions. Proximal processes included expectation of rejection, concealment, and internalized self-stigma. Nine themes were identified according to the LOSO. Two related to the individual (knowledge and abilities, respect), 2 related to interpersonal relations (rapport and trust, holistic care), and 5 related to systemic factors (policies and procedures, representation and symbols, training/specialization, environment/privacy, technology). ConclusionFindings support the notion that individual, interpersonal, and systemic strategies can be implemented to reduce or prevent minority stress processes from occurring in pharmacy practice. Future studies should evaluate these strategies to better understand effective ways to improve inclusivity for 2SLGBTQIA+ people in pharmacy settings.

Impact of family rejection and racism on sexual and gender minority stress among LGBTQ young people of color during COVID-19.

Given the inequitable impact of COVID-19 on sexual and gender minority (SGM) youth and current sociopolitical racial justice concerns in the United States, this study examines the impact of SGM-related family rejection and racism since the start of COVID-19 on SGM-related internalized homophobia and identity concealment among SGM college students of color (SOC). Participants were a subset of SOC (n = 200) from a larger nonprobability cross-sectional study about minority stress and COVID-19 pandemic experiences among SGM college students. Participants completed survey items specifically related to changes in minority stress and racism experiences since the start of COVID-19. Logistic regression models were used to examine the independent and interactive effects of racism and family rejection on identity concealment and internalized homophobia since the start of COVID-19 (adjusting for covariates). Main effects models revealed that increased racism and family rejection were significantly associated with greater odds of experiencing identity concealment since the start of COVID-19. The interaction of increased racism and family rejection was also significantly associated with greater odds of experiencing identity concealment since the start of COVID-19. Study findings suggest that the intersection of racism and family rejection since the start of COVID-19 consequently translates to increased experiences of identity concealment. Such experiences are known to negatively impact mental health across the life course among SGM young people. Public health, medical, mental health, and higher education stakeholders must implement SGM-affirmative and antiracist practices and interventions to support SGM SOC during COVID-19 and beyond its containment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Minority Stress and Intimate Partner Violence among Sexual and Gender Minorities assigned Female at Birth.

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV). Using multiwave longitudinal data, the present study tested the following associations of minority stress and IPV among SGM-AFAB: concurrent within-person (i.e., whether changes in minority stress co-occur with changes in IPV), prospective within-person (i.e., whether changes in minority stressors precede changes in IPV), and between-persons (i.e., whether individuals who experience more minority stress, on average, experience more IPV). Data were from Waves 1-7 (spanning 3.5 years) of a longitudinal cohort study of 488 young SGM-AFAB. At each wave, participants reported on SGM victimization, sexual orientation microaggressions, internalized heterosexism, and five types of IPV for up to three partners in the past six months. Controlling for other minority stress experiences, microaggressions showed concurrent within-person associations with two types of IPV victimization (psychological and coercive control) and three types of IPV perpetration (psychological, physical, and sexual), and between-persons associations with psychological IPV victimization and coercive control victimization and perpetration. Microaggressions also had a significant prospective within-persons association with SGM-specific IPV perpetration. SGM victimization showed no unique within-person associations with IPV but, between-persons, was associated with all types of IPV victimization (except coercive control), and psychological and sexual IPV perpetration. Internalized heterosexism was not associated with any IPV outcome. Minority stress, particularly distal stressors, appear to contribute to risk for IPV among SGM-AFAB. Clinicians working with SGM-AFAB individuals in relationships may benefit from screening for experiences of minority stress.

A bottom-up approach to developing a unified trauma-minority stress model for transgender and gender diverse people.

Transgender and gender diverse (TGD) people are at heightened risk of both Criterion A trauma exposure and other bias-related minority stressors (e.g., discrimination, rejection). In the absence of a unified trauma-minority stress theory, it remains unclear how to best conceptualize psychopathology for people who experience both trauma and minority stress. Using a participant-driven q-sort methodology and network analytic approach, we analyzed card sort data from 18 TGD people and 16 providers with expertise in TGD care to derive thematic networks of trauma and minority stress experiences, as they connected to transdiagnostic symptoms (e.g., hyperarousal, avoidance). The TGD participants' resulting network illustrates conceptualizations of identity- and nonidentity-based Criterion A traumas as similar and only related to psychiatric symptoms via the shared connection through other minority stressors. The provider network was more granular, although the general pattern was consistent with TGD participants, demonstrating similar perceptions of how these experiences are associated. Evidence of inextricable links between trauma and psychiatric symptoms through the conduit of minority stressors lays the groundwork for novel, integrated models of trauma, minority stress, and their transdiagnostic symptom sequelae. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reactions to Participation in Research on Violence Experiences and Minority Stress Among Sexual and Gender Minority Young Adults.

Given the growing body of research seeking to examine adverse childhood experiences (ACEs) and intimate partner violence (IPV) among sexual and gender minority (SGM) individuals, Institutional Review Boards must consider whether participating in violence research is emotionally distressing for SGM people. Yet, little research has studied SGM participants' reactions to participating in research on ACEs, IPV, and minority stress. Thus, the current study examined reactions, including negative emotional reactions, to participating in violence research among SGM young adults. In total, 230 participants who self-identified as a sexual minority (30.1% also identified as a gender minority) in a dating relationship completed a cross-sectional assessment on ACEs, IPV (including identity abuse victimization and perpetration), minority stress (i.e., internalized homo/bi/transphobia), and reactions to research participation. Results indicated that participants identifying as a gender minority had significantly higher negative emotional reactions to study participation compared to cisgender participants, but this increase among gender minority individuals was small. In addition, gender minority participants and those with higher minority stress (i.e., internalized trans/bi/homo-negativity) and ACEs reported significantly higher negative emotional reactions to participation. Furthermore, gender minority participants scored worse on a scale indicating appreciation for contributing to research. Finally, reporting IPV victimization and perpetration was not associated with negative emotional reactions. Findings suggest that questions assessing minority stress and negative childhood experiences may be more emotionally salient or stressful for gender minority participants compared to questions measuring IPV.

The relationship between school bullying victimization and mental health among high school sexual minority students in China: A cross-sectional study

BackgroundSchool bullying has become a matter of global concern for the general public. Sexual minority youth (SMY) may experience minority stress and victimization which are known to adversely affect mental health and happiness. However, a few scholars explored and linked sexual orientation with campus bullying, depression, and anxiety symptoms under the specific cultural background of China. ObjectiveThis study was to examine the effect of traditional and cyber bullying victimization on depression and anxiety among Chinese sexual minority adolescents. MethodsThis is a cross-sectional survey with a total of 3841 subjects among senior high school students in Hunan Province, China. Related information was collected through a series of self-reported questionnaires. The association between variables was examined via a set of logistic regressions. ResultsHomosexuality (OR: 6.398; 95 % CI: 3.321 to 12.325), bisexuality (OR: 3.146; 95 % CI: 1.499 to 6.603) and uncertainty of sexual orientation (OR: 2.341; 95 % CI: 1.516 to 3.615) were significantly associated with a combination of traditional and cyber bullying victimization. Compared to the heterosexual group, the sexual minority students, especially the bisexual students has a higher risk of depressive mood (OR: 2.349; 95 % CI: 1.664 to 3.316) and anxiety mood (OR: 3.049; 95 % CI: 2.150 to 4.324). Further multivariate binary hierarchical regression showed that the effects of sexual orientation and mental health were statistically significant only among those who are not involved in bullying victimization, OR values are from 1.929 (95 % CI: 1.061 to 3.507) to 3.209 (95 % CI: 2.090 to 4.927). ConclusionsHomosexuals are most likely to be victims of a combination of traditional and cyber bullying victims. Bisexuals are most at risk for emotional problems. Sexual minorities in particular, showed differences in mental health risks between bullied and non-bullied groups. More attention needs to be paid to bullying and mental health among sexual minority students in China.

Daily experiences of minority stress and mental health in transgender and gender-diverse individuals.

Transgender and gender-diverse people experience various minority stressors although minimal research has examined prospective effects on daily affect or mental health. We explored rates of marginalization for transgender and gender-diverse participants in a daily diary study and the concurrent and prospective associations with daily affect and weekly measures of depression and anxiety symptoms, as well as the mediating effects of internalized stigma, rumination, and isolation. There were 167 participants (82.2% white; M age = 25) retained in the daily surveys. Participants completed surveys for 56 days reflecting exposure to marginalization, gender nonaffirmation, internalized stigma, rumination, isolation, affect (negative, anxious, and positive affect), and mental health (anxiety and depression symptoms). Participants experienced marginalization on 25.1% of the days. Within-person analyses revealed concurrent associations between marginalization and gender nonaffirmation with increased negative and anxious affect and increased anxiety and depression symptoms, as well as associations for gender nonaffirmation and decreased positive affect. At the within-person level, there were prospective associations between marginalization and gender nonaffirmation with increased negative affect on the next day, as well as increased anxiety and depression symptoms the next week. Concurrent analyses revealed significant indirect effects with marginalization and gender nonaffirmation associated with all three affect variables and mental health via increases in internalized stigma, rumination, and isolation. However, only gender nonaffirmation was related to isolation and affect or mental health in the prospective analyses. Clinical considerations include strategies to address the immediate effects of minority stress as well as the long-term interpersonal effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual Identity Disclosure and Alcohol Experiences Among LGBTQ+ Adolescents

Sexual and gender minority youth (SGMY) report greater alcohol use in comparison to their heterosexual counterparts. Prior research has found that elevated alcohol use among SGMY can be explained by minority stress experiences. Sexual identity outness may be another factor that drives alcohol use among SGMY, given that outness is associated with alcohol use among older sexual and gender minority samples. We examined how patterns of sexual identity outness were associated with lifetime alcohol use, past-30-day alcohol use, and past-30-day heavy episodic drinking. Data were drawn from the LGBTQ National Teen Survey (N = 8884). Participants were SGMY aged 13 to 17 (mean age = 15.59) years living in the US. Latent class analysis was used to identify sexual identity outness patterns. Multinomial regressions were used to examine the probability of class membership by alcohol use. Six outness classes were identified: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ+ peers (n = 1707), out to LGBTQ+ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). SGMY in classes characterized by greater outness to peers, friends, and family had greater odds of lifetime alcohol use compared with SGMY in classes characterized by lower outness. These findings suggest that SGMY with greater sexual identity outness may be a target for alcohol use prevention programming. Differences in sexual identity outness may be explained by minority stress factors.

Compassion and gender diversity: evaluation of an online compassion-focused therapy group in a gender service

ABSTRACT Transgender and gender non-conforming (TGNC) people may experience minority stress and internalised transnegativity, leading to increased psychological distress. Self-compassion has been suggested as a protective factor which can buffer against the impact of minority stress and stigma. This service evaluation study examined the outcomes of a novel compassion-focused therapy group intervention delivered online in a Gender Service. Twenty-one TGNC adults participated in the group and completed pre-group and post-group measures of psychological distress, internalised transnegativity, and compassion to self, to others, and from others. Participants had high levels of psychological distress and low levels of self-compassion pre-group. At the group level, there was a significant increase in levels of compassion to self and from others, and a significant decrease in pride (reverse scored) and alienation internalised transnegativity subscales. At an individual level, compassion to self and compassion from others were the most frequent areas where significant change was observed post-group. The compassion-focused therapy group appears to be effective in increasing levels of self-compassion and reducing aspects of internalised transnegativity, but without clear impact on psychological distress. This is preliminary evidence in support of the use of compassion-focused therapy groups within gender services, but further research is warranted and encouraged.

Longitudinal association of homonegative school climate with body dysmorphic disorder among cisgender sexual minority adolescents: Testing mediation through proximal minority stressors

In a US national cohort study of cisgender sexual minority adolescents (SMAs), we prospectively (1) assessed whether within-person changes in homonegative school climate (i.e., school contextual factors that lead SMAs to feel unsafe or threatened) were associated with risk of probable body dysmorphic disorder (BDD) and (2) tested whether internalized homonegativity and negative expectancies mediated this association. Data came from consecutive time points (18-month, 24-month, 30-month) of the Adolescent Stress Experiences over Time Study (ASETS; N = 758). The Body Dysmorphic Disorder Questionnaire measured probable BDD. Sexual Minority Adolescent Stress Inventory subscales measured past 30-day minority stress experiences. Multilevel models were specified with person mean-centered predictor variables to capture within-person effects. Across one year of follow-up, 26.86% screened positive for probable BDD at least once. Model results indicated significant total (risk ratio [RR]=1.43, 95% credible interval [CI]=1.35–1.52) and direct effects (RR=1.18, 95% CI=1.05–1.34) of homonegative school climate. Internalized homonegativity was independently associated with probable BDD (RR=1.28, 95% CI=1.12–1.46) and mediated 49.7% (95% CI=12.4–82.0) of the total effect. There was limited evidence of mediation via negative expectancies. Implementing SMA-protective school policies and targeting internalized homonegativity in clinical practice may reduce the prevalence and incidence of probable BDD among cisgender SMAs.

Experiences of minority stress and their impact on suicidality among asexual individuals

IntroductionWhile the asexual community has become increasingly visible, the pathologization and denial of asexuality remain strong, which may be linked to a higher prevalence of suicidality in this population. The present study examined experiences of minority stress and their relationship with suicidality among asexual individuals. MethodsThis study included a global sample of 12,449 individuals on the asexual spectrum. They completed an online survey assessing minority stress (including verbal aggression, victimization, and health care discrimination), impairment in different aspects of life, and suicidality. ResultsThe results showed that 64.8 % of asexual individuals had experienced minority stress based on sexual and/or romantic orientation. Approximately 32.2 % reported suicidal ideation, 10.6 % had suicide plans, and 2.7 % had attempted suicide in the past 12 months. Suicidality was more prevalent among asexual men and non-binary individuals than among asexual women. Asexual individuals who were younger, identified as transgender, and lived in lower-income countries were more likely to report suicidality. Among the different dimensions of minority stress, victimization was most significantly associated with suicidal ideation, plans, and attempts. The positive association between minority stress and suicidality was mediated by impairment in health. LimitationsThe cross-sectional nature of the data might prevent causal inferences from being drawn. Validated measures of asexual-specific minority stress were not available. ConclusionThe findings have implications for asexuality-affirming mental health practices supporting asexual individuals in coping with minority stress experiences. Public education efforts are needed to raise awareness of asexuality as a valid sexual orientation and to dispel misconceptions about asexuality.

Supplemental Material for Daily Experiences of Minority Stress and Mental Health in Transgender and Gender-Diverse Individuals

Supplemental Material for Daily Experiences of Minority Stress and Mental Health in Transgender and Gender-Diverse Individuals

ALIGNMENT OF COMMUNICATION AND SUPPORT NEEDS BETWEEN LGBTQ+ FAMILY CAREGIVERS OF HOSPICE PATIENTS AND PROVIDERS

Abstract Effective and equitable end-of-life care requires alignment between the support and communication needs of hospice family caregivers and the knowledge and competence of hospice care team members. We investigate alignment between LGBTQ+ caregivers and hospice providers in a secondary analysis of data collected in three studies: 1) Surveys identifying predictors of hospice providers’ (N=122) attitudes toward LGBTQ+ caregivers and patients; 2) focus groups assessing hospice interdisciplinary care team members’ (N=48) knowledge, training, and opinions regarding LGBTQ+ family caregiver and patient communication and care needs; and 3) in-depth interviews with LGBTQ+ hospice family caregivers (N=20). Synthesis of key findings show how alignment is impacted by lack of systematic, inclusive orientation and gender data, provider religiosity, expectations of disclosure, cisheteronormative assumptions about the universality of EOL experiences, and caregivers’ experiences of minority stress. We discuss implications for developing interventions to improve provider communication, empowering caregivers, and addressing hospice-specific sources of minority stress.

LGBTQ+ OLDER ADULT COUPLES' EXPERIENCES OF MINORITY STRESS BY SERVICE PROVIDERS

Abstract This study explored LGBTQ+ older adult couples’ experiences of minority stress with service providers and effects on their relationships. Twelve LGBTQ+ cancer patient-partner couples (N = 24) completed surveys assessing demographics, stress, and health, and participated in dyadic semi-structured interviews. Descriptive statistics summarized demographic characteristics. Interview data were content analyzed to identify sources of minority stress. Participants were aged 50.9 years on average (SD = 9.9, R =32-70), mostly white (21, 87.5%), and had been together for 19.1 years (SD = 9.9, R = 9-44). Common minority stress sources included derogatory language, belittling comments, heteronormativity, and cisnormativity in routine healthcare, cancer care, and legal services. Couples attributed relationship strength and durability as mitigating negative effects of stress; they described feeling closer, stronger, and more confident in their relationships. Some couples denied experiences of minority stress by service providers and these couples ascribed their equitable care to their geographic location.