Minority Stress Research Articles

Minority stress in relation to biological outcomes among sexual and gender minority people: a systematic review and update.

Here we present an updated systematic review identifying studies published 2019-2024, since our prior systematic review in 2020, that examine the association between minority stress and a biological outcome among sexual and gender minority (SGM) people. Pubmed, Web of Science, and Embase were queried to identify studies that examined an association between minority stress (including prejudice events and conditions, anticipation of rejection and discrimination, concealment or disclosure of SGM identity(ies), internalized stigma, or structural stigma) and a biological health outcome among SGM people. Included studies were coded for methodological approaches, study population, minority stress measure, biological outcomes, count of overall analyses, and count of analyses where an association was detected. Fifty-nine studies met inclusion criteria and included a total of 391 analyses between an element of minority stress and a biological outcome, among which 38% of analyses detected an association (44% detected this association when study outliers were removed). All elements of minority stress demonstrated associations with outcomes: multicomponent measures, prejudice events and conditions, and structural stigma demonstrated the highest proportion of associations. Associations with minority stress were detected for general physical health, sleep, immune, cardiovascular, metabolic, hormonal, brain health, allostatic load, epigenetic and transcriptional regulation. The highest proportion of associations were detected among sleep, immune,cardiovascular, and hormonal outcomes. These studies evidence associations between minority stress and biological outcomes among gender minority people in addition to evidence among sexual minority people. Future research should consider increasing rigor in methodology and expanding our understanding of moderators and mediators of these relationships.

Patient Perspectives on the Psychosocial Impact of Chronic Pelvic Pain and Implications for Integrated Behavioral Care Approaches.

Chronic pelvic pain (CPP) is a medically complex, multifaceted gynecological condition associated with psychological comorbidities and sexual trauma among women. Low rates of positive treatment outcomes underscore the need to better understand complex relationships between CPP, trauma exposure, and the psychosocial context of patients' lives. We conducted a secondary analysis of English and Spanish qualitative interviews with female-identity patients (N = 48) about CPP's impact on psychosocial well-being. Interviews were coded and analyzed in accordance with reflexive thematic analysis. We generated 4 themes regarding CPP and psychosocial well-being: navigating pain-filled relationships, multiple burdens of mental health challenges and marginalization, sexual trauma exposure embedded in illness experience, and harnessing hope in healing and dealing with CPP. We used insights from these findings to generate a list of treatment recommendations for trauma-informed, CPP-specific integrated care. Patients described the importance of social support and how psychological comorbidities and trauma exposure contributed to CPP's psychosocial toll. Findings provide insight into the burden of CPP-related minority stress and the role of hope on patients' well-being. Patients with CPP endorse the integration of psychosocial support into their CPP treatment plans. The authors encourage the incorporation of behavioral health providers into integrated care teams to deliver trauma-informed, culturally responsive methods for engaging patients with CPP in psychosocial interventions addressing multiple domains of well-being.

Voices from the Rainbow: Exploring Participants' Experiences in an Online LGBTIQ+-Affirmative Psychoeducation Program.

Background/Objectives: This article highlights the importance of addressing the mental health of LGBTQ people, specifically through psychoeducation/intervention programs. The primary objective was to understand the effects of participating in an online affirmative program. The theoretical frameworks of the minority stress model and the concept of decompensation were used to understand and address disparities with the general population. Methods: A detailed protocol was designed to understand the participants' experiences. An analysis of the results was carried out using a content analysis of the data collected from a convenience sample of participants from two groups. Results: The findings show that the participants' experiences were satisfactory, especially with developing coping skills and changing their attitudes towards homophobia, also showing improvements in mental health indicators. Conclusions: This study concludes that online LGBTQ-affirmative psychoeducation programs can be positive in enhancing the mental health and well-being of the LGBTQ population. The research highlights the importance of extending these programs to LGBTQ family members. It is also important to acknowledge the specificities of each subgroup.

“I Feel like This Contributed to my Ongoing Pattern of Hiding from my Sexuality Throughout my Later Life”: A Reflexive Thematic Analysis of the Biphobic Experiences of Bi+ Men

Minority stress theory posits a direct link for LGBTQ+ individuals between societal treatment (distal factors) and health concerns (Brooks, 1981; Meyer, 2003). Bi+individuals (individuals who are attracted to more than one gender) have disproportionately high rates of these concerns (Polihronakis et al., 2021). This study uses a reflexive thematic analysis to understand the biphobic experiences of bi+ men in hopes of knowing how best to tailor interventions aimed at reducing adverse health outcomes. Covert and overt experiences such as microaggressions, rejection, discrimination, harassment, and trauma were identified as common themes. Internalized biphobia was found to be a major commonality, typically following a biphobic event. Several participants also identified a religious basis for their experiences of biphobia. Participants identified these experiences as having a significant impact on their wellbeing. Each of the participants shared stories that provide insight into bi+ men’s experiences with biphobia.

Sexual minority stressors and disordered eating behaviors in daily life: a daily diary study of sexual minority cisgender female couples

ABSTRACT Young cisgender sexual minority women (e.g. lesbian, queer) in the U.S. are at risk for disordered eating behaviors (DEB). Minority stress theory proposes sexual minority stressors (SMS; e.g. discrimination) related to marginalized statuses are culturally specific stressors that may explain engagement in these behaviors. However, little is known about daily SMS-DEB associations. We conducted a 14-day daily diary study of 321 U.S.-based sexual minority cisgender women ages 19–35 who were in a relationship with a woman. SMS were assessed using an 8-item daily measure of distal SMS (e.g. heard anti-LGBT talk, verbal harassment), and DEB with single items capturing dietary restraint, overeating, loss of control eating, and emotional eating. Multi-level models revealed on days when women experienced SMS, they were more likely to report dietary restraint and emotional eating, but not overeating or loss of control eating. Women who generally reported more frequent SMS were more likely to report all four DEB. There were no significant couple-level SMS-DEB associations. These findings expand our understanding of how SMS is associated with DEB in the daily lives of cisgender sexual minority women. Future studies are needed to explore the temporal sequencing of the associations. Findings may also help to inform the design of culturally tailored interventions aimed at reducing DEB among sexual minority women.

Mental Health Disparities by Sexual Orientation and Gender Identity in the All of Us Research Program.

Limited research explores mental health disparities between individuals in sexual and gender minority (SGM) populations and cisgender heterosexual (non-SGM) populations using national-level data. To explore mental health disparities between SGM and non-SGM populations across sexual orientation, sex assigned at birth, and gender identity within the All of Us Research Program. This cross-sectional study used survey data and linked electronic health records of eligible All of Us Research Program participants from May 31, 2017, to June 30, 2022. Self-identified SGM status. Prevalence of common mental health conditions identified from linked electronic health records. Logistic regression adjusted for age, race and ethnicity, educational level, income, employment status, and geographic region was used to assess the association between SGM status and mental health conditions. Among 413 457 participants, 269 947 (65.3%) were included in the analysis (median age, 59 [IQR, 43-70] years), with 22 189 (8.2%) self-identified as SGM. Men with cisgender sexual minority identity had higher odds of bipolar disorder (adjusted odds ratio [AOR], 1.87; 95% CI, 1.70-2.56) compared with cisgender heterosexual men. Women with cisgender sexual minority identity had higher odds of bipolar disorder (AOR, 2.09; 95% CI, 1.95-2.25) compared with cisgender heterosexual women. Gender diverse people assigned female sex at birth had higher odds of posttraumatic stress disorder (PTSD) compared with both cisgender heterosexual men (AOR, 3.67; 95% CI, 2.99-4.50) and cisgender heterosexual women (AOR, 2.77; 95% CI, 2.26-3.40). Gender diverse individuals assigned male sex at birth had higher odds of bipolar disorder (AOR, 2.35; 95% CI, 1.66-3.33) compared with cisgender heterosexual men and higher odds of attention-deficit/hyperactivity disorder (AOR, 2.19; 95% CI, 1.48-3.23) compared with cisgender heterosexual women. Transgender men had higher odds of depression (AOR, 2.11; 95% CI, 1.80-2.49) compared with cisgender heterosexual men, while transgender women had higher odds of any personality disorder (AOR, 2.71; 95% CI, 1.84-3.99) compared with cisgender heterosexual women. In this cross-sectional study of participants in the All of Us Research Program, there were significant mental health disparities between participants in SGM and non-SGM groups. These findings underscore the need for tailored mental health interventions to improve the well-being of SGM populations, while noting that the associations do not imply causality but reflect the stigma and minority stress experienced by these individuals.

Sexualized drug use factors among rural sexual minority men.

Although rural sexual minority men (SMM) use substances immediately before/during sex (i.e., sexualized drug use), the factors contributing to this behavior are unknown. We examined the factors associated with past year sexualized drug use among rural SMM. Rural SMM in the Southern region of the United States (N = 345) completed an online cross-sectional survey from February to March 23, 2024. Participants answered questions about their sexualized drug use behaviors, sexual behaviors, minority stressors, and demographics. We conducted a hierarchical logistic regression to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with past year sexualized drug use. Over three-quarters of participants (79.7%) used substances immediately before/during sex in the past year. Sexualized drug use was associated with exposure to sexual minority stressors, polysubstance use, sexually transmitted infection testing, having oral sex, receiving drugs from a man in exchange for sex, and older age. Sexualized drug use is prevalent among rural SMM, and sexual minority stressors and past year sexual risk and substance misuse behaviors were contributing factors. Rural primary care clinics, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) service organizations, and outpatient and inpatient substance use organizations should implement integrative sexual and substance use screening, counseling, and referral services for their rural clients.

EFFECTS OF MINORITY AND CAREGIVING STRESS ON THE HEALTH OF BI+ INFORMAL DEMENTIA CAREGIVERS

Abstract Bi+ people (e.g., bisexual, pansexual) are more likely to experience poor physical and mental health compared with monosexual minority (i.e., gay[G], lesbian[L]) people. These poor health outcomes stem from minority stress related to sexual minority status. Due to minority and caregiver stress, LGB+ people providing care to someone with Alzheimer’s disease and related dementias (ADRD) are more likely to have worse health than their straight counterparts. Little is known about how minority and caregiver stress affect the health of bi+ ADRD caregivers versus monosexual minority ADRD caregivers. Data from ADRD caregivers (bi+, n=125; gay/lesbian, n=161) were used to examine associations between minority stress, caregiver stress and overall health and if associations differed among bi+ and gay/lesbian ADRD caregivers. Multivariable regression, adjusting for demographics, was used to investigate if sexual orientation moderated the association between minority/caregiver stress variables and overall health. All minority stressors and two caregiving stressors (caring for spouse/care recipient’s level of independence) were associated with health. In our adjusted model, lifetime victimization, day-to-day discrimination, and caring for spouse/partner, moderated the association between sexual orientation and overall health. As lifetime victimization scores increased, bi+ health decreased while monosexual minority health increased. Caring for a spouse/partner, protective for both groups, had a greater effect on health for monosexual minorities. Higher day-to-day discrimination scores predicted worse health for both groups, but the magnitude was greater for monosexual minorities. Qualitative inquiries can illuminate underlying mechanisms for this phenomenon, informing interventions and policy aimed at supporting health and well-being of bi+ ADRD caregivers.

Conceptualizing discrimination against LGBTQ+ workers in the unbounded workplace

AbstractThe workplace is a key space where LGBTQ+ people face discrimination leading to mental health distress. This paper shows how spatial attributes of work shape experiences and perceptions of discrimination and mental health distress. Building on minority stress theory, we demonstrate how spatial attributes of work can cause, amplify, or mitigate mental health distress among LGBTQ+ people through direct and indirect mechanisms, such as anticipated discrimination, perceived discrimination, and the availability of coping devices. Our findings suggest that understanding the connection between workplace discrimination and poor mental health requires a more nuanced understanding of the workplace, highlighting how workplace stressors are simultaneously emplaced in and exceed the spatiotemporal bounds of the workplace.

Mental Health and Well-Being of LGBTQ+ Refugees in Comparison to LGBTQ+ Host Country Population

Abstract Introduction LGBTQ+ refugees are likely to experience heightened mental health burdens and lower levels of well-being when compared to LGBTQ+ individuals without refugee experience. Still, the distinctive psychological mechanisms explaining their heightened levels of distress remain understudied. We examined the mental health and well-being of LGBTQ+ refugees in comparison to LGBTQ+ host country individuals in Germany and explored whether disparities are potentially mediated by proximal and distal minority stress. Methods In 2019, LGBTQ+ refugees (n1 = 139) and LGBTQ+ Germans (n2 = 262) participated in a cross-sectional online survey. Using path analysis, we compared mental health burdens (symptoms of depression/anxiety, post-traumatic stress) and well-being (life satisfaction, self-esteem) to understand how these variables are mediated by proximal (internalized homophobia, heightened vigilance) and distal minority stress (experiences of discrimination). Results LGBTQ+ refugees reported higher mental health burdens and lower life satisfaction yet no differences in self-esteem. Distal minority stress (discrimination) mediated the link between LGBTQ+ refugee status and symptoms of post-traumatic stress. Proximal minority stress mediated both heightened symptoms of depression/anxiety and lower well-being for LGBTQ+ refugees. Conclusions Linked to experiences of minority stress, LGBTQ+ refugees in Germany might be at a heightened risk for increased mental health burdens and lower well-being. Compared to host-country LGBTQ+ communities, LGBTQ+ refugees might experience different profiles of minority stress, including more distal minority stress. Policy Implications Both administrators and the local LGBTQ+ community need to be aware of the particular vulnerability and needs of LGBTQ+ refugees for protection and safety (e.g., housing) and the prevention of exploitation.

Examining the Prospective Effects of Alexithymia and Minority Stress on Emotion Regulation in Sexual Minority Adults

Examining the Prospective Effects of Alexithymia and Minority Stress on Emotion Regulation in Sexual Minority Adults

Supplemental Material for Interactive Effects of Intersectional Minority Stress and Adaptive Coping on Intimate Partner Violence Perpetration in Cisgender Sexual and Racial Minoritized Adults: An I3 Model Analysis

Supplemental Material for Interactive Effects of Intersectional Minority Stress and Adaptive Coping on Intimate Partner Violence Perpetration in Cisgender Sexual and Racial Minoritized Adults: An I3 Model Analysis

Gender and sexual minorities’ intergenerational connection: Considerations for wellness, generativity, and minority stress in older age.

Gender and sexual minorities’ intergenerational connection: Considerations for wellness, generativity, and minority stress in older age.

Supplemental Material for Differential Gene Expression in Response to AWARENESS: A Randomized Controlled Trial of an Intersectional Minority Stress Intervention

Supplemental Material for Differential Gene Expression in Response to AWARENESS: A Randomized Controlled Trial of an Intersectional Minority Stress Intervention

The potential role of visible solidarity in mitigating minority stress in subscribers to a theory of generalised prejudice

The potential role of visible solidarity in mitigating minority stress in subscribers to a theory of generalised prejudice

Dual-continual examination and differential prediction of well-being and distress in LGBTQIA+ populations.

Although studies on the dual-continua model have demonstrated that distress and well-being are two separate but interrelated factors of mental health, only limited research exists regarding these concepts for lesbian, gay, bisexual, transgender, queer, intersex, asexual+ (LGBTQIA+) individuals. The present study aimed to investigate the factor structure of mental health in the LGBTQIA+ community. The second aim was to investigate whether different correlates are relevant for the prediction of well-being and psychological distress in LGBTQIA+ individuals when these mental health outcomes are considered separately. LGBTQIA+ individuals from Germany, Austria, and Switzerland were recruited via collaborating organizations and social media to participate in a cross-sectional survey. Participants (n = 1,686, Mage = 27.74) completed self-report measures of well-being and psychological distress. Included correlates were self-esteem, social support, resilience, and various minority stress factors. Data were analyzed using structural equation modeling and latent regression analyses. A very strong correlation at the latent level (r = -.82) suggested that well-being and psychological distress refer to opposite poles of mental health in the LGBTQIA+ sample. Different minority stress factors were relevant for the prediction of well-being and distress when these factors were disentangled. The present study highlights the close inverse relation between well-being and distress in LGBTQIA+ individuals. Several correlates were found that could inform tailored counseling for LGBTQIA+ community members, irrespective of whether the focus is on positive or negative aspects of mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sexuality-Based Stigma, Other Painful and Provocative Events, and Suicide Attempt Among Cisgender Sexually Minoritized Men in the United States

Objective Guided by Minority Stress and Interpersonal and Ideation-to-Action Theories of Suicide, we sought to identify latent classes of painful and provocative events (PPEs), determine associations with class membership, and assess class-specific suicide attempt prevalence among cisgender sexually minoritized men (SMM) with suicidal ideation in the United States. Method Using data collected from October 2020 to January 2021 from 1617 SMM reporting past-year suicidal ideation, we performed latent class analysis on 22 PPE items spanning sexual behavior stigma, substance use, high-risk sex, and food and housing insecurity. We used multinomial logistic regression to assess associations with class membership and the Bolck-Croon-Hagenaars method to estimate class-specific past-year suicide attempt prevalence. Results Participant mean age was 29 years, 63% (n = 1010) were non-Hispanic white, and 14% (n = 221) reported a past-year suicide attempt. Five classes emerged: Extreme (7%, n = 113), featuring pervasive stigma, polysubstance use, high-risk sex, and food and housing insecurity; Severe/marijuana (15%, n = 236), featuring pervasive stigma, alcohol use, marijuana use, high-risk sex, and food insecurity; Severe (18%, n = 296), featuring the same PPEs minus marijuana use; Moderate (17%, n = 267), featuring family stigma, verbal harassment, some polysubstance use, and high-risk sex; and Mild (44%, n = 705), featuring family and friends stigma, verbal harassment, and alcohol use. Significantly higher suicide attempt prevalence emerged in the Extreme/Severe classes (12–16%) relative to the Mild/Moderate classes (2%). Conclusions Stigma and substance use were common across classes, implicating both as key factors shaping suicide risk among SMM. Holistic, multipronged, tailored interventions targeting stigma, substance use, and other PPEs are needed.

Chronic Joint Pain Disparities for U.S. Transgender Adults: Behavioral Risk Factor Surveillance System, 2020.

Purpose: Several studies have found that sexual minority individuals are at greater risk for chronic pain. However, these studies did not ask about gender identity, and research on chronic pain in transgender populations remains scarce. This present study examined the relationship between transgender status and chronic joint pain disorders among U.S. adults. Methods: Data were obtained from the 2020 Behavioral Risk Factor Surveillance System. We compared odds of chronic joint pain disorders by transgender status (n transgender = 967, cisgender = 217,943, don't know/not sure = 648, refused = 2072) using logistic regression adjusting for age. Results: After adjusting for age, transgender respondents reported greater odds of chronic joint pain disorders (adjusted odds ratio [AOR] = 1.24, 95% confidence interval [CI] = 1.05-1.48), compared with cisgender respondents. Odds for chronic joint pain disorders were lower for the "refused" group (AOR = 0.84, 95% CI = 0.76-0.93) and for those who answered "don't know/not sure" (AOR = 0.73, 95% CI = 0.61-0.88). Conclusion: Consistent with preliminary evidence and with the minority stress model, transgender respondents were at increased odds of chronic joint pain disorders when adjusting for age.

The lived experiences and minority stress of lesbian-identifying teachers in Australia

ABSTRACT The lived experiences and minority stress of lesbian-identifying teachers in Australia contribute to ongoing compromised social and wellbeing outcomes for this cohort of people. While past research focuses on lesbian, gay and bisexual teachers as a collective, research specifically examining lesbian teachers within the Australian context, is limited, ultimately presenting a lack of representation to experiences unique to this specific cohort of teachers. Drawing upon the lived experiences of four lesbian-identifying teachers in Australian primary and secondary schools, and employing Ilan Meyer’s minority stress model, we present an analysis which delineates the adverse experiences still present in the working lives of lesbian teachers. We highlight the diverse adversities they experience because of the intersection between their sexualities and professional identities. Through thematic analysis, the study developed three themes related to 1) social influences of teachers’ context, 2) adverse experiences unique to being a lesbian-identifying teacher, 3) and identity management. This study contributes to knowledge regarding the unique experiences and minority stressors of lesbian teachers and provides specific insights to the challenges still present and felt for this cohort of teachers.

Potential Harm in the Psychological Treatment of Sexual and Gender Minority Youth.

Sexual and gender minority (SGM) individuals show disproportionately high rates of mental distress relative to their cisgender, heterosexual peers resulting from minority stress, or unique identity-related stressors. The majority of research on minority stress and mental health in SGM individuals has focused on adults, a notable gap given that SGM youth face unique developmental factors that intersect with identity development and availability of support resources. SGM youth therefore represent a critical population for the mental health workforce to serve competently. Mental health providers risk significant harm to their SGM youth clients if they do not understand the mechanisms underlying mental health disparities in this population. This article will review treatment practices that carry the potential for harm with SGM youth, including harms that are more overt and attempt to change SGM identities (i.e., so-called "conversion therapies"), and others that are more covert, such as neglecting to consider SGM identity in conceptualization and treatment (e.g., eating disorders), pathologizing SGM identity and behaviors (e.g., personality disorders, social anxiety), and reinforcing stigma related to SGM identities (e.g., obsessive-compulsive disorder). Accordingly, this article reviews each of these potential harms in detail and provides alternative recommendations for affirming and justice-based treatment for SGM youth.