Minority Mental Health Research Articles

Beyond the (family) binary: Family environment heterogeneity among transgender adults

AbstractObjectiveTo identify latent profiles of family environments among transgender adults and to examine the relationships between these profiles and mental and physical health.BackgroundHow a family‐of‐origin responds to a transgender family member has significant implications for that individual's mental and physical health. However, the extant research on the health of transgender people has largely relied on a binary conceptualization of family environments that has been critiqued as simplistic, reductionistic, and misrepresentative. To date, no known quantitative studies have assessed transgender family environments beyond this ostensibly antiquated conceptualization.MethodData were collected in 2018 from transgender adults via Amazon's MTurk (N = 873). Participants completed questionnaires about their family environment, experiences of minority stress, mental and physical health, and quality of life.ResultsLatent profile analysis yielded five profiles of transgender family environments: disengaged; accepting and affirming; repudiating; moderate family ambiguity; and high family ambiguity. Over half of respondents were assigned membership to one of the two ambiguity profiles (56.4%). Distal regression models demonstrated that, relative to embracing and affirming, membership in each of the other four profiles was negatively associated with both mental and physical health. Participants assigned to the ambiguity profiles did not statistically differ on health outcomes when compared to those in the repudiating profile.ConclusionAmbiguity is prevalent in transgender people's families‐of‐origin. It also appears equally detrimental as family rejection is to the mental and physical health of transgender adults.

Minority Stress and Mental Health of Gay Men in Turkey: The Mediator Roles of Shame and Forgiveness of Self

ABSTRACT Proximal minority stressors (i.e., internalized homonegativity, anticipation of rejection, and concealment of sexual identity) lead to depression and anxiety. General psychological factors mediate the association of proximal stressors with depression and anxiety. Based on this, the present study aimed to investigate the sequential mediating roles of shame and forgiveness of self on the relations of proximal stressors with depression and anxiety in a sample of self-identified gay men in Turkey (N = 200). The findings revealed that proximal stressors significantly predicted depression and anxiety indirectly through shame and self-forgiveness. Thus, the link between minority stress and shame should be considered in clinical practice, and self-forgiveness should be integrated into intervention programs to eliminate the negative impacts of shame on depression and anxiety among this population. Limitations and directions for future studies are presented.

Complicating Narratives of Sexual Minority Mental Health: An Intersectional Analysis of Frequent Mental Distress at the Intersection of Sexual Orientation, Gender Identity, and Race/Ethnicity

Purpose: Research indicates that sexual minority populations experience mental health inequities. However, few studies have examined mental health outcomes in sexual minority populations while including intersecting dimensions of social identity. This study had two objectives: (1) to quantify the prevalence of frequent mental distress among U.S. adults across intersecting social identity categories and (2) to evaluate the contribution of intersectional interactions to observed inequities. Methods: Using data from the Behavioral Risk Factor Surveillance System 2014-2019 (N = 1,024,261), we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA). Participants were nested in 45 intersectional groups defined by combining 3 sexual orientation (gay/lesbian, bisexual, and heterosexual), 5 gender identity (transgender women, transgender men, gender nonconforming, cisgender women, and cisgender men), and 3 racial/ethnic (non-Hispanic Black, Hispanic/Latinx, and non-Hispanic White) categories. We estimated the predicted probability of frequent mental distress for each stratum. We then calculated the variance partition coefficient (VPC) and proportional change in variance (PCV). Results: We found that multiply marginalized groups tended to have the highest prevalence of frequent mental distress. Groups with racial/ethnic minority individuals were equally represented among low- and high-prevalence groups. The VPC indicated that slightly over 10% of observed variance in prevalence was attributable to group-level differences, while the PCV revealed that a small but meaningful amount of observed heterogeneity in prevalence was due to intersectional interactions between the dimensions of social identity. Conclusion: I-MAIHDA is a promising method for examining the patterning of sexual orientation-based mental health inequities at the population level.

Community ethnic density, ethnic segregation, and ethnic minorities' common mental disorders in the UK.

Studies in the UK demonstrate evidence that ethnic minorities living in communities with a higher proportion of co-ethnics report better mental health: co-ethnic density effects. This paper aims to address three gaps in this literature. Firstly, most UK research has focused on acute mental disorders (e.g., psychosis), with little work examining co-ethnic density effects for more common mental disorders. Secondly, there is a paucity of research exploring the role that residential segregation may play alongside co-ethnic density in minority mental health. Thirdly, little systematic testing has examined at what geographic-scale co-ethnic density effects are most salient for minority-group mental health. To address these potential gaps, we apply multi-level linear regression modelling to a large-scale, nationally-representative UK panel dataset, containing an ethnic minority booster-sample, to study the community-level drivers of mental health-related quality-of-life (SF-12 Mental Component Summary Score). The results demonstrate mixed support for the protective-effects of co-ethnic density on mental well-being. However, they demonstrate broadly consistent support for the impact of residential segregation on mental well-being. In particular, that segregation exerts a non-linear effect: mental well-being is at its most positive at medium-levels of segregation, somewhat more negative at low-levels of segregation, and much more negative at higher-levels of segregation. These patterns are present for the 'all ethnic minority' sample, and stronger for Black sub-groups compared to Asian sub-groups. These relationships appear most consistent at meso-local geographic scales (Middle Super Output Areas). These findings have important implications for theorising our understanding of the nexus between the community and mental health among minority-groups.

Images

Images Sean P. Murphy (bio) [End Page 142] Click for larger view View full resolution IMAGE: DIALECTICAL MATERIALISM, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 143] Click for larger view View full resolution FORMALISM, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 3] Click for larger view View full resolution NEW HISTORICISM, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 89] Click for larger view View full resolution DECONSTRUCTION, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 141] Sean P. Murphy Sean P. Murphy, PhD, MSN, PMHNPBC, is a Clinical Assistant Professor teaching in the University of Illinois Chicago's Psychiatric-Mental Health Nurse Practitioner doctoral program. He practices at university health and counseling centers, specializing in sexual and gender minority mental health, emerging adult populations, and trauma. Murphy holds a PhD in Literature, Cultural Theory, and Social Practice and was a tenured professor of English and Humanities prior to entering nursing. He uses visual art as a space to digest and metabolize emotions associated with clinical practice as well as to explore connections between the humanities, literary and critical theories, and science. Email: sean@murphynp.com Copyright © 2023 Cornell University

Loneliness in Sexual Minority Individuals in the Southeastern United States: The Role of Minority Stress and Resilience

ABSTRACT Health disparities in the sexual minority population may be exacerbated by the loneliness experienced due to minority stress. Using a minority stress framework, this study examined minority stress, protective variables, and mental health as correlates of loneliness in sexual minority individuals in a small metropolitan area in the southeastern United States. Participants (n = 273) were a subsample of sexual minority individuals from a broader sample of LGBTQ adults in the Central Savannah River area who completed a health needs assessment. Bivariate correlations were calculated to assess for degree of significant relationships between loneliness and barriers to health care, minority stress, and mental health. Hierarchical linear regression was conducted to examine the relative importance of the study variables’ associations with loneliness. A multiple regression model found household income, assault victimization, depressive symptoms, and sense of community to be significant correlates of loneliness. Interventions to decrease loneliness in this population will need to consider these interconnected, multi-level influences.

Minority Stress and Mental Health: A Review of the Literature

ABSTRACT Lesbian, gay, bisexual, and transgender (LGBT) populations experience significant health disparities, theorized to result from LGBT specific minority stressors. The fully conceptualized Minority Stress Model was published more than 15 years ago. Minority stressors include external conditions and events, such as discrimination and victimization. Internal minority stressors include expectations of rejection and discrimination, concealment of minority identity, and internalizations of negative dominant cultural attitudes, beliefs, stereotypes, and values. Connection to sexual and gender minority communities is theorized to moderate the effects of minority stressors. In this integrative review, I examine two decades of research on minority stress. Based on this review, I highlight strengths and limitations of the model, and suggest next steps for moving minority stress research forward.

Minority Stress & Mental Health for Sexual Minority Adults from Religious Families: the Role of Religious Coping

ABSTRACT Background A majority of sexual minority (SM; lesbian, gay, bisexual, queer) adults identify as religious and use religious copingstrategies for dealing with life’s stressors. SM people report experiencingunique minority stressors of interpersonal rejection in family and religioussettings as a product of religious doctrine that rejects same-sex relationshipsand attraction; however, the usefulness of religious coping strategies forhandling minority stressors for improving the mental health of SM people isstill unknown given mixed findings in previous studies. In addition, locatingparticular measures of religiously based minority stress may aid in identifyingkey factors affecting mental health. Method This study utilized quantitative data from a web-based survey to explore the relationships between religious coping,interpersonal religious discontent, minority stressors of family rejection andinternalized stigma, and depressive symptoms of SM adults from religiousfamilies (n = 384). Results Moderation analysis demonstrated the significant interaction of religious coping and interpersonal religious discontent withminority stress factors for exacerbating the influence of greater minoritystress on greater depressive symptoms when religious coping and interpersonalreligious discontent were higher. In addition, those who left their religiousaffiliations experienced decreased minority stress and used less religiouscoping strategies. Conclusions Implications for family psychotherapy and future research are addressed.

23.2 LGBTQ FAMILIES AND THE U.S. SUPREME COURT

This session aims to review the literature on how the Supreme Court of the United States (SCOTUS) decisions have impacted the mental health of LGBTQ families and the upcoming cases that may impact LGBTQ families, and to provide practical clinical recommendations on how to support families with the impact of these decisions. The peer-reviewed literature on the impact of recent SCOTUS decisions on LGBTQ mental health will be reviewed and discussed. Transcripts from oral arguments from recent cases were reviewed (Fulton v The City of Philadelphia, Obergefell v Hodges, Employment Division v Smith, Bostock v Clayton County), along with published commentary by constitutional scholars. In 2015, SCOTUS established marriage equality with its decision in Obergefell v Hodges. Marriage equality for sexual minority people has resulted in decreased mental healthcare visits and lower suicide attempt rates. These outcomes are thought to be secondary to broad cultural impacts on society’s views of homosexuality. Conversely, policies that limit LGBTQ civil rights, including those that permit the denial of services to LGBTQ people, have been linked to adverse mental health outcomes. SCOTUS recently heard oral arguments in Fulton v The City of Philadelphia, a case examining an organization’s right to refuse adoption screening services to LGBTQ people on the basis of religious beliefs. A case permitting such denial of services, based on extant literature, would be expected to result in worsening mental health outcomes for LGBTQ people. Past court precedent relevant to the case, including Employment Division v Smith, will be discussed. Recent changes in the court’s composition and their implications for this case and potential future cases will be discussed. The mental health impact of these cases will be discussed through the minority stress framework, and practical recommendations for supporting LGBTQ families in this regard will be reviewed. Public policies and related SCOTUS decisions have profound public health impacts in the realm of sexual minority mental health. These decisions have important implications for LGBTQ families, and clinicians should be aware of these implications and strategies to mitigate adverse impacts on mental health.

Call for Papers on Minority Mental Health and Diversity

Call for Papers on Minority Mental Health and Diversity

Development and Validation of Two Abbreviated Intraminority Gay Community Stress Scales.

Social stressors stemming from within the gay community might render gay and bisexual men vulnerable to mental health problems. The 20-item intraminority Gay Community Stress Scale (GCSS) is a reliable measure of gay community stress, but the scale's length limits its widespread use in sexual minority mental health research. Using three independent samples of gay and bisexual men, the present research developed two abbreviated versions of the GCSS using nonparametric item response modeling and validated them. Results indicated that eight items provided maximal information about the gay community stress construct; these items were selected to form the eight-item GCSS. The eight-item GCSS reproduced the factor structure of the parent scale, and gay community stress scores obtained from it correlated with other identity-specific social stress constructs and mental health symptoms. Associations between gay community stress and mental health symptoms remained significant even after controlling for related identity-specific stressors, general life stress, and relevant demographics. A four-item version was also developed and assessed, showing good structural, convergent, criterion, and incremental validity and adequate reliability. The eight- and four-item versions of the GCSS offer efficient measures of gay community stress, an increasingly recognized source of stress for gay and bisexual men.

Pennsylvania leaders reinforce need to maintain focus on racial inequity

State leaders in Pennsylvania used last month's commemoration of National Minority Mental Health Awareness Month to reinforce the importance of addressing racial disparities in access to high‐quality mental health services. A July 23 press event addressed themes articulated in a state Department of Human Services (DHS) report on racial equity, one that also looks inward to where the state agency can do better.

Mental health service utilisation among transgender women sex workers who are at risk of mental health problems in Shenyang, China: An application of minority stress theory.

Transgender women sex workers (TGSW), as a highly stigmatised population, are at substantial risk for mental health problems but lack access to mental health care. This study investigated factors of mental health service utilisation (MHSU) behaviour and related behavioural intention among TGSW who were at risk of mental health problems in the past year [subsample 1: scored above the cut-off for probable depression or probable anxiety or had suicidal ideation (N=126); subsample 2: perceived needs for mental health services (N=109)]. A cross-sectional survey was conducted among TGSW in Shenyang, China during 2017-2018. Data on minority stress, coping, mental health and MHSU were collected. 10.3% of participants in subsample 1 and 14.7% in subsample 2 had sought help from mental health professionals in the last year. Unwillingness to disclose minority identity and gender non-affirmation were negatively associated with MHSU. Factors for behavioural intention of MHSU included unwillingness to disclose minority identity and social support for both subsamples and adaptive coping for subsample 2. Confidentiality concern, discrimination and cost were the most frequently endorsed barriers to mental health services. Interventions should promote gender affirmation, social support and adaptive coping as well as remove stigma to increase health service access and utilisation among minority populations.

“Strong Together”: Minority Stress, Internalized Homophobia, Relationship Satisfaction, and Depressive Symptoms among Taiwanese Young Gay Men

ABSTRACT Taiwan’s legalization of same-sex marriage affords legal status for romantic relationships between sexual minority individuals. Yet, little is known about the role of intimate relationships in the experiences of minority stress and mental health among gay men. This study tested a model where internalized homophobia mediated the association between distal minority stress and depressive symptoms and relationship satisfaction was posited as a moderator. Data came from a sample (n = 557) of Taiwanese young gay men who were in a romantic relationship. Respondents completed the scales of distal minority stress, internalized homophobia, relationship satisfaction, and depressive symptoms. Mediation and moderation analyses were performed on the macro PROCESS. The Johnson-Neyman (J-N) technique was used to interpret the moderating effect of relationship satisfaction. Results show that both distal minority stress and internalized homophobia were positively associated with depressive symptoms. Internalized homophobia partially mediated the association between distal minority stress and depressive symptoms. Relationship satisfaction had a moderating effect. The effect of distal minority stress was lower among those who reported high satisfaction in their current romantic relationship. This study suggested that a satisfying relationship provides protection for gay men’s mental health. Clinicians should attend to relationship issues when working with sexual minority clients.

Mental health care among marginalized populations in the United States

Mental health care among marginalized populations in the United States

Acculturation Mitigates the Negative Impact of Perceived Stress on Depressive Symptoms Among U.S. Chinese Older Adults.

The present study aimed to examine the role of acculturation in mitigating the negative impact of perceived stress on depressive symptoms among U.S. Chinese older adults. Data of 3,159 Chinese adults over 60 years old were drawn from the Population Study of Chinese Elderly in Chicago (PINE). In addition to socio-demographic variables, participants' acculturation levels, perceived stress, and depressive symptoms were assessed. Perceived stress was positively related to depressive symptoms among Chinese older adults. However, no significant association was found between acculturation level and depressive symptoms. Regression analysis supported the moderation hypothesis of acculturation level on the relationship between perceived stress on depressive symptoms. The negative impact of perceived stress on depressive symptoms was mitigated for Chinese older adults who had higher levels of acculturation than for those who had lower levels of acculturation. The findings have implications in minority aging and mental health policies during the on-going pandemic era.

Minority statuses and mental health outcomes among young gay, bisexual and queer men in Singapore

Minority gay, bisexual and queer (GBQ) men face not only stigma from the general population based on their sexual orientation, but stigma as well based on their race, body type and their gender identity. Results of this study were derived from baseline data of the Pink Carpet Y Cohort Study in Singapore comprising a sample of 570 GBQ men aged 18 to 25 years old. Controlling for key demographic variables, being non-Chinese was associated with depression severity (aPR = 1.21, 95%CI [1.01,1.45]), experienced homophobia (aPR = 1.13, 95%CI [1.05,1.22]) and a past suicide attempt (aPR = 1.77, 95%CI [1.08,2.92]); being non-cisgender male was associated with depression severity (aPR = 1.27, 95%CI [1.05,1.55]) and experienced homophobia (aPR = 1.20, 95%CI [1.09,1.32]); reporting a BMI of 25 or more was associated with depression severity (aPR = 1.20, 95%CI [1.00,1.44]). Reporting one minority status was associated with depression severity (aPR = 1.23, 95%CI [1.05,1.45]) experienced homophobia (aPR = 1.08, 95%CI [1.01,1.15]), and a past suicide attempt (aPR = 1.61, 95%CI [1.01,2.56]), while reporting at least two minority statuses was associated with depression severity (aPR = 1.47, 95%CI [1.17,1.83]), experienced homophobia (aPR = 1.26, 95%CI [1.14,1.40]), and past suicide ideation (aPR = 1.28, 95%CI [1.01,1.62]), compared to participants in the general sample. Interventions are needed to buffer the effects of stigma in this vulnerable group of individuals.

Under-Representation of Transgender Identities in Research: The Limitations of Traditional Quantitative Survey Data.

Research indicates that the portrayal and representation of transgender individuals within society, or lack thereof, impact the way in which they are able to reconcile their gender identity. Quantitative research methodology often requires that participants select one identity label from a limited list for each identity characteristic (e.g., race, sexual orientation, and relationship status). The process of choosing from limited items that do not represent one's identities limits our understanding of the nuances of identity and may create minority stress for the participant. This study included 325 diverse transgender adults who participated in a national anonymous online survey as part of a broader study focused on minority stress and mental health. Participants answered questions about gender, sexual orientation, relationship status, race, and religion, and were given the option to select multiple response options and to write in additional identities that were not listed. Descriptive results indicated that 95 unique gender identities written in were not captured by the 14 gender labels provided, over 43% of participants selected multiple sexual orientations, and participants wrote in additional options for every identity variable. The nuance of transgender identities may not be adequately captured by standard demographic research methodologies and research would benefit from ongoing revision of demographic response options informed by the literature. Through the process of acknowledging and validating less visible identities, transgender individuals will be better represented and understood by researchers.

Lifecourse-varying structural stigma, minority stress reactions and mental health among sexual minority male migrants.

BackgroundIncreasing evidence suggests that structural stigma (e.g. discriminatory laws, policies and population attitudes) can give rise to minority stress reactions (i.e. rejection sensitivity, internalized homophobia and identity concealment) to compromise sexual minorities’ mental health. Yet, many sexual minorities encounter divergent structural stigma climates over the life course, with potential implications for their experience of minority stress reactions and mental health. We take advantage of sexual minority male migrants’ lifecourse-varying exposures to structural stigma contexts to examine this possibility.MethodsA sample of 247 sexual minority men who had migrated from 71 countries to the low-structural-stigma context of Sweden completed a survey regarding migration experiences, minority stress reactions and mental health. This survey was linked to objective indices of structural stigma present in these men’s countries of origin, diverse in terms of structural stigma.ResultsCountry-of-origin structural stigma was significantly associated with poor mental health and this association was mediated by rejection sensitivity and internalized homophobia, but only among those who arrived to Sweden at an older age and more recently.ConclusionsProlonged exposure to high levels of structural stigma can give rise to stressful cognitive, affective and behavioural coping patterns to jeopardize sexual minority men’s mental health; yet, these consequences of structural stigma may wane with increased duration of exposure to more supportive structural contexts.

Paying the widening participation penalty: Racial and ethnic minority students and mental health in British universities

AbstractRacial and ethnic minority (REM) students are more likely to experience poor mental health than their White peers yet are less likely to seek help from university counseling services. In attempting to explain this puzzle, the role of environmental factors are rarely explored, despite evidence which suggests that the university environment is itself a major factor. Here, I take a qualitative paired comparison approach to examine the influence of the university environment on the mental health and help‐seeking attitudes of REM undergraduate students, evaluating their experiences at a Russell Group university (RGU) with low REM participation and a neighboring non‐Russell Group university with high REM participation. While both universities declared a commitment to widen participation and promote inclusion for REM individuals, semi‐structured interviews with 48 REM students reveal that feelings of isolation and the experience of discrimination were heightened at the RGU. However, students at both universities described having to navigate a “minefield” of racial microaggressions and “othering.” Further, these environmental pressures are compounded by personal factors (i.e., prior help‐seeking experiences, cultural norms, and family pressures). Together, these factors largely influence both their mental health and their help‐seeking attitudes. I argue that these factors create a widening participation penalty for REM students and suggest that support for these students must go beyond initial acts of increasing diversity on campus (for example, through Widening Participation schemes). Rather, efforts should focus on addressing and reforming the institutional environments and behaviors that hinder university campuses from becoming truly inclusive and mentally healthy environments.