Minority Stress Research Articles

Asian Hate, religion, and perceived changes in physical health: exploring the flip side of minority stress during the COVID-19 pandemic

ABSTRACT Objectives Prior research suggests that racism is associated with adverse mental health outcomes for Asians in the United States. Relatively less research has been conducted to examine the effects of racism on physical health, particularly the changes in physical health among Asians and Asian Americans. This study aims to fill in this gap in prior research. Design Survey was conducted via Qualtrics in March 2023. A panel sample of 356 Asian and Asian American adults from across the US was collected. Ordinary Least Squares Regression was employed to examine the interrelationships among racism, religion, and perceived changes in physical health during the COVID-19 pandemic. Results Contrary to conventional wisdom, more frequent experience with blatant racism was associated with a perceived improvement in physical health after controlling for subtle racism, anxiety, acculturation, and various sociodemographic variables. Interestingly, this robust relationship was more significant among Asians who attended religious services more frequently. Additional three-way interactions revealed that the interaction between blatant racism and religious service attendance on perceived changes in physical health was more significant for US-born Asians and Asians of Indian or Japanese ethnicity. Conclusion Racism exerts a significant influence on physical health outcomes among Asians and Asian Americans. However, this relationship was contingent upon the specific aspect of racism and intersected with religiosity, acculturation, and ethnic identity.

Psychological Distress Mediates the Relationship Between HIV-Related Stigma and Prescription Opioid Misuse Among Chinese People Living with HIV.

Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.

A patient-centered model of mental health care for trauma and minority stress in transgender and gender diverse people: A bottom-up network analysis.

Transgender and gender diverse (TGD) individuals are disproportionately exposed to traumatic and high-impact minority stressors which can produce an array of transdiagnostic symptoms. Some clinical presentations align well with established evidence-based treatments, but others may require patient-centered modifications or combined approaches to address treatment needs. In this study, we employed a novel, bottom-up approach to derive insights into preferred intervention strategies for a broad range of trauma- and TGD-minority stress-related expressions of clinical distress. Participants (18 TGD individuals, 16 providers) completed a q-sort task by first sorting cards featuring traumatic experiences and/or minority stressors and transdiagnostic psychiatric symptoms into groups based on perceived similarity. Next, participants sorted interventions they believed to be most relevant for addressing these concerns/symptoms. We overlayed networks of stressors and symptoms with intervention networks to evaluate preferred intervention strategies. TGD networks revealed transdiagnostic clustering of intervention strategies and uniquely positioned the expectancy of future harm as a traumatic stressor. Provider networks were more granular in structure; both groups surprisingly emphasized the role of self-defense as intervention. While both networks had high overlap, their discrepancies highlight patient perspectives that practical, material, and structural changes should occur alongside traditional clinical interventions.

Minority stress and relationship satisfaction among bi+ individuals: The roles of partner gender and sexual orientation.

Minority stress and relationship satisfaction among bi+ individuals: The roles of partner gender and sexual orientation.

Minority stress and resilience experiences in adolescents and young adults with intersex variations/differences of sex development.

Minority stress and resilience experiences in adolescents and young adults with intersex variations/differences of sex development.

Supplemental Material for A Patient-Centered Model of Mental Health Care for Trauma and Minority Stress in Transgender and Gender Diverse People: A Bottom-Up Network Analysis

Supplemental Material for A Patient-Centered Model of Mental Health Care for Trauma and Minority Stress in Transgender and Gender Diverse People: A Bottom-Up Network Analysis

Supplemental Material for Minority Stress and Resilience Experiences in Adolescents and Young Adults With Intersex Variations/Differences of Sex Development

Supplemental Material for Minority Stress and Resilience Experiences in Adolescents and Young Adults With Intersex Variations/Differences of Sex Development

Negative Associations between Minority Stressors and Self-Reported Health Status among Sexual Minority Adults Living in Colombia.

Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients.

Resilience and depression during COVID-19 pandemic shelter-in-place order among Black sexual diverse individuals

This study investigates the relationship between resilience and mental health among Black sexual diverse men residing in Atlanta, GA, during the COVID-19 pandemic. Minority stressors often impact the well-being of sexual diverse individuals; however, resilience may be an important protective factor against the negative effects of such stressors. A total of 109 participants completed surveys during the 2020 COVID-19 state of emergency, shelter-in-place, and social distancing orders in Georgia. Logistic regression models were utilized to examine the associations between resilience, internalized sexual orientation stigma, and depressive symptoms. The results indicate that nearly half of the participants reported high levels of depressive symptoms during the COVID-19 pandemic. The relationship between internalized sexual orientation stigma and depressive symptoms was found to be moderated by resilience. Specifically, higher levels of internalized stigma were associated with higher levels of depressive symptoms among individuals with low and average levels of resilience. These findings emphasize the critical role of resilience in explaining mental health disparities among Black sexual diverse men during large-scale disasters and periods of cultural turmoil. Understanding the complex interplay between resilience, internalized stigma, and mental health can inform targeted interventions and support systems to enhance the well-being of sexual diverse individuals in similar contexts.

Psychological Distress and Suicidality Among Transgender Young Adults in the United States

PurposeTransgender young adults (TYA) are burdened by adverse mental health outcomes. Guided by intersectionality and minority stress frameworks, we compared prevalence of psychological distress and suicidality among TYA of different social identities to inform future interventions. MethodsIn this secondary data analysis of 12,738 TYA, ages 18–25 years, from the 2015 United States Transgender Survey, we developed multivariable regression models examining associations between social identities and psychological distress and suicidality, adjusting for relevant covariates. Self-reported identities were used as proxies for minority stress resulting from structural oppressions related to gender binarism, transmisogyny, heterosexism, and racism. ResultsOverall, 53% met criteria for serious psychological distress, and 66% reported suicidal ideation. Statistically higher odds of serious psychological distress and suicidal ideation and plan were found for TYA assigned male compared to assigned female at birth (adjusted odds ratios [aORs] = 1.14–1.50). Nonbinary TYA assigned male at birth also had lower odds of all outcomes compared to all other TYA (aORs = 0.6–0.7). Compared to White TYA, Latiné/x TYA were more likely to experience serious psychological distress (aOR = 1.19, 95% confidence interval: 1.02, 1.39) and multiracial TYA were more likely to report suicide plan(s) and attempt(s) (aORs = 1.25–1.30). Finally, compared to heterosexual TYA, bisexual/pansexual TYA were more likely to report suicide plan(s) (aOR = 1.28, 95% confidence intervals: 1.04, 1.52), and all sexual minority TYA were more likely to report serious psychological distress and suicidal ideation (aORs = 1.31–2.00). DiscussionResults highlight complex associations between intersectional minority stress and mental health outcomes among TYA. Associations between identities and mental health morbidity highlight an urgent need for targeted mental health interventions.

Prospective examination of mechanisms linking minority stress and anxious/depressed affect at the event level: The roles of emotion regulation strategies and proximal minority stressors.

While studies have linked sexual minority stress with anxious/depressed affect, few studies have prospectively examined how mechanistic processes linking minority stress and anxious/depressed affect unfold in near-real time. Furthermore, studies of mechanisms have focused exclusively on rumination and proximal minority stressors (e.g., internalized stigma). This limits our understanding of other potential mechanisms, such as decreases in the use of reappraisal and reflection, strategies associated with reducing anxious/depressed affect. We used data from a 30-day ecological momentary assessment study with 429 sexual minority women and gender diverse sexual minorities assigned female at birth to determine whether concurrent and prospective event-level associations between minority stress and anxious/depressed affect were mediated by changes in six emotion regulation strategies, perceived coping efficacy, and proximal stressors. In partially lagged analyses, when individuals experienced enacted or internalized stigma, they reported increased rumination and expressive suppression on the same day, which predicted increases in anxious/depressed affect into the next day. Decreases in reappraisal also mediated partially lagged associations between internalized stigma and anxious/depressed affect. Fully lagged mediation was only demonstrated for rumination as a mechanism linking internalized stigma with anxious/depressed affect. We found concurrent evidence for other mechanisms (i.e., perceived coping efficacy, reflection, internalized stigma, and rejection sensitivity). Results provided support for the roles of rumination and expressive suppression as mechanisms of linking minority stress and anxious/depressed affect. The concurrent evidence for other mechanisms suggests that future research with more temporal resolution is necessary to determine the temporality and directionality of these associations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining Factors Associated with Cannabis Use Among Sexual and Gender Minority and Cisgender Heterosexual Emerging Adults in California.

Purpose: We explored correlates of cannabis risk and examined differences between sexual and gender minority (SGM) and cisgender heterosexual emerging adults (ages 18-29) in California. Methods: We recruited 1491 participants aged 18-29 years for a cross-sectional online survey. Ordinal logistic regressions assessed associations between minority stress (discrimination and internalized homophobia [IH]), social support (perceived social support and lesbian, gay, bisexual, transgender, and queer+ [LGBTQ+] community connectedness), and cannabis risk scores (low, medium, and high risk of developing problems related to their cannabis use). We also explored differences in cannabis risk scores by sexual orientation and gender identity (SOGI). Results: Higher everyday discrimination scores were associated with increased odds of self-scoring in a higher cannabis risk range (adjusted odds ratio = 1.53, 95% confidence interval [CI] = 1.31-1.79). We found no significant associations for IH, LGBTQ+ community connectedness, or social support on cannabis risk scores. There were also no statistically significant differences by SOGI groups; however, SOGI did moderate the relationship between IH and cannabis risk score such that the slope for IH was 0.43 units higher for cisgender sexual minority women compared to cisgender sexual minority men (95% CI = 0.05-0.81). Conclusion: Our findings suggest that experiences of everyday discrimination are important contributors to developing cannabis-related problems and IH may have more pronounced effects for sexual minority women compared to sexual minority men. More research is needed to better understand risk and protective factors of cannabis risk to inform the development of culturally tailored interventions for SGM emerging adults.

A qualitative exploration of minority stress, mental health, and sexual health among Arab immigrant sexual minority men in the United States.

To examine experiences of immigration, sexual minority stressors, and mental health and sexual health among first-generation (born outside of the United States) Arab immigrant sexual minority men (SMM) in the United States. We conducted in-depth one-on-one virtual interviews with 16 cisgender men residing in different U.S. states. Interview transcripts were analyzed using thematic analysis to identify the most salient themes and relationships among them. The experiences of Arab immigrant SMM centered around five themes: "my whole plan was to come to the U.S. to be open to who I am," "not fitting in" (homophobia, racism, sexual racism, xenophobia), "a lot of impact on my mental health," sexual health (inconsistent condom use, multiple sexual partners, preexposure prophylaxis use, testing), and coping strategies. Participants reported multiple forms of stressors related to their intersectional identities that affected their mental health, sexual health, and coping strategies. Many stressors were experienced before immigrating to the United States; however, several stressors persisted, and some new ones emerged after immigration. Results call for the development of mental health interventions informed by the unique experiences of Arab immigrant SMM and integrated within community-based organizations to foster adaptive coping strategies, social support, and community belonging. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Mediating Effect of Self-Esteem on the Association Between Minority Stress and Social Well-Being Among Indonesian Young Adult Gay Men and Lesbian Women

This study explores the correlation between minority stress, self-esteem, and social well-being among young adult gay men and lesbian women in Indonesia, by analyzing the mediating role of self-esteem on the correlation between minority stress and social well-being. Design utilized in this study is correlational design with mediation analysis. This study draws on a sample of 437 gay men and lesbian women (Mage = 24). The authors employed Spearman’s correlation and mediation analysis on the three measurement instruments. Results showed that all the measurement instruments correlated with each other significantly. Specifically, minority stress reduces self-esteem and in turn it will also lower the social well-being among young adult gay men and lesbian women in Indonesia. Moreover, the result also indicated that self-esteem have a partial mediating role on the relationship between minority stress and social well-being among young adult gay men and lesbian women. From the result of this study, it can be concluded that self-esteem is an important protective factor on gay men and lesbian women’s self-esteem. Therefore, the authors endorse a cultural shift to reduce minority stress among gay men and lesbian women in Indonesia. Additionally, organizations or mental health professionals may utilize self-esteem and social well-being as a mean for enhancing the mental health of Indonesian gay men and lesbian women.
 
 Studi ini mengeksplorasi korelasi antara minority stress, self-esteem, dan kesejahteraan sosial di kalangan laki-laki gay dan perempuan lesbian dewasa muda di Indonesia, dengan menganalisis peran mediasi self-esteem terhadap korelasi antara minority stress dan kesejahteraan sosial. Desain yang digunakan dalam studi ini adalah desain korelasional dengan analisis mediasi. Studi ini memiliki sampel 437 laki-laki gay dan perempuan lesbian (Mage = 24). Penulis menggunakan korelasi Spearman dan analisis mediasi dengan ketiga instrumen pengukuran. Hasil studi menunjukkan bahwa seluruh instrumen pengukuran berkorelasi satu sama lain secara signifikan. Secara spesifik, minority stress menurunkan self-esteem dan hal ini berakibat pada penurunan kesejahteraan sosial di kalangan laki-laki gay dan perempuan lesbian dewasa muda di Indonesia. Selain itu, hasil studi juga menunjukkan bahwa self-esteem memiliki peran mediasi parsial pada hubungan antara minority stress dan kesejahteraan sosial di kalangan laki-laki gay dan perempuan lesbian dewasa muda. Dari hasil studi ini, dapat disimpulkan bahwa self-esteem merupakan faktor pelindung yang penting terhadap self-esteem laki-laki gay dan perempuan lesbian. Maka dari itu, penulis mendukung perubahan budaya untuk mengurangi minority stress di kalangan laki-laki gay dan perempuan lesbian di Indonesia. Selain itu, organisasi atau layanan profesional kesehatan mental dapat memanfaatkan self-esteem dan kesejahteraan sosial sebagai sarana untuk meningkatkan kesehatan mental laki-laki gay dan perempuan lesbian di Indonesia.

Sexual orientation and gender identity expression, internalized stigma, and mental health during the COVID-19 pandemic

For college students, holding a minoritized, stigmatized sexual orientation, gender identity, or both (SOGI) may have compounded the stress and upheaval of the COVID-19 pandemic, impacting not only their ability to freely express their SOGI but also their mental health and well-being. Using minority stress theory and mixed methodologies, we examined associations among lesbian, gay, bisexual, transgender, queer, questioning, or other sexual and/or gender diverse (LGBTQ+) college students’ (N = 368, M age = 20.5) perceived pandemic-related changes in SOGI expression, internalized LGBTQ+ stigma, and mental health. Consistent with minority stress theory, students who thought the pandemic restricted their SOGI expression and who had more internalized LGBTQ+ stigma had worse mental health than their peers. In addition, students who thought the pandemic restricted their SOGI expression perceived that their mental health worsened due to the pandemic. The importance of SOGI expression for mental health during the pandemic has implications for tailored university programming to support LGBTQ+ students’ mental health during times of stress and transition beyond the pandemic.

166. Relationship Quality and Minority Stressors Predicts Health Symptoms Among Partnered Adolescent Sexual Minority Males

166. Relationship Quality and Minority Stressors Predicts Health Symptoms Among Partnered Adolescent Sexual Minority Males

Everyday prejudices: an intersectional exploration of the experiences of lesbian and gay entrepreneurs

PurposeThere is a gap in understanding with regards to the discrimination and prejudice experienced by gay entrepreneurs. To address this, an intersectional perspective is adopted to facilitate a better understanding of how lesbian and gay entrepreneurs may experience heterosexism.Design/methodology/approachThis qualitative study uses semi-structured interviews to explore the experiences of 14 lesbian and gay entrepreneurs as they navigate homophobia and heterosexism.FindingsThe study contributes novel insights to the field of entrepreneurship, extending the study of lesbian and gay entrepreneurs to include gender and a fine-grained analysis of the experience of heterosexism. Its inclusion of an intersectional perspective of the lesbian-female entrepreneur expands the emerging body of literature examining intersectional identities of minority entrepreneurs.Originality/valueThe authors provide a more nuanced understanding of the impact of heterosexism on LGBT+ entrepreneurial activities. This is facilitated by the authors' adoption of an intersectional perspective which shows how the different axes of identity influenced gender identity performance in relation to the model of perceived neutrality in LGBT+ entrepreneurship. The authors also make an original contribution to minority stress literature through the authors' exploration of one facet of minority entrepreneurship, namely the impact of heterosexism on LGBT+ entrepreneurial activities.

Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals.

Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.

Affectionate Communication Mediates the Effects of Minority Stress on Mental Wellness for LGBTQIA+ Adults

ABSTRACT As a prosocial behavior, affectionate communication evidences a stress-buffering effect, ameliorating the deleterious effects of stressors on stress. Although much previous research has documented such an effect on physiological stress reactivity, the present study examines the ability of trait-level affectionate communication to mediate the effect of minority stress on mental wellness for LGBTQIA+ adults. Using a sample of U.S. American LGBTQIA+ adults (N = 494), this project demonstrates that psychological stress and depressive symptoms are negatively associated with trait affectionate communication and that trait affectionate communication partially mediates the effect of minority stress on these outcomes.

Emphasizing Sexual Orientation and Gender Identity Data Capture for Improved Cardiovascular Care of the LGBTQ+ Population

ImportanceThe rising self-identifying lesbian, gay, bisexual, transgender, and queer (LGBTQ+) population makes understanding the unique health care needs of sexual and gender minoritized patients an urgent one. The interaction between minority stress and cardiovascular disease has been well described among underrepresented minoritized populations. The underrepresentation of minoritized populations in clinical research is partly responsible for worse cardiovascular outcomes in these populations. The absence of sexual orientation and gender identity and expression (SOGIE) data makes it difficult to understand the cardiovascular health of LGBTQ+ adults, thereby widening health care disparities in this population. Advancing cardiovascular health equity for LGBTQ+ patients must begin with careful and accurate SOGIE data collection.ObservationsCurrent SOGIE data capture remains inadequate despite federal mandates. Challenges in data collection include political and regulatory discrimination, patient/practitioner hesitancy, lack of supportive guidance on SOGIE data collection, improper terminology, regulatory inertia, and inadequate and often incorrect integration of SOGIE data into electronic health records (EHRs). Additional challenges include grouping participants as “others” for statistical significance. The inclusion of SOGIE data has demonstrated an impact in other fields like cancer survivorship and surgery. The same needs to be done for cardiology.Conclusions and RelevancePotential solutions for improving much-needed SOGIE data collection include (1) implementing LGBTQ+ inclusive policies, (2) integrating SOGIE data into the EHR, (3) educating health care professionals on the relevance of SOGIE to patient-centered care, and (4) creating a diverse cardiovascular workforce. These steps can substantially enhance the ability to collect SOGIE data to address LGBTQ+ cardiovascular health care disparities.