Minority Stress Research Articles

Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals

IntroductionIndividuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression, anxiety, and suicide. Gender dysphoria is a DSM-5 diagnosis but is not necessary for transition therapy. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience “minority stress” from increased discrimination, leading to a greater risk for mental health problems. This study aimed to identify possible health disparities in patients hospitalized for depression with gender dysphoria across the United States. Depression was selected because patients with gender dysphoria are at an increased risk for it. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.MethodsThe National Inpatient Sample was used to identify nationwide patients with depression (n = 378,552, weighted n = 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals’ gender dysphoria was associated with healthcare utilization measured by hospital cost per stay. Multivariate survey regression models were used to identify predictors.ResultsAmong the 1,892,760 total depression inpatient samples, 14,145 (0.7%) patients had gender dysphoria (per ICD-10 codes). Over the study periods, depression inpatients with gender dysphoria increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital cost per stay than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.ConclusionDifferences in hospital cost per stay for depression inpatients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital cost per stay and add to the cycle.

Effects of Alcohol Use and Minority Stress on Intimate Partner Violence Perpetration among Transgender and Gender Diverse People.

Intimate partner violence (IPV) is highly prevalent among transgender and gender diverse (TGD) adults. Integrated theories of minority stress and alcohol-related IPV suggest minority stress risk and protective factors should interact with alcohol use to predict IPV, although this has never been examined in TGD adults. Thus, we examined the synergistic influence of alcohol use, minority stress, and TGD community connectedness on IPV perpetration among TGD adults. A sample of 137 TGD adults completed a cross-sectional survey assessing minority stressors (i.e., internalized transnegativity, identity outness), TGD community connectedness, alcohol use/problems, and IPV perpetration (i.e., psychological, physical, and gender minority identity-specific abuse). We regressed each form of IPV perpetration on alcohol use/problems and tested the moderating effect of internalized transnegativity, identity outness, and community connectedness on the association between alcohol use/problems and IPV perpetration. The association between alcohol use/problems and all forms of IPV perpetration were moderated by internalized transnegativity and identity outness, but not TGD community connectedness. Alcohol use/problems related to each form of IPV perpetration at low and medium, but not high levels, of identity outness and internalized transnegativity. Alcohol use/problems is an important risk factor for IPV perpetration among TGD adults and this association may be exacerbated by less identity outness. Further, internalized transnegativity might not influence IPV risk at high levels of alcohol use. TGD-affirming IPV prevention programs might focus on reducing alcohol use and related problems while providing a safe and accessible space for TGD individuals at various levels of identity outness.

The Role of Attachment Anxiety and Avoidance in Predicting Proximal Minority Stressors among Gay and Lesbian People in Italy.

As has been widely documented, minority stress affects the psychosocial well-being of gay and lesbian people. Recently, researchers have turned their attention to psychological factors that may influence the level of minority stress experienced, in order to explain individual differences in perceptions of proximal minority stressors. The present research aimed at assessing the effect of attachment avoidance and anxiety on levels of perceived stigma and internalized homonegativity. A total of 163 participants who self-identified as lesbian or gay (Mage = 32.56, SD = 10.87) were recruited and responded to the self-report questionnaires. Two multiple regression models were applied to assess the association between adult attachment and perceived stigma and internalized homonegativity. Results showed a positive association between attachment anxiety and avoidance and internalized homonegativity, as well as between attachment avoidance and perceived stigma. The emerging results demonstrate the impact of attachment anxiety and avoidance on proximal minority stressors and provide useful data for interventions addressing lesbian and gay people aimed at promoting security-based strategies of affect regulation and positive representations of self and others, which in turn may reduce the level of proximal minority stressors experienced and promote psychosocial well-being.

Exploring the Situational Contexts of Heterosexual and Sexual Minority Adolescent Suicidality: A Partial Test of Minority Stress Theory

Data from the 2019 Minnesota Student Survey, consisting of 166,176 students ranging in age from 10 to 18 years, were used to investigate patterns of adolescent suicidal ideation and attempt through the lens of Minority Stress Theory (MST). Through a conjunctive analysis of case configurations (CACC), the current study demonstrates that adolescent suicidal ideation and attempt cluster significantly among specific situational profiles defined by the unique combination of variable attributes. Students most likely to indicate suicidal ideation were generally sexual minority females in high school who experienced cyberbullying, parental abuse, dating violence, and sexual abuse. Students least likely to report suicidal ideation were generally non-sexual minorities in elementary school who nearly never experienced parental abuse, dating violence, or sexual abuse. Results regarding adolescent suicide attempt indicate analogous results. The current findings highlight the importance of furthering research on contextual predictors of adolescent suicidality, with particular emphasis on sexual minority adolescents.

Suicide Ideation Among Transgender and Gender Diverse Adolescents: The Role of Parental Invalidation of Adolescents' Gender Identity.

Transgender and gender diverse (TGD) youth experience chronic and acute stressassociated with their gender identity contributing to their increased risk of suicide and suicide ideation (SI) compared to non-TGD peers. This study examined how invalidating and accepting gender-related experiences with a parent impact SI severity among TGD adolescents cross-sectionally and longitudinally, within-person.Participants were 15 TGD adolescents with past month SI recruited across community and clinical settings. Adolescents completed a baseline assessment of validated interviews and self-report measures on parental invalidation and SI severity. Over a 14-day follow-up period, adolescents reported instances of parental gender invalidation and acceptance, relative stress of those experiences, and SI severity multiple times/dayvia ecological momentary assessment (EMA). Bivariate associations of parental invalidation and acceptance with SI were examined at baseline, while multilevel models examined the relationship within-person over follow-up. Cross-sectionally, greater perceived invalidation and non-affirmation by their parents was associated with more severe SI. Over the follow up, instances ofperceivedparental invalidation were associated with passive SI within-person. Findings partially supportthe minority stress theory and social safety perspectiveby showing that perceived gender-invalidation from parents affectsSIin TGD adolescents, both cross-sectionally and longitudinally. Further research is needed to identify specific emotional and cognitive factors, such as perceived stress, that contribute to the risk ofSIamong TGD youth and inform the development of targeted interventions for this vulnerable population.

Experimental study on the deformation and failure mode of surrounding rocks of a tunnel in a jointed rock mass

The existence of jointed rock masses in tunnels is a key problem that leads to the deformation and instability of the surrounding rock. Based on the engineering background of the Qingdao Metro, a physical model and a numerical model are constructed to analyze the mechanism of deformation and instability of the surrounding rock of a jointed tunnel using model blocks that conform to the characteristics of joint distribution. The results show that during the whole test process, the cracks between the blocks in the tunnel arch are in the “development − stability − closure − penetration” state. Finally, the block falls in the left area of the tunnel, and the corresponding anchor axial force transits from the linear growth stage to the steady growth stage. After the axial force of the rock bolt suddenly decreases in the loading stage, the bolt enters the stability stage, and finally, S-shaped failure occurs when the surrounding rock is unstable. Under the action of a prestressed rock bolt, the normal stress and radial stress of the rock mass increase, and the difference between the major and minor principal stresses decreases significantly. The radial stress on the surrounding rock surface of the arch is approximately 8 % greater than that in the traditional rock bolt scheme, which improves the strength reserve of the rock mass. In the field test, the prestressed rock bolt can control the deformation of the surrounding rock in the arch within 2 ∼ 5 mm, which provides a reference for the control of the surrounding rock in jointed tunnels.

Measuring Shame Related to Sexual Orientation: Validation of Sexual Minority—External and Internal Shame Scale (SM-EISS)

Abstract Introduction Shame is a self-conscious emotion involving negative self-evaluations, being a transdiagnostic factor for psychopathology. Due to stigma and discrimination experiences related to having a minority sexual orientation, LGB+ (lesbian, gay, bisexual, and other minority sexual orientations) people report higher levels of general shame than heterosexual people. To our knowledge, there is no specific measure of shame related to sexual orientation. This study aimed to develop and explore the psychometric properties of the Sexual Minority—External and Internal Shame Scale (SM-EISS) in a sample of Portuguese LGB+ people. Method The sample was recruited online between December 2021 and January 2022 and comprised 200 Portuguese LGB+ people (Mage = 27.8 ± 8.9) who completed measures about shame, proximal minority stressors, and mental health. Results Good psychometric characteristics were found for a second-order two-factor structure (general, external, and internal shame related to sexual orientation), with the SM-EISS demonstrating good reliability and validity values. Conclusion The SM-EISS seems to be a valid and reliable instrument to assess shame related to sexual orientation among LGB+ people and may be beneficial in clinical and research contexts. Policy Implications Measuring shame related to sexual orientation experienced by LGB+ people could enhance the clinical understanding of this population. It can help researchers and clinicians to better understand this emotion and how it affects LGB+ people’s mental health and well-being. The research has important implications for clinical practice, social interventions, and public policies to protect LGB+ people’s rights. This is especially relevant in Portugal, where, despite positive legal developments, LGB+ people continue to experience harmful situations that negatively impact their mental health.

"Being Queer, It Was Really Isolating": Stigma and Mental Health Among Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Young People During COVID-19.

Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual and gender minority (LGBTQ+) youth and young adults (YYAs) have poorer mental health outcomes than their cisgender, heterosexual peers in large part due to multilevel stigmatization and minority stress. This was exacerbated by psychological stressors stemming from the COVID-19 pandemic; these experiences intersected with YYA unique developmental stage. Here we explored LGBTQ+ YYA's pandemic-related experiences, focusing on intersections between stigma and belonging, developmental processes, and their relationship to mental health. We conducted qualitative interviews from August to November 2021 with 34 LGBTQ+ YYA ages 14 to 24; interviews were nested within a quantitative study on YYA experiences during COVID-19. Interviews were transcribed and coded using thematic analysis. YYA described how pandemic impacts like quarantine and isolation directly impacted their mental health; these coalesced around four types of thematic shifts: shifts in (1) time, (2) living situations, (3) community supports, and (4) social and political climate. Multilevel stigmatization also created new mechanisms of norm enforcement for LGBTQ+ YYA. Interviews demonstrated how the pandemic also impacted key developmental processes including identity formation and autonomy seeking. The potential consequences of these pandemic-related shifts largely depended on YYA's experiences of stigma and/or belonging throughout the pandemic. Findings suggested that isolation from the COVID-19 pandemic intersected with existing socio-ecological structures in LGBTQ+ young people's lives. Efforts to investigate longitudinal impacts of the pandemic, as well as to intervene to reduce the stigmatization experienced by LGBTQ+ YYA, remain urgent.

Social Connectedness and Identity Resilience Buffer Against Minority Stress and Enhance Life Satisfaction in Ethnic and Sexual Minorities in the UK

Social Connectedness and Identity Resilience Buffer Against Minority Stress and Enhance Life Satisfaction in Ethnic and Sexual Minorities in the UK

Effects of Racist Microaggressions and Sexual and Gender Minority Stress on Mental Health Among Latinx Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning + Young Adults.

This study examines the effects of racist microaggressions and lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-related minority stressors (i.e., identity concealment, family rejection, internalized LGBTQ-phobia, victimization, and racialized heterosexism/cisgenderism) on psychological distress among Latinx LGBTQ+ young people, specifically college students. Participants are a Latinx subset (n = 80) from a national online nonprobability cross-sectional survey of LGBTQ+ college students. The study aim was examined using linear/logistic regression. Findings indicated that racist microaggressions and family rejection were associated with psychological distress. In addition, racist microaggressions were the only stressor associated with clinically significant psychological distress that may warrant psychiatric/psychological treatment. Therefore, racist microaggressions and family rejection are unique stressors that may saliently affect mental health among Latinx LGBTQ+ students. There is a great need to integrate minority stress theory with other critically-oriented theories, such as intersectionality, in research and intervention to eliminate mental health inequities faced by Latinx LGBTQ+ young people.

Burden of the Fruity: Family Support and Suicide Ideation as Mediators Between Discrimination and Suicide Behavior in LGBTQ+ Malaysians

ABSTRACT Malaysian pervasive climate places its LGBTQ+ residents at heightened risk for suicidal behaviors (SB). This cross-sectional study aimed to elucidate connections between minority stressors (discrimination), types of social supports, and suicidality in this marginalized population. Utilizing online surveys, 317 LGBTQ+ Malaysians aged 18–49 provided data regarding experienced discrimination, perceived social support from family, friends, and significant others, suicidal ideation (SI), and SB. Quantitative analyses illuminated several key findings. First, discrimination is positively associated with SB, while all support types are inversely related to SB, with family support demonstrating the strongest correlation. Regression modeling revealed family support as the sole unique predictor of reduced SB. Serial mediation analysis uncovered nuanced indirect pathways from discrimination to SB, with SI, but not family support alone, significantly mediating this relationship. However, reduced family support resulting from discrimination sequentially heightened SI and SB. Despite pervasive societal bias, family and friend acceptance may curb the LGBTQ+ community’s elevated suicide risk by mitigating resultant ideation. These insights highlight the need for public health initiatives promoting social support and LGBTQ+ inclusivity laying the groundwork to safeguard this population’s psychological wellbeing.

A National Longitudinal Study of Same-Sex Partnership and Self-Rated Health Trajectories

We know little about population-based patterns on same-sex partnership and health from a longitudinal perspective, largely due to data limitations. In this study, we analyzed nationally representative longitudinal data to compare changes in self-rated health trajectories for individuals in same-sex cohabitation, different-sex marriage, and different-sex cohabitation. Data were drawn from the 1996, 2001, 2004, and 2008 panels of the Survey of Income and Program Participation, with each panel including 2–4 years of follow-up information on self-rated health. The analytic sample included 103,995 respondents who contributed 294,944 person-period records. Results from growth curve models suggest that same-sex cohabitors experienced a slower rate of decline in self-rated health over time than both different-sex married and different-sex cohabiting respondents. Further analyses show that same-sex cohabitation is associated with a slower rate of health decline only for women but not for men. We discuss the implications of these findings in relation to the minority stress theory and the gender-as-relational perspective.

Mental Healthcare Needs and Experiences of LGBT+ Individuals in Malaysia: Utility, Enablers, and Barriers.

Access to mental healthcare is undoubtedly of major importance for LGBT+ people worldwide, given the high prevalence of mental health difficulties due to minority stress exposures. This study drew mixed-method survey data from the community-based KAMI Survey (n = 696) to examine the enablers, barriers, and unmet needs experiences of LGBT+ individuals in accessing mental healthcare services in Malaysia. First, we present findings from a series of descriptive analyses for sociodemographic differences in unmet needs for mental healthcare, barriers, and satisfaction levels with different types of mental healthcare. Next, we conducted an inductive thematic analysis of open-text comments (n = 273), with relevance drawn to Andersen's Behavioural Model of Healthcare. More than a quarter (29.5%) reported an unmet need for mental healthcare, and some groups (younger, asexual or queer, or participants living in non-major cities) reported higher unmet needs. More than three-fifths (60.5%) reported not knowing where to find culturally safe mental health professionals. The thematic analysis uncovered key contextual (e.g., mental health practitioners' stance, stigma, collaborative client-care) and individual (e.g., positive expectation of mental health services and anticipated stigma) attributes that influence healthcare experiences. Participants also identified resources that facilitate healthcare utilisation, such as affordability, availability of suitable professionals, and geographical considerations. The implications of our findings for the mental healthcare practices in Malaysia were outlined.

Picturing the dance: intersections of gender, sexuality, and age in older women queer square dancers

A dearth of research has focused on the diverse experiences of aging sexual minority populations and, in particular, older sexual minority women. Studies that have disaggregated the population of lesbian, gay, bisexual, transgender, questioning, queer, intersex and two-spirit (LGBTQIS+) older adults reveal that due to minority stress and a lifetime of disadvantage. Lesbians experience higher rates of chronic health conditions and mental health problems (including loneliness) than heterosexual women and greater financial inequalities compared to gay men or heterosexual women. Despite this, limited inquiry has explored the everyday lives of older queer women and fewer still draws upon women’s commentary on their own lived experiences or centers older women as authoritative agents and experts on their own lives. In response to this knowledge deficit, this research traverses the aging experiences of female-identified members of a gay square dance (GSD) club in Toronto, Canada. We apply queer theory to explicate the unique ways in which a GSD club queers the aging process for 14 older women dancers. Findings of the inquiry highlight the ways in which these dancers confront and reject heteronormativity, while illuminating pathways to successful aging for older sexual diverse women. The older women dancers in this study perform gender in ways that challenged heteronormativity and gender binaries, enhanced belongingness and acceptance, embodied joy, and fostered wellness. These concepts have been identified as critical factors in successful aging and highlight what queering aging might look like for this resilient population who have overcome a lifetime of disadvantage.

A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals

A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals

The gender minority stress model and/or cisnormativity? The need for pluralistic theoretical perspectives in improving trans health and medicine

The minority stress model has become a well-used framework to explain and analyse health among LGBTQ people, and specifically among transgender and gender-diverse people (TGD), when it is sometimes called ‘the gender minority stress model’. Scholars have argued the need for critical discussions about some of the assumptions underlying the gender minority stress model and how it has been used and discussed. Drawing on a pluralistic understanding of theories and employing a Foucauldian understanding of critique, we discuss implicit assumptions and epistemological standpoints of the gender minority stress model and the connected limitations. We also ask what the concept of cisnormativity can give rise to in comparison with the minority stress framework. We make four arguments: 1) the calls for extensions to the model could be seen as a desire to understand and analyse TGD people's health from an all-encompassing perspective, resulting in theoretical vagueness and the silencing of excluded aspects; 2) in the gender minority stress literature, identity is largely taken for granted and there is no consideration of how power is constitutive for all subjects; 3) the model risks individualising the effects of social norms, and internalisation could be further theoretically developed in relation to the repression hypothesis; 4) in the translation process from LGB minorities to TGD, as well as in thinking about cisnormativity, the issue of gender-affirming care has largely been neglected. By initiating a critical discussion around these issues and illustrating how different theories and frameworks can illuminate different possibilities for thinking and knowing, we aim to open up new routes for thinking about TGD health and medicine.

Trends in simultaneous alcohol and marijuana use among US adult recent drinkers: Differences by sexual identity, 2015–2020

Simultaneous alcohol and marijuana (SAM) use has become increasingly prevalent among young adult populations. Moreover, lesbian, gay, and bisexual populations are at increased risk for substance use initiation. To date, little research has examined trends in SAM use by sexual identity. This study aimed to investigate trends in SAM use among recent drinkers using nationally representative data. Pooled data from the 2015–2019 and 2020 National Survey on Drug Use and Health (NSDUH) were examined among 120,061 individuals (5.75% LGB) 18 years or older who reported using alcohol in the past month. Given the methodological changes in the study design, we analyzed these waves separately. Covariates included age, race, biological sex, sexual identity, rurality, and past month use of tobacco. Weighted logistic regression models and trend analyses were conducted. An estimated 11,952 of the sample reported using marijuana during their last episode of drinking. A significant linear trend (b = 0.12) of increasing SAM use among recent drinkers from 2015 to 2019. When compared to heterosexual individuals, lesbian or gay (aPR: 1.44, 95% CI 1.26, 1.63) and bisexual (aPR: 1.92, 95% CI 1.77, 2.09) individuals were more likely to report SAM use. Among the entire sample, females had a lower risk of SAM use than males (aPR: 0.68, 95% CI 0.65, 0.72). For 2020, a total of 25,679 adults 18 years or older participated in the survey, with 2622 identifying as LGB and 54.1% reporting past month alcohol use. An estimated 1503 individuals reported SAM use. Consistent with our findings, of those reporting past month alcohol use, LGB populations were at higher risk for SAM use, with gay individuals (aPR: 1.59, 95% CI 1.11, 2.30) at increased risk and bisexual individuals having higher risk (aPR: 2.12, 95% CI 1.73, 2.60). SAM use among individuals presents several critical health concerns, especially for at-risk populations. Findings from the present study can inform tailored interventions to reduce minority stress and stigmatized identities are needed.

Understanding daily and momentary drinking motives among transgender and gender diverse adults

Background Transgender and gender diverse (TGD) adults may be at increased risk for alcohol use due to gender minority stress (GMS) and specific drinking motives. Aim The current study evaluated the relations between GMS and resilience, drinking motives, and alcohol outcomes among TGD adults. Methods Twenty-five primarily White TGD adults (7 transgender men, 7 transgender women, and 11 gender diverse) who were 19 years of age or older (mean: 32.60; SD: 10.82), lived in Canada, and drank regularly were prompted to complete surveys multiple times per day indexing drinking motives, GMS and resilience factors, contexts, and alcohol use and craving. Multilevel models examined predictors of each drinking motive and relations between drinking motives and alcohol outcomes at the daily and momentary levels. Results Days with increased GMS corresponded with increased social (p<.05) and conformity motives (p<.01). Days with increased resilience also corresponded with elevated social (p<.01) and conformity (p<.05) motives. Days with higher enhancement and social motives predicted increased alcohol use (ps<.01). All momentary motives were elevated when participants reported higher momentary resilience (p<.001). Significant associations between drinking motives, contexts, and alcohol craving were also evident. Discussion GMS and certain drinking motives may contribute to increased alcohol use and craving among TGD adults. Findings encourage the development of gender-inclusive interventions that address GMS and specific drinking motives to support a reduction in this population’s alcohol use.

An mHealth Intervention for Gay and Bisexual Men's Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică): Protocol for a Randomized Controlled Trial.

The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men's co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. To test Comunică's efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men's identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753. DERR1-10.2196/52853.

A latent profile analysis of bi+ women’s minority stress experiences: Associations with partner gender.

A latent profile analysis of bi+ women’s minority stress experiences: Associations with partner gender.