Proximal Minority Stressors Research Articles

School Climate and Student Mental Health: Conceptions and Experiences of Nonbinary Students

Anti-transgender school policies have proliferated in the United States from 2019 to 2024, impacting school climate for transgender and nonbinary learners. In this quantitative study, we examined differences in the experiences of school climate factors (e.g., safety, mattering, mental health outcomes, etc.) between male, female, and nonbinary high school students in Virginia ( N = 219,233) using a gender minority stress framework. Nonbinary students reported greater exposure to distal and proximal minority stressors and worse mental health outcomes than male or female students. We explore implications for school counselors.

Workplace harassment as a moderator of sexual minority employees’ minority stress and psychological distress

ABSTRACT Proximal minority stressors (e.g. internalised homonegativity, motivation to conceal a sexual minority identity) have severe adverse effects on sexual minority individuals’ mental health. Many sexual minorities report experiencing workplace harassment, which is linked to poorer mental health outcomes. However, the precise nature of how workplace harassment shapes the relationship between minority stress and mental health is unknown. To address this question, we tested the moderation effect of workplace harassment on the relationship between proximal minority stressors, specifically internalised homonegativity and concealment motivation, and psychological distress (i.e. depression, anxiety, somatisation) using Hayes’ PROCESS macro package in SPSS. Sexual minority employees living in the United States (N = 529) completed a survey involving measures of proximal minority stressors, workplace harassment, and psychological symptoms via Prolific. Results of the moderation analyses supported the hypothesis that workplace harassment amplifies the positive relationship between internalised homonegativity and anxiety symptoms as well as the relationship between internalised homonegativity and somatic symptoms, though a similar moderation effect was not found for depression. We did not find a significant moderation effect of workplace harassment on the link between concealment motivation and psychological symptoms. We conclude by emphasising the importance of creating safer workplace environments for sexual minorities and identifying directions for future research.

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.

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.

Development and validation of the nonbinary distal minority stressors, proximal minority stressors, and resilience scales.

Development and validation of the nonbinary distal minority stressors, proximal minority stressors, and resilience scales.

Supplemental Material for Development and Validation of the Nonbinary Distal Minority Stressors, Proximal Minority Stressors, and Resilience Scales

Supplemental Material for Development and Validation of the Nonbinary Distal Minority Stressors, Proximal Minority Stressors, and Resilience Scales

The Associations Between Gender Minority Stressors and PTSD Symptom Severity Among Trauma-Exposed Transgender and Gender Diverse Adults

ABSTRACT This study investigates associations between minority stressors, traumatic stressors, and post-traumatic stress disorder (PTSD) symptom severity in a sample of transgender and gender diverse (TGD) adults. We utilized surveys and clinical interview assessments to assess gender minority stress exposures and responses, and PTSD. Our sample (N = 43) includes adults who identified as a minoritized gender identity (i.e., 39.5% trans woman or woman, 25.6% trans man or man, 23.3% genderqueer or nonbinary, 11.6% other identity). All participants reported at least one traumatic event (i.e., life threat, serious injury, or sexual harm). The most common trauma events reported by the sample were sexual (39.5%) and physical violence (37.2%), with 40.9% of participants anchoring their symptoms to a discrimination-based event. PTSD symptom severity was positively correlated with both distal (r = 0.36, p = .017) and proximal minority stressors (r = 0.40, p < .01). Distal minority stress was a unique predictor of current PTSD symptom severity (b = 0.94, p = .017), however, this association was no longer significant when adjusting for proximal minority stress (b = 0.18, p = 0.046). This study suggests that minority stress, especially proximal minority stress, is associated with higher PTSD symptom severity among TGD adults.

Problematic alcohol use among gay, bisexual, and other men who have sex with men in Canada: the role of proximal stressors and anxiety

BackgroundGay, bisexual, and other men who have sex with men (GBM) report high rates of problematic alcohol use, anxiety, and depression. This may, in part, be due to stressors related to their sexual identity (i.e., minority stressors). However, few studies have examined both distal and proximal stressors, as well as the specific psychological mechanisms by which these stressors may be related to alcohol use outcomes, in a representative sample of GBM. We explored the relationship between distal and proximal stressors and alcohol use outcomes, as well as the role of anxiety and depression as potential mediators of these relationships.MethodsWe analyzed the baseline data of 2,449 GBM from Engage, a cohort study of sexually active GBM recruited using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver from February 2017 to August 2019. Using structural equation modeling, we examined the associations between distal minority stressors (i.e., experiences of heterosexist harassment, rejection, and discrimination), proximal minority stressors (i.e., internalized homonegativity, concerns about acceptance, concealment, and lack of affirmation), anxiety and depression, and alcohol consumption and alcohol use problems. RDS-adjusted analyses controlled for age, income, sexual orientation, ethnicity, recruitment city, and HIV serostatus.ResultsThere were positive direct associations between distal stress and proximal stress, anxiety, and depression, but not alcohol use outcomes. Proximal stress had a positive direct association with anxiety, depression, and alcohol use problems, but not alcohol consumption. Anxiety was positively associated with alcohol consumption and alcohol use problems. Depression was negatively associated with alcohol consumption but not alcohol use problems. Regarding indirect effects, distal stress was associated with alcohol use outcomes via proximal stress and anxiety, but not via depression.ConclusionsWe found support for a minority stress model as it relates to alcohol use outcomes among GBM. Findings suggest that proximal minority stress and anxiety differentially impact the problematic alcohol use among GBM who experience heterosexist discrimination. Clinical providers should consider incorporating the treatment of proximal minority stressors and anxiety into existing alcohol interventions for GBM.

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).

Distal and Proximal Minority Stressors on Patterns of Tobacco and Cannabis Use Among Young Bisexual Women.

Bisexual women have high rates of tobacco and cannabis use, but few studies have examined co-use behavior in this population. Although the role of distal minority stressors (eg, discrimination) on substance use has been examined, fewer studies have examined proximal minority stressors (eg, negative sexual identity self-schemas). The current study was a secondary data analysis that examined patterns of tobacco and cannabis use, and the role of distal (instability of bisexuality, sexual irresponsibility of bisexual people, and hostility toward bisexual people) and proximal (illegitimacy of bisexuality, anticipated binegativity, internalized binegativity, and identity affirmation) bisexual-specific minority stressors among bisexual women. Participants were 224 young (aged 18-30 years old) self-identified bisexual women who reported on their past 30-day tobacco and cannabis use and completed measures of distal and proximal bisexual-specific minority stressors. Participants were categorized into one of 4 patterns: no use, tobacco use only, cannabis use only, and tobacco and cannabis co-use. The most common pattern of past 30-day use was tobacco and cannabis co-use (39.1%). Results from a multinomial logistic regression revealed that bisexual women who reported higher illegitimacy of bisexuality, a proximal minority stressor, were significantly more likely to engage in tobacco and cannabis co-use, relative to no use. Bisexual women have particularly high rates of substance use, with tobacco and cannabis co-use as the most common pattern. Incorporating the role of proximal minority stressors, and specifically, beliefs about the legitimacy of bisexuality, may be an important target of substance use interventions for bisexual women.

Supplemental Material for 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

Supplemental Material for 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

Adult attachment and minority stress in lesbian and gay people in Italy

As widely demonstrated, minority stress negatively affects well-being of LGBTQIA+ people. Recently, the literature has inquired into the psychological factors that may explain individual differences in levels of minority stressors experienced. In particular, some studies have focused on the role of adult attachment, although further studies seem necessary to understand its impact on proximal minority stressors. Through three multiple regression models, the present research analyzed the impact of adult attachment avoidance and anxiety on perceived stigma, internalized homonegativity and sexual orientation concealment, controlling for theeffect of proximaland distal minority stressors. One hundred and twenty-one people who self-identified as lesbian or gay and were involved in a romantic relationship when completing the questionnaire participated in the research. After controlling for the effect of distal and proximal minority stressors, data support a positive relationship between attachment anxiety and internalized homonegativity, and between attachment avoidance and sexual orientation concealment. However, the latter regression model was not significant. Finally, no significant relationship emerged between adult attachment and perceived stigma. The results are at least in part in line with the scarce literature on the topic. Further studies are needed to further support and extend the data emerging in the present study, in order to inform interventions aimed at promoting the well-being of LGBTQIA+ people.

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

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

Chronic illness and disability among sexual minority persons: Exploring the roles of proximal minority stress, adaptation, and quality of life.

Chronic illness and disability among sexual minority persons: Exploring the roles of proximal minority stress, adaptation, and quality of life.

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

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

Minority stress, repetitive negative thinking, and internalizing symptoms in sexual minorites: Does cognitive content matter?

The Psychological Mediation Framework theorizes that repetitive negative thinking (RNT) mediates the relationship between minority stress and mental health, and this theory has been consistently supported by previous research. Yet, it is unclear whether the process or content of RNT is more important in the development of internalizing symptoms in sexual minorities. Consequently, the goal of the current study was to use structural equation modeling to determine whether there are significant indirect effects of repetitive negative thought content in the relationship between minority stress and internalizing psychopathology. Measures of RNT, internalizing symptoms, and proximal minority stress were completed online by 205 cisgender sexual minority adults. Structural equation modeling was used to examine indirect effects of proximal stress on internalizing symptoms through content-independent RNT, depressive rumination, and sexual orientation-related rumination. Significant direct effects of proximal minority stress on internalizing symptoms were observed. Indirect effects of proximal stress on internalizing symptoms were observed for content-independent RNT and depressive rumination, but not sexual orientation-related rumination. The current study provides evidence that the process and affective valence of RNT contributes more to internalizing symptoms in sexual minorities when compared with sexual orientation-related content. Theoretical and clinical implications are discussed.

Mental health in transgender adults: The role of proximal minority stress, community connectedness, and gender nonconformity.

Mental health in transgender adults: The role of proximal minority stress, community connectedness, and gender nonconformity.

Effect of perceived public stigma on internalized homophobia, anticipated stigma, shame, and guilt: Outness as a moderator

Although previous studies found that distal minority stress contributes to proximal minority stress and shame/guilt among the lesbian, gay, and bisexual (LGB) population, it is unclear whether the extent to which LGB individuals' open display and discussion their sexual orientation moderates these relationships. A total of 1,452 Chinese LGB adults provided demographic information and completed measures of outness, perceived public stigma, internalized homophobia, anticipated stigma, shame, and guilt. Structural equation modelling was conducted to test the hypothesized moderation analyses. Perceived public stigma had positive associations with internalized homophobia, anticipated stigma, shame, and guilt. Outness played a moderating role in the associations of perceived public stigma with internalized homophobia, anticipated stigma, shame, and guilt. Specifically, when LGB individuals had higher levels of outness, the effects of perceived public stigma on internalized homophobia, anticipated stigma, shame, and guilt were lower. Moreover, such moderating effect did not differ by sexual orientation. The degree to which sexual minority individuals' sexual orientation is known by and openly discussed with others may lower the extent to which LGB individuals internalize sexual stigma, expect rejection after coming out, and develop shame and guilt as a result of perceived social prejudice and discrimination.

Performance anxiety related to sexual functioning – the role of sexual identity and minority stress.

Aim of the studyThe study aimed to inquire if sexual identity was related to performance anxiety, and if proximal minority stress processes contributed to performance anxiety in gay and bisexual men.Subject or material and methodsThe present study was based on a database obtained from a larger Internet-based research project on the sexuality of Polish men of different sexual identities. The present sample consisted of 3,495 participants, i.e., 1,096 straight, 1,701 gay, and 698 bisexual men. The main outcome measure was performance anxiety which was measured using a single-item question: During the last 12 months has there ever been a period of several months when you felt anxious about your ability to perform sexually? Explanatory variables were demographics, relational and sex life characteristics – measured using a self-designed questionnaire, and minority stress processes – measured using the Sexual Minority Stress Scale.ResultsGay and bisexual identities were related to performance anxiety in bivariate analyses however they lost their significance when other factors were controlled for. Relational status was identified as responsible for this change. Internalised homophobia, and expectations of rejection contributed to performance anxiety in minority men.DiscussionA subset of gay and bisexual men, i.e., men who do not stay in committed relationships, may be particularly prone for developing performance anxiety, which is one of major factors contributing to sexual dysfunctions. Minority stress processes should be included in planning clinical interventions targeting sexual problems in theses populations.ConclusionsGay and bisexual men’s sexual problems need to be addressed in an individualised manner, with inclusion of minority specific processes.

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.