On the Relationship Between Online Heterosexist Discrimination and Mental Health and Substance Use Among LGBTQ+ Young Adults

LGBTQ+ individuals experience disproportionately higher rates of mental health and substance use difficulties. Discrimination is a significant factor in explaining these disparities. Meyer's (2003) minority stress theory (MST) indicates that proximal group-specific processes mediate the relationship between discrimination and health outcomes, with the effects moderated by other social factors. However, online discrimination has been understudied among LGBTQ+  people. Focusing on LGBTQ+  young adults experiencing online heterosexist discrimination (OHD), the current study aimed to investigate the effect of OHD on mental health outcomes and explore whether the effect was mediated by proximal factors of internalized heterosexism, online concealment, and acceptance concerns and moderated by social support. Path analysis was used to examine the effects. A total of 383 LGBTQ+  young adults (18-35) from an introductory psychology subject pool, two online crowdsourcing platforms, and the community completed a questionnaire assessing these constructs. OHD was associated with increased psychological distress and cannabis use. Two proximal stressors (acceptance concerns and sexual orientation concealment) mediated the relationship between OHD and psychological distress. Sexual orientation concealment also mediated the relationship between OHD and cannabis use. There was no evidence that online social support from LGBTQ+ peers moderated any of the relationships. MST is a viable guiding framework for exploring OHD. Acceptance concerns and online concealment are important constructs to consider and may be potential treatment targets for individuals experiencing psychological distress or engaging in cannabis use due to OHD.

Utilizing Latent Class Analysis to Assess the Association of Intersectional Stigma on Mental Health Outcomes Among Young Adult Black, Indigenous, and Sexual Minority Women of Color

Purpose: Discrimination has detrimental effects on mental health, particularly among Black, Indigenous, and people of color who are also sexual minority women (BIPOC SMW); however, measurement of multiple intersecting forms of discrimination (e.g., race, gender, and sexual identity discrimination among BIPOC SMW) poses methodological challenges. This analysis uses latent class analysis (LCA) to examine the influences of discrimination on mental health in a convenience sample of BIPOC SMW. Methods: Online survey data from BIPOC SMW aged 18-29 years (n = 324) were used to estimate latent classes for discrimination type (race, gender, and sexual identity). Data for this study were collected from July to October 2018. Adjusted linear regressions examined the influences of discrimination profiles on perceived stress and depressive symptoms. Results: Utilizing LCA, the following four classes emerged: (1) low discrimination; (2) mid-level discrimination; (3) high racial, medium gender, and low sexual identity discrimination; (4) high discrimination. Classes 3 and 4 were positively associated with perceived stress and depressive symptoms relative to Class 1 in adjusted models. Conclusion: This analysis highlights the importance of intersectionality and the adverse impact of multiple forms of discrimination on mental health outcomes for BIPOC SMW. Respondents reporting higher levels of racial or multiple forms of discrimination had poorer mental health outcomes. LCA is a promising analytical tool for investigating intersectional stigma and discrimination. There is an urgent need to develop tailored, culturally appropriate intersectional mental health interventions to address the multiple identities and oppressions faced by BIPOC SMW.

Reducing Internalized Homonegativity: Refinement and Replication of an Online Intervention for Gay Men

We refined and replicated an efficacious brief intervention to reduce internalized homonegativity (IH) with a sample of gay and exclusively same-sex attracted men recruited from outside of LGBT community networks using Amazon Mechanical Turk. We sought to 1) determine if levels of IH differed between the original study's community-based sample and our non-community-based sample, 2) examine the efficacy of the replicated intervention, and 3) assess for longitudinal effects of the intervention at a 30-day follow-up. Four hundred eighty-four participants completed either the intervention or a stress management control condition. Mean levels of IH were higher in the current sample compared with the earlier study's community sample. The intervention was efficacious at reducing global IH, reducing personal homonegativity, and increasing gay affirmation. Ninety-six participants completed the follow-up; follow-up results were not significant and may have been affected by high rates of attrition. Implications for research and practice are discussed.

Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight

OBJECTIVE

This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity.

METHODS

Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant.

RESULTS

Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period.

CONCLUSIONS

Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.

Examining the Interplay between Queerness and Teacher Wellbeing: A Qualitative Study Based on Foreign Language Teacher Trainers

Oftentimes, teachers who identify themselves as LGTBIQ+ may feel unsafe at work, which may upset their wellbeing and destabilize their key psychological traits. Hence, feelings such as insecurity, lack of self-confidence, anxiety, and fear are on loop in their everyday lives. Thus, in this study we pursued an examination of the interplay between sexual orientation and teacher wellbeing in a cohort of seven university foreign language teacher trainers in a Spanish context. To gain insight into this issue, a qualitative study in line with the ecological paradigm was designed for the elaboration of semi-structured in-depth interviews and for the analysis of results. The main findings display teacher wellbeing as a complex interwoven system in which sexual orientation had played a core role in their identities, competences, private and professional relationships, and in the cultural and political spheres. We conclude by stating that although homophobic discrimination was a hard trial to overcome, the psychosocial capital of the participants allowed them to transform this negativity into positive assets such as queer activism in their private and political lives and in their profession as foreign language teacher trainers.

The influence of internalized heterosexism on life satisfaction: comparing sexual minority women in Belgium and Turkey

To date, the majority of research studying lesbian, gay, bisexual, transgender, and queer (LGBTQ) health has been conducted in Westernized, predominantly individualistic countries. Building on minority stress theory and models of LGBTQ health, we explored how sexual orientation and nationality moderated the association between internalized heterosexism and life satisfaction for lesbian and bisexual (LB) women living in two countries (Turkey and Belgium) with contrasting social contexts. The results of two-way MANOVA, in a sample of 339 Turkish and 220 Belgian LB women, revealed main effects but no interaction effects. LB women in Belgium reported less internalized heterosexism and more life satisfaction than LB women in Turkey. The results of moderation analyses indicated no moderation effect, however internalized heterosexism and country emerged as the best predictors of life satisfaction. Findings were interpreted with a focus on how culture-specific aspects contribute to life satisfaction among LB women. Our findings suggest mental health professionals working with LB women need to tailor therapeutic interventions to reflect the social context connected to their patients’ nationality, in order to effectively address internalized heterosexism, improve life satisfaction, and promote self- and social advocacy. Cultural values, such as adherence to collectivistic or individualistic norms, should be included as variables in future research examining determinants of LGBTQ health.

Differential Reactions to Male and Female Gender-Role Violations: Testing the Sexual Orientation Hypothesis

Previous research has found that gender-atypical males are evaluated more negatively than gender-atypical females. According to the sexual orientation hypothesis, this asymmetry in evaluations occurs because the feminine characteristics taken on by males when they violate gender roles are more closely tied to perceived sexual orientation than are the masculine characteristics of gender-atypical females. The current series of studies were designed to confirm the existence and generality of the asymmetry phenomenon (Study 1), the preconditions for testing the sexual orientation hypothesis (Study 2), and then to test the hypothesis itself (Study 3). Study 1 found that, as predicted, adults (N = 195, females = 97) displayed more intolerance of males than of females committing gender-role violations across a wide variety of characteristics within multiple domains, although the existence of asymmetry varied somewhat depending on the domain. Study 2 revealed that, as predicted, adults (N = 196, females = 117) believed that gender-role violations indicate homosexuality more so for males than for females overall and across all four domains studied (occupation, activity, trait, and appearance). Study 3 directly tested the sexual orientation hypotheses by examining the relationship between intolerance of specific gender-role violations (scores from Study 1) and the perceived homosexuality associated with those violations (scores from Study 2). Overall, there was a positive relationship between intolerance and perceived homosexuality, indicating that the more a given gender-role violation is thought to implicate homosexuality, the more negatively/less positively people tend to react to the violation, consistent with the sexual orientation hypothesis.

Stressors Based on Sexual Orientation and Mental Health Among Lesbian, Gay, and Bisexual Individuals in China: Minority Stress and Perceived Pressure to Get Married

Chinese Confucian filial piety posits that getting married and having children to maintain family bloodlines is a fundamental duty of children to their parents. Chinese lesbian, gay, and bisexual (LGB) individuals experience added stresses because of the pressure to get married from parents, social environments, and themselves. However, no research thus far has examined the influence of this added stressor, called "pressure to get married," on the mental health of LGB individuals in China. This study examined the influence of sexual orientation-based stresses (i.e., LGB minority stress and perceived pressure to get married) on mental health among 543 Chinese single LGB individuals (259 gay men, 161 lesbians, 68 bisexual men, and 55 bisexual women). We developed a new measure of stress based on perceived pressure to get married and found three factors based on pressure sources: social pressure, parental pressure, and internalized pressure. Both minority stress and perceived pressure to get married were associated with worse mental health. Minority stress and perceived external pressure (i.e., perceived social and parental pressure) were found to be components of a second-order latent variable, called sexual orientation-based stress, which was associated with worse mental health. Sexual orientation-based stress is associated with mental health through coping/emotion and cognitive, but not social, processes. The results indicate that the pressure to get married experienced by Chinese LGB individuals need to be examined further. The findings indicated that the perceived pressure to get married was another significant stressor based on sexual orientation and minority stress, and was associated with mental health among Chinese LGB individuals.

Gender Bias Experiences of Female Surgical Trainees

OBJECTIVE

Medical schools now average approximately 50% female students, yet a disproportionate number of women continue to choose nonsurgical over surgical specialties. Once in training, studies indicate that pervasive gender stereotypes, sexism and harassment negatively affect female surgeons. The aim of this study is to describe female surgeons' experiences with gender bias and microaggressions in the workplace during residency and fellowship training, and understand if differences exist in the experiences of trainees in male-dominant vs female-dominant surgical specialties.

DESIGN

A mixed methods approach was used to explore the experiences of female surgical trainees. Participants were recruited from all surgical disciplines at an academic center. Initially, focus groups were used to explore themes that trainees face related to gender bias. A trained moderator conducted all focus groups, which were audio recorded and transcribed. Qualitative analysis of de-identified transcripts was performed to identify emerging themes. We then created an online survey using the validated 44-question Sexist Microaggression Experiences and Stress Scale to assess frequency and psychologic impact of these events with additional questions developed from the focus groups. The survey was sent to all female residents and fellows at one academic institution.

SETTING

University of New Mexico Hospital, a tertiary care academic medical center.

PARTICIPANTS

Fifteen female surgical trainees participated in focus groups. Thirty-three female surgical trainees participated in the online survey.

RESULTS

Two focus groups including 15 female trainees were conducted, revealing 4 themes: Exclusion, Adaptation, Increased effort, and Development of Resilience Strategies. All participants had experienced gender bias or discrimination during medical school or surgical training. The quantitative survey had a 66% response rate (33/50 female trainees). Significant differences were found in the experience of female trainees in male-dominant vs female-dominant specialties, with those in male-dominant fields often reporting more frequent, severe, and stressful microaggression experiences. When describing how gender bias would affect their future in medicine, trainees in male-dominant specialties were more likely to report that due to gender bias, they "may leave medicine/retire early" (33% vs 6%, p = 0.040) and that they "would not recommend my profession to trainees or family members" (40% vs 6%, p = 0.015)."

CONCLUSIONS

Female surgical trainees continue to experience gender bias. A culture of sexism leads to physical and social adaptations to fit into the role of surgeon. Participants expressed significant effort to sustain this level of adaptation, leading to fatigue and creation of resilience mechanisms. The environment in which a trainee operates (male-dominant vs female-dominant) significantly impacts their experience. Those experiencing more bias were less likely to recommend their specialty and reported plans to leave medicine earlier. Culture change across institutions and system-level interventions are necessary to create meaningful and sustainable change that improves the experience of female surgical trainees.

Sexual orientation-related stigma and relationship functioning among female same-sex couples

This article discusses how sexual orientation-based stigma serves to undermine functioning in female same-sex relationships. We particularly focus on the unique roles of interpersonal stigma (e.g., victimization, microaggressions) and structural stigma (e.g., institutional forms of discrimination), highlighting critical limitations and gaps in this literature and offering suggestions for future studies. We also discuss the need for future work on sexual orientation-related stigma and relationship functioning to consider the unique experiences of bisexual women, intersecting identities, and couple-level perspectives on stigma.

For Better or for Worse? A Systematic Review of the Evidence on Social Media Use and Depression Among Lesbian, Gay, and Bisexual Minorities

BACKGROUND

Over 90% of adults in the United States have at least one social media account, and lesbian, gay, and bisexual (LGB) persons are more socially active on social media than heterosexuals. Rates of depression among LGB persons are between 1.5- and 2-fold higher than those among their heterosexual counterparts. Social media allows users to connect, interact, and express ideas, emotions, feelings, and thoughts. Thus, social media use might represent both a protective and a risk factor for depression among LGB persons. Studying the nature of the relationship between social media use and depression among LGB individuals is a necessary step to inform public health interventions for this population.

OBJECTIVE

The objective of this systematic review was to synthesize and critique the evidence on social media use and depression among LGB populations.

METHODS

We conducted a literature search for quantitative and qualitative studies published between January 2003 and June 2017 using 3 electronic databases. Articles were included if they were peer-reviewed, were in English, assessed social media use either quantitatively or qualitatively, measured depression, and focused on LGB populations. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed appropriate reporting of studies using the Strengthening the Reporting of Observational Studies in Epidemiology and the Consolidated Criteria for Reporting Qualitative Research for quantitative and qualitative studies, respectively.

RESULTS

We included 11 articles in the review; 9 studies were quantitative and cross-sectional and 2 were qualitative. Appropriate reporting of results varied greatly. Across quantitative studies, we found heterogeneity in how social media use was defined and measured. Cyberbullying was the most studied social media experience and was associated with depression and suicidality. Qualitative studies found that while social media provides a space to disclose minority experiences and share ways to cope and get support, constant surveillance of one's social media profile can become a stressor, potentially leading to depression. In most studies, sexual minority participants were identified inconsistently.

CONCLUSIONS

This review supports the need for research on the role of social media use on depression outcomes among LBG persons. Using social media may be both a protective and a risk factor for depression among LGB individuals. Support gained via social media may buffer the impact of geographic isolation and loneliness. Negative experiences such as cyberbullying and other patterns of use may be associated with depression. Future research would benefit from more consistent definitions of both social media use and study populations. Moreover, use of larger samples and accounting for patterns of use and individuals' experiences on social media may help better understand the factors that impact LGB mental health disparities.

Discrimination, Harassment, and Gendered Health Inequalities: Do Perceptions of Workplace Mistreatment Contribute to the Gender Gap in Self-reported Health?

This study examines the extent to which discrimination and harassment contribute to gendered health disparities. Analyzing data from the 2006, 2010, and 2014 General Social Surveys ( N = 3,724), we ask the following: (1) To what extent are perceptions of workplace gender discrimination and sexual harassment associated with self-reported mental and physical health? (2) How do multiple forms of workplace mistreatment (e.g., racism, ageism, and sexism) combine to structure workers' self-assessed health? and (3) To what extent do perceptions of mistreatment contribute to the gender gap in self-assessed health? Multivariate analyses show that among women, but not men, perceptions of workplace gender discrimination are negatively associated with poor mental health, and perceptions of sexual harassment are associated with poor physical health. Among men and women, perceptions of multiple forms of mistreatment are associated with worse mental health. Gender discrimination partially explains the gender gap in self-reported mental health.

The Mediating Roles of Rejection Sensitivity and Proximal Stress in the Association Between Discrimination and Internalizing Symptoms Among Sexual Minority Women

The negative impact of discrimination on mental health among lesbian, gay, and bisexual populations has been well documented. However, the possible mediating roles of sexual orientation rejection sensitivity and rejection-based proximal stress in the association between discrimination and internalizing symptoms remain unclear. Rejection-based proximal stress is a subset of proximal stressors that are theorized to arise from concerns about and expectations of sexual orientation-based rejection and discrimination. Drawing on minority stress theory, we tested potential mediating effects using indirect effects structural equation modeling in a sample of 300 sexual minority women. Results indicated that the indirect effect of discrimination on internalizing symptoms (a latent variable indicated by depression and anxiety symptoms) through sexual orientation rejection sensitivity and rejection-based proximal stress (a latent variable indicated by preoccupation with stigma, concealment motivation, and difficulty developing a positive sexual identity) was significant. Additionally, the indirect effects of discrimination on rejection-based proximal stress through sexual orientation rejection sensitivity and of sexual orientation rejection sensitivity on internalizing symptoms through rejection-based proximal stress were also significant. These findings indicate that sexual orientation rejection sensitivity plays an important role in contributing to rejection-based proximal stress and internalizing symptoms among sexual minority women.

A Grounded Theory of Sexual Minority Women and Transgender Individuals' Social Justice Activism

Psychosocial benefits of activism include increased empowerment, social connectedness, and resilience. Yet sexual minority women (SMW) and transgender individuals with multiple oppressed statuses and identities are especially prone to oppression-based experiences, even within minority activist communities. This study sought to develop an empirical model to explain the diverse meanings of social justice activism situated in SMW and transgender individuals' social identities, values, and experiences of oppression and privilege. Using a grounded theory design, 20 SMW and transgender individuals participated in initial, follow-up, and feedback interviews. The most frequent demographic identities were queer or bisexual, White, middle-class women with advanced degrees. The results indicated that social justice activism was intensely relational, replete with multiple benefits, yet rife with experiences of oppression from within and outside of activist communities. The empirically derived model shows the complexity of SMW and transgender individuals' experiences, meanings, and benefits of social justice activism.

Usability of a Culturally Informed mHealth Intervention for Symptoms of Anxiety and Depression: Feedback From Young Sexual Minority Men

BACKGROUND

To date, we are aware of no interventions for anxiety and depression developed as mobile phone apps and tailored to young sexual minority men, a group especially at risk of anxiety and depression. We developed TODAY!, a culturally informed mobile phone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive behavioral therapy (CBT) and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (eg, tips for current distress and visualizations of mood by context).

OBJECTIVE

The aim of this study was to conduct usability testing to understand how young sexual minority men interact with the app, to inform later stages of intervention development.

METHODS

Participants (n=9) were young sexual minority men aged 18-20 years (Mean=19.00, standard deviation [SD]=0.71; 44% black, 44% white, and 11.1% Latino), who endorsed at least mild depression and anxiety symptoms. Participants were recruited via flyers, emails to college lesbian, gay, bisexual, and transgender (LGBT) organizations, Web-based advertisements, another researcher's database of sexual minority youth interested in research participation, and word of mouth. During recorded interviews, participants were asked to think out loud while interacting with the TODAY! app on a mobile phone or with paper prototypes. Feedback identified from these recordings and from associated field notes were subjected to thematic analysis using a general inductive approach. To aid interpretation of results, methods and results are reported according to the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

Thematic analysis of usability feedback revealed a theme of general positive feedback, as well as six recurring themes that informed continued development: (1) functionality (eg, highlight new material when available), (2) personalization (eg, more tailored feedback), (3) presentation (eg, keep content brief), (4) aesthetics (eg, use brighter colors), (5) LGBT or youth content (eg, add content about coming out), and (6) barriers to use (eg, perceiving psychoeducation as homework).

CONCLUSIONS

Feedback from usability testing was vital to understanding what young sexual minority men desire from a mobile phone intervention for symptoms of anxiety and depression and was used to inform the ongoing development of such an intervention.

Coping with workplace minority stress: Associations between dyadic coping and anxiety among women in same-sex relationships

Sexual minorities are exposed to stressors in the workplace (workplace minority stress), which can be detrimental for well-being (e.g., levels of anxiety). The present study examined whether a particular set of relationship processes, dyadic coping, served to moderate the association between workplace minority stress and symptoms of anxiety. Using a dyadic sample of 64 female same-sex couples, we found that partner problem-focused supportive dyadic coping (DC) and emotion-focused supportive DC (marginally) buffered, whereas partner delegated DC and negative DC did not moderate, the association between workplace minority stress and symptoms of anxiety. Implications for relationship researchers and mental health practitioners are discussed.

Investigating the influence of shame, depression, and distress tolerance on the relationship between internalized homophobia and binge eating in lesbian and bisexual women

There is limited research evidence about the specific factors influencing disordered eating for lesbian and bisexual women. Therefore, this study investigated relationships among binge eating, internalized homophobia, shame, depression, and distress tolerance in a sample of lesbian (n=72) and bisexual women (n=66). Two hypotheses were tested. First, it was hypothesized that shame and depression would mediate the relationship between internalized homophobia and binge eating. Second, it was hypothesized that distress tolerance would moderate the relationship between shame and binge eating and the relationship between depression and binge eating in the mediation relationships proposed in the first hypothesis. Results indicated that shame was a significant mediator for the relationship between internalized homophobia and binge eating, that depression was not a significant mediator, and that distress tolerance did not moderate the significant mediation relationship between shame and binge eating. The data in this study also indicated that the proportions of lesbian and bisexual participants who reported binge eating and compensatory behavior did not differ significantly, but that bisexual participants reported significantly more depression and shame than lesbian participants.

The Feminist Identity Composite

The Feminist Identity Composite is a commonly used measure of feminist identity development. However, psychometric examinations of this measure with samples of diverse women are lacking. The current study presents the first investigation, to our knowledge, to examine the factor structure of the Feminist Identity Composite with two subsamples of sexual minority women ( N = 402). We used exploratory factor analysis (EFA), partial confirmatory factor analysis (CFA), and CFA and found both the EFA and subsequent partial CFA ( n = 201) indicated a six-factor solution, which was upheld in the final CFA ( n = 201). The results generally corroborated four (Passive Acceptance, Embeddedness/Emanation, Synthesis, Active Commitment) of the five original subscales reported in previous studies with predominately heterosexual (or sexual orientation not reported) undergraduate women. However, the subscale Revelation was further delineated into two subscales labeled Societal Revelation and Contact Revelation. Convergent validity of the obtained Feminist Identity Composite subscale scores was largely supported by correlations in expected directions with measures of perceived sexism and heterosexism. We encourage future researchers to investigate the structural and convergent validity of the Feminist Identity Composite with other diverse samples of women.

Development and Psychometric Evaluation of the Counseling Women Competencies Scale (CWCS)

This article describes the development and psychometric evaluation of the Counseling Women Competencies Scale (CWCS). The CWCS is designed to assess clinicians' self-perceived competencies with regard to therapeutic practice with diverse female clients. Through an extensive review of the literature on counseling women and expert review by 32 members of the Section for the Advancement of Women (Division 17, APA), content validity was supported. Exploratory factor analysis, conducted on a sample of 321 male and female counseling and psychology graduate students and professionals, supported a two-factor model consisting of knowledge/skills and self-awareness factors. Findings also provided support for the internal consistency reliability and construct (convergent, divergent, and incremental) validity of the scale.

Online Evaluative Conditioning Did Not Alter Internalized Homonegativity or Self-Esteem in Gay Men

OBJECTIVE

Internalized homonegativity is linked to psychological distress in sexual minorities and is thus a potential treatment target in this population. Previous studies have shown that evaluative conditioning (EC) can modify self-esteem, another self-directed attitude. The present study aimed to determine if EC deployed over the Internet could modify self-esteem and internalized homonegativity.

METHOD

Gay men recruited online (N = 184) were randomly assigned to a control group or an experimental condition. Participants completed self-reports and measures of implicit attitudes before and after being exposed to control or experimental tasks. The study was administered online.

RESULTS

There were no significant between-group differences on implicit or explicit self-esteem (ps > .49) or internalized homonegativity (ps > .28).

CONCLUSION

Despite past laboratory success, Internet-based EC did not produce significant effects in implicit or explicit self-directed attitudes. Post hoc analyses did not support any of several potential explanations for these results. Alternative explanations are discussed.

A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

Discrimination against sexual minorities is widespread and has deleterious consequences on victims' psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are "adapted" from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures' construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of "gold standard" measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.

Sexual orientation and first-year college students' nonmedical use of prescription drugs

OBJECTIVE

To examine differences between heterosexual and lesbian, gay, bisexual, and questioning students' nonmedical use of prescription drugs (NMUPD).

PARTICIPANTS

First-year university students between October 2009 and October 2013 who self-identified as heterosexual, lesbian, gay, bisexual, or questioning.

METHODS

Students completed questionnaires on demographic variables and NMUPD. Any NMUPD was examined, as were stimulants, anxiolytics, and painkillers. Hierarchical regression was used to examine differential NMUPD based on sexual orientation, gender, and race.

RESULTS

For any NMUPD and painkillers, bisexual and questioning students reported higher rates of nonmedical use than heterosexual students and gay men. When compared with heterosexual females, lesbian, bisexual, and questioning females reported higher any NMUPD and nonmedical painkiller use. For stimulants and anxiolytics, bisexual students reported the highest nonmedical use, followed by gay and lesbian students.

CONCLUSIONS

There may be particular risk for NMUPD associated with membership in marginalized groups in terms of both sexual orientation and gender.

The Relationship between Social Support and Suicide Risk in a National Sample of Ethnically Diverse Sexual Minority Women

This study examined the relationship between three types of social support and suicidal ideation and lifetime attempts among a national sample of ethnically diverse sexual minority women (SMW). Participants (N = 150) completed measures of social support and suicidal ideation/attempts. After controlling for socioeconomic status, social support explained 12.3% of the variance in past suicidal ideation and 10.7% in lifetime suicide attempts. Social support from family and significant other were both inversely associated with suicidal ideation, and social support from family inversely with lifetime attempts. Interventions that strengthen family relationships could be a buffer of suicidality in this population.

Development and Initial Validation of the Sexual Minority Women Rejection Sensitivity Scale

The goals of the current studies were to develop a measure of sexual orientation rejection sensitivity (RS) for sexual minority women (SMW) and to examine its preliminary reliability and validity. In Study 1a, data from 150 SMW were used to develop scenarios for the SMW Rejection Sensitivity Scale (SMW-RSS). In Study 1b, data from a second sample of 128 SMW were used to streamline the SMW-RSS and test its factor structure. In Study 2, data from a third sample of 300 SMW were used to test the convergent and discriminant validity of the SMW-RSS. The SMW-RSS demonstrated strong convergent validity, correlating with the indices of minority stress (discrimination, sexual identity acceptance concerns, difficulty developing a positive sexual identity, internalized negativity, and concealment motivation) and internalizing psychopathology (anxiety and depression symptoms). The measure also demonstrated strong discriminant validity, predicting psychosocial outcomes above and beyond existing measures of RS. Findings demonstrate the utility of the SMW-RSS to assess concerns and expectations of sexual orientation rejection among women and underscore the importance of examining the unique concerns about rejection that SMW experience. Additional online materials for this article are available to PWQ subscribers on PWQ’ s website at http://pwq.sagepub.com/supplemental

Attitudes toward homosexuality among young adults: connections to gender role identity, gender-typed activities, and religiosity

Individual differences in attitudes toward homosexuality have been linked to numerous personality and demographic variables. This study investigated the influence that gender role identity, involvement in gender-typed activities, and religiosity plays in this relationship. The sample included 194 undergraduate students from a Northeastern university. Analyses revealed that both males and females who held a more masculine gender role identity and individual commitment to religion scored higher on measures of homophobia and heteronormativity, whereas there was no association between spiritual meaning in life and attitudes toward homosexuality. Among males, but not females, more masculine gender identity and less spiritual meaning in life was associated with greater homophobia. The importance of the findings for research on the origins of attitudes toward individuals with a homosexual orientation are discussed, as well as the potential directions for future research on connections between gender role identity, religious affiliation, and attitudes toward gays and lesbians.

Exploring Discrimination and Mental Health Disparities Faced By Black Sexual Minority Women Using a Minority Stress Framework

Black sexual minority women are triply marginalized due to their race, gender, and sexual orientation. We compared three dimensions of discrimination-frequency (regularity of occurrences), scope (number of types of discriminatory acts experienced), and number of bases (number of social statuses to which discrimination was attributed)-and self-reported mental health (depressive symptoms, psychological well-being, and social well-being) between 64 Black sexual minority women and each of two groups sharing two of three marginalized statuses: (a) 67 White sexual minority women and (b) 67 Black sexual minority men. Black sexual minority women reported greater discrimination frequency, scope, and number of bases and poorer psychological and social well-being than White sexual minority women and more discrimination bases, a higher level of depressive symptoms, and poorer social well-being than Black sexual minority men. We then tested and contrasted dimensions of discrimination as mediators between social status (race or gender) and mental health outcomes. Discrimination frequency and scope mediated the association between race and mental health, with a stronger effect via frequency among sexual minority women. Number of discrimination bases mediated the association between gender and mental health among Black sexual minorities. Future research and clinical practice would benefit from considering Black sexual minority women's mental health in a multidimensional minority stress context.

Multiple Oppressions and the Mental Health of Sexual Minority Latina/o Individuals

This study investigated the additive and interactive relations of two forms of external oppression (racist discrimination and heterosexist discrimination) and internalized oppression (internalized racism and internalized heterosexism) with psychological distress, life satisfaction, and self-esteem in a sample of 173 sexual minority Latina/o adults. A combination of external and internalized oppressions was associated uniquely with psychological distress whereas the two internalized oppressions were linked uniquely with life satisfaction and self-esteem. The Racist discrimination × Internalized racism, Racist discrimination × Internalized heterosexism, and Heterosexist discrimination × Internalized racism interactions each accounted for unique variance in self-esteem. Specifically, low internalized racism protected self-esteem at low levels of racist discrimination, low internalized heterosexism protected self-esteem at high levels of racist discrimination, and low internalized racism protected self-esteem at high levels of heterosexist discrimination. Thus, multiple forms of oppression contribute additively and interactively to mental health in this population.

Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma

There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions.

Stepparents and parenting stress: the roles of gender, marital quality, and views about gender roles

Previous research suggests that stepparenting can be stressful, although the mechanisms that contribute to the experience of parenting stress in stepfamilies are less clear. This study examines gender, marital quality, and views about gendered family roles as correlates of parenting stress among 310 stepmothers, stepfathers, and biological mothers and fathers. Findings suggest that stepparents, and especially stepmothers, experience higher levels of parenting stress than biological parents. Findings also suggest that less traditional views about gendered family roles and higher dyadic adjustment are associated with lower parenting stress for stepparents, particularly in combination. Stepparents reporting both of these protective factors were indistinguishable in terms of parenting stress from biological parents. These findings indicate potential pathways to mitigate the stress associated with stepparenting.

The Protective Power of Collective Action for Sexual Minority Women of Color

We utilize an additive intersectionality framework in the present study to examine the relations among perceived racism, sexism, and heterosexism and the psychological distress of self-identified sexual minority women of color. Participants ( N = 134) aged 19 to 75 recruited through electronic mailing lists, discussion groups, and virtual communities aimed toward sexual minority women of color completed online surveys. When each form of discrimination was examined in a single multiple regression analysis, only perceived heterosexism explained significant and positive variance in psychological distress. In addition, collective action was tested as a moderator of the effects of racism, sexism, and heterosexism on psychological distress; specifically, the potential attenuating roles of three forms of collective action (race and ethnicity, feminist, and sexual minority) in the respective racism → distress, sexism → distress, and heterosexism → distress links were investigated. Sexual minority collective action buffered the heterosexist experiences → psychological distress link. More specifically, in the context of lower collective action, perceived heterosexism positively predicted distress; however, perceived heterosexism did not predict psychological distress at higher levels of collective action. No other significant interaction effects were found. Our results suggest that discrimination experiences continue to be important to assess in research and practice with marginalized individuals. Also, encouraging clients to engage in collective action could represent a useful intervention tool for counselors.

Perceived Sexist Events and Psychological Distress of Sexual Minority Women of Color

Scholars have argued that much of the sexism literature has not acknowledged diversity among women, and they have called for more attention to the intersectionality of the multiple marginalized identities of sexual minority women of color (WOC) in particular. With a sample of 182 sexual minority WOC, we examined (a) the links between perceived lifetime and recent sexist events and psychological distress and (b) the potential moderating role in these relations of womanism (a perspective of feminism that recognizes the roles of both gender and race/ethnicity in the lives of WOC). Findings from our Internet survey indicated that lifetime and recent sexism were related significantly and positively to psychological distress. Womanism was also associated positively with both forms of sexism and psychological distress. In partial support of study hypotheses, womanism moderated the relationship between perceived lifetime sexist events, but not recent sexist events, and psychological distress. More specifically, the link between lifetime sexist events and psychological distress was significant and positive for sexual minority WOC with lower levels of womanism and not significant for those with higher levels of womanism. With regard to practice implications, assessing and exploring sexist events, placing these experiences in a larger sociocultural context of oppression, connecting with the legacy of social activism of marginalized groups, and encouraging supportive networks may diminish distress.

Correlates of homophobia, transphobia, and internalized homophobia in gay or lesbian and heterosexual samples

This research assessed the correlates of homophobia and transphobia in heterosexual and homosexual individuals, based on a theory of different sources of perceived symbolic threat to social status. Compared to 310 heterosexual college students, a sample of 30 gay male and 30 lesbian college students scored lower on homophobia, transphobia, and religious fundamentalism. Mean gender differences were smaller for gay men and lesbians for homophobia, aggressiveness, benevolent sexism, masculinity, and femininity. Fundamentalism, right-wing authoritarianism, and hostile and benevolent sexism were correlated only with homophobia in lesbians, whereas fundamentalism and authoritarianism were correlated only with transphobia in gay men. Correlates of internalized homophobia were different than those found for homophobia and transphobia, which was discussed in terms of gender differences in threats to status based on sexual orientation versus gender identity.

A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues

OBJECTIVE

To investigate selected mental health characteristics of lesbians and bisexual undergraduate college women as compared with heterosexual college women.

PARTICIPANTS

Self-identified lesbians and bisexual and heterosexual female college students who took part in the American College Health Association National College Health Assessment II (ACHA-NCHA-II) in Fall 2008, Spring 2009, and Fall 2009.

METHODS

A secondary analysis of the ACHA-NCHA-II data set for 3 semesters was conducted. Comparisons of lesbians and bisexual and heterosexual female college students were made.

RESULTS

Bisexual women reported the worst mental health status in all areas studied including anxiety, anger, depressive symptoms, self-injury, and suicidal ideation and attempts. Both bisexual women and lesbians had a far greater likelihood of having these mental health issues when compared with heterosexual women. Lesbians and bisexual women utilized significantly more mental health services (with the exception of clergy) than heterosexual women.

CONCLUSIONS

College health professionals should recognize and address the mental health needs of bisexual and lesbian undergraduate college women.

Attributions for discriminatory events and satisfaction with social support in gay men

Attributions modulate the impact of stressful events on mental health. However, little is known about attributions for discriminatory events and their relationship to psychosocial outcomes in sexual minority individuals. Relationships were examined between gay men's attributions for discrimination and their satisfaction with social support, a variable critical to mental health in this population. Gay men (N=307) completed online measures of satisfaction with social support, attributions for discriminatory events, and key minority stress constructs. Self blaming attributions for discrimination were associated with decreased satisfaction with social support, independent of the frequency with which participants reported experiencing discrimination. The link between self blaming and satisfaction with social support was partially mediated by a latent affective construct comprised of anxiety, depression, and low positive affect. A moderation effect was also found, such that the relationship between frequency of perceived discriminatory events and dissatisfaction with social support was amplified for men reporting more blame toward perpetrators of discrimination. Results support attributions for discrimination as valuable additions to minority stress models. Assessing self and other blame for these discriminatory events may help to clarify pathways by which discrimination can undermine gay men's satisfaction with their social support networks.

Sexual minority women's gender identity and expression: challenges and supports

Sexual minority women were divided into four groups to study their gender identities (butch and femme), and gender expression (traditionally gendered and non-traditionally gendered women who do not identify as butch or femme). Experiences of heterosexist events (discrimination, harassment, threats of violence, victimization, negative emotions associated with these events), mental health (self esteem, stress, depression), and supports for a sexual minority identity (social support, outness, internalized homophobia) were examined across these groups. Findings suggested that butch-identified women experienced more heterosexist events than femme women or women with non-traditional gender expressions. There were no differences in mental health variables.

Still stressful after all these years: a review of lesbians' and bisexual women's minority stress

This article reviews the conceptualization of, and empirical literature on, lesbians' and bisexual women's sexual minority stress. In much of the early research, the experiences of sexual minority women and men were considered together (or women's experiences were inferred from men's), obscuring important differences. There is empirical and theoretical justification to consider the experiences of women and men separately and to develop and evaluate comprehensive models of sexual minority stress for women. Existing conceptualizations of sexual minority stress that include assessment of discrimination, victimization, harassment, concealment, internalized homonegativity may be applied, and perhaps adapted, to facilitate understanding of the unique stressors associated with women's sexual minority status. Future research must include mediators of the relationship between stressors and outcomes such as individual (e.g., coping and resilience) and group (e.g., social support, identification with a sexual minority community) resources. It is also essential to understand what factors may buffer the deleterious effects of these stressors.