The Rejection Sensitivity Model as a Framework for Understanding Sexual Minority Mental Health

The importance of community engagement in experimental stress and substance use research with marginalized groups: Lessons from research with sexual and gender minority populations

There is a growing need for experimental stress paradigms tailored for use with marginalized groups to better understand the impact of experiencing minoritized stress on substance use outcome. Experimental stress research that examines the role of minority stress in substance use is not only innovative, but also has the potential to improve health equity. However, this research also has anticipated risks. As a result, community-engaged research (CEnR) is critical. CEnR can improve experimental stress and substance use research by engaging applicable communities in research design, recruitment, data interpretation, and dissemination. When conducting CEnR, there are also unique challenges and considerations that need to be taken into account. Recommendations are provided based on prior experiences in experimental stress induction and alcohol research with SGM (sexual and gender minority) groups.

Age and Gender Identity in the Relationship Between Minority Stress and Loneliness: A Global Sample of Sexual and Gender Minority Adults

Loneliness is prevalent among sexual minority adults and is associated with minority stress. Yet there is limited understanding of how loneliness and minority stress vary across key demographic variables. This cross-sectional study explored age and gender differences in a minority stress model linking sexual orientation marginalization to social and emotional loneliness via proximal stress (internalized homonegativity, concealment, and stigma preoccupation) and via social anxiety and inhibition. The study also assessed age and gender differences in the protective influence of LGBTQ community involvement. 7,856 sexual minority adults from 85 countries completed an online survey. They were categorized as emerging adults (18-24, n = 3,056), young adults (25-34, n = 2,193), midlife adults (35-49, n = 1,243), and older adults (50-88, n = 1,364). Gender identity groups were cisgender men (n = 4,073), cisgender women (n = 3,017), and transgender individuals (n = 766). With each successive age group, there was a lower prevalence of sexual orientation marginalization, proximal stress, social anxiety, inhibition, and emotional loneliness, along with more community involvement. Sexual orientation marginalization was more pronounced among cisgender women and, especially, transgender individuals. The latter also exhibited the most social anxiety, inhibition, loneliness, and community involvement. Proximal stress was more prevalent among cisgender men than cisgender women and transgender individuals. Multiple group structural equation modeling supported the applicability of the loneliness model across age and gender groups, with only a few variations; these mainly related to how strongly community involvement was linked to marginalization, internalized homonegativity, and social loneliness.

Characterizing Life Stress Exposure Among Sexual Minority Adolescents: Temporality, Content, And Mediating Role in Mental Health Disparities

Though sexual minority adolescents face a wide array of deleterious stressors, few studies have examined the role of specific types of stress exposure (i.e., chronic vs. episodic, interpersonal vs. non-interpersonal) on mental health disparities. This study utilizes a contextual threat-based assessment to (a) compare levels of stress exposure types between sexual minority and non-sexual minority adolescents, and (b) examine stress type as a mediator between sexual orientation and two outcomes: depressive symptoms and emotion dysregulation. Data comes from a longitudinal sample (14-17 years-old, N = 241; 17.6% sexual minority; 54% assigned female at birth; 73.9% White), with two time-points (T1 and T2) utilized. Sexual minority adolescents reported higher chronic interpersonal stress, but no differences in non-interpersonal chronic or episodic stress, relative to non-sexual minority adolescents. Chronic interpersonal stress exposure mediated the link between membership in an oppressed group (i.e., sexual minority teens) and the primary outcomes (emotion dysregulation and depressive symptoms) at both T1 and T2. Findings demonstrate the utility of contextual threat-based assessments within sexual minority research.

Development and Initial Validation of Measures of Proximal Stigmas and Experiences of Discrimination for Minor Attracted People

Stigma-related stressors are central to understanding psychopathology, distress, and coping in stigmatized groups; individuals who experience attractions to children are a highly stigmatized group. Currently, few validated self-report measures exist to assess stigma-related stressors in minor attracted people (MAPs) and the current research describes the development and initial validation of two measures of internalized stigma and experiences of discrimination. A sample of MAPs (n = 289; mean age = 31.8 years, SD = 12.2) was recruited online and completed a set of self-report measures assessing stigma-related stress, negative mental health outcomes, substance use, and coping. Exploratory factor analyses of the two newly developed stigma-related stress measures were conducted and convergent associations with other constructs were examined for validity evidence. Exploratory factor analyses indicated a two-factor solution to both the measure of internalized stigma and experiences of discrimination. The total scale scores and factors scores generally demonstrated the anticipated patterns of correlations with mental health concerns, distress, coping, and substance use. Clinical intervention with MAPs may benefit from an exploration of stigma-related stressors in clients' lives to improve mental health outcomes. The relatively large sample that was recruited from multiple online forums is a strength of the current study. The use of a self-report measurement modality for all measures used in the study weakens that strength of the validation evidence presented here. These results provide initial validity evidence for the measures of stigma-related stress in MAPs and the promise of stigma processes in understanding negative outcomes in this population.

An Internet-Based Intervention to Increase the Ability of Lesbian, Gay, and Bisexual People to Cope With Adverse Events: Single-Group Feasibility Study

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at higher risk of mental health problems due to widespread hetero- and cisnormativity, including negative public attitudes toward the LGBTQ+ community. In addition to combating social exclusion at the societal level, strengthening the coping abilities of young LGBTQ+ people is an important goal.

OBJECTIVE

In this transdiagnostic feasibility study, we tested a 6-week internet intervention program designed to increase the ability of nonclinical LGBTQ+ participants to cope with adverse events in their daily lives. The program was based on acceptance and commitment therapy principles.

METHODS

The program consists of 6 web-based modules and low-intensity assistance for homework provided by a single care provider asynchronously. The design was a single-group assignment of 15 self-identified LGB community members who agreed to participate in an open trial with a single group (pre- and postintervention design).

RESULTS

Before starting the program, participants found the intervention credible and expressed high satisfaction at the end of the intervention. Treatment adherence, operationalized by the percentage of completed homework assignments (32/36, 88%) was also high. When we compared participants' pre- and postintervention scores, we found a significant decrease in clinical symptoms of depression (Cohen d=0.44, 90% CI 0.09-0.80), social phobia (d=0.39, 90% CI 0.07-0.72), and posttraumatic stress disorder (d=0.30, 90% CI 0.04-0.55). There was also a significant improvement in the level of self-acceptance and behavioral effectiveness (d=0.64, 90% CI 0.28-0.99) and a significant decrease in the tendency to avoid negative internal experiences (d=0.38, 90% CI 0.09-0.66). The level of general anxiety disorder (P=.11; d=0.29, 90% CI -0.10 to 0.68) and alcohol consumption (P=.35; d=-0.06, 90% CI -0.31 to 0.19) were the only 2 outcomes for which the results were not statistically significant.

CONCLUSIONS

The proposed web-based acceptance and commitment therapy program, designed to help LGBTQ+ participants better manage emotional difficulties and become more resilient, represents a promising therapeutic tool. The program could be further tested with more participants to ensure its efficacy and effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05514964; https://clinicaltrials.gov/study/NCT05514964.

"Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches"

Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.

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.

Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status

The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis.

Mental health and help-seeking in Czech sexual minorities: a nationally representative cross-sectional study

AIMS

The mental health of sexual minority (SM) individuals remains overlooked and understudied in Czechia. We aimed to estimate (1) the prevalence rate and (2) the relative risk of common mental disorders and (3) the mental distress severity among the Czech SM people compared with the heterosexual population. In addition, we aimed to investigate help-seeking for mental disorders in SM people.

METHODS

We used data from a cross-sectional, nationally representative survey of Czech community-dwelling adults, consisting of 3063 respondents (response rate = 58.62%). We used the Mini-International Neuropsychiatric Interview to assess the presence of mental disorders. In individuals scoring positively, we established help-seeking in the past 12 months. We assessed symptom severity using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. We computed the prevalence of mental disorders and the treatment gap with 95% confidence intervals. To assess the risk of having a mental disorder, we used binary logistic regression.

RESULTS

We demonstrated that the prevalence of current mental disorders was 18.85% (17.43-20.28), 52.27% (36.91-67.63), 33.33% (19.5-47.17) and 25.93% (13.85-38) in heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. Suicidal thoughts and behaviours were present in 5.73% (4.88-6.57), 25.00% (11.68-38.32), 22.92% (10.58-35.25) and 11.11% (2.45-19.77) of heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. After confounder adjustment, gay or lesbian individuals were more likely to have at least one current mental disorder compared with heterosexual counterparts (odds ratio = 3.51; 1.83-6.76). For bisexual and sexually more diverse individuals, the results were consistent with a null effect (1.85; 0.96-3.45 and 0.89; 0.42-1.73). The mean depression symptom severity was 2.96 (2.81-3.11) in heterosexual people and 4.68 (2.95-6.42), 7.12 (5.07-9.18) and 5.17 (3.38-6.95) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. The mean anxiety symptom severity was 1.97 (1.85-2.08) in heterosexual people and 3.5 (1.98-5.02), 4.63 (3.05-6.2) and 3.7 (2.29-5.11) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. We demonstrated broadly consistent levels of treatment gap in heterosexual and SM individuals scoring positively for at least one current mental disorder (82.91%; 79.5-85.96 vs. 81.13%; 68.03-90.56).

CONCLUSIONS

We provide evidence that SM people in Czechia have substantially worse mental health outcomes than their heterosexual counterparts. Systemic changes are imperative to provide not only better and more sensitive care to SM individuals but also to address structural stigma contributing to these health disparities.

Identity Processes and Psychological Wellbeing Upon Recall of a Significant "Coming Out" Experience in Lesbian, Gay and Bisexual People

This study focuses on the relations between minority stressors, protective factors and psychological wellbeing among lesbian, gay and bisexual (LGB) people. Experimental data based on a sample of 156 showed that participants asked to recall a negative coming out experience to somebody significant reported more identity threat and distress and less positive affect compared to those recalling a neutral coming out experience. In the negative recall condition, the effects of the stressors of discrimination and rejection on the variance of distress through the mediation of identity threat were statistically significant but not in the neutral recall condition and the two conditions statistically significantly differed in regards to the relationship between discrimination and distress. Identity resilience-continuity was associated with less identity threat and distress in the negative recall condition only, while social support was negatively associated and LGB stigma sensitivity was positively associated with distress in both conditions. Degree of outness (operating as a coping strategy) was associated with increased positive affect in both the neutral and negative recall conditions. When recalling a negative coming out experience, LGB people may be more susceptible to distress associated with minority stressors but also capitalize on available coping strategies.

The Association Between Sexual Identity, Depression, and Adolescent Substance Use

Sexual minority youth (SMY) represent a population vulnerable to several adverse health consequences. Specifically, SMY experience depression and substance use at substantially higher rates than heterosexual peers. Better understanding the relationship between depression and substance use among SMY may help reduce morbidity and mortality. We hypothesize that depression will moderate increased substance use rates seen in SMY. Weighted logistical analyses of covariance, adjusted for race/ethnicity, sex, and age, compared the relationship between sexual identity, depression, and substance use (14 outcomes), using data from the 2019 Youth Risk Behavior Survey (n = 13,677) of high school students. SMY reported depression at rates nearly double than heterosexual peers (63.9% vs 33.0%). Except for vaping and alcohol, SMY had significantly higher odds of all SU (aORs 1.41-2.45, p < 0.001-0.0011). After adjusting for depression, odds of all SMY substance use decreased; most relationships remained significant (aORs 0.73-1.89), though the relationship between SMY and lifetime cannabis use became non-significant. The relationship between SMY and current vaping became significant and the relationship between SMY and alcohol and binge-drinking remained non-significant. SMY are at higher risk for use of most substances and depression compared to heterosexual youth. As depression consistently plays a role in the relationship between sexual minority status and adolescent substance use across a wide variety of substances, it may be a modifiable risk factor for substance use among sexual minority youth that should be screened for and treated. This study additionally provides important information for future studies examining nuances of SMY substance use patterns.

Future Directions in the Mental Health of Transgender Youth: Towards a Social-Affective Developmental Model of Health Disparity

Mental health disparities in transgender and gender diverse (TGD) youth are well-documented. These disparities are often studied in the context of minority stress theory, and most of this research focuses on experiences of trauma and discrimination TGD youth experience after coming out. However, TGD youth may be targets of violence and victimization due to perceived gender nonconformity before coming out. In this Future Directions, we integrate research on attachment, developmental trauma, and effects of racism and homophobia on mental health to propose a social-affective developmental framework for TGD youth. We provide a clinical vignette to highlight limitations in current approaches to mental health assessment in TGD youth and to illustrate how using a social-affective developmental framework can improve clinical assessment and treatment approaches and deepen our understanding of mental health disparities in TGD people.

The Loneliness of the Odd One Out: How Deviations From Social Norms Can Help Explain Loneliness Across Cultures

Loneliness is an important health risk, which is why it is important to understand what can cause persistent or severe loneliness. Previous research has identified numerous personal or relational risk factors for loneliness. Cultural predictors, however, have been considered less. The new framework of norm deviations and loneliness (NoDeL) proposes that social norms, which are defining features of culture, can help explain loneliness within and across cultural contexts. Specifically, people who deviate from social norms are suggested to be at an increased risk for feeling lonely because they are more likely to experience alienation, inauthenticity, lower self-worth, social rejection, relationship dissatisfaction, and/or unfulfilled relational needs. Given that social norms vary by social, geographical, and temporal context, they can furthermore be considered cultural moderators between individual-level risk factors and loneliness: Personal or relational characteristics, such as shyness or being single, may increase the risk for loneliness particularly if they do not fit social norms in a specific environment. Integrating previous quantitative and qualitative findings, I hence offer a framework (NoDeL) to predict loneliness and cultural differences in risk factors for it. Thus, the NoDeL framework may help prepare culture-sensitive interventions against loneliness.

Minority Stress and Psychosocial Influences on Cognitive Performance in Sexual Minority Older Adults

Background and Objectives

Sexual minorities experience health inequalities, but little is known about differences in neurocognitive health between heterosexual and sexual minority older adults and potential risk factors. To investigate minority stress, depression, and marital status as risk factors for worse cognitive performance in sexual minority older adults.

Research Design and Methods

A total of 336 sexual minorities and 5,561 heterosexual participants aged 50+, noninstitutionalized, and free from neurodegenerative diseases from Wave 6 of the English Longitudinal Study of Ageing were included. Cognitive performance (i.e., temporal orientation, episodic memory, and fluid intelligence) of sexual minority and heterosexual older adults was compared using general linear models including age, sex, and education as covariates. The differential impact of minority stress, depressive symptoms, and marital status on cognition in the 2 groups were also tested. Analyses were weighted for sampling probability and differential nonresponse.

Results

Sexual minority participants were more likely to report minority stress and to be single but had better episodic memory than heterosexual participants. Depression and being single were associated with worse cognitive performance in both groups. However, minority stress was negatively associated (B = -2.116, p = .016) with fluid intelligence in the sexual minority group only.

Discussion and Implications

Better memory in sexual minority participants and a negative effect of risk factors on cognition are in line with previous studies. However, this study provides the first evidence of a potential negative impact of minority stress on cognitive performance in sexual minorities. Further investigations are needed to assess minority stress more in detail and clarify its potential mechanisms of action on cognition in sexual minorities.

Touch Avoidance with Close People and Strangers: Effects of Gender, Sexual Orientation, and Relationship Status

Human contact through physical touch is a core element in social bonding, which facilitates psychosocial well-being. Touch avoidance is an individual disposition that may prevent individuals from engaging in or benefiting from physical touch. The present study recruited 450 Italian participants (51.1% female) with a mean age of 32.2 ± 13.5 to complete a battery of demographic questionnaires and the Touch Avoidance Questionnaire (TAQ). Individuals who were single and reporting same-sex attraction avoided touch with family more often than their coupled counterparts or those reporting opposite-sex attraction. Moreover, males reporting same-sex attraction avoided touch with a potential partner more frequently. When comparing sex differences, women reported greater touch avoidance with opposite-sex friends more frequently, while males avoided touch with same-sex friends more frequently. Individuals reporting opposite-sex attraction reported greater touch amongst same-sex friends. Single males avoided touch with same-sex friends more frequently than those in a relationship. Overall, this contribution reflects the individual differences related to social touch avoidance with respect to sex, relationship status, and sexual orientation in an Italian sample.

Healthcare discrimination and treatment adherence among sexual and gender minority individuals living with chronic illness: the mediating effects of anticipated discrimination and depressive symptoms

Background: Sexual and gender minority (SGM) individuals are at increased risk for an array of chronic illness due to minority stress. Up to 70% of SGM individuals report healthcare discrimination, which may cause additional challenges for SGM people living with chronic illness including avoiding necessary healthcare. The extant literature highlights how healthcare discrimination is associated with depressive symptoms and treatment nonadherence. However, there is limited evidence on the underlying mechanisms between healthcare discrimination and treatment adherence among SGM people living with chronic illness.Methods: Among a sample of SGM individuals living with chronic illness (n = 149) recruited from social media, the current study examined the mediating roles of anticipated discrimination and depressive symptoms on the relation between healthcare discrimination and treatment adherence in a serial mediation model.Results: We found that healthcare discrimination was associated with greater anticipated discrimination, increased depressive symptoms, and, in turn, poorer treatment adherence. Conclusion: These findings highlight the association between minority stress and both depressive symptoms and treatment adherence among SGM individuals living with chronic illness. Addressing institutional discrimination and the consequences of minority stress may improve treatment adherence among SGM individuals living with chronic illness.

Branched sexuality and sexual health among Black cisgender sexual minority men in Baltimore, Maryland: an exploratory study

Branched sexuality - in form of combinations of sexual identity, behaviour and attraction (e.g. heterosexual identity, sex with men, attraction to women) that differ from coincident combinations (e.g. gay/homosexual/same-gender-loving identity, sex with men, attraction to men) - has been observed among Black sexual minority men and may correlate with sexual health. Using baseline survey data from Black sexual minority men (N = 323) enrolled in a sexual health intervention trial, we examined sexual identity, behaviour and attraction to determine the prevalence of branched sexuality and used modified Poisson regression with robust variance estimation to test associations with sexual health. Black sexual minority men reporting branched sexuality (n = 50, 15.5%) were marginally more likely to endorse negative condom-use attitudes compared to those reporting coincident sexuality (n = 273, 84.5%; adjusted prevalence ratio [aPR] = 1.48, 95% confidence interval [CI] = 0.94, 2.32) and significantly more likely to endorse negative condom-use attitudes compared to those reporting gay/homosexual/same-gender-loving-coincident sexuality (aPR = 1.85, 95% CI = 01.07, 3.22). Those reporting branched sexuality were significantly less likely to report past-year testing for sexually transmitted infections compared to those reporting coincident (PR = 0.52, 95% CI = 0.28, 0.94) or gay/homosexual/same-gender-loving-coincident sexuality (PR = 0.46, 95% CI = 0.25, 0.84) in bivariate analyses only. Increased understanding of Black sexual minority men's sexuality and improved sexuality data collection efforts are needed.

Dyadic effects of minority stress and problematic alcohol use on sexual intimate partner violence in same sex couples

Little is known about the factors that facilitate the perpetration of sexual violence within the context of same-sex romantic relationships (sexual intimate partner violence perpetration [S-IPV]). The present study sought to identify the effects of external and internal minority stress and problematic drinking on perpetration of S-IPV within a dyadic framework. A community-based sample of 137 sexual and gender minority (SGM) couples (N = 274; 59 male assigned at birth and 78 female assigned at birth couples) completed self-report surveys about minority stressors, alcohol use, and S-IPV perpetration. Multilevel logistic regression analyses were conducted within an actor-partner interdependence framework. This approach accounted for both actor effects (e.g., how much one's S-IPV perpetration is predicted by their own risk factors) and partner effects (e.g., how much one's S-IPV perpetration is influenced by their partner's risk factors). Both Actor external minority stress and internal minority stress were positively associated with Actor S-IPV perpetration. Actor problematic drinking was not associated with Actor S-IPV perpetration; however, Partner problematic drinking was positively associated with Actor S-IPV perpetration. Observed effects were robust above the addition of other risk factors. This research innovatively extricates S-IPV perpetration from other forms of IPV and indicates that Actor minority stress and Partner problematic drinking increase S-IPV likelihood. Results serve as a starting point for development of etiological models to inform the design of culturally-informed interventions to reduce S-IPV among SGM couples.

Development and Validation of the Sexual Minority Adolescent Rejection Sensitivity Scale

Because no measure for sexual orientation-related rejection sensitivity (RS) for adolescents exists, we aimed to develop and validate the Sexual Minority Adolescent Rejection Sensitivity Scale (SMA-RSS). In Study 1, interviews with 22 sexual minority youth were conducted (M age = 18.86, SD = 3.03). Based on these interviews, 29 scenarios were developed as potential items for the SMA-RSS. In Study 2, exploratory factor analyses were conducted on these 29 scenarios in a sample of 397 sexual minority adolescents (M age = 16.63, SD = 1.07). The 14 best performing items were selected and a two-factor structure best fit the data. In Study 3, a confirmatory factor analysis was conducted and the test-retest reliability, criterion validity, convergent validity, and incremental validity of the SMA-RSS were assessed in a sample of 499 sexual minority adolescents (M age = 16.61, SD = 1.34). A bifactor model best fit the data and evidence was provided for a strong enough general factor to justify unidimensionality. For criterion validity, the SMA-RSS evidenced small to moderate correlations with minority stressors and mental health indicators. For convergent validity, we found a moderate correlation with general RS. For incremental validity, the SMA-RSS was associated with mental health indicators over and above minority stressors and general RS. Participants were moderately stable in their scores on the SMA-RSS over a one-month period. Taken together, the SMA-RSS captured unique situations in which sexual minority adolescents anxiously expect rejection and can aid in better understanding health disparities among sexual minority adolescents.

"It's the Environment, Not Me": Experiences shared by transgender and gender diverse adults living in Texas

Transgender and gender diverse people (TGD) experience elevated rates of behavioral health problems, including depression, anxiety, substance misuse, and suicidality. Minority stressors (e.g., discrimination and victimization) contribute to these poor health outcomes. A salient form of discrimination is the use of gender nonaffirming language, such as using incorrect pronouns or names, yet less is known about other environmental stimuli that may be reined as affirming or nonaffirming. A recent study uncovered the impact symbols (e.g., flags, stickers) may have on invoking positive or negative feelings among TGD youth in the Midwest. Our study further investigates this phenomenon with TGD adults in Texas. During Summer 2021, 3 researchers conducted audio-recorded semistructured focus groups and interviews with 11 participants who identified as transgender, gender nonconforming, or nonbinary. Interview topics included gender-affirming and nonaffirming language, positive and negative experiences, nonsupportive and supportive symbolism, and coping mechanisms. In this manuscript, we present findings regarding symbolism. Within our two primary themes, supportive and nonsupportive symbolism, subthemes emerged. Supportive symbolism includes flags and signage, written and oral language and communication, and representation of diversity. Nonsupportive symbolism includes extreme patriotism and religious symbols and highly gendered settings. Further, Texas-specific culture and a meter of safety were identified as being related to interacting with and observing an array of symbols. Symbolism can have a profound impact on someone's identity development, expression, emotions, coping mechanisms, and access to and engagement with social environments, exemplifying the importance of understanding geographic and cultural-specific mechanisms within environments TGD people occupy.

Causal Influences of Same-Sex Attraction on Psychological Distress and Risky Sexual Behaviors: Evidence for Bidirectional Effects

Although health disparities among same-sex attracted compared to heterosexual individuals are typically explained by minority stress, there is limited evidence for a causal effect. This study investigated whether same-sex attraction was causally associated with psychological distress and risky sexual behavior using sociosexual behavior as a proxy. The sample comprised monozygotic and dizygotic twins and their non-twin siblings (n = 2036, 3780 and 2356, respectively) genotyped and assessed for same-sex attraction, psychological distress (anxiety and depressive symptoms), and risky sexual behavior. Causal influences were investigated with same-sex attraction as the predictor and psychological distress and risky sexual behavior as the outcomes in two separate Mendelian Randomization-Direction of Causation (MRDoC) models using OpenMx in R. The MRDoC model improves on the Mendelian Randomization and Direction of Causation twin models by allowing analyses of variables with similar genetic architectures, incorporating polygenic scores as instrumental variables and specifying pleiotropy and residual covariance. There were significant causal influences flowing from same-sex attraction to psychological distress and risky sexual behavior (standardized coefficients = 0.13 and 0.16; 95% CIs 0.03-0.23 and 0.08-0.25, respectively). Further analyses also demonstrated causal influences flowing from psychological distress and risky sexual behavior toward same-sex attraction. Causal influences from same-sex attraction to psychological distress and risky sexual behavior may reflect minority stress, which reinforces ongoing measures to minimize social disparities. Causal influences flowing in the opposite direction may reflect rejection sensitivity, stigma-inducing outcomes of risky sexual behavior, and recall bias; however, further research is required to specifically investigate these processes.

Social Reactions and Trauma Symptoms Among Gender and Sexual Minority Students Disclosing Sexual Violence

Addressing the higher rates of sexual violence experienced by gender and sexual minority students in university contexts requires an understanding of responses to disclosures of sexual violence. Using data from a large-scale study of sexual violence in university contexts, the current study examined (1) whether gender and sexual minority status was associated with responses to sexual violence disclosure and (2) how disclosure responses were associated with trauma symptoms among these students. Linear regression indicated that university students' (n = 1,464) reports of responses to disclosures of sexual violence did not differ across gender or sexual minority status. Focusing on gender and sexual minority participants (n = 327), linear regression linked turning against the victim and positive responses to higher levels of trauma symptoms.

Bidirectional Causal Associations Between Same-Sex Attraction and Psychological Distress: Testing Moderation and Mediation Effects

Only one study has examined bidirectional causality between sexual minority status (having same-sex attraction) and psychological distress. We combined twin and genomic data from 8700 to 9700 participants in the UK Twins Early Development Study cohort at ≈21 years to replicate and extend these bidirectional causal effects using separate unidirectional Mendelian Randomization-Direction of Causation models. We further modified these models to separately investigate sex differences, moderation by childhood factors (retrospectively-assessed early-life adversity and prospectively-assessed childhood gender nonconformity), and mediation by victimization. All analyses were carried out in OpenMx in R. Same-sex attraction causally influenced psychological distress with significant reverse causation (beta = 0.19 and 0.17; 95% CIs = 0.09, 0.29 and 0.08, 0.25 respectively) and no significant sex differences. The same-sex attraction → psychological distress causal path was partly mediated by victimization (12.5%) while the reverse causal path was attenuated by higher childhood gender nonconformity (moderation coefficient = -0.09, 95% CI: -0.13, -0.04).

Influence of Public Sports Services on Residents' Mental Health at Communities Level: New Insights from China

It is generally believed that sports play an important role in healing and boosting mental health. The provision of public sports services is important for enhancing residents' physical fitness and mental health, and for promoting their satisfaction with government public services. To build and strengthen a high-quality sports service-oriented society, it is important to explore whether community public sports services influence residents' mental health. To explore this phenomenon, the study gathered data from China and employed multi-level regression models to meet the study objective. The results show that the residents' age difference is 0.03, and the average daily exercise time is 0.02, which is significantly correlated with residents' mental health. The results show that the lower the availability and greening of sports facilities, and the fewer rest facilities there are, the higher the mental distress of residents may be. Conversely, the improvement of the greening and availability of sports facilities can facilitate the promotion of residents' mental health levels. Moreover, it was found that the mental health of residents is mainly and positively affected by the cleanliness of sports facilities. The street environment affects mental health and is attributed to the damage to sports facilities. Neighborhood communication also improves residents' mental health, and trust between neighbors has the greatest impact on reducing mental distress. Finally, the study proposes that the government should propose strategies to optimize the provision of community public sports services in the study area to boost both social and mental health benefits.

'Why aren't you on PrEP? You're a gay man': reification of HIV 'risk' influences perception and behaviour of young sexual minority men and medical providers

Public health models and medical interventions have often failed to consider the impact of reductionist HIV 'risk' discourse on how sexual minority men interpret, enact and embody biomedical knowledge in the context of sexual encounters. The aim of this study was to use an anthropological lens to examine sexual minority men's perception of HIV risk and experience within the medical system in order to examine the influence of risk discourse on their health, behaviour and social norms. In-depth interviews (n = 43) were conducted with a racially, ethnically and socioeconomically diverse sample of young sexual minority men and explored HIV-related beliefs and experiences, as well as their interactions with healthcare providers. Findings suggest that the stigmatisation of behaviours associated with HIV appears to be shaped by three key forces: healthcare provider perceptions of sexual minority men as inherently 'risky', community slut-shaming, and perceptions of risk related to anal sex positioning. Stigmatising notions of risk appear to be embodied through sexual health practices and identities vis-à-vis preferred anal sex positions and appear to influence condom use and PrEP initiation.

Associations between sexual stigma, enacted HIV stigma, internalized HIV stigma and homonegativity, and depression: testing an extended minority stress model among men who have sex with men living with HIV in India

Limited data is available on the associations between intersectional stigmas and mental health outcomes among men who have sex with men living with HIV (MSMLH) in India. The minority stress model postulates that sexual stigma contributes to depression through proximal stressors like internalized homonegativity (IHN). Using cross-sectional survey data from 119 MSMLH in 2015/16, we tested whether: (1) sexual stigma and enacted HIV stigma (EHS) are associated with depression; (2) their effects on depression are mediated through IHN and internalized HIV stigma (IHS); and (3) their effects on IHN are mediated through IHS. Significant direct associations were observed between scores on sexual stigma and IHS (β = .49, 95% CI .27, .70), EHS and IHN (β = .19, 95% CI .03, .36), and IHS and IHN (β = .07, 95% CI .03, .12). IHS scores mediated the associations of sexual stigma with depression (β = .17, 95% CI .07, .27) and IHN scores (β = .04, 95% CI .004, .07). EHS was not found to be significantly associated with depression or IHN. The findings partially support the minority stress model among MSMLH and highlight the importance of addressing both sexual and HIV-related stigmas to improve mental health of MSMLH, especially by screening for and reducing IHS, IHN and depression.

Internalized Homophobia, Body Dissatisfaction, Psychological Distress, and Nonsuicidal Self-Injury Among Young Sexual Minority Men in China

Purpose: Sexual minority men (SMM) have been shown to be at high risk of nonsuicidal self-injury (NSSI). Internalized homophobia, body dissatisfaction, and psychological distress have been found to be related to NSSI among SMM, but few studies have focused on the mechanisms underlying these associations. Thus, the current study was conducted to examine the association between internalized homophobia and NSSI, and whether body dissatisfaction and psychological distress mediate this relationship among young SMM in China. Methods: In total, 264 young SMM (mean age, 22.00 ± 2.86 years) in Henan Province, China, participated in the study. A set of questionnaires were used to assess participants' internalized homophobia, body fat dissatisfaction, muscularity dissatisfaction, psychological distress, and NSSI. Correlation and mediation analyses were used to examine the data. Results: Internalized homophobia correlated positively with NSSI (r = 0.24, p < 0.001) among young SMM in China. This relationship was partly mediated by body fat dissatisfaction, muscularity dissatisfaction, and psychological distress. Conclusion: The study findings suggest that internalized homophobia is a risk factor for NSSI among young SMM in China, and that body fat and muscle dissatisfaction and psychological distress underlie the association between internalized homophobia and NSSI. In developing interventions targeting NSSI among SMM, the findings of the current study should be considered to improve intervention outcomes.

Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications

Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.

Sexual and Gender Identity-Based Microaggressions: Differences by Sexual and Gender Identity, and Sex Assigned at Birth Among Dutch Youth

Research describes several sexual and gender identity-based microaggressions that sexual and gender minority (SGM) people might experience. We aimed to examine the occurrence of different sexual and gender identity-based microaggressions among SGM youth and to identify differences by sexual and gender identity, and sex assigned at birth. Open-ended questions about daily experiences were coded for 16 types of sexual and gender identity-based microaggressions in two daily diary studies among Dutch SGM youth (Study 1: N = 90, M age = 17.64 SD = 1.78; Study 2: N = 393, M age = 18.36 SD = 2.65). Several types of microaggressions were identified, and there was sizable variability in the reported frequency. Overall, lesbian women and bisexual youth were less likely to report microaggressions than gay youth. Bisexual youth were less likely to report use of heterosexist or transphobic terminology than gay youth and youth assigned male at birth were less likely to report invalidation of LGBTQ identity than youth assigned female at birth. Last, gender minority youth were more likely to report familial microaggressions, invalidation of LGBTQ identity, and threatening behaviors than cisgender youth. Overall, this study provides empirical support using mixed qualitative and quantitative methods for theorized typologies of microaggressions among Dutch SGM youth.

Minority Stress and Positive Identity Aspects in Members of LGBTQ+ Parent Families: Literature Review and a Study Protocol for a Mixed-Methods Evidence Synthesis

BACKGROUND

Parents and children in LGBTQ+ parent families face unique stressors (i.e., minority stress), but also possess unique resources (i.e., positive identity aspects) related to their family identity. Empirical evidence and theory suggest that these minority stressors and positive identity aspects are situated on the individual, couple, and family level and may be associated with key outcomes, including parent and child health, family functioning, and school-related outcomes. A systematic evidence synthesis and a theoretical placement are currently lacking. The aims of the systematic review outlined in this protocol are thus to (1) map minority stressors and positive identity aspects according to multiple levels in the family system, and (2) to synthesize evidence on their associations with key outcomes.

METHODS

We will conduct a PRISMA-conform mixed-methods systematic review. Studies will be retrieved using a multi-tiered search strategy, including database searches (PsycInfo, PubMed, Scopus, Web of Science), cited literature searches, authors' publication lists, and study requests. The mixed-methods synthesis will follow a parallel-results convergent synthesis design, where quantitative results will be synthesized via meta-analysis and qualitative results via thematic synthesis.

CONCLUSIONS

Our proposed systematic review may add to the theoretical understanding of LGBTQ+ parent family functioning and advance social inclusion of LGBTQ+ parent families.

Divergent patterns of cognitive deficits and structural brain alterations between older adults in mixed-sex and same-sex relationships

Background

Sexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and MSR.

Methods

Data were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse/partner, and availability of T1-MRI brain volumes/thickness. Participants were labeled as either SSR or MSR based on their/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR−555 cognitively unimpaired [CU]; 36 SSR−23 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (n = 939; 908 MSR−494 CU; 31 SSR−22 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype.

Results

Multivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group.

Conclusion

In our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation.

Doubly Marginalized: Addressing the Minority Stressors Experienced by LGBTQ+ Researchers Who Do LGBTQ+ Research

Lesbian, gay, bisexual, transgender, and nonbinary, and queer people (LGBTQ+) experience significantly higher levels of stressors due to discrimination, stigma, and marginalization than do cisgender heterosexual people. These high levels of stressors have impacts on health and well-being as well as career impacts. Limited research suggests that within higher education LGBTQ+ faculty experience bullying, discrimination, and harassment within the workplace. There is also data to suggest that research on marginalized populations is perceived to be less objective and valuable than research on majority populations. Research on the challenges of being a member of a marginalized population who conducts research on the same population suggests potentially negative career and personal impacts. To my knowledge, there has been little to no research on the double marginalization related to being an LGBTQ+ researcher doing research within the LGBTQ+ community. To describe the potential impacts of being an LGBTQ+ researcher who does LGBTQ+ research, I apply the extant literature on marginalized researchers who do research among marginalized populations to LGBTQ+ researchers. I also describe the potential minority stressors that LGBTQ+ researchers may face and how that may impact careers. Finally, I offer multiple recommendations for improvements for our research community and argue that senior faculty, leadership, and mentors can take specific actions to lessen stressors for LGBTQ+ researchers studying LGBTQ-related topics.

Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses

Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.

Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women

Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.

Childhood emotional abuse, rejection sensitivity, and depression symptoms in young Chinese gay and bisexual men: Testing a moderated mediation model

BACKGROUND

There is a high and increasing prevalence of depression symptoms among gay and bisexual individuals. Studies have found that childhood emotional abuse (CEA) can impact mental-health problems in adulthood; however, limited research on this association among marginalized populations, especially in China. This study aimed to explore the relationship between CEA and depression symptoms in adulthood among gay and bisexual youths in China and to test the mediating role of rejection sensitivity and the moderating role of sexual identity in this relationship.

METHODS

Participants comprised 496 gay and bisexual Chinese men aged 18-29 years. They responded to a questionnaire that assessed history of CEA, rejection sensitivity, and depression symptoms.

RESULTS

CEA showed a positive association with depression symptoms among participants. Participants' rejection sensitivity played a partial mediating role in the relationship between CEA and depression symptoms. Sexual identity had a moderating effect on the CEA's influence on depression symptoms, with a stronger impact for gay men than bisexual men.

LIMITATIONS

Cross-sectional approach limited casual inferences among variables. Recall bias regarding CEA may have impacted the accuracy of the effect sizes observed.

CONCLUSION

This study contributes to improving understanding of CEA's role as a substantial risk factor for strong depression symptoms in adulthood among gay and bisexual youths and it demonstrates that focusing on educating families and establishing equal policies is important to decrease and eliminate depression symptoms. Theories of sexual minority stress and biphobia are applicable for explaining mental health outcomes among young members of sexual minorities in China.

The Affective Consequences of Minority Stress Among Bisexual, Pansexual, and Queer (Bi+) Adults: A Daily Diary Study

Bisexual, pansexual, and queer (bi+) individuals are at increased risk for depression and anxiety. These disparities are hypothesized to be due to the unique, minority-specific stressors that they experience. Prior research supports that bi+ stressors are associated with depression and anxiety, but nearly all studies have been cross-sectional, limiting our understanding of how experiencing bi+ stress influences individuals' levels of depression and anxiety as they occur in their day-to-day lives. To address this gap, we examined the daily associations between bi+ stressors (discrimination, internalized stigma, rejection sensitivity, and identity concealment) and depressed/anxious mood in a 28-day diary study. Participants were 208 bi+ individuals who completed daily measures of bi+ stressors and depressed/anxious mood. We tested unlagged (same-day) and lagged (next-day) associations, and we also tested whether internalized stigma, rejection sensitivity, and identity concealment functioned as mechanisms underlying the daily associations between discrimination and depressed/anxious mood. Participants reported higher depressed/anxious mood on days when they reported higher discrimination, internalized stigma, rejection sensitivity, and identity concealment. There were significant unlagged indirect effects of discrimination on depressed and anxious mood via internalized stigma and rejection sensitivity, and there was also a significant unlagged indirect effect of discrimination on anxiety via identity concealment. However, none of the lagged associations were significant. Results suggest that bi+ stress is related to same-day, but not next-day, depressed/anxious mood. The nonsignificant lagged associations could reflect that bi+ individuals are using adaptive coping skills in response to bi+ stress, or that other experiences throughout the day have stronger influences on next-day mood.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

Childhood Gender Nonconformity and Recalled Perceived Parental and Peer Acceptance Thereof, Internalized Homophobia, and Psychological Well-Being Outcomes in Heterosexual and Gay Men from Poland

The link between gender nonconformity and psychopathology may be due in part to negative childhood experiences resulting from other people's reactions to gender nonconformity. The aim of this study was to test whether recalled perceived levels of parental and peer acceptance of childhood gender nonconforming behaviors and play mediate the relationship of childhood gender nonconformity with depression and social anxiety in adulthood. We also tested whether this relationship was moderated by sexual orientation and, among gay men, whether internalized homophobia was an additional mediator. All variables were measured in a large sample of male participants using self-report (n = 449 gay men, age: M = 27.8 years, SD = 6.69; and n = 296 heterosexual men, age: M = 27.4 years, SD = 6.57) in Poland. Gay men reported more childhood gender nonconformity than heterosexual men. The relationship between gender nonconformity and depressive symptoms as well as social anxiety symptoms was significant in both gay and heterosexual men. Among gay men, this relationship was partially mediated by peer but not parental acceptance of the measured aspects of gender nonconformity and internalized homophobia. Among heterosexual men, recalled perceived parental acceptance of gender nonconformity partially mediated the relationship between gender nonconformity and depressive and social anxiety symptoms. Our findings were partially in line with those found in Western European and North American samples. Although the two groups differed in their recalled perceived gender nonconformity, they did not differ in their depression or social anxiety scores. Nevertheless, childhood gender nonconformity may be an indirect risk associated with mental health symptoms, irrespective of sexual orientation. Its higher prevalence among nonheterosexual individuals makes it a particular risk for this group.

Minority Stress and Loneliness in a Global Sample of Sexual Minority Adults: The Roles of Social Anxiety, Social Inhibition, and Community Involvement

Research suggests that loneliness among sexual minority adults is associated with marginalization, but it is unclear which processes may underlie this relationship. This cross-sectional study examined five possibilities: stigma preoccupation, internalized homonegativity, sexual orientation concealment, social anxiety, and social inhibition. The study also examined the possible protective role of LGBTQ community involvement. Respondents were 7856 sexual minority adults aged 18-88 years from 85 countries who completed an online survey. Results of structural equation modeling indicated that marginalization was positively associated with both social and emotional loneliness, and that part of this relationship was indirect via proximal minority stress factors (especially stigma preoccupation) and, in turn, social anxiety and social inhibition. Moreover, while LGBTQ community involvement was associated with greater marginalization, it was also associated with lower levels of proximal stress and both forms of loneliness. Among those who were more involved in the LGBTQ community, the associations between marginalization and proximal stress were somewhat weaker, as were those between stigma preoccupation and social anxiety, and between social inhibition and social loneliness. In contrast, the associations between concealment and social anxiety were somewhat stronger. Model fit and patterns of association were similar after controlling for the possible confounding effect of dispositional negative affectivity, but several coefficients were lower. Findings underscore the continuing need to counter marginalization of sexual minorities, both outside and within the LGBTQ community, and suggest possible avenues for alleviating loneliness at the individual level, such as cognitive-behavioral interventions targeting stigma preoccupation and social anxiety.

Identity and Relationship-Based Discrimination, and Mental Health in a Sample of Sexual Minority Male Couples

PURPOSE

The study explored the unique associations of individual identity-based discrimination and relationship-based discrimination with mental health among sexual minority male couples. It also examined whether couples' relationship functioning moderated associations between relationship-based discrimination, the experience of one's romantic relationship being devalued, and mental health outcomes.

METHODS

Baseline dyadic data drawn from a clinical trial involving 70 couples (N= 140) were analyzed using Actor-Partner Interdependence Modeling. The sample consisted of sexual minority men, of which 54.3% identified as a person of color. Each partner completed the computerized survey independently. Data were collected using the Relationship Marginalization Scale, Dyadic Adjustment Scale, Generalized Anxiety Disorder-7, and Center for Epidemiologic Studies Depression Scale-Revised scales.

RESULTS

Dyadic adjustment moderated (i.e., buffered against) the association between relationship-based discrimination and depressive symptoms. The effects appeared to follow an intra-individual pattern (B _ACTOR = -0.06, p = .048 and B _PARTNER = -0.07, p = .030) indicating the lack of evidence for crossover effects. The interaction terms predicting anxiety yielded non-significant results.

CONCLUSIONS

The current research suggests that dyadic functioning buffers against the effects of stigma. These findings point to the potential utility of interventions to improve relationship functioning into interventions addressing stigma among partnered sexual minority men.

A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda

BACKGROUND

Systemic oppression, particularly towards sexual minorities, continues to be deeply rooted in the bedrock of many societies globally. Experiences with minority stressors (e.g. discrimination, hate-crimes, internalized homonegativity, rejection sensitivity, and microaggressions or everyday indignities) have been consistently linked to adverse mental health outcomes. Elucidating the neural adaptations associated with minority stress exposure will be critical for furthering our understanding of how sexual minorities become disproportionately affected by mental health burdens.

Following PRISMA-guidelines, we systematically reviewed published neuroimaging studies that compared neural dynamics among sexual minority and heterosexual populations, aggregating information pertaining to any measurement of minority stress and relevant clinical phenomena.

RESULTS

Only 1 of 13 studies eligible for inclusion examined minority stress directly, where all other studies focused on investigating the neurobiological basis of sexual orientation. In our narrative synthesis, we highlight important themes that suggest minority stress exposure may be associated with decreased activation and functional connectivity within the default-mode network (related to the sense-of-self and social cognition), and summarize preliminary evidence related to aberrant neural dynamics within the salience network (involved in threat detection and fear processing) and the central executive network (involved in executive functioning and emotion regulation). Importantly, this parallels neural adaptations commonly observed among individuals with posttraumatic stress disorder (PTSD) in the aftermath of trauma and supports the inclusion of insidious forms of trauma related to minority stress within models of PTSD.

CONCLUSIONS

Taken together, minority stress may have several shared neuropsychological pathways with PTSD and stress-related disorders. Here, we outline a detailed research agenda that provides an overview of literature linking sexual minority stress to PTSD and insidious trauma, moral affect (including shame and guilt), and mental health risk/resiliency, in addition to racial, ethnic, and gender related minority stress. Finally, we propose a novel minority mosaic framework designed to inform future directions of minority stress neuroimaging research from an intersectional lens.

Metrics of Sexual Behavior Stigma Among Cisgender Men Who Have Sex With Men in 9 Cities Across the United States

Men who have sex with men (MSM) in the United States are stigmatized for their same-sex practices, which can lead to risky sexual behavior, potentiating risk for human immunodeficiency virus (HIV) infection. Improved measurement is necessary for accurately reporting and mitigating sexual behavior stigma. We added 13 sexual behavior stigma items to local surveys administered in 2017 at 9 sites in the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance system, which uses venue-based, time-sampling procedures to survey cisgender MSM in US Census Metropolitan Statistical Areas. We performed exploratory factor analytical procedures on site-specific (Baltimore, Maryland; Denver, Colorado; Detroit, Michigan; Houston, Texas; Nassau-Suffolk, New York; Portland, Oregon; Los Angeles, California; San Diego, California; and Virginia Beach-Norfolk, Virginia) and pooled responses to the survey items. A 3-factor solution-"stigma from family" (α = 0.70), "anticipated health-care stigma" (α = 0.75), and "general social stigma" (α = 0.66)-best fitted the pooled data and was the best-fitting solution across sites. Findings demonstrate that MSM across the United States experience sexual behavior stigma similarly. The results reflect the programmatic utility of enhanced stigma measurement, including tracking trends in stigma over time, making regional comparisons of stigma burden, and supporting evaluation of stigma-mitigation interventions among MSM across the United States.

Differences by sex and gender in the association between minority stress and alcohol use among sexual and gender minority youth: A daily diary study

Rationale

Sexual and gender minority (SGM) youth consume more alcohol than their heterosexual, cisgender peers. The experience of minority stress is theorized to explain these disparities. Research often neglects the day-to-day variability in minority stress that SGM youth encounter and whether alcohol use is associated with daily experiences of minority stress. Further, there is heterogeneity in alcohol use among SGM youth. Sex assigned at birth and gender identity could potentially explain this heterogeneity.

Objective

Therefore, this study aimed to examine whether daily experiences of minority stress were associated with daily alcohol use among SGM youth and how these associations differed by sex assigned at birth and gender identity.

Methods

A 14-day daily diary study was conducted among 393 Dutch SGM youth (M age = 18.36 SD = 2.65).

Results

Results showed few significant associations between both mean levels of minority stress and daily experiences with minority stress with alcohol use. However, higher mean levels of prejudice events were associated with higher odds of daily alcohol use (OR = 7.01, 95% CI: 1.20–40.89). Daily experiences with identity concealment were associated with lower odds of daily alcohol use for males (OR = 0.72, 95% CI: 0.60–0.86), but not for females (OR = 1.11, 95% CI: 0.93–1.32). Further, for cisgender youth, daily experiences with prejudice events were associated with higher odds of alcohol use (OR = 1.99, 95% CI: 1.05–3.78), but this was not the case for gender minority youth (OR = 0.42, 95% CI: 0.15–1.18).

Conclusions

The findings showed few significant associations between minority stressors and alcohol use, but daily experiences of concealment and prejudice events were associated with daily alcohol use and these associations varied by sex assigned at birth and gender identity, respectively.

Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

BACKGROUND

For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma.

METHODS

We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d'Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data.

RESULTS

Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations.

CONCLUSIONS

Research to determine the factors driving disclosure's differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.