Overall, sexual minorities have poorer mental health than heterosexual individuals, and stress is thought to underlie such disparities. However, sexual minorities include both those identifying as lesbian, gay, or bisexual (LGB) and many who do not (e.g., individuals identifying as mostly heterosexual, or as heterosexual but with discordant same-sex attractions or behaviors), and little is known about the mental health or stress experiences of non-LGB identified sexual minorities. This study assessed perceived stress and depressive symptom differences between concordant heterosexual individuals and three groups of sexual minority young adults (LGB, mostly heterosexual, and discordant heterosexual individuals).Data were from the National Longitudinal Study of Adolescent to Adult Health, Wave IV (2008-2009). Descriptive and bivariate statistics were estimated. Path analyses assessed whether perceived stress mediated differences in depressive symptomatology. Analyses were weighted and gender-stratified.Mostly heterosexual individuals comprised the largest sexual minority group, for both men (3.58%) and women (15.88%). All sexual minority groups reported significantly more depressive symptoms than concordant heterosexual individuals, for both men and women (all P < 0.05). Among women, all sexual minority groups reported significantly higher perceived stress than concordant heterosexual individuals (all P < 0.05), which partially mediated elevations in depressive symptomatology (all P < 0.05). Mostly-heterosexual-identified men reported significantly higher perceived stress than concordant heterosexual men (P < 0.01), which partially mediated elevations in depressive symptomatology (P < 0.01).Our results underscore the importance of assessing sexual orientation comprehensively to fully understand sexual minority health disparities. Additional research should examine the stressors specific to different sexual minority groups.
Purpose: We assessed how psychological distress and felt stigma (perceived sexual minority stigma in one's community) are associated with key HIV prevention outcomes in a U.S. national probability sample of sexually active, HIV-negative sexual minority men. Methods: Using data from the Generations study (2017–2018, N = 285), the present study assessed the effects of psychological distress and felt stigma and their interaction on three HIV prevention outcomes: testing for HIV as per Centers for Disease Control and Prevention guidelines (once or more in the past year), use of latex barriers (e.g., condoms), and familiarity with pre-exposure prophylaxis (PrEP). Results: In main effects models, neither psychological distress nor felt stigma was associated with any of the screening and prevention outcomes. However, the interaction between psychological distress and felt stigma was associated with each outcome. Specifically, at higher levels of felt stigma, greater psychological distress was associated with lower odds of HIV testing (exponentiated coefficient = 0.93, confidence interval [95% CI] 0.87–1.00), use of latex barriers (exponentiated coefficient = 0.92, 95% CI 0.86–0.99), and familiarity with PrEP (exponentiated coefficient = 0.90, 95% CI 0.82–0.98). Conclusion: These findings highlight the importance of felt stigma in shaping the association between psychological distress and engagement in HIV screening and prevention and offer important considerations for future HIV prevention research and interventions.
During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956–1963), visibility (born 1974–1981), and equality (born 1990–1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors—both distal stressors, such as violence and discrimination, and proximal stressors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities.
Abstract This chapter addresses the question: How do Black lesbians, gay men, and bisexuals (LGBs) who inhabit two socially significant identities, experience these identities? It considers two dominant perspectives in identity theory. One perspective views multiple salient identities as competing; the other perspective argues that multiple identities coexist to form a coherent self. It supplements these perspectives with two notions: (1) that individuals recognize the social origin of constraints placed on their identities; and (2) that identity is a dialectical process that occurs in distinctive interpersonal, sociocultural, and historical contexts. This conceptual framework shows how unity can exist alongside multiplicity and personal agency alongside social determination in Black LGB identities.
Amnesty International's (AI) recent report Crimes of Hate, Conspiracy of Silence examines the torture and ill-treatment of lesbian, gay, bisexual, and transgender (LGBT) people. The report documents widespread human rights abuses, ranging from loss of dignity to assault, rape, and murder. The report also reveals that both the state and society continue to sanction these human rights abuses through formal mechanisms, such as discriminatory laws, and through informal mechanisms, including stigma and prejudice. The disinterest or active hostility of the criminal justice system has allowed many of these abuses to be conducted with impunity.l This disturbing picture of abuses that goes against human decency should rouse health professionals-as well as citizens everywhere-to action. Health professionals should be particularly alarmed that health-care workers are implicated in these violations not
