Minority stress

Last updated

Minority stress describes high levels of stress faced by members of stigmatized minority groups. [1] It may be caused by a number of factors, including poor social support and low socioeconomic status; well understood causes of minority stress are interpersonal prejudice and discrimination. [2] [3] Indeed, numerous scientific studies have shown that when minority individuals experience a high degree of prejudice, this can cause stress responses (e.g., high blood pressure, anxiety) that accrue over time, eventually leading to poor mental and physical health. [1] [3] [4] [5] Minority stress theory summarizes these scientific studies to explain how difficult social situations lead to chronic stress and poor health among minority individuals.

Contents

Theoretical development

Emergence

Over the past three decades, social scientists have found that minority individuals suffer from mental and physical health disparities compared to their peers in majority groups. This research has focused primarily on racial and sexual minorities. For example, Black Americans have been found to suffer elevated rates of hypertension compared to whites. [6] Lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals face higher rates of suicide, substance abuse, and cancer relative to non-queer people. [7] [8] [9] More recent data suggest the association of minority stressors with higher rates of migraine headaches, [10] stroke, [11] and functional neurological disorder among LGBTQ+ people. [12] [13] Newer hypotheses propose that intersections of multiple minority stigmata increase experiences of stress. [14] [15]

Social selection hypothesis

One causal explanation for minority health disparities is the social selection hypothesis, which holds that there is something inherent to being in a minority group (e.g., genetics) that makes individuals susceptible to health problems. [16] [17] In general, this view has not been supported by empirical research. Instead, research suggests that environmental factors explain minority health disparities better than do genetic factors. [18] [19] While the social selection hypothesis is still debated, it is clear that genetic and dispositional factors do not fully explain the health disparities observed in minority groups.

Social causation hypothesis

A second hypothesis regarding the causes of minority health disparities suggests that minority group members face difficult social situations that lead to poor health. [17] This hypothesis has received broad empirical support. [4] Indeed, social psychologists have long recognized that minority individuals have different social experiences compared to majority individuals, including prejudice and discrimination, unequal socioeconomic status, and limited access to health care. [20] [21] According to the social causation hypothesis, such difficult social experiences explain health differences between minority and majority individuals. [17] [4]

Overview of minority stress theory

Minority stress theory extends the social causation hypothesis by suggesting that social situations do not lead directly to poor health for minority individuals, but that difficult social situations cause stress for minority individuals, which accrues over time, resulting in long-term health deficits. [22] [1] [23]

When being applied to sexual and gender minorities, the term minority stress first appeared in the 1981 book Minority Stress in Lesbian Women by Virginia Rae Brooks, later known as Winn Kelly Brooks. [24] [25]

Minority Stress Theory, as it is currently referenced, was coined by Illan Meyer in his 1995 research study "Minority stress and mental health in gay men.". Meyer's version of minority stress theory distinguishes between distal and proximal stress processes. [4] Distal stress processes are external to the minority individual, including experiences with rejection, prejudice, and discrimination. Proximal stress processes are internal, and are often the byproduct of distal stressors; they include concealment of one's minority identity, vigilance and anxiety about prejudice, and negative feelings about one's own minority group. Together, distal and proximal stressors accrue over time, leading to chronically high levels of stress that cause poor health outcomes. Thus, minority stress theory has three primary tenets:

  1. Minority status leads to increased exposure to distal stressors.
  2. Minority status leads to increased exposure to proximal stressors, due to distal stressors.
  3. Minority individuals suffer adverse health outcomes, which are caused by exposure to proximal and distal stressors.

These three tenets of the minority stress theory have been tested in over 134 empirical studies, most of which examined racial and sexual minority populations. [3] Generally, the studies have confirmed that difficult social situations are associated with stress among minority individuals, and that minority stress helps to explain health disparities.

Evidence of key concepts

Minority status and distal stressors

The first tenet of minority stress theory holds that being in a minority group is associated with increased exposure to distal stressors, such as prejudice and discrimination. Indeed, despite significant improvement over the past several decades, numerous studies have confirmed that minority individuals continue to face high rates of distal stressors. [26] For example, in large-scale national surveys, LGBTQ+ individuals report high rates of prejudice and discrimination across the lifespan. [27] [28] [29] One survey found that one-fourth of LGB adults have experienced victimization related to their sexual orientation, and another found that as many as 90% of LGBTQ+ youth report hearing prejudiced remarks at school. [30] [31] Similarly, up to 60% of African Americans report experiencing distal stressors throughout their lives, ranging from social rejection at school to housing discrimination and employment discrimination. [32] [33] [34] [35] In one study, 37 African American respondents recalled over 100 discrete experiences with racist prejudice in a two-year period. [36] In another study, 98% of Black participants reported experiencing at least one incidence of prejudice in the past year. [37]

Rates of exposure to distal stressors are much higher among racial and sexual minorities than among majority individuals. For example, LGBTQ+ adults are twice as likely to recall experiencing prejudice throughout their lives compared to heterosexuals, and LGBTQ+ youth report significantly higher rates of prejudice and discrimination compared to their heterosexual and cisgender peers. [31] [38] [39] In one carefully controlled study, researchers compared rates of victimization among LGBTQ+ youth and their heterosexual siblings, and they found significantly higher rates of abuse among the LGBTQ+ individuals. [40] Comparing rates of perceived discrimination among African American and White individuals, researchers have found large differences in reports of discrimination: 30.9% of Whites reported experiencing "major discrimination" throughout their lives compared to 48.9% of African Americans. Similarly, 3.4% of Whites reported experiencing discrimination "often" in their lives, compared to 24.8% of African Americans. [41] Thus, collectively, research suggests that minority individuals face frequent exposure to distal stressors compared to their majority group counterparts. [2] [42] [43]

Minority status and proximal stressors

Proximal stressors are internal processes that are presumed to occur following exposure to distal stressors. [4] Examples of proximal stressors include fear of rejection, rumination on previous experiences with prejudice, and distaste for one's own minority group following a prejudice event. [1] [23] Most research on this topic focuses on either sexual minorities or African Americans, and it is unclear whether the proximal stress processes are conceptually similar between these two groups. Thus, it is necessary to review proximal stress processes separately for sexual minority and African American populations.

Proximal stressors among sexual minorities

A growing body of research indicates that exposure to distal stressors leads to proximal stressors in sexual minority populations. While sexual minority stress and gender minority stress both use Meyer's Minority Stress Model as a framework, and share some characteristics with gender minority stress, some researchers have suggested that sexual minority stress is distinct from the minority stress experienced by transgender, gender non-conforming, and non-binary-gender individuals. [44] For example, LGBTQ+ youth and adults who have experienced prejudice about their sexual orientation sometimes choose to conceal their sexual identity from others. [45] [46] [47] Concealing such personal information causes significant psychological distress, including intrusive thoughts about the secret, shame and guilt, anxiety, and isolation from other members of the minority group. [46] [48] [49] [50] Internalized homophobia is another proximal stressor prevalent among LGBT individuals. It refers to the internalization of negative social views about homosexuality, which leads to self-hatred and poor self-regard. [51] [52] As predicted by minority stress theory, internalized homophobia is associated with exposure to distal stressors, insofar as it only occurs because LGB individuals are exposed to negative societal attitudes toward same-sex attraction. [53] Rejection sensitivity represents a third proximal stress among sexual minority individuals. Rejection sensitivity refers to chronic, anxious expectations of rejection based on one's stigmatized status. Among sexual minority individuals, rejection sensitivity emerges from experiences of rejection from parents and is associated with internalized homophobia, unassertiveness, depression, and anxiety. [54] [55] Thus, previous experiences with prejudice are associated with proximal stress among LGBTQ+ individuals, including concealment of their sexual identity, internalized homophobia, and rejection sensitivity.

Proximal stressors among gender minorities

In comparison to cis (non-transgender) individuals, gender variant minorities face a higher rate of distal stressors, including exclusion, verbal trans bashing, as well as physical and sexual violence. [56] [57] [58] The more distal stressors are sourced in family, friends, partners, neighbors, co-workers, acquaintances, strangers, and even the police, the more likely it is for gender variant people to experience proximal stress, including internalized transphobia. [56] [58] [59] Internalized transphobia may initially appear as anxiety and depression, marked by a severe decrease in self-tolerance or self-empathy, yet needs to be understood diagnostically within the context of minority stress. [59]

Proximal stressors among African Americans

Among African Americans, proximal stressors were described by early social psychological theorists. For example, Erving Goffman observed that racial minorities approach social interactions with a high degree of anxiety, because they have been discriminated against in the past. [60] Similarly, Gordon Allport asserted that African American individuals display vigilance after exposure to prejudice, actively scanning the social environment for potential threats. [20] Such vigilance is presumed to be taxing, sapping emotional and cognitive energy from minority individuals and thus becoming stressful. Proximal stressors also have been demonstrated among African Americans in terms of stereotype threat. [61] [62] Researchers have shown that, when African Americans are reminded of their racial minority status in an academic context, they face a high degree of anxiety, causing their intellectual performance to suffer. [62]

General proximal stressors among minority individuals

The proximal stress processes reviewed above are unique to specific minority groups; for example, internalized homophobia is a proximal stressor unique to LGBTQ+ individuals who experience prejudice about their sexual and or/gender orientation/expression, and vigilance against racism is unique to racial minorities who fear future experiences with race-based discrimination. It is also possible that more general psychological processes act as proximal stressors for minority individuals. [63] For example, exposure to prejudice may lead to rumination, which is a common psychological phenomenon characterized by a maladaptive, repetitive, and obsessive focus on a past event that leads to depressive and anxious symptoms. [64] [65] Several studies have shown that distal stressors are associated with such general proximal stress processes among minority individuals. In one 2010 longitudinal study, researchers found that gay men who experienced distal stressors related to their sexual orientation had an increased tendency to ruminate, which was associated with increased depressive and anxious symptoms compared to gay men who did not experience distal stressors. [66] In another study from 2009, LGBT youth reported higher rates of rumination on days when they experienced distal stressors; rumination in turn was associated with psychological distress. [67] Because minority individuals have been shown to face high rates of distal stressors compared to majority individuals, and because experiencing distal stressors is associated with general psychological stress processes such as rumination and anxiety, these findings highlight the more general ways in which prejudice and discrimination may affect internal stress processes among minority individuals.

Health outcomes

The bulk of minority stress research has examined the third tenet of the theory – namely, that distal and proximal stressors are associated with adverse health outcomes for minority individuals. [68] These outcomes include both mental and physical health disparities, which differ across minority groups. Again, studies have yet to systematically determine whether minority stress is associated with different health outcomes among different minority groups. Thus, it is necessary to review associations between minority stress and health separately for LGBTQ+, African Americans, and immigrant groups, as social scientists do not know whether stress causes similar outcomes across groups. The immigrant paradox outlines health outcomes among immigrant populations.

Health outcomes among sexual minorities

LGBTQ+ individuals face higher rates of psychopathology compared to their non-LGBTQ+ peers. For example, population-based studies have shown that LGBTQ+ people are at risk for increased rates of substance abuse, suicide attempts, depression, anxiety, and somatoform disorders across the lifespan. [7] [8] [69] [70] [71] [72] [73] In fact, one meta analysis found that LGBT individuals are 2.5 times more likely to have a lifetime history of mental disorder compared to heterosexuals, and 2 times more likely to have a current mental disorder. [1] In terms of physical health, LGBTQ+ individuals are at heightened risks for some types of cancer and immune dysfunction. [9]

Several studies have linked these negative health outcomes to distal stressors. For example, in a national survey, LGBT adults displayed higher rates of psychiatric morbidity and also reported significantly higher rates of prejudice and discrimination compared to their heterosexual peers; prejudice and discrimination fully explained the link between sexual orientation and psychiatric symptoms for LGBT respondents. [38] In another study, level of peer victimization partially explained associations between sexual orientation and suicide risk. [74] Perceived level of discrimination has also been shown to predict anxiety and substance abuse disorders among LGBTQ+ individuals. [30] [75] Multiple studies have also established an association between same-sex marriage legalization and reduced suicidality of youth and adolescents, indicating that the structural stigma embedded in denying equivalent rights to sexual minorities mediates part of the relationship between distal stressors and mental health. [76] [77]

Proximal stressors have also been linked to negative health outcomes for sexual minorities. For example, internalized homophobia has been linked to self-harm and eating disorders as well as sexual risk-taking behavior. [52] [78] Internalized homophobia has also been linked to general psychological distress, which predicts long-term mental health outcomes. [30] Another example is pathologization of asexuality possibly being linked with suicidality among asexual people. [79] Thus, both distal and proximal social stressors are associated with negative mental health outcomes among sexual minorities. A 2013 study suggests similar links between proximal stressors and physical health disparities in LGBTQ+ communities, including cardiovascular disease, asthma, diabetes, and some cancers. [80] More recently, gender dysphoria has been suggested to represent a proximal minority stressor. [81]

Health outcomes among African Americans

African Americans have been shown to suffer notable health disparities compared to their White peers. For example, they suffer higher rates of morbidity due to stroke, perinatal disease, and diabetes mellitus compared to Whites. [82] They also suffer high rates of colorectal, pancreatic, and stomach cancers. [82] In terms of mental health, African Americans report lower rates of overall life satisfaction, as well as heightened depressive symptoms and substance abuse compared to Whites. [83] [84]

Distal stressors have been linked to these health disparities among African Americans. For example, one study showed that perceived prejudice was associated with irregular blood pressure throughout the day, which has been linked to long-term cardiovascular disease. [85] [86] Exposure to racial prejudice has also been linked to negative health behaviors, such as smoking and substance abuse, which are associated with poor cardiovascular health. [37] [87] Indeed, a 2009 meta analysis of 36 empirical studies revealed consistent effects of prejudice and discrimination on physical health (e.g., cardiovascular disease, hypertension, diabetes) among racial minorities. [3] That same review revealed that racial prejudice and discrimination were related to depressive symptoms and psychiatric distress in 110 empirical studies. [3] Individual studies have shown that reports of discrimination are associated with lower reports of happiness and life satisfaction, higher psychiatric distress, and depressive symptoms. [88] [89] [90] Thus, exposure to distal stressors has been linked to poor mental and physical health outcomes for African Americans.

Other studies have linked proximal stressors and health outcomes for African Americans. For example, researchers have found that African Americans have a sense of inferiority and low self-worth due to experiences with prejudice, which are associated with emotional distress. [91] Similarly, internalized racism has been linked to psychiatric symptoms, including high rates of alcohol consumption, low self-esteem, and depression. [92] [93] [94] These findings corroborate the minority stress theory by demonstrating that proximal stressors are associated with health disparities among racial minorities. Non-Hispanic Whites are more than twice as likely to receive antidepressant prescription treatments as are Non-Hispanic Blacks. The death rate from suicide for African American men was almost four times that for African American women, in 2009. However, the suicide rate for African Americans is 60% lower than that of the Non-Hispanic White population. A report from the U.S. Surgeon General found that from 1980 - 1995, the suicide rate among African Americans ages 10 to 14 increased 233%, as compared to 120% of Non-Hispanic Whites.

Criticism and limitations

Despite multiple studies indicating that minority individuals face a high degree of stress related to their minority identity, and that minority stress is associated with poor health outcomes, there are several methodological limitations and ongoing debates on this topic.

First, the minority stress concept has been criticized as focusing too narrowly on the negative experiences of minority individuals and ignoring the unique coping strategies and social support structures available to them. [95] [96] While theoretical writings about minority stress do note the importance of coping mechanisms for minority individuals, [1] individual studies that use minority stress theory tend to focus on negative health outcomes rather than on coping mechanisms. In the future, it will be important for researchers to consider both positive and negative aspects of minority group membership, examining whether and why one of those aspects outweighs the other in determining minority health outcomes.

Also, few studies have been able to test minority stress theory in full. Most studies have examined one of the three links described above, demonstrating that minority individuals face heightened rates of prejudice, that minority individuals face health disparities, or that prejudice is related to health disparities. Together, findings from these three areas corroborate minority stress theory, but a stronger test would examine all three parts in the same study. While there have been a few such studies, [38] further replication is necessary to support the presumed pathways underlying minority stress.

Most studies of minority stress are correlational. [3] While these studies have the advantage of using large, national datasets to establish links between minority status, stressors, and health, they cannot demonstrate causality. That is, most of the existing research cannot prove that prejudice causes stress, which causes poor health outcomes among minority individuals, because correlation does not imply causation. One way to remedy this limitation is to employ experimental and longitudinal research designs to test the impact of social stressors on health. Indeed, several studies from the 2000s made use of these more stringent tests of minority stress. [97] [98] Additional studies are needed to confidently state that prejudice causes poor health for minority individuals.

It is unclear whether different minority groups face different types of minority stress and different health outcomes following prejudice. Minority stress theory was originally developed to explain associations between social situations, stress, and health for LGB individuals. [1] Still, researchers have used the same general theory to examine stress processes among African Americans, and findings have generally converged with those from LGB populations. Thus, it is possible that minority stress applies broadly to members of diverse minority groups. However, studies have yet to directly compare experiences, stress responses, and health outcomes among individuals from diverse minority groups. [3] Systematic comparisons are necessary to clarify whether minority stress applies to all minority individuals broadly, or whether different models are required for different groups.

J. Michael Bailey, best known for his research on sexual orientation, argues that the minority stress model deserves reconsideration since it fails to take temperament and genetics into account. Bailey argues that there is a biological component to increased stress among non-heterosexual populations, and says that "it would be a shame—most of all for gay men and lesbians whose mental health is at stake—if sociopolitical concerns prevented researchers from conscientious consideration of any reasonable hypothesis". [99]

Practical applications

Minority stress research has demonstrated that several specific processes are associated with minority health disparities. For example, existing studies highlight the differences between distal and proximal stressors, drawing attention both to socio-cultural factors (e.g., high rates of prejudice against minority individuals) and internal processes (e.g., rumination) that affect minority well-being. By separating the socio-cultural and individual aspects of minority stress, the theory suggests that practical interventions must occur at both the individual and social levels. [23]

Social applications

On the societal level, minority stress research shows that prejudice and discrimination are common occurrences for minority individuals, and that they have damaging effects for individual well-being. This information has been used by law enforcement, policymakers, and social organizations to target and minimize the occurrence of distal stressors and, thus, to improve minority health on a large scale. [23] For example, evidence that prejudice is associated with minority stress has been used in several amicus curiae briefs to settle important court cases regarding prejudice and discrimination against minority groups. [100] [101] Evidence that prejudice and discrimination are associated with minority stress that harms well-being for LGBT individuals has also been invoked in the congressional debate about anti-harassment protection for LGBT youth at the federal level. [23] In the future, the minority stress concept can be used to advocate for federal funding for nationwide campaigns and interventions that aim to reduce intergroup prejudice. If successful, these programs may reduce the rate of distal stressors, significantly improving the mental and physical health of minority individuals.

Individual applications

On the individual level, minority stress research has uncovered differences in how minorities react to prejudice. For example, studies have shown that some individuals ruminate on experiences with prejudice, which is associated with anxiety and depression. [66] Similarly, minority stress research has revealed that internalized stigma (i.e., distaste for one's own minority group) is associated with negative psychological outcomes. From these findings, clinicians have developed some interventions to decrease internalized stigma and improve well-being for minority individuals. [23] [102] When paired with structural interventions, these clinical applications for reducing minority stress may help to improve the pervasive health disparities observed in minority communities. [23]

See also

Related Research Articles

<span class="mw-page-title-main">Homosexuality and psychology</span> Homosexuality as studied by the field of psychology

The field of psychology has extensively studied homosexuality as a human sexual orientation. The American Psychiatric Association listed homosexuality in the DSM-I in 1952, but that classification came under scrutiny in research funded by the National Institute of Mental Health. That research and subsequent studies consistently failed to produce any empirical or scientific basis for regarding homosexuality as anything other than a natural and normal sexual orientation that is a healthy and positive expression of human sexuality. As a result of this scientific research, the American Psychiatric Association removed homosexuality from the DSM-II in 1973. Upon a thorough review of the scientific data, the American Psychological Association followed in 1975 and also called on all mental health professionals to take the lead in "removing the stigma of mental illness that has long been associated" with homosexuality. In 1993, the National Association of Social Workers adopted the same position as the American Psychiatric Association and the American Psychological Association, in recognition of scientific evidence. The World Health Organization, which listed homosexuality in the ICD-9 in 1977, removed homosexuality from the ICD-10 which was endorsed by the 43rd World Health Assembly on 17 May 1990.

Disordered eating describes a variety of abnormal eating behaviors that, by themselves, do not warrant diagnosis of an eating disorder.

<span class="mw-page-title-main">Questioning (sexuality and gender)</span> Process of self-exploration

The questioning of one's sexual orientation, sexual identity, gender, or all three is a process of exploration by people who may be unsure, still exploring, or concerned about applying a social label to themselves for various reasons. The letter "Q" is sometimes added to the end of the acronym LGBT ; the "Q" can refer to either queer or questioning.

Gay affirmative psychotherapy is a form of psychotherapy for non-heterosexual people, specifically gay and lesbian clients, which focuses on client comfort in working towards authenticity and self-acceptance regarding sexual orientation, and does not attempt to "change" them to heterosexual, or to "eliminate or diminish" same-sex "desires and behaviors". The American Psychological Association (APA) offers guidelines and materials for gay affirmative psychotherapy. Affirmative psychotherapy affirms that homosexuality or bisexuality is not a mental disorder, in accordance with global scientific consensus. In fact, embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse. Clients whose religious beliefs are interpreted as teaching against homosexual behavior may require some other method of integration of their possibly conflicting religious and sexual selves.

Various topics in medicine relate particularly to the health of lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals as well as other sexual and gender minorities. According to the US National LGBTQIA+ Health Education Center, these areas include sexual and reproductive health, mental health, substance use disorders, HIV/AIDS, HIV-related cancers, intimate partner violence, issues surrounding marriage and family recognition, breast and cervical cancer, inequities in healthcare and access to care. In medicine, various nomenclature, including variants of the acronym LGBTQIA+, are used as an umbrella term to refer to individuals who are non-heterosexual, non-heteroromantic, or non-cis gendered. Specific groups within this community have their own distinct health concerns, however are often grouped together in research and discussions. This is primarily because these sexual and gender minorities groups share the effects of stigmatization based on their gender identity or expression, and/or sexual orientation or affection orientation. Furthermore, there are subpopulations among LGBTQIA+ groups based on factors such as race, ethnicity, socioeconomic status, geographic location, and age, all of which can impact healthcare outcomes.

Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, and transgender (LGBT) youth are significantly higher than among the general population.

Ilan H. Meyer is an American psychiatric epidemiologist, author, professor, and a senior scholar for public policy and sexual orientation law at the Williams Institute of UCLA. He has conducted extensive research on minority identities related to sexual orientation, gender, race and ethnicity, drawing conclusions on the impact of social stresses on their mental health. Meyer was an expert witness for the plaintiffs in Perry v. Schwarzenegger (2010), the federal case that overturned California Proposition 8.

Domestic violence within lesbian relationships is the pattern of violent and coercive behavior in a female same-sex relationship wherein a lesbian or other non-heterosexual woman seeks to control the thoughts, beliefs, or conduct of her female intimate partner. In the case of multiple forms of domestic partner abuse, it is also referred to as lesbian battering.

Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

LGBT psychology is a field of psychology of surrounding the lives of LGBTQ+ individuals, in the particular the diverse range of psychological perspectives and experiences of these individuals. It covers different aspects such as identity development including the coming out process, parenting and family practices and support for LGBTQ+ individuals, as well as issues of prejudice and discrimination involving the LGBT community.

Due to the increased vulnerability that lesbian, gay, bisexual, and transgender (LGBT) youth face compared to their non-LGBT peers, there are notable differences in the mental and physical health risks tied to the social interactions of LGBT youth compared to the social interactions of heterosexual youth. Youth of the LGBT community experience greater encounters with not only health risks, but also violence and bullying, due to their sexual orientation, self-identification, and lack of support from institutions in society.

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic, and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion, and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, telomere shortening, and accelerated brain aging.

<span class="mw-page-title-main">Sexual assault of LGBT persons</span>

Sexual assault of LGBT people, also known as sexual and gender minorities (SGM), is a form of violence that occurs within the LGBT community. While sexual assault and other forms of interpersonal violence can occur in all forms of relationships, it is found that sexual minorities experience it at rates that are equal to or higher than their heterosexual counterparts. There is a lack of research on this specific problem for the LGBT population as a whole, but there does exist a substantial amount of research on college LGBT students who have experienced sexual assault and sexual harassment.

<span class="mw-page-title-main">LGBT health in South Korea</span>

The health access and health vulnerabilities experienced by the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA) community in South Korea are influenced by the state's continuous failure to pass anti-discrimination laws that prohibit discrimination based on sexual orientation and gender identity. The construction and reinforcement of the South Korean national subject, "kungmin," and the basis of Confucianism and Christian churches perpetuates heteronormativity, homophobia, discrimination, and harassment towards the LGBTQI community. The minority stress model can be used to explain the consequences of daily social stressors, like prejudice and discrimination, that sexual minorities face that result in a hostile social environment. Exposure to a hostile environment can lead to health disparities within the LGBTQI community, like higher rates of depression, suicide, suicide ideation, and health risk behavior. Korean public opinion and acceptance of the LGBTQI community have improved over the past two decades, but change has been slow, considering the increased opposition from Christian activist groups. In South Korea, obstacles to LGBTQI healthcare are characterized by discrimination, a lack of medical professionals and medical facilities trained to care for LGBTQI individuals, a lack of legal protection and regulation from governmental entities, and the lack of medical care coverage to provide for the health care needs of LGBTQI individuals. The presence of Korean LGBTQI organizations is a response to the lack of access to healthcare and human rights protection in South Korea. It is also important to note that research that focuses on Korean LGBTQI health access and vulnerabilities is limited in quantity and quality as pushback from the public and government continues.

This article addresses victimization of bisexual women. Victimization is any damage or harm inflicted by one individual onto another. In the United States, bisexual women are more prone to various types of victization, for example, they experience childhood sexual abuse at rates 5.3 times higher than heterosexual women.

LGBT trauma is the distress an individual experiences due to being a lesbian, gay, bisexual, trans, queer person or from possessing another minoritized sexual or gender identity. This distress can be harmful to the individual and predispose them to trauma- and stressor-related disorders.

Margaret Rosario is a health psychologist who studies the development of sexual identity and health disparities associated with sexual orientation. Rosario was President of the American Psychological Association (APA) Division 44, the Society for Psychology of Sexual Orientation and Gender Diversity, from 2017-2018. Rosario received the APA Division 44 Award for Distinguished Contributions to Ethnic Minority Issues in 2008 and the Award for Distinguished Scientific Contributions in 2012, as well as the Society for the Scientific Study of Sexuality Distinguished Scientific Achievement Award in 2021.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

The psychological impact of discrimination on health refers to the cognitive pathways through which discrimination impacts mental and physical health in members of marginalized, subordinate, and low-status groups. Research on the relation between discrimination and health became a topic of interest in the 1990s, when researchers proposed that persisting racial/ethnic disparities in health outcomes could potentially be explained by racial/ethnic differences in experiences with discrimination. Although the bulk of the research tend to focus on the interactions between interpersonal discrimination and health, researchers studying discrimination and health in the United States have proposed that institutional discrimination and cultural racism also give rise to conditions that contribute to persisting racial and economic health disparities.

People who are LGBT are significantly more likely than those who are not to experience depression, PTSD, and generalized anxiety disorder.

References

  1. 1 2 3 4 5 6 7 Meyer IH (2003). "Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence". Psychological Bulletin. 129 (5): 674–697. doi:10.1037/0033-2909.129.5.674. ISSN   1939-1455. PMC   2072932 . PMID   12956539.
  2. 1 2 Clark R, Anderson NB, Clark VR, Williams DR (1999). "Racism as a stressor for African Americans: A biopsychosocial model" (PDF). American Psychologist. 54 (10): 805–816. doi:10.1037/0003-066X.54.10.805. ISSN   0003-066X. PMID   10540593. Archived from the original (PDF) on 2021-02-27. Retrieved 2018-07-05.
  3. 1 2 3 4 5 6 7 Pascoe EA, Smart Richman L (2009). "Perceived discrimination and health: A meta-analytic review". Psychological Bulletin. 135 (4): 531–554. doi:10.1037/a0016059. ISSN   1939-1455. PMC   2747726 . PMID   19586161.
  4. 1 2 3 4 5 Dohrenwend, BP (2000). "The role of adversity and stress in psychopathology: some evidence and its implications for theory and research". Journal of Health and Social Behavior. 41 (1): 1–19. doi:10.2307/2676357. JSTOR   2676357. PMID   10750319.
  5. ↑ Meyer, I. H., & Northridge, M. E. (Eds.). (2007). The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual and transgender populations. New York: Springer.
  6. ↑ McNeilly, M., Anderson, N. B., Robinson, E. F., McManus, C. F., Armstead, C. A., Clark, R., Pieper, C. F., Simons, C, & Saulter, T. D. (1996). The convergent, discriminant, and concurrent criterion validity of the perceived racism scale: A multidimensional assessment of White racism among African Americans. In R. L. Jones (Ed.), Handbook of tests and measurements for Black populations (Vol. 2, pp. 359-374). Hampton: Cobb and Henry.
  7. 1 2 Cochran, S. D., & Mays, V. M. (2000). Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III. American Journal of Public Health, 90, 573-578.
  8. 1 2 Burgard, S. A., Cochran, S. D., & Mays, V. M. (2005). Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women. Drug and Alcohol Dependence, 77, 61-70.
  9. 1 2 Bowen, D. J., Boehmer, U., & Russo, M. (2003). Cancer and sexual minority women. In I. H. Meyer and M. E. Northridge (Eds.), The Health of Sexual Minorities. Washington, DC: APA.
  10. ↑ Rosendale N, Guterman EL, Obedin-Maliver J, Flentje A, Capriotti MR, Lubensky ME, Lunn MR (2022-07-11). "Migraine, Migraine Disability, Trauma, and Discrimination in Sexual and Gender Minority Individuals". Neurology. 99 (14): e1549–1559. doi:10.1212/WNL.0000000000200941. ISSN   1526-632X. PMC   9576305 . PMID   35817570.
  11. ↑ Streed CG, Beach LB, Caceres BA, Dowshen NL, Moreau KL, Mukherjee M, Poteat T, Radix A, Reisner SL, Singh V, on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Hypertension; and Stroke Council (2021-08-10). "Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association". Circulation. 144 (6): e136–e148. doi:10.1161/CIR.0000000000001003. ISSN   0009-7322. PMC   8638087 . PMID   34235936.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Morsy SK, Huepe-Artigas D, Kamal AM, Hassan MA, Abdel-Fadeel NA, Kanaan RA (June 2021). "The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study". Australasian Psychiatry. 29 (3): 261–265. doi:10.1177/10398562211009247. ISSN   1440-1665. PMID   33899527. S2CID   233400618.
  13. ↑ Lerario MP, Rosendale N, Waugh JL, Turban J, Maschi T (April 2023). "Functional Neurological Disorder Among Sexual and Gender Minority People". Neurologic Clinics. 41 (4): 759–781. doi:10.1016/j.ncl.2023.02.010. PMID   37775203. S2CID   258291244.
  14. ↑ Shangani S, Gamarel KE, Ogunbajo A, Cai J, Operario D (April 2020). "Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status". Culture, Health & Sexuality. 22 (4): 398–412. doi:10.1080/13691058.2019.1604994. ISSN   1464-5351. PMC   6884660 . PMID   31144598.
  15. ↑ Parra LA, Hastings PD (September 2018). "Integrating the Neurobiology of Minority Stress with an Intersectionality Framework for LGBTQ-Latinx Populations: Integrating the Neurobiology of Minority Stress". New Directions for Child and Adolescent Development. 2018 (161): 91–108. doi:10.1002/cad.20244. PMC   6320723 . PMID   29978937.
  16. ↑ Bailey, J. M. (1999). Homosexuality and mental illness. Archives of General Psychiatry, 56, 883-884.
  17. 1 2 3 Dohrenwend, B. P. (1966). Social status and psychological disorder: An issue of substance and an issue of method. American Sociological Review, 31, 14-34.
  18. ↑ Williams, D. R. (1994). The concept of race in Health Services Research: 1966 to 1990. Health Services Research, 29, 261–74.
  19. ↑ Goodman, A. H. (2000). Why genes don't count (for racial differences in health). American Journal of Public Health, 90, 1699–702.
  20. 1 2 Allport, G. W. (1954). The nature of prejudice. New York: Anchor.
  21. ↑ Garnets, L. D., Herek, G. M., & Levy. B. (1990). Violence and victimization of lesbians and gay men: Mental health consequences. Journal of Interpersonal Violence, 5, 366-383.
  22. ↑ Brooks, VR (1981). Minority stress and lesbian women. Lexington, MA: Lexington Books.
  23. 1 2 3 4 5 6 7 Meyer, I. H. (2007). Prejudice and discrimination as social stressors. In I. H. Meyer and M. E. Northridge (Eds.), The Health of Sexual Minorities. Washington, DC: APA.
  24. ↑ Rich AJ, Salway T, Scheim A, Poteat T (1 April 2020). "Sexual Minority Stress Theory: Remembering and Honoring the Work of Virginia Brooks". LGBT Health. 7 (3): 124–127. doi:10.1089/lgbt.2019.0223. PMID   32053038. S2CID   211101733.
  25. ↑ "Minority Stress and Lesbian Women by Virginia R. Brooks - 9780669039535". www.bookdepository.com. Retrieved 2023-03-14.
  26. ↑ Williams, D. R. (1999). Race, socioeconomic status, and health: The added affects of racism and discrimination. Annals of the New York Academy of Sciences, 896, 173-188.
  27. ↑ Herek, G. M., & Berrill, K. T. (1992). Hate crimes: Confronting violence against lesbian and gay men. Thousand Oaks, CA: Sage.
  28. ↑ Human Rights Watch. (2001). Hatred in the hallways: Violence and discrimination against lesbian, gay, bisexual, and transgender students in U.S. schools. New York: Human Rights Watch.
  29. ↑ Safe Schools Coalition of Washington. (1999). Eighty-three thousand youth: Selected findings of eight population-based studies as they pertain to anti-gay harassment and the safety and well-being of sexual minority students. Seattle: Safe Schools Coalition of Washington.
  30. 1 2 3 Herek, G. M., Gillis, J. R., & Cogan, J. C. (1999). Psychological sequelae of hate-crime victimization among lesbian, gay, bisexual and transgender adults. Journal of Consulting and Clinical Psychology, 67, 945-951.
  31. 1 2 GLSEN. (1999). GLSEN's national school climate survey: Lesbian, gay, bisexual and transgender students and their experiences in school. New York: GLSEN.
  32. ↑ Sigelman, L., & Welch, S. (1991). Black Americans' views of racial inequality: The dream deferred. New York: Cambridge University Press.
  33. ↑ Farrell, W. C, Jr., & Jones, C. K. (1988). Recent racial incidents in higher education: A preliminary perspective. The Urban Review, 20, 211-226.
  34. ↑ Yinger, J. (1995). Closed doors, opportunities lost: The continuing costs of housing discrimination. New York: Sage.
  35. ↑ Kirschenman, J., & Neckerman, K. M. (1991). We'd love to hire them, but... The meaning of race for employers. In C. Jenkins & P. E. Peterson (Eds.), The urban underclass (pp. 203-232). Washington, DC: Brookings Institution.
  36. ↑ Feagin, J. R. (1991). The continuing significance of race: Antiblack discrimination in public places. American Sociological Review, 56, 101-116.
  37. 1 2 Landrine, H., & Klonoff, E. A. (1996). The Schedule of Racist Events: A measure of racial discrimination and a study of its negative physical and mental health consequences. Journal of Black Psychology, 22, 144-168.
  38. 1 2 3 Mays, V.M., & Cochran, S.D. (2001). Mental health correlates of perceived discrimination among LGBTQ+ adults in the United States. American Journal of Public Health, 91, 1869–1876.
  39. ↑ Faulkner, A. H., & Cranston, K. (1998). Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students. American Journal of Public Health, 88, 262-266.
  40. ↑ Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings Archived 2018-07-05 at the Wayback Machine . Journal of Consulting and Clinical Psychology, 73, 477-487.
  41. ↑ Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208-230.
  42. ↑ Bell, D. (1992). Faces at the bottom of the well: The permanence of racism. New York: Basic Books.
  43. ↑ Dovidio, J. F. and Gaertner, S.L. (Eds.) (1986) Prejudice, discrimination and racism. New York: Academic Press.
  44. ↑ Hendricks M (2012). "A conceptual framework for clinical work with transgender and gender nonconforming clients". Professional Psychology: Research and Practice. 43 (5): 460–467. doi:10.1037/a0029597.
  45. ↑ Croteau, J. M. (1996). Research on the work experience of lesbian, gay, and bisexual people: an integrative review of methodology and findings. Journal of Vocational Behavior, 48, 195-209.
  46. 1 2 D'Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual/gender orientation, victimization, and mental health among lesbian, gay, bisexual and transgender older adults. Journal of Interpersonal Violence, 16, 1008-1027.
  47. ↑ Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133, 328-345.
  48. ↑ Smart, L., & Wegner, D. M. (1999). Covering up what can't be seen: Concealable stigma and mental control. Journal of Personality and Social Psychology, 77, 474-486.
  49. ↑ Bucci, W. (1995). The power of the narrative: A multiple code account. In Pennebaker, J. W. (Ed.) Emotion, disclosure, & health. American Psychological Association, Washington, DC, pp. 93-122.
  50. ↑ Frable, D. E. S., Platt, L., & Hoey, S. (1998). Concealable stigmas and positive self-perceptions: feeling better around similar others Archived 2019-09-22 at the Wayback Machine . Journal of Personality and Social Psychology, 74, 909-922.
  51. ↑ Maylon, A. (1982). Psychotherapeutic implications of internalized homophobia in gay men. In Gonsiorek, J. (Ed.) Homosexuality and psychotherapy: A practitioner's handbook of affirmative models. New York: Haworth Press, pp. 59-70.
  52. 1 2 Meyer, I. H., & Dean, L. (1998). Internalized homophobia, intimacy, and sexual behavior among gay and bisexual men. In Herek, G. M. (Ed.) Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals. Thousand Oaks, CA: Sage, pp. 160-186.
  53. ↑ Smith, J. (1980). Ego-dystonic homosexuality. Comprehensive Psychology, 21, 119-127.
  54. ↑ Feinstein, Brian A., Marvin R. Goldfried, and Joanne Davila. "The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms." Journal of Consulting and Clinical Psychology 80.5 (2012): 917-927.
  55. ↑ Pachankis, J.E., Goldfried, M.R., & Ramrattan, M. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76, 306-317.
  56. 1 2 Stotzer RL (2009). "Violence against transgender people: A review of United States data". Aggression and Violent Behavior. 14 (3): 170–179. doi:10.1016/j.avb.2009.01.006. ISSN   1359-1789.
  57. ↑ Weir C, Piquette N (2018). "Counselling transgender individuals: Issues and considerations". Canadian Psychology. 59 (3): 252–261. doi:10.1037/cap0000129. ISSN   1878-7304. S2CID   149607596.
  58. 1 2 McKay T, Lindquist CH, Misra S (2017). "Understanding (and Acting On) 20 Years of Research on Violence and LGBTQ + Communities". Trauma, Violence, & Abuse. 20 (5): 665–678. doi:10.1177/1524838017728708. ISSN   1524-8380. PMID   29334007. S2CID   43156503.
  59. 1 2 Stitt A (2020). ACT For Gender Identity: The Comprehensive Guide. London: Jessica Kingsley Publishers. ISBN   978-1-78592-799-7. OCLC   1089850112.
  60. ↑ Goffman E. (1963). Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, New Jersey: Prentice-Hall.
  61. ↑ Steele, C. M. (1997). A threat in the air: how stereotypes shape intellectual identity and performance. The American Psychologist, 52, 613-629.
  62. 1 2 Steele, C. M., & Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69, 797-811.
  63. ↑ Hatzenbuehler, M. L. (2009). How does sexual minority stigma "get under the skin"? A psychological mediation framework. Psychological Bulletin, 135, 707-730.
  64. ↑ Nolen-Hoeksema S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569-582.
  65. ↑ Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400-424.
  66. 1 2 Hatzenbuehler, M. L., Hilt, L. M., & Nolen-Hoeksema, S. (2010). Gender, sexual orientation, and vulnerability to depression. In Chrisler, J., & McCreary, D. (Eds.) Handbook of Gender Research in Psychology. New York: Springer.
  67. ↑ Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Dovidio, J. F. (2009). How does stigma "get under the skin?" The mediating role of emotion regulation. Psychological Science, 20, 1282-1289.
  68. ↑ Paz GM, Ramirez JL (March 2019). "Multiple minority stress: The role of proximal and distal stress on mental health outcomes among lesbian, gay, and bisexual people of color". Journal of Gay & Lesbian Mental Health . 23 (2): 145–167. doi:10.1080/19359705.2019.1568946. hdl: 11603/11195 . S2CID   197756063 . Retrieved 10 May 2020.
  69. ↑ Cochran, S. D., Keenan, C., Schober, C., & Mays, V. M. (2000). Estimates of alcohol use and clinical treatment needs among LGBTQ+ individuals in the United States. Journal of Consulting and Clinical Psychology, 68, 1062-1071.
  70. ↑ Surace A, Riordan BC, Winter T (2019-05-26). "Do New Zealand sexual minorities engage in more hazardous drinking than non-sexual minorities?". Drug and Alcohol Review. 38 (5): 519–522. doi:10.1111/dar.12940. ISSN   0959-5236. PMID   31131504. S2CID   167210900.
  71. ↑ Cochran, S. D., & Mays, V. M. (2000). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. American Journal of Epidemiology, 151, 516-623.
  72. ↑ Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91, 933-939.
  73. ↑ Konrad M, Kostev K (2020-09-01). "Increased prevalence of depression, anxiety, and adjustment and somatoform disorders in transsexual individuals" . Journal of Affective Disorders. 274: 482–485. doi:10.1016/j.jad.2020.05.074. ISSN   0165-0327. PMID   32663979. S2CID   219758568.
  74. ↑ Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91, 1276-1281.
  75. ↑ McKirnan, D. J., & Peterson, P. L. Stress, expectancies, and vulnerability to substance abuse: A test of a model among homosexual men. Journal of Abnormal Psychology, 97, 461-466.
  76. ↑ Kennedy A, Genç M, Owen PD (2021). "The Association Between Same-Sex Marriage Legalization and Youth Deaths by Suicide: A Multimethod Counterfactual Analysis". The Journal of Adolescent Health. 68 (6): 1176–1182. doi:10.1016/j.jadohealth.2021.01.033. ISSN   1879-1972. PMID   33812751. S2CID   233028334.
  77. ↑ Raifman J, Moscoe E, Austin SB, McConnell M (2017-04-01). "Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts". JAMA Pediatrics. 171 (4): 350–356. doi:10.1001/jamapediatrics.2016.4529. ISSN   2168-6211. PMC   5848493 . PMID   28241285.
  78. ↑ Williamson, I. R. (2000). Internalized homophobia and health issues affecting lesbians and gay men. Health Education Research, 15, 97-107.
  79. ↑ Chan RC, Leung JS (2022). "Experiences of minority stress and their impact on suicidality among asexual individuals". Journal of Affective Disorders . 325: 794–803. doi:10.1016/j.jad.2023.01.025. PMID   36623572. S2CID   255568192.
  80. ↑ Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. "Perspectives on Psychological Science, 8", 521-548.
  81. ↑ Lindley L, Galupo MP (September 2020). "Gender dysphoria and minority stress: Support for inclusion of gender dysphoria as a proximal stressor". Psychology of Sexual Orientation and Gender Diversity. 7 (3): 265–275. doi:10.1037/sgd0000439. ISSN   2329-0390. S2CID   234633391.
  82. 1 2 U.S. Center for Disease Control. (2004). Health, United States, 2004. Hyattsville, MD: U.S. Department of Health and Human Services.
  83. ↑ Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and disctimination. Journal of Health Psychology, 2, 335-351.
  84. ↑ Williams, D. R., & Williams-Morris, R. (2000). Racism and mental health: The African American experience. Ethnicity & Health, 5, 243-268.
  85. ↑ Brondolo, E., Libby, D. J., Denton, E., Thompson, S., Beatty, D. L., Schwartz, J., Sweeney, M., Tobin, J. N., Cassells, A., Pickering, T. G., and Gerin, W. (2008). Racism and ambulatory bood pressure in a community sample. Psychosomatic Medicine, 70, 49-56.
  86. ↑ Steffen, P. R., McNeilly, M., Anderson, N., & Sherwood, A. (2003). Effects of perceived racism and anger inhibition on ambulatory blood pressure in African Americans. Psychosomatic Medicine, 65, 746-750.
  87. ↑ Bennett, G. G., Wolin, K. Y., Robinson, E. L., Fowler, S., & Edwards, C. L. (2005). Perceived racial/ethnic harassment and tobacco use among African American young adults. American Journal of Public Health, 95, 238-240.
  88. ↑ Thompson, V. L. (1996). Perceived experiences of racism as stressful life events. Community Mental Health, 32, 223-233.
  89. ↑ Jackson, J. S., Brown, T. N., Williams, D. R., Torres, M., Sellers, S. L., & Brown, K. (1996). Racism and the physical and mental health status of African Americans: A thirteen year national panel study. Ethnicity and Disease, 6, 132-147.
  90. ↑ Krieger, N. (1990). Racial and gender discrimination: Risk factors for high blood pressure? Social Science and Medicine, 30, 1273-1281.
  91. ↑ McCarthy, J. D., & Yancey, W. L. (1971). Uncle Tom and Mr. Charlie: Metaphysical pathos in the study of racism and personal disorganization. American Journal of Sociology, 76, 648-672.
  92. ↑ Taylor, J., & Jackson, B. (1990). Factors affecting alcohol consumption in black women, Part II. The International Journal of Addictions, 25, 1415-1427.
  93. ↑ Taylor, J., & Jackson, B. (1991). Evaluation of a holistic model of mental health symptoms in African American women. The Journal of Black Psychology, 18, 19-45.
  94. ↑ Tomes, E., Brown, A., Semenya, K., & Simpson, J. (1990). Depression in black women of low socioeconomic status: Psychological factors and nursing diagnosis. Journal of National Black Nurses Association, 4, 37-46.
  95. ↑ Diamond, L. M. (2003). Integrating research on sexual-minority and heterosexual development: Theoretical and clinical implications. Journal of Clinical Child and Adolescent Psychology, 32, 490-498.
  96. ↑ Savin-Williams, R. C. (2008). Then and now: recruitment, definition, diversity, and positive attributes of same-sex populations. Developmental Psychology, 44, 135-138.
  97. ↑ Merritt, M. M., Bennett, G. G., Jr., Williams, R. B., Edwards, C. L., & Sollers, J. J., 3rd. (2006). Perceived racism and cardiovascular reactivity and recovery to personally relevant stress. Health Psychology, 25, 364-369.
  98. ↑ Pavalko, E. K., Mossakowski, K. N., & Hamilton, V. J. (2003). Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women's physical and emotional health. Journal of Health and Social Behavior, 44, 18-33.
  99. ↑ Michael Bailey J (2020-10-01). "The Minority Stress Model Deserves Reconsideration, Not Just Extension" (PDF). Archives of Sexual Behavior. 49 (7): 2265–2268. doi:10.1007/s10508-019-01606-9. ISSN   1573-2800. PMID   31853696. S2CID   209417458 – via ResearchGate.
  100. ↑ Brief for the NLF as Amicus Curiae, Perry v. Schwarzenegger and Hollingsworth, No. 10-16696 (2010).
  101. ↑ Brief for the USCA as Amicus Curiae, Log Cabin Republicans v. United States and Gates, No. 10-56634 (2010).
  102. ↑ Crocker, J., & Major, B. (1989). Social stigma and self-esteem: The self-protective properties of stigma Archived 2014-03-06 at the Wayback Machine . Psychological Review, 96, 608-630.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.