Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications

Pediatric Clinics of North America

Volumn 63, Issue 6, 2016, Pages 985-997

  Hatzenbuehler, Mark L ^a   Pachankis, John E ^b  

^a Columbia University ^*  (United States)

^b YALE UNIVERSITY   (United States)

Author keywords

Health; LGBT youth; Minority stress; Stigma

Indexed keywords

BISEXUALITY; BULLYING; COGNITIVE BEHAVIORAL THERAPY; HOMOSEXUAL FEMALE; HUMAN; JUVENILE; PUBLIC HEALTH; SOCIAL DETERMINANTS OF HEALTH; STIGMA; STRESS; TRANSGENDER; ADOLESCENT; HOMOPHOBIA; MENTAL DISORDERS; PSYCHOLOGY; SEXUAL MINORITY; SOCIAL STIGMA; STATISTICS AND NUMERICAL DATA; STEREOTYPING;

ADOLESCENT; HOMOPHOBIA; HUMANS; MENTAL DISORDERS; SEXUAL MINORITIES; SOCIAL STIGMA; STEREOTYPING;

EID: 85001930553     PISSN: 00313955     EISSN: 15578240     Source Type: Journal    
DOI: 10.1016/j.pcl.2016.07.003     Document Type: Review

References (77)

1. 1 Institute of Medicine, The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. 2011, The National Academies Press, Washington, DC.
2. 2 Link, B.G., Phelan, J.C., Conceptualizing stigma. Annu Rev Sociol 27 (2001), 363–385.
3. 3 Meyer, I.H., Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129:5 (2003), 674–697.
4. 4 Lick, D.J., Durso, L.E., Johnson, K.L., Minority stress and physical health among sexual minorities. Perspect Psychol Sci 8:5 (2013), 521–548.
5. 5 Operario, D., Yang, M.F., Reisner, S.L., et al. Stigma and the syndemic of HIV-related health risk behaviors in a diverse sample of transgender women. J Community Psychol 42:5 (2014), 544–557.
6. 6 White-Hughto, J.M., Reisner, S.L., Pachankis, J.E., Stigma and transgender health: a critical review of stigma determinants, mechanisms, and interventions in U.S. transgender populations. Soc Sci Med 147 (2015), 222–231.
7. 7 Weber, G., Using to numb the pain: substance use and abuse among lesbian, gay, and bisexual individuals. J Ment Health Couns 30:1 (2008), 31–48.
8. 8 Hatzenbuehler, M.L., Nolen-Hoeksema, S., Erickson, S.J., Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychol 27:4 (2008), 455–462.
9. 9 Reilly, A., Rudd, N.A., Is internalized homonegativity related to body image?. Fam Consum Sci Res J 35:1 (2006), 58–73.
10. 10 Rosario, M., Schrimshaw, E.W., Hunter, J., A model of sexual risk behaviors among young gay and bisexual men: longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process. AIDS Educ Prev, 18(5), 2006, 444.
11. 11 Perez-Brumer, A., Hatzenbuehler, M.L., Oldenburg, C.E., et al. Individual-and structural-level risk factors for suicide attempts among transgender adults. Behav Med 41:3 (2015), 164–171.
12. 12 Mendoza-Denton, R., Downey, G., Purdie, V.J., et al. Sensitivity to status-based rejection: implications for African American students' college experience. J Pers Soc Psychol, 83(4), 2002, 896.
13. 13 Westenberg, P.M., Drewes, M.J., Goedhart, A.W., et al. A developmental analysis of self-reported fears in late childhood through mid- adolescence: social-evaluative fears on the rise?. J Child Psychol Psychiatry 45:3 (2004), 481–495.
14. 14 Lev-Wiesel, R., Nuttman-Shwartz, O., Sternberg, R., Peer rejection during adolescence: psychological long-term effects—a brief report. J Loss Trauma 11:2 (2006), 131–142.
15. 15 Downey, G., Bonica, C., Rincon, C., Rejection sensitivity and adolescent romantic relationships. The Development Romantic Relationships Adolescence. 1999, Cambridge University Press, Cambridge, UK, 148–174.
16. 16 Cole, S.W., Kemeny, M.E., Taylor, S.E., Social identity and physical health: accelerated HIV progression in rejection-sensitive gay men. J Pers Soc Psychol, 72(2), 1997, 320.
17. 17 Wang, K., Rendina, H.J., Pachankis, J.E., Gay-related rejection sensitivity as a risk factor for condomless sex. AIDS Behav 20:4 (2016), 763–767.
18. 18 Pachankis, J.E., The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychol Bull, 133(2), 2007, 328.
19. 19 Pachankis, J.E., Cochran, S.D., Mays, V.M., The mental health of sexual minority adults in and out of the closet: a population-based study. J Consult Clin Psychol, 83(5), 2015, 890.
20. 20 Frost, D.M., Bastone, L.M., The role of stigma concealment in the retrospective high school experiences of gay, lesbian, and bisexual individuals. J LGBT Youth 5:1 (2008), 27–36.
21. 21 Frable, D.E., Platt, L., Hoey, S., Concealable stigmas and positive self-perceptions: feeling better around similar others. J Pers Soc Psychol, 74(4), 1998, 909.
22. 22 Frable, D.E., Wortman, C., Joseph, J., Predicting self-esteem, well-being, and distress in a cohort of gay men: the importance of cultural stigma, personal visibility, community networks, and positive identity. J Pers 65:3 (1997), 599–624.
23. 23 Ragins, B.R., Singh, R., Cornwell, J.M., Making the invisible visible: fear and disclosure of sexual orientation at work. J Appl Psychol, 92(4), 2007, 1103.
24. 24 Petroll, A.E., Mosack, K.E., Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men. Sex Transm Dis, 38(1), 2011, 63.
25. 25 Cochran, S.D., Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter?. Am Psychol, 56(11), 2001, 931.
26. 26 Cohen-Kettenis, P.T., van Goozen, S.H., Adolescents who are eligible for sex reassignment surgery: parental reports of emotional and behavioural problems. Clin Child Psychol Psychiatry 7:3 (2002), 412–422.
27. 27 Reisner, S.L., White-Hughto, J.M., Dunham, E.E., et al. Legal protections in public accommodations settings: a critical public health issue for transgender and gender-nonconforming people. Milbank Q 93:3 (2015), 484–515.
28. 28 Gagné, P., Tewksbury, R., Conformity pressures and gender resistance among transgendered individuals. Soc Probl 45 (1998), 81–101.
29. 29 Samuel, L., Zaritsky, E., Communicating effectively with transgender patients. Am Fam Physician 78:5 (2008), 648–650.
30. 30 Alegria, C.A., Transgender identity and health care: implications for psychosocial and physical evaluation. J Am Acad Nurse Pract 23:4 (2011), 175–182.
31. 31 Herek, G.M., Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample. J Interpers Violence 24:1 (2009), 54–74.
32. 32 Woodford, M.R., Howell, M.L., Kulick, A., et al. “That's so gay” heterosexual male undergraduates and the perpetuation of sexual orientation microagressions on campus. J Interpers Violence 28:2 (2013), 416–435.
33. 33 Hatzenbuehler, M.L., Link, B.G., Introduction to the special issue on structural stigma and health. Soc Sci Med 103 (2014), 1–6.
34. 34 Hatzenbuehler, M.L., Structural stigma and the health of lesbian, gay, and bisexual populations. Curr Dir Psychol Sci 23:2 (2014), 127–132.
35. 35 Duncan, D.T., Hatzenbuehler, M.L., Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. Am J Public Health 104:2 (2014), 272–278.
36. 36 Hatzenbuehler, M.L., Duncan, D.T., Johnson, R.M., Neighborhood-level LGBT hate crimes and bullying among sexual minority youths: a geospatial analysis. Violence Vict 30:4 (2015), 663–675.
37. 37 Duncan, D.T., Hatzenbuehler, M.L., Johnson, R.M., Neighborhood-level LGBT hate crimes and current illicit drug use among sexual minority youth. Drug Alcohol Depend 135 (2014), 65–70.
38. 38 Hatzenbuehler, M.L., The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics 127:5 (2011), 896–903.
39. 39 Hatzenbuehler, M.L., Jun, H.-J., Corliss, H.L., et al. Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Ann Behav Med 47:1 (2014), 48–56.
40. 40 Hatzenbuehler, M.L., Jun, H.-J., Corliss, H.L., et al. Structural stigma and sexual orientation disparities in adolescent drug use. Addict Behav 46 (2015), 14–18.
41. 41 Hatzenbuehler, M.L., How does sexual minority stigma “get under the skin”? a psychological mediation framework. Psychol Bull, 135(5), 2009, 707.
42. 42 Hatzenbuehler, M.L., Phelan, J.C., Link, B.G., Stigma as a fundamental cause of population health inequalities. Am J Public Health 103:5 (2013), 813–821.
43. 43 Crocker, J., Major, B., Steele, C., Social stigma. Gilbert, D., Fiske, S., Lindzey, G., (eds.) The handbook of social psychology, Vol. 2, 1998, McGraw-Hill, Boston, MA, 504–553.
44. 44 Gump, B.B., Matthews, K.A., Vigilance and cardiovascular reactivity to subsequent stressors in men: a preliminary study. Health Psychol, 17(1), 1998, 93.
45. 45 Pachankis, J.E., Goldfried, M.R., Ramrattan, M.E., Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. J Consult Clin Psychol, 76(2), 2008, 306.
46. 46 Gross, J.J., Emotion regulation in adulthood: timing is everything. Curr Dir Psychol Sci 10:6 (2001), 214–219.
47. 47 Nolen-Hoeksema, S., Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol, 100(4), 1991, 569.
48. 48 McLaughlin, K.A., Hatzenbuehler, M.L., Hilt, L.M., Emotion dysregulation as a mechanism linking peer victimization to internalizing symptoms in adolescents. J Consult Clin Psychol, 77(5), 2009, 894.
49. 49 Hatzenbuehler, M.L., McLaughlin, K.A., Nolen-Hoeksema, S., Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. J Child Psychol Psychiatry 49:12 (2008), 1270–1278.
50. 50 Hatzenbuehler, M.L., Nolen-Hoeksema, S., Dovidio, J., How does stigma “get under the skin”? The mediating role of emotion regulation. Psychol Sci 20:10 (2009), 1282–1289.
51. 51 Cacioppo, S., Grippo, A.J., London, S., et al. Loneliness clinical import and interventions. Perspect Psychol Sci 10:2 (2015), 238–249.
52. 52 Ryan, C., Russell, S.T., Huebner, D., et al. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs 23:4 (2010), 205–213.
53. 53 Kelly, A.E., Clients' secret keeping in outpatient therapy. J Couns Psychol, 45(1), 1998, 50.
54. 54 Dickerson, S.S., Kemeny, M.E., Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull, 130(3), 2004, 355.
55. 55 Lundberg, U., Stress hormones in health and illness: the roles of work and gender. Psychoneuroendocrinology 30:10 (2005), 1017–1021.
56. 56 Hatzenbuehler, M.L., McLaughlin, K.A., Structural stigma and hypothalamic–pituitary–adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Ann Behav Med 47:1 (2014), 39–47.
57. 57 Gunnar, M.R., Frenn, K., Wewerka, S.S., et al. Moderate versus severe early life stress: associations with stress reactivity and regulation in 10-12 year-old children. Psychoneuroendocrinology 34:1 (2009), 62–75.
58. 58 Yehuda, R., Bierer, L.M., Schmeidler, J., et al. Low cortisol and risk for PTSD in adult offspring of holocaust survivors. Am J Psychiatry 157:8 (2000), 1252–1259.
59. 59 Chaudoir S, Wang K, Pachankis JE. What reduces sexual minority stress? A review of the intervention toolkit. Unpublished Manuscript, College of the Holy Cross, Worcester, MA; 2016.
60. 60 Hatzenbuehler, M.L., Birkett, M., Van Wagenen, A., et al. Protective school climates and reduced risk for suicide ideation in sexual minority youths. Am J Public Health 104:2 (2014), 279–286.
61. 61 Movement Advancement Project. Safe Schools Laws. 2015. Available at: http://www.lgbtmap.org/equality-maps/safe_school_laws. Accessed June 7, 2015.
62. 62 Hatzenbuehler, M.L., Keyes, K.M., Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth. J Adolesc Health 53:1 (2013), S21–S26.
63. 63 Huebner, D.M., Rullo, J.E., Thoma, B.C., et al. Piloting lead with love: a film-based intervention to improve parents’ responses to their lesbian, gay, and bisexual children. J Prim Prev 34:5 (2013), 359–369.
64. 64 Rutter, P.A., Estrada, D., Ferguson, L.K., et al. Sexual orientation and counselor competency: the impact of training on enhancing awareness, knowledge and skills. J LGBT Issues Couns 2:2 (2008), 109–125.
65. 65 Greytak, E.A., Kosciw, J.G., Boesen, M.J., Educating the educator: creating supportive school personnel through professional development. J Sch Violence 12:1 (2013), 80–97.
66. 66 Pachankis, J.E., Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clin Psychol (New York) 21:4 (2014), 313–330.
67. 67 Pachankis, J.E., Hatzenbuehler, M.L., Rendina, H.J., et al. LGB-Affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol 83:5 (2015), 875–889.
68. 68 Millar, B., Wang, K., Pachankis, J.E., The moderating role of implicit internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: results from a randomized controlled trial with young adult gay and bisexual men. J Consult Clin Psychol 84:7 (2016), 565–570.
69. 69 Craig, S.L., Austin, A., Alessi, E., Gay affirmative cognitive behavioral therapy for sexual minority youth: a clinical adaptation. Clin Soc Work J 41:3 (2013), 258–266.
70. 70 Diamond, G.M., Diamond, G.S., Levy, S., et al. Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: a treatment development study and open trial with preliminary findings. Psychotherapy 49:1 (2012), 62–71.
71. 71 LaSala, M., Cognitive and environmental intervention for gay males: addressing stigma and its consequences. Fam Soc 87:2 (2006), 181–189.
72. 72 Mustanski, B., Greene, G.J., Ryan, D., et al. Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: the queer sex Ed intervention. J Sex Res 52:2 (2015), 220–230.
73. 73 Anderson, S., McNair, R., Mitchell, A., Addressing health inequalities in Victorian lesbian, gay, bisexual and transgender communities. Health Promot J Austr 11:1 (2001), 32–38.
74. 74 Obedin-Maliver, J., Goldsmith, E.S., Stewart, L., et al. Lesbian, gay, bisexual, and transgender–related content in undergraduate medical education. JAMA 306:9 (2011), 971–977.
75. 75 McGarry, K.A., Clarke, J.G., Cyr, M.G., et al. Evaluating a lesbian and gay health care curriculum. Teach Learn Med 14:4 (2002), 244–248.
76. 76 White, W., Brenman, S., Paradis, E., et al. Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students' Preparedness and Comfort. Teach Learn Med 27:3 (2015), 254–263.
77. 77 Grant, M., Mottet, L., Tanis, J., et al. National transgender discrimination survey report on health and health care. 2010, National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, DC.