Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence

Abstract

• LGB individuals have a higher prevalence of mental disorders than heterosexuals.
• Stigma, prejudice, and discrimination create a stressful social environment leading to mental health issues.
• The framework of minority stress involves stress processes like prejudice events, rejection expectation, hiding, internalized homophobia, and coping.
• Understanding these can guide research and policy.

Historical Context

• Debate on classification of homosexuality as a mental disorder in 1960s-1970s.
• Homosexuality removed from DSM in 1973.
• Stress and mental disorders in the LGB community were linked to social prejudice, not intrinsic aspects of homosexuality.

Minority Stress

• Minority Stress Theory: Excess stress experienced by minority groups due to social position.
• Stress from social structures, norms, and lack of acceptance.
• Conflict with dominant culture creates stress for minorities.
• Social identity and self-categorization theories explain minority stress impact.

Stress-Ameliorating Factors

• Minority groups often develop coping mechanisms.
• Group solidarity and cohesiveness can protect against stress.
• Support from family and self-acceptance is crucial for LGB individuals.

Empirical Evidence

Within-Group Studies

• Studies show stigma leads to alienation and self-acceptance issues.
• Minority stress processes linked to depression, substance use, and suicide ideation.

Between-Group Studies

• LGB individuals show higher prevalence of mental disorders compared to heterosexuals.
• Studies indicate LGB people are more vulnerable to mental distress.

Suicide

• LGB youth have higher rates of suicide ideation and attempts than heterosexual peers.
• Studies indicate elevated lifetime prevalence of suicide attempts in LGB populations.

Methodology Challenges

• Non-probability samples and small sample sizes in studies.
• Need for population-based studies with improved sexual orientation measures.

Minority Resilience Hypothesis

• Suggests stigma doesn't negatively impact self-esteem.
• Minority stress may affect LGB individuals differently from racial/ethnic minorities.

Conceptual Views of Stress

Objective vs Subjective Stress

• Objective stress: Real, observable phenomena causing stress.
• Subjective stress: Depends on individual-environment relationship.

Victim vs Resilient Actor

• Viewing minorities as victims emphasizes societal responsibility.
• Viewing them as resilient actors emphasizes individual coping skills.

Summary

• The minority stress model posits that social stressors lead to higher mental disorder prevalence in LGB communities.
• Both societal and individual interventions are necessary to address these issues, focusing on both altering stress-inducing environments and improving individual coping mechanisms.

Acknowledgments

• Work funded by Grant G13LM007660 from the National Library of Medicine.
• Thanks to colleagues for valuable insights and feedback on the manuscript.