In recent decades, there has been significant progress towards achieving equality and acceptance for the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, etc.) population. Yet despite this momentum, many individuals within the community continue to face unique challenges and stressors that can affect well-being and overall mental health outcomes.
One example is the mental health consequences of increased blatant anti-LGBTQIA+ sentiment in government policy the United States. A systematic review shows that as of March 2024, the American Civil Liberties Union is currently tracking 479 anti-LGBTQ bills in the U.S (ACLU, 2024). This leads us to question what kind of impact, both short and long term, these trends will have on LGBTQIA+ people – perhaps on ourselves, our loved ones, or our children?
The answers to some of these questions can be found in systematic review of recent and current studies which show large disparities in both physical and mental health outcomes in sexual minorities as compared with heterosexual individuals. This research has shown many troubling conceptual issues and everyday realities in the queer community:
- Nearly 1 in 3 LGBTQ young people (lesbian, gay, bisexual people, etc.) said their mental health was poor most of the time or always due to anti-LGBTQ policies and legislation (The Trevor Project, 2023).
- Sexual minorities are between 1.4 and 4 times more likely to have a lifetime history of mental disorders including depressive symptoms and substance use disorder when compared with straight adults (Journal of Epidemiological and Community Health, 2017).
- Lesbian, gay and bisexual (LGB) youth have a greater risk for suicide attempts than non-LGB youths and higher prevalence of depression and anxiety diagnoses (SAMSHA, 2022).
- Over 90% of transgender Minnesotans feel anxious at least one day per week and nearly half feel nervous, anxious or on edge 5-7 days per week (Rainbow Health, 2021).
What Causes These Mental Health Disparities?
Based on the statistics listed above, it is clear that LGBTQIA+ people are at a higher risk for mental health issues such as anxiety, substance abuse, depressive symptoms, and suicide, compared to their heterosexual and cisgender counterparts. So, why exactly do sexual minority populations experience these stark negative health outcomes?
One useful framework for understanding these differences is the Minority Stress Model, which sheds light on the various stressors experienced by minority identities, including LGBTQIA+ and sexual minority individuals, and the impact that these stressors have on both physical and mental health outcomes.
What is the Minority Stress Model/Minority Stress Theory?
The Minority Stress Model is a theory and conceptual framework that provides insight into the relationship between minoritized/marginalized (such as LGBTQIA+ individuals) and dominant (such as heterosexual or cisgender individuals) groups that result in minority stress experiences and a contentious social environment for the minority group members.
The theory of minority stress was first developed in 1981 by a lesbian-identified scholar, Winn Kelley Brooks, in her book Minority Stress and Lesbian Women. In this book, Brooks describes a multilevel model detailing the various sources of minority stressors (cultural, social, economic) to which sexual minority women are chronically exposed to and discusses how these minority stressors have a long-term negative impact on both the psychological and physical health of lesbian women.
Brook’s work about minority stress theory is viewed as being critical in changing the way society thinks about queer and trans people, and both challenges and rejects the cultural notion that being queer or trans is pathological and the result of a traumatic past. Over time, her work was broadened from its focus on sexual minority women and applied to sexual minority men through the work of Ilan Meyer, Ph.D.
In 2003, Ilan H. Meyer, Ph.D. began applying the Minority Stress Model more broadly to lesbian, gay, and bisexual populations. Through this foundational work it was determined that sexual minorities experience minority stressors over and above typical stress experienced by straight and/or cisgender people which can lead to mental health consequences. Although the model was originally conceptualized for sexual minorities, it has since been researched and applied similarly to gender minorities and racial and ethnic minorities.
These minority stressors are unique and chronic stigma-specific stressors that are related to their marginalized identity, and negatively impact both their physical and mental health. In other words, when the culture (the perspectives and practices of your legislators, your colleagues, your teachers, your neighbors) sanctions discrimination, it communicates that you are inferior. This can be a daily lived experience and is invalidating, painful and difficult to tolerate.
In addition to the impact of the discrimination itself (i.e., not being able to read books about people who hold your identity), it also affects how you think (cognitive structure) more broadly about yourself and others. These experiences of minority stress has an impact on your physical and psychological well-being.
According to the Minority Stress Model, three key factors distinguish minority stress from general stress. Minority stress is (1) unique, (2) chronic, and (3) socially-based.
- Minority stress is unique because it is not a stressor that is experienced by everyone. For example, starting a new job can be stressful for anyone but starting a new job and being afraid to mention your spouse for fear of being fired is a combined stressor that individuals in same-sex relationships experience.
- Minority stress is viewed as an ongoing chronic stressor because it remains a relatively stable presence in someone’s life due to underlying social and cultural structures.
- Minority stress is also considered to be socially-based in that it is about more than individuals. Sexual minority stress stems from social processes, institutions, and structures beyond the individual events or conditions that characterize general stressors. For example, a transgender woman might experience stress symptoms when visiting the doctor, as would many people. But that same transgender woman may have to deal with a medical record that does not recognize her affirmed gender identity and that could cause her to be continually misgendered during her doctor’s appointment – added degrees of stress caused by a medical institution that influences the behavior of medical professionals and staff.
Meyer’s version of minority stress theory also distinguishes between distal and proximal stress processes.
- Distal stress processes are external to the minority individual, including experiences with rejection, prejudice, and discrimination. Distal stressors include stressors that originate from people or institutions that impact the LGBTQIA+ person. These include discriminatory policies and laws, acute major life events (e.g., losing a job, being victimized by violence), chronic stressors (e.g., living in poverty), social stress, and more minor, “everyday” experiences of discrimination or microaggressions (e.g., being treated unfairly or with disrespect). Distal stressors, over time, can lead to proximal stressors.
- Proximal stress processes are internal and are often the byproduct of distal stressors. Proximal stressors fall into the following three categories:
- Expectations of rejection: Many LGBTQIA+ individuals grow up in environments where their identities are not affirmed or accepted. As a result, they may develop depressive symptoms, etc. and expectations of rejection from family, peers, and society at large, leading to feelings of alienation and isolation.
- Internalized stigma: Internalized homophobia, biphobia (phobia of bisexual people), and transphobia refer to the internalization of negative beliefs and attitudes about one’s own sexual orientation or gender identity. LGBTQIA+ individuals who internalize stigma may experience mental health symptoms such low self-esteem, self-hatred, and psychological distress as a result.
- Concealment of Identity: Due to fear of discrimination or violence, some LGBTQIA+ individuals may conceal or minimize their sexual orientation or gender identity in certain contexts. This concealment can be emotionally taxing and may lead to feelings of inauthenticity and social isolation. Although concealment may be protective in some environments, it also limits access to social support and affirmation which further complicates its role in minority stress theory.
Together, proximal and distal stressors accrue over time, and create the excess stress burden that places gender and sexual minority populations at greater risk for negative mental and physical health outcomes and mental health disorders compared with straight cisgender people.
Healing from Minority Stress
This leads us to the question of what can be done to help address and buffer the associations between minority stress and adverse health outcomes for LGBTQIA+ individuals? Minority Stress Theory hypothesizes that coping strategies and social support can buffer the associations between minority stress and negative outcomes (Meyer, 2003).
Unfortunately, systematic review shows that there are few specialized treatment models solely focused on minority stress. Nevertheless, using a framework of resilience through community building can help LGBTQIA+ individuals better deal with the impact of trauma caused by experiences of minority stress in their lives. This can include building social supports, connecting individuals to community groups, and helping them engage in activism. In fact, one study found that engaging in LGBTQ-specific coping strategies (such as getting involved in LGBTQ organizations) led to greater psychosocial adjustment for youth and young adults when compared to individual-level coping efforts (Toomey, 2018).
Therapy is another great resource for LGBTQIA+ folks to develop coping strategies to increase their sense of self and well-being amidst the many factors that try to do the opposite. LGBTQIA+ Affirming therapy takes into account the minority stress model when addressing mental health symptoms faced by LGBTQIA+ folks. With both individual and community support, healing is possible!
Blog written by Sentier therapist Becky Lawyer, LPCC, LPC.
Sources
2023 U.S. National Survey on the mental health of LGBTQ Young People. The Trevor Project. https://www.thetrevorproject.org/survey-2023/
Bränström, R. (2017, May 1). Minority stress factors as mediators of sexual orientation disparities in mental health treatment: A longitudinal population-based study. Journal of Epidemiology & Community Health. https://jech.bmj.com/content/71/5/446
Lesbian, gay, and bisexual behavioral health: Results from the 2021 and 2022 National Surveys on Drug Use and Health. SAMHSA. (2022). https://www.samhsa.gov/data/sites/default/files/reports/rpt41899/2022_LGB_Brief_Final_06_07_23.pdf
Meyer IH. Prejudice as stress: Conceptual and measurement problems. American Journal of Public Health. 2003;93:262–265.
Miller CT, Major B. Coping with stigma and prejudice. In: Heatherton TF, Kleck RE, Hebl MR, Hull JG, editors. The social psychology of stigma. New York: Guilford Press; 2000. pp. 243–272.
Toomey, R. B., Ryan, C., Diaz, R. M., & Russell, S. T. (2018). Coping With Sexual Orientation-Related Minority Stress. Journal of homosexuality, 65(4), 484–500. https://doi.org/10.1080/00918369.2017.1321888
Voices of Health – Annual Report on LGBTQ+ Health Access and Experiences in Minnesota. Rainbow Health. (2021). https://rainbowhealth.org/wp-content/uploads/2022/11/2021-Voices-of-Health-Full-Report.pdf
