LGBTQ stress

The Population Cohort: LGBTQ
The lesbian, gay, bisexual, transgender, and questioning (LGBTQ) comprise a minority population. Although a diverse group in terms of socioeconomic class background, age, ethnicity, and gender identity, shared experiences of discrimination will impact mental health outcomes. In fact, self-hatred and internalized stigma due to continued exposure to prejudicial attitudes leads to problems like hiding or identity concealment—remaining in the closet—will compound mental health issues by preventing the person from seeking help when needed (Edwards, 2012). Stress due to stigma and discrimination will be compounded by additional factors like race/ethnicity and gender. The composition of the LGBTQ population is incredibly diverse, with the possibility for double or triple minority status such as with Asian American, African American, and other minority groups within the LGBTQ community (Chong-suk Han, Ayala, Paul, et al., 2015; Syzmanski & Sung, 2010). Research has shown that members of the LGBTQ community experience stressors that are “unique to their sexual orientation,” necessitating research into how the LGBTQ community can develop effective coping mechanisms and build resilience (Lewis, Derlega, Griffin, et al., 2003, p. 716). Several public health organizations and public health initiatives like the Healthy People 2020 program and the National Institute of Medicine have recently drawn attention to the stress-related risks and needs of the LGBTQ community (Mink, Lindley & Weinstein, 2014).
Specificity of Minority Stress
Sources of minority stress experienced by the LGBTQ community in particular include intimate partner violence, identity distress, bullying and hate crime, lack of social support, intersectionality, and persistent stigma and hostility.
Intimate Partner Violence
While intimate partner violence is not unique among the LGBTQ community, it may be untreated for longer in this population because of barriers to accessing social and human servies. Researchers have shown that minority stress experiences in general are correlated with higher rates of aggression and violent behavior among LGBTQ youth: implying that intimate partner violence in this population cohort may actually be an effect of minority stress and not just a cause of minority stress (Edwards, 2012). As both a cause and an effect of stress in the LGBTQ community, intimate partner violence is an issue that may also be poorly addressed in existing mental health settings. Lack of access to mental health services, relationship counseling, and other remedial services that could otherwise build resilience and reduce the prevalence and severity of the violence can also exacerbate the stress related to discrimination, and the stress related to abusive relationships.
Identity Distress
In a society that does not yet actively support the expression of non-normative sexual identities, orientations, and gender identities, individuals may experience serious identity stress, which can then lead to adverse health outcomes (Kelleher, 2009). In fact, Kelleher’s (2009) study found that identity conflict, including the perceived need to hide one’s true self or express oneself differently in different social situations, was one of the major sources of stress among LGBTQ populations. Some members of the LGBTQ population even report not being able to divulge their sexual orientation to therapists, as “clients do not believe that anyone will respond positively to their LGBTQ identity,” (Budge, 2014, p. 351). On the other hand, being among a supportive community mitigated the stressors that might have been associated with identity distress (Kelleher, 2009). Reducing identity-related stress among the LGBTQ population requires an abundance of positivity and support.
Bullying and Hate Crime
Bullying is a complex social phenomenon that can include verbal as well as physical abuse. As Kelleher (2009) points out, hearing an anti-gay joke is a type of bullying that can lead to significant stress, as can being physically assaulted. Hate crimes constitute a major source of stress for the LGBTQ population. Hate crimes can include violent assault, as well as rape and sexual assault, vandalism, and robbery (Szymanski & Sung, 2010). Harassment and teasing, whether at school or in the workplace, are also sources of stress for the LGBTQ population (Szymanski & Sung, 2010).
Lack of Social Support
Social support is one of the primary means of ameliorating stress and creating resilience. One of the most effective coping mechanisms, social support systems may be sorely lacking for members of the LGBTQ community (Han, Ayala, Paul, et al., 2014). For example, people within the LGBTQ community may experience stress related to discrimination or bullying but feel unable to speak of their problems to friends and family members for fear of ridicule or heterosexist attitudes. When members of the LGBTQ community form strong internal alliances, they can create the type of social support system that can ameliorate stress and mitigate its impact on mental and physical health.
Intersectional (Race-Related) Stress
An increasing number of studies have been conducted to show how LGBTQ persons of color experience compounded stress. For example, Han, Ayala, Paul, et al., (2014) found “minority stress may be even more detrimental given that status-based rejection, particularly those based on race,” (p. 412). Experiencing prejudice related to one’s ethnicity or race, as well as related to one’s sexual orientation, can prove distressing particularly when the individual lacks the support systems otherwise available to them in their community of origin or their family. If the culture or community generally holds homophobic or anti-gay attitudes, then the stressors will be exacerbated (Szmanski & Sung, 2010).
Persistent Stigma, Discrimination, and Hostility
Heteronormativity and heterosexism are pervasive, in spite of a major and transformative shift in social norms. There are still hostile environments, encountered all over the world, in which members of the LGBTQ community will experience stigma and Research consistently shows that stigma is linked with mental health issues among the LGBTQ community. For example, Lewis, Derlega, Griffin, et al. (2003) found that stigma was associated with depressive symptoms in the LGBTQ population. Stereotyping is another possible source of stress experienced within the LGBTQ community. Related to persistent stigma, stereotyping refers to bland assumptions and generalizations that prevent individuals from being able to fully engage and feel part of their communities or workplaces. All of these issues can contribute to health problems among the LGBTQ population.
Conclusion
Stress is a serious concern among minority populations. The deleterious health outcomes of acute and chronic stress are known well enough among the general population, but minority groups experience an additional set of stressors related to issues like discrimination and internalized hatred. Therefore, the specific stressors associated with minority status lead to a clustering of adverse psychological and physical effects. Stigma, discrimination, and similarly negative attitudes and behaviors can exacerbate existing stress from other sources such as job-related stress. In fact, one of the main sources of stress among the LGBTQ community is related to the barriers encountered when seeking access to mental health services, or even in healthcare in general. Ancillary stress experienced by the LGBTQ community relates to intersectionality, such as the race-related stressors that a person of color encounters in addition to the stress related to a stigmatized sexual orientation or gender identity. Additional sources of stress for the LGBTQ community have to do with intimate partner violence. Minority stress in relation to the LGBTQ community has been studied more in depth recently, to yield evidence-based practice data for healthcare professionals.
References
Budge, S. L. (2014). Navigating the balance between positivity and minority stress for LGBTQ clients who are coming out. Psychology of Sexual Orientation and Gender Diversity, 1(4), 350–352. doi:10.1037/sgd0000077
Edwards, K. M., & Sylaska, K. M. (2012). The Perpetration of Intimate Partner Violence among LGBTQ College Youth: The Role of Minority Stress. Journal of Youth and Adolescence, 42(11), 1721–1731. doi:10.1007/s10964-012-9880-6
Han, C. S., Ayala, G., Paul, J. P., Boylan, R., Gregorich, S. E., & Choi, K. H. (2015). Stress and coping with racism and their role in sexual risk for HIV among African American, Asian/Pacific Islander, and Latino men who have sex with men. Archives of sexual behavior, 44(2), 411-420.
Kelleher, C. (2009). Minority stress and health: Implications for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people. Counselling psychology quarterly, 22(4), 373-379.
Lewis, R. J., Derlega, V. J., Griffin, J. L., & Krowinski, A. C. (2003). Stressors for gay men and lesbians: Life stress, gay-related stress, stigma consciousness, and depressive symptoms. Journal of Social and Clinical Psychology, 22(6), 716-729.
Mink, M. D., Lindley, L. L., & Weinstein, A. A. (2014). Stress, stigma, and sexual minority status: The intersectional ecology model of LGBTQ health. Journal of Gay & Lesbian Social Services, 26(4), 502-521.
Szymanski, D. M., & Sung, M. R. (2010). Minority stress and psychological distress among Asian American sexual minority persons 1?7. The Counseling Psychologist, 38(6), 848-872.