In contrast, the more proximal stress processes are more subjective and are therefore related to self-identity as lesbian, gay, or bisexual. Such identities vary in the social and personal meanings that are attached to them and in the subjective stress they entail. Minority identity is linked to a variety of stress processes; some LGB people, for example, may be vigilant in interactions with others expectations of rejection , hide their identity for fear of harm concealment , or internalize stigma internalized homophobia.
As early as , Allport suggested that minority members respond to prejudice with coping and resilience. Modern writers have agreed that positive coping is common and beneficial to members of minority groups Clark et al.
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Empirical evidence supports these contentions. For example, in a study of Black participants Branscombe, Schmitt, and Harvey found that attributions of prejudice were directly related to negative well-being and hostility toward Whites but also, through the mediating role of enhanced in-group identity, to positive well-being.
In a separate study, Postmes and Branscombe found that among Blacks, a racially segregated environment contributed to greater in-group acceptance and improved well-being and life satisfaction. The importance of coping with stigma has also been asserted in LGB populations. Thus, stress and resilience interact in predicting mental disorder. A distinction between personal and group resources is often not addressed in the coping literature. It is important to distinguish between resources that operate on the individual level e.
Like other individuals who cope with general stress, LGB people use a range of personal coping mechanisms, resilience, and hardiness to withstand stressful experiences Antonovsky, ; Masten, ; Ouellette, Jones et al. Social evaluation theory suggests another plausible mechanism for minority coping Pettigrew, Members of stigmatized groups who have a strong sense of community cohesiveness evaluate themselves in comparison with others who are like them rather than with members of the dominant culture. The in-group may provide a reappraisal of the stressful condition, yielding it less injurious to psychological well-being.
Through reappraisal, the in-group validates deviant experiences and feelings of minority persons Thoits, The distinction between personal and group-level coping may be somewhat complicated because even group-level resources e.
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Whether individuals can access and use group-level resources depends on many factors, including personality variables. Nevertheless, it is important to distinguish between group-level and personal resources because when group-level resources are absent, even otherwise-resourceful individuals have deficient coping. Group-level resources may therefore define the boundaries of individual coping efforts. Using this distinction, it is conceivable that an individual may have efficient personal coping resources but lack minority-coping resources. For example, a lesbian or gay member of the U.
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Group identities are essential for individual emotional functioning, as they address conflicting needs for individuation and affiliation Brewer, Characteristics of identity may be related to mental health both directly and in interaction with stressors. A direct effect suggests that identity characteristics can cause distress. An interactive effect with stress suggests that characteristics of identity would modify the effect of stress on health outcomes. For example, Linville found that participants with more complex self-identities were less prone to depression in the face of stress.
For example, Brooks noted that the stress process for lesbians is complex because it involves both sexual and gender identities. Valence refers to the evaluative features of identity and is tied to self-validation. Identity valence is a central feature of coming out models, which commonly describe progress as improvement in self-acceptance and diminishment of internalized homophobia. Finally, more complex identity structures may be related to improved health outcomes.
For example, Cass saw the last stage of coming out as an identity synthesis , wherein the gay identity becomes merely one part of this integrated total identity. Using the distal—proximal distinction, I propose a minority stress model that incorporates the elements discussed above. Dohrenwend b , described the stress process within the context of strengths and vulnerabilities in the larger environment and within the individual.
For the purpose of succinctness, I include in my discussion only those elements of the stress process unique to or necessary for the description of minority stress. It is important to note, however, that these omitted elements—including advantages and disadvantages in the wider environment, personal predispositions, biological background, ongoing situations, and appraisal and coping—are integral parts of the stress model and are essential for a comprehensive understanding of the stress process Dohrenwend, b , The model Figure 1 depicts stress and coping and their impact on mental health outcomes box i.
Minority stress is situated within general environmental circumstances box a , which may include advantages and disadvantages related to factors such as socioeconomic status.
For example, minority stressors for a gay man who is poor would undoubtedly be related to his poverty; together these characteristics would determine his exposure to stress and coping resources Diaz et al. Circumstances in the environment lead to exposure to stressors, including general stressors, such as a job loss or death of an intimate box c , and minority stressors unique to minority group members, such as discrimination in employment box d.
Similar to their source circumstances, the stressors are depicted as overlapping as well, representing their interdependency Pearlin, b. For example, an experience of antigay violence box d is likely to increase vigilance and expectations of rejection box f. Because they involve self-perceptions and appraisals, these minority stress processes are more proximal to the individual, including, as described above for LGB individuals, expectations of rejection, concealment, and internalized homophobia box f.
Of course, minority identity is not only a source of stress but also an important effect modifier in the stress process. First, characteristics of minority identity can augment or weaken the impact of stress box g. In exploring evidence for minority stress two methodological approaches can be discerned: Studies of within-group processes shed light on stress processes, such as those depicted in Figure 1 , by explicitly examining them and describing variability in their impact on mental health outcomes among minority group members.
Studies of between-groups differences test whether minority individuals are at greater risk for disease than nonminority individuals; that is, whether LGB individuals have higher prevalences of disorders than heterosexual individuals. On the basis of minority stress formulations one can hypothesize that LGB people would have higher prevalences of disorders because the putative excess in exposure to stress would cause an increase in prevalence of any disorder that is affected by stress Dohrenwend, Typically, in studying between-groups differences, only the exposure minority status and outcomes prevalences of disorders are assessed; minority stress processes that would have led to the elevation in prevalences of disorders are inferred but unexamined.
Thus, within-group evidence illuminates the workings of minority stress processes; between-groups evidence shows the hypothesized resultant difference in prevalence of disorder. Ideally, evidence from both types of studies would converge. Within-group studies have attempted to address questions about causes of mental distress and disorder by assessing variability in predictors of mental health outcomes among LGB people. These studies have identified minority stress processes and often demonstrated that the greater the level of such stress, the greater the impact on mental health problems.
Within-group studies have typically measured mental health outcomes using psychological scales e. In reviewing this evidence in greater detail I arrange the findings as they relate to the stress processes introduced in the conceptual framework above. As has already been noted, this synthesis is not meant to suggest that the studies reviewed below stemmed from or referred to this conceptual model; most did not.
Antigay prejudice has been perpetrated throughout history: Institutionalized forms of prejudice, discrimination, and violence have ranged from Nazi extermination of homosexuals to enforcement of sodomy laws punishable by imprisonment, castration, torture, and death Adam, In , Amnesty International reported that lesbian, gay, bisexual, and transgender LGBT people are subject to widespread human rights abuses, torture, and ill treatment, ranging from loss of dignity to assault and murder. Many of these abuses are conducted with impunity and sanctioned by governments and societies through formal mechanisms such as discriminatory laws and informal mechanisms, including prejudice and religious traditions Amnesty International, Surveys have documented that lesbians and gay men are disproportionately exposed to prejudice events, including discrimination and violence.
For example, in a probability study of U. Some research has suggested variation by ethnic background as well, although the direction of the findings is not clear. Research has suggested that LGB youth are even more likely than adults to be victimized by antigay prejudice events, and the psychological consequences of their victimization may be more severe.
Surveys of schools in several regions of the United States showed that LGB youth are exposed to more discrimination and violence events than their heterosexual peers. Several such studies, conducted on population samples of high school students, converge in their findings and show that the social environment of sexual minority youth in U. Compared with heterosexual youth, LGB youth are at increased risk for being threatened and assaulted, are more fearful for their safety at school, and miss school days because of this fear Safe Schools Coalition of Washington, Gay men and lesbians are also discriminated against in the workplace.
Garnets et al. The authors noted that victimization interferes with perception of the world as meaningful and orderly. Antigay bias crimes had greater mental health impact on LGB persons than similar crime not related to bias, and bias-crime victimization may have short- or long-term consequences, including severe reactions such as posttraumatic stress disorder Herek et al. Goffman discussed the anxiety with which the stigmatized individual approaches interactions in society.
Allport described vigilance as one of the traits that targets of prejudice develop in defensive coping.
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This concept helps to explain the stressful effect of stigma. Like other minority group members, LGB people learn to anticipate—indeed, expect—negative regard from members of the dominant culture. To ward off potential negative regard, discrimination, and violence they must maintain vigilance. By definition such vigilance is chronic in that it is repeatedly and continually evoked in the everyday life of the minority person. As a result of this conflict, self-perception is likely to be at least somewhat unstable and vulnerable.
Maintaining stability and coherence in self-concept is likely to require considerable energy and activity.
Branscombe, Ellemers, Spears, and Doosje described four sources of threat relevant to the discussion of stress due to stigma. Categorization threat involves threat that a person will be categorized by others as a member of a group against his or her will, especially when group membership is irrelevant within the particular context e. Distinctiveness threat is an opposite threat, relating to denial of distinct group membership when it is relevant or significant also Brewer, For example, Ethier and Deaux found that Hispanic American students at an Ivy League university were conflicted, divided between identification with White friends and culture and the desire to maintain an ethnic cultural identity.
Research evidence on the impact of stigma on health, psychological, and social functioning comes from a variety of sources.