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Indiana University-Purdue University Indianapolis (IUPUI) / AIM People with marginalized sexual orientations experience mental health and substance use problems at a higher rate compared to heterosexuals. Experiences of discrimination have been identified as a significant factor in explaining such disparities, and a growing body of literature has developed seeking to explore the contexts in which discrimination occurs. However, one context that is understudied is the online environment. Based on Meyer’s (2003) Minority Stress Model (MSM), it is postulated that specific proximal group-specific processes mediate the relationship between discrimination and health outcomes, with other social factors providing protective effects. However, research is sparse empirically investigating different mechanisms, consequences, and potential modifying factors for sexual minority young adults experiencing online heterosexist discrimination (OHD). Thus, the current study aims to explore experiences of OHD among young adults. METHODS Using the MSM as a guiding framework, the study examined proximal factors of internalized heterosexism, online concealment, and rejection sensitivity as mechanisms underlying the effect of OHD on health outcomes and online social support as a moderating factor. 383 young adults (18-35) with marginalized sexual orientations were recruited from an introductory psychology subject pool, two online crowdsourcing platforms (Prolific, MTurk), and the community. They completed measures of OHD, online social support, online concealment, rejection sensitivity, internalized heterosexism, psychological distress, and substance use. RESULTS Path analyses in Mplus revealed that two proximal stressors (rejection sensitivity, sexual orientation concealment) were positively related to psychological distress as a result of OHD. Sexual orientation concealment was associated with increased risk for cannabis use due to OHD. Online social support from LGBTQ+ peers did not buffer these relationships. CONCLUSION The MSM is a viable guiding framework in exploring OHD. Rejection sensitivity and online sexual orientation concealment are important constructs to consider for future research and may be ideal treatment targets for individuals experiencing psychological distress or engaging in cannabis use due to OHD.

Unique factors associated with the experience of spirituality and religiosity for many in lesbian, gay and bisexual (LGB) communities include minority stress. Using structural equation modeling, we examined whether minority stress mediates the relationship between spirituality and psychological quality of life (QOL). Results indicate minority stress mediates the relationship between spirituality and psychological QOL for gay men and bisexuals. However, minority stress is not a significant mediator for lesbians. Therefore, lesbians may experience minority stress and its relationship to psychological QOL differently than gay men and bisexuals due to higher societal acceptance. This study provides support for examining lesbians, gay men and bisexuals separately rather than as one sexual minority group.

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Mental health issues have been the primary focus of much of the health research concerning lesbian, gay, and bisexual (LGB) individuals over the previous decade. Studies have demonstrated that LGB individuals experience psychological distress due to prejudice and discrimination (Lewis, Derlega, Berndt, Morris, & Rose, 2002; Meyer, Schwartz, & Frost, 2008; Rostosky, Riggle, Horne, & Miller, 2009). Health researchers have not given the physical health of LGB individuals the same level of attention (Dibble, Eliason, & Christiansen, 2007). The Gay and Lesbian Medical Association (GLMA; 2001) asserted that little was known about LGB physical health disparities and called for more research in this area. However, the Institute of Medicine (2011) showed that comparatively little is known about LGB physical health. There is growing evidence from population-based studies that LGB individuals may be at greater risk than heterosexuals for many physical health conditions (Cochran & Mays, 2007; Dilley, Simmons, Boysun, Pizacani, & Stark, 2010; Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2009). Many of these studies (e.g., Cochran & Mays, 2007; Sandfort et al., 2009) referred to the stigmatization of LGB individuals; however, none of these studies empirically explored the relation between stigmatization and physical health in LGB individuals. The goal of this study was to test the utility of Meyer’s (2003) minority stress model as a means of explaining the physical health of LGB individuals in the context of a heterosexist society. This study investigated empirical questions about minority stress factors, physical health, and coping self-efficacy (CSE) of LGB individuals. Five-hundred fifteen LGBidentified adult participants (n = 222 women and n = 293 men) were recruited to complete a web-based survey. Participants were primarily recruited through online forums sponsored by LGB-affirming organizations. Results indicated that higher expectations of rejection based on sexual identity, internalized homonegativity, and LGBbased victimization predicted greater reported physical symptoms severity (PSS). CSE fully mediated the relation between expectation of rejection and physical symptom severity and internalized homonegativity and PSS. CSE partially mediated the relation between victimization and PSS. The document proposed several clinical and systemic interventions that may benefit physical health in LGB individuals.

It is widely accepted that the LGB (Lesbian, gay and bisexual) population have a higher risk of psychological distress compared to their heterosexual counterparts. Meyer (2003) proposed the minority stress model to explain this increased prevalence. This model proposed that the LGB population are subjected to additional stressors due to their minority status which results in the increased psychological distress observed. The purpose of this study was to investigate some of the risk factors proposed by this model, specifically experiences of sexual prejudice, negative internalised beliefs about homosexuality/bisexuality, coping strategies and how these factors interact to influence the development of psychological distress. This study included 542 LGB individuals who completed measures of sexual prejudice, internalised homophobia, coping strategies and current levels of psychological distress using an online survey. The study found a high prevalence of sexual prejudice within the sample, with 84% of the sample reporting at least one experience of sexual prejudice. 67% reported being verbally abused and 17% reported being physically assaulted. A high number of participants scored above the cut-off for a diagnosis of depression (27%) and anxiety (19%). Regression and path analysis revealed that maladaptive coping had the strongest effect on psychological distress. Sexual prejudice and internalised homophobia, also both had a significant direct impact upon psychological distress, and they were also partially mediated by maladaptive coping. Problem-focused coping was found to be a protective factor with a direct, albeit weak, effect on psychological distress. Problem-focused coping also partially mediated the relationship between sexual prejudice and psychological distress, slightly reducing the negative impact of sexual prejudice. The results suggest that maladaptive coping was the greatest risk factor, out of the ones measured, in the development of psychological distress in the LGB population. The outcomes suggest that clinical psychologists may wish to target their interventions at the development of more adaptive coping strategies, and the reduction of internalised homophobia. They should consider ways to reduce experiences of sexual prejudice by working at a community level to reduce the stigma of homosexuality/bisexuality.

In this two-manuscript dissertation, framed through queer and minority stress theories, I focus on heteronormative pressures and their impact on sexual identity fluidity and health of lesbian, gay, and bisexual youth and young adults. Heteronormativity, or the expectation to meet heterosexual norms in relationships, may be stressful for lesbian, gay, and bisexual (LGB) youth and be linked to poorer health. In particular, I focus on bisexual young people because bisexual people can enter into either same- or different-gender relationships; these young people could experience pressure from family members and religious communities to conform to heterosexual norms, resulting in sexual identity transitions that could explain health differences between sexual minority groups. In the first manuscript, I conducted life history narratives interviews with 14 racially and ethnically diverse youth and young adults between the ages of 18-24 on how LGB youth make sense of expectations to conform to heterosexual norms and how their experiences vary based on youths’ characteristics. In the second manuscript, I used structural equation modeling analysis of one of the largest community samples of LGB youth and young adults between the ages of 15-21 in the U.S. to examine youths' current and future relationship desires in a broader system of heteronormative expectations and how these expectations operate as mechanisms to influence the mental health of sexual minority youth. Qualitative results from the first manuscript show that for many youth and youth adults, gender and sexuality intersect to influence their experiences of heteronormativity: Gender and sexuality were conflated for gay men who stated that their gender nonconformity meant that family members already knew their sexuality before they came out as gay. Many bisexual women described their experiences being gender conforming in which they struggled to legitimize their sexuality to others because they were feminine. Though gay and lesbian identities were present in discussions of gender, an expression of gender that signaled and was named as bisexuality was fundamentally missing in the interviews. That is, participants did not describe a gender presentation that would indicate someone attracted to more than one gender. Participants consistently considered childbearing, but not marriage, to be highly desirable. Latino participants discussed heteronormativity through the racialized lens of machismo. However, religion was a greater source of pressure to conform to heterosexuality for Latino participants than were racial communities. My quantitative results from the second manuscript showed that gay men, lesbian women, and bisexual men are more likely to desire same-gender marriages later in life compared to bisexual women, who are more likely to desire different-gender marriages. Participants who desired different-gender marriage were more likely to identify as a different sexual identity over time. However, neither relationship desires nor sexual identity transitions related to depressive symptoms. The findings of this manuscript suggest that initial transition to a sexual minority identity may be the most vulnerable time for youth. After this initial transition, lesbian, gay, and bisexual youth may be inoculated to stress related to identity transitions, even in the context of heteronormativity. This research informs queer and minority stress theories: Gender, sexuality, and family norms intersect to structure how youth understand heteronormativity and predicts whether youth maintain their sexual identity, but such norms might not be stressors that influence health after youth first identify as LGB.

Thesis advisor: James R. Mahalik / Most stage models of gay identity development posit that gay men follow a distinct hierarchical blueprint wherein internal identity processes (e.g. dismantling internalized homonegativity) co-occur with increasing disclosure of their sexual orientation to others (i.e. greater outness). However, some scholars contend that linear stage models lack flexibility and do not account for the diversity of gay men's experience (Fassinger & Miller, 1996). Specifically, gay men's internal and public identity processes may advance by way of distinct, unparallel pathways and for that reason should be evaluated in conjunction and independently of one another. Extending Meyer's (1995; 2003) minority stress model, this study examined the role of childhood gender behavior, adult masculinity, social support and socioeconomic status in explaining gay men's identity status and degree of outness. Five hundred eighteen gay men recruited from online sources (e.g. listservs, Usenet groups) completed measures assessing stigma, anti-gay attack, recalled childhood gender behavior, masculinity, social support, and socioeconomic status. Hierarchical and logistic regression analyses supported several hypotheses reflected in the findings that stigma, anti-gay attack, masculinity, and social support were significantly associated with gay men's identity status and outness. In addition, socioeconomic status moderated the relationship between masculinity and outness, as well as between minority stress (anti-gay attack) and identity status. Altogether, each of the factors examined in this study appear to play a unique role in explaining gay men's identity development and outness, underscoring the complexity of the social context that may intensify or alleviate the stress of these processes. The theoretical implications, future research, limitations, and recommendations for counselors are discussed. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Thesis advisor: Paul Poteat / Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for mental and physical health disparities than heterosexuals, and research has related some of these disparities to minority stressors such as institutional heterosexism, sexual prejudice, and discrimination. Yet, there is a dearth of research elucidating factors that predict the development of these health risks, and factors that protect and promote resiliency against them. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health disparities within a relational framework. Specifically, the study examined the mediating and moderating factors between the deleterious effects of distal stressors (i.e., heterosexist relational disconnections such as discrimination and victimization) and proximal stressors (i.e., self-disparaging relational images such as internalized homophobia, sexual orientation concealment) on mental and physical health for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test three models of: the relations between minority stressors and health; mediating effects of diminished agency, loneliness, and shame on the relations between minority stressors and health; and the moderated-mediation effects of growth-fostering relationships with peers, mentors, and community on the mediating pathways between minority stressors and health. Results indicated that heterosexist distal and proximal minority stressors predicted poor mental health (i.e., depression, anxiety, and suicidality) and physical health (i.e., cardiovascular disease risk, distressing physical symptoms). The relations between proximal minority stressors and health were mediated by diminished sense of agency, loneliness, and shame, and there were mixed results for the relations between distal stressors and health. Although the direct effects of growth-fostering relationships were significant in predicting lower levels of diminished agency, loneliness, and shame, these factors had mixed moderating effects. Findings have research, practice, and policy implications that underscore the possible mechanisms by which sexual minority stressors lead to poor health. Researchers and practitioners need to addresses and advocate against societal forces contributing to heterosexist relational disconnections and for sexual minority health policies and research. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

Facial feminization surgery (FFS) is a set of procedures performed with the goal of creating a facial appearance that is considered phenotypically female. These procedures are usually sought by cisgender women but have become increasingly popular among male to female (MTF) transgender individuals. FFS has been shown to decrease appearance anxiety and increase quality of life. Sexual minorities, including transgender individuals, are subject to a unique set of stressors termed minority stress, which involves the interplay of perceived and outright discrimination. This type of stress has been shown to lead to adverse physical and mental health outcomes. The workplace is no exception to this type of discrimination, and workplace discrimination has specifically been associated with adverse physical health outcomes. However, there have been few studies to date evaluating workplace discrimination and transgender identity. This study aims to expand on that knowledge, and determine the potential role for FFS as an intervention to reduce perceived bias.