Stress Among Students Essay About Stereotype

Being a college student is often considered the best period of life. However, from a certain viewpoint, it is also one of the most difficult periods in the life of an individual; the reason for this is the lack of experience, maximalism, treatment from adults, expectations, and so on. College is a perfect stress environment, as it usually incorporates multiple major stress factors, and throws it at a student all at once.

College freshmen are, perhaps, the most vulnerable category of students. This is due to the fact that they face the social challenges that involve leaving their whole support structure behind—friends, parents, hometown, habits. Freshmen have to create new social networks, deal with having to solve their problems on their own without parents’ assistance, and so on. Naturally, this leads to stress. Additionally, bad roommates, their homework load, part-time jobs, and dealing with the dynamics of young adult relationships is incredibly difficult for people in their teenage years (About Health).

Lifestyle is also one of the major factors causing stress in students. Whenever we say “student life,” we usually imply unhealthy eating habits, late night parties, alcohol, a lack of sleep in favor of extensive studying and social activity, and so on. There is no doubt all this negatively affects the physical (and psychological) health of students. Chronic fatigue causes students to feel exhaustion, and negatively influences their performance or attendance in class. They have less energy for academic exercises, and may choose to skip classes or do homework less thoroughly, which can become an additional stress factor on its own (Livestrong.com).

Poor work and priority organization is yet another scourge for many young men and women living and studying on campuses. They are on their own now: no teachers, parents, or relatives are going to tell them what, how, and when to do activities. Because of the lack of experience, students cannot figure out what to pay attention to, and what is not urgent at the moment; how to organize their routine; how to spend less time doing mundane tasks; how to keep a balance between private and academic life, and so on. This causes frustration, poor performance, and stress. Effective ways to help it might be keeping records on what and how you do certain activities. After you see how much time this or that activity takes, you can start planning (IFR).

Being young is not only fun, but also stressful, especially when you are a college student. New social challenges combined with the absence of a habitual support network (like family or old friends), a poor and unhealthy lifestyle, and the lack of organization, often cause frustration and stress in students. The stereotype that college life is the greatest time in one’s life might be a fallacy.

References

Scott, Elizabeth. “Stress in College: Where It Comes From, and How to Manage.” About Stress. N.p., n.d. Web. 17 Apr. 2015.

“What Are the Causes of Stress Among College Sudents?” Livestrong.com. N.p., 27 Jan. 2015. Web. 17 Apr. 2015.

“Reasons of Stress Among Students.” IFR. N.p., 23 Oct. 2014. Web. 17 Apr. 2015.

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Abstract

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress—explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating—even equating—claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999).

However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental disorder (American Psychiatric Association, 1994). To use postmodernist understanding of scientific knowledge, such a debate on classification concerns the social construction of mental disorder—what we as a society and as scientists agree are abnormal behaviors, cognitions, and emotions. The answer, therefore, depends on scientific and social consensus that evolves and is subject to the vicissitudes of social change (Gergen, 1985, 2001).

This distinction between prevalences of mental disorders and classification in the DSM was apparent to Marmor (1980), who in an early discussion of the debate said,

The basic issue … is not whether some or many homosexuals can be found to be neurotically disturbed. In a society like ours where homosexuals are uniformly treated with disparagement or contempt—to say nothing about outright hostility—it would be surprising indeed if substantial numbers of them did not suffer from an impaired self-image and some degree of unhappiness with their stigmatized status. … It is manifestly unwarranted and inaccurate, however, to attribute such neuroticism, when it exists, to intrinsic aspects of homosexuality itself. (p. 400)

If LGB people are indeed at risk for excess mental distress and disorders due to social stress, it is important to understand this risk, as well as factors that ameliorate stress and contribute to mental health. Only with such understanding can psychologists, public health professionals, and public policymakers work toward designing effective prevention and intervention programs. The relative silence of psychiatric epidemiological literature regarding the mental health of LGB populations may have aimed to remove stigma, but it has been misguided, leading to the neglect of this important issue.

Recently, researchers have returned to the study of mental health of LGB populations. Evidence from this research suggests that compared with their heterosexual counterparts, gay men and lesbians suffer from more mental health problems including substance use disorders, affective disorders, and suicide (Cochran, 2001; Gilman et al., 2001; Herrell et al., 1999; Sandfort, de Graaf, Bijl, & Schnabel, 2001). Researchers’ preferred explanation for the cause of the higher prevalence of disorders among LGB people is that stigma, prejudice, and discrimination create a stressful social environment that can lead to mental health problems in people who belong to stigmatized minority groups (Friedman, 1999). This hypothesis can be described in terms of minority stress (Brooks, 1981; Meyer, 1995). In this article I review research evidence on prevalences of mental disorders and show, using meta-analyses, that LGB people have higher prevalences of mental disorders than heterosexual people. I offer a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for a review of research evidence, suggestions for future research directions, and exploration of public policy implications.

The Stress Concept

In its most general form, recent stress discourse has been concerned with external events or conditions that are taxing to individuals and exceed their capacity to endure, therefore having potential to induce mental or somatic illness (Dohrenwend, 2000). Stress can be described as “any condition having the potential to arouse the adaptive machinery of the individual” (Pearlin, 1999a, p. 163). This general form also reflects the phenomenological meaning of stress, which refers to physical, mental, or emotional pressure, strain, or tension (Random House Webster’s Dictionary, 1992). Some have used an engineering analogy, explaining that stress can be assessed as a load relative to a supportive surface (Wheaton, 1999). Stress researchers have identified both individual and social stressors. In psychological literature, stressors are defined as events and conditions (e.g., losing a job, death of an intimate) that cause change and that require that the individual adapt to the new situation or life circumstance. Stress researchers have studied traumatic events, eventful life stressors, chronic stress, and role strains, as well as daily hassles and even nonevents as varied components of stress (Dohrenwend, 1998a).

The concept of social stress extends stress theory by suggesting that conditions in the social environment, not only personal events, are sources of stress that may lead to mental and physical ill effects. Social stress might therefore be expected to have a strong impact in the lives of people belonging to stigmatized social categories, including categories related to socioeconomic status, race/ethnicity, gender, or sexuality. According to these formulations, prejudice and discrimination related to low socioeconomic status, racism, sexism, or homophobia—much like the changes precipitated by personal life events that are common to all people—can induce changes that require adaptation and can therefore be conceptualized as stressful (Allison, 1998; Barnett, Biener, & Baruch, 1987; Clark, Anderson, Clark, & Williams, 1999; Meyer, 1995; Mirowsky & Ross, 1989; Pearlin, 1999b).

The notion that stress is related to social structures and conditions is at once intuitively appealing and conceptually difficult. It is appealing because it recalls the commonplace experience that environmental and social conditions can be stressful. Also, it rests on rich foundations of psychological and sociological theory that suggest the person must be seen in his or her interactions with the social environment (Allport, 1954). It is conceptually difficult because the notion of stress, in particular as conceived of by Lazarus and Folkman (1984), has focused on personal rather than social elements (Hobfoll, 1998). I return to the discussion of this tension between the social and the personal, or objective and subjective, conceptualizations of stress.

Minority Stress

One elaboration of social stress theory may be referred to as minority stress to distinguish the excess stress to which individuals from stigmatized social categories are exposed as a result of their social, often a minority, position. The foundation for a model of minority stress is not found in one theory, nor is the term minority stress commonly used. Rather, a minority stress model is inferred from several sociological and social psychological theories. Relevant theories discuss the adverse effect of social conditions, such as prejudice and stigma, on the lives of affected individuals and groups (e.g., Allport, 1954; Crocker, Major, & Steele, 1998; Goffman, 1963; Jones et al., 1984; Link & Phelan, 2001).

Social theorists have been concerned with the alienation from social structures, norms, and institutions. For example, the importance of social environment was central to Durkheim’s (1951) study of normlessness as a cause of suicide. According to Durkheim, people need moral regulation from society to manage their own needs and aspirations. Anomie, a sense of normlessness, lack of social control, and alienation can lead to suicide because basic social needs are not met. Pearlin (1982) has emphasized the relevance of Merton’s (1957/1968) work to stress theory, explaining that “according to Merton, society stands as a stressor … by stimulating values that conflict with the structures in which they are to be acted upon” (p. 371). The minority person is likely to be subject to such conflicts because dominant culture, social structures, and norms do not typically reflect those of the minority group. An example of such a conflict between dominant and minority groups is the lack of social institutions akin to heterosexual marriage offering sanction for family life and intimacy of LGB persons. More generally, Moss (1973) explained that interactions with society provide the individual with information on the construction of the world; health is compromised when such information is incongruent with the minority person’s experience in the world.

Social psychological theories provide a rich ground for understanding intergroup relations and the impact of minority position on health. Social identity and self-categorization theories extend psychological understanding of intergroup relations and their impact on the self. These theories posit that the process of categorization (e.g., distinction among social groups) triggers important intergroup processes (e.g., competition and discrimination) and provides an anchor for group and self-definition (Tajfel & Turner, 1986; Turner, 1999). From a different perspective, social comparison and symbolic interaction theorists view the social environment as providing people with meaning to their world and organization to their experiences (Stryker & Statham, 1985). Interactions with others are therefore crucial for the development of a sense of self and well-being. Cooley (1902/1922) referred to the other as the “looking glass” (p. 184) of the self. Symbolic interaction theories thus suggest that negative regard from others leads to negative self-regard. Similarly, the basic tenet of social evaluation theory is that human beings learn about themselves by comparing themselves with others (Pettigrew, 1967). Both these theoretical perspectives suggest that negative evaluation by others—such as stereotypes and prejudice directed at minority persons in society—may lead to adverse psychological outcomes. Similarly, Allport (1954) described prejudice as a noxious environment for the minority person and suggested that it leads to adverse effects. In discussing these effects, which he called “traits due to victimizations,” (p. 142) Allport (1954) suggested that the relationship between negative regard from others and harm to the minority person is self-evident: “One’s reputation, whether false or true, cannot be hammered, hammered, hammered, into one’s head without doing something to one’s character” (p. 142).

Beyond theoretical variations, a unifying concept may emerge from stress theory. Lazarus and Folkman (1984) described a conflict or “mismatch” (p. 234) between the individual and his or her experience of society as the essence of all social stress, and Pearlin (1999b) described ambient stressors as those that are associated with position in society. More generally, Selye (1982) described a sense of harmony with one’s environment as the basis of healthy living; deprivation of such a sense of harmony may be considered the source of minority stress. Certainly, when the individual is a member of a stigmatized minority group, the disharmony between the individual and the dominant culture can be onerous and the resultant stress significant (Allison, 1998; Clark et al., 1999). I discuss other theoretical orientations that help explain minority stress below in reviewing specific minority stress processes.

American history is rife with narratives recounting the ill effects of prejudice toward members of minority groups and of their struggles to gain freedom and acceptance. That such conditions are stressful has been suggested regarding various social categories, in particular for groups defined by race/ethnicity and gender (Barnett & Baruch, 1987; Mirowsky & Ross, 1989; Pearlin, 1999b; Swim, Hyers, Cohen, & Ferguson, 2001). The model has also been applied to groups defined by stigmatizing characteristics, such as heavyweight people (Miller & Myers, 1998), people with stigmatizing physical illnesses such as AIDS and cancer (Fife & Wright, 2000), and people who have taken on stigmatizing marks such as body piercing (Jetten, Branscombe, Schmitt, & Spears, 2001). Yet, it is only recently that psychological theory has incorporated these experiences into stress discourse explicitly (Allison, 1998; Miller & Major, 2000). There has been increased interest in the minority stress model, for example, as it applies to the social environment of Blacks in the United States and their experience of stress related to racism (Allison, 1998; Clark et al., 1999).

In developing the concept of minority stress, researchers’ underlying assumptions have been that minority stress is (a) unique—that is, minority stress is additive to general stressors that are experienced by all people, and therefore, stigmatized people are required an adaptation effort above that required of similar others who are not stigmatized; (b) chronic—that is, minority stress is related to relatively stable underlying social and cultural structures; and (c) socially based—that is, it stems from social processes, institutions, and structures beyond the individual rather than individual events or conditions that characterize general stressors or biological, genetic, or other nonsocial characteristics of the person or the group.

Reviewing the literature on stress and identity, Thoits (1999) called the investigation of stressors related to minority identities a “crucial next step” (p. 361) in the study of identity and stress. Applied to lesbians, gay men, and bisexuals, a minority stress model posits that sexual prejudice (Herek, 2000) is stressful and may lead to adverse mental health outcomes (Brooks, 1981; Cochran, 2001; DiPlacido, 1998; Krieger & Sidney, 1997; Mays & Cochran, 2001; Meyer, 1995).

Minority Stress Processes in LGB Populations

There is no consensus about specific stress processes that affect LGB people, but psychological theory, stress literature, and research on the health of LGB populations provide some ideas for articulating a minority stress model. I suggest a distal–proximal distinction because it relies on stress conceptualizations that seem most relevant to minority stress and because of its concern with the impact of external social conditions and structures on individuals. Lazarus and Folkman (1984) described social structures as “distal concepts whose effects on an individual depend on how they are manifested in the immediate context of thought, feeling, and action—the proximal social experiences of a person’s life” (p. 321). Distal social attitudes gain psychological importance through cognitive appraisal and become proximal concepts with psychological importance to the individual. Crocker et al. (1998) made a similar distinction between objective reality, which includes prejudice and discrimination, and “states of mind that the experience of stigma may create in the stigmatized” (p. 516). They noted that “states of mind have their grounding in the realities of stereotypes, prejudice, and discrimination” (Crocker et al., 1998, p. 516), again echoing Lazarus and Folkman’s conceptualization of the proximal, subjective appraisal as a manifestation of distal, objective environmental conditions. I describe minority stress processes along a continuum from distal stressors, which are typically defined as objective events and conditions, to proximal personal processes, which are by definition subjective because they rely on individual perceptions and appraisals.

I have previously suggested three processes of minority stress relevant to LGB individuals (Meyer, 1995; Meyer & Dean, 1998). From the distal to the proximal they are (a) external, objective stressful events and conditions (chronic and acute), (b) expectations of such events and the vigilance this expectation requires, and (c) the internalization of negative societal attitudes. Other work, in particular psychological research in the area of disclosure, has suggested that at least one more stress process is important: concealment of one’s sexual orientation. Hiding of sexual orientation can be seen as a proximal stressor because its stress effect is thought to come about through internal psychological (including psychoneuroimmunological) processes (Cole, Kemeny, Taylor, & Visscher, 1996a, 1996b; DiPlacido, 1998; Jourard, 1971; Pennebaker, 1995).

Distal minority stressors can be defined as objective stressors in that they do not depend on an individual’s perceptions or appraisals—although certainly their report depends on perception and attribution (Kobrynowicz & Branscombe, 1997; Operario & Fiske, 2001). As objective stressors, distal stressors can be seen as independent of personal identification with the assigned minority status (Diamond, 2000). For example, a woman may have a romantic relationship with another woman but not identify as a lesbian (Laumann, Gagnon, Michael, & Michaels, 1994). Nevertheless, if she is perceived as a lesbian by others, she may suffer from stressors associated with prejudice toward LGB people (e.g., antigay violence). 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).

Stress-Ameliorating Factors

As early as 1954, 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., 1999). Therefore, minority status is associated not only with stress but with important resources such as group solidarity and cohesiveness that protect minority members from the adverse mental health effects of minority stress (Branscombe, Schmitt, & Harvey, 1999; Clark et al., 1999; Crocker & Major, 1989; Kessler, Price, & Wortman, 1985; Miller & Major, 2000; Postmes & Branscombe, 2002; Shade, 1990). Empirical evidence supports these contentions. For example, in a study of Black participants Branscombe, Schmitt, and Harvey (1999) 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 (2002) 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. Weinberg and Williams (1974) noted that “occupying a ‘deviant status’ need not necessarily intrude upon [gay men’s] day-to-day functioning” (p. 150) and urged scientists to “pay more attention to the human capacity for adaptation” (p. 151). Through coming out, LGB people learn to cope with and overcome the adverse effects of stress (Morris, Waldo, & Rothblum, 2001). Thus, stress and resilience interact in predicting mental disorder. LGB people counteract minority stress by establishing alternative structures and values that enhance their group (Crocker & Major, 1989; D’Emilio, 1983). In a similar vein, Garnets, Herek, and Levy (1990) suggested that although antigay violence creates a crisis with potential adverse mental health outcomes, it also presents “opportunities for subsequent growth” (p. 367). Among gay men, personal acceptance of one’s gay identity and talking to family members about AIDS showed the strongest positive associations with concurrent measures of support and changes in support satisfaction (Kertzner, 2001). Similarly, in a study of LGB adolescents, family support and self-acceptance ameliorated the negative effect of antigay abuse on mental health outcomes (Hershberger & D’Augelli, 1995).

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.g., personality), in which members of minority groups vary, and resources that operate on a group level and are available to all minority members (Branscombe & Ellemers, 1998). 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, 1987; Masten, 2001; Ouellette, 1993). But in addition to such personal coping, group-level social structural factors can have mental health benefits (Peterson, Folkman, & Bakeman, 1996). Jones et al. (1984) described two functions of coping achieved through minority group affiliations: to allow stigmatized persons to experience social environments in which they are not stigmatized by others and to provide support for negative evaluation of the stigmatized minority group. Social evaluation theory suggests another plausible mechanism for minority coping (Pettigrew, 1967). 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, 1985). Indeed, reappraisal is at the core of gay-affirmative, Black, and feminist psychotherapies that aim to empower the minority person (Garnets & Kimmel, 1991; hooks, 1993; Shade, 1990; Smith & Siegel, 1985).

The distinction between personal and group-level coping may be somewhat complicated because even group-level resources (e.g., services of a gay-affirmative church) need to be accessed and used by individuals. 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. Thus, minority coping may be conceptualized as a group-level resource, related to the group’s ability to mount self-enhancing structures to counteract stigma. This formulation highlights the degree to which minority members may be able to adopt some of the group’s self-enhancing attitudes, values, and structures rather than the degree to which individuals vary in their personal coping abilities. 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.S. Armed Forces, where a “don’t ask, don’t tell” policy discourages affiliation and attachments with other LGB persons, may be unable to access and use group-level resources and therefore be vulnerable to adverse health outcomes, regardless of his or her personal coping abilities. Finally, it is important to note that coping can also have a stressful impact (Miller & Major, 2000). For example, concealing one’s stigma is a common way of coping with stigma and avoiding negative regard, yet it takes a heavy toll on the person using this coping strategy (Smart & Wegner, 2000).

Stress and Identity

Characteristics of minority identity—for example, the prominence of minority identity in the person’s sense of self—may also be related to minority stress and its impact on health outcomes. Group identities are essential for individual emotional functioning, as they address conflicting needs for individuation and affiliation (Brewer, 1991). 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. For example, Burke (1991) said that feedback from others that is incompatible with one’s self-identity—a process he called identity interruptions—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 (1987) found that participants with more complex self-identities were less prone to depression in the face of stress. Thoits (1999) explained, “Since people’s self conceptions are closely linked to their psychological states, stressors that damage or threaten self concepts are likely to predict emotional problems” (p. 346). On the other hand, as described above, minority identity may also lead to stronger affiliations with one’s community, which may in turn aid in buffering the impact of stress (Branscombe, Schmitt, & Harvey, 1999; Brown, Sellers, Brown, & Jackson, 1999; Crocker & Major, 1989).

Prominence (or salience), valence, and level of integration with the individual’s other identities may be relevant to stress (Deaux, 1993; Rosenberg & Gara, 1985; Thoits, 1991, 1999). Prominence of identity may exacerbate stress because “the more an individual identifies with, is committed to, or has highly developed self-schemas in a particular life domain, the greater will be the emotional impact of stressors that occur in that domain” (Thoits, 1999, p. 352). In coming out models, and in some models of racial identity, there has been a tendency to see minority identity as prominent and ignore other personal and social identities (Cross, 1995; de Monteflores & Schultz, 1978; Eliason, 1996). However minority identities, which may seem prominent to observers, are often not endorsed as prominent by minority group members themselves, leading to variability in identity hierarchies of minority persons (Massey & Ouellette, 1996). For example, Brooks (1981) noted that the stress process for lesbians is complex because it involves both sexual and gender identities. LGB members of racial/ethnic minorities also need to manage diverse identities. Research on Black and Latino LGB individuals has shown that they often confront homophobia in their racial/ethnic communities and alienation from their racial/ethnic identity in the LGB community (Diaz, Ayala, Bein, Jenne, & Marin, 2001; Espin, 1993; Loiacano, 1993). Rather than view identity as stable, researchers now view identity structures as fluid, with prominence of identity often shifting with social context (Brewer, 1991; Crocker & Quinn, 2000; Deaux & Ethier, 1998).

Valence refers to the evaluative features of identity and is tied to self-validation. Negative valence has been described as a good predictor of mental health problems, with an inverse relationship to depression (Allen, Woolfolk, Gara, & Apter, 1999; Woolfolk, Novalany, Gara, Allen, & Polino, 1995). Identity valence is a central feature of coming out models, which commonly describe progress as improvement in self-acceptance and diminishment of internalized homophobia. Thus, overcoming negative self-evaluation is the primary aim of the LGB person’s development in coming out and is a central theme of gay-affirmative therapies (Coleman, 1981–1982; Diaz et al., 2001; Loiacano, 1993; Malyon, 1981–1982; Meyer & Dean, 1998; Rotheram-Borus & Fernandez, 1995; Troiden, 1989).

Finally, more complex identity structures may be related to improved health outcomes. Distinct identities are interrelated through a hierarchal organization (Linville, 1987; Rosenberg & Gara, 1985). In coming out models, integration of the minority identity with the person’s other identities is seen as the optimal stage related to self-acceptance. For example, Cass (1979) saw the last stage of coming out as an identity synthesis, wherein the gay identity becomes merely one part of this integrated total identity. In a optimal identity development, various aspects of the person’s self, including but not limited to other minority identities such as those based on gender or race/ethnicity, are integrated (Eliason, 1996).

Summary: A Minority Stress Model

Using the distal–proximal distinction, I propose a minority stress model that incorporates the elements discussed above. In developing the model I have emulated Dohrenwend’s (1998b, 2000) stress model to highlight minority stress processes. Dohrenwend (1998b, 2000) 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, 1998b, 2000).

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. An important aspect of these circumstances in the environment is the person’s minority status, for example being gay or lesbian (box b). These are depicted as overlapping boxes in the figure to indicate close relationship to other circumstances in the person’s environment. 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., 2001). 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, 1999b). For example, an experience of antigay violence (box d) is likely to increase vigilance and expectations of rejection (box f). Often, minority status leads to personal identification with one’s minority status (box e). In turn, such minority identity leads to additional stressors related to the individual’s perception of the self as a stigmatized and devalued minority (Miller & Major, 2000). 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).

Figure 1

Minority stress processes in lesbian, gay, and bisexual populations.

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). For example, minority stressors may have a greater impact on health outcomes when the LGB identity is prominent than when it is secondary to the person’s self-definition (Thoits, 1999). Second, LGB identity may also be a source of strength (box h) when it is associated with opportunities for affiliation, social support, and coping that can ameliorate the impact of stress (Branscombe, Schmitt, & Harvey, 1999; Crocker & Major, 1989; Miller & Major, 2000).

Empirical Evidence for Minority Stress in LGB Populations

In exploring evidence for minority stress two methodological approaches can be discerned: studies that examined within-group processes and their impact on mental health and studies that compared differences between minority and nonminority groups in prevalence of mental disorders. 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. For example, such studies may describe whether LGB people who have experienced antigay discrimination suffer greater adverse mental health impact than LGB people who have not experienced such stress (Herek, Gillis, & Cogan, 1999). 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, 2000). 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.

Research Evidence: Within-Group Studies of Minority Stress Processes

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. Such studies have shown, for example, that stigma leads LGB persons to experience alienation, lack of integration with the community, and problems with self-acceptance (Frable, Wortman, & Joseph, 1997; Greenberg, 1973; Grossman & Kerner, 1998; Malyon, 1981–1982; Massey & Ouellette, 1996; Stokes & Peterson, 1998). Within-group studies have typically measured mental health outcomes using psychological scales (e.g., depressive symptoms) rather than the criteria-based mental disorders (e.g., major depressive disorder). These studies have concluded that minority stress processes are related to an array of mental health problems including depressive symptoms, substance use, and suicide ideation (Cochran & Mays, 1994; D’Augelli & Hershberger, 1993; Diaz et al., 2001; Meyer, 1995; Rosario, Rotheram-Borus, & Reid, 1996; Waldo, 1999). 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.

Prejudice events

Similar to research with African Americans and other ethnic minority groups (Kessler, Mickelson, & Williams, 1999), researchers have described antigay violence and discrimination as core stressors affecting gay and lesbian populations (Garnets et al., 1990; Herek & Berrill, 1992; Herek, Gillis, & Cogan, 1999; Kertzner, 1999). 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, 1987). With the formation of a gay community, as LGB individuals became more visible and more readily identifiable by potential perpetrators, they increasingly became targets of antigay violence and discrimination (Badgett, 1995; Herek & Berrill, 1992; Human Rights Watch, 2001; Safe Schools Coalition of Washington, 1999). In 2001, 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, 2001).

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.S. adults, LGB people were twice as likely as heterosexual people to have experienced a life event related to prejudice, such as being fired from a job (Mays & Cochran, 2001). In a study of LGB adults in Sacramento, CA, approximately 1/5 of the women and 1/4 of the men experienced victimization (including sexual assault, physical assault, robbery, and property crime) related to their sexual orientation (Herek et al., 1999). Some research has suggested variation by ethnic background as well, although the direction of the findings is not clear. For instance, among urban adults aged 25 to 37 who reported having same-sex sexual partners, Krieger and Sidney (1997) found that 1/2 of Whites compared with 1/3 of Blacks reported discrimination based on sexual orientation. On the other hand, in a study of HIV-positive gay men in New York City, Siegel and Epstein (1996) found that African American and Puerto Rican men had significantly more gay-related minority stressors than Caucasian men.

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.S. high schools is characterized by discrimination, rejection, and violence (Faulkner & Cranston, 1998; Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998). 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, 1999). For example, in a random sample of Massachusetts high schools students, LGB students more often than heterosexual students had property stolen or deliberately damaged (7% vs. 1%), were threatened or injured with a weapon (6% vs.1%), and were in physical fight requiring medical treatment (6% vs. 2%; Safe Schools Coalition of Washington, 1999). A national survey of LGBT youth conducted by the advocacy organization Gay, Lesbian, and Straight Education Network (GLSEN; 1999) reported that those surveyed experienced verbal harassment (61%), sexual harassment (47%), physical harassment (28%), and physical assault (14%). The overwhelming majority of LGBT youth (90%) sometimes or frequently heard homophobic remarks at their schools, with many (37%) reporting hearing these remarks from faculty or school staff (GLSEN, 1999).

Gay men and lesbians are also discriminated against in the workplace. Waldo (1999) demonstrated a relationship between employers’ organizational climate and the experience of heterosexism in the workplace, which was subsequently related to adverse psychological, health, and job-related outcomes in LGB employees. Badget’s (1995) analysis of national data showed that gay and bisexual male workers earned from 11% to 27% less than heterosexual male workers with the same experience, education, occupation, marital status, and region of residence.

Garnets et al. (1990) described psychological mechanisms that could explain the association between victimization and psychological distress. The authors noted that victimization interferes with perception of the world as meaningful and orderly. In an attempt to restore order to their perception of the world, survivors ask “Why me?” and often respond with self-recrimination and self-devaluation. More generally, experiences of victimization take away the victim’s sense of security and invulnerability. Health symptoms of victimization include “sleep disturbances and nightmares, headaches, diarrhea, uncontrollable crying, agitation and restlessness, increased use of drugs, and deterioration in personal relationship” (Garnets et al., 1990, p. 367). 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., 1999; McDevitt, Balboni, Garcia, & Gu, 2001).

Stigma: Expectations of rejection and discrimination

Goffman (1963) discussed the anxiety with which the stigmatized individual approaches interactions in society. Such an individual “may perceive, usually quite correctly, that whatever others profess, they do not really ‘accept’ him and are not ready to make contact with him on ‘equal grounds’” (Goffman, 1963, p. 7). Allport (1954) described vigilance as one of the traits that targets of prejudice develop in defensive coping. 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. The greater one’s perceived stigma, the greater the need for vigilance in interactions with dominant group members. By definition such vigilance is chronic in that it is repeatedly and continually evoked in the everyday life of the minority person. Crocker et al. (1998) described this as the “need to be constantly ‘on guard’ … alert, or mindful of the possibility that the other person is prejudiced” (p. 517). Jones et al. (1984) described the effect of societal stigma on the stigmatized individual as creating a conflict between self-perceptions and others-perceptions. 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.

This exertion of energy in maintaining one’s self-concept is stressful, and would increase as perceptions of others’ stigmatization increase. Branscombe, Ellemers, Spears, and Doosje (1999) 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.g., categorization as a woman when applying for a business loan). Distinctiveness threat is an opposite threat, relating to denial of distinct group membership when it is relevant or significant (also Brewer, 1991). Threats to the value of social identity involves undermining of the minority group’s values, such as its competence and morality. A fourth threat, threat to acceptance, emerges from negative feedback from one’s in-group and the consequent threat rejection by the group. For example, Ethier and Deaux (1994) 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. Link (1987; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997) showed that in mentally ill individuals, perceived stigma was related to adverse effects in mental health and social functioning. In a cross-cultural study of gay men, Ross (1985) found that anticipated social rejection was more predictive of psychological distress outcomes than actual negative experiences. However, research on the impact of stigma on self-esteem, a main focus of social psychological research, has not consistently supported this theoretical perspective; such research often fails to show that members of stigmatized groups have lower self-esteem than others (Crocker & Major, 1989; Crocker et al., 1998; Crocker & Quinn, 2000). One explanation for this finding is that along with its negative impact, stigma has self-protective properties related to group affiliation and support that ameliorate the effect of stigma (Crocker & Major, 1989). This finding is not consistent across various ethnic groups: Although Blacks have scored higher than Whites on measures of self-esteem, other ethnic minorities have scored lower than Whites (Twenge & Crocker, 2002).

Experimental social psychological research has highlighted other processes that can lead to adverse outcomes. This research may be classified as somewhat different from that related to the vigilance concept discussed above. Vigilance is related to feared possible (even if imagined) negative events and may therefore be classified as more distal along the continuum ranging from the environment to the self. Stigma threat, as described below, relates to internal processes that are more proximal to the self. This research has shown that expectations of stigma can impair social and academic functioning of stigmatized persons by affecting their performance (Crocker et al., 1998; Farina, Allen, & Saul, 1968; Pinel, 2002; Steele, 1997; Steele & Aronson, 1995). For example, Steele (1997) described stereotype threat as the “social–psychological threat that arises when one is in a situation or doing something for which a negative stereotype about one’s group applies” (p. 614) and showed that the emotional reaction to this threat can interfere with intellectual performance. When situations of stereotype threat are prolonged they can lead to “disidentification,” whereby a member of a stigmatized group removes a domain that is negatively stereotyped (e.g., academic success) from his or her self-definition. Such disidentification with a goal undermines the person’s motivation—and therefore, effort—to achieve in this domain. Unlike the concept of life events, which holds that stress stems from some concrete offense (e.g., antigay violence), here it is not necessary that any prejudice event has actually occurred. As Crocker (1999) noted, because of the chronic exposure to a stigmatizing social environment, “the consequences of stigma do not require that a stigmatizer in the situation holds negative stereotypes or discriminates” (p. 103); as Steele (1997) described it, for the stigmatized person there is “a threat in the air” (p. 613).

Concealment versus disclosure

Another area of research on stigma, moving more proximally to the self, concerns the effect of concealing one’s stigmatizing attribute. Paradoxically, concealing one’s stigma is often used as a coping strategy, aimed at avoiding negative consequences of stigma, but it is a coping strategy that can backfire and become stressful (Miller & Major, 2000). In a study of women who felt stigmatized by abortion, Major and Gramzow (1999) demonstrated that concealment was related to suppressing thoughts about the abortion, which led to intrusive thoughts about it, and resulted in psychological distress. Smart and Wegner (2000) described the cost of hiding one’s stigma in terms of the resultant cognitive burden involved in the constant preoccupation with hiding. They described complex cognitive processes, both conscious and unconscious, that are necessary to maintain secrecy regarding one’s stigma, and called the inner experience of the person who is hiding a concealable stigma a “private hell” (p. 229).

LGB people may conceal their sexual orientation in an effort to either protect themselves from real harm (e.g., being attacked, getting fired from a job) or out of shame and guilt (D’Augelli & Grossman, 2001). Concealment of one’s homosexuality is an important source of stress for gay men and lesbians (DiPlacido, 1998). Hetrick and Martin (1987) described learning to hide as the most common coping strategy of gay and lesbian adolescents, and noted that

individuals in such a position must constantly monitor their behavior in all circumstances: how one dresses, speaks, walks, and talks become constant sources of possible discovery. One must limit one’s friends, one’s interests, and one’s expression, for fear that one might be found guilty by association. … The individual who must hide of necessity learns to interact on the basis of deceit governed by fear of discovery. … Each successive act of deception, each moment of monitoring which is unconscious and automatic for others, serves to reinforce the belief in one’s difference and inferiority. (pp. 35–36)

Hiding and fear of being identified do not end with adolescence. For example, studies of the workplace experience of LGB people found that fear of discrimination and concealment of sexual orientation are prevalent (Croteau, 1996) and that they have adverse psychological, health, and job-related outcomes (Waldo, 1999). These studies showed that LGB people engage in identity disclosure and concealment strategies that address fear of discrimination on one hand and a need for self-integrity on the other. These strategies range from passing, which involves lying to be seen as heterosexual; covering, which involves censoring clues about one’s self so that LGB identity is concealed; being implicitly out, which involves telling the truth without using explicit language that discloses one’s sexual identity; and being explicitly out (Griffin, 1992, as cited in Croteau, 1996).

Another source of evidence comes from psychological research that has shown that expressing emotions and sharing important aspects of one’s self with others—through confessions and disclosures involved in interpersonal or therapeutic relationships, for example—are important factors in maintaining physical and mental health (Pennebaker, 1995). Studies have shown that suppression, such as hiding secrets, is related to adverse health outcomes and that expressing and disclosing traumatic events or characteristics of the self improve health by reducing anxiety and promoting assimilation of the revealed characteristics (Bucci, 1995; Stiles, 1995). In one class of studies, investigators have shown that repression and inhibition affect immune functions and health outcomes, whereas expression of emotions, such as writing about traumatic experiences, produces improvement in immune functions, decreases in physician visits, and reduced symptoms for diseases such as asthma and arthritis (Petrie, Booth, & Davison, 1995; Smyth, Stone, Hurewitz, & Kaell, 1999). Research evidence in gay men supports these formulations. Cole and colleagues found that HIV infection advanced more rapidly among gay men who concealed their sexual orientation than those who were open about their sexual orientation (Cole et al., 1996a). In another study among HIV-negative gay men, those who concealed their sexual orientation were more likely to have health problems than those who were open about their sexual orientation (Cole et al., 1996b)

In addition to suppressed emotions, concealment prevents LGB people from identifying and affiliating with others who are gay. Psychological literature has demonstrated the positive impact of affiliation with other similarly stigmatized persons on self-esteem (Crocker & Major, 1989; Jones et al., 1984; Postmes & Branscombe, 2002). This effect has been demonstrated by Frable, Platt, and Hoey (1998) in day-to-day interactions. The researchers assessed self-perceptions and well-being in the context of the immediate social environment. College students with concealable stigmas, such as homosexuality, felt better about themselves when they were in an environment with others who were like them than when they were with others who are not similarly stigmatized. In addition, if LGB people conceal their sexual orientation, they are not likely to access formal and informal support resources in the LGB community. Thus, in concealing their sexual orientation LGB people suffer from the health-impairing properties of concealment and lose the ameliorative self-protective effects of being “out.”

Internalized homophobia

In the most proximal position along the continuum from the environment to the self, internalized homophobia represents a form of stress that is internal and insidious. In the absence of overt negative events, and even if one’s minority status is successfully concealed, lesbians and gay men may be harmed by directing negative social values toward the self. Thoits (1985, p. 222) described such a process of self-stigmatization, explaining that “role-taking abilities enable individuals to view themselves from the imagined perspective of others. One can anticipate and respond in advance to others’ reactions regarding a contemplated course of action.”

Clinicians use the term internalized homophobia to refer to the internalization of societal antigay attitudes in lesbians and gay men (e.g., Malyon, 1981–1982). Meyer and Dean (1998) defined internalized homophobia as “the gay person’s direction of negative social attitudes toward the self, leading to a devaluation of the self and resultant internal conflicts and poor self-regard” (p. 161). After they accept their stigmatized sexual orientation, LGB people begin a process of coming out. Optimally, through this process they come to terms with their homosexuality and develop a healthy identity that incorporates their sexuality (Cass, 1979, 1984; Coleman, 1981–1982; Troiden, 1989). Internalized homophobia signifies the failure of the coming out process to ward off stigma and thoroughly overcome negative self-perceptions and attitudes (Morris et al., 2001). Although it is most acute early in the coming out process, it is unlikely that internalized homophobia completely abates even when the person has accepted his or her homosexuality. Because of the strength of early socialization experiences, and because of continued exposure to antigay attitudes, internalized homophobia remains an important factor in the gay person’s psychological adjustment throughout life. Gay people maintain varying degrees of residual antigay attitudes that are integrated into their self-perception that can lead to mental health problems (Cabaj, 1988; Hetrick & Martin, 1984; Malyon, 1981–1982; Nungesser, 1983). Gonsiorek (1988) called such residual internalized homophobia “covert,” and said, “Covert forms of internalized homophobia are the most common. Affected individuals appear to accept themselves, yet sabotage their own efforts in a variety of ways” (p. 117).

Williamson (2000) reviewed the literature on internalized homophobia and described the wide use of the term in gay and lesbian studies and gay-affirmative psychotherapeutic models. He noted the intuitive appeal of internalized homophobia to “almost all gay men and lesbians” (Williamson, 2000, p. 98). Much of the literature on internalized homophobia has come from theoretical writings and clinical observations, but some research has been published. Despite significant challenges to measuring internalized homophobia and lack of consistency in its conceptualization and measurement (Mayfield, 2001; Ross & Rosser, 1996; Shidlo, 1994; Szymanski & Chung, 2001), research has shown that internalized homophobia is a significant correlate of mental health including depression and anxiety symptoms, substance use disorders, and suicide ideation (DiPlacido, 1998; Meyer & Dean, 1998; Williamson, 2000). Research has also suggested a relationship between internalized homophobia and various forms of self-harm, including eating disorders (Williamson, 2000) and HIV-risk-taking behaviors (Meyer & Dean, 1998), although Shidlo (1994) failed to show this relationship. Nicholson and Long (1990) showed that internalized homophobia was related to self-blame and poor coping in the face of HIV infection/AIDS. Other research showed that internalized homophobia was related to difficulties with intimate relationships and sexual functioning (Dupras, 1994; Meyer & Dean, 1998; Rosser, Metz, Bockting, & Buroker, 1997).

Research Evidence: Between-Groups Studies of Prevalence of Mental Disorder

Despite a long history of interest in the prevalence of mental disorders among gay men and lesbians, methodologically sound epidemiological studies are rare. The interest in mental health of lesbians and gay men has been clouded by shifts in the social environment within which it was embedded. Before the 1973 declassification of homosexuality as a mental disorder, gay-affirmative psychologists and psychiatrists sought to refute arguments that homosexuality should remain a classified disorder by showing that homosexuals were not more likely to be mentally ill than heterosexuals (Bayer, 1981). At the time, some writers insisted that homosexuals were more likely than heterosexuals to be ill and that this demonstrated that homosexuality should be classified as a mental disorder, but many of these studies were based on biased samples, for example of prison populations or clinical (primarily psychoanalytic) observations (Marmor, 1980). An exception to authors of earlier studies is Evelyn Hooker, who in several studies that became influential during the debate on the status of homosexuality, found that homosexual and heterosexual subjects were indistinguishable in psychological projective testing (e.g., Hooker, 1957).

Most of the early studies used symptom scales that assessed psychiatric symptoms rather than prevalence of classified disorders. An exception was a study by Saghir, Robins, Welbran, and Gentry (1970a, 1970b), which assessed criteria-defined prevalences of mental disorders among gay men and lesbians as compared with heterosexual men and women. The authors found “surprisingly few differences in manifest psychopathology” between homosexuals and heterosexuals (Saghir et al., 1970a, p. 1084). In the social atmosphere of the time, research findings were interpreted by gay-affirmative researchers conservatively, so as to not erroneously suggest that lesbians and gay men had high prevalences of disorder. Thus, although Saghir and colleagues (1970a) were careful not to claim that gay men had higher prevalences of mental disorders than heterosexual men, they noted that they did find “that whenever differences existed they showed the homosexual men having more difficulties than the heterosexual controls,” including, “a slightly greater overall prevalence of psychiatric disorder” (p. 1084). Among studies that assessed symptomatology, several showed slight elevation of psychiatric symptoms among LGB people, although these levels were typically within a normal range (see Gonsiorek, 1991; Marmor, 1980). Thus, most reviewers have concluded that research evidence has conclusively shown that homosexuals did not have abnormally elevated psychiatric symptomatology compared with heterosexuals (see Marmor, 1980). This conclusion has been widely accepted and has been often restated in most current psychological and psychiatric literature (Cabaj & Stein, 1996; Gonsiorek, 1991).

More recently, there has been a shift in the popular and scientific discourse on the mental health of lesbians and gay men. Gay-affirmative advocates have begun to advance a minority stress hypothesis, claiming that discriminatory social conditions lead to poor health outcomes (Dean et al., 2000; Krieger & Sidney, 1997; Mays & Cochran, 2001; Meyer, 2001; Rosario et al., 1996). In 1999, the journal Archives of General Psychiatry published two articles (Fergusson, Horwood, & Beautrais, 1999; Herrell et al., 1999) that showed that as compared with heterosexual people, LGB people had higher prevalences of mental disorders and suicide. The articles were accompanied by three editorials (Bailey, 1999; Friedman, 1999; Remafedi, 1999). One editorial heralded the studies as containing “the best published data on the association between homosexuality and psychopathology,” and concluded that “homosexual people are at a substantially higher risk for some forms of emotional problems, including suicidality, major depression, and anxiety disorder” (Bailey, 1999, p. 883). All three editorials suggested that homophobia and adverse social conditions are a primary risk for mental health problems of LGB people. This shift in discourse is also reflected in the gay-affirmative popular media. For example, in an article titled “The Hidden Plague” published in Out, a gay and lesbian lifestyle magazine, Andrew Solomon (2001) claimed that compared with heterosexuals “gay people experience depression in hugely disproportionate numbers” (p. 38) and suggested that the most probable cause is societal homophobia and the prejudice and discrimination associated with it.

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