The Effects of Discriminatory Stress on Depression and Contextual Factors Among Lesbians, Gay Men, and Bisexuals

Background and Purpose:

Depression is a prevalent psychological health issue that impacts the morbidity and mortality of all people. However, lesbians, gay men, and bisexual (LGB) persons are disproportionately impacted by depression when compared to heterosexuals. The predominant explanatory framework for psychological health disparities among LGB is Minority Stress Theory. Minority Stress is the excess stress that LGB experience due to their marginalized status in society and has two types. The first type, distal minority stress, is the excess stress experienced from discriminatory acts. The second type is proximal minority stress and includes internal stressors. The main tenet of the model that LGB persons, who experience distal minority stress, are more likely to experience negative psychological health outcomes has strong empirical support. The other suppositions within the model, which include the relation of contextual factors, have conflicting empirical support or are largely unexplored. Based on a comprehensive review of the literature, an alternative conceptual model based on Minority Stress Theory, the Transactional Model of Coping, and the Syndemics perspective is advanced to explain these psychological health disparities. I posit in this model that distal minority stress and the proposed, mediating determinants of health risk behaviors and social support are factors related to depressive outcomes among LGB persons. The purpose of this study is to examine the relationships between depression and its determinants of distal minority stress, health risk behaviors, and social support as depicted in the conceptual model.

Methods:

I used The National Survey of Midlife in the United States II (2004 – 2006), which had a non-experimental, correlational design and employed multi-stage probability sampling techniques. There were 108 LGB participants in the subsample. 

The LGB subsample was measured according to their identification of their sexual orientation. I defined depression as a composite of clinically-defined anhedonia and depressed mood. Social support was received from either family members or friends. Last, I defined health risks as various substance use behaviors. The relationships among the study variables were explored using parametric correlations, t tests, and path analyses using SPSS and Mplus6.

Results:  Results indicated that distal minority stress was: 1.) positively correlated with depressive symptomatology; 2.) positively correlated with health risk behaviors; and 3.) negatively correlated with social support. Path analysis was conducted, and the conceptual model was not supported. The revised model was a direct effects one. Distal minority stress directly effected depression, health risk behaviors, and social support.

Conclusions and Implications:  Sexual orientation discrimination and its subsequent minority stress had deleterious effects on LGB persons’ psychological health but also minimized their ability to receive help, or social support. The results further suggest that minority stress may be associated with physical health disparities through its direct effect on health risk behaviors. Social work practitioners should assess members of the LGB community for discriminatory experiences and minority stress. Additional research is directed to subpopulations of LGB population, such as persons affected by poverty.