Emotion-Regulation Mechanisms As Risk Factors for Depression Among Sexual Minority Women

BACKGROUND AND PURPOSE: Sexual minority (e.g., lesbian, bisexual) women experience depression at approximately twice the rate of heterosexual women. Though stigma serves as a common explanation for this disparity, less is known about the mechanisms through which stigma may contribute to depression. Past research has found the strategies that individuals use to regulate their emotions in response to experiences of stigma may influence their mental health outcomes. Among general samples, seeking social support and engaging in cognitive reappraisal following a stigma-related stressor have been linked to lower levels of depression, whereas consuming alcohol and suppressing feelings have been linked to higher levels of depression. The current study proposes and validates a model to test whether lower levels of social support and cognitive reappraisal and greater levels of alcohol consumption and suppression help explain 1) sexual minority women’s disproportionally high rates of depression symptoms and 2) the relationship between stigma-related stressors and depression symptoms for sexual minority women.

METHODS: A national sample of 1,761 sexual minority women participated in an online survey in 2017 through the PRIDE Study. Respondents self-reported demographic information and levels of stigma, social support, cognitive reappraisal, alcohol use, suppression, and depression. Structural equation modeling was used to test the proposed relationships, and RMSEA, CFI, TLI, and SRMR were all employed to assess model fit.

RESULTS: Lower levels of social support (standardized β = -0.177; p < 0.001) and cognitive reappraisal (standardized β = -0.278; p < 0.001), higher levels of alcohol use (standardized β = 0.072; p < 0.001) and suppression (β = 0.162; p < 0.001), and greater number of stigma-related stressors (standardized β = 0.219; p < 0.001) were all significantly associated with a greater number of depression symptoms. Only social support appears to mediate the relationship between stigma-related stressors and depression (standardized indirect effect estimate β = 0.033; p < 0.001). All fit statistics exceeded established standards.

CONCLUSIONS AND IMPLICATIONS: Levels of social support, cognitive reappraisal, alcohol use, and suppression are were all associated with depression among this sample and are factors that are amenable to existing evidence-based practices; future research should focus on developing and evaluating clinical interventions that target these mechanisms using existing evidence-based practices. Furthermore, stigma-related stressors may cause sexual minority women to deplete their social support resources, potentially increasing risk for depression symptoms; this finding suggests that cultivating social support networks that are responsive to experiences of stigma may be an important component of depression treatments for sexual minority women. Though the cross-sectional design of this study limits the potential for causal inference, this study makes an important contribution to the literature by utilizing a largescale, national sample of sexual minority women to evaluate potential mechanisms driving depression symptoms among this vulnerable population. Future research should use longitudinal methods to improve potential for causal inference.