How Does Self-Esteem Act As a Mediator in the Relationship between Minority Stress and Depression for Sexual Minority Men?

Background and Purpose. A substantial body of research has demonstrated depression is a burgeoning epidemic amongst sexual minority men and is explained by minority stress (i.e., additional stressors, like discrimination, experienced by minority individuals). Sexual orientation microaggressions, perceived stress, and self-esteem have been shown to be associated with depression, however, research on the indirect effect of self-esteem on depression is limited. The aim of this study is to 1) understand the relationship between stress (i.e., general perception, and minority) and depression 2) investigate whether self-esteem mediates the relationships between stress and depression, and 3) evaluate the impact of these relationships on African American sexual minority men compared to other races/ethnicities.

Methods. In 2020, a sample of 239 sexual minority men were recruited in Georgia (U.S.) to participate in an online survey using three geosocial networking applications. The sample majority included 46.9% White and 41.4% Black/African American sexual minority men. Participants completed validated scales to assess for depression (e.g., Center for Epidemiologic Studies Depression Scale), perceived stress (e.g., Perceived Stress Scale), and sexual orientation microaggressions (Sexual Orientation Microaggression Inventory). The analysis was completed in SAS using three steps: first, a descriptive analysis was performed to examine sample characteristics and variables within the model; next, a correlation matrix was tested to assess bivariate relationships between variables; and last, linear regressions investigated how self-esteem mediates the relationships between sexual orientation microaggressions, perceived stress, and depression when controlling for race, age, and income. Mediation was assessed using a Sobel test.

Results. Controlling for race, age, and income, all covariates (microaggressions, perceived stress, and self-esteem) had a significant association with the outcome variable depression. The regression model was significant, p <.0001. Findings revealed sexual orientation microaggressions (p=.0064) and perceived stress (p<.0001) had a significant positive direct effect on depression. Self-esteem had a significant negative relationship with depression (p<.0001). Income, age, and race were not related to depression. Sixty-seven percent of the variance in depression can be explained by the model. There was only one significant indirect relationship: between perceived stress and depression (Z = -2.69, p = .007).

Conclusions and Implications. The current findings confirm previous literature regarding self-esteem as a factor that mitigates the experience of depressive symptoms associated with stressors. However, distal stressor, microaggressions, did not have a significantly reduced effect on depression through self-esteem. This finding suggests the hostile and overtly discriminatory nature of distal stressors cannot be mitigated solely by intrinsic characteristics. Study findings suggest the need for clinical intervention that would target stress management and the development of adaptive strategies to increase self-efficacy. Future research should include a larger sample of African American participants to further explore multiple minority status, and an increased number of bisexual participants, whose experiences may vastly differ from a gay individual.