Julia Leschi
Research has repeatedly found that members of oppressed social groups (e.g., sexual or racial/ethnic minorities) have worse mental health outcomes than their dominant counterparts (Dhejne et al., 2016; Hendricks & Testa, 2012; Meyer, 2003; Paradies et al., 2015; Pieterse et al., 2012; Williams & WilliamsMorris, 2000). For example, African American adults are 20% more likely to report high levels of psychological distress than White adults, while Latina teenagers are more likely to attempt suicide than their non-Hispanic White counterparts (Centers for Disease Control and Prevention [CDC], 2019). Similarly, lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults are three times more likely to report suicidal ideation than heterosexual adults (CDC, 2016), with 40% of transgender adults having attempted suicide in their lifetime, compared to 5% of the general population (James et al., 2016). Minority stress theory has been applied to explain these differences, positing that stigma, prejudice, and discrimination directed at minority groups create a hostile and stressful environment which leads to mental health problems (Meyer, 2003). Minority stress includes distal stressors (e.g., workplace and housing discrimination, microaggressions), objective events that are visible in the environment to an outside observer, and proximal stressors (e.g., self-stigma, identity concealment, expectation of rejection), which arise secondary to distal ones and have been defined as the internalization of negative messaging and attitudes projected by others (Hendricks & Testa, 2012; Meyer, 2003; Ramirez & Paz Galupo, 2019). Although the literature on minority stress has mostly focused on LGBTQ, as well as ethnic and racial minority (i.e., people of color) , individuals (Paradies et al., 2015; Pieterse et al., 2012), it has typically explored the relation between a single minority identity and poor mental health outcomes. Less attention has been given to how minority stress affects LGBTQ individuals who also belong to racial/ethnic minority groups. Some have hypothesized that the intersection of these two identities amplifies the risks of exposure to discrimination leading to minority stress and, therefore, alters the processes through which one is affected by it; however, others suggest this intersection might lead to resilience as a result of LGBTQ people of color’s prior experiences with discrimination (Ching et al., 2018; Ramirez & Paz Galupo, 2019; Rodriguez-Seijas et al., 2019; Rosenfield, 2012). Hence, the present literature review explored the following question: How does minority stress impact the mental health of LGBTQ people of color?
Excess Risks and Mental Health Outcomes
Having multiple minority identities exposes LGBTQ people of color to both racist and heterosexist microaggressions, leaving them susceptible to excess minority stress (Balsam et al., 2011; Szymanski & Sung, 2010). This specific vulnerability has been termed the “double-jeopardy” hypothesis, which posits that the intersection of two marginalized identities leads to a double health disadvantage (Dowd & Bengston, 1978). Research studying LGBTQ people of color has found that they suffer from negative mental health outcomes such as general psychological distress, increased anxiety, and depressed mood at a higher rate than their heterosexual and cisgender counterparts (Diaz et al., 2001; Szymanski & Sung, 2010). Such outcomes are seen as a consequence of social discrimination, unique tensions between their sexual/gender identity, and the perceived heterosexist and cissexist norms of their ethnic or racial community (Consolacion et al., 2004; Diaz et al., 2001; Szymanski & Sung, 2010). Indeed, minority stress factors can be perceived differently based on one’s own cultural beliefs and the messaging from one’s environment (Ramirez & Paz Galupo, 2019; Sarno et al., 2015). Presently, LGBTQ people of color report being discriminated against in both of their communities, having to deal with heterosexism, homophobia, or transphobia within their racial/ethnic groups, while dealing with racism and fetishization in LGBTQ spaces (i.e., social and political spaces catering specifically to an LGBTQ population; Balsam et al., 2011; Consolacion et al., 2004; McConnell et al., 2018; Ramirez & Paz, 2019; Szymanski & Sung, 2010). LGBTQ spaces give queer individuals the opportunity to be true to themselves, as well as find support and community; however, when LGBTQ people of color experience racism in these spaces, they are isolated from a source of support more accessible to White LGBTQ people (Gieseking, 2016).
Additionally, queer people of color face community specific struggles in their home environments, such as clashes between traditional cultural norms and queer identity (Balsam et al., 2011; Ching et al., 2018; Noyola et al., 2020). These situations can trigger a conflict in allegiance, which has been defined as a perceived incompatibility between one’s racial and ethnic and sexual orientation identities, and leads to psychological distress (Sarno et al., 2015). Specifically, conflicts in allegiances are positively correlated with experiences of racism in LGBTQ spaces and heterosexism from family (Sarno et al., 2015), highlighting the negative effects of this double-sided rejection. Moreover, conflict in allegiance levels are highest among those with high racial/ethnic behavioral engagement and low sexual orientation behavioral engagement, leaving them more likely to suffer from poor mental health (Sarno et al., 2015). This suggests that strong identification and engagement with the LGBTQ community could mediate the extent to which distress caused by conflicts in allegiances develop (Ching et al., 2018; Sarno et al., 2015). 24 Gender, Sexuality, & Inequality • 25 These findings, in keeping with minority stress theory, confirm that alienation from one’s community because of identity factors is harmful to mental health, leading to greater psychological distress and internalized stigma (Meyer, 2003; Sarno et al., 2015; Szymanski & Sung, 2010). They also emphasize the importance of LGBTQ people of color having access to welcoming LGBTQ spaces to reduce the effects of this double-minority stress (Balsam et al., 2011; Cyrus, 2017). However, LGBTQ people of color often face a dearth of resources catering to the particular needs resulting from their intersecting identities, or are faced with barriers to access, leaving them further vulnerable to the effects of minority stress (Balsam et al., 2011; Cyrus, 2017; McConnell et al., 2018; Ramirez & Paz, 2019).
Resilience
Despite their increased exposure to discrimination, LGBTQ people of color do not consistently present with more compromised mental health than their White counterparts, challenging the double-jeopardy hypothesis (Rosenfield, 2012). In addition, Black LGBTQ adults have repeatedly been found to have a lower prevalence of mental health disorders than the rest of the LGBTQ population, despite their higher exposure to discrimination and adversity, suggesting higher resilience (i.e., ability to address adversity; Rodriguez-Seijas et al., 2019; Rosenfield, 2012). The resilience hypothesis posits that individuals who experience racism from a young age are better prepared to deal with later heterosexist microaggressions, partly because of the benefits derived from community-based resilience (i.e., community resources and connectedness; Rodriguez-Seijas et al., 2019; Rosenfield, 2012). The apparent protective effects of racial/ethnic minority belonging against poor mental health for LGBTQ individuals further challenge the double-jeopardy hypothesis and the perception of minority stress as being additive, showing instead that the experience of discrimination in one aspect of life can mitigate the outcomes of further discrimination (McConnell et al., 2018, Rosenfield, 2012).
Similarly, strong identification with the LGBTQ community reduces the effects of minority stress and leads to better mental health outcomes in LGBTQ individuals, irrespective of race/ethnicity (McConnell et al., 2018; Sarno et al., 2015). However, LGBTQ people of color report seeking out primarily intersectional community spaces, which are more attuned to the needs of multiple minority individuals and facilitate identification to a queer community of color (McConnell et al., 2018; Sarno et al., 2015). Interestingly, research has found antiLGBTQ stigma less damaging to people of color’s identification with the LGBTQ community than to that of White LGBTQ individuals (Ramirez & Paz Galupo, 2019 ; Sarno et al, 2015). These findings suggest that anti-LGBTQ stigma leads to greater rejection of LGBTQ affiliation in White people than in people of color, which could be explained by previous reports that people of color have stronger community and familial orientations than White people (Gaines et al., 1997; McConnell et al., 2018). This hints at another process through which double-minority status surprisingly protects LGBTQ people of color’s mental health (Consolacion et al., 2004; Rodriguez-Seijas et al., 2019), challenging the double-jeopardy and minority stress hypothesis. Conclusion
LGBTQ people of color are surprisingly resilient to the effects of minority stress due to heterosexism (Rodriguez-Seijas et al., 2019; Rosenfield, 2012). Yet, their multiple minority identities put them at higher risk of exposure to discrimination and adverse events, placing a strain on their capacity to bounce back from these societal attacks (Meyer, 2003; Rodriguez-Seijas et al., 2019). The resources that LGBTQ people of color typically use to develop their resilience are different than those used by the White LGBTQ community (Balsam et al., 2011, Szymanski & Sung, 2010). LGBTQ people of color do find solace in spaces centered around an intersectional experience (McConnell et al., 2018), but these are less prevalent and less funded, leaving LGBTQ people of color more vulnerable to isolation, at the expense of their mental health (Balsam et al., 2011, Szymanski & Sung, 2010). This discrepancy within the LGBTQ community needs to be addressed in order to help LGBTQ people of color better mobilize their resilience. The findings from this literature review also indicate that it is important to continue to research minority stress theory as more than an additive process, but one that is mediated and can be buffered by a series of individual characteristics and mental processes. More research needs to be done on how these specificities interact with minority stress to gain a better understanding of risk and resilience factors.
Many of the studies in this review recruited participants with LGBTQ labels; however, some individuals prefer terms like “men having sex with men,” “sexually diverse,” or “fluid” (Ramirez & Paz Galupo, 2019). Hence, a portion of the LGBTQ community may have been missed. Future studies should try to use different recruitment methods in order to capture a greater part of the population. Moreover, too few studies focus on a unique racial/ethnic minority group, and instead study people of color as a homogeneous group. This could lead to missing the intricacies of each group’s experience and result in unrepresentative results. The particularities of each ethnic/racial group’s experience of discrimination need to be explored in further depth in order to better address the mental health needs of people of color within the LGBTQ community. To address this gap in the research, future studies should be qualitative in nature, as they are better suited to focus on the unique cultural factors affecting the various racial/ethnic groups in the LGBTQ community. Thus, in order to reduce the risks of negative mental health outcomes due to conflicts in allegiance and minority stress, this review highlights the need to develop and fund more community spaces aimed at LGBTQ people of color, and further combat racism in White LGBTQ spaces and homophobia and transphobia in the home communities of people of color.
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