Minority Stress

Minority Stress is the excess stress individuals from minority social groups are exposed to because of their social position. Examples of minority social groups are: race, gender, ethnicity, and sexual orientation.

What is Minority Stress?

The Minority Stress model specifies stress and coping processes experienced by individuals from stigmatized social categories. The Minority Stress model outlines the excess stress individuals from minority social groups are exposed to as a result of their social position [1]. The Minority Stress model has five main components, they are:

1. Stressful events and conditions
2. Expectations of rejection and discrimination
3. Concealment of one’s identity
4. Internalized stigma (internalized homophobia and transphobia)
5. Coping and social support [2]

These five components either add to the stress burden that causes negative health outcomes or decrease the negative impact of stress. The proportion of these components determine adverse health outcomes (including mental and physical health problems that are known to be caused at least in part by stress) in sexual and gender minority individuals [2].

Stressful Events and Conditions

The first component, Stressful Events and Conditions, occurs in three different ways:

1. Prejudice Events: Are usually experienced during interpersonal interactions, perpetrated by individuals either in violation of the law or within the law in the form of hate crimes and lawful but discriminatory practices [2]. One unique aspect of prejudice events towards sexual and gender minority individuals is that these events are often experienced at home perpetrated by family members (unlike most prejudice events experienced by racial minorities) [2].
2. Everyday Discrimination: Refers to minor incidents and everyday stressors like rejection, disrespect, snubs, insults, and avoidance that can have symbolic meaning and create pain and indignity beyond its seemingly low magnitude [2].
3. Nonevent Stress: A form of social stress that is not as easily identified as the first two; nonevents are anticipated events or experiences that do not happen and can cause negative effects on mental health [2]. Nonevents include expected life milestones that do not occur when expected or do not occur at all [2]. Examples include; graduating, receiving a promotion, getting married, and having children.

Expectations of Rejection and Discrimination

Minority individuals learn to anticipate and, in some environments, expect negative responses from dominant culture [2]. To protect themselves from this discrimination, harassment, and violence, sexual and gender minority individuals must maintain vigilance and constantly assess their surroundings for safety. These expectations are a response to stigma and perceived danger.

Concealment

In an attempt to avoid the impact of stigma, sexual and gender minority individuals might attempt to conceal their minority identity. This concealment can take place in a variety of environments such as: school, workplace, health care contexts, and even among family [2]. Keeping one’s sexual or gender minority identity a secret can shield someone from overt forms of minority stress but can also further isolate a person and is demanding and stressful to maintain [2].

For transgender individuals and gender nonconforming individuals, not affirming, or refusal to affirm, an individual’s gender identity creates an environment where they are unable to tell others their true gender identity and prevent them from experiencing affirmation of their identity [2].

Internalized Stigma

Internalized homophobia and transphobia is when a person begins to adopt or accept negative social attitudes about their identity [2]. In extreme situations, internalized homophobia and transphobia can lead to complete denial of a person’s own sexual and gender identity; for transgender individuals, this takes the form of self-imposed acceptance of one’s gender assigned at birth.

Coping and Social Support

Individuals who experience minority stress will cope with this stress in a variety of ways; both negative and positive. However, one documented result of minority stress is resilience which is often a result of finding community connectedness and creation of safe spaces where healthy coping strategies can be shared and reinforced [2]. Resilience is also obtained when individuals can make meaning of the minority stress they’re experiencing in ways that externalize (rather than internalize) the cause of the stress [2]. Being able to make positive comparisons with people who share an identity (social support groups and finding affirmative communities) instead of negative comparisons based on social stigma can prevent the negative effects of minority stressors [2].

How Minority Stress Leads to Health Inequities for LGBT Individuals

Minority stress is related to poor mental health and is often considered an explanation for mental health disparities between minority individuals and non-minority individuals, particularly related to depression, anxiety, and suicidal ideation [1] [3].

Minority Stress and Youth

• Minority stressors often lead sexual and gender minority youth to feel they are a burden (perceived burdensomeness) and do not belong (thwarted belongingness) [3] [4].
  • The association between perceived burdensomeness and thwarted belongingness with suicidal ideation is conditional on the level of perceived or anticipated rejection due to sexual identity [3] [4].
• Experiences of both sexual orientation victimization and internalized homophobia is directly related to depressive symptoms through perceived burdensomeness [3].

Minority Stress and Transgender Individuals

• On top pf general life stressors, trans people are subjected to high rates of discrimination, violence, and rejection related to their gender identity or expression. The result of hostile and stressful social environments is higher rates of negative mental health outcomes [1] [5].
• Transgender individuals face sexual violence at higher rates than their LGB counterparts. With reported rates of physical violence ranging from 43% to 60% and reported rates of sexual violence ranging from 43% to 46% [5] [6] [7] [8] [9].
• Transgender individuals who experienced physical or sexual violence were approximately four times more likely than those who had not to have made a suicide attempt [5] [10] [11].
  • Increased suicide attempts for transgender individuals were also associated with recent unemployment, forced sex/rape, verbal and physical victimization related to gender, and low self-esteem; among other factors [5] [6].
• Transgender individuals also experience feelings of being a burden and not belonging because of minority stress [5]. These feelings do not have to develop because of exposure to overt rejection, discrimination, or violence, but can occur as a result of not seeing people like themselves represented in their community or society [5] [10].
  • Perceived burdensomeness contributes to increased suicide risk for transgender individuals [5].
  • Transgender individuals have a higher rate of multiple suicide attempts than other populations; through these experiences, the individual learns that pain can be sustained and tolerated which can contribute to continued serious self-harm, suicide attempts, and completed suicide.

Coping and Resiliency

The one component of the Minority Stress model that prevents negative health outcomes due to minority stress is "Coping and Social Support." By providing healthy coping strategies and social support, negative health outcomes can be interrupted and prevented [1]. When focusing on providing healthy coping strategies and reinforcing resiliency within members of minority communities, it’s important to ensure the focus isn’t too individualistic as this could lead to ignoring the need for important structural and systemic changes and place complete responsibility on the minority individual [1].

• School Setting:
  • Many LGB adolescents obtain social support from LGB-focused groups and organizations like gay-straight alliances and community level interventions focused on providing safe spaces for sexual and gender minority identities [1] [12]
• Work Setting:
  • Inclusion of sexual orientation and sexual identity in company diversity statements or diversity trainings [13];
  • Extending domestic partner benefits to same sex couples [13];
  • Offering sexual and gender minority resource-support groups [13];
  • Publicly support LGBTQ issues [13];
  • Create a culture that affirms and accepts LGBTQ individuals and their families (ensure language used in organization invitations to social activities is not hetero-normative and express that all families are welcome) [13].
• General Social Settings:
  • Create and support an “in-group” identity in which LGBTQ individuals can compare themselves, rather than using those who prejudice they face as their comparison group [5].
  • Increase visibility of LGBTQ individuals within media, politics, and as community leaders; being able to see themselves in someone else who is visible in a positive way helps affirm and validate LGBTQ identities and effectively counteracts stigma [5].

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