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Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.

Sexual minorities are disproportionately affected by mental health problems (e.g., depression, anxiety, substance use disorders, suicidality). Minority stress theory and the psychological mediation framework have become the predominant conceptual models used to explain these disparities, and they have led to substantial advances in research on stigma-related stress and mental health. However, the field’s reliance on these models has limited the extent to which other theories have been considered as potential frameworks for further advancing our understanding of sexual minority mental health. In this article, I discuss how the rejection sensitivity (RS) model can be used to complement and extend minority stress theory and the psychological mediation framework by: (1) emphasizing the role of perception in stigma-related experiences; (2) acknowledging the unique consequences of different anticipatory emotions; (3) describing additional mechanisms linking proximal minority stressors to mental health; and (4) further specifying the temporal order of these processes. I conclude by discussing the importance of attending to developmental processes in research on sexual orientation-related RS and describing important directions for future research.

Population-level increases in psychopathology and other negative mental health outcomes, including posttraumatic stress, depression, anxiety, and elevated substance use, are directly linked to large-scale disasters in the United States. Thus, it is unsurprising that the current coronavirus disease 2019 (COVID-19) pandemic is seriously impacting population-level mental health in the United States, especially among socially disadvantanged, young, and racial and ethnic minority persons. The indirect psychological harms of the COVID-19 pandemic for those who belong to minoritized communities are complicated, exacerbated, and compounded by experiences and stressors specific to their marginalized social identities. In this regard, lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adolescents and young adults have received limited public health attention. This commentary aims to provide a nuanced perspective on the potential indirect mental health effects of the COVID-19 pandemic crisis on LGBTQ young persons. International research suggests that heteronormativity and cisnormativity in practice and policy-level response to large-scale disasters systematically ignores the needs of LGBTQ populations.7 Globally, issues relevant to LGBTQ communities in disaster contexts (eg, discrimination in accessing emergency government services because of LGBTQ status) are largely unreported, and government agencies historically fail to support LGBTQ-affirming interventions during recovery efforts.7 International guidelines and policy frameworks on disaster response and recovery have further failed to consider the needs of LGBTQ populations.7 The dearth of existing research on LGBTQ communities and disaster response in the United States speaks to the invisibility of LGBTQ young persons in the current public health response to the COVID-19 pandemic crisis. Despite limited attention to the mental health needs of LGBTQ young persons during the COVID-19 pandemic, LGBTQ young persons may face unique mental health challenges6,8 driven by the overlapping experience of pandemic-related9-11 and sexual and gender minority–related3,11,12 stressors.

Social stress resulting from stigma, prejudice, and discrimination—\"minority stress\"—negatively impacts sexual minority individuals' health and relational well-being. The present study examined how being in a same-sex couple can result in exposure to unique minority stressors not accounted for at the individual level. Relationship timeline interviews were conducted with 120 same-sex couples equally distributed across two study sites (Atlanta and San Francisco), gender (male and female), and relationship duration (at least six months but less than three years, at least three years but less than seven years, and seven or more years). Directed content analyses identified 17 unique couple-level minority stressors experienced within nine distinct social contexts. Analyses also revealed experiences of dyadic minority stress processes (stress discrepancies and stress contagion). These findings can be useful in future efforts to better understand and address the cumulative impact of minority stress on relational well-being and individual health.

This study examined the effects of minority stress on the physical health of lesbians, gay men, and bisexuals (LGBs). Participants ( N  = 396) completed baseline and one year follow-up interviews. Exposure to stress and health outcomes were assessed with two methods: a subjective self-appraisal method and a method whereby two independent judges externally rated event narratives using standardized criteria. The odds of experiencing a physical health problem at follow-up were significantly higher among LGBs who experienced an externally rated prejudice event during the follow-up period compared to those who did not. This association persisted after adjusting for experiences of general stressful life events that were not related to prejudice. Self-appraised minority stress exposures were not associated with poorer physical health at 1-year follow-up. Prejudice-related stressful life events have a unique deleterious impact on health that persists above and beyond the effect of stressful life events unrelated to prejudice.

Background Prevalence rates of mental health disorders, non-suicidal self-injury and suicidality among Lesbian, Gay, Bisexual, Transgender, Queer and Asexual (LGBTQA+) higher education students are consistently higher than rates for heterosexual students. Nevertheless, in the United Kingdom, there remains limited prevalence data and evidence on the risk factors that confer increased risk of suicide among this population. The purpose of the present study was to investigate mental health disorders, childhood adversities, and recent stressors as risk factors for non-suicidal self-injury, and suicidality among LGBTQA + students. Methods The Student Psychological Interventional Trial (SPIT) was conducted as part of the World Mental Health International College Student Initiative (WMH-ICS). First year undergraduate students aged 18–24 years were recruited ( n  = 1525), including LGBTQA + students ( n  = 190). Chi-squared test of independence was used to identify significant differences in lifetime prevalence rates between heterosexual and LGBTQA + students. Bivariate and multivariate logistic regression analyses examined the associations between mental health disorders, childhood adversities, recent stressors, non-suicidal self-injury, and suicidality among LGBTQA + students. Results LGBTQA + students were significantly more likely to have experienced mental health difficulties, childhood adversities, recent stressors, non-suicidal self-injury, and suicidality than their heterosexual counterparts. One in four LGBTQA + students reported experiencing major depressive episode, and non-suicidal self-injury in their lifetime. LGBTQA + students also reported earlier onset of mental health disorders and suicidality, with much higher rates of interpersonal conflict, and probable post-traumatic stress disorder. Among LGBTQA + students, major depressive disorder, probable post-traumatic stress disorder, and non-suicidal self-injury were significantly associated with an increased likelihood of suicidal ideation and suicide plan. Childhood adversities, and recent stressors such as bullying were significantly associated with an increased likelihood of suicide attempt. Conclusions Our findings highlight the existing mental health disparities, childhood adversities, and recent stressors which may contribute to higher prevalence rates of non-suicidal self-injury, and suicidality among LGBTQA + students. The results emphasise the importance of early intervention, prevention, and treatment, focused on reducing the impact of childhood adversities and recent stressors such as bullying. In addressing these risk factors, educational settings may offer unique opportunities for the practice of inclusion, preventative care, and harm reduction for LGBTQA + students.

Oppression refers to systemic discrimination where the injustice targets or disproportionately impacts specific groups of people. The Trauma Symptoms of Discrimination Scale (TSDS) is a self-report measure designed to assess the traumatizing impact of discrimination broadly by measuring anxiety-related symptoms of trauma due to discriminatory experiences. This may include symptoms arising from racism, homophobia, sexism, poverty, or other forms of marginalization. Almost all studies of the TSDS have examined its use in marginalized ethnoracial groups, primarily African Americans. This paper will extend prior work to help us better understand racial trauma across groups by reporting and comparing TSDS mean scores across ethnoracial identities in a diverse national sample (n  =  923). It also explores trauma with other marginalized identities and demographic dimensions, including gender, sexual minority/LGBQ status, education, and income. The relationship of TSDS scores to clinical psychopathologies are examined, including stress, depression, anxiety, and PTSD. We also examine the unique risks associated with intersectionality, and how having multiple marginalized identities may increase traumatization. Clinical implications and future directions are discussed.

Lesbian, gay, and bisexual (LGB) individuals suffer serious mental health disparities relative to their heterosexual peers, and researchers have linked these disparities to difficult social experiences (e.g., antigay victimization) and internalized biases (e.g., internalized homophobia) that arouse stress. A recent and growing body of evidence suggests that LGB individuals also suffer physical health disparities relative to heterosexuals, ranging from poor general health status to increased risk for cancer and heightened diagnoses of cardiovascular disease, asthma, diabetes, and other chronic conditions. Despite recent advances in this literature, the causes of LGB physical health problems remain relatively opaque. In this article, we review empirical findings related to LGB physical health disparities and argue that such disparities are related to the experience of minority stress—that is, stress caused by experiences with antigay stigma. In light of this minority stress model, we highlight gaps in the current literature and outline five research steps necessary for developing a comprehensive knowledge of the social determinants of LGB physical health.

Little research has examined subtle, intersectional, and everyday minority stress, such as microaggressions specific to being a queer person of color, and its associations with depressive symptoms among sexual and gender minority adolescents (SGMA) of color. Moreover, research is needed to identify mechanisms that might explain the associations between minority stress and depression. This study examined the associations between subtle and intersectional minority stress (i.e., SGMA of color-specific microaggressions) and depressive symptoms among SGMA of color and tested self-concept factors (i.e., self-esteem and sense of mastery) as mediators of these associations. A large national US sample of SGMA of color (N = 3398; 31.8% transgender; 55.7% plurisexual) ages 13 to 17 years (M = 15.56, SD = 1.27) were recruited online. Participants’ race/ethnicity were Asian/Pacific Islander (12.2%), Black/African American (13.2%), Hispanic/Latina(o)/x (30%), Native American/Alaska Native (1.2%), Middle Eastern (1.9%), Biracial or Multiracial (40%), and other racial/ethnic minority groups (1.7%). Over and above the effects of racism and SGM-based victimization, subtle intersectional minority stressors were associated with greater depressive symptoms and lower self-esteem and sense of mastery. Mediation analyses indicated that subtle intersectional minority stressors had indirect effects on depressive symptoms through lower self-esteem and sense of mastery for the aggregate sample of SGMA of color and most racial/ethnic groups in the sample. The results demonstrate that subtle and intersectional minority stress is a unique and significant form of minority stress that is a risk factor for depressive symptoms for SGMA of color. Moreover, our findings underscore self-concept mechanisms as targets for prevention and intervention.

Meta-analytic methods were used to analyze 179 effect sizes retrieved from 32 research reports on the implications that sexual minority stress may have for same-sex relationship well-being. Sexual minority stress (aggregated across different types of stress) is moderately and negatively associated with same-sex relationship well-being (aggregated across different dimensions of relationship well-being). Internalized homophobia is significantly and negatively associated with same-sex relationship well-being, whereas heterosexist discrimination and sexual orientation visibility management are not. Moreover, the effect size for internalized homophobia is significantly larger than those for heterosexist discrimination and sexual orientation visibility management. Sexual minority stress is significantly and negatively associated with same-sex relationship quality but not associated with closeness or stability. Sexual minority stress is significantly and negatively associated with relationship well-being among same-sex female couples but not among same-sex male couples. The current status of research approaches in this field is also summarized and discussed.