Christina Dyar

Bisexuality, Minority Stress, and Health

Purpose of ReviewBisexual individuals are at increased risk for negative health outcomes compared to heterosexual individuals and often compared to gay/lesbian individuals as well. The goal of this article is to summarize the current evidence-base on bisexual health disparities, to describe factors that influence them, and to review interventions designed to improve the health of bisexual individuals.Recent FindingsBased on our review of the literature, we conclude that there is strong evidence that bisexual individuals are at increased risk for mental health and substance use problems. These disparities are evident across dimensions of bisexuality (identity, attraction, and behavior), but there are important nuances to these findings. There is also evidence that bisexual men are at increased risk for sexually transmitted infections (STIs) compared to heterosexual men and that bisexual women are at increased risk for STIs compared to both lesbians and heterosexual women. Although there are numerous causes of these disparities, a leading contributor is stress related to stigma and discrimination. Most of the interventions that have been developed for bisexual individuals are HIV prevention programs for behaviorally bisexual men of color. Despite less attention to mental health and substance use interventions for bisexual individuals, recent developments show promise in their potential application to this population.SummaryBisexual individuals are at increased risk for mental health, substance use, and sexual health problems, and this is due, in part, to stigma and discrimination. Future research should continue to examine how different dimensions of bisexuality relate to health disparities and factors that influence them. There is also an urgent need to develop, test, and disseminate interventions to improve the health of bisexual individuals..

Essentialist beliefs: Understanding contact with and attitudes towards lesbian and gay individuals.

Sexual prejudice remains a widespread problem worldwide. Past research demonstrates that cross-orientation contact (contact between heterosexuals and lesbian/gay individuals) reduces sexual prejudice among heterosexuals, especially when contact is high quality. This study extends the literature on the relationship between cross-orientation contact and sexual prejudice and the mediation of this relationship by intergroup anxiety by examining the role of a key ideology - essentialist beliefs about homosexuality (immutability, universality, and discreteness beliefs). Findings indicate that the mediation of the relationship between cross-orientation contact and sexual prejudice by intergroup anxiety differs by level of essentialist beliefs. Additionally, the relationship between cross-orientation contact and sexual prejudice appears to be mediated by essentialist beliefs as well as intergroup anxiety. These results suggest that individuals who endorse essentialist beliefs commonly associated with increased bias (high discreteness and low immutability and universality beliefs) may benefit the most from cross-orientation contact and resultant decreases in intergroup anxiety. Further, decreasing essentialist beliefs generally associated with increased bias may be a mechanism through which cross-orientation contact reduces sexual prejudice. Implications and future directions are discussed.

Minority stress, sexual identity uncertainty, and partner gender decision making among nonmonosexual individuals.

Despite decades of research on sexual identity development and minority stress, sexual identity uncertainty has received relatively little attention. Sexual identity uncertainty refers to the extent to which an individual is uncertain about which sexual identity label best captures their pattern of attractions and behavior. Although theory suggests that sexual identity uncertainty is a consequence of negative experiences related to one’s sexual identity, this has not been empirically tested. The current study examined factors that influence sexual identity uncertainty as well as its potential consequences for relationship decision making in a sample of nonmonosexual individuals (individuals attracted to more than one gender; N = 397). For nonmonosexual individuals who reported low sexual identity disclosure, more frequent experiences of monosexism were associated with greater internalized monosexism, which in turn, was associated with greater sexual identity uncertainty. Additionally, among nonmonosexual individuals who reported that others frequently made assumptions about their sexual orientation, higher sexual identity uncertainty was associated with more partner gender management. Specifically, these individuals reported that their relationship decisions were more influenced by concern about being seen in relationships with one gender over another and desire to be seen in relationships with one gender over another. In summary, findings are consistent with a theoretical model of how sexual identity uncertainty develops among nonmonosexual individuals (Weinberg, Williams, & Pryor, 1994). Results also suggest that sexual identity uncertainty can influence the decisions that nonmonosexual individuals make about relationships. Implications and directions for future research are discussed.

Development and Initial Validation of the Sexual Minority Women Rejection Sensitivity Scale

The goals of the current studies were to develop a measure of sexual orientation rejection sensitivity (RS) for sexual minority women (SMW) and to examine its preliminary reliability and validity. In Study 1a, data from 150 SMW were used to develop scenarios for the SMW Rejection Sensitivity Scale (SMW-RSS). In Study 1b, data from a second sample of 128 SMW were used to streamline the SMW-RSS and test its factor structure. In Study 2, data from a third sample of 300 SMW were used to test the convergent and discriminant validity of the SMW-RSS. The SMW-RSS demonstrated strong convergent validity, correlating with the indices of minority stress (discrimination, sexual identity acceptance concerns, difficulty developing a positive sexual identity, internalized negativity, and concealment motivation) and internalizing psychopathology (anxiety and depression symptoms). The measure also demonstrated strong discriminant validity, predicting psychosocial outcomes above and beyond existing measures of RS. Findings demonstrate the utility of the SMW-RSS to assess concerns and expectations of sexual orientation rejection among women and underscore the importance of examining the unique concerns about rejection that SMW experience. Additional online materials for this article are available to PWQ subscribers on PWQ’s website at http://pwq.sagepub.com/supplemental

Are Outness and Community Involvement Risk or Protective Factors for Alcohol and Drug Abuse Among Sexual Minority Women

Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW’s substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one’s sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.

Piloting relationship education for female same-sex couples: Results of a small randomized waitlist-control trial.

Relationship education represents a promising, nonstigmatizing approach to promoting the health and stability of same-sex couples. A new culturally sensitive adaptation of relationship education was developed specifically for female same-sex couples (The Strengthening Same-Sex Relationships Program, Female version; SSSR-F). SSSR-F includes adaptations of evidence-based strategies to build core relationship skills (e.g., communication skills training) as well as new content to address unique challenges faced by this population (e.g., discrimination; low social support). A small randomized waitlist-control trial (N = 37 couples) was conducted to evaluate program feasibility, acceptability, and efficacy. Three proximal outcomes targeted by SSSR-F (communication, perceived stress, social support) and 3 distal outcomes (global relationship satisfaction, instability, and confidence) were assessed at pre- and posttreatment and 3-month follow-up. Results of multilevel models accounting for nonindependence in dyadic data indicated statistically significant program effects on positive and negative couple communication, relationship satisfaction, and relationship confidence and small, nonsignificant program effects on stress, social support, and relationship instability. Analyses of follow-up data suggest maintenance of effects on the proximal but not the distal outcomes. Ratings of program satisfaction were high. Overall, findings support the feasibility, acceptability, and initial efficacy of SSSR-F, highlighting the potential value of culturally sensitive relationship education for same-sex couples. Continued efforts are needed to increase sustainability of program effects on global relationship quality over time.

A weekly diary study of minority stress, coping, and internalizing symptoms among gay men.

Objective: Research has demonstrated that gay men are at increased risk for internalizing disorders compared with heterosexual men and that minority stressors are risk factors. However, the mechanisms underlying the associations between minority stressors and internalizing symptoms remain unclear. The current study examined coping strategies (active and disengaged coping) as mediators of the associations between minority stressors (internalized homonegativity [IH] and rejection sensitivity [RS]) and internalizing symptoms. Method: A sample of 147 gay men completed a baseline questionnaire and weekly questionnaires for seven consecutive weeks. Results: At the between-person level, higher IH and RS were associated with higher disengaged coping, but not active coping. In turn, higher disengaged coping was associated with higher internalizing symptoms. Disengaged coping mediated the between-person association between IH and internalizing symptoms. At the within-person level, higher IH and RS were associated with higher disengaged coping, which, in turn, was associated with higher internalizing symptoms. Higher RS was also associated with higher active coping. Disengaged coping mediated the within-person associations between both minority stressors and internalizing symptoms. Of note, some associations with IH became nonsignificant controlling for RS, suggesting that the latter has a stronger influence on coping and internalizing symptoms. Conclusions: Findings demonstrate that gay men’s negative thoughts and feelings about their sexual orientation and anxious expectations of rejection vary from week to week and this weekly fluctuation has an impact on mental health. Further, findings implicate disengaged coping as a mechanism through which minority stressors influence internalizing symptoms.

Psychosocial Pathways to STEM Engagement among Graduate Students in the Life Sciences

Perceived support from one’s advisor may promote science, technology, engineering, and mathematics (STEM) engagement among women by predicting greater gender–STEM identity compatibility for women, which predicts higher perceived STEM importance, which in turn predicts a higher sense of belonging and increased STEM self-efficacy. The implications of this work for educational policy are described.

The Mediating Roles of Rejection Sensitivity and Proximal Stress in the Association Between Discrimination and Internalizing Symptoms Among Sexual Minority Women

The negative impact of discrimination on mental health among lesbian, gay, and bisexual populations has been well documented. However, the possible mediating roles of sexual orientation rejection sensitivity and rejection-based proximal stress in the association between discrimination and internalizing symptoms remain unclear. Rejection-based proximal stress is a subset of proximal stressors that are theorized to arise from concerns about and expectations of sexual orientation-based rejection and discrimination. Drawing on minority stress theory, we tested potential mediating effects using indirect effects structural equation modeling in a sample of 300 sexual minority women. Results indicated that the indirect effect of discrimination on internalizing symptoms (a latent variable indicated by depression and anxiety symptoms) through sexual orientation rejection sensitivity and rejection-based proximal stress (a latent variable indicated by preoccupation with stigma, concealment motivation, and difficulty developing a positive sexual identity) was significant. Additionally, the indirect effects of discrimination on rejection-based proximal stress through sexual orientation rejection sensitivity and of sexual orientation rejection sensitivity on internalizing symptoms through rejection-based proximal stress were also significant. These findings indicate that sexual orientation rejection sensitivity plays an important role in contributing to rejection-based proximal stress and internalizing symptoms among sexual minority women.

An experimental investigation of the application of binegative stereotypes.

Binegativity (the stigmatization of bisexuality) is prevalent in the United States and has a detrimental impact on bisexual individuals’ sexual identity and mental health. However, little research has experimentally examined binegative stereotyping or how stereotypes influence assumptions about bisexual individuals. The current experimental study examined the application of binegative stereotypes to hypothetical individuals who varied in gender and sexual orientation among 3 samples: a heterosexual undergraduate sample (HUS), a lesbian and gay community sample (LGCS), and a heterosexual community sample (HCS; ns = 772, 500, and 546, respectively). Results indicated that hypothetical bisexual individuals were rated as more likely to be in noncommitted or nonmonogamous relationships in the future and to change their sexual orientation identity than heterosexual and lesbian and gay targets. Results also indicated that the participants’ endorsement of stereotypes about the promiscuity of bisexual individuals and the bisexual target’s involvement in a current same-sex or different-sex relationship predicted the participant’s expectations regarding the bisexual target’s future involvement in a committed or noncommitted, same-sex or different-sex relationship. These expectations about the bisexual target’s future relationship type, combined with the participant’s endorsement of stereotypes about the instability of bisexuality predicted the participants’ expectations about the bisexual target’s future sexual orientation identity. Implications of these finding are discussed.