Ilan H. Meyer

Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence.

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

Minority Stress and Mental Health in Gay Men

This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay mens direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.

Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns

Laura Dean, MEd,1 Ilan H. Meyer, PhD,1 Kevin Robinson, MHA, MSW,1 Randall L. Sell, ScD,1 Robert Sember, PhD,1 Vincent M.B. Silenzio, MPH, MD,1 Deborah J. Bowen, PhD,2 Judith Bradford, PhD,2 Esther Rothblum, PhD,2 Scout, MA,2 Jocelyn White, MD,2 Patricia Dunn, MSW, JD,3 Anne Lawrence, M.D., Ph.D.(c),4 Daniel Wolfe,1 Jessica Xavier,5 and With acknowledgment to Darren Carter, MD, Jennifer Pittman, and Ronald Tierney

Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources?

Despite its centrality to social stress theory, research on the social patterning of stress exposure and coping resources has been sparse and existing research shows conflicting results. We interviewed 396 gay, lesbian and bisexual, and 128 heterosexual people in New York City to examine variability in exposure to stress related to sexual orientation, gender, and race/ethnicity. Multiple linear regressions showed clear support for the social stress hypothesis with regard to race/ethnic minority status, somewhat mixed support with regard to sexual orientation, and no support with regard to gender. We discuss this lack of parsimony in social stress explanations for health disparities.

The Trouble With “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse

Men who have sex with men (MSM) and women who have sex with women (WSW) are purportedly neutral terms commonly used in public health discourse. However, they are problematic because they obscure social dimensions of sexuality; undermine the self-labeling of lesbian, gay, and bisexual people; and do not sufficiently describe variations in sexual behavior.MSM and WSW often imply a lack of lesbian or gay identity and an absence of community, networks, and relationships in which same-gender pairings mean more than merely sexual behavior. Overuse of the terms MSM and WSW adds to a history of scientific labeling of sexual minorities that reflects, and inadvertently advances, heterosexist notions. Public health professionals should adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups.

Prejudice as Stress: Conceptual and Measurement Problems

In the field of social sciences, there has been a renewed interest in studying prejudice and discrimination as stressors and assessing their impact on various health outcomes. This raises a need for theoretically based and psychometrically sound measures of prejudice. As researchers approach this task, there are several conceptual issues that need to be addressed. The author describes 3 such issues related to (1) individual versus structural measures of the impact of prejudice, (2) objective versus subjective assessments of stress, and (3) measures of major events versus everyday discrimination. How researchers approach the problem of measurement depends on the specific study aims, but they must consider these conceptual issues and understand the advantages and limitations of various approaches to the study of prejudice as stress.

Social and psychological well-being in lesbians, gay men, and bisexuals: the effects of race, gender, age, and sexual identity.

Using a social stress perspective, the authors studied the mental health effects of added burden related to socially disadvantaged status (being African American or Latino, female, young, and identifying as bisexual vs. gay or lesbian) in a community sample of 396 self-identified lesbian, gay, and bisexual (LGB) adults. Mental health outcomes were social and psychological well-being contrasted with depressive symptoms. When mental health deficiencies by disadvantaged social status were detected, the authors examined whether LGB community connectedness and positive sexual identity valence played a mediating role, reducing the social status disparity in outcome. The authors found different patterns when looking at social versus psychological well-being and positive versus negative mental health outcomes. Bisexuality and young age, but not gender and racial/ethnic minority status, were associated with decreased social well-being. In bisexuals, this relationship was mediated by community connectedness and sexual identity valence. Although no differences in social or psychological well-being were found by gender, female gender was associated with depressed mood. The authors conclude that there is limited support for an additive stress model.

Stigma, prejudice, discrimination and health

There is a great urgency to understand more fully the linkages between stigma, prejudice, discrimination and health to aide in the development of effective public health strategies. A goal of the US Healthy People 2010 programme is to eliminate health disparities among different segments of the population (DHHS, 2002). Prejudice and discrimination are believed to be important contributors to the production of health disparities (IOM, 2002). It is difficult to pick up a consensus report on mental illness or HIV/AIDS without finding numerous references to the ways the stigmatization of these health conditions undercuts prevention and treatment efforts (DHHS, 2003; USAID, 2000). For this reason, in September 2006, the Health & Society Scholars Working Group on Stigma, Prejudice, Discrimination and Health convened scholars across the social and health sciences who study the social and psychological processes of stigmatization and prejudice. The objective of this conference was to strengthen collaboration across disciplines, discuss challenging conceptual issues, and identify the most pressing research objectives facing this relatively new line of inquiry. Driving discussions was the budding idea for a Special Issue that would attempt to bridge disparate research traditions in stigma, on the one hand, and in prejudice and discrimination on the other. As editors of the Special Issue, we believe the importance of this endeavor lies in missed opportunities for conceptual coherence and for capitalizing on insights generated from each research tradition and possibly, to an underestimation of the impact of stigma and prejudice on health. Several exciting manuscripts emerged from the conference making up the content of this Special Issue. The Special Issue breaks from existing volumes in fundamental ways. To date, manuscript collections on stigma and those on prejudice and discrimination are organized around a single disciplinary perspective and focus on either stigma or prejudice but never both. Authors included in the Special Issue write from diverse disciplinary perspectives and represent a starting point of cooperation among scholars interested in these two traditions. The articles develop conceptual and empirical research linking stigma and prejudice; identify under-recognized cultural and policy dynamics that contribute to the formation of stigma and prejudice and may mediate their health impacts; describe pathways through which stigma and prejudice affect health outcomes; and explore the implications of these themes for public health practice. In this commentary, we explain why these themes are important and introduce articles in the Special Issue.

Lifetime Prevalence of Mental Disorders and Suicide Attempts in Diverse Lesbian, Gay, and Bisexual Populations

Past studies have reported little about variability in mental disorders among lesbians, gay men, and bisexual individuals. We assessed the prevalence of psychiatric disorders in 388 lesbian, gay, and bisexual Black, Latino, and White individuals. Black lesbians, gay men, and bisexual individuals had lower prevalence of all disorders than did Latino and White individuals; younger cohorts had fewer mood disorders than did older cohorts; bisexual persons had more substance use disorders than did gay men and lesbians; and Latino respondents attempted suicide more often than did White respondents.

Prejudice and Discrimination as Social Stressors

Lesbians, gay men, and bisexuals (LGBs) vary in sociodemographic characteristics such as cultural, ethnic or racial identity, age, education, income, and place of residence as well as in the degree to which their LGB identities are central to their self-definition, their level of affiliation with other LGB people, and their rejection or acceptance of societal stereotypes about and prejudice against homosexuality. In that diversity, it is difficult to describe many common themes. Despite the many differences that separate them, LGB people share remarkably similar experiences related to prejudice, stigma, discrimination, rejection, and violence directed toward them across cultures and locales (Espin, 1993; Fullilove & Fullilove, 1999; Herek, 2000; Diaz et al., 2001). Even after a historic U.S. Supreme Court ruling that the criminalization of homosexuality is unconstitutional, gay men and lesbians continue to be subjected to legal discrimination in housing, employment, and basic civil rights—most prominent in recent years are discrimination related to family law, including marriage and adoption.