Jae A. Puckett

The Effects of Cumulative Victimization on Mental Health Among Lesbian, Gay, Bisexual, and Transgender Adolescents and Young Adults

OBJECTIVES To examine the effects of the cumulative victimization experienced by lesbian, gay, bisexual, and transgender youths on mental disorders. METHODS We recruited 248 participants from the Chicago, Illinois, area in 7 waves of data collected over 4 years, beginning in 2007 (83.1% retention rate). Mean age at enrollment was 18.7 years, and 54.7% were Black. We measured depression and posttraumatic stress disorder using structured psychiatric interviews. RESULTS Latent class analyses of victimization over time identified a 4-class solution. Class 1 (65.4%) had low, decreasing victimization. Class 2 (10.3%) had moderate, increasing victimization. Class 3 (5.1%) had high, steady victimization. Class 4 (19.2%) had high, decreasing victimization. Controlling for baseline diagnoses and birth sex, lesbian, gay, bisexual, and transgender youths in classes 2 and 3 were at higher risk for depression than were those in class 1; youths in classes 2, 3, and 4 were at elevated risk for posttraumatic stress disorder. CONCLUSIONS Lesbian, gay, bisexual, and transgender youths with steadily high or increasing levels of victimization from adolescence to early adulthood are at higher risk for depression and posttraumatic stress disorder.

Internalized transphobia: Exploring perceptions of social messages in transgender and gender-nonconforming adults

ABSTRACT Background: Transgender and gender nonconforming (TGNC) individuals encounter a variety of minority stressors that have yet to be fully articulated or explored within the research literature. The purpose of this study is to better understand internalized stigma—the experience of accepting and internalizing negative social messages and experiences about ones identity—an underexplored minority stressor for TGNC people. Method: We conducted in-depth interviews with 30 diverse TGNC participants using consensual qualitative research (CQR) methodology. Results: Following data saturation and analysis, six distinct themes emerged across participants: (1) TGNC identities are regarded negatively by society; (2) social messages are perceived as originating from the media and religious ideology; (3) TGNC individuals report emotional distress; (4) negative self-perceptions in response to social messages; (5) TGNC individuals report resilience processes in response to negative social messages; and (6) social messages are perceived generally to differentially impact TGNC people of color. Conclusion: Findings highlight the common experience of encountering social marginalization for TGNC individuals. Structural interventions that target pervasive sociocultural messages regarding TGNC identities are warranted.

How therapist self-disclosure relates to alliance and outcomes: A naturalistic study

This study examined therapists’ self-disclosure within early sessions of a naturalistic database of 52 therapy dyads collected at a university counseling center. Therapist orientations and client issues varied. We identified both types and functions of therapist self-disclosure in order to explore how self-disclosures related to therapy alliance and outcomes. Findings indicated that the number of disclosures was not significantly correlated with outcome or alliance scores. Central findings regarding the function of self-disclosures included that disclosures that acted to humanize the therapist were associated with fewer clinical symptoms post-session than disclosures expressing appreciation or encouragement. Also, disclosures that conveyed similarity between the therapist and client were associated with fewer post-session clinical symptoms and interpersonal problems when compared to disclosures that conveyed neither similarity nor dissimilarity. As well, neutral therapist self-disclosures were associated with better client functioning than disclosures that relayed negative or positive information about the therapist. Suggestions are provided for clinical practice and future research.

Trajectories of Internalized Heterosexism among Young Men Who have Sex with Men

Minority stress, or the unique stressors encountered by sexual minorities, has a significant impact on the mental health and well-being of this population. One minority stressor, internalized heterosexism, refers to incorporating stigma against sexual minorities into one’s self-concept as a product of social bias. This minority stressor has been consistently related to worse mental health in sexual minorities. We evaluated experiences of internalized heterosexism longitudinally, over 24 months, in a sample of 450 young men who have sex with men (YMSM; age range = 16–20 years old at baseline). Latent class growth analyses revealed three classes: individuals with low-decreasing internalized heterosexism (57.1%), medium-stable internalized heterosexism (37.3%), and high-stable internalized heterosexism (5.6%). Multinomial logistic regression analyses revealed that some racial/ethnic minorities, non-gay identified individuals (i.e., bisexual/other), and individuals with less femininity and greater masculinity were significantly more likely to be in the medium- and high-stable internalized heterosexism classes. Higher victimization, as well as lower gay/bisexual community involvement, peer support, and outness predicted membership in the medium-stable internalized heterosexism class (relative to the low-decreasing class). Further, higher past 6-month victimization and lower outness were also predictive of high-stable internalized heterosexism class membership (relative to the low-decreasing class). These findings reveal that there is not a single trajectory of internalized heterosexism—the degree to which it changes differs across men and depends on demographic characteristics and interpersonal experiences. Furthermore, the results indicate interpersonal targets for future work aimed at promoting positive identity development and decreased internalized heterosexism for sexual minority youth.

Internalized Homophobia and Perceived Stigma: a Validation Study of Stigma Measures in a Sample of Young Men who Have Sex with Men

Young men who have sex with men (YMSM) experience minority stressors that impact their mental health, substance use, and sexual risk behaviors. Internalized homophobia (IH) and perceived stigma represent two of these minority stressors, and there has been limited research empirically validating measures of these constructs. We validated measures of IH and perceived stigma with a sample of 450 YMSM (mean age = 18.9) and a sample of 370 YMSM (mean age = 22.9). Results from exploratory and confirmatory factor analyses supported modifications to the IH and perceived stigma scales, ultimately revealing a three factor and one factor structure, respectively. Convergent and discriminant validity were examined utilizing correlations between IH, perceived stigma, and other variables related to minority stress (e.g., victimization). We evaluated predictive validity by examining relations with mental health, substance use, and risky sexual behaviors measured 12-months from baseline. There were mixed findings for IH, with subscales varying in their relations to mental health, drinking, and sexual risk variables. Perceived stigma was not related to mental health or substance use, but was associated with greater prevalence of STIs. Findings supported the use of these modified scales with YMSM and highlight the need for further measurement studies.

Differences Across Contexts: Minority Stress and Interpersonal Relationships for Lesbian, Gay, and Bisexual Women

Minority stressors encountered by lesbian, gay, and bisexual (LGB) women are inherently connected to contextual experiences. Although there is a growing body of research on the benefits of gaining political rights and the costs of their denial, little research has focused on the effects of access to LGB-affirmative resources. In the current study with 1,017 women in same-sex relationships, we created profiles using latent class analysis to characterize the contexts in which participants were raised and the contexts in which they lived at the time of the study. We examined differences in interpersonal relationships, internalized heterosexism (IH), and outness across these profiles. Class 1 (28%) included participants who always lived in affirmative contexts with LGB-supportive resources. Class 2 participants (28%) always lived in more heterosexist contexts with few resources. Class 3 participants (44%) originally lived in more heterosexist contexts with few resources but shifted to more affirmative contexts. Class 3 individuals had greater social support and lower IH than Class 2 participants. Classes 1 and 3 had greater outness than Class 2. This study provides evidence linking IH to the lack of contextual supports. Our data also suggest that the quality of relationships for LGB women may remain strong even in heterosexist contexts. Actions that increase affirming resources will provide avenues for more positive identity development and interpersonal relationships for LGB individuals. Online slides for instructors who want to use this article for teaching are available on PWQs website at http://journals.sagepub.com/page/pwq/suppl/index .

Predictors of sexual minority youth's reported suicide attempts and mental health

ABSTRACT Lesbian, gay, and bisexual youth (LGBY) report higher rates of mental health concerns compared to heterosexual youth due to minority stressors. This study examined the interpersonal and intrapersonal variables that predict psychological distress and self-reported suicide attempts in a sample of 61 LGBY in the Mid-South, which is a highly overlooked regional area for LGBY research. Youth who lost friends when coming out were 29 times more likely to report suicide attempts, and those who experienced psychological maltreatment from caregivers were 9.5 times more likely to report a suicide attempt. Internalized heterosexism, feelings of guilt or shame, and psychological maltreatment from caregivers were significant predictors of depression and anxiety symptoms. This study highlights the importance of creating affirming spaces for LGBY, particularly in areas of the country that experience greater political oppression of sexual minorities, such as the Mid-South.

Identity concealment in transgender adults: A qualitative assessment of minority stress and gender affirmation.

Minority individuals might conceal their identity in social contexts in an effort to avoid stigma and victimization. Unfortunately, identity concealment is thought to impact psychological distress in transgender and gender nonconforming (TGNC) individuals. Thus, through 30 in-depth interviews, we sought to understand if and how identity concealment was experienced by TGNC individuals. Findings indicated that (a) TGNC identity concealment is a source of stress, (b) individuals might conceal their TGNC identity based on social context, (c) concealment of assigned sex and gender history can function to affirm one’s true gender identity, and (d) concealment of gender history is a rejection of one’s assigned sex. In addition, (a) passing/blending is an important interpersonal and intrapersonal process, (b) the importance of passing/blending can change over time, and (c) not passing/blending may result in worrying about personal safety. The authors discuss how concealment can both inhibit and promote psychological health for TGNC individuals, and they offer clinical applications for health providers.

Sexuality and gender affirmation in transgender men who have sex with cisgender men

ABSTRACT Background: Transgender men who have sex with men (trans MSM) are underrepresented in the behavioral and social sciences literature, especially in research concerning sexual health. The available literature indicates that, in relation to gender affirmation (sometimes called “transition”), some trans men may experience shifts in their sexual attractions and the identity labels that they use to describe their sexual orientation. Most commonly, this shift entails increased attraction to cisgender men. Aims: The purpose of this qualitative analysis was to investigate positive and negative aspects of sexuality and sexual behavior relevant for trans MSM who have affirmed their gender. Methods: We conducted individual interviews with 16 trans MSM (M age = 32.5, SD = 11.1) who were recruited via venue-based recruitment and chain referral/snowball sampling methods. Interviews were transcribed verbatim and analyzed using a rigorous team-based approach to grounded theory. Results: The four theoretical constructs that emerged included: (1) harmful social influences; (2) support and validation of a trans masculine identity; (3) sexual exploration and self-acceptance; and (4) internalized oppression. Overall, these themes described complex experiences of trans MSM managing oppression, both external and internalized, at the intersection of gender and sexuality. Discussion: Affirming ones identity within a social context that marginalizes trans men and sexual minorities and promotes adherence to strict gender norms has important implications for the sexuality of trans men. In part, gender affirmation created an increased confidence and openness to exploring sexual interests for participants. Furthermore, trans MSMs identities and gender can be affirmed through sexual relationships with cisgender MSM. Greater understanding of gender affirmation and sexuality for trans MSM can inform healthcare recommendations for working with trans MSM, including healthcare policies and practices in sexual health.

An Investigation of Religion and Spirituality of Sexual Minorities in the United States: Exploring Perceptions, Intrinsic Religiosity, and Outness to Religious Communities

ABSTRACT We investigated how sexual minority participants in the United States (N = 217; M age = 36.36 years) viewed organized religion and their relationships with a higher power. In addition, we examined the associations between levels of outness in religious communities, internalized heterosexism (IH), intrinsic religiosity, and depression. Open-ended responses revealed that views of organized religion fell into three categories—negative (57.9%), positive (9.1%), and ambivalent (33%)—and participants reported a variety of relationships to a higher power—existing relationship (61.5%), no relationship (19%), fractured relationship (4.6%), and some who felt unsure (10.8%). Participants with greater outness to a religious community reported less IH and higher intrinsic religiosity. Also, outness to a religious community moderated the association between IH and depression, such that there was not a significant association between IH and depression for individuals with low levels of outness. However, at average to high levels of outness, there was a significant association between IH and depression.