Stigma, Mental Health, and Dyadic Coping for Sexual Minority Persons in the United States

Abstract

There is increasing evidence that sexual minority individuals experience high levels of stigma associated with their sexuality, and this stigma is detrimental to the health of sexual and gender minority persons. However, the majority of this research has involved indivudals in urban settings. The overall aim of this work is to examine these knowledge gaps for these dyads and rural individuals, understudied subpopulations about whom there has been a paucity of research. This dissertation included three separate but highly related studies, each with its own specific aim. The first study examined the association between self-reported sexuality-based stigma and self-reported depression among a nationally representative online sample of 771 rural sexual minority persons. Using multiple and binary regression modeling, significant associations were demonstrated between three types of stigma (internalized, enacted, and anticipated) and clinically significant depression for this population. The second study used a multilevel modeling technique known as actor partner interdependence modeling (APIM) to examine aspects of dyadic functioning that contribute to the maintenance of health behaviors that prevent new HIV infection. Among a sample of 270 partnerships, hypothesized associations between stigma and adverse outcomes were not demonstrated. However, relationship satisfaction was significantly associated with three communal coping outcome scales (planning and decision-making, communication, and joint effort) as antecedents to the maintenance of health-enhancing behaviors. The third study also involved male couples, but utilized qualitative thematic analysis to explore how individuals in 30 same-sex male partnerships describe their experiences of coping with sexuality-based stigma, as well as the meaning they ascribe to those experiences. This was accomplished by analyzing transcribed interviews of male couples discussing stigmatizing events during their relationships and coping strategies used to manage those events. Results from this study indicated same-sex male couples utilize a number of both adapative and maladaptive coping mechanisms, though adaptive strategies were more commonly reported. Couples placed particular emphasis on the importance of social support, as well as specific stigma management strategies such as avoidance, concealment, anticipating stigma, and purposefully living as openly gay men. Results indicated the need to tailor existing theory to address this population.

Despite recent gains made in human rights and social justice for sexual minority persons, what has already been done is not enough. LGBT persons still endure an unfair distribution of decreased benefits and increased burdens in both healthcare and research. This dissertation work aims to establish equity for this disadvantaged population by increasing their representation in research. These results address gaps in knowledge and inform recommendations for future research, interventions, laws, policies, and clinical practice to address these health disparities and protect the health of this vulnerable population. Future research and interventions that are evidence-based, theoretically driven, and formed with the help of the community they serve will have the greatest capacity for improving the health of LGBT persons, both for individuals and for couples. National policy changes must be made to prohibit stigma and discrimination in all domains that might impact social determinants of health, including housing, employment, and healthcare to create comprehensive protections. With changes made informed by this research, the social benefit of this work lies in potential disparity reduction, establishing equity for this disadvantaged population.