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. The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating— even equating— claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental

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

This chapter addresses the psychological effects of social stigma. Stigma directly affects the stigmatized via mechanisms of discrimination, expectancy confirmation, and automatic stereotype activation, and indirectly via threats to personal and social identity. We review and organize recent theory and empirical research within an identity threat model of stigma. This model posits that situational cues, collective representations of one's stigma status, and personal beliefs and motives shape appraisals of the significance of stigma-relevant situations for well-being. Identity threat results when stigma-relevant stressors are appraised as potentially harmful to one's social identity and as exceeding one's coping resources. Identity threat creates involuntary stress responses and motivates attempts at threat reduction through coping strategies. Stress responses and coping efforts affect important outcomes such as self-esteem, academic achievement, and health. Identity threat perspectives help to explain the...

https://courses.washington.edu/pbafhall/514/514%20Readings/majorandobrien.pdf

The social psychology of stigma.

“WHAT can men do, what do they do, and what do they want to do ?”—these are the uestions that Prof. Thorndike seeks to answer in a very comprehensive and elaborate treatise. His undertaking is inspired by the belief that man has the possibility of almost complete control of his fate if only he will be guided by science, and that his failures are attributable to ignorance or folly. The main approach is through biological psychology, but all the social sciences are appealed to and utilized in an effort to deal with the human problem as a whole. The relative immaturity of the sciences dealing with man is continually stressed, but it is claimed that they provide a body of facts and principles which are “far above zero knowledge”, and that even now they are capable of affording valuable guidance in the shaping of public policy. Human Nature and the Social Order By E. L. Thorndike. Pp. xx + 1020. (New York: The Macmillan Company, 1940.) 18s. net.

Human Nature and the Social Order

The authors offer a framework for conceptualizing collective identity that aims to clarify and make distinctions among dimensions of identification that have not always been clearly articulated. Elements of collective identification included in this framework are self-categorization, evaluation, importance, attachment and sense of interdependence, social embeddedness, behavioral involvement, and content and meaning. For each element, the authors take note of different labels that have been used to identify what appear to be conceptually equivalent constructs, provide examples of studies that illustrate the concept, and suggest measurement approaches. Further, they discuss the potential links between elements and outcomes and how context moderates these relationships. The authors illustrate the utility of the multidimensional organizing framework by analyzing the different configuration of elements in 4 major theories of identification.

An organizing framework for collective identity: Articulation and significance of multidimensionality

This paper reviews 138 empirical quantitative population-based studies of self-reported racism and health. These studies show an association between self-reported racism and ill health for oppressed racial groups after adjustment for a range of confounders. The strongest and most consistent findings are for negative mental health outcomes and health-related behaviours, with weaker associations existing for positive mental health outcomes, self-assessed health status, and physical health outcomes. Most studies in this emerging field have been published in the past 5 years and have been limited by a dearth of cohort studies, a lack of psychometrically validated exposure instruments, poor conceptualization and definition of racism, conflation of racism with stress, and debate about the aetiologically relevant period for self-reported racism. Future research should examine the psychometric validity of racism instruments and include these instruments, along with objectively measured health outcomes, in existing large-scale survey vehicles as well as longitudinal studies and studies involving children. There is also a need to gain a better understanding of the perception, attribution, and reporting of racism, to investigate the pathways via which self-reported racism affects health, the interplay between mental and physical health outcomes, and exposure to intra-racial, internalized, and systemic racism. Ensuring the quality of studies in this field will allow future research to reveal the complex role that racism plays as a determinant of population health.

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A systematic review of empirical research on self-reported racism and health

This study introduces new measures of ethnicity-related stress and a newly adapted measure of ethnic identity. Ethnicity-related stressors assessed in this study were perceived discrimination, stereotype confirmation concern, and own-group conformity pressure. Ethnic identity refers to the subjective sense of ethnic group membership and, following Luhtanen and Crocker (1992), was assessed as public regard, identity centrality, and private feelings. Data for 333 undergraduates from diverse ethnic groups indicated that the measures are psychometrically sound. Ethnic group differences for mean scores demonstrated the measures’ known-groups validity. Cross-sectional analyses indicated that ethnicity-related stress and identity constructs captured by the instruments are related to measures of psychological and physical well-being. The new measures may be useful in the investigation of psychological aspects of ethnicity and their adaptive consequences.

Measures of Ethnicity-Related Stress: Psychometric Properties, Ethnic Group Differences, and Associations With Well-Being1

This article reports a prospective study of religiousness and recovery from heart surgery. Religiousness and other psychosocial factors were assessed in 142 patients about a week prior to surgery. Those with stronger religious beliefs subsequently had fewer complications and shorter hospital stays, the former effect mediating the latter. Attendance at religious services was unrelated to complications but predicted longer hospitalizations. Prayer was not related to recovery. Depressive symptoms were associated with longer hospital stays. Dispositional optimism, trait hostility, and social support were unrelated to outcomes. Effects of religious beliefs and attendance were stronger among women than men and were independent of biomedical and other psychosocial predictors. These findings encourage further examination of differential health effects of the various elements of religiousness.

Psychosocial Factors in Outcomes of Heart Surgery: The Impact of Religious Involvement and Depressive Symptoms.

Early research on ethnicity focused on the stereotyped thinking, prejudiced attitudes, and discriminatory actions of Euro-Americans. Minority-group members were viewed largely as passive targets of these negative reactions, with low self-esteem studied as the main psychological outcome. By contrast, recent research has increasingly made explicit use of stress theory in emphasizing the perspectives and experiences of minority-group members. Several ethnicity-related stressors have been identified, and it has been found that individuals cope with these threats in an active, purposeful manner. In this article, we focus on ethnicity-related stress stemming from discrimination, from stereotypes, and from conformity pressure arising from one's own ethnic group. We discuss theory and review research in which examination of ethnicity-related outcomes has extended beyond self-esteem to include psychological and physical well-being.

/pdf/ethnicity-related-sources-of-stress-and-their-effects-on-1nxfy0iqbq.pdf

Ethnicity-Related Sources of Stress and Their Effects on Well-Being

Objectives: The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery Methods: Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors Results: Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery A similar effect on psychosocial functioning fell short of significance An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores Conclusions: Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery

Tanya M. Goyal

Papers

Measures of Ethnicity-Related Stress: Psychometric Properties, Ethnic Group Differences, and Associations With Well-Being1

Psychosocial Factors in Outcomes of Heart Surgery: The Impact of Religious Involvement and Depressive Symptoms.

Ethnicity-Related Sources of Stress and Their Effects on Well-Being

Quality of Life Following Cardiac Surgery: Impact of the Severity and Course of Depressive Symptoms

Individual Differences, Health and Illness: The Role of Emotional Traits and Generalized Expectancies