Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications

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Key points

  • Stigma occurs at multiple levels to affect the health of lesbian, gay, bisexual, and transgender (LGBT) youth, including structural, interpersonal, and individual levels.

  • Stigma disrupts cognitive (eg, vigilance), affective (eg, rumination), interpersonal (eg, isolation), and physiologic (eg, stress reactivity) processes that influence the health of LGBT youth.

  • These stigma-inducing mechanisms can be targeted with both clinical and public health interventions to reduce LGBT health disparities

Theories of stigma and minority stress

Link and Phelan2 (2001) put forward a widely used conceptualization of stigma that recognized the overlap in meaning among concepts like stigma, labeling, stereotyping, and discrimination. Their conceptualization defines stigma as the co-occurrence of several interrelated components:

In the first component, people distinguish and label human differences. In the second, dominant cultural beliefs link labeled persons to undesirable characteristics – to negative stereotypes. In the third, labeled

Stigma and minority stress as risk indicators for adverse health outcomes among lesbian, gay, bisexual, and transgender youth

It has long been recognized that stigma and minority stress exist at individual, interpersonal, and structural levels (Fig. 1). In the following section, we selectively review research evidence bearing on the health consequences of stigma across these levels for LGBT youth.

Stigma-inducing mechanisms

Thus far, we have discussed research establishing that stigma and minority stress confer risk for a variety of adverse health outcomes among LGBT youth. An obvious question arises: How is it that stigma and minority stress “get under the skin” to contribute to poor health? The identification of mechanisms linking stigma to health is important because it points to potential targets for both clinical and public health interventions aimed at reducing LGBT health disparities. In this section, we

Interventions to reduce stigma and improve health among lesbian, gay, bisexual, and transgender youth

Given mounting evidence of the adverse impact of stigma on LGBT health, researchers have begun to develop and test the efficacy of interventions aimed at reducing stigma’s health impacts among this population. A recent systematic review identified 43 interventions that either aim to eradicate sexual minority stigma or support sexual minority individuals’ abilities to cope with stigma.59 The majority of these studies were conducted in the past 5 years, suggesting a rapidly increasing momentum to

Future directions

We highlight 3 key areas for future research. First, research on the stigma–health association, and particularly on mechanisms explaining this association, among transgender youth is lacking relative to research among LGB youth. Given the unique risk and protective factors across these 2 populations, more research is needed to understand whether and how stigma and minority stress may operate differentially among transgender youth compared with LGB youth.

Second, there are several important

Summary

Stigma occurs at multiple levels—including individual (eg, concealment), interpersonal (eg, victimization), and structural (eg, laws and policies)—to affect the health of LGBT youth. Stigma at each of these levels disrupts several cognitive (eg, vigilance), affective (eg, rumination), interpersonal (eg, social isolation), and physiologic (eg, stress reactivity) processes that in turn influence health. Several of these stigma-inducing mechanisms can be targeted in both clinical and public health

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    Disclosure Statement: The authors have nothing to disclose. This article was funded, in part, by a Mentored Research Scientist Development Award to M.L. Hatzenbuehler (DA032558).

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