Dr Mohamed Zaki

Head of research

Minority stress is probably the least well known of Helsa’s wellbeing dimensions, but it is the only dimension that is unique to the LGBTQ+ community. The minority stress framework evolved out of a need to better understand and explain the health disparities between sexual minorities and their heterosexual counterparts.

Following on from social stress paradigms, the minority stress framework explains these disparities by pointing to the excessive levels of social stress that sexual minority groups are subjected to due to their stigmatization by wider society. It also posits that sexual minorities have more limited or reduced access to common stress-ameliorating resources that could potentially counteract the effects of heighted and cumulative levels of stress specific to their sexual or gender identities. These two factors create a perfect storm that can account for the higher rates of health problems typically found among LGBTQ+ people.

What’s crucial to remember here is that these issues are not the result of some inherent factor specific to LGBTQ+ people but the result of external stressors that, over time, place undue burdens on members of our community. LGBTQ+ people are not naturally predisposed to higher levels of health and mental health issues but are placed under tremendous stress factors, such as stigma, discrimination and prejudice, due to their sexual and/or gender minority status, that put them at risk for poorer health outcomes, relative to the heterosexual/cisgender population who are not exposed to these stressors.

There are five stressors that are specific to sexual minorities and that make up the minority stress framework:

• Prejudice events

• Everyday and chronic discrimination (microaggressions)

• Concealment of identity

• Internalized stigma

• Expectations of rejection
  

Prejudice events

These are one-off experiences of overt discrimination that typically happen within interpersonal interactions. These interactions can be with colleagues, family members, or strangers out in public, and may sometimes be illegal depending on the social context. For example, physically assaulting someone because they of their sexual or gender identity is illegal in contexts where physical assault is illegal and may be considered a hate or bias crime where such laws exist.

Unlike prejudice events experienced by racial and ethnic minorities, prejudice events experienced by sexual minorities can occur at home and may be perpetrated by family members. For example, sexual minority youth are often forced to leave their homes and may face becoming homeless due to family rejection of their sexual identity.

These events are known to have a drastic and severe impact on LGBTQ+ people’s mental and emotional health and wellbeing, above and beyond the impact of general life events that are not caused by, or involve, prejudice.

Everyday and chronic discrimination (microaggressions)

Everyday forms of discrimination are low-grade, common and largely unobtrusive forms of harassment and discrimination that, while covert, nevertheless communicate prejudice and disrespect towards and rejection of members of sexual minorities.

This type of minority stress includes microaggressions and everyday insults, such as being ignored, stared at, or being treated with disgust and fear. Although these more subtle forms of discrimination are less severe than prejudice events, everyday discrimination experiences are often chronic and can accumulate over time. Incidents such as these may be perceived as momentary, low-impact events, but they can erode LGBTQ+ people’s sense of self-worth over time, negatively impacting their mental health and wellbeing.

Concealment of identity

Many LGBTQ+ people feel the need to conceal their sexual or gender identities to some degree, at one point or another or in certain contexts and settings. While LGBTQ+ people usually use this type of concealment to protect themselves against prejudice and discrimination, it often acts as a double-edged sword, taking a toll on their mental and emotional wellbeing. This type of concealment can shield LGBTQ+ persons from overt or violent forms or discrimination and oppression but it nevertheless requires a significant mental and emotional effort thereby placing a huge burden on the person in question.

Internalized stigma

Internalized stigma refers to situations where LGBTQ+ persons have internalized wider society’s negative, disparaging and degrading views of themselves. In some of its most dangerous forms, internalized stigma can lead to the condemnation of a person’s own sexual identity. Wrestling with forms of internalized stigma can be an extremely painful and damaging process for a person’s psyche and often involves some dissonance between a person’s sexual desires and how they feel they ‘ought’ to behave to conform of society’s heteronormative standards. Overcoming internalized stigma is essential to achieving and sustaining a healthy and positive self-image which is vital for any person’s mental and emotional health.

Expectations of rejection

Members of sexual minorities may sometimes approach certain situations or social interactions anticipating negative treatment. These expectations may be the result of previous negative experiences or an awareness of wider, negative stereotypes of or prejudices against LGBTQ+ people. While people’s expectations may not come to pass during the actual interactions, the fact that this type of preparedness exists constitutes minority stress since it places undue mental and emotional burdens on members of sexual minorities.

Who is vulnerable?

Minority stress affects almost all members of LGBTQ+ communities around the world, albeit to varying degrees, depending on their personal circumstances and cultural and social contexts. While many societies have made and are continuing to make progress towards eradicating forms of prejudice and discrimination against sexual minorities, there’s still quite a way to go. Moreover, heteronormative ideals and ideas are so hardwired into the cultural and social fabrics of so many communities around the world, including some of the most sexually progressive ones, that LGBTQ+ people have to remain vigilant about if, how and when those may be impacting their mental and emotional health.

The next steps?

As we started off by saying, minority stress may be the least well known of Helsa’s wellbeing dimensions but, if you’re a member of the LGBTQ+ community, it could be vital for you to understand it better and carefully examine if and how it may be affecting you.

The increased visibility and understanding of common mental health issues, such as depression and anxiety, have led to people being more able to recognize their possible impacts on their lives and to act accordingly, seeking professional support whenever necessary. We’re hoping that increased awareness of minority stress among LGBTQ+ people can allow those who are struggling with aspects of it to better understand it and to address it effectively.