By Elli Fowler • 8th June 2022
Photo by Martinedoucet
Mental Health Research Analyst
In the first article in this series, we explored the founding concepts of the minority stress model, including its original purpose to account for health disparities, both physical and mental, between the homosexual and heterosexual communities. From its original conception, the model has progressed, first to encompass gender minorities, and now is being used to explore the experiences of other groups of minorities. In this article I will explore its application for understanding stress in racial minorities, including EU migrants in a post-Brexit world, and possible future directions in the neurodivergent and disabled communities, as they become increasingly recognised as social minorities. Each of the groups discussed possess well documented disparities in both physical and mental health as compared to majority groups, and thus the minority stress framework may allow us greater insight into the mechanisms and root causes of such issues.
One of the most prominent applications of the minority stress framework outside of its origin is within the field of exploring the impacts of racism on the lives of racial minorities. Different forms of racism, from overt hate crime to microaggressions equate in nature to the stressors proposed within the minority stress framework, with the exception in many cases of concealment of identity, as in the case of race, this can be difficult to conceal. Therefore, like sexual minority individuals, racial minority individuals will face objective acts of prejudice, will anticipate these events, and may struggle with the internalisation of racist attitudes within society. A meta-analysis of this type of research carried out in the time period from 1983-2003 demonstrated that racism is consistently associated with poorer mental health, including depression, anxiety and psychological stress as well as poorer physical health (Paradies et al, 2015).
It also revealed that the stress induced by racism can act to impact health via a number of different mechanisms. Firstly, there are several direct paths by which this can occur, an example of which is adverse impacts to an individual’s cognitive processes and resulting psychopathology (active mental health issues), or even more simply, physical injury as a result of racial violence. However, as discussed in the case of sexual minority individuals, there are a number of indirect routes by which minority stress can translate into adverse health consequences. Institutional racism may lead to reduced access to employment, housing and healthcare, each of which has the potential to directly impact both physical and mental health outcomes (Paradies et al, 2015). Racial minority stress can also result in decreased participation in healthy behaviours, such as healthy eating or exercise, or conversely can promote increased participation in risky behaviours such as substance use. One study that explored risky drinking behaviour in African American college students in the USA found that both acculturative stress and race related stress contributed to risky alcohol use, which included both regular drinking to excess and using alcohol as a mechanism of coping with stress (Pittman et al, 2017).
The occurrence of acculturative stress is a key example of how the stress experienced by minorities can often be far more nuanced than as displayed in the media. Acculturation “comprehends those phenomena which result when groups of individuals having different cultures come into continuous firsthand contact, with subsequent changes in the original culture patterns of either or both groups”. (Pittman et al, 2017). It has been hypothesised that for many racial minorities living in America, they are faced with continual psychological negotiation between their culture and the culture of white America. This is highly psychologically taxing and thus contributes to chronic stress which occurs alongside overt, acute forms of racial stress.
Like sexual minority individuals, racial minority individuals will face objective acts of prejudice, will anticipate these events, and may struggle with the internalisation of racist attitudes within society.
Such nuance is also represented in studies such as (Mereish et al, 2021) which explored how microaggressions serve to generate minority stress. Though the majority of research has focused on overt stressors such as outright racism or violent discrimination, it is important to consider more subtle but more frequent forms of distal minority stress. Since these occur at higher frequencies than overt forms of discrimination, it is likely that they have a unique impact on mental wellbeing. This study specifically explored how microaggressions impact the mental health of sexual and gender minority adolescents (SGMA) of colour, and not only found that more “subtle” forms of minority stress were common across all regions of the USA for SGMA of colour but that these events were directly correlated with elevated depressive symptoms even after controlling for the effects of overt, acute forms of minority stress. This illustrates how crucial it is to explore all of the various means by which stress can be inflicted upon minorities, and think beyond the most acute obvious forms of discrimination. Overall however, these studies do demonstrate how effective the minority stress framework is in allowing greater insight into the lived experiences of racial minorities, and thus potentially provide resources for interventions to combat the health consequences of minority stress.
The majority of minority stress research based on racial stress has been focused on people of colour, particularly those in America. Whilst this research is demonstrably desperately needed, it is important to consider other racial and ethnic minorities that face discrimination. This is no more pressing than in a post-Brexit United Kingdom, where hate crimes against EU migrants became increasingly reported and intolerant cultural attitudes became broadcasted across popular media platforms. One paper measuring the mental wellbeing of EU immigrants after the Brexit vote found that immigrants living in majority “leave” vote areas experienced increased levels of discrimination, and consequently had increased feelings of anxiety as measured on generalised anxiety disorder (GAD) surveys (Frost, 2020). However, whilst Brexit has undoubtedly impacted the wellbeing of EU migrants living in the UK, it is important to note that the occurrence of the Brexit vote is quite specifically associated with greater coverage and awareness of xenophobic abuse and hate crimes. It is paramount to recognise that these events were happening and impacting the lives of EU immigrants long before 2016. One study found that for Polish people living in certain areas of the UK, such as Humberside and certain boroughs of London, Brexit had changed very little, but rather anti-Polish sentiment had been apparent for decades prior, resulting in frequent events of minority stress (Rzepnikowska, 2018).
It is therefore important to not allow Brexit alone to dominate discourse surrounding minority stress in immigrant populations. Another study concerning Polish migrants found that they possess a unique set of mental health needs relating to a range of issues related to migration (Maciagowska & Hanley, 2017). Such needs were grouped into three main themes, the first of which was the negative mental health aspects of being a migrant. These included a number of factors that would absolutely be considered minority stressors, including language difficulties, discrimination and isolation, cultural barriers and stigma (akin to the forementioned acculturative stress) and financial hardship worsened by institutional prejudice. The second theme related more to individual coping factors such as social capital and cultural assimilation. The final theme encompassed the positive aspects of migration, which consisted of increased freedoms and novel opportunity. These themes convey three crucial considerations when studying minority stress. Firstly, each minority group will experience some shared experiences with other minority groups, however there will also be some unique stressors that are highly contextual. Secondly, minority people remain individuals, and should not be overly generalised as such, and, finally, being a minority does not automatically confer negative consequences and this should be held in consideration alongside discussions of specific minority stress (Williams et al, 2020).
As in all other minority groups, there is complexity and diversity within their community dynamics, which must be acknowledged in terms of studying minority stress. For the migrant population, there is a clear distinction that should be made between economic migrants who move county by choice, and those who are forcibly displaced, and are therefore classified as refugees, asylum-seekers or internally displaced people. At the time of writing, there are 84 million people who fall into this category, and yet very little research has focused on their wellbeing (UNHCR, 2022). A study examining the psychological wellbeing of LGBTQ+ refugees in Germany is therefore of great novelty and importance (Golembe et al, 2021). In many parts of the world, to this day, sexual and gender minority people experience intense rejection, discrimination and even severe violence and death threats. Many LGBTQ+ refugees will therefore have fled their home countries in the hope of finding somewhere more socially inclusive. However, this leaves this demographic vulnerable to multiple forms of trauma, including the trauma they experience before migration, trauma encountered during the process of migration and then the trauma of living life as a refugee in the host country. Both the LGBTQ+ and the refugee population as isolated units are observed to have a higher rate of mental health issues than the general population, and LGBTQ+ refugees show even higher levels of psychological distress than either of these individual groups (Golembe et al, 2021). This multi-minority identity held by LGBTQ+ refugees is a key feature of their experiences of minority stress, a discussion that will be returned to later. Overall it is clear that minority stress has applications far beyond its original basis, and can be a powerful tool in understanding the lives of all kinds of minorities all over the world.
A relatively novel use of the minority stress framework is its application to groups that have only recently become increasingly recognised as social minorities, namely the disabled and neurodivergent communities. The neurodivergency movement is one that has gained traction in recent years and fought to have disorders such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) accepted as part of natural human psychological diversity. Crucially it has also championed the idea that rather than considering these disorders as “diseases” that a person possesses, they can instead be conceptualised as fundamental cornerstones of an individual’s identity, after all, the way their brain works is what makes them them!
There is strong evidence that disabled individuals experience both proximal and distal stressors in the same vein as are experienced by other minority groups.
In terms of the discussion surrounding minority stress, such a consideration of conditions such as ASD being an integral part of someone’s identity opens doors in allowing us to consider neurodivergent people as a minority and thus generate greater insight into their lived experiences in a neurotypical environment. ASD is known to be comorbid with increased risk of a number of mental health conditions including depression and anxiety, something that people have generally disregarded as an inevitability. However, by the principles of the minority stress framework it should be considered whether people with ASD can struggle as a result of the stress they experience as a minority. A 2018 paper by Berth and Frost tested whether minority stress provides a plausible link between autism and the common mental health conditions in the autistic community (Botha & Frost, 2018). In this case, the sample was of “high functioning” autistic individuals, who may previously have held an Asperger’s diagnosis, though neither of these labels are currently used. The paper found that even when controlling for general life stressors, minority specific environmental stressors predicted diminished wellbeing and increased psychological distress. There was a notable difference in one of the sources of minority stress, namely concealment of identity. In the context of sexual minority individuals, “outness”, i.e. being open about disclosing ones identity is associated with increased psychological wellbeing, whereas for ASD individuals in this study, “outness” was associated with decreased wellbeing. This raises an important point that although the minority stress framework is applicable to many different minorities, the exact nature and impact of the stressors will not be universal.
Another group that has more recently gained social recognition as a “minority” is the disabled community. Individuals with disabilities are one of the largest minority groups in the USA, however statistics demonstrate that they are also at very high risk of mental health issues and suicide, trends that persists across demographic groups and type of disability (Lund, 2021). The exact mechanism for such however is widely unknown, and so it has been investigated whether the minority stress model is applicable. There is strong evidence that disabled individuals experience both proximal and distal stressors in the same vein as are experienced by other minority groups, including harassment, discrimination and internalised stigma (Lund, 2021). People with disabilities are at increased risk for various forms of victimisation throughout their lives, experiencing elevated rates of violence, including forms of violence specific to their disability such as the denial of personal assistance or equipment, or harassment specific to their disability. Disability is often a topic of verbal bullying and harassment, and it's therefore unfortunately unsurprising that disabled youths are 2-4 times more likely to be victimised by a peer than a non-disabled youth. On top of all of this, the disabled community have experienced stigmatisation for as long as time can tell, which inevitably leads to increased internal stigmatisation by those who are disabled. This generates stress in all manners, however presents particular danger to life in the case of suicide. There is a social attitude that suicide is more “acceptable” for disabled people, and they are frequently granted the right to want to die. Internalisation of such a belief is incredibly harmful, and can mean that they are less likely to seek help and more likely to exhibit symptoms of depression such as hopelessness. Understanding how these social attitudes and behaviours influence the lives of disabled people can allow for more effective interventions in those experiencing depression and suicidal ideanation.
The minority stress framework therefore clearly possesses uses and immense value beyond that for which it was originally conceptualised. As we as a society increasingly recognise certain communities as social minorities, it can be an important step to better understanding their lived experiences and the mental and physical issues they face as a result of the inherent oppression they experience. Such understanding not only allows for individual intervention in the recognition and treatment of mental illness as a result of minority stress, but may also inform the development of a more empathetic, emotionally intelligent society. It should come as little surprise however, that the discussion surrounding minority identity is not as simple as has been presented thus far. An important, and yet so far glossed over, point to consider when discussing any marginalised identities is that they do not exist in isolation. Many people, like LGBTQ+ refugees, will hold multiple minority status, and thus an extra layer of complexity is added to the discussion surrounding minority stress, so the question becomes how do we account for this? The answer to this question, and the discussion of how minority stress can be incorporated into other sociological frameworks will be contained within the next, and final, article of the series.