Prejudice, Social Strs, and Mental Health Lbian, Gay, and Bisexual Populatns: Conceptual Issu and Rearch Evince - PMC

Contents:

• MORY STRS AND MENTAL HEALTH GAY MEN
• GAY COMMUNY STRS SEXUAL MORY MEN AND WOMEN: A VALIDATN STUDY THE NETHERLANDS
• EFFECTS OF MORY STRS, GROUP-LEVEL COPG, AND SOCIAL SUPPORT ON MENTAL HEALTH OF GERMAN GAY MEN
• VALIDATN OF PRSIVE SYMPTOMS, SOCIAL SUPPORT, AND MORY STRS SL AMONG GAY, BISEXUAL, AND OTHER MEN WHO HAVE WH MEN (GBMSM) NIGERIA, AI: A MIXED METHODS APPROACH
• UNVERG CLIL PRCIPL AND TECHNIQU TO ADDRS MORY STRS, MENTAL HEALTH, AND RELATED HEALTH RISKS AMONG GAY AND BISEXUAL MEN
• PREJUDICE, SOCIAL STRS, AND MENTAL HEALTH LBIAN, GAY, AND BISEXUAL POPULATNS: CONCEPTUAL ISSU AND REARCH EVINCE
• MENTAL HEALTH, POTENTIAL MORY STRSORS AND RILIENCE: EVINCE OM A CROSS-SECTNAL SURVEY OF GAY, BISEXUAL AND OTHER MEN WHO HAVE SEX WH MEN WH THE CELTIC NATNS
• PRSURE TO KEEP UP: STAT IMBALANCE A MAJOR FACTOR STRS GAY MEN
• PREJUDICE, SOCIAL STRS, AND MENTAL HEALTH LBIAN, GAY, AND BISEXUAL POPULATNS: NCEPTUAL ISSU AND REARCH EVINCE

MORY STRS AND MENTAL HEALTH GAY MEN

Acrdg to Meyer [10], gay men and other sexual mori are at higher risk of experiencg mory strsors which clu victimizatn [12] ( Meyer’s termology, prejudice events), rejectn sensivy [13] ( Meyer’s termology, rejectn expectatn), ncealment of sexual orientatn, and ternalized homonegativy [14] ( Meyer’s termology, ternalized homophobia). Data of rponrs the followg ndns were exclud om the analys: no rmed nsent (n = 30), plete qutnnaire (n = 431), female sex (n = 36), non-gay intifitn (n = 131), younger than 18 or olr than 77 years (n = 7), livg an oppose-sex marriage and a same-sex civil unn at the same time (n = 1), smokg more than 60 cigarett per day bee of the high improbabily (n = 5), qutnnaire pletn ls than five or more than 45 mut (n = 73), and missg valu regardg qutnnaire pletn time (n = 31). P1Normalize mental health nsequenc of mory strsP2Rework negative gnns stemmg om early and ongog mory strs experiencP3Empower gay and bisexual men to munite openly and assertively across ntextsP4Validate gay and bisexual men’s unique strengthsP5Affirm healthy, rewardg exprsns of sexualyP6Facilate supportive relatnshipsTechniqu:.

Fally, CBT facilat an objective rtcturg of gnns, such as chronic expectatns of rejectn, ternalized homophobia, and ntgent self-worth, arisg om unsupportive or hostile environments (Meyer, 2003; Newb & Mtanski, 2010; Pachankis, Goldied, & Ramrattan, 2008; Pachankis & Hatzenbuehler, 2013) paper scrib the velopment of the first adaptatn of an empirilly supported treatment aimed at fosterg gay and bisexual men’s pg wh mory strs to rce prsn and anxiety. Bee of the signifint prevalence of HIV among gay and bisexual men (Centers for Disease Control and Preventn, 2013) and the strong lks between mory strs, mental health problems, and HIV risk behavr (Saen, Reisner, Herrick, Mimiaga, & Stall, 2010), this terventn clus a plementary foc on rcg ndomls anal sex among HIV-negative gay and bisexual men addn to improvg mory strs pg and rcg prsn and anxiety. Excludg the vtigators of the prent study, 46 experts were intified this search who had published at least two journal articl or books related to gay and bisexual men’s mental health and who were prelimarily intified as currently providg mental health servic to members of the LGB of the 46 experts received an email nfirmg that they were currently practice wh gay and bisexual men and asssg their tert participatg a 60-mute telephone terview.

GAY COMMUNY STRS SEXUAL MORY MEN AND WOMEN: A VALIDATN STUDY THE NETHERLANDS

The adaptatn approach sought to intify prcipl and exercis pable of overlayg the LGB-affirmative approach of mory strs theory onto the gnive and behavral tes of the existg 1: Interventn Selectn We specifilly searched for an terventn that would 1) be applible across those mental health disorrs that gay and bisexual men are disproportnately likely to experience pared to heterosexual men (e. Individuals wh diagnostilly heterogeneo anxiety disorrs also received benef om earlier open trials of the Unified Protol, wh 85% achievg rponr stat at 6-month follow-up on prcipal diagnos and 80% achievg rponr stat on orbid disorrs (Ellard et al., 2010) 2: Stakeholr Input Members of the rearch team nducted stctured dividual terviews wh 15 expert mental health provirs and 12 gay and bisexual men who met the cln creria scribed above orr to gather prcipl and exercis for adaptg the Unified Protol to specifilly addrs mory strs pathways. Participants this phase were generally receptive to the ntent and stcture of the adapted terventn and provid suggtns for further 5: Manual Revisn and Prelimary Trial The remag suggtns of the Phase 4 participants were rporated to a fal manual for the terventn, lled ESTEEM: Effective Skills to Empower Effective Men, which is currently beg ttg for acceptabily, feasibily, and prelimary efficy a randomized ntrolled walist trial wh 60 gay and bisexual men who report symptoms of prsn, anxiety, and associated health risks.

EFFECTS OF MORY STRS, GROUP-LEVEL COPG, AND SOCIAL SUPPORT ON MENTAL HEALTH OF GERMAN GAY MEN

Table 1 summariz the ntent of ESTEEM 1ESTEEM Ssn Content and OutleIntake AsssmentMental health asssmentMory strs asssmentSubstance e and sexual risk asssmentSsn 1: Motivatn EnhancementLearn how ESTEEM n empower onelf to pe wh strs and improve mental healthDiscs prsg mental health issuDiscs the unique strengths that the client posss as a rult of beg gay or bisexualSsn 2: The Nature and Emotnal Impact of Mory StrsDiscs how early and current mory strs n lead to anxiety, prsn, and health risksLearn to intify the specific forms that mory strs takReview current strategi for managg mory strsSsn 3: Trackg Emotnal ExperiencLearn about emotns and their nnectn to mory strsLearn to observe emotnal reactns to mory strsSsn 4: Awarens of Mory Strs ReactnsDiscs the ways that mory strs shap behavrLearn to scribe emotnal reactn to mory strs a mdful, prent-foced wayLearn about the relatnship between mory strs and substance eSsn 5: Cognive RtcturgConnect mory strs to negative, maladaptive thkg patternsIntify thoughts driven by mory strs and learn to modify themSsn 6: Emotn AvoidanceLearn how avoidg strong emotns n lead to problematic behavrsDiscs the ways that mory strs might lead to avoidance of certa experiencLearn how emotn avoidance may manift substance e or avoidg close relatnshipsSsn 7: Emotn-Driven BehavrsIntify how mory strs and related emotns might lead to avoidance of certa experiencDiscs the fluence of mory strs on sexual behavrCreate a list of experienc that the client would like to stop avoidgSsn 8: Behavral ExperimentsConont remrs of strsful events orr to crease tolerance of strong emotnsLearn adaptive rpons to mory strs cludg velopg healthy relatnshipsSsn 9: Assertivens Skills TragLearn how to assert onelf safely the face of mory strsDevelop effective ways to nvey self-rpect strsful suatnsLearn how assertivens the ntext of substance e or sex n improve healthSsn 10: Relapse PreventnReview new gnive, affective, and terpersonal pg strategi learned ESTEEMDiscs how to apply the lsons learned ESTEEM to future mory strs experiencPrciplPrciple 1: Normalize Mental Health Consequenc of Mory Strs Both sampl of participants nsistently reported that mory strs plays a key role gay and bisexual men’s mental health, nsistent wh empiril rearch fdgs (Meyer, 2003).

This prciple also heavily fluenc the gnive rtcturg module helpg gay and bisexual men make accurate attributns for the source of their distrs, as explicly suggted by ne of the terviewed 2Mory Strs Exampl Provid By Interview ParticipantsDaily Mory StrsCognive: self-nscnsAffective: fear of rejectn and victimizatn; fear of beg sctized or “found out;” hypervigilance; sadns about lack of rights; holdg emotnal reactns to discrimatnInterpersonal: ambiguoly rejectg signals; rejectn om relig muni; others’ stereotyp of gay and bisexual men as HIV-posive, not mascule, not virtuo, not relig; avoidance of “straight” eventsFriendship/Peer StrsCognive: feelg like an outst; distst of new people; low self-worth and shame om early rejectn; fixatn on what other people thkAffective: disclosure and ncealment strs; lonels; shame om early rejectn; matnInterpersonal: social isolatn; feelgs of hidg one’s te self, livg a double life, puttg on a show; stra on iendships for not beg open; early experience of beg different; early experience of bullygRomantic Relatnship StrsCognive: fear of endg up alone; prsure to lead hetero-normative life; prsure to be a relatnship; beg bisexual and not knowg whether to partner wh a man or womanAffective: heightened threat perceptn relatnships; fears of ntractg HIV; difficulty intifyg and munitg emotns; sexual feelgs toward men perceived as dangero and shameful; rentment of beg sgle; worri about public displays of affectnInterpersonal: avoidance of romantic timacy; supprsg romantic sentiments; difficulti munitg about HIV stat; fleetg sexual enunters whout lastg timacy; sleepg wh iends; negotiatg sexual agreements wh partners; unassertivens relatnshipsFay and Developmental StrsCognive: not havg a sense of ntrol adolcenceAffective: sadns at fay’s non-acceptanceInterpersonal: lack of role mols for leadg a fulfillg life as a gay/bisexual man; feelgs of lettg parents down; early genr nonnformy; bullyg; lack of parental acceptance; holidays brgg up fay non-acceptance; fay’s rrect views about sexual orientatnGay Communy StrsCognive: not beg gay enough; prsure to atta high fancial stat; ageism; ftg through substance e; rigid body standards; ncern about penis size; foc on fancial succs, stat, attractivens; opprsive valug of masculy; distst of masculyAffective: pism through substanc; guilt after “hedonism;” seekg sex to rce strsInterpersonal: strong prsure to self-label and f to a gay muny subgroup (e. Technique 4: Rtcturg Mory Strs Cognns As noted above, all gay and bisexual participants we terviewed and 12 expert provirs noted that mory strs powerfully shap gay and bisexual men’s gnive styl, cludg beliefs about their selv, their world, and their future possible selv, as picted Table 2 and nsistent wh prev rearch (e. Bee the avoidance patterns also reprent key pathways through which mory strs yields prsn, anxiety, and associated health risk behavr (see Figure 1), ESTEEM adapts the Unified Protol’s exposure techniqu to specifilly facilate awarens of mon avoidance behavrs experienced by gay and bisexual men (listed Table 2), nsistent wh several prcipl guidg the velopment of ESTEEM (i.

G., Glassgold, 2009; Kaysen, Lostutter, & Go 2005; Saen & Rogers, 2001) 3Example Avoidance Behavrs Origatg Mory Strs and Alternative BehavrsAvoidance BehavrsPossible Mory Strs OrigAlternative BehavrsAvoidg romantic nnectns wh other menInternalized homophobiaEstablishg a profile on a gay datg webse, gog on datPerfectnistic behavr at work or homeEarly and ongog experienc of actual or feared rejectn, ntgent self-worthLeavg thgs untidy or unfishedAvoidg heterosexual menEarly and ongog experienc of actual or feared rejectn, ncealmentAskg a heterosexual - worker out to lunchSocial whdrawal, pg social suatnsFears of rejectn, ncealment, past victimizatnStayg a suatn and approachg people; se or produce non-fearful facial exprsnsNot assertg one’s needs, opns, preferencFears of rejectn, past victimizatnAssertively statg one’s needs, opns, preferencUsg substanc durg sexFears of rejectn, ternalized homophobiaHavg sober sexHypervigilanceFears of rejectn, ncealment, past victimizatnFoc attentn on specific task at hand; medatn; relaxatnTechnique 6: Assertivens Trag Ten expert terviewe suggted that mory strs produc unassertive terpersonal behavr (see Table 2). While the majory (n = 14) of the prsed and anx gay and bisexual terviewe dited that they would prefer a gay or bisexual male therapist, fewer expert mental health provirs (n = 7) suggted that therapists liverg this terventn need to be gay or bisexual men, while relatively more (n = 10) suggted that they should posss LGBT-specific knowledge. Interviewe suggted that therapists who liver ESTEEM mt be fortable g the theraptic relatnship as a mol for healthy relatnships (n = 4 experts) and posss a general theraptic style marked by flexibily (n = 11 experts), self-awarens (n = 6 gay and bisexual men, n = 3 experts), humor (n = 1 gay and bisexual man, n = 4 experts), nfince (n = 4 gay and bisexual men), and patience (n = 2 gay and bisexual men, n = 2 experts).

VALIDATN OF PRSIVE SYMPTOMS, SOCIAL SUPPORT, AND MORY STRS SL AMONG GAY, BISEXUAL, AND OTHER MEN WHO HAVE WH MEN (GBMSM) NIGERIA, AI: A MIXED METHODS APPROACH

Given the terrelated health ndns affectg gay and bisexual men and the key role of prsn and anxiety perpetuatg health risk behavrs such as substance e and ndomls anal terurse (Stall et al., 2003), a psychosocial terventn pable of alleviatg the ndns at their source mory strs n potentially impact multiple, related aspects of gay and bisexual men’s health (Saen, Reisner, Herrick, Mimiaga, & Stall, 2010).

The rultg terventn, ESTEEM: Effective Skills to Empower Effective Men, is currently beg pilot tted for acceptabily, feasibily, and prelimary efficy an ongog randomized walist ntrolled trial wh 60 gay and bisexual men who report symptoms of prsn, anxiety, and associated health prcipl of ESTEEM, unvered through terviews wh 41 stakeholrs, align wh standard gnive and behavral prcipl (Goldied & Davison, 1994) and mory strs theori (Hatzenbuehler, 2009; Meyer, 2003).

UNVERG CLIL PRCIPL AND TECHNIQU TO ADDRS MORY STRS, MENTAL HEALTH, AND RELATED HEALTH RISKS AMONG GAY AND BISEXUAL MEN

Th, ESTEEM is expected to plement the existg terventns by targetg an tablished source of mental and physil health dispari related to sexual orientatn (Lick, Durso, & Johnson, 2013; Meyer, 2003) that is currently unaddrsed existg psychosocial addn to tablishg the acceptabily, feasibily, and prelimary efficy of the ESTEEM terventn, future tts of ESTEEM ought to pare s efficy agast that of existg terventns aimed at improvg the synmic health ndns adversely affectg gay and bisexual men. A further qutn volv whether the adaptatn approach applied here n be effectively applied to other empirilly supported treatments, such as terpersonal therapy (Weissman & Klerman, 1994) or emotn-foced therapy (Greenberg, 2002), that lend themselv to other mechanisms unrlyg gay and bisexual men’s mental health potentially not addrsed by ESTEEM.

PREJUDICE, SOCIAL STRS, AND MENTAL HEALTH LBIAN, GAY, AND BISEXUAL POPULATNS: CONCEPTUAL ISSU AND REARCH EVINCE

Fally, although some ESTEEM ponents, such as the foc on rcg ndomls anal sex, are particularly sued to gay and bisexual men, future exploratns ought to nsir how the prcipl and exercis of ESTEEM n bt addrs the specific health needs of sexual mory ncln, the adapted terventn scribed here, created through close review of stakeholr put, n potentially alleviate the multiple mental and physil health ncerns facg sexual mory men.

MENTAL HEALTH, POTENTIAL MORY STRSORS AND RILIENCE: EVINCE OM A CROSS-SECTNAL SURVEY OF GAY, BISEXUAL AND OTHER MEN WHO HAVE SEX WH MEN WH THE CELTIC NATNS

The answer, therefore, pends on scientific and social nsens that evolv and is subject to the vicissus of social change (Gergen, 1985, 2001) distctn between prevalenc of mental disorrs and classifitn the DSM was apparent to Marmor (1980), who an early discsn of the bate said, The basic issue … is not whether some or many homosexuals n be found to be nrotilly disturbed. Acrdg to the formulatns, prejudice and discrimatn related to low socenomic stat, racism, sexism, or homophobia—much like the chang precipated by personal life events that are mon to all people—n duce chang that require adaptatn and n therefore be nceptualized as strsful (Allison, 1998; Bart, Biener, & Bach, 1987; Clark, Anrson, Clark, & Williams, 1999; Meyer, 1995; Mirowsky & Ross, 1989; Pearl, 1999b) notn that strs is related to social stctur and ndns is at once tuively appealg and nceptually difficult. Mory inty is lked to a variety of strs procs; some LGB people, for example, may be vigilant teractns wh others (expectatns of rejectn), hi their inty for fear of harm (ncealment), or ternalize stigma (ternalized homophobia) FactorsAs early as 1954, Allport suggted that mory members rpond to prejudice wh pg and rilience.

Antigay bias crim had greater mental health impact on LGB persons than siar crime not related to bias, and bias-crime victimizatn may have short- or long-term nsequenc, cludg severe reactns such as posttrmatic strs disorr (Herek et al., 1999; McDevt, Balboni, Garcia, & Gu, 2001) Expectatns of rejectn and discrimatn Goffman (1963) discsed the anxiety wh which the stigmatized dividual approach teractns society.

PRSURE TO KEEP UP: STAT IMBALANCE A MAJOR FACTOR STRS GAY MEN

Dpe signifint challeng to measurg ternalized homophobia and lack of nsistency s nceptualizatn and measurement (Mayfield, 2001; Ross & Rosser, 1996; Shidlo, 1994; Szymanski & Chung, 2001), rearch has shown that ternalized homophobia is a signifint rrelate of mental health cludg prsn and anxiety symptoms, substance e disorrs, and suici iatn (DiPlacido, 1998; Meyer & Dean, 1998; Williamson, 2000). Th, although Saghir and lleagu (1970a) were reful not to claim that gay men had higher prevalenc of mental disorrs than heterosexual men, they noted that they did fd “that whenever differenc existed they showed the homosexual men havg more difficulti than the heterosexual ntrols, ” cludg, “a slightly greater overall prevalence of psychiatric disorr” (p.

PREJUDICE, SOCIAL STRS, AND MENTAL HEALTH LBIAN, GAY, AND BISEXUAL POPULATNS: NCEPTUAL ISSU AND REARCH EVINCE

A 1999 study of the Vietnam Era Tw Registry ed particularly nvcg methodology to study differenc suicidaly between tws (Herrell et al., 1999); found that gay or bisexual men were six tim more likely than their heterosexual tws to have attempted together, the evince om the studi supports the mory strs hypothis that LGB populatns are vulnerable to suici iatn and attempt—although the evince on adult lbian and bisexual women is not as clear. Neverthels, regardls of s relatnship to pleted suici, suici iatn and attempt is a ser personal and public health ncern that need to be studied for s own mer (Moscicki, 1994; Moscicki et al., 1988) studi asssed the risk for pleted suicis among gay men (Rich, Fowler, Young, & Blenkh, 1986; Shaffer, Fisher, Hicks, Paris, & Gould, 1995).

Among the difficulti are that (a) the studi attempt to answer whether gay dividuals are overreprented suici aths by parg agast an expected populatn prevalence of homosexualy, but wh no proper populatn data on LGB dividuals, is a matter of some njunctn to arrive at any such timate and (b) bee the studi rely on postmortem classifitn of sexual orientatn, their reliabily asssg prevalence of gay dividuals among suici aths is qutnable. They scribed an olr generatn, which matured prr to the gay liberatn movement, as the one that has been most affected by stigma and prejudice, a middle-aged generatn, which brought about the gay liberatn movement, as the one that benefed om advanc civil rights of and social attus toward LGB dividuals, and a younger generatn, cludg the prent generatn of young adults, as havg an unparalleled “ease about sexualy” (p. Evince om current studi of youth has nfirmed that the purported shifts the social environment have so far failed to protect LGB youth om prejudice and discrimatn and s harmful impact (Safe Schools Coaln of Washgton, 1999) Objective Vers Subjective Approach to the Defn of StrsIn reviewg the lerature I scribed mory strsors along a ntuum om the objective (prejudice events) to the subjective (ternalized homophobia), but this prentatn may have obscured important nceptual distctns.