Dissertations / Theses on the topic 'LGBTQ sexual health'

Doctor of Philosophy
Department of Kinesiology
Katie M. Heinrich
Engagement in regular physical activity is essential to prevent chronic diseases, yet few individuals are active enough to receive health benefits. Social factors such as relationship status, social support, and social capital are important for engagement in physical activity, although research investigating this area has not accounted for sexual orientation, including gay and bisexual men. The purpose of this dissertation was to examine the associations between relationship status, social support, and social capital by sexual orientation for men by using national-level epidemiologic data from the National Institutes of Health. Chapter one reviewed the literature examining the relationship among social variables, physical activity and sexual orientation to identify the gaps in sexual orientation/physical activity research. Chapter two used logistic regression to identify the prevalence of meeting physical activity recommendations for single and coupled gay and straight men by determining the association between relationship status and physical activity by sexual orientation. Coupled gay men were 1.61 (95% CI: 1.01-2.56) times more likely to meet physical activity recommendations compared to coupled straight men. Chapter three used linear and logistic regression to test the relationships between social support and physical activity by sexual orientation. Social support was not related to increases in physical activity for gay (AOR: 0.98, 95% CI: 0.49-1.97) or bisexual (AOR: 0.64, 95% CI: 0.28-1.51) men as it was for straight men (AOR: 1.63, 95% CI: 1.44-1.90). Chapter four used multiple group structural equation modeling to test the association between social capital and physical activity by sexual orientation. Social capital was related to more light/moderate-intensity physical activity for gay (β = .14, p <.05) and straight men (β = .06, p <.001), and social capital was related to more vigorous-intensity physical activity for straight men only (β = .06, p <.001). Lastly, chapter 5 introduces a conceptual model of how sexual orientation is related to social variables, and ultimately, physical activity. These results provide insight into the complex associations among a social determinant of health and physical activity while highlighting the need for future descriptive and intervention studies.

Doctor of Philosophy
Department of Kinesiology
Katie M. Heinrich
Engagement in regular physical activity is essential to prevent chronic diseases, yet few individuals are active enough to receive health benefits. Social factors such as relationship status, social support, and social capital are important for engagement in physical activity, although research investigating this area has not accounted for sexual orientation, including gay and bisexual men. The purpose of this dissertation was to examine the associations between relationship status, social support, and social capital by sexual orientation for men by using national-level epidemiologic data from the National Institutes of Health. Chapter one reviewed the literature examining the relationship among social variables, physical activity and sexual orientation to identify the gaps in sexual orientation/physical activity research. Chapter two used logistic regression to identify the prevalence of meeting physical activity recommendations for single and coupled gay and straight men by determining the association between relationship status and physical activity by sexual orientation. Coupled gay men were 1.61 (95% CI: 1.01-2.56) times more likely to meet physical activity recommendations compared to coupled straight men. Chapter three used linear and logistic regression to test the relationships between social support and physical activity by sexual orientation. Social support was not related to increases in physical activity for gay (AOR: 0.98, 95% CI: 0.49-1.97) or bisexual (AOR: 0.64, 95% CI: 0.28-1.51) men as it was for straight men (AOR: 1.63, 95% CI: 1.44-1.90). Chapter four used multiple group structural equation modeling to test the association between social capital and physical activity by sexual orientation. Social capital was related to more light/moderate-intensity physical activity for gay (β = .14, p <.05) and straight men (β = .06, p <.001), and social capital was related to more vigorous-intensity physical activity for straight men only (β = .06, p <.001). Lastly, chapter 5 introduces a conceptual model of how sexual orientation is related to social variables, and ultimately, physical activity. These results provide insight into the complex associations among a social determinant of health and physical activity while highlighting the need for future descriptive and intervention studies.

Rural populations are traditionally understudied, especially as it is concerned with the experiences of sexual minority women. Previous research has found that sexual minorities experience worse health outcomes in comparison to heterosexual individuals, which could be due to minority stress (the unique stressors they face as sexual minorities, such as discrimination and concealment of sexual orientation) (Meyer, 2003). More recent research has found that the relationship between minority stress and health outcomes has been mediated by social variables, like social isolation (Hatzenbuehler et al., 2009). Thus, the current study examined the indirect effects of proximal minority stress of concealment on self-rated health and quality of life through various social factors (community connectedness, social support, indirect support seeking, and belongingness). Participants included 134 sexual minority women in Northeast Tennessee. Participants completed the following measures: the Short Form LIHS (Szynmanski & Chung, 2001); Indirect Social Seeking Scale (Barbee & Cunningham, 1995); the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988); the Belongingness Scale (Malone et al., 2012); the Connectedness to the LGBT Community Scale (Frost & Meyer, 2012); WHOQOL-BREF (World Health Organization, 1998); SF36v2 (Health Survey, 1996). In order to test that belongingness, social support, indirect support seeking, and community connectedness mediated the relationship between concealment to quality of life and self-rated health, a mediational analysis was conducted using PROCESS (Hayes, 2014) macro. Analysis showed that concealment was indirectly linked through belongingness with quality of life and self-related health. Concealment significantly predicted belongingness (b = -.327, p = .021), which in turn significantly predicted self-rated health life (b = .214, p = .004) and quality of life (b = .251, p < .001). A mediational analysis was conducted, and it was found that concealment had an indirect effect on self-rated health through belongingness (effect = -.070, 95% CI = -.1865, -.0105) and indirect effect on quality of life through belongingness (effect = -.066, 95% CI = -.161, -.001). All other mediational analyses were nonsignificant. Our results suggest that cognitive aspects of social life, like perceived belongingness, may be an important mechanism through which minority stress affects health.

In the United States and abroad, the LGBTQ+ population has both historically and currently, suffered from a higher likelihood of poorer health outcomes than their heterosexual and cisgender counterparts due to stigma and discrimination (Alencar Albuquerque et al., 2016). While these health disparities have been well studied for the United States LGBTQ+ community as a whole, there is less understanding of what subgroups within this population may be disproportionately more susceptible to poorer health outcomes and risky behaviors, as well as, less understanding for the reasons behind such health outcomes and behaviors. One such subgroup is that of sexual minority women (SMW), or women who are sexually and/or romantically attracted to other women or who identify outside of heterosexual norms (Youatt, Harris, Harper, Janz, & Bauermeister, 2017). Preliminary studies have found that SMW are less likely than their sexual minority male and heterosexual female peers to have regular access to healthcare providers and are more likely to have negative experiences in healthcare settings, specifically in regards to sexual and reproductive healthcare (Riskind, Tornello, Younger, & Patterson, 2014). For these reasons, coupled with discrimination and risky sexual and health behaviors, SMW are a vulnerable population in need of social, political, and medical attention. This thesis aims to understand the causes and barriers SMW face when accessing sexual and reproductive health resources, as well as, provide direction for navigating such barriers on a multifactorial level. This research analyzes how hegemonic heteronormativity and sexism take root in (a) economic and political barriers in obtaining health insurance and health knowledge for SMW, (b) SMW patient ignorance of health risks and needs, (c) minimal to no medical provider training and understanding for SMW health risks, behaviors, and needs. Each barrier is addressed holistically; a novel approach necessary for the initial alleviation of such barriers to sexual and reproductive care and knowledge for SMW.

Most research on body image and disordered eating has focused largely on women, as women are at higher risk than men for eating disorders. In recent years research has revealed that men are at increasing risk for these outcomes, especially as the ideal male body represented in media images and therefore frequently internalized among men is becoming so lean and muscular as to make it very difficult for most men to realistically achieve. Sexual minority men in particular have been found to be at increased risk for body dissatisfaction, body shame, and disordered eating than their heterosexual counterparts. The research on sexual minority men, however, is in the beginning stages and it is unclear to date how and why body dissatisfaction and eating pathology may be systematically different in this population in comparison to heterosexual men. The current study sought to investigate mediating and moderating factors into the relationship between sexual orientation, body dissatisfaction, and disordered eating. Sexual minority men (n = 112) reported higher levels of body dissatisfaction and disordered eating than heterosexual men (n = 242). Contrary to hypotheses, integration into gay culture was not related to the outcome variables, nor were appearance conversations. Also contrary to hypotheses, exercise motivations were similar in both groups of men, with the exception that heterosexual men were more likely to report exercising for the purpose of competition. Implications and possible directions for future research are discussed.

Previous literature on LGBTQ+ people (lesbian, gay, bisexual, transgender, queer/questioning, and other sexual minorities) reports that this community experiences greater health problems than heterosexuals. LGBTQ+ people experience higher rates of chronic conditions, STIs, addiction, poor mental health, and cancer, which highlights the importance of capturing data regarding health. A growing concern is that social surveys fail to find meaningful ways to gather gender and sexuality data to understand possible health disparities for LGBTQ+ people. This study uses data from the General Social Survey to examine the physical and mental health outcomes of LGB people compared to straight people in a nationally representative sample of Americans. An analysis of potential disparities in the self-reported health of straight and LGB respondents finds that respondents who identified as bisexual reported significantly lower levels of self-rated health and more problems with mental health compared to respondents who identified as gay, lesbian, or heterosexual.

Rural populations are traditionally understudied, especially as it is concerned with the experiences of sexual minority women and the experiences of internalized stigma (negative attitudes towards the self) are often related to poor health outcomes within the LGBTQ+ community (Meyer, 2003). This relationship has been found to be mediated by rumination, suppression, and social isolation, which has been generalized to cognitive, coping, and social mediators (Hatzenbuehler, Nolen-Hoeksema, & Dovidio 2009). The current study examines the indirect effect of internalized stigma on self-rated health and quality of life through cognitive mediators (self-esteem, self-compassion, and feelings of guilt and shame) in sexual minority women located in northeast Tennessee (N=134). Participants completed the following scales: Perceived Self Stigma Scale (Mickelson, 2001), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Self-Compassion Scale- Short Form (Raes, Pommier, Neff, & Van Gucht, 2011), Personal Feelings Questionnaire (Harder & Zalma, 1990), WHOQOL-BREF (World Health Organization, 1998), and the SF-36v2 (Health Survey, 1996). Results suggested that only self-esteem mediated the relationship between internalized stigma and both self-rated health and quality of life. Analyses were conducted via the data software SPSS. Internalized stigma was found to predict self-esteem (b = -0.153, p =.023). In turn, self-esteem was then predictive of self-rated health (b = .399, p =.043) and quality of life (b = 0.438, p = .007). A mediational analysis was conducted using a PROCESS (Hayes, 2014) macro to test the hypothesis that self-esteem acts as a mediator between internalized stigma and quality of life and self-rated health. There was an indirect effect of internalized stigma on quality of life (effect = -.067, 95% CI (-.157, -.016)) and self-rated health (effect = -.061, 95% CI (-.151, -.013)) through self-esteem. All other regression and mediational analyses with self-compassion, shame, and guilt were nonsignificant. With these findings, clinical therapy may be improved for sexual minority women by focusing on internalized stigma as an underlying cause of lower self-esteem and poor health. If the focus of therapy becomes internalized stigma, based on our findings, reduction of internalized stigma could increase self-esteem and in turn increase self-rated health and quality of life in sexual minority women.

Surveillance and epidemiological studies over the last number of years show that HIV incidence has remained relatively stable, and even increased in some populations. Ironically, some of the most substantial increases have been seen in the very populations that have been most heavily targeted for HIV prevention interventions. This suggests that current prevention models, which primarily emphasize rational thought process, may be neglecting some important mechanisms that influence or cause high-risk sexual behavior. This study examines how non-rational thought processes may relate to high-risk sexual behavior in the face of social stressors. Grounded in Carver’s & Scheier’s (1996, 1998) Self-Regulatory Failure Model, which suggests that under certain circumstances, individuals may shift from abstract goals to more immediate sensory oriented goals. I explored a model that includes gay-related discrimination, hate crimes, and social stressors as predictors of high-risk sexual behavior, mediated by negative affect. I also explore whether the putative link between negative affect and high-risk sexual behavior is moderated by sensation seeking and avoidant coping personality styles. Lastly, I conducted exploratory analyses on the role alcohol may play in this model. The study employed a two stage purposive sampling procedure: First, 20 different U.S. media markets were selected at random; and next, individuals were recruited from within those media markets to participate in an online survey about these topics. Because the outcome data were counts of sexual behavior with a large proportion of zero responses, I employed Zero Inflated Poisson regression modeling. This modeling procedure allows one to examine if different variables predict initiation of behavior versus frequency of behavior. The results show partial support for the hypothesized model. Interpersonal stressors and discrimination appear to be consistent predictors of high-risk sexual behavior in this sample; however, the relationship to the outcomes differ for initiation of behavior as opposed to frequency of behavior, and further by type of sexual behavior. Hate crime rates showed little ability to predict high-risk sexual behavior outcomes. There is tentative evidence for distancing forms of coping as moderators of the relationship between negative affect and high-risk sexual behavior. Negative affect did not emerge as a mediator in the primary model examined in this study; although, negative affect was independently related to some sexual behavior outcomes. When alcohol use during sex was added as part of the exploratory analyses, negative affect emerged as a mediator for some high-risk sexual behavior outcomes. Exploratory analyses also revealed relationships between alcohol with sex, discrimination, and social stressors that suggest a strong interplay between all four variables and the sexual behavior outcomes. Hate crimes, however, were still mostly unrelated to high-risk sexual behavior in the exploratory analyses. Overall, these results point to a dynamic, complex, and non-linear set of relationships between interpersonal stressors, affect, sexual behavior, and alcohol use. Larger sample sizes, longitudinal study designs, and more granular measures of affect may help to clarify the causal relationships between these constructs. These results have implications for prevention interventions that emphasize emotional self-regulation at the individual level and address discrimination and stigma at a structural level.

Elevated social anxiety (SA) is linked to issues with emotional distress, substance use, and social anxiety disorder (SAD). Notwithstanding concerns of how sexuality has been defined in the extant literature, emerging evidence suggests that the prevalence of SA and related challenges may be disproportionately present among sexual minorities, including lesbians, gay men, and bisexuals (LGBs). This trend may be especially relevant within the developmental context of emerging adulthood, an important period for development of sexual identity, and a time when individuals are already predisposed to heightened feelings of SA. The present study examined the relationship between sexual orientation (measured using sexual identity, sexual attraction, and past romantic and sexual behavior) and social anxiety (related to social interaction and social performance) among emerging adults. minority sexual identities [Welch's F(5,48.08) = 5.56, p = .002, ηp2 = .02.], same-sex attraction [Welch's F(4,108.06) = 11.27, p < .001, ηp2 = .04], and same-sex romantic [Welch's F(5,85.91) = 6.88, p < .001, ηp2 = .03] and sexual experiences[F(5,61.95) = 8.88, p < .001, ηp2 = .04], particularly among those who indicated attraction to multiple sexes. Findings support research that indicates that sexual minority adults experience higher levels of SA than majority (i.e., heterosexual, opposite-sex oriented) adults, and that assessment of sexuality may reflect number of sexual minorities identified. Future directions including intersections of race/ethnicity and gender are discussed.

Bakgrund: Forskning visar att homo- bi- och/eller transsexuella ungdomar inte alltid får relevant sexualundervisning som är kopplad till deras sexuella läggning. Studier visar även på att homo- bi- och/eller transsexuella ungdomar har ett riskbeteende när det kommer till sex, att dessa ungdomar hämtar information från pornografin. Homo- bi- och/eller transsexuella ungdomar är i större utsträckning påverkade av alkohol eller droger när de har sexuellt umgänge. Dessa ungdomar upplever även utanförskap och vågar inte tala om sin sexualitet, vilket kan resultera i att de utsätter sig för risk att skada sig själva. Syfte: Att undersöka det stöd som homo- bi- och/eller transsexuella ungdomar får gällande sexuell hälsa från skola och skolsköterskor. Metod: Studien hade en kvantitativ ansats, den genomfördes som en enkätstudie som skapades via Google Form och kunde nås via en länk. Enkäten hade totalt 17 stycken frågor, 15 stycken med fasta svarsalternativ och 2 stycken öppna. Resultat: Ungdomar var mest negativt inställda till skolsköterskans bemötande kring sexuell hälsa och sexuella frågor vilket berodde på skolsköterskans heteronormativa synsätt. Många av homo- och bisexuella ungdomar ansåg att skolan var en viktig del i att kunna erbjuda rätt information om sexuell hälsa. Vissa ungdomar sökte information på egen hand och visste inte ens att de kunde samtala med skolsköterskan om sexuella hälsa. Slutsats: Skolsköterskan behöver ha mer kunskap för att kunna bemöta ungdomar som identifierar sig som homo- bi- och/eller transsexuella och inte ha ett heteronormativ inställning samt anpassa miljön inne på mottagning som bidrar till öppen klimat för homo- bi- och/eller transsexuella ungdomar.
Background: Research shows that LGBT youth do not always receive relevant sexual education linked to their sexual orientation. Studies also show that LGBT youth have a risk behavior when it comes to sex, that they get their information from alternative sites that also includes pornography. LGBT youth are more likely to be influenced by alcohol or drugs when they have sexual intercourse. LGBT youth experience exclusion and dare not to talk about their sexuality, which may result in the risk of harming themselves. Aim: The purpose is to investigate the support that gay and transgender youth receive regarding sexual health from school and school nurses. Method: The study had a quantitative approach, it was conducted by a survey that was created through Google Forms and could be accessed through a link. The survey had a total of 17 questions, 15 questions with fixed options and 2 were open.   Results: Young people were most disadvantaged to the school nurse's concerns about sexual health and sexual issues, which was due to the heteronormative approach by the school nurse. Many of the LGBT youths considered that school was an important part of being able to offer proper information on sexual health. Some young people searched for information on their own and did not even know that they could talk to the school nurse about sexual health.   Conclusion: The nurse needs more knowledge to be able to approach adolescence who identify as LGBT and not have a heteronormative attitude as well as adapt the environment at the reception that promotes open climate for LGBT youths.

Death by suicide, and suicidal behaviors, are a significant public mental health problem, and individuals who are lesbian, gay, bisexual, transgendered and questioning (LGBTQ), may be at increased risk. Potential underlying mechanisms of this association are unknown, but may involve the impact of LGBTQ status on future orientation and mood. Our purpose was to determine the influence of sexual identity, sequentially, on cognitive and emotional functioning, and consequent relation to suicidal behavior. In a sample of 349 college students, we used serial mediation models to investigate the relation between self-identification as LGBTQ and suicidal behavior, with hope and hopelessness as first-order mediators and depression as a second order mediator. Supporting hypotheses, we found that LGBTQ status was related to less hope and greater hopelessness and, in serial fashion, to depressive symptoms and consequent suicidal behavior. Our findings may have clinical implications. Resolution of hopelessness and depression, and promotion of hopefulness, perhaps via Motivational Interviewing and Cognitive Behavioral Therapy strategies, such as goal-setting, may reduce suicidal risk in LGBTQ young adults.

SAMMANFATTNING Bakgrund: Historiskt sett har homosexualitet setts som ett psykiatrisk eller medicinskt problem. Trots att dagsläget till viss mån förändrats, kan homosexualitet och könsöverskridande identitet till följd av heteronormen ses som tabubelagda ämnen. HBTQ-personer har en ökad risk att utveckla psykiska sjukdomar, men undviker att söka vård till följd av tidigare erfarenheter eller rädsla. Sjuksköterskans uppgift är att generera acceptans och trygghet. Syfte: Sammanställa kunskap om HBTQ-personers erfarenheter av bemötandet i vården. Metod: Litteraturöversikt över 12 originalartiklar. Ingående studier är utförda i olika vårdinstanser i Sverige, USA och Nya Zeeland. Resultat: Resultaten visar att det finns både styrkor och brister i bemötandet i vården. Vissa informanter upplevde att vårdpersonalen var heteronormativt inställd, opåläst om HBTQ och i enstaka fall homo- och/eller transfobisk. Fler av informanterna kände oro inför att avslöja sin sexuella läggning för vårdpersonal. Men resultaten visar också att det finns vårdpersonal som enligt informanterna uppvisar acceptans och neutralitet. Slutsats: HBTQ-personers erfarenheter av bemötandet i vården är att det präglas av heteronormativitet och okunskap, men att det också finns vårdpersonal som är påläst och accepterande.
ABSTRACT Background: Through history, homosexuality has been recognized as a psychological or medicational condition. Regardless of present amendments, homosexuality and gender-specific identity may to some extent be seen as tabu. LGBTQ persons generally has an increased risk for developing psychological illnesses, but refrain from seeking care due to previous experiences or fear of poor treatment. The nurse shall generate acceptance and a sense of safety. Aim: To compile knowledge of LGBTQ persons´experiences of treatment in health care. Method: An overview of 13 original articles. The studies viewed in this overview are performed in varied care units in Sweden, the USA and New Zealand. Results: The results point to both strengths and shortcomings of the treatment towards LGBTQ persons in health care. Some informants sensed a heteronormative attitude and ignorance among the healthcare professionals, and in some cases homo- and/or transphobia. Many informants felt uneasy about revealing their sexual orientation to the health care professionals. But the results also show that some healthcare professionals expressed acceptance and neutrality. Conclusion: LGBTQ persons experience a sense of heteronormativity and ignorance in regards to treatment in healthcare, but there are healthcare professionals that are educated and accepting.

Although the world has experienced great progress in the area of Sexual and Reproductive Health and Rights (SRHR), the contemporary transnational turn towards nationalist, right-wing and populist politics has generated a backlash, primarily affecting women and members of the LGBTQ-community (lesbian, gay, bisexual, transgender and queer/questioning). Yet, opposition to gender and sexual equality, particularly in the European context, is undertheorized. Hence, this thesis sets out to explore and understand the dynamics of political homophobia as a conscious political strategy in Poland and how the homophobic rhetoric pursued by the governing party PiS and their allies has achieved resonance. That is, how anti-LGBTQ ideas have gained support as they echo the ideas, beliefs and values central to potential adherents. The advancements of political homophobia in today’s Poland is rather puzzling since there has not been an upswing in homophobic values among the population. Although the Polish society is not intrinsically homophobic, the dominating values, norms, rules and practices are generally patriarchal and heteronormative. Due to the heteropatriarchal bias of the institutional context, this thesis suggests that both informal and formal institutions may enhance the resonance of the ideas embedded in the anti-LGBTQ ideas framing. Drawing on framing theory and new institutionalism, this thesis develops a framework to analyze this dynamic and reciprocal relationship between framing strategies and the institutional context. The first section of the two-stepped analysis describes how LGBTQ has been framed by identifying the core framing tasks and various framing strategies while the second part outlines various formal rules and informal norms that have facilitated the campaign and identifies how these institutions are heteronormative. The main findings suggest that conservative elites have managed to enhance resonance for their anti-LGBTQ ideas by framing the issue in congruence with heteronormative informal norms, which are perceived to be fundamental for Polish national identity and by exploiting pre-existing formal regulations, which are seemingly neutral but produce heteronormative effects.

Lesbian, gay and bisexual (LGB) individuals are found that be at a greater risk of a range of psychopathologies compared to their heterosexual counterparts (King et al., 2008). This disparity has been attributed to increased social adversity faced by sexual minorities, including exposure to sexuality based discrimination, as well as negative attitudes and beliefs that sexual minority individuals may develop about their stigmatised identities (Meyer, 2003). The aim of this thesis was twofold. The first aim was to examine how beliefs about the nature and aetiology of sexual orientation are linked to a range of sexual identity outcomes relevant to psychological wellbeing, including self-acceptance and certainty in one’s sexual orientation, and, whether these associations differ between sexual minority subgroups (i.e., gay vs. lesbian vs. bisexual men and women). The second aim was to examine a macro-level factor, geographical locality, to examine how the experience of sexual minority stress, LGB community connectedness, and social isolation differ for LGB Australians residing in rural vs. metropolitan localities. In the first chapter of this thesis (Chapter 1), I review literature relevant to mental health disparities in LGB populations and sexual minority stress, before going on to examine the structure and implications of heterosexuals’ beliefs about sexual orientation, and the limited literature examining the sexual orientation beliefs of sexual minority individuals. I then propose a theoretical model linking certain facets of sexual orientation essentialism with sexual orientation outcomes and psychological wellbeing in LGB individuals. Three studies (Chapters 2 through 4) sequentially examine the implications of sexual orientation beliefs for sexual identity outcomes in sexual minority subgroups. Two correlational studies examine the proposed theoretical model using Structural Equation Modeling (SEM) in a large sample of gay men (Study 1) and lesbian vs. bisexual women (Study 2). Study 1 found that gay men endorse a mixture of essentialist and social constructionist beliefs about sexual orientation, and that these beliefs hold divergent relationships for internalised homonegativity and sexual orientation uncertainty. Most notably, those perceiving sexual orientation as biologically based and immutable (natural) reported increased certainty in their sexual orientation, whilst those viewing sexuality as existing in discrete categories (discrete) reported increased internalised homonegativity, and in turn poorer psychological wellbeing. In Study 2, a slightly modified theoretical model was tested among lesbian and bisexual women. Similar to the case in gay men, biological-immutability beliefs were linked to less sexual orientation uncertainty in lesbian and bisexual women. Notably however, discreteness beliefs were associated with increased internalised stigma and poorer psychological wellbeing in bisexual women only; presumably, as such beliefs imply that bisexual identity is unstable or illegitimate. Finally, inclusion of sexual attraction patterns in this model revealed that 1) lesbian women reporting more exclusive same-sex attraction are more likely to embrace biological-immutability and discreteness beliefs, and 2) a-prototypical attraction patterns (non-exclusive same-sex attraction among lesbian women and same or opposite-sex preference among bisexual women) predicts poorer wellbeing via increased sexual orientation uncertainty. As such, sexual orientation beliefs appear to predict sexual identity outcomes among LGB individuals, with unique patterns of associations observed across sexual minority subgroups. Study 3 examined how sexual orientation was conceptualised across sexual minority subgroups, focusing in particular on the emerging sexual identities of “pansexual” and “queer”. This study found that gay men were most likely to conceive of sexual orientation as biologically based/immutable and categorical in nature, followed by lesbian women, and that bisexual men and women, and those adopting pansexual and queer identities, were least likely to adopt these beliefs. Demographics and sexual orientation indicators revealed that pansexual participants were most reminiscent of bisexual, whilst queer participants were most reminiscent of gay/lesbian populations. Chapter 5 (Study 4) addressed the second aim of this thesis, examining whether rural vs. metropolitan locality independently predicted exposure to sexual minority stress, connectedness with the LGB community and social isolation among sexual minority Australians. Residing in rural-remote localities was linked to increased concealment of sexuality from friends, more concern regarding disclosure of sexuality, fewer friendships with other LGB people and, among men, higher levels of internalised homonegativity. Unexpectedly, those residing in outer-metropolitan areas of major cities demonstrated comparable disadvantages, as those in rural-remote localities. In the final chapter (Chapter 7) the contribution of these findings to understanding the implications of sexual orientation beliefs among distinct sexual minority communities, as well the role of geographical locality in conferring risk for psychopathology among LGB populations, are interpreted in light of previous findings. Finally, I examine implications of these findings for the ethics of scientific research into sexual orientation, LGB advocacy, and counselling psychology, before discussing limitations and future directions for research.

Thesis advisor: V. Paul Poteat
Intimate partner violence (IPV) occurs in LGBTQ (lesbian, gay, bisexual, transgender, queer) relationships at rates equal to or even higher than cisgender heterosexual relationships (Walters, Chen, & Breidig, 2013). The health consequences of IPV are well documented (Kwako et al., 2011). Trauma-informed care (TIC) is one service approach receiving increasing support for use with IPV survivors (Warshaw, Lyon, Phillips, & Hooper, 2014). Nevertheless, there is little research exploring the association between TIC and health among LGBTQ IPV survivors. Immobilization is prevalent for IPV survivors for whom fight or flight may increase risk of violence during traumatic situations (van der Kolk, 1989). TIC might be well-positioned to counter these immobilizing effects in effort to facilitate mobilization and better health for IPV survivors. The relationship between TIC and health through mobilizing mechanisms has not yet been tested. This study examined several mobilizing mechanisms as mediating the relationship between TIC and health including: 1) lower social withdrawal; 2) lower shame; 3) greater emotion regulation; and, 4) greater empowerment. Among 227 LGBTQ adults, structural equation modeling analyses tested the relationship between TIC and health, and the mediating effects of lower social withdrawal and shame, and greater emotion regulation and empowerment on the relationship between TIC and health. Results indicated that the direct effects of TIC on mental and physical health were not significant. Indirect effects of TIC on mental and physical health through the set of mobilizing mechanisms were not significant. However, TIC did predict greater empowerment and emotion regulation and lower social withdrawal. Lower social withdrawal and lower shame also predicted better mental health, while lower shame and emotion regulation predicted better physical health. Practitioners need to uncover additional services and resources beyond TIC that could improve health among LGBTQ IPV survivors. Research should continue to examine the potential effects of TIC in addition to how it is applied in the context of evidence-based treatment programs that are adapted for sexual and gender minorities
Thesis (PhD) — Boston College, 2018
Submitted to: Boston College. Lynch School of Education
Discipline: Counseling, Developmental and Educational Psychology

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A população LGBT tem dificuldade em buscar atendimentos de saúde, principalmente, pela falta de Políticas Públicas específicas e pelo despreparo dos profissionais que os atendem. A Atenção Básica deveria ser a porta de entrada tanto para atendimentos mais prevalentes quanto para demandas especializadas. Dentro dela insere-se a Estratégia de Saúde da Família que tem por fundamento aproximar a população dos serviços de saúde disponíveis. O Agente Comunitário de Saúde (ACS) é o profissional responsável por facilitar este encontro. No seu território de atuação ele conhece a fundo seus pacientes não apenas nas questões relativas a saúde, mas também nas questões sociais, econômicas, religiosas, entre outras. O vínculo estabelecido entre profissional/paciente é o precursor para a adesão aos atendimentos. Assim sendo este profissional seria o facilitador para que a população LGBT encontre espaço na busca pelos serviços de saúde. Esta pesquisa teve como objetivos investigar como os ACS realizam atendimentos ao grupo LGBT; elaborar uma proposta de intervenção por meio de Grupos Focais (GF) com o conteúdo pertinente sobre esta população estigmatizada e avaliar de que forma a pesquisa influenciou a prática profissional destes ACS. Os sujeitos da pesquisa foram 12 Agentes Comunitários de Saúde que trabalham em uma Unidade de Saúde da Família na região periférica de uma cidade no interior de São Paulo. O método utilizado foi uma entrevista individual semiestruturada, sendo que as entrevistas forneceram subsídios para a elaboração de Grupos Focais com a finalidade de sensibilizar os ACS no atendimento à população LGBT. Constatou-se que os profissionais não se sentiam seguros no atendimento à população LGBT, porém demonstraram interesse quando a temática lhes foi apresentada. Por meio do último GF, realizado nove meses depois dos outros, os ACS puderam relatar situações reais de atendimento humanizado a população LGBT, e de como o conhecimento adquirido foi essencial para fazê-los mais seguros quando se depararam com essa população na busca por atendimentos.
The LGBT population has difficulty in seeking health care, mainly due to the lack of specific Public Policies and the lack of preparation of the professionals that attend them. Primary Care should be the gateway to both more prevalent care and specialized demands. Within it is inserted the Family Health Strategy, whose purpose is to bring the population closer to the available health services. The Community Health Agent is the professional responsible for facilitating this meeting. In his territory, he knows his patients thoroughly, not only in matters related to health, but also in social, economic and religious matters, among others. The established link between professional patient is the precursor for adherence to care. Thus, this professional would be the facilitator for the LGBT population to find space in the search for health services. The objective of this research was to investigate how Community Health Agents perform care for the LGBT group. To elaborate a proposal of intervention through Focal Groups with the pertinent content on this stigmatized population and to evaluate how the research influenced the professional practice of these Community Health Agents. The subjects of the research were 12 Community Health Agents working in a Family Health Unit in the peripheral region of a city in the interior of São Paulo. The method used was a semi-structured individual interview, and the interviews provided support for the elaboration of Focus Groups with the purpose of sensitizing the Community Health Agents in the care of the LGBT population. It was verified that the professionals did not feel safe in serving the LGBT population, but they showed interest when the theme was presented to them. Through the last Focus Groups, conducted nine months after the others, Community Health Agents were able to report real situations of humanized care to the LGBT population, and how the knowledge acquired was essential to make them safer when they encountered this population in the search for care.

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the Health Equity Promotion Model in order to investigate the interplay of medical heterosexism, social and community, behavioral, biological, and social identity/position factors on cervical cancer screening rates in a sample of SMW from a large metro area in the southeastern United States. 145 women who identify as sexual minorities were recruited from local LGBT-friendly venues, events, community organizations, email LISTSERVs, and related social media accounts and were asked to complete a fifteen-minute survey. A series of bivariate correlation, t-test, and multivariate regression analyses were run. Findings from mediation analyses demonstrated that health communication factors mediated the relationship between perceived medical heterosexism and cervical cancer screening outcomes. Further, after accounting for demographic factors, greater provider communication quality, provider trust, eHealth literacy, and ever having an HIV test significantly and differentially predicted cervical cancer screening outcomes in the multivariate models (ps < .05). Findings suggest that health communication factors play an important role in facilitating cervical cancer screenings for SMW, and provider training interventions and policy that focus on reducing medical heterosexism may aid in improving patient-provider relationships in this population.

This thesis provides an examination of the disproportionate use of licit and illicit substances among sexual minority young people. It shows a clear picture that substance use is not equally distributed among all groups within this population, and that a range of underlying factors are responsible for existing disparities between this population and the general population. These include marginalisation and mental health as well as characteristics of the LGBT community such as peer pressure, high concentration of licensed venues, and socio-political values. Both connectedness to and participation in the LGBT community were significantly associated with substance use involvement.

Human papillomavirus (HPV) is a preventable infection responsible for anogenital and oropharyngeal cancers, as well as genital warts. Two safe and effective vaccines are recommended for adolescents and young adults to protect against HPV infection. Both are severely underutilized. Sexual and ethnic minorities are disproportionately affected by HPV infection and its sequelae. The goals of this study were to (1) assess baseline differences in HPV-related awareness, knowledge, and attitudes between men and women, and (2) evaluate the differential efficacy of a brief, educational HPV intervention among ethnically and sexually diverse college students. Students attending undergraduate courses from 2015 to 2017 participated in a brief, tailored, classroom intervention designed to improve HPV-related awareness, knowledge, and attitudes. These outcomes were assessed immediately before and following an evidence-based educational presentation about HPV risks, outcomes, treatments, and prevention. At baseline, 84% of participants (N=386) had heard of HPV; 28% of men and 55% of women reported receiving ≥1 dose of HPV vaccine. Vaccinated women were seven times more likely to report favorable attitudes than unvaccinated women (RR=7.1, CI[3.3-15.5]). Hispanic participants had more positive attitudes toward HPV vaccination (62% vs. 44%; P=0.009) and were more willing to become vaccinated (66% vs. 46%; p=0.02) than non-Hispanic participants at baseline. Gay and bisexual men (92%) were more likely than heterosexual men (68%) to have heard of HPV, to receive any doses of HPV vaccine (37% vs 19%), to view HPV vaccination positively (58% vs 39%), and more willing to be vaccinated (86% vs 39%; P

Le virus de l'immunodéficience humaine (VIH) constitue l'une des principales causes de décès dans les pays à revenu faible ou moyen. Le 8 juin 2021, les Nations unies ont adopté la Déclaration politique visant à mettre fin aux inégalités et mettre fin au sida d'ici 2030. Seulement, les besoins en matière de prévention et de traitement antirétroviral dans les pays les moins riches dépassent de loin leur capacité de payer. De plus, le sida touche principalement des groupes de population à risque comme ceux appartenant à des minorités de sexe et de genre. Cette thèse montre que les bénéfices liés à cet investissement massif de la communauté internationale pour mettre fin à l'épidémie de sida d'ici 2030 excède 6 dollar pour chaque dollar investis. Bien que cela soit un investissement attrayant, l’atteinte de l’objectif mondial est loin d’être acquis, notamment concernant les minorités sexuelles et de genres pour qui le risque d’acquérir le VIH est jusqu’à 26 fois plus élevé. Les modèles économiques utilisés ici permettent d’identifier trois facteurs principaux qui freinent l’atteinte des cibles. Premièrement le stigma et la discrimination qui sont la principale barrière à l’accès aux services HIV. Deuxièmement, une trop faible importance est accordée au rôle de la santé mentale sur la vulnérabilité à l’infection par VIH. Finalement, les inégalités qui minent les efforts de la riposte au VIH en diminuant le recours aux tests VIH. Les résultats de cette thèse encouragent les décideurs à prendre en compte l’importance des inégalités, de la santé mentale et de la marginalisation des personnes à haut risque de VIH pour mettre fin au sida
Human immunodeficiency virus (HIV) is one of the leading causes of death in low- and middle-income countries.On June 8, 2021, the United Nations adopted the Political Declaration on Ending Inequality and Ending AIDS by 2030. Nevertheless, the need for prevention and treatment in many of the most affected countries far exceed their ability to pay. In addition, AIDS mainly affects most-at-risk population groups. This thesis shows that the benefits of this massive investment by the international community to end the AIDS epidemic by 2030 exceed 6 for every 1 invested. While this is an attractive investment, achieving the global 95-95-95 HIV target is far from certain, especially for sexual and gender minorities who are up to 26 times more likely to acquire HIV.The economic models used in this research identify three main factors that impede the achievement of the targets. First, stigma and discrimination are the main barrier to accessing HIV services. Second, too little emphasis is placed on the role of mental health in vulnerability to HIV infection. Finally, it demonstrates that inequalities undermine HIV response efforts by reducing the uptake of HIV testing.The findings of this thesis encourage policy makers to consider the importance to address inequality, mental health and homophobia in order to ending AIDS

Formål: Formålet med denne undersøgelse er at få viden om, og belyse fænomenet seksuel orienterings diskrimination (SOD), og få indsigt i hvordan homoseksuelle mænd, på en mandsdomineret arbejdsplads som det danske Forsvar, oplever SOD og hvilken betydning det har for dem. Desuden er hensigten at få viden om og indsigt i hvordan problematikker vedrørende SOD på en mandsdomineret arbejdsplads, som Forsvaret i Danmark kan imødegås og håndteres. Metode: Transskriberede semi-strukturede dybde interviews er anvendt som undersøgelsesredskab. Teoretisk udvælgelse, kodning, komparation og konceptualisering som beskrevet i ”Grounded Theory” er anvendt som analyseinstrument. Resultater: Ud fra analysen af data voksede en kernekategori og fire hovedkategorier frem, som tilsammen udgør kerneprocessen. Minoritetsstyrkeblev studiets kernekategori, som har sit udspring fra de fire hovedkategorier: Stressorer, Identifikation, Mestring og Miljø. Ud fra resultaterne voksede en Minoritesstyrkemodelfrem. Konklussion: Homoseksuelle mænd håndterer et komplekst udvalg af mestringsstrategier, som anvendes i forskellige situationer hvor diskriminering på baggrund af seksuel orientering finder sted. På trods af de negative minoritetsstressorer, som homoseksuelle mænd i den danske Forsvar erfarer, så udviser informanterne en unik Oplevelse af sammenhæng; Meningsfuldhed; Begribelighedog Håndterbarhed, hvilket leder til Minoritetsstyrke. For at forskningen skal være til gavn for hele befolkningen, så gøres i denne undersøgelse opmærksom på nødvendigheden af at inkludere spørgsmål om seksuel orientering i folkesundhedsvidenskabelig forskning. En inkluderende personale politik, undervisning vedrørende HBT personers vilkår og rekrutteringskampagner specielt rettet mod homoseksuelle, medføre større kompetence blandt alle på arbejdspladsen. Studiet har vist at arbejdet, med at forebygge diskriminering på baggrund af seksuel orientering, kræver en multistrategisk indsats på tværfagligt, intersektorielt niveau og et salutogent perspektiv uden at placere alt ansvar på det enkelte individ
Aim: This study aimed to improve knowledge about and illuminate the phenomenon of sexual orientation discrimination (SOD), particularly as perceived by homosexual men in a male-dominated workplace such as the Danish Armed Forces. We also sought to increase understanding of how such discrimination affects those individuals. Moreover, wesought to increase knowledge about and highlight the challenges and problems regarding SOD in the context of coping strategies. Method: We used transcribed semi-structured in-depth interviews as our survey tool. To analyze our results, we used open, axial, and selective coding, as described in grounded theory. Results: Data analysis allowed us to identify minority power (MP) as a core variable. Further, MP is sourced in the four main categories: stressors, coping, environment, and identity, which are elements of the core process. The MP model that emerged from our results illustrates the core process. Conclusion: The study shows that homosexual men use a complex range of coping strategies in different situations where SOD occurs. Despite the negative minority stressors experienced by homosexual men in the Danish Armed Forces, the subjects showed a unique sense of coherence—meaningfulness, comprehension, and manageability—that leads to MP. To benefit the entire population, this study emphasized the need to include questions about sexual orientation in public health research. The study shows that training about the special social conditions for the LGBT population, a diversity policy, and recruitment campaigns aimed at homosexuals result in greater competence among all individuals in the workplace. Preventing discrimination based on sexual orientation requires a salutogen perspective and multifactorial strategy on an intersectorial and interdisciplinary level without placing all responsibility on the individual

ISBN 978-91-85721-72-6

Syftet med denna examensuppsats var att kvalitativt undersöka upplevelsen av minoritetsstress samt dess påverkan och hantering hos homosexuella i Sverige. Detta gjordes genom semistrukturerade intervjuer med tio personer i åldern 22 till 44 år, vars berättelser analyserades med hjälp av en tematisk analys. Resultatet visar på en utbredd upplevelse av minoritetsstress inom flera områden i samhället och livet. Minoritetsstressen berodde på alltifrån hat och avståndstagande, diskriminering, utanförskap, heteronormativt bemötande, exotifiering och internaliserad homofobi till problem vid kontakt med myndigheter, vård och juridik. Minoritetsstressen upplevdes ge en sämre psykisk hälsa, ge upphov till komplexa negativa känslor, begränsa livsutrymmet, dränera energi samt ge upphov till en förhöjd rädsla och vaksamhet för potentiellt ofarliga situationer. Strategier för hantering av minoritetsstressen omfattade allt från socialt stöd, arbete med sin självbild och gränssättning till engagemang för hbtq+- frågor. Informanternas vittnesmål gick i linje med internationell forskning på samma område och kunde vidare förstås när de ställdes bredvid tidigare fynd och teorier kring minoritetsstress och hanteringsstrategier. Vittnesmålen visade även på minoritetsstressens komplexa verkan och genes. Resultatet indikerar ett stort behov av kunskap om homosexuellas utsatthet och livsvillkor inom samhällets alla arenor. Vidare forskning rörande minoritetsstressens omfattning, intersektion med andra minoritetspositioner samt fördjupning kring de olika delområden denna examensuppsats har berört bedöms nödvändig i framtiden.
Minoritetsstress hos hbtqi-personer: Upplevelser och coping

A link between binge drinking, negative sexual health outcomes, and sexual victimization among university populations is well established in the research literature (Messman-Moore et al., 2013; PHAC, 2016; Smith et al., 2009). Despite these known risks, young people often hold beliefs that alcohol consumption can enhance or facilitate their sexual experiences, however, less is known about the role of alcohol in young women’s consensual sexual experiences. In this qualitative study, I used a feminist perspective to explore young women’s perceptions and experiences of the role of alcohol in their sexual agency – the ability to communicate and fulfill their sexual desires and boundaries – and the social norms that influence this relationship. I collected data through interviews with 14 young university women between the ages of 19 and 25 who identified as heterosexual, lesbian, bisexual, or queer. Participants identified heteronormative sexuality norms that influence the role of alcohol in their sexual agency, namely the prioritization of women’s sexual inexperience, female sexual fidelity, and women’s attractiveness. Participants perceived that alcohol influenced their sexual agency at an individual and social level. In their individual experiences, participants discussed the dis-inhibitory effects of alcohol as a “tool” to alleviate feelings of shame associated with sexual expression and negative body image. At a social level, participants used alcohol as a means to deflect social stigma associated sexual expression as they could “blame the alcohol” as their motivation for engaging in sexual activity. These findings suggest that young women’s motivations for drinking may be linked to sexuality norms that discourage young women’s sexual agency, which could be relevant to consider in health promotion and harm reduction efforts.
Graduate
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Problem: Gay, bisexual, and queer (GBQ) adolescent males are disproportionately affected by negative sexual health outcomes compared to their heterosexual counterparts. Their sex education needs are not sufficiently addressed in the home and the larger ecological systems. The omission of their sex education needs at a time when they are forming a sexual identity during adolescence compels GBQ males to seek information in unsupervised settings. Evidence-based interventions aimed at ensuring positive sexual health outcomes through sex communication cannot be carried out with these youth as research on how parents and GBQ males discuss sex in the home has been largely uninvestigated.

Methods: This naturalistic qualitative study focused on the interpretive reports of 15- to 20-year-old GBQ males’ discussions about sex-related topics with their parents. From a purposive sample of 30 male adolescents who self-identified as GBQ, participants who could recall at least one conversation about sex with their parents were recruited for one-time interviews and card sorts. This strategy revealed, using Bronfenbrenners’ Bioecological Theory, their perceptions about sex communication in the context of their reciprocal relationship and the ecological systems that GBQ males and their parents navigate.

Results: Parents received poor ratings as sex educators, were generally viewed as not confident in their communication approach, and lacked knowledge about issues pertinent to GBQ sons. Nevertheless, participants viewed parents as their preferred source of sex information and recognized multiple functions of sex communication. The value placed by GBQ youth on sex communication underscores their desire to ensure an uninterrupted parent-child relationship in spite of their GBQ sexual orientation. For GBQ children, inclusive sex communication is a proxy for parental acceptance.

Results show that the timing, prompts, teaching aids, and setting of sex communication for this population are similar to what has been reported with heterosexual samples. However, most GBQ sons rarely had inclusive guidance about sex and sexuality that matched their attraction, behavior, and identities. Furthermore, the assumption of heterosexuality resulted in the early awareness of being different from their peers which led them to covertly search for sex information. The combination of assumed heterosexuality and their early reliance on themselves for applicable information is a missed parental opportunity to positively impact the health of GBQ sons. More importantly, due to the powerful reach of new media, there is a critical period of maximum receptiveness that has been identified which makes inclusive sex communication paramount in the pre-sexual stage for this population. Our findings also indicate that there are plenty of opportunities for systemic improvements to meet this population’s sexual education needs.

Dissertation

This Master's Thesis reports on the experiences of Type 2 Diabetes of Lesbian, Queer, and Women-Loving Women. The thesis examines the impact of sexual orientation on experiences with diabetes, and how this chronic disease affects the way a woman views herself, her health, and her body image. Each participant presented her narrative and world views in regards to her diabetes health care and management, stress and trauma, and management of relationships. Through narrative analysis, I have revealed differing mechanisms of coping and explanatory models; the many women of this study selectively chose to be more open about her sexual orientation than her diabetes status.

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção de grau de Mestre na especialidade em Psicologia Clínica
Espera-se que até 2050 a população com 60 ou mais anos, atualmente representada por 841 milhões, passe a dois bilhões. Prevê-se que em Portugal, até 2080, a população de idade avançada passe de 2.1 a 2.8 milhões. As investigações atuais demonstram um aumento significativo da população LGBT nesta faixa etária, sendo que a literatura tem-se manifestado desatualizada e insuficiente parecendo não acompanhar as necessidades destes indivíduos. Esta população, constituindo-se como minoria sexual e de idade avançada, está particularmente sujeita a um duplo estigma. Neste estudo, pretende-se avaliar de que forma o estatuto minoritário, associado ao estigma sexual, à discriminação associada à idade e a outras variáveis psicossociais, interfere em variáveis de saúde mental, como a satisfação sexual e relacional. A amostra é constituída por 96 homens gays/bissexuais com 60 anos ou mais (M = 62.9; DP = 4.37) que responderam ao protocolo do projeto Silver Rainbow. Os dados foram recolhidos em formato online e em papel. A discriminação associada à idade explica de forma significativa a satisfação sexual e relacional, embora o estigma sexual apenas contribua significativamente para a explicação da satisfação sexual. Ainda, os níveis de coming out contribuem para a explicação da satisfação relacional. Verifica-se que o duplo estigma explica significativamente os níveis de satisfação sexual, mas não os de satisfação relacional. O Modelo de Stress Minoritário afigura-se como um modelo explicativo sólido no estudo desta população. Devido à escassez de estudos nesta área, sugere-se mais investigação no âmbito do envelhecimento LGBT.
ABSTRACT: It is expected that by 2050 the population with 60 or more years, currently represented by 841 million, will reach the number two billions. It is expected that in Portugal, by the year 2080, the elderly population will go from 2.1 to 2.8 million. Current research demonstrates a significant increase of the LGBT population in this age group, and literature is currently outdated and insufficient, and does not seem to address the needs of these individuals. This population, constituting itself as sexual minority and elderly people, is particularly subject to a double stigma. In this research, the aim is to evaluate how minority status, associated with sexual stigma, age discrimination and other psychosocial variables, interferes with mental health variables such as sexual and relationship satisfaction. The sample consisted of 96 gay/bisexual men aged 60 years or older (M = 62.9; SD = 4.37) who responded to the Silver Rainbow protocol. The data were collected in online and in paper format. Age discrimination significantly explains sexual and relationship satisfaction, although sexual stigma only contributes significantly to the explanation of sexual satisfaction. Moreover, the levels of coming out contribute to the explanation of relationship satisfaction. It is verified that the double stigma explains significantly the levels of sexual satisfaction, but not those of relationship satisfaction. The Minority Stress Model appears as a solid explanatory model in the study of this population. Due to the lack of studies in this area, more research in the field of LGBT aging is suggested.

O presente estudo, pretende avaliar o impacto que o estigma internalizado, o estigma sentido e níveis de coming out têm na saúde mental, como o distress e suicidalidade, e nos comportamentos com impacto na saúde física, como o abuso de substâncias e comportamentos sexuais de risco, de pessoas LGBT. Pretendeu ainda explorar se existem diferenças entre géneros e entre pessoas monossexuais (gays e lésbicas) e plurissexuais (bissexuais, pansexuais, queer e fluídos). A presente investigação utilizou uma metodologia quantitativa e uma amostragem não probabilística, por conveniência, online e em papel. A amostra é constituída por 313 participantes LGBT, dos quais 153 são mulheres, 149 homens e 11 Transgénero/não binário. Os participantes tinham entre 25 e 59 anos (M = 35.94; SD = 8.366). O coming out e a gestão de autoestigma face ao preconceito contribuíram significativamente para a explicação dos níveis dos outcomes de saúde. Nomeadamente, maiores níveis de autoestigma e menores níveis de coming out foram associados a maior distress psicológico. Maiores níveis de autoestigma e coming out foram associados a maior ideação suicida. Menores níveis de coming out e maiores níveis de autoestigma foram associados a maior envolvimento em comportamentos de risco. A prevalência de suicidalidade na amostra e o facto de cerca de 1/3 dos participantes terem apresentado níveis de distress severo evidenciam o quão importante a intervenção psicológica, a nível do estigma internalizado e do coming out pode ser para a melhoria da saúde mental e física, e, consequentemente da qualidade de vida dos indivíduos LGBT.
The present study aims to assess the impact that internalized stigma, felt stigma, and coming out levels have on mental health, such as distress and suicide, and behaviours impacting on physical health, such as substance abuse and sexual behaviour risk of LGBT people. As well as exploring if there are differences between genders and between monosexual (gays e lesbians) and plurisexual (bisexuals, pansexual, queer and fluid) people. This research used a quantitative methodology and a non-probabilistic sample. The data being collected in online and in paper format. The sample consisted of 313 LGBT participants, 153 are women, 149 men and 11 Transgender/non-binary. The participants were between 25 and 59 years old (M = 35,94; SD = 8,366). Coming out and managing self-stigma against prejudice contributed significantly to the explanation of the levels of health outcomes. Namely, higher levels of self-stigma and lower levels of coming out were associated with greater psychological distress. Higher levels of self-stigma and coming out were associated with higher suicidal ideation. Lower levels of coming out and higher levels of self-stigma were associated with greater involvement in risk behaviours. The prevalence of suicidality in the sample and the fact that about 1/3 of the participants had severe distress levels show how important psychological intervention in internalized stigma and coming out can be for improving mental and physical health, and consequently, the quality of life of LGBT individuals.

A growing body of research shows that social identities have a profound impact on health-related outcomes. However, the relationships between identity and health are complex and may be complicated by stigmatization and the social-cultural context. This is the case for sexual minorities, where on one hand their identity can lead to adverse mental health outcomes but on the other, they can unlock psychological resources. The present research examines if an LGBT+ identity can provide a “social cure” to buffer the effects of perceived discrimination against the psychological health of sexual minorities by exploring how (1) ingroup identification and perceived social support from the LGBT+ community may mediate this relationship, and (2) these relationships differ across collectivistic and individualistic societies. Participants (n = 441) from collectivistic (the Dominican Republic and Portugal) and individualistic (the United States of America, the Republic of Ireland) countries completed measures of perceived discrimination, LGBT+ in-group identification, LGBT+ perceived social support and psychological health. Serial mediation analysis indicated that the negative relationship between perceived discrimination and psychological health mediated by in-group identification and perceived social support from the LGBT+ community. Subsequent analysis revealed that there was evidence of a combined mediation effect on the collectivistic sample but not in the individualistic one. Findings revealed that the social identity processes in sexual minority individuals may buffer the effects of perceived discrimination through their LGBT+ identity, and the cultural context may influence how sexual minorities relate to the LGBT+ community.
Education, Audiovisual and Culture Executive Agency (EACEA) for the Erasmus+ Erasmus Mundus Joint Master’s Degree and Erasmus+: Erasmus Mundus Scholarships