Year of Award

2019

Document Type

Thesis

Degree Type

Master of Arts (MA)

Degree Name

Clinical Psychology

Department or School/College

Psychology

Committee Chair

Bryan Cochran, Ph.D.

Commitee Members

David Schuldberg, Ph.D., Jingjing Sun, Ph.D.

Keywords

concealment, gender minority, sexual minority, depression, anxiety, substance use

Subject Categories

Multicultural Psychology | Psychology

Abstract

Background: Sexual and gender minority (SGM) individuals suffer at disproportionate rates of depression, anxiety, and substance use, among other mental and physical health outcomes, compared to heterosexual individuals. Concealment of non-heterosexual sexual identity and/or non-cisgender gender identity may be a key contributor to these disparities. Many SGM individuals engage in concealment as a means to avoid victimization, or because of negative perceptions of their own identity. Concealment as a construct has been conceptualized as comprising cognitive, affective, and behavioral components, each of which individually has been demonstrated to have negative health impacts. Additionally, concealment occurs over time between the intrapersonal recognition of an identity and first interpersonal disclosure. In the current study, a fully-integrated convergent mixed methods design was employed. I hypothesized that more extensive past concealment of gender and sexual identity - through the endorsement of cognitive, affective, and behavioral components implicated in concealment – would be associated with greater present mental health impact (as indicated by current depression and anxiety symptomatology and substance use). I anticipated that this relationship would be mediated by the length of time an individual concealed their identity. The qualitative data was assessed to identify aspects related to concealment that emerge, and the qualitative and quantitative databases were compared for convergence and divergence.

Methods: SGM participants (N = 640; Mage = 24.36, SD = 7.51) were predominantly white (92%) and highly diverse with respect to sexual orientation and gender. For the purpose of this study, a new measure of concealment was devised to assess for cognitive, affective, and behavioral components of concealment of both gender and sexual identity. Each participant completed a survey that included an identity milestone questionnaire, the extent of concealment measure, qualitative questions, and measures testing the outcome variables. The qualitative sample (N = 61; Mage = 23.85, SD = 6.85) was proportionally representative of the larger sample in regard to identity.

Results: Based on a Principal Component Analysis, a three-component structure of concealment was not borne out with the current sample. However, based on quantitative response rates as well as qualitative analyses, evidence suggested that concealment experiences included cognitive, affective, and behavioral aspects. Additional aspects of concealment also qualitatively emerged, indicating that the measure of concealment may not have comprehensively captured the construct of concealment. In regard to hypothesis 1, as predicted, the more individuals concealed their identity, the more severe their current level of depression and anxiety symptomatology, and the more intense their current alcohol and drug use. Furthermore, some of these psychological impacts of concealment were further supported based on participants’ self-report of struggles with depression, anxiety, and suicidality. Finally, despite minor relationships with depression and anxiety symptomatology, the duration of concealment of both gender and sexual identity failed to predict any of the other outcome variables on its own (hypothesis 2). Therefore, duration of concealment did not mediate the relationship between concealment and the outcomes (hypothesis 3).

Discussion: Based on a fully-integrated convergent mixed methods analysis, these findings highlight that concealment is a common phenomenon in the lives of SGM individuals, and that the experience of concealment includes engagement in a variety of internal and external behaviors. These behaviors include tightly intertwined psychological processes. Notably, concealing a sexual and/or gender identity is associated with significant mental health impacts, including depression, anxiety, and substance use. Based on the findings of this study, which diverge from limited past research, these impacts do not seem to be predicted by the length of time an individual is closeted about their gender and/or sexual identity.

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© Copyright 2019 James Michael M. Brennan