Year of Award

2023

Document Type

Dissertation

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Bryan N. Cochran

Commitee Members

Jacqueline Brown, Christine Fiore, Daniel Denis, Elizabeth Hubble

Keywords

adolescents, gender and sexual minority, LGBTQ, minority stress

Abstract

Substantial epidemiological research (Talley et al., 2016; Burton et al., 2013; Institute of Medicine [IOM], 2011) indicates that gender and sexual minorities (GSM; non-cisgender and non-heterosexual, respectively) disproportionately experience health disparities, including anxiety disorders (e.g., panic disorder, generalized anxiety disorder, social anxiety disorder; Cochran et al., 2003; Gillman et al., 2001). Disparities in anxiety symptoms and disorders for GSM adults may begin to emerge in adolescence (Fish & Pasley, 2015; Needham, 2012; Ueno, 2010). In particular, GSM adolescents report higher rates of anxiety symptoms and anxiety disorders (Kosciw et al., 2014; Mutanski & Liu, 2013) than heterosexual, cisgender adolescents. Minority stress theory (Cochran & Mays, 2000; Meyers, 2003) posits that health disparities for GSM individuals are best explained by the larger stress load experienced by GSM individuals due to unique social stressors, both directly observable and indirectly experienced, that arise from living with a minority sexual or gender identity (e.g., discrimination, rejection, internalized stigma, expectations of rejection, concealment; binegativity, for individuals attracted to more than one gender, or plurisexual people; Ochs, 1996, Yost & Thomas, 2012; gender minority stress, for gender minority, or non-cisgender individuals; Hendricks & Testa, 2012). Minority stress theories also emphasizes the development of resilience to minority stressors via psychosocial, or as conceptualized using Bronfenbrenner’s (1977) model, social ecological factors, such as perceived social support.

Conceptualizing the social environment of GSM adolescents using both minority stress and social ecological theory provides structure for exploring important social ecological factors that may confer risk or protection for anxiety symptoms for GSM adolescents at different places in the adolescents' social context (e.g., in schools versus state policy). The relationships between minority stress, anxiety, and different social ecological systems of the adolescent GSM social ecology—the focus of this study--are not well known, especially how social ecological factors between different systems (i.e., how peer relationships and community acceptance) relate to each other and to anxiety. Additionally, this project examined the relationships between institutional discrimination, other social ecological factors, and anxiety.

GSM emerging adults retrospectively reported on their past and present anxiety symptoms, minority stress, and their social ecology during high school. As expected, minority stress was related to past and present anxiety, and several social ecological variables were correlated with past and present anxiety across different systems in the social ecological systems (e.g., concealment of a minority gender or sexual identity [GSI] within the family, losing friends due to GSI, or experiencing victimization). In order to test the minority-stress informed social ecological model, a backwards regression identified social ecological models related to past and present anxiety, and those models were validated via hierarchical regression. Distress due to hearing peers use bias-based language predicted past anxiety. Once social ecological variables were entered into the regression model, minority stress was not related to past or current anxiety symptoms in the context of social ecological variables. Implications for practice and future directions for study are discussed, particularly as they relate to interventions for clinicians or school-based providers.

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© Copyright 2023 Kinsie Jean Dunham