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The Role of Stigma Visibility on Stigma-Related Stress, Coping, and Health: An Exploration among Gay Men and Lesbians
AuthorDoane, Michael J.
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Members of stigmatized groups experience compromised mental and physical health as a result of their disadvantaged social status. While a large body of literature addresses the health consequences of belonging to conspicuous or visible stigmatized groups (e.g., race, gender), researchers know relatively less about the consequences of belonging to stigmatized groups with concealable or “hidden” identities (e.g., mental illness, HIV-positive status). The visible nature of a stigmatized identity might play an important role in shaping processes related to stress, coping, and ultimately health. To address this gap in the current literature, a series of four studies sought to directly examine the role of stigma visibility in shaping (1) stigma-related experiences (e.g., discrimination), (2) psychosocial coping resources (e.g., in-group identification), and (3) mental and physical health. These studies integrated models of stress, coping, and health, and used diverse research methods (i.e., cross-sectional and longitudinal) to explore how living with a more or less visible identity may explain health disparities among members of stigmatized groups. The studies included in this dissertation research focus on the experiences of gay men and lesbians. While sexual orientation is primarily defined as a concealable stigmatized identity, there is evidence suggesting that the gendered-nature of physical characteristics and behaviors leave some gay men and lesbians more or less identifiable as such (e.g., effeminate gay men, masculine lesbians). Pilot Study Wave 1 (N = 151 gay men; N = 186 lesbians) found stigma visibility to be empirically distinct from openness of sexual orientation. This study also provided initial evidence that stigma visibility is associated with more frequent experiences of discrimination among gay men and lesbians. Stigma visibility was associated with several other key variables, including lower sense of control and greater depressive symptomatology. Pilot Study Wave 2 (N = 68 gay men; N = 83 lesbians), a follow-up to Wave 1, found stigma visibility to be a relatively stable construct over three months. The factor structure of the stigma visibility measure held together over time, and visibility was again empirically distinct from openness of sexual orientation.Study 1 (N = 1,627 gay men; N = 848 lesbians) involved participants recruited from LGBT organizations and online resources (e.g., Facebook). These participants completed an online survey assessing the main stress, coping, and health model integrated from several theoretical perspectives. Among the various findings, stigma visibility was associated with more frequent experiences of discrimination. Stigma visibility primarily operated through experiences of discrimination to affect mental and physical health, though in both positive and negative ways. For example, experiences of discrimination predicted increases in the internalization of stigma and lowered sense of control, harming health and well-being. Experiences of discrimination also increased social identification with similarly stigmatized others, which improved health outcomes.Study 2 (N = 67 gay men; N = 47 lesbians) was a daily diary survey distributed to a subset of participants from Study 1 who scored either high or low on the stigma visibility measure. Participants completed one survey per day for a total of 10 days. Results corroborate the key finding from Study 1: stigma visibility is indirectly associated with compromised mental and physical health via experiences of discrimination. That is, gay men and lesbians who are more visible experience relatively more discrimination on a day-to-day basis. Experiences of discrimination reduce health, thereby linking stigma visibility with various health-related outcomes (e.g., depression, anxiety, and physical illness). Results of this dissertation research inform how the visibility of stigmatized identities may be related to stigma-related stressors, psychosocial coping resources, and ultimately both mental and physical health. The empirically-tested model suggests reasons why some stigmatized group members report poor health while other members remain relatively healthy and resilient in the face of their social disadvantage. While these studies focus on gay men and lesbians, the results may apply to members of other stigmatized groups that differ in the degree to which they are more or less visible. Research identifying factors that put certain minority group members at risk for worse health outcomes relative to other members is vital to address health disparities; the visibility of minority identities appears to be one such risk factor.