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. Author manuscript; available in PMC: 2025 Jul 14.
Published in final edited form as: J Contextual Behav Sci. 2024 Jul 14;33:100804. doi: 10.1016/j.jcbs.2024.100804

Minority Stress, Mental Health, and Mindfulness and Self-Compassion as Moderators among Young Sexual Minority Men: A Moderated Structural Equation Analysis

Shufang Sun 1, Arryn A Guy 2, Matthew J Murphy 3, David G Zelaya 4,5, Yohansa Fernandez 6, Don Operario 7
PMCID: PMC11488792  NIHMSID: NIHMS2025218  PMID: 39430428

Abstract

Young adult sexual minority men are at heightened risk for psychological distress (i.e., depression and anxiety). Mounting evidence suggests the adverse consequences of distal stigma, and existing frameworks (the Minority Stress Theory and Psychological Mediation Framework) posit that distal minority stress may impact psychological distress through minority stress-specific processes, such as internalized homonegativity, as well as general psychological vulnerability factors, such as emotion dysregulation. There is a lack of research examining this process integrating both frameworks and understanding potential resilience factors such as mindfulness and self-compassion and where they may assert impact. Using structural equation modeling, the current study investigated the relationship between distal minority stress, measured by heterosexist discrimination, and psychological distress (i.e., depression and anxiety) through a serial indirect effect via internalized homonegativity and emotion dysregulation, while including internalized homonegativity and emotion dysregulation for their unique indirect effects separately, among young adult sexual minority men (n = 307). Further, the study explored mindfulness and self-compassion as potential moderators in subsequent models. Results indicate that two significant paths explain the association between heterosexist discrimination and psychological distress, including through internalized homonegativity and emotion dysregulation as a serial indirect path, as well as through internalized homonegativity alone. Both mindfulness and self-compassion emerged as protective factors in the “upstream” part of the model, particularly in the effect of heterosexist discrimination on internalized homonegativity. Contrary to expectation, both mindfulness and self-compassion had a strengthening impact on the positive association between internalized homonegativity and emotion dysregulation. Findings support the conceptualization of emotion dysregulation as a “downstream” effect of minority stress, as well as adapting and utilizing mindfulness and self-compassion to alleviate the impact of distal minority stress. Additional longitudinal research, particularly rigorously designed clinical trials, is needed to further evaluate such intervention programs.

Keywords: sexual minority, mindfulness, self-compassion, minority stress, structural equation modeling

Sexual minority men, including those who identify as gay, bisexual, and other nonheterosexual orientations in the U.S., face a disproportionate burden of psychological distress, such as depression and anxiety, compared to their heterosexual male peers (Batchelder et al., 2017; Cochran & Mays, 2009; Krueger et al., 2020; Mills et al., 2004; Plöderl & Tremblay, 2015). Meta-analytic research indicates that sexual minority men are more than twice as likely to experience depression and anxiety and receive a lifetime diagnosis of depressive or anxiety disorders compared to their heterosexual counterparts (King et al., 2008; Wittgens et al., 2022).

Young/emerging adult sexual minority men may be particularly vulnerable to psychological distress. Regardless of sexual orientation, this stage of life is known for its heightened risk for mental health issues globally, which can lead to long-term consequences if not addressed early, including mortality, educational underachievement, and ongoing mental health struggles (Davey & McGorry, 2019; Patel et al., 2007). The 2022 Trevor Project National Survey on LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning) Youth Mental Health revealed that 63% and 49% of young gay men reported experiencing symptoms of anxiety and depression, respectively (The Trevor Project, 2022). Understanding and addressing mental health issues among emerging adult sexual minority men remains a crucial task, especially in the current climate of increasing anti-LGBTQ legislation (The Human Rights Campaign, 2023). This effort can also help to prevent other adverse outcomes associated with poor mental health in this population, such as suicide, alcohol and substance use disorder, and HIV/STIs (Goldbach et al., 2014; Hatchel et al., 2021; Operario et al., 2022).

Minority Stress-Specific and General Psychological Vulnerability Pathways

A theoretical framework that explains the disparities faced by sexual minority individuals is the Minority Stress Theory (Meyer, 2003). This theory posits that being in a discriminatory environment exposes sexual minority individuals to distal minority stressors, such as discrimination, harassment, and prejudice based on one’s sexual orientation. These experiences can lead to internalization, resulting in proximal minority stressors, such as internalized homonegativity, heightened expectations of rejection, and identity concealment. Ultimately, this process increases the risk of mental health challenges among sexual minority people (Meyer, 2003). Mounting evidence consistently supports key pathways illustrated by the Minority Stress Theory (Newcomb & Mustanski, 2010; Pachankis et al., 2018; Pascoe & Richman, 2009), especially the crucial role of internalized homonegativity. A meta-analysis revealed a strong association between internalized homonegativity and increased symptoms of depression and anxiety among sexual minority individuals (Newcomb & Mustanski, 2010). Moreover, several cross-sectional studies demonstrated that discrimination has an indirect effect on psychological distress among sexual minorities via internalized homonegativity (Dyar et al., 2018; Feinstein et al., 2012; Igartua et al., 2003; Longares et al., 2016; McLaren, 2016; Soo Hoong Yean, 2017).

In addition to the unique processes outlined in the Minority Stress Theory, the Psychological Mediation Framework proposes that distal minority stressors could also lead to general psychological processes that increase the risk of psychopathology in both sexual minority and general populations (Hatzenbuehler, 2009). These general processes include affective factors (e.g., emotion dysregulation), social factors (e.g., interpersonal problems), and cognitive factors (e.g., hopelessness) (Hatzenbuehler, 2009). Findings from several longitudinal studies support the role of emotion dysregulation, such as rumination, as a mechanism through which minority stress contributes to psychological distress (Lattanner et al., 2022; Sarno et al., 2020; Timmins et al., 2020).

However, limited research has integrated both models to illustrate how distal minority stressors, such as discrimination, are associated with poor mental health outcomes through the interaction of minority stress-specific pathways (i.e., internalized homonegativity) and general processes (i.e., emotion dysregulation). For example, Liao and colleagues (2015) found in a cross-sectional online survey that experienced discrimination was associated with expectations of rejection, which, in turn, was associated with increased anger rumination and psychological distress among sexual minorities. Another longitudinal study focused on proximal minority stress found that emotion dysregulation mediated the relationship between internalized homonegativity and psychological distress in a sample of gay and bisexual men with HIV (Rendina et al., 2017).

In summary, the evidence supports the notion that heightened distal stressors (e.g., discrimination) lead to both proximal minority stress and general psychological processes, each of which independently increases the risk of mental health issues. However, further research is needed to explore how these minority stress-specific pathways (e.g., internalized homonegativity) and general processes (e.g., emotion dysregulation) may concomitantly affect psychological distress. Such understanding may help clarify the pathways through which distal stressors are associated with mental health outcomes and guide intervention efforts. For instance, investigating whether heterosexist discrimination has an indirect effect on mental health issues through emotion dysregulation as a general process alone or through internalized homonegativity in a serial pathway will contribute to a better understanding of how both processes may be intertwined. This knowledge can inform interventions aimed at promoting mental health in this group by addressing both minority stress and emotion regulation skills (e.g., Pachankis et al., 2015; Parsons et al., 2017).

Mindfulness and Self-Compassion as Moderators

Another critical aspect to consider in our understanding and the dismantling of minority stress is the role of psychological factors that may disrupt the process of minority stress to distress, acting as buffers (i.e., moderators) in this relationship. Emerging evidence suggests that mindfulness and self-compassion may serve as crucial moderating factors in alleviating psychological distress among sexual minority individuals. Originating from Buddhist traditions, mindfulness and self-compassion have gained popularity in mainstream settings over the past decades, with several evidence-based programs (e.g., Mindfulness-based Stress Reduction, Mindful Self-Compassion) demonstrating efficacy in addressing mental health in clinical and non-clinical general populations (Ferrari et al., 2019; Goldberg et al., 2018; Khoury et al., 2015). Mindfulness involves being aware of the present moment without judgment (Kabat-Zinn, 2009), while self-compassion entails treating oneself with kindness, without judgment, and recognizing one’s shared common humanity (Neff, 2003). Meta-analytic evidence supports the association between self-compassion and mental health among sexual minority individuals (Carvalho & Guiomar, 2022). Several cross-sectional studies have found that mindfulness and self-compassion moderate the association between experienced discrimination and psychological distress among sexual minority youth and college students (Helminen et al., 2023; Toomey & Anhalt, 2016). Additionally, two formative research findings with young sexual minority men and sexual minority youth who participated in affirmative mindfulness intervention programs suggested that mindfulness and self-compassion are relevant practices to alleviate the negative mental health consequences of minority stress (Iacono et al., 2022; Sun et al., 2022).

Further research is necessary to explore how mindfulness and self-compassion may disrupt the pathways between experienced discrimination and proximal minority stress, or the links between proximal minority stress, emotion dysregulation, and subsequent psychological distress. Mindfulness and self-compassion may serve as moderating factors on one or several pathways from distal stigma to distress. Structural equation modeling can facilitate a comprehensive examination of multiple mechanisms simultaneously, including both serial indirect effects and moderation (Sardeshmukh & Vandenberg, 2017). Understanding these processes can guide mindfulness and self-compassion-based interventions and potentially improve the relevance and efficacy of interventions for mental health in sexual minority populations (Iacono et al., 2022; Sun et al., 2021, 2022, 2023).

The Present Study

There is a pressing need for researchers to gain a deeper understanding of the nuanced processes of minority stress, involving both proximal minority stressors and general psychological processes, that contribute to psychological distress among sexual minority individuals, including young adult sexual minority men. In Figure 1, we present our research hypotheses in the form of a path model, informed by the Minority Stress Theory (Meyer, 2003) and the Psychological Mediation Framework (Hatzenbuehler, 2009). Based on previous research suggesting that proximal minority stress may have an indirect effect on mental health issues via emotion dysregulation (Rendina et al., 2017), we incorporate it as a potential pathway in our model. Figure 1 illustrates a serial indirect model, with heterosexist discrimination as the exogenous variable, internalized homonegativity and emotion dysregulation representing minority stress-specific and general psychological processes, and psychological distress (depression and anxiety) as the outcome/endogenous variable. We hypothesize that (a) heterosexist discrimination will be positively associated with psychological distress; (b) heterosexist discrimination will have a serial indirect effect on psychological distress via internalized homonegativity and emotion dysregulation; and (c) heterosexist discrimination will have indirect effects on psychological distress, via internalized homonegativity and emotion dysregulation, separately and independently.

Figure 1.

Figure 1.

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Standardized path coefficients (SE) for structural paths in the model

Note. Standardized path coefficients (SE) are reported for the structural paths in the model. Paths that were hypothesized as a priori yet were not found to be statistically significant are retained in this figure with path lines unbolded and dotted. Bolded path lines represent significant associations. p < .001 ***, p < .01 **, p < .05 *

In addition, this study will explore mindfulness and self-compassion as potential protective factors, using explorative, moderator analyses. This study intends to contribute to the growing knowledge base on the role of mindfulness and self-compassion in the impact of minority stress and mental health to guide future intervention efforts in this regard.

Method

Participants and Procedure

Recruitment took place via advertisement on social media and LGBTQ+ organizations (e.g., university-based LGBTQ+ student organizations). Eligibility criteria included: (1) being 18 to 35 years of age, (2) assigned male sex at birth, (3) self-identify as a sexual minority man (e.g., gay, bisexual, pansexual, queer), (4) can read and speak English. Since the larger survey also aimed to understand HIV prevention-related issues, it also required participants to have engaged in sexual behavior with a man in the past and self-report as HIV-negative or status-unknown.

Interested individuals completed a brief screener (~2–3 minutes) to determine their eligibility and if eligible, they were then invited to participate in the full survey. Two sets of informed consent were presented (for screener and main survey), and participants provided consent by choosing “I agree” to proceed with study participation. Individuals were encouraged to take part in the study in a private setting. A list of LGBTQ-affirmative mental health resources and a suicide hotline were presented at the beginning of the study. The survey was designed to take approximately 30–45 minutes. Participants were compensated with a $15 Amazon gift card for survey completion. The survey included several techniques to assess data integrity (e.g., bots) described in detail elsewhere (manuscript under review; Author et al). Responses were reviewed for data integrity before inclusion in the final sample. The study was approved by the Institutional Review Board at [masked for review] (protocol number: 2004002698).

Measures

Sociodemographic information.

The survey assessed a battery of sociodemographic information: age, gender identity, sexual orientation, race/ethnicity, US residence, geographic residence, education, and past-year household income, among others. As a variable of interest, race was collapsed into a binary variable (0 = white, non-Hispanic, 1 = people of color) for analysis. Additionally, past-year household income was collected as an ordinal, categorical variable with seven levels (1 = Less than $10,000, 7 = Over $100,000).

Discrimination.

Discrimination was measured by the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS; Szymanski, 2006). The 14 items measured past-year experiences of heterosexism across various domains (e.g., harassment/rejection, work/school). The original scale was primarily developed with lesbian women. Thus, its language was adapted for the current study. Example items include “How many times have you been rejected by friends because you are an LGBTQ person?”, “How many times have you heard anti-gay/anti-LGBTQ remarks from family members?” and “How many times have you been treated unfairly by your co-workers, fellow students, or colleagues because you are a LGBTQ person?” Participants rated each item according to the frequency with which they experienced the listed events on a Likert scale (1 = never happened, 6 = almost all the time). A total score for each participant was created from the sum of their ratings, where higher scores reflect a greater prominence of heterosexist experiences in the past year. HHRDS items demonstrated a strong robust internal consistency (α = .93) in this sample and others (Szymanski, 2006). The three HHRDS subscales had fair internal consistency in the sample (α1 = .89, α2 = .79, α3 = .69).

Internalized homonegativity.

Internalized homonegativity was measured by the Internalized Homophobia Scale (IHS; Frost & Meyer, 2009; Martin & Dean, 1992). The nine items assessed how participants feel about being gay, bisexual, or queer men. The scale instructed participants to rate the frequency with which they experienced listed thoughts and feelings (e.g., “You have wished you weren’t gay, bisexual, or queer”) in the past year. Participants rated each item on a four-point Likert scale (1 = never, 4 = often). Item responses were summed for a total score, such that a higher total score represents more frequent experiences of internalized stigma. The IHS demonstrated excellent internal consistency in this sample (α = .90) and others (Walch et al., 2016; Meyer, 1995; Martin & Dean, 1992).

Emotion dysregulation.

Emotion dysregulation was measured by the Short-Form Difficulties in Emotion Regulation Scale (DERS-SF; Gratz & Roemer, 2004; Kaufman et al., 2016). The 18 items assessed how often participants experienced typical difficulties in emotion regulation across six subscales: (1) nonacceptance of emotional response, (2) difficulties engaging in goal-directed behavior, (3) impulse control difficulties, (4) lack of emotional awareness, (5) limited access to emotion regulation strategies, and (6) lack of emotional clarity. Participants rated each item on a five-point Likert scale (1 = almost never, 5 = almost always). Example items include “I have no idea how I am feeling” and “When I’m upset, it takes me a long time to feel better.” A total score for each participant was created from the sum of their six subscale scores, such that a higher total score reflects a greater salience of emotion dysregulation. The DERS-SF demonstrated good internal consistency in this sample (α = .89) and others (Pachankis et al., 2014; Rogers et al., 2017).

Mindfulness.

Mindfulness was measured by the Mindful Attention Awareness Scale (Brown & Ryan, 2003), a 15-item scale that assesses everyday experiences of dispositional mindfulness (e.g., “I find myself preoccupied with the future or the past,” “I find it difficult to stay focused on what’s happening in the present). Participants rated each item on a six-point Likert scale (1 = almost always, 6 = almost never), such that higher averaged scores reflect higher levels of dispositional mindfulness. The Mindful Attention Awareness Scale demonstrated excellent internal consistency in our same (α = .92) and elsewhere (MacKillop & Anderson, 2007).

Self-compassion.

Self-compassion was measured by the Self-Compassion Scale (Chan et al., 2020; Vigna et al., 2018). The 26 items assessed core components of self-compassion across six subscales: (1) self-kindness, (2) self-judgement, (3) common humanity, (4) isolation, (5) mindfulness, and (6) over-identification. Participants used a five-point Likert scale (1 = almost never, 5 = almost always) to rate items such as “When I fail at something important to me, I become consumed by feelings of inadequacy” according to how they would typically act toward themselves during difficult times. A total score was calculated from the sum of the six subscale scores, such that a higher total score reflects a greater self-compassion. The Self-Compassion Scale demonstrated a good internal consistency in our sample (α = .80) and elsewhere (Chan et al., 2020; Vigna et al., 2018).

Psychological distress.

Psychological distress was assessed by two scales, including PHQ-9 for depressive symptoms and GAD-7 for anxiety symptoms. The nine-item Patient Health Questionnaire depression module (PHQ-9; Kroenke & Spitzer, 2002) of the PRIME-MD Diagnostic Instrument (Spitzer et al., 1994) reflects the nine DSM-IV criteria for a major depressive episode, and assessed severity of depressive symptoms in the past two weeks. Participants rated the nine items on a four-point Likert scale (0 = not at all, 3 = nearly every day). Item responses were summed, such that higher totals indicated greater symptom frequency. The PHQ-9 demonstrated good internal consistency in this sample (α = 0.88) and in others (Grant et al., 2014; Sakharkar & Friday, 2022). Likewise, the seven-item Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006) assessed anxiety symptom frequency in the past two weeks. Participants rated the seven items on a four-point Likert scale (0 = not at all, 3 = every day) and items were summed such that high totals indicated greater anxiety symptom frequency. The GAD-7 demonstrated good internal consistency in this sample (α = 0.86) and in similar populations (Borgogna et al., 2019; Gibbs & Fusco, 2023).

Data Analytic Approach

Outlier detection.

Prior to conducting SEM, we screened data for missing values and assessed the normality of each of the analyzed variables. As the survey data was already screened for completion and validity (details on sample collection methodology described in Author et al.), no missing data was found in the current study sample. No variables showed non-normal distribution (skewness values > 3 or kurtosis values > |1| (Weston & Gore Jr., 2006). Mahalanobis’ distance test was used to detect multivariate outliers, which led to the subsequent removal of outlier cases, providing a final analytic sample of 307 cases from n = 325 of the original sample. Table 1 presents the zero-order correlations, means, and standard deviations of variables for the current study.

Table 1.

Means, Standard Deviations, and Intercorrelations among Study Variables (n = 307)

Variables 1 2 3 4 5 6 7
1. Heterosexist discrimination -
2. Internalized homonegativity 69*** [.63, .74] -
3. Emotion dysregulation .56*** [.48, .64] .76*** [.70, .80] -
4. Depression .56*** [.48, .63] 74*** [.69, .79] .67*** [.60, .73] -
5. Anxiety .39*** [.29, .48] .62*** [.54, .68] .61*** [.54, .68] .84*** [.80, .87] -
6. Mindfulness −23*** [−.34, −.13] −.59*** [−.66, −.51] −.58*** [−.65, −.50] −59*** [−.66, −.51] −.56*** [−.63, −.46]
7. Self-compassion −.13* [−.24, −.02] −.49*** [−.57, −.40] −64*** [−.70, −.57] −48*** [−.56, −.39] −.50*** [−.58, −.42] .58*** [.50, .65] -
M 38.59 19.08 46.29 9.07 6.91 3.64 81.45
SD 11.66 5.69 11.05 5.45 4.34 0.89 12.76
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Note.

***

p < .001

**

p < .01

*

p < .05.

Endogenous and exogenous variables.

Approximately three indicators, often ranging from two to four, are considered as an ideal number to model each latent variable (Bollen & Bauldry, 2011; Kline, 2016). We modeled discrimination, internalized homonegativity, and emotion dysregulation using item parcels as indicators, given that the measures either does not have subscales or contains more than 4 subscales (e.g., Short-Form Difficulties in Emotion Regulation Scale has six subscales). Specifically, for each of these latent variables we created three parcels by conducting an exploratory factor analysis (EFA) of items on the corresponding measure. A balancing approach to parceling was used (Landis et al., 2000). Psychological distress was indicated by participants’ depression and anxiety levels, measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7).

Sample size consideration.

It is recommended that a minimum of 200 cases or five to ten times the number of parameter estimates is necessary for SEM analysis. Our SEM model includes a total of 39 parameters. The analytic sample size (n = 307) thus is deemed as sufficient given that it is above the recommended 200 cases as well as at least five times the number of parameters.

Structural equation modeling.

We conducted structural equation modeling (SEM) with full information maximum likelihood (FIML) estimation to examine hypothesized associations. SEM runs a series of tests on associations between all latent variables specified against a structural model and examines the overall model fit. This process identifies direct and indirect effects and the associations among independent (exogenous) and dependent (endogenous) variables. We performed SEM analysis, reporting, and interpretation of results following established principles (Kline, 2016; Weston & Gore Jr., 2006). Specifically, we used a two-step SEM analytic approach (Anderson & Gerbinng, 1998), which evaluated the fit of indicators to the hypothesized latent factors and the validity of the measurement model, followed by examining the fit of the full structural model with the measurement model. Fit indices, including Chi-square, Comparative Fit Index (CFI), root mean square error of approximation (RMSEA), the standardized root mean residual (SRMR) were assessed. Model fit criteria often range from more conservative standards of CFI ≥ 0.95, RMSEA ≤ .06, and SRMR ≤ .08 to more liberal cutoffs of CFI ≥ 0.90, RMSEA ≤ .10, and SRMR ≤ .10 (Hu & Bentler, 1998, 1999). In the current study, we evaluated model fit using the more rigorous and conservative standards (CFI ≥ 0.95, RMSEA ≤ .06, and SRMR ≤ .08). SEM analysis was conducted using the Lavann and semTools in R (Jorgensen et al., 2020; Rosseel, 2012).

Moderation analysis.

After the SEM analysis, we performed two sets of moderation analyses to explore the roles of mindfulness and self-compassion as a moderator to the SEM model. As an exploratory analysis, we included the moderator (mindfulness or self-compassion) in various pathways of the SEM model, including from discrimination to internalized homonegativity, from internalized homonegativity to emotion dysregulation, from internalized homonegativity to psychological distress, and from emotion dysregulation to psychological distress, to understand where mindfulness or self-compassion exerts impact as a potential resilience factor by moderating the adverse impacts of the minority stress processes. We created residual-centered interaction indicators (e.g., in the measurement model, an interaction term of discrimination X self-compassion was indicated by interactions of each residual-centered parcel of discrimination X self-compassion) for measurement and structural models (Marsh et al., 2004, 2013). Given that the purpose of the test is to understand the potential moderating roles of mindfulness and self-compassion and where precisely in the minority stress pathways they may exert impact, we report the results of the structural model with an emphasis on findings of the interaction terms described above.

Results

Sample characteristics

The final analytic sample consisted of 307 individuals, with an average age of 26.85 (SD = 3.83). Among them, a majority identified as White (60.26%, n = 185), followed by Black/African American (36.16%, n = 111), American Indian and Alaska Native (0.10%, n = 3), Multiracial (0.10%, n = 3), Asian (0.07%, n = 2), Pacific Islander (0.03%, n = 1), Central/South American or Caribbean (0.03%, n = 1), or a race not listed (0.03%, n = 1). In terms of ethnicity, a quarter (25.73%, n = 79) of participants were of Hispanic or Latin American descent. Additionally, most participants identified their sexual orientation as gay (81.11%, n = 249), bisexual (17.59%, n = 54), or pansexual (1.30%, n = 4), and all participants identified their gender as male.

At the time of the survey, close to a third (32.57%, n = 100) of participants resided in the Western region of the United States (AZ, CO, ID, MT, NV, NM, UT, WY, AK, CA, HI, OR, WA), followed by Southern (26.71%, n = 82; DE, FL, GA, MD, NC, SC, VA, DC, WV, AL, KY, MS, TN, AR, LA, OK, TX), Northeastern (26.38%, n = 81; CT, ME, MA, NH, RI, VT, NJ, NY, PA), and Midwestern (14.33%, n = 44; IL, IN, MI, OH, WI, IA, KS, MN, MO, NE, ND, SD) regions. Participant education level was particularly high: 91.53% had experienced at least some form of college-level education and 59.93% had obtained at least a bachelor’s degree from a college or university. At the time of the survey, most (90.55%, n = 278) participants resided in urban geographic areas. A majority (30.0%, n = 92) of participants reported an annual household income between $35,000 and $49,999, followed by $20,000 to $34,999 (25.4%, n = 78), $50,000 to $74,999 (24.4%, n = 24.4%), $75,000 to $99,999 (10.1%, n = 31), over $100,000 (7.82%, n = 24), and $10,000 to $19,999 (2.28%, n = 7). Notably, the majority of the sample endorsed psychological distress: most participants experienced at least mild levels of depression (75.6%, n = 232) and anxiety (69.1%, n = 212) symptoms in the past two weeks. The majority of participants in the sample are mindfulness naïve (77.2%), such that they responded “No” to a question on whether they have participated in any mindfulness programs or practices.

Model Estimation: Discrimination to Psychological Distress through Internalized Homonegativity and Emotion Dysregulation

Measurement model.

The measurement model had an excellent fit to the data, x2(38) = 62.63, p = .007, CFI = 0.992, RMSEA = 0.046 (90% CI = [0.024, 0.066]), SRMR = 0.027. All factor loadings were significant and presented in Table 2.

Table 2.

Measurement Model

Unstandardized
 Standardized
Latent variable Indicator B B 95% CI SE
Discrimination Discrimination parcel 1 1.000 0.919 0.893, 0.944 0.013
Discrimination parcel 2 0.937 0.891 0.862, 0.921 0.015
Discrimination parcel 3 0.977 0.888 0.858, 0.918 0.015
Internalized homonegativity IHS parcel 1 1.000 0.875 0.843, 0.906 0.016
IHS parcel 2 1.019 0.908 0.882, 0.935 0.013
IHS parcel 3 0.962 0.849 0.813, 0.885 0.019
Emotion dysregulation DERS parcel 1 1.000 0.901 0.871, 0.913 0.015
DERS parcel 2 0.903 0.861 0.825, 0.897 0.018
DERS parcel 3 0.849 0.854 0.817, 0.891 0.019
Psychological distress Depression, measured by PHQ-9 1.000 0.996 0.966, 1.027 0.016
Anxiety, measured by GAD-7 0.673 0.842 0.800, 0.883 0.021
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Note. IHS = Internalized Homophobia Scale. DERS = Difficulties in Emotion Regulation Scale. PHQ-9 = Patient Health Questionnaire – 9 items. GAD-7 = Generalized Anxiety Disorder 7 item.

Structural model.

The structural component of the final model is presented in Figure 1. Age, income, and race (0 = White, non-Hispanic, 1 = People of Color) were included as known predictors of discrimination in the model. Results indicated that the model had an excellent fit to the data, x2(68) = 141.51, p < .001, CFI = 0.976, RMSEA = 0.059 (90% CI = [0.045, 0.073]), SRMR = 0.046. As hypothesized, internalized homonegativity was associated with heterosexist discrimination (b = .76, 95% CI = [.70, .81], p < 0.001). Older age (b = .17, 95% CI = [.06, .29], p < 0.01), lower income (b = −.14, 95% CI = [−.26, −.03], p = 0.01), and being a Person of Color (b = .20, 95% CI = [.10, .32], p = 0.001) were also associated with heterosexist discrimination. Emotion dysregulation was associated with internalized homonegativity (b = .84, 95% CI = [.72, .97], p < 0.001). Psychological distress was associated with emotion dysregulation (b = .20, 95% CI = [.03, .38], p = 0.02) and internalized homonegativity (b = .61, 95% CI = [.41, .82], p < 0.001).

Indirect Effects.

We examined two indirect effects using 1,000 bootstrapped samples (Table 3). Both indirect effects were found to be significant: heterosexist discrimination was associated with psychological distress through (a) its association with internalized homonegativity alone (b = .46, 95% CI = [.28, .65], p < 0.001) and (b) a serial indirect effect through internalized homonegativity and emotion dysregulation (b = .13, 95% CI = [.02, .25], p = 0.03).

Table 3.

Indirect Effects Analyses

Standardized indirect effect Bootstrap estimate 95% CI bootstrap bias corrected
Paths β SE β SE p Lower bound Upper bound
Heterosexist discrimination →Internalized homonegativity → Emotion dysregulation → Psychological distress 0.13 0.06 0.13 0.06 0.03 0.02 0.25
Heterosexist discrimination → Internalized homonegativity → Psychological distress 0.46 0.08 0.46 0.10 < 0.001 0.28 0.65
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Moderator analysis

Two sets of moderator analyses explored mindfulness and self-compassion as a potential moderator. We included the moderator (mindfulness or self-compassion) in various pathways of the model, including from discrimination to internalized homonegativity, from internalized homonegativity to emotion dysregulation, from internalized homonegativity to psychological distress, and from emotion dysregulation to psychological distress, to understand where mindfulness or self-compassion exerts impact as a potential resilience factor by moderating the adverse impacts of the minority stress processes. Table 4 presents results from the moderator analysis regarding mindfulness. Mindfulness emerged as a significant predictor (b = −.53, SE = .04, 95% CI = [−.61, −.44]) and moderator (mindfulness x discrimination b = −.10, SE = .04, 95% CI = [−.19, −.02]) on the path from discrimination to internalized homonegativity. Mindfulness was also a significant moderator on the association between internalized homonegativity and emotion dysregulation (b = .34, SE = .05, 95% CI = [.24, .44]). Mindfulness had a significant association with psychological distress (b = −.20, SE = .07, 95% CI = [−.34. −.07]) but did not moderate the associations between emotion dysregulation and distress or between internalized homonegativity and distress.

Table 4.

Analysis of Mindfulness as a Moderator

Outcome variable Predictor variable b SE p-value 95%CI
Internalized homonegativity
Mindfulness −.53 .04 < .001 −.61, −.44
Mindfulness X discrimination −.10 .04 .02 −.19, −.02
Emotion dysregulation
Mindfulness .02 .08 .83 −.13, .17
Mindfulness X internalized homonegativity .34 .05 < .001 .24, .44
Psychological distress
Mindfulness −.20 .07 < .01 −.34, −.07
Mindfulness X internalized homonegativity .15 .11 .19 −.08, .37
Mindfulness X emotion dysregulation −.14 .09 .11 −.31, .03
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Table 5 presents results from the moderator analysis on self-compassion. As shown, self-compassion was a significant predictor (b = −.52, SE = .03, 95% CI = [−.59, −.46]) and moderator (self-compassion X discrimination b = −.20, SE = .04, 95% CI = [−.28, −.13]) on the path from discrimination to internalized homonegativity. Self-compassion was also a significant moderator on the effect of internalized homonegativity on emotion dysregulation (b = .32, SE = .06, 95% CI = [.19, .44]).

Table 5.

Analysis of Self-Compassion as a Moderator

Outcome variable Predictor variable b SE p-value 95%CI
Internalized homonegativity
Self-compassion −.52 .03 < .001 −.59, −.46
Self-compassion X discrimination −.20 .04 < .001 −.27, −.13
Emotion dysregulation
Self-compassion −.13 .07 .08 −.27, .02
Self-compassion X internalized homonegativity .32 .06 < .001 .19, .44
Psychological distress
Self-compassion −.08 .11 .49 −.30, .14
Self-compassion X internalized homonegativity .06 .21 .77 −.35, .47
Self-compassion X emotion dysregulation −.02 .14 .90 −.28, .25
Open in a new tab

Discussion

Young adult sexual minorities, including gay, bisexual, and queer men, face alarmingly high rates of mental health issues. The prevalence of depressive and anxiety symptoms in this sample of young adult sexual minority men is 75.57% and 69.06%, respectively. While distal minority stressors like discrimination have been shown to predict poor mental health, less is known about this process for young adult sexual minority men, particularly regarding an integrated understanding of both proximal minority stress and general psychological processes associated with psychological distress, as well as the roles of potential resilience factors like mindfulness and self-compassion. Findings highlight (a) the detrimental role of heterosexist discrimination, a distal minority stressor, on psychological health, (b) internalized homonegativity and emotion dysregulation had a serial indirect effect through which discrimination impacts psychological distress, and (c) the protective role of both mindfulness and self-compassion, both associated with less internalized homonegativity and disrupted the minority stress process by weakening the association between heterosexist discrimination and internalized homonegativity. However, contrary to the hypotheses, mindfulness and self-compassion moderated the relationship between internalized homonegativity and emotion dysregulation in a positive direction, exacerbating the positive association between internalized homonegativity and emotion dysregulation.

Findings based on the Minority Stress Theory (Meyer, 2003) and Psychological Mediation Framework (Hatzenbuehler, 2009) suggest two processes linking distal minority stressors to poor mental health. As hypothesized, heterosexist discrimination had an indirect effect on psychological distress via internalized homonegativity, a proximal minority stressor, representing a minority stress-specific process. Furthermore, there was a serial indirect effect linking heterosexist discrimination, internalized homonegativity, emotion dysregulation, and psychological distress. This supports the hypothesis that minority stressors contribute to mental health vulnerability by increasing universal vulnerability factors like emotion regulation difficulties. Contrary to Hatzenbuehler’s (2009) mediation model, the path between discrimination (distal stressor) and psychological distress through emotion dysregulation was not significant, suggesting that emotion dysregulation is a “downstream” process of minority stress. Thus, emotion dysregulation could be conceptualized as a result of coping with cognitive and/or emotional disturbance related to internalized homonegativity stemming from experiences of discrimination.

There has been a growing interest in mental health intervention development for vulnerable sexual minority youth and young adults (Austin et al., 2021; Iacono, 2019; Pachankis et al., 2015, 2022; Sun et al., 2022). Given that minority stress is a significant factor contributing to poor mental health in this population, interventions need to be tailored to the experiences of sexual minorities (Austin et al., 2021; Iacono, 2019; Pachankis et al., 2015, 2022; Sun et al., 2022). Coping strategies such as mindfulness and self-compassion have been suggested as potentially useful for sexual minority young people (Iacono, 2019; Sun et al., 2022). Through moderation analysis, we sought to uncover where in the “minority stress – poor mental health” pathway that mindfulness and self-compassion could exert their impact to inform future intervention development. Findings suggest that mindfulness and self-compassion may disrupt the minority stress pathway by impacting the “upstream” of this process, particularly as a resilience factor against heterosexist discrimination (in its association with internalized homonegativity). This supports prior research on mindfulness intervention development, such as Mindfulness-based Queer Resilience (MBQR), which emphasizes becoming aware of structural oppressions and their consequences as key philosophical guidance for applying mindfulness and self-compassion in this population (Sun et al., 2022). Thus, mindfulness and self-compassion practices may be most effective in enhancing the mental health of young adult sexual minority men when implemented in the context of their everyday coping with discrimination. Specific exercises could be developed to help young men increase mindfulness, self-kindness, and a sense of common humanity (including in the context of sexual minority experience) when encountering or following experiences of prejudice, exclusion, and discrimination, as well as internal stimuli of minority stress (e.g., negative thoughts or emotions related to being gay/bisexual/queer). Therefore, the “locations” of intervention targets identified in this study also provide direct support for the need of intervention adaptation in the context of minority stress.

Intriguingly, mindfulness and self-compassion heightened the positive association between internalized homonegativity and emotion dysregulation. Specifically, higher levels of mindfulness and self-compassion could exacerbate the negative emotional regulation consequence for those with high levels of internalized homonegativity (for individuals with low internalized homonegativity, however, higher mindfulness/self-compassion means lower emotion dysregulation). Since mindfulness and self-compassion emphasize awareness and acceptance of one’s emotional experiences, bringing awareness to one’s internalized stigma could heighten unpleasant emotions associated with negative self-beliefs. In this sample that is largely mindfulness-naïve, this finding suggests potential emotional vulnerability among young adult sexual minority men with higher mindfulness and self-compassion traits. In another cross-sectional study, authors found that discrimination predicted internalized stigma only among individuals with high psychological flexibility (Igarashi et al., 2022), suggesting that resilience traits could be a double-edged sword. It is perhaps also important to note that the main effects of mindfulness on both internalized homonegativity and psychological distress were negative (higher mindfulness was linked to lower levels of internalized homonegativity and distress), and the same was observed for the main effect of self-compassion on internalized homonegativity. These effect sizes were larger than the magnitude of moderation effects. Thus, mindfulness and self-compassion-based programs may be most effective in addressing the upstream factors of minority stress (e.g., bringing awareness and self-kindness to discrimination experiences may reduce their link to internalized homonegativity) as well as acting as a resilience factor in general. However, mindfulness and self-compassion may be less effective in immediately tackling internalized self-beliefs as they may increase awareness of negative emotional states associated with them, which can appear as negative emotionality before the reduction of symptoms. A randomized controlled trial of Acceptance Commitment Therapy (ACT) for people who use substances found that those assigned to ACT had significantly higher shame compared to treatment as usual at post-intervention, although the shame reduction was also higher at 4-month follow-up (Luoma et al., 2012). Longitudinal studies, particularly clinical intervention research, are needed to further understand the potential impact of mindfulness and self-compassion practices for this population.

Limitations

The study has several limitations. Firstly, the cross-sectional design prohibits us from determining the direction of relationships identified in the model. Assessment of distal minority stressors (i.e., heterosexist discrimination) in the past 12 months may also be subject to recall bias. Secondly, since participants in the sample were all young adult sexual minority men who are mostly educated and reside in urban settings, the findings may not be generalizable to other sexual and gender minorities (e.g., women, nonbinary individuals) and those who are older, have lower education, or live in rural areas. For instance, certain pathways may be stronger or weaker for those who experience higher levels and more chronic structural discrimination, and there may be other sources of stress that perhaps play a bigger role (e.g., homelessness, gender-based violence, etc.) (Lewis et al., 2012; Robinson, 2023). Thirdly, depression and anxiety were measured through self-report, which may not be as accurate as diagnostic interviews conducted by trained clinicians.

Implications for Future Research and Clinical Interventions

Study findings point to several directions for future research. Firstly, although the current research suggests that emotion dysregulation as a general psychological process is a “downstream” mediator between minority tress (from distal to proximal) and psychological distress, future research is needed to replicate this finding and examine other psychological vulnerability factors in interpersonal and cognitive domains, such as rejection sensitivity and negative self-schemas. Secondly, the findings indicate the need for mindfulness and self-compassion based interventions for this population to be contextualized in their day-to-day experiences of minority stress. In particular, interventions may consider adapting practices responsive to structural stigma (Sun et al., 2022). Given that mindfulness and self-compassion based programs often are conceptualized as individual-level interventions, it may be helpful to examine non-individual focused ways that mindfulness and self-compassion can be bolstered, such as awareness of the potential impact of structural oppression, enhancing a collective sense of compassion for one’s community, utilizing group-based format, and cultivating a sense of shared experience as sexual minority people. Thirdly, the potential impact of mindfulness and self-compassion practices is still yet to be examined in rigorous clinical trials, including evaluating safety, documenting potential adverse effects, and short-term and long-term efficacy in mental health.

Supplementary Material

Supp Figure

Highlights:

  • Heterosexist discrimination was associated with distress through internalized homophobia.

  • This association was also mediated through internalized homophobia and emotion dysregulation.

  • Mindfulness lessened the impact of heterosexist discrimination on internalized homophobia.

  • Mindfulness had a strengthening role in the adverse effect of internalized homophobia and emotion dysregulation.

  • Similar effects were found for self-compassion.

Funding Acknowledgement:

Funding supporting this research was awarded to Dr. Shufang Sun from Brown University School of Public Health. Work by Shufang Sun was also supported by the National Center for Complementary and Integrative Health (K23AT011173). Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number P30MH062294. Work by Arryn A. Guy was also supported by the National Institute on Drug Abuse (K99DA055508). David Zelaya’s work was also supported by the National Institute on Alcohol Abuse and Alcoholism (K23AA030339).

We would like to thank participants for their time and participation in the study.

Footnotes

Conflict of Interest:

The authors declare no conflict of interest.

Author’s Note: Data is available upon request.

Contributor Information

Shufang Sun, Department of Behavioral and Social Sciences, Brown University School of Public Health.

Arryn A. Guy, Department of Behavioral and Social Sciences, Brown University School of Public Health

Matthew J. Murphy, Department of Behavioral and Social Sciences, Brown University School of Public Health

David G. Zelaya, Department of Behavioral and Social Sciences, Brown University School of Public Health Department of Psychiatry, Harvard Medical School.

Yohansa Fernandez, Department of Psychiatry and Human Behavior, Brown University Alpert Medical School.

Don Operario, Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins, School of Public Health.

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