Minority stress and psychological well-being in queer populations

Abstract

Queer individuals experience unique stressors related to their minority status, negatively impacting their mental health. One factor contributing to these disparities is exposure to minority stress, which involves social stressors related to minority status. Previous research has focused on the negative impacts of minority stress, with less attention to its impact on positive psychological functioning. This study explored the relationship between minority stress and psychological well-being among 270 queer individuals in German-speaking countries. Participants completed an online survey assessing minority stress and psychological well-being. Analyses of Covariance indicated that proximal factors of minority stress—such as self-stigma, concealment, and expectations of rejection—had a particularly negative impact on psychological well-being, but no effects could be found for gender and sexual orientation. Additionally, gender identity but not sexual orientation had a significant effect on minority stress, with non-binary and other gender identities reporting higher minority stress compared to females. Thematic analysis revealed concerns about survey inclusivity, gender identity challenges, and intersectionality of minority identities. Our findings emphasize the significant impact of minority stress on the psychological well-being of queer individuals, particularly non-binary people and those with diverse gender identities, while demonstrating the need for inclusive research methodologies, tailored interventions, and policies addressing the diverse experiences within the queer community.

Minority stress and psychological well-being in queer populations

Originally used as a pejorative against those who did not adhere to heteronormative standards¹, the term queer has been successfully reclaimed as a self-identification: In its contemporary usage, queer is employed as an umbrella term for individuals who are not heterosexual, cisgender, dyadic, binary, and/or allosexual/alloromantic. In this manner, the term queer serves as a substitute for the various iterations of lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, asexual (LGBTQIA +), without excluding any groups by not explicitly naming them².

Throughout history, queer individuals have faced systemic marginalization within society, confronting a spectrum of stressors associated with their minority status³. This chronic exposure to minority stressors leads to a higher risk of mental health difficulties in queer populations compared to their heterosexual peers. The most frequently cited cause of these disparities is minority stress, which refers to the unique stress experienced by sexual minorities living in a social environment marked by anti-queer, or “heterosexist”, prejudice and stigma⁴.

Minority stress theory posits that individuals from stigmatized social categories, such as queer populations, face unique stressors related to their minority status as a result of their divergence from heterosexual social norms⁴. These stressors are divided into distal and proximal categories. Distal stressors include external events like discrimination, harassment, and microaggressions, while proximal stressors involve internal processes such as self-stigma, concealment, and expectations of rejection⁴. Self-stigma is the process by which queer individuals internalize heterosexist attitudes; concealment describes how queer individuals may hide their minority status to avoid prejudice; and expectations of rejection refer to how queer individuals come to anticipate prejudice and become hypervigilant. These stressors are additive to general stressors experienced by all individuals and are linked to stable cultural and social structures.

Much attention in research on queer communities has focused on mental disorders: In comparison to their heterosexual counterparts, queer individuals show decreased cardiovascular and endocrine health, as evidenced by an increase in heart rate, systolic blood pressure, and salivary cortisol^5,6. Moreover, queer individuals demonstrate significantly higher prevalence rates of depression (approximately 1.5 times the risk observed in heterosexual individuals)^7–9, anxiety^10–12, and suicidal ideation^13,14 in contrast to their heterosexual peers. This trend extends to various other mental health concerns^4,15,16. Additionally, a quarter of trans individuals and one in five non-binary individuals reported attempting suicide, in contrast to 9% of cisgender individuals¹⁰.

There has also been little attention on the psychological health and positive functioning of queer individuals¹⁵, as well as factors having an influence on it. More recently, academics have advocated for a change in the direction of studying mental health in queer communities, emphasizing the exploration of positive outcomes and psychological health^15,16. In recent years, there has been a significant increase in evidence supporting the positive impact of enhanced psychological well-being (PWB) on mental and physical health. An essential preliminary step in facilitating this transition is to reveal the core relations by which marginalization affects positive functioning, including psychological well-being. Previous research has indicated that elevated levels of minority stressors in queer populations were negatively correlated with mental health⁷and led to a greater risk of a range of common mental disorders. However, it has been demonstrated that it is incorrect to assume that positive outcomes, such as psychological well-being (PWB), operate in the same manner as negative ones, such as distress¹⁷, showing the necessity of examining PWB as a construct separate from mental health. Enhanced PWB may protect from the adverse mental and physical health outcomes that can be attributed to high levels of minority stress. However, research on the well-being of queer individuals is limited and employs a variety of measures to conceptualize PWB, making it challenging to draw meaningful overall comparisons. Thus, it is essential to demonstrate the connection between minority stress and psychological well-being to be able to positively influence the latter while decreasing the negative impacts of the former.

When doing so, it is also crucial to identify particularly vulnerable queer subgroups. Although it is increasingly recognized that minority stressors significantly contribute to mental health disparities and reduced psychological well-being (as explained in detail above), the majority of research has focused on cisgender lesbian, gay, and bisexual individuals. However, it is important to recognize that sexual minorities are not a homogenous population. Indeed, sexual orientation is a complex and multifaceted concept that encompasses a range of identities beyond the labels typically associated with it, including asexuality, polyamory, and other forms of non-heterosexuality. Similarly, those individuals may simultaneously identify as transgender, non-binary, genderqueer, or any other possible identity while also being a sexual minority. It is therefore vital that research is conducted in a more inclusive manner, encompassing all genders and identities.

The objective of this study was to examine the relationship between minority stress and psychological well-being, with a particular focus on expanding research on queer populations in the German-speaking region. Given that comparisons between queer individuals and heterosexuals tend to reinforce the heteronormative narrative, this study aimed to primarily investigate the impact of minority stress on the psychological well-being of individuals within sexual minority groups, with an emphasis on interactions within the queer population. Given the high levels of discrimination faced by queer individuals, it is essential to investigate how specific aspects of identity impact psychological well-being to understand how mental health challenges impact different subgroups within the queer community. Two variables were of particular interest when taking a glance into our data: The influence of queer individuals’ gender identity (an individual’s sense of their gender, which may or may not align with the sex they were assigned at birth¹⁸—and sexual orientation (the attraction to and formation of romantic or sexual relationships with individuals of a specific gender or gender identity¹⁹). Not all individuals align with and/or fit into the concept of a gender binary established by society: While some individuals have a gender identity and/or expression that aligns with their sex assigned at birth (cisgender individuals), others do not (transgender individuals)¹⁹; still others identify as non-binary. There is a wide spectrum of existing sexual orientations, including attraction to individuals of the opposite sex or gender (heterosexuality), the same sex or gender (homosexuality), both sexes or genders (bisexuality), multiple sexes or genders (pansexuality), and a lack of sexual attraction to any sex or gender (asexuality).

A governmental health report on the Austrian queer population¹⁰ revealed that 89% of the respondents had experienced discrimination in at least one area of life surveyed. Three-quarters of those who reported experiencing discrimination in at least one of the areas surveyed indicated that the discrimination they had encountered was due to their sexual orientation, with 61% attributing it to their gender or gender identity. Although previous research (e.g.,^20,21) has indicated that sexual orientation and gender identity influence minority stress, the present study aims to expand these findings by examining which subgroups may be particularly affected. To the best of our knowledge, no study has investigated the influence of these two variables on psychological well-being.

As a result of the research gaps described above, in this study, we defined three hypotheses: Firstly, we hypothesized that distal and proximal stressors of minority stress contribute significantly to the explanation of lower psychological well-being (Hypothesis 1; H1). Secondly, we expected that individuals with a non-binary, trans- and “other” gender identity as well as individuals with a sexual orientation labelled as “other” (e.g., asexuality, pansexuality) experience significantly lower psychological well-being than their cis counterparts (female / male) (H2). Similarly, we expected that individuals with a non-binary, trans- and other gender identity as well as individuals with other sexual orientation (e.g., asexuality, pansexuality) experience significantly higher minority stress than individuals identifying as queer (H3).

Method

Participants

Targeted and snowball sampling methods were employed to recruit the participants throughout Austria. The study was accessible online via advertisements posted in queer social media groups, student text messenger groups, as well as flyers in queer and student spaces. A URL link and QR code incorporated within all advertisements directed respondents to a participant information statement and informed consent form that had to be signed to participate in the study. Those who took part in the study did not receive any form of compensation. The incentive utilized in the study call was to effect change and facilitate the creation of a more inclusive future.

Inclusion criteria was limited to adults (18 years of age or older) identifying as a sexual minority (e.g. lesbian, gay, bisexual) living in a German-speaking country. Individuals who were under the age of 18, identified as heterosexual, or resided outside of Germany or Austria were excluded from participation in this study, as the focus was to expand research on sexual minorities within these countries. Accordingly, every participant who did not self-identify as heterosexual was classified as a member of a sexual minority, with this classification confirmed by the subsequent questions on the corresponding sexual and gender affiliation.

The study was performed in accordance with the Declarations of Helsinki. We adhered to the Austrian Universities Act, 2002 (UG2002, Article 30 § 1), according to which only medical universities or studies conducting applied medical research have to obtain an additional approval by an ethics committee. Thus, no additional ethical approval was required for the present study. After providing consent, participants completed a 10-minute survey hosted on Qualtrics. It was conducted in English, as this was the original language of the instruments used to assess the constructs of interest, thus avoiding translation errors and reduced reliability.

Procedure

An a priori power analysis was conducted using G*Power version 3.1.9.7²² to determine the minimum sample size required to test the study hypothesis. For an ANCOVA with five groups and five covariates, assuming a medium effect size (f² = 0.25), a significance level of α = 0.05, and desired power of 80%, the analysis indicated a required sample size of N = 270. A total of 281 participants completed the survey, out of which eight were living outside of the targeted countries and three were minors. Thus, the obtained sample size of N = 270 was adequate to test the study hypotheses.

Measures

Minority stress was assessed by the validated 43-item Minority Stress Scale (MSS²³), which includes two distal minority stress factors and six proximal minority stress factors. Respondents rated their agreement with statements relating to structural and enacted stigma, expectations of discrimination in general and from family members, sexual orientation concealment, internalized homophobia towards others and themselves as well as stigma awareness. Example items include: “Because of my sexual orientation: I have been the target of verbal aggressions” and “Seeing two men or two women holding hands, I feel: Intense discomfort”. Depending on the factors, participants responded either on a 5-point Likert scale (ranging either from 1 = completely disagree to 5 = completely agree or from 1 = never to 5 = always) or with categories being yes and no. The score of every item is summed to obtain one score representing the severity of minority stress, with higher scores indicating higher minority stress. Scores obtained from the present sample indicated good reliability (α = 0.88).

Psychological well-being was assessed by the 42-item Psychological Wellbeing Scale (PWBS²⁴), which consists of seven subscales of overall psychological well-being. Respondents rated their agreement with statements relating to autonomy, environmental mastery, personal growth, positive relations with others, purpose in life as well as self-acceptance. Example items include: “In general, I feel I am in charge of the situation in which I live” and “I tend to worry about what other people think of me”. Participants responded on a 7-point Likert scale (ranging from 1 = strongly agree to 7 = strongly disagree). The score of every item is summed to obtain one score representing the degree of psychological well-being, with higher scores indicating better psychological well-being. For the present study, the scale score reliability was excellent (α = 0.92).

All participants reported their age, ethnicity, highest education, current employment status, and country of residence. Additionally, participants were able to choose one of the following options regarding their gender identity: male, female, trans male / trans man, trans female / trans woman, non-binary, or other (to be specified). In response to the question of how they define their sexual orientation, participants were given the option to select from the following categories: heterosexual / straight, gay, lesbian, bisexual, queer, or other (to be specified).

At the end of the survey, respondents were afforded the option of responding in an unstructured, open-text format, rather than selecting from a predefined set of response categories. The participants were invited to share any additional information they wished to provide on the subject matter. In this way, it was possible to solicit authentic and unexpected feedback and highlight the diversity of responses or nuances in opinions.

Statistical analyses

We used RStudio (Version 1.4.1717²⁵) with R (version 4.2.3²⁶) as well as JASP 0.18.3.0²⁷ for our statistical analyses. To test our hypotheses, we fitted two linear models to the data, employing Analyses of Covariance (ANCOVAs) to deal with both linear and categorical predictor and outcome variables as well as categorical covariates. Thus, along the inferential statistics of the ANCOVA (F-test, p values, effect sizes), we also report the regression coefficients of the continuous independent variables to help the reader categorize the results. To further explore significant differences between groups that were theoretically interesting for the current hypotheses, the Games-Howell post-hoc test was used due to its robustness in handling unequal variances and sample sizes (as was the case for e.g. sexual orientation).

Besides the effects of distal and proximal factors on psychological well-being, we also wanted to quantify the levels of both psychological well-being and minority stress experienced by certain subgroups of interest. Thus, the first model (dealing with H1 and H2) with PWB scores as a dependent variable included mean MSS scores for both proximal and distal dimensions as an independent variable, as well as gender and sexual orientation to be able to investigate H2. The second model (looking at H3), with MSS scores as its dependent variable, included gender and sexual orientation as an independent variable. For both models, age, ethnicity, highest education, and occupational status were used as control variables, based on previous literature^28,29. Occupational status was additionally split into the following variables: full-time plus another occupation or study (full-time +) as well as part-time plus another occupation or study (part-time +). This was done as it was assumed that individuals with more than one occupation might experience reduced psychological well-being due to increased overall stress.

A thematic analysis utilizing a coding system (by which unstructured data was reviewed and coded using inductive thematic codes) was conducted to organize the responses to the optional open-ended question, which read: “Is there anything you would like to share regarding this topic?” As the coding process progressed, the initial codes were grouped into categories, while attributes emerged, forming new codes and resulting in thematic focal points. Finally, the themes were clearly defined and named (see also³⁰). The analysis was computer-assisted using MAXQDA 24 software³¹.

Results

Participant characteristics

Data from 270 people was analyzed in this study. Demographic characteristics are reported in Table 1. The majority of participants lived in Austria (90.0%) or Germany (10.0%). Participants’ ages ranged from 18 to 55, with a mean age of 26.7 years (SD = 6.6 years). In terms of sexual orientation, 13.7% of participants described themselves as asexual, pansexual, biromantic, spectrasexual, polyamorous and/or having more than one sexual orientation – these responses are categorized as “other” sexual orientation below.

Table 1.

Demographic characteristics for queer sample (N = 270).

Variable	n	%
Gender identity
Female	146	54.0
Male	26	9.6
Trans female	8	2.9
Trans male	19	7.0
Non-binary	53	19.6
Other	16	5.9
Sexual orientation
Bisexual	67	24.8
Gay	25	9.2
Lesbian	52	19.2
Queer	89	32.9
Other	37	13.7
Education
No high school	8	2.9
High school degree	102	37.7
Some college	12	4.4
Bachelor’s degree	90	33.3
Master’s degree	51	18.8
Doctorate or professional degree	6	2.2
Employment status
Full-time	45	16.6
Full-time + a	8	2.9
Part-time	37	13.7
Part-time + a	64	23.7
Self-employed	10	3.7
Self-employed + a	2	0.7
Student	84	31.1
Unemployed/unable to work/retired	20	7.4
Ethnicity
Asian	2	0.7
Black	1	0.3
Hispanic	3	1.1
White/Caucasian	245	90.7
Other	16	5.9

^aParticipants indicated having multiple occupations.

^bPsychological well-being was registered using the PWBS (7-point, 42-item scale). Some items were reverse coded and the sum score was divided by the number of items, producing a composite score of psychological well-being.

^cMinority stress was registered using the MSS (5-point, 43-item scale). Some items were reverse coded and the sum score was divided by the number of items, producing a composite score of minority stress.

Relationship between minority stress and psychological well-being

To test H1 and H2, which hypothesize that distal and proximal factors of minority stress, gender, and sexual orientation negatively predict psychological well-being, an ANCOVA was performed. This analysis aimed to detect statistically significant differences in PWB across distal and proximal minority stress factors, gender, and sexual orientation. The model controlled for potential confounding variables including age, ethnicity, highest level of education attained, and occupational status (Model 1, Table 2). The analysis revealed that proximal factors, B =  −0.77, SE = 0.10, and distal factors, B = 0.18, SE = 0.08, individually explained variance in addition to the control variables, albeit in different directions (note, however, that the effect size for proximal factors was almost 10 times as large as for distal factors). However, no significant effects for gender and sexual orientation on PWB could be found.

Table 2.

Model 1. The impact of MSS, gender, and sexual orientation on PWB.

Measure	Sum of squares	df	F	p	η2
Distal MSS	2.31	1	4.87	.028	0.02
Proximal MSS	27.72	1	58.40	< .001	0.20
Gender	3.26	6	1.14	.335	0.03
Sexual orientation	3.29	4	1.73	.143	0.03
Control variables
Age	0.16	1	0.34	.556	0.00
Occupation	10.81	8	2.84	.004	0.09
Education	3.80	6	1.33	.241	0.03
Ethnicity	2.48	5	1.04	.391	0.02

Results of the ANCOVA measuring the impact of distal and proximal MSS, gender, and sexual orientation on psychological well-being (N = 270). Significant results are depicted in boldface.

Potential impact of gender and sexual orientation on minority stress

To test H3, which hypothesize that gender, and sexual orientation negatively predict minority stress, a second ANCOVA was performed. This analysis aimed to detect statistically significant differences in MSS across different gender expressions, and sexual orientations. The model controlled for potential confounding variables including age, ethnicity, highest level of education attained, and occupational status (Model 2, Table 3). The results revealed a significant effect of gender on MSS; however, no significant effect of sexual orientation on MSS could be found.

Table 3.

Model 2. The impact of gender and sexual orientation on MSS.

Measure	Sum of Squares	df	F	p	η2
Gender	3.80	6	2.69	.015	0.06
Sexual orientation	0.55	4	0.59	.666	0.01
Control variables
Age	0.10	1	0.44	.507	0.00
Occupation	1.73	8	0.92	.497	0.03
Education	2.18	6	1.54	.163	0.04
Ethnicity	0.62	5	0.52	.754	0.01

Results of the ANCOVA measuring the impact of gender and sexual orientation on minority stress (N = 270). Significant results are depicted in boldface.

Looking at the analyses of gender, the ANCOVA demonstrated that minority stress scores exhibited significant variation across gender identity groups. The results of the Games-Howell post-hoc tests for gender are presented in Table 4. We found that non-binary individuals and members of other gender identities were significantly more impacted by minority stress than (cis) females; all other differences were not significant.

Table 4.

Games-howell post-hoc comparisons for gender of minority stress as dependent variable (N = 270).

(I) Gender	(J) Gender	Mean difference (I-J)	Std. Error	p a	95% CI
					UL	LL
Female	Male Trans female Trans male Non-binary Other gender	0.03 0.04  − 0.29  − 0.23  − 0.43	0.12 0.20 0.12 0.07 0.12	> .999  > .999 .237 .020 .039	− 0.35  − 0.73  − 0.68  − 0.45  − 0.84	0.42 0.83 0.09  − 0.02  − 0.01
Male	Trans female Trans male Non-binary Other gender	0.01  − 0.32  − 0.27  − 0.46	0.23 0.16 0.13 0.16	> .999 .437 .397 .110	− 0.79  − 0.83  − 0.68  − 0.98	0.82 0.18 0.13 0.05
Trans female	Trans male Non-binary Other gender	− 0.34  − 0.28  − 0.48	0.22 0.20 0.23	.748 .800 .426	− 1.14  − 1.07  − 1.29	0.46 0.50 0.33
Trans male	Non-binary Other gender	0.05  − 0.13	0.12 0.16	.999 .979	− 0.35  − 0.65	0.46 0.38
Non-binary	Other gender	− 0.19	0.13	.767	− 0.62	0.23

CI confidence interval, LL lower limit, UL upper limit.

^aTukey corrected. Significant comparisons are depicted in boldface.

Thematic analysis

The thematic analysis of the open-text responses provided by the participants illuminated several key thematic focal points pertaining to minority stress and marginalized identities within the queer community. The thematic focal points are shown in Fig. 1. Regarding our design, participants emphasized the need for more inclusive survey designs. Critique highlighted exclusions of certain minority identities, such as asexual and panromantic individuals, and the focus on same-sex attraction, which overlooks the diverse experiences within the queer community. Many respondents pointed out the cisnormative and binary nature of the questions, which made it difficult for non-binary and gender-diverse participants to respond accurately. Additionally, participants noted that the questions relating to family lacked options for those with non-traditional family structures, indicating a bias towards conventional models.

Fig. 1.

Thematic focal points resulting from open-ended question (N = 56). The survey item read as follows: “Is there anything you would like to share regarding this topic?” The size of the circles represents the approximate relative frequency of mentions; positioning of/distance of the circles is for illustrative purposes only and does not reflect the result of any underlying statistical analysis.

Looking at concerns regarding minority stress and identity, gender identity emerged as another important point. Trans and non-binary individuals expressed that their gender identity often poses more difficulties and causes more distress than their sexual orientation. Further, asexual individuals described feeling excluded from significant aspects of life, while polyamorous individuals faced discrimination regarding perceptions of their relationships. This discrimination often outweighed the discrimination related to their sexual orientation. Moreover, some participants highlighted that much of their stress stems more from their neurodivergence than their sexual orientation, emphasizing the intersectionality of identities and the unique challenges faced by those with multiple marginalized identities.

Political influences were also a cause for concern among participants. Some expressed worries about the possibility of right-wing parties being elected and implementing policies detrimental to the queer community. Others noted that the association of queer identity with left-leaning politics has resulted in a greater incidence of familial discord than the mere fact of being queer. Additionally, family dynamics emerged as a significant source of stress for many participants. Some participants described enduring daily homo-, trans-, and queerphobia from family members, others found it challenging to navigate family support due to the presence of both supportive and conservative ignorant family members, leading to a mix of close and distant relationships.

Discussion

Prior research has underscored the adverse mental health consequences experienced by queer individuals in comparison to their heterosexual counterparts, a phenomenon attributed to the stress associated with minority status. A recent health report on the Austrian queer population corroborated these findings. However, by failing to consider the relationships that influence positive functioning, we may fail to identify the central aspects of well-being. Therefore, the objective of this study was to examine the relationship between minority stress and psychological well-being outcomes in a diverse sample as well as to identify potential patterns and interactions within the data, while also contributing to the growing body of research on queer populations in the German-speaking region. Further, it aimed to capture the individual voices to illustrate the diversity of responses and nuances in opinions.

Impact of minority stress on psychological well-being

The findings of the study indicate that in a predominantly Austrian sample of individuals who identify as queer, proximal forms of minority stress are associated with significantly reduced psychological well-being outcomes. These findings align with Meyer’s (2003)⁴ minority stress theory, which posits that minority stressors adversely impact the psychological well-being outcomes among queer individuals. Consistent with previous research, this study corroborates the notion that minority stress can predict psychological distress and lower psychological well-being (e.g.^32–34) as shown for a diverse Austrian sample.

However, in contrast with the initial hypothesis and previous findings, the results of this study indicated a positive relationship between distal stressors and psychological well-being (with a rather small effect size when compared to the relationship between proximal stressors and PWB). Accordingly, the initial hypothesis (H1) was only partially approved. One potential explanation is that there are additional variables that impact psychological well-being and are associated with minority stress but are not included in the model. Meyer’s (2003)⁴ minority stress model includes coping mechanisms that can reduce the negative impact of minority stress. In accordance with his model, the overall impact on health in the context of minority stress is determined by the negative impact of stressful experiences and the positive impact of coping, social support, and resilience^4,35. Therefore, the failure to consider variables such as resilience and social support may account for the positive association observed in this study. Some research indicates that individuals who experience minority stress may develop robust coping mechanisms and resilience over time, which can actually enhance their psychological well-being. For example, a study by Chen and Tryon (2012)³⁶ on Asian American gay men demonstrated that while sexual minority stress was a significant predictor of psychological distress, racial minority stress was not. This indicates that individuals may develop resilience to specific types of stress, which can offset the negative impact on well-being³⁶.

In line with recent research advocating for a shift towards studying positive psychological outcomes in queer populations^15,16, this study adds to an already emerging body of literature further focused on increasing psychological well-being among sexual minorities. The significant negative correlation between proximal factors of minority stress and psychological well-being suggests that social and psychological stressors strongly impact the psychological welfare of queer individuals.

Impact of sexual orientation and gender on psychological well-being

Contrary to our hypothesis 2, sexual orientation and gender did not influence PWB. One potential explanation can be the role of coping and social support as discussed above. Another explanation might be that other factors could have a more substantial impact on psychological well-being than specific sexual orientations or gender identities within the queer community. Our results show a significant impact of the current occupation status on the participants’ PWB. The results highlight that queer individuals are not solely defined by their sexual orientation or gender identity. Other aspects of their lives, such as their occupation status, play crucial roles in their overall well-being. The strong link between occupation status and PWB may reflect the importance of economic stability, job satisfaction, and career fulfillment in shaping mental health outcomes, regardless of an individual’s sexual orientation and gender identity.

Impact of sexual orientation and gender on minority stress

Finally, our hypothesis 3 was partially validated, indicating that gender identity, but not sexual orientation, affects minority stress outcomes. The group differences on minority stress in our analyses showed that non-binary individuals and those with ‘other’ gender identities, including agender, intersex, and genderqueer individuals, reported significantly higher levels of minority stress compared to female participants. These results are consistent with previous research, which has demonstrated that individuals who identify as gender diverse experience significantly higher levels of anxiety and depression, as well as poorer well-being, compared to those who identify as cisgender^21,37.

One possible explanation for the impact of gender identity but not sexual orientation might be that gender identity can be more visibly apparent than sexual orientation. This visibility can make them more vulnerable to direct discrimination, harassment, and violence, leading to heightened minority stress compared to those whose sexual orientation is less visibly apparent. However, the stressors associated with gender identity include not only external discrimination and prejudice but also pressure to conform to gender norms, and the psychological burden of navigating environments that are often not inclusive of non-cisgender identities. These unique stressors might explain why gender identity has a stronger impact on minority stress outcomes than sexual orientation.

Diversity of responses

The necessity for more inclusive structures and societies is also evident in the thematic analysis of the open-ended question. The findings illustrate just how convoluted and intricate the nature of minority stress is within the queer community, highlighting significant deficiencies in current research methodologies and support systems. The critique of our survey design shines a spotlight on the need for more comprehensive and tailored approaches to studying queer experiences, enabling research to fully encapsulate the broad spectrum of gender identities, sexual orientations, and relationship structures. The results emphasize that minority stress extends far beyond sexual orientation alone, with gender identity, neurodiversity, and relationship styles often playing equally or more significant roles in individuals’ experiences of marginalization. This intersectionality of identities presents unique challenges that need to be taken into consideration, the intricacies of these challenges are often neglected in conventional approaches to queer issues. In light of this, it is crucial to adopt more holistic, intersectional frameworks that encompass the queer spectrum and experiences within the queer community. This may involve developing more sophisticated research tools, creating more inclusive policies, and designing support systems that mirror the complexities of individuals living with multiple marginalized identities.

Implications of the present study for research and the queer community

The findings of this article highlight several key areas for future investigation and intervention in the context of minority stress within queer communities. The assumption that coping mechanisms and social support can buffer individuals and communities against external minority stressors highlights the need for an approach that should simultaneously address systemic discrimination and promote individual and community-level protective factors. Targeted interventions that enhance resilience and social support networks, while also implementing broader societal initiatives to reduce discrimination and stigma, are urgently needed, along with specialized support services addressing the unique stressors experienced by different subgroups within the queer community. This goes in line with previous findings showing that social rejection and stigma directly contribute to psychological distress in a queer population. While discrimination and unfair treatment in social, educational, and professional settings harm physical and mental health, family acceptance, social support and resilience promote better health outcomes^36,38–40.

Individuals with non-binary and diverse gender identities may experience unique challenges, potentially leading to heightened or more frequent stressors related to their identity. Given the observed differences among various identities, a one-size-fits-all approach to queer support may be insufficient. Similarly, Scandurra et al. (2023) emphasize that bisexual experiences differ significantly based on gender identity and age, also highlighting the importance of considering intersecting identities⁴¹. It is therefore recommended that mental health professionals and support services are prepared to address the specific needs of different subgroups within the community. Such tailored interventions may also focus on addressing the internalized stressors faced by queer individuals, particularly those with non-binary or other gender-diverse identities. On a more systemic level, mental health support systems need to incorporate gender-affirming care and specialized counseling that targets internalized stigma and rejection expectations. Accordingly, studies found that concealing one’s sexual orientation and healthcare-related stigma fears lead to poorer mental health outcomes, and while discrimination and stigma increase psychological distress, collective action serves as a protective factor by buffering against internalized heterosexism and discrimination-related stress^33,37,42. Strengthening anti-discrimination policies, systematic well-being monitoring⁴³ and community-based resilience programs could help reduce the presence of both proximal and distal stressors, ultimately improving the mental health outcomes for queer individuals.

Our research also points to important implications for methodological advancement and theoretical framework development. The complexity of minority stress experiences, requires a more differentiated approach to research. We recommend that future studies prioritize the development of comprehensive measurement tools and methodologies that are able to capture the complex nature of queer experiences.

Limitations

Although the present results provide clear evidence of the relationship between minority stress and psychological well-being in a queer sample, it is appropriate to recognize several potential limitations. First, the sample was predominantly young, white, and educated, which limits generalizability to more diverse queer populations. The cross-sectional design precludes causal inferences about the relationships between minority stress and psychological well-being. Additionally, the study relied on self-report measures, which may be subject to social desirability bias. Future research should aim for more diverse samples, employ longitudinal designs, and incorporate objective measures of stress and psychological well-being.

Conclusion

The current study provides important insights into the relationship between minority stress and psychological well-being among queer individuals in German-speaking countries. Our findings show the negative impact of both distal and proximal minority stressors on psychological well-being, particularly for individuals with non-binary and diverse gender identities. Tailored mental health interventions and policies that truly address diversity within the queer community are needed to increase psychological well-being and resilience among this particularly vulnerable population.

Author contributions

Conceptualization: D.G., B.S.; Methodology: D.G., B.S.; Formal analysis: D.G., B.S.; Investigation: D.G.; Writing—Original Draft: D.G.; Writing – Review & Editing: D.G., B.S.; Visualization: D.G., B.S., Supervision: B.S.; Project administration: B.S.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Competing interests

This study utilized DeepL Translate (Deepl SE, 2024) for translation purposes to ensure accuracy and clarity in the presentation of research materials across different languages. The use of this tool was strictly limited to translation, with no data manipulation or alteration of research outcomes. All procedures performed in this study were in strict accordance with the ethical guidelines outlined in the Declaration of Helsinki. The principles of respect for individuals, beneficence, and justice were adhered to throughout the research process. The authors declare no competing interests.