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. Author manuscript; available in PMC: 2025 Jul 1.
Published in final edited form as: Cultur Divers Ethnic Minor Psychol. 2023 Mar 2;30(3):566–576. doi: 10.1037/cdp0000580

Intersectional Stigma and Mental Health: Interactions with Identity Authenticity and SGM Community in Sexual and Gender Minoritized Young Adults of Color

Gregory Swann 1,2, Shariell Crosby 1,2, Michael E Newcomb 1,2, Sarah W Whitton 3
PMCID: PMC11809203  NIHMSID: NIHMS2050831  PMID: 36862483

Abstract

Objectives:

Sexual and gender minoritized people (SGM) of color experience stigma unique to their intersection of identities, such as racism from SGM and heterosexism from people of color (POC) in their same racial/ethnic group. SGM POC who experience enacted stigma, like microaggressions, have been found to have poorer mental health outcomes. SGM identity authenticity and connections to the SGM community have been associated with better mental health. We sought to test if intersectional enacted stigma, identity authenticity, community connectedness, and the interactions between enacted stigma and authenticity and community were associated with mental health in assigned female at birth (AFAB) SGM young adults of color.

Methods:

Data come from 341 racial/ethnic minoritized SGM-AFAB (Mage = 21.23, SD = 3.80). Multivariate linear regressions tested main effects of intersectional enacted stigma (heterosexism from POC and racism from SGM) and authenticity and community on mental health, as well as interaction effects on mental health.

Results:

SGM-AFAB POC who experienced more heterosexism from POC reported more anxiety and depression symptoms. Greater connection to the SGM community was associated with fewer anxiety and depression symptoms. Heterosexism from POC and community connection interacted such that SGM-AFAB who experienced less heterosexism from POC reported fewer mental health symptoms if they were more connected to the SGM community, but SGM-AFAB who experienced more heterosexism did not benefit from stronger community connection.

Conclusions:

Heterosexism from other POC may put SGM POC at higher exposure for negative mental health outcomes and reduce the mental health benefits of a stronger connection to the SGM community.

Keywords: SGM-AFAB, intersectional stigma, community, identity, mental health

Sexual and gender minoritized people (SGM) of color exist at a unique intersection of minoritized identities that increase their exposure to enacted stigma (i.e., overt and covert forms of victimization and discrimination) based on their sexual and gender identity, their race/ethnicity, and forms of stigma unique to people of multiple minoritized statuses (Crenshaw, 1990; McCall, 2005). Existing research with SGM and with people of color has repeatedly found poorer mental health outcomes for those who experience more heterosexism (Espelage, Aragon, Birkett, & Koenig, 2008; Marshal et al., 2012; Swann, Minshew, Newcomb, & Mustanski, 2016), racism (Brown et al., 2000; Carter, Lau, Johnson, & Kirkinis, 2017; Hurd, Varner, Caldwell, & Zimmerman, 2014), and intersectional forms of enacted stigma (Jackson, Mohr, Sarno, Kindahl, & Jones, 2020; Ouch & Moradi, 2019). This is particularly true for those who are assigned female at birth (AFAB) who experience more mental health problems compared to their assigned male at birth (AMAB) counterparts (Hankin & Abramson, 2001; McLean & Anderson, 2009). For SGM-AFAB of color, experiences of stigma have also been understudied in comparison to other SGM subpopulations (Richards, Gateri & Massaquoi, 2018). At the same time, research has begun to identify unique protective factors for mental health among SGM, including a positive SGM identity, (Riggle, Rostosky, Black, & Rosenkrantz, 2017) and a sense of connection to the SGM community (McLaren, 2009; McLaren, Jude, & McLachlan, 2008). However, to date these unique intersectional stressors and protective factors have not been examined in the context of one another. Questions therefore remain about whether positive SGM identity and community connection may buffer the negative effects of intersectional stressors, or whether intersectional stigma experiences may dampen the potential protective effects of positive SGM identity and community connection.

Understanding these associations has important clinical implications for SGM of color. If positive SGM identity and community connection increase one’s resiliency to experiences of intersectional stigma, intervention and prevention work that aims to facilitate greater integration of one’s SGM identity or encourage more connection to the SGM community may be integral to improving mental health outcomes for SGM of color. Conversely, if experiences of intersectional stigma reduce the benefits of community connection and positive SGM identity, then efforts to reduce racism in SGM spaces and heterosexism within racial/ethnic communities become even more integral to eliminating systemic differences in health outcomes.

Minoritized Stress and Mental Health

Minority stress theory describes a framework through which minoritized people become more susceptible to negative outcomes (Hatzenbuehler, 2009; Meyer, 2003). According to this theory, people in minoritized groups are at risk of experiencing discrimination based on their minoritized identity. Exposure to that enacted stigma generates stress that increases minoritized peoples’ vulnerability to poorer mental health. These processes are especially important to understand for AFAB people, who begin to diverge from their AMAB counterparts early on in childhood in their experiences of higher negative affectivity (McLean & Anderson, 2009). Those differences in negative affectivity are linked with symptoms of anxiety and depression and mirror the increasing role gender socialization plays in development during childhood and adolescence. These existing systemic differences coupled with membership in a minoritized group, make SGM-AFAB and AFAB of color particularly important to include in research on minoritized stress, especially for SGM-AFAB who are subject to gendered heterosexism (i.e., heterosexism experiences unique to sexual minoritized women) when they break traditional gender roles (Friedman & Leaper, 2010). Experiences of minoritized stress associated with SGM status is also especially relevant during adolescence and young adulthood because this is the developmental period when experiences of victimization and discrimination peak (Birkett, Newcomb, & Mustanski, 2015).

For SGM of color, there are additional risks of experiencing enacted stigma compared to those who identify with only one minoritized group. Intersectionality theory states that a person’s many intersecting identities converge to create an experience unique to their combination of identities that cannot solely be explained by considering the impact of each identity separately (Bauer, 2014; Crenshaw, 1990; McCall, 2005). In the case of those who possess multiple intersecting minoritized identities, those identities can converge to create unique opportunities for harm exposure.

Existing research has documented how racism negatively impacts the mental health of people of color (Brown et al., 2000; Carter et al., 2017) and how heterosexism has a similar deleterious effect on SGM people (Espelage et al., 2008; Marshal et al., 2012). There is now a growing literature that describes the negative effects of enacted stigma on the mental health of SGM of color in particular. Previous studies have found an additive effect of experiencing enacted stigma based on both race/ethnicity and sexual orientation. Sexual minoritized men of color who experience racial discrimination and gay-related internalized stigma report poorer emotional regulation and more depression and anxiety (English, Rendina, & Parsons, 2018). In a sample of lesbian, gay, and bisexual men and women, prevalence of a depressive or anxiety disorder in the previous year was significantly associated with experiencing a combination of at least two of race/ethnicity-, sexual orientation-, and gender-based stressors, but was not significantly associated with experiencing only one type of stressor (Bostwick, Boyd, Hughes, West, & McCabe, 2014). In the cohort of SGM-AFAB young adults of color included in the present study, previous research has found that more experiences of both racial/ethnic discrimination and sexual orientation-based microaggressions were associated with more depression and anxiety symptoms within the same model (Swann, Stephens, Newcomb, & Whitton, 2020). However, not all research that has considered race/ethnicity-based and SGM-based enacted stigma as separate dimensions has found an additive effect. In a sample of Black homeless youth, Gattis and Larson (2016) found that both racial and sexual orientation discrimination were correlated with depression, but only racial discrimination was significantly associated when both were accounted for in the same model.

What these additive studies miss are the effects of stigma unique to SGM people of color. To date, only a handful of studies have measured intersectional enacted stigma experiences related specifically to being an SGM of color. In homeless Black queer youth, intersectional microaggressions (in this case a composite score of both SGM racist and POC heterosexist microaggressions) were associated with higher depression (Gattis & Larson, 2017). Ouch and Moradi (2019) found that among adult SGM of color, those that reported higher perceived discrimination related to their identity as a sexual minoritized person of color using a composite score of racial discrimination, heterosexism, and intersectional microaggression items reported more psychological distress. In a sample of Black sexual minoritized adults who completed daily diaries for seven days, Jackson et al. (2020) found that on days participants reported a negative intersectional experience (i.e., a negative experience they attributed specifically to their intersectional identity as a Black sexual minoritized person and controlling for events that they attributed to only their racial or sexual minoritized identity), they reported more negative affect and rumination. Since few studies have employed an intersectional approach to researching the negative effects of enacted stigma, it is not surprising that none have considered how intersectional stigma may interact with other facets of the SGM experience to influence mental health.

SGM Protective Factors

Positive SGM identity and community connection are two such potential facets. According to social identity theory, when individuals associate themselves with a group, they emphasize the positive aspects of that group that lend themselves to a more favorable view of the group and by extension a more favorable view of themselves (Henri & Turner, 1986; Stets & Burke, 2000; Tajfel, 1981). For people of minoritized identities, in particular, because their identities are marginalized they become more salient to their personal identity. That increased saliency means that if they view their minoritized group more poorly it has a greater effect on how they view themselves and can result in poorer outcomes. However, the opposite is also true: if one views their minoritized group more positively or has a more positive association with their minoritized community, it can promote positive coping mechanisms.

Researchers have found various aspects of holding a positive SGM identity to be associated with better mental health outcomes. More authenticity, the feeling of being honest and comfortable with one’s SGM identity, has been associated with reports of more psychological wellbeing and lower depression in SGM adults (Riggle et al., 2017). SGM identity affirmation, the feeling that your SGM identity is accepted, has been shown to be negatively associated with depression in sexual minoritized college students (Mohr & Kendra, 2011) and SGM adults (Cramer et al., 2018), though not every study has replicated this association (Ghabrial & Andersen, 2020). It has also been associated with higher self-esteem in Latinx sexual minoritized youth (Toomey, Anhalt, & Shramko, 2016). Identity superiority, the feeling amongst SGM that they are superior to heterosexual people, has been associated with lower depression and anxiety in sexual minoritized adults in some samples (Cramer, Burks, Golom, Stroud, & Graham, 2017) but not others (Cramer et al., 2018; Ghabrial & Andersen, 2020). There is also evidence that holding a positive SGM identity may protect mental health in the face of adverse experiences related to stigma against SGM. SGM authenticity has been found to buffer the effects of externalized stigma on quality of life in sexual minoritized adults (Fredrick, LaDuke, & Williams, 2020). Woulfe and Goodman (2019) found that identity affirmation moderated the association between SGM identity abuse (e.g., someone threatening to out you), and depression, such that identity affirmation was protective against the depressive effects of identity abuse for SGM adults. In sum, though the findings have not always been consistent across studies, many researchers have found different measures of positive SGM identity to be related to better mental health. SGM authenticity, in particular, has been shown to be both associated with better mental health and to be protective from the negative effects of stigma. However, it has not been tested in relation to intersectional enacted stigma experiences.

SGM community connection has also been identified as a protective factor for mental health. For SGM adults, higher community connectedness has been correlated with better psychological wellbeing (Frost & Meyer, 2012) and fewer depressive symptoms (Lozano-Verduzco, Castillo, & Padilla-Gámez, 2019; Lozano-Verduzco, Fernández-Niño, & Baruch-Domínguez, 2017; Petruzzella, Feinstein, Davila, & Lavner, 2019). Among bisexual women, a greater connection to the bisexual community reduced the negative effect of internalized stigma toward their bisexual identity on depression (Lambe, Cerezo, & O’Shaughnessy, 2017). Similarly, community connectedness reduced the association between internalized stigma and psychological distress among SGM adults (Puckett, Levitt, Horne, & Hayes-Skelton, 2015).

These unique SGM protective factors, positive SGM identity and connection to the SGM community, are associated with better mental health for SGM people and appear to buffer the negative effects that stigma has on the mental health of SGM. These associations, however, have not been explored specifically in SGM of color and it is not clear if these previous findings will generalize to the types of intersectional enacted stigma experiences that are unique to SGM of color.

Current Study

In the present study we applied an intersectional lens to minority stress theory by examining associations between intersectional enacted stigma experiences and mental health in SGM-AFAB young adults of color. We also drew from social identity theory to consider the potential protective role of positive identity and community with mental health. For intersectional enacted stigma experiences we considered both racism from other SGM and heterosexism from other members of the same racial/ethnic group. Previous research that has identified SGM community connection and SGM identity authenticity as associated with better mental health, and in some cases protective from the negative effects of enacted stigma, made those measures ideal for exploring unique SGM factors in the context of intersectional stigma experiences. We hypothesized that 1) SGM of color who experience more intersectional enacted stigma would report more anxiety and depression symptoms, 2) SGM of color who feel their SGM identity is more authentic or who report a stronger connection to the SGM community will have fewer mental health symptoms, and 3) that intersectional enacted stigma will interact with both identity and community. The interaction of these factors is a new area of research. We believe that identity and community are likely to play a protective role in interaction with intersectional stigma, but it is also conceivable that the positive effects of identity and community could be attenuated by more experiences of intersectional enacted stigma (both of these conceptual models are illustrated in Figure 1).

Figure 1.

Figure 1.

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Conceptual Models for Interactions between Intersectional Minoritized Stress and Social Identity Measures on Mental Health Outcomes

METHODS

Participants

Participants for the present study come from FAB 400, a longitudinal cohort study of SGM-AFAB (N = 488). Included in FAB 400 are (1) a cohort recruited in 2016–2017 (N = 400; 16–20 years old at first visit), and (2) a cohort of young adults from the Project Q2 study that began in 2007 (N = 88; 23–32 years old at first FAB 400 visit). Inclusion criteria for both cohorts were identical. Participants had to be between 16–20 when first recruited into Project Q2 or FAB 400, report a minoritized sexual orientation or gender identity, report same-gender sexual behavior or same-gender attraction, be English-speaking, and be AFAB. Participants were recruited directly from venues (i.e., SGM community organizations, health fairs, high school/college groups) and online social media advertisements. Incentivized snowball sampling was used to expand the sample, in which enrolled participants could refer up to 5 peers. Participants were paid $10 for every person they recruited.

The FAB 400 study consists of an assessment administered every six months made up of a battery of self-report measures delivered via a computer-assisted self-interview. Participants were paid $50 at each visit. Every participant provided written informed consent and safeguards were taken to ensure their confidentiality was maintained (i.e., a federal certificate of confidentiality). The protocol for the study was approved by the Institutional Review Board at Northwestern University with a waiver of parental permission for participants under 18 years of age under 45 CFR 46, 408(c). The analytic sample for the present study comes from the third visit of FAB 400 (N = 461, 94.7% retention) when intersectional enacted stigma experiences were first measured. Only racial/ethnic minorities in the sample were asked about intersectional enacted stigma so the analytic sample excludes 119 SGM-AFAB who identified as non-Hispanic/Latinx White. Two additional participants were excluded because they did not provide data on the primary measures included in the present analyses (final analytic N = 340).

SGM-AFAB of color in the sample reported an average age of 21.22 (SD = 3.79). The racial/ethnic breakdown was 50.3% (N = 171) African American/Black, 31.5% (N = 107) Hispanic/Latinx, 8.2% (N = 28) multiracial, 7.4% (N = 25) Asian/Pacific Islander, and 2.6% (N = 9) participants who selected “other.” The gender identity breakdown was 74.7% (N = 254) cisgender, 9.4% (N = 32) non-binary, 4.7% (N = 16) gender non-conforming, 4.7% (N = 16) transgender, 3.8% (N = 13) gender queer, and 2.6% (N = 9) male. Trans/GNC AFAB people were included in the present analyses because gender diverse people are historically understudied and are likely to be negatively impacted by race/ethnicity and sexual orientation based intersectional stigma like their cisgender counterparts. For sexual orientation, 33.4% (N = 114) identified as bisexual, 24.1% (N =82) lesbian, 15.9% (N = 54) pansexual, 15.0% (N = 51) queer, 3.8% (N = 13) unsure/questioning, 2.4% (N = 8) gay, 2.4% (N = 8) asexual, 2.1% (N = 7) straight/heterosexual, and 0.9% (N = 3) reported their orientation was not listed.

Measures

Intersectional Enacted Stigma Experiences

Participants answered the LGBT People of Color Microaggression Scale (LGBTPOC) (Balsam, Molina, Beadnell, Simoni, & Walters, 2011). The LGBTPOC consists of eighteen items that ask about enacted stigma experiences unique to SGM of color in the past 30 days. It was administered on a five-point scale with responses from 1 (“Not at all”) to 5 (“21–30 times (almost daily)”). The LGBTPOC consists of three 6-item subscales: 1) POC Heterosexism which measured experiences of heterosexism from others in your racial/ethnic group (e.g., “Not being accepted by other people of your race/ethnicity because you are LGBTQ+”), 2) SGM Racism, which measured racism from other SGM (e.g., “Having to educate White LGBTQ+ people about race issues”), and 3) SGM Relationship Racism, which measured experiences of racism in the context of dating. The present study utilized only the first two subscales. We excluded SGM Relationship Racism because of the conceptual overlap with SGM Racism and because the current study was not focused on SGM intimate relationships. We computed mean composites for each subscale (Cronbach’s alpha: POC Heterosexism = .79, SGM Racism = .91). Higher scores indicated more experiences of enacted stigma.

SGM Identity Authenticity & SGM Community Connection

SGM-AFAB were administered the Lesbian, Gay, and Bisexual Positive Identity Measure (Riggle, Mohr, Rostosky, Fingerhut, & Balsam, 2014). We used the Authenticity (e.g., “I feel I can be honest and share my LGBTQ identity with others”) and Community Connection (e.g., “I feel included in the LGBTQ community”) subscales. Items were changed to be inclusive of transgender and queer people (i.e., changing “LGB” to “LGBTQ”). Each item was asked on a seven-point scale ranging from 1 (“Strongly Disagree”) to 7 (“Strongly Agree”). A mean composite was formed for each subscale (Cronbach’s alpha: Authenticity = .90, Community Connection = .88). Higher scores indicated more feelings of authenticity and community connection, respectively.

Mental Health Problems

Participants were administered the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression – short form 8b to calculate depression scores (Choi, Schalet, Cook, & Cella, 2014; Pilkonis et al., 2011). The PROMIS Depression consists of eight items that measure depression (e.g., “I felt hopeless”) in the previous seven days on a 1 (“Never”) to 5 (“Always”) scale. We created a sum score composite across all items (Cronbach’s alpha = .94). Higher scores indicated more depression symptoms.

The PROMIS Anxiety – short form 8a was used to measure anxiety (Pilkonis et al., 2011; Schalet, Cook, Choi, & Cella, 2014). There are eight items on the PROMIS Anxiety that measure anxiety feelings (e.g., “I felt nervous”). The measure used the same time frame and scale as the PROMIS Depression. A sum score composite was formed from all eight items (Cronbach’s alpha = .94). Higher scores indicated more anxiety symptoms.

Statistical Analyses

Linear regressions were run in SPSS 26 to test the associations of intersectional stressors and SGM protective factors with mental health outcomes. Descriptives for the primary study variables are in Table 1. Of the 340 individuals included in analyses, there was no missingness across all measures. We first regressed symptoms of anxiety and depression onto the two intersectional enacted stigma measures (SGM racism and POC heterosexism). We then ran models that included both SGM protective factors (identity authenticity and community connection) as predictors of the mental health variables. Next, to test for interactions between the intersectional enacted stigma measures and the SGM protective factors, we ran models regressing the mental health outcomes onto each intersectional stigma measure, identity/community, and the interaction terms formed by multiplying the centered intersectional stigma measures with centered identity/community. Interactions with identity and community were tested in separate models.

Table 1.

Study Variable Descriptives

Range Mean SD
Racism from SGM 1–5 1.58 0.80
Heterosexism from POC 1–5 1.52 0.65
SGM Community Connection 1–7 4.85 1.30
SGM Identity Authenticity 1–7 5.70 1.19
Anxiety Symptoms 8–40 17.85 8.10
Depression Symptoms 8–40 16.28 7.74
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In total, eight models were run: 1) two that included both internalized stigma measures with each outcome, 2) two that included both SGM protective factors with each outcome, and 3) four that included both internalized stigma measures but separately considered how they interacted with authenticity and community connection with each outcome. Simple slopes were graphed to interpret significant interaction effects. Effect sizes were calculated using f2 (Cohen, 1988). All models controlled for the effects of race/ethnicity, sexual orientation, gender identity, and age. These variables were selected as covariates because they were associated with significant differences on the primary study variables (see Preliminary Analyses) and have previously been associated with mental health differences in published research with the FAB 400 cohort (Swann, et al., 2020). We conducted sensitivity analyses by rerunning our models excluding 12 individuals who identified as male or straight/heterosexual (results not shown). The direction and significance of our results were consistent whether or not these participants were included.

RESULTS

Preliminary Analyses

Bivariate correlations are in Table 2. The only variables that were not significantly correlated were SGM identity authenticity with both SGM racism (r = −.01) and POC heterosexism (r = −.08). Demographic differences among the primary study variables were tested using linear regression. SGM who identified their race/ethnicity as “other” experienced more SGM racism compared to Black SGM (std. beta = .13, p =.020). Cisgender participants reported less SGM racism (std. beta = −.18, p = .001) and POC heterosexism (std. beta = −.15, p = .009) compared to GNC/trans participants. Bisexual/pansexual participants reported less POC heterosexism compared to lesbian participants (std. beta = −.13, p = .044). Participants who identified their sexual orientation as “other” felt less connected to the SGM community (std. beta = −.16, p = .008) and less SGM identity authenticity (std. beta = −.31, p < .001) compared to lesbian participants. Older SGM reported less SGM racism (std. beta = −.14, p = .015), less POC heterosexism (std. beta = −.19, p = .001), fewer anxiety symptoms (std. beta = −.19, p = .001), and fewer depressive symptoms (std. beta = −.19, p = .002) compared to younger SGM.

Table 2.

Bivariate Correlations Between Primary Study Variables

1 2 3 4 5 6
1. Racism from SGM -
2. Heterosexism from POC .67*** -
3. SGM Community Connection −.14* −.16** -
4. SGM Identity Authenticity −.01 −.08 .57*** -
5. Anxiety Symptoms .30*** .43*** −.18** −.11* -
6. Depression Symptoms .27*** .41*** −.19*** −.13* .75*** -
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Notes.

*

p < .05

**

p <.01

***

p <.001. SGM = Sexual and Gender Minoritized, POC = Person of Color.

Main Effects of Intersectional Enacted Stigma, Authenticity, and Community on Mental Health

Results for the associations between intersectional enacted stigma, identity authenticity, and SGM community with mental health are shown in Table 1. The models of associations between intersectional stigma and mental health were both significant (anxiety: F = 8.98, p < .001; depression: F = 7.56, p < .001). Contrary to our hypothesis, racism from other SGM was not significantly associated with anxiety (beta = .05, SE = .67, p = .94) or depression symptoms (beta = −.18, SE = .65, p = 79). However, as hypothesized, SGM-AFAB of color who experienced more POC heterosexism reported more symptoms of anxiety (beta = 4.86, SE = .82, p < .001) and depression (beta = 4.97, SE = .80, p < .001). Measures of effect size indicated a small-to-medium sized effect of heterosexism on mental health (anxiety symptoms: f2 = .09; depression symptoms: f2 = .10).

Models of associations between positive identity and mental health were significant (anxiety: F = 3.97, p < .001; depression: F = 4.63, p < .01). SGM-AFAB of color who reported a stronger SGM community connection experienced fewer symptoms of anxiety (beta = −1.14, SE = .40, p < .01) and of depression (beta = −1.12, SE = .39, p < .01). Effect sizes suggested that this was a small effect (anxiety symptoms: f2 = .02; depression symptoms: f2 = .02). There were no significant associations between authenticity and either anxiety (beta = .15, SE = .46, p = .75) or depression (beta = .07, SE = .45, p = .88).

Identity Authenticity and Community Connection Interacting with Intersectional Enacted Stigma Experiences on Mental Health

Results for interaction models are presented in Table 2. The models of intersectional stigma interacting with community connection to predict mental health were both significant (anxiety: F = 8.15, p < .001; depression: F = 6.84, p < .001). There was a significant interaction between POC heterosexism and community connection in the prediction of both anxiety (beta = 1.65, SE = .64, p < .01) and depressive symptoms (beta = 1.41, SE = .62, p < .05; see Figure 2 for all significant interaction effects). The interaction did not suggest a protective effect of community. Rather, community connection was only associated with fewer anxiety and depressive symptoms for SGM-AFAB of color who experienced low levels of POC heterosexism. For those who had experienced high levels of POC heterosexism, anxiety and depression scores were similar regardless of connection to the SGM community. Effect sizes for this interaction indicated a small effect (anxiety symptoms: f2 = .02; depression symptoms: f2 = .01). Community connection did not interact with SGM racism in the prediction of either anxiety or depression symptoms.

Figure 2.

Figure 2.

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Simple Slopes of POC Heterosexism and SGM Community Connection on Mental Health

The models of intersectional stigma interacting with identity authenticity were both significant (anxiety: F = 7.42, p < .001; depression: F = 6.26, p < .001). However, SGM-AFAB of color’s reports of identity authenticity did not significantly interact with SGM racism to predict either anxiety (beta = −.38, SE = .69, p = .58) or depression symptoms (beta = .28, SE = .67, p = .68). It also did not significantly interact with POC heterosexism to predict outcomes (anxiety: beta = 1.14, SE = .68, p = .10; depression: beta = .56, SE = .66, p = .40).

DISCUSSION

Findings & Implications

Our findings suggest that intersectional enacted stigma experiences may put SGM of color at higher exposure for negative mental health and that those who experience this stigma do not experience the same benefits of a positive connection with the SGM community compared to SGM of color who experience less intersectional enacted stigma. In other words, connecting with the SGM community can promote psychological well-being, but this process appears to be less effective for SGM of color who experience more heterosexism from their racial/ethnic community.

Our first hypothesis was that SGM-AFAB of color who experienced more intersectional enacted stigma experiences would report higher anxiety and depression. This proved true for those who experienced more heterosexism from within their racial/ethnic group. Throughout our results we saw that heterosexism from other POC was consistently associated with worse outcomes and that racism from other SGM was not. We also saw that POC heterosexism had the largest effect size that we observed. It could be that members of one’s ethnic/racial group have a unique capacity to harm SGM-AFAB of color, but more likely these results reflect the differing relationships SGM-AFAB of color have with other POC and other SGM. Heterosexism from within their racial/ethnic group encompasses experiences with family and close friends. Previous research with SGM has highlighted how heterosexism from family can be uniquely harmful (Puckett, Woodward, Mereish, & Pantalone, 2015; Ryan, Huebner, Diaz, & Sanchez, 2009; Willoughby, Doty, & Malik, 2010). On the other hand, racism from SGM may come from people that SGM-AFAB of color are less close to.

The second hypothesis, that SGM identity authenticity and SGM community connection would be associated with fewer mental health problems, was only partially supported. Greater community connection was associated with better mental health, whereas identity authenticity was not. Previous research on SGM identity and mental health has been mixed and this result falls in line with other researchers who have not found this association (Cramer et al., 2018; Ghabrial & Andersen, 2020). The current inconsistencies in the literature on the associations between SGM identity and mental health make it unclear if identity is truly an influential factor. The studies that have identified associations between SGM identity authenticity and mental health have done so in relation to quality of life and positive wellbeing (Fredrick, et. al, 2020; Riggle et al., 2014). It may be that SGM identity authenticity has more impact on the positive spectrum of mental health. Those studies also recruited SGM samples that were primarily adults and majority White. Perhaps the benefits of a positive SGM identity are more apparent later in adulthood or that, for SGM of color, measurement of both SGM and racial/ethnic identity is necessary to understand how identity may improve mental health. Ghabrial and Andersen (2020) developed a measure of identity affirmation based on cohesion between racial/ethnic and SGM identity that was negatively associated with depression. This type of measure might have more utility in understanding the experiences of SGM of color. The positive associations between community connection and mental health likely speak to the benefits of a stronger connection with other SGM people, including higher quality social support (Paceley, Hwu, & Arizpe, 2017) and better access to SGM-specific resources (Paceley, Fish, Conrad, & Schuetz, 2019). The size of the effect between community connection and mental health was small and may suggest that SGM community connection plays a minor role in determining mental health outcomes.

Our third hypothesis was that identity authenticity and positive sense of SGM community would interact with intersectional enacted stigma to predict mental health. We considered that the two unique SGM protective factors could have stress buffering effects. This was not the case. The association between heterosexism from POC and the mental health outcomes was actually stronger when SGM community connection was higher. Closer examination of the plotted simple slopes (Figure 2) suggested that this unexpected finding reflects how participants had elevated levels of anxiety when heterosexism from other POC was high, when community connectedness was low, or both. Only among those who reported both high community connection and low POC heterosexism were anxiety and depression lower. This suggests an alternate conceptual model, in which intersectional minoritized stress moderates the association between SGM community connection and mental health. SGM community connectedness may reduce mental health problems in some contexts, but that potential effect appears to be diminished by heterosexism from other POC. Previous research has found that POC heterosexism is associated with both more internalized SGM-related stigma and greater conflict between one’s racial/ethnic and SGM identities (Sarno, Swann, Newcomb, Whitton, 2021). If more positive associations with one’s minority community can promote better mental health, it is possible that having minoritized identities in conflict can mute that benefit. Identity conflict as a potential mechanism would be consistent with racial/ethnic identification as a possible explanation for our findings (Ashmore, Deaux, & McLaughlin-Volpe, 2004; Begeny, & Huo, 2017). SGM-AFAB of color who view their race/ethnicity as a more central part of their identity could experience worse mental health in the face of heterosexism from others in their racial/ethnic community and find less to gain from SGM community connection.

Our results suggest some important avenues for improving the mental health of SGM of color. Prevention efforts should include outreach tailored to specific racial/ethnic communities to raise awareness of the effects of heterosexism and homophobia, dispel myths and stereotypes about SGM people, and provide resources to SGM in those communities. Interventions that target SGM of color should address heterosexism they may experience from within their racial/ethnic community. They should also focus on the ways in which their racial/ethnic and SGM identities can come into conflict and the development of skills and strategies to promote cohesion between those identities. Finally, more support should be provided for community spaces that cater specifically to SGM of color.

Our findings across both anxiety and depression were remarkably similar in both direction of effects and effect sizes. This likely indicates that the associations we see with these measures taps into a shared variance between anxiety and depression. This is consistent with the conceptual framework of the PROMIS that identifies anxiety and depression as subdomains (along with anger) of mental distress (Cella, et al., 2010).

Overall, our results suggest the importance of taking a truly intersectional approach to studying the effects of stigmatizing experiences on mental health. Previous research has primarily focused on the additive effects of enacted stigma based on race/ethnicity and SGM status (Bostwick et al., 2014; English et al., 2018; Swann, Stephens, et al., 2019). That research, while valuable, ignores the unique forms of stigma, like intersectional enacted stigma, that SGM of color experience. Our study is part of a growing literature that documents the impact of these experiences on the mental health of SGM of color (Gattis & Larson, 2017; Jackson et al., 2020; Ouch & Moradi, 2019). It is important that researchers continue to expand this literature and to center AFAB-SGM young adults within this discussion since they are already at increased exposure for poorer mental health (Hankin & Abramson, 2001; McLean & Anderson, 2009). It is also important that, like our study, they begin to consider factors that may moderate risk for those exposed to intersectional enacted stigma experiences.

Limitations

The analyses reported were entirely cross-sectional, so the direction of effects cannot be verified. It could be that poorer mental health leads to less community connectedness or that individuals with a stronger connection with the SGM community are less cognizant of intersectional stigma. Researchers should verify these associations using longitudinal data. We only observed identity authenticity and community connection based on SGM status and we did not consider the role of racial/ethnic identity and community. Intersectional enacted stigma experiences may have a meaningful impact on how SGM of color feel about their racial/ethnic identity and how they feel specifically about their identity as a sexual or gender minoritized person of color. The population surveyed in this study were also all AFAB individuals. We did not consider how sexism or gendered heterosexism may have shaped their experiences. Finally, we did not account for socioeconomic status in our models. Education and income likely effect both experiences of intersectional stigma and mental health.

Future Directions

Future researchers should expand on the current study by considering additional moderators that have associations with mental health in SGM populations such as social support (McConnell, Birkett, & Mustanski, 2016; McConnell, Birkett, & Mustanski, 2015). It would also be important to expand the current study to consider male-assigned at birth SGM of color. Potential pathways through which intersectional stigma may result in poorer mental health through mechanisms such as internalized stigma and rumination, as well as how identity may impact those mechanisms, would also be worth exploration. Research should consider the environmental context in which intersectional stigma occurs. Racial/ethnic and SGM identities may take on different degrees of salience in different environments that could inform the impact of experiencing intersectional stigma. Finally, researchers should expand this research to additional outcomes that have been associated with enacted stigma for SGM, like substance use problems (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014; Huebner, Thoma, & Neilands, 2015; Swann, Forscher, Bettin, Newcomb, & Mustanski, 2019; Swann, Stephens, et al., 2019) and physical health (Frost, Lehavot, & Meyer, 2015; Lick, Durso, & Johnson, 2013).

Conclusions

The findings of this study indicate that heterosexism from within one’s racial/ethnic group is related to worse mental health and less benefit to mental health from connecting to the SGM community for young SGM-AFAB of color. As such, they emphasize the importance of considering the unique stigma experiences of people at the intersection of multiple minoritized identities and how those experiences can negatively affect mental health.

Table 3.

Multivariate Linear Regressions of Intersectional Enacted Stigma Experiences, Community Connection, and Identity Authenticity on Mental Health

Mental Health
Measure Anxiety Depression
Beta (SE) f2 F Beta (SE) f2 F
Racism from SGM 0.05 (0.67) 0.00 8.98*** −0.18 (0.65) 0.00 7.56***
Heterosexism from POC 4.86 (.82)*** 0.09 4.97 (.80)*** 0.10
SGM Community Connection −1.14 (.40)** 0.02 2.26* −1.12 (0.39)** 0.02 4.63***
SGM Identity Authenticity 0.15 (0.46) 0.00 0.07 (0.45) 0.00
Open in a new tab

Notes.

*

p < .05

**

p <.01

***

p <.001. SGM = Sexual and Gender Minoritized, POC = Person of Color. All models controlled for age, race/ethnicity, sexual orientation, and gender identity.

Table 4.

Multivariate Linear Regressions of the Interaction of Intersectional Enacted Stigma Experiences, Community Connection, and Identity Authenticity on Mental Health

Mental Health
Measure Anxiety Depression
Beta (SE) f2 F Beta (SE) f2 F
Racism from SGM (SGM-R) 0.14 (0.67) 0.00 8.15*** −0.24 (0.65) 0.00 6.84***
Heterosexism from POC (POC-H) 4.75 (.82)*** 0.08 4.78 (0.80)*** 0.09
SGM Community Connection −0.66 (0.31)* 0.01 −0.73 (0.30)* 0.01
SGM-R*Community −0.57 (0.53) 0.00 −0.95 (0.51) 0.01
POC-H*Community 1.65 (0.64)** 0.02 1.41 (0.62)* 0.01
SGM-R 0.09 (0.67) 0.00 7.42*** −0.17 (0.66) 0.00 6.26***
POC-H 4.93 (0.83)*** 0.09 5.01 (0.81)*** 0.10
SGM Identity Authenticity −0.41 (0.36) 0.00 −0.40 (0.45) 0.00
SGM-R*Authenticity −0.38 (0.69) 0.00 0.28 (0.67) 0.00
POC-H*Authenticity 1.14 (0.68) 0.01 0.56 (0.66) 0.00
Open in a new tab

Notes.

*

p < .05

**

p <.01

***

p <.001. SGM = Sexual and Gender Minoritized, POC = Person of Color. All models controlled for age, race/ethnicity, sexual orientation, and gender identity.

PUBLIC SIGNICANCE STATEMENT:

Sexual and gender minoritized (SGM) young adults of color who experience heterosexism from others in their same racial/ethnic group report poorer mental health. A greater connection with the SGM community is associated with better mental health, but that connection is less effective for SGM young adults of color who experience more heterosexism from their racial/ethnic community.

Funding:

This study was supported by a grant from the National Institute of Child Health and Human Development (grant no. R01HD086170: PI Dr. Sarah Whitton).

REFERENCES

  1. Ashmore RD, Deaux K, & McLaughlin-Volpe T (2004). An organizing framework for collective identity: articulation and significance of multidimensionality. Psychological bulletin, 130(1), 80. [DOI] [PubMed] [Google Scholar]
  2. Balsam KF, Molina Y, Beadnell B, Simoni J, & Walters K (2011). Measuring multiple minority stress: the LGBT People of Color Microaggressions Scale. Cultural diversity and ethnic minority psychology, 17(2), 163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Balsam KF, Molina Y, Blayney JA, Dillworth T, Zimmerman L, & Kaysen D (2015). Racial/ethnic differences in identity and mental health outcomes among young sexual minority women. Cultural diversity and ethnic minority psychology, 21(3), 380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bauer GR (2014). Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Social science & medicine, 110, 10–17. [DOI] [PubMed] [Google Scholar]
  5. Begeny CT, & Huo YJ (2017). When identity hurts: How positive intragroup experiences can yield negative mental health implications for ethnic and sexual minorities. European Journal of Social Psychology, 47(7), 803–817. [Google Scholar]
  6. Birkett M, Newcomb ME, & Mustanski B (2015). Does it get better? A longitudinal analysis of psychological distress and victimization in lesbian, gay, bisexual, transgender, and questioning youth. Journal of Adolescent Health, 56(3), 280–285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bostwick WB, Boyd CJ, Hughes TL, West BT, & McCabe SE (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84(1), 35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Brown TN, Williams DR, Jackson JS, Neighbors HW, Torres M, Sellers SL, & Brown KT (2000). “Being black and feeling blue”: The mental health consequences of racial discrimination. Race and Society, 2(2), 117–131. [Google Scholar]
  9. Carter RT, Lau MY, Johnson V, & Kirkinis K (2017). Racial discrimination and health outcomes among racial/ethnic minorities: A meta-analytic review. Journal of Multicultural Counseling and Development, 45(4), 232–259. [Google Scholar]
  10. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, ... & PROMIS Cooperative Group. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of clinical epidemiology, 63(11), 1179–1194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Choi SW, Schalet B, Cook KF, & Cella D (2014). Establishing a common metric for depressive symptoms: linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression. Psychological assessment, 26(2), 513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cohen J (1988). Statistical Power Analysis for the Social Sciences (2nd. Edition). Hillsdale, New Jersey, Lawrence Erlbaum Associates. [Google Scholar]
  13. Cramer RJ, Burks AC, Golom FD, Stroud CH, & Graham JL (2017). The Lesbian, Gay, and Bisexual Identity Scale: Factor analytic evidence and associations with health and well-being. Measurement and Evaluation in Counseling and Development, 50(1–2), 71–88. [Google Scholar]
  14. Cramer RJ, Golom FD, Gemberling TM, Trost K, Lewis R, & Wright S (2018). Examining the Lesbian, Gay, and Bisexual Identity Scale among members of an alternative sexuality special interest group. Archives of Sexual Behavior, 47(4), 1251–1264. [DOI] [PubMed] [Google Scholar]
  15. Crenshaw K (1990). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stan. L. Rev, 43, 1241. [Google Scholar]
  16. English D, Rendina HJ, & Parsons JT (2018). The effects of intersecting stigma: A longitudinal examination of minority stress, mental health, and substance use among Black, Latino, and multiracial gay and bisexual men. Psychology of violence, 8(6), 669. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Espelage DL, Aragon SR, Birkett M, & Koenig BW (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School psychology review, 37(2), 202–216. [Google Scholar]
  18. Fredrick EG, LaDuke SL, & Williams SL (2020). Sexual minority quality of life: The indirect effect of public stigma through self-compassion, authenticity, and internalized stigma. Stigma and Health, 5(1), 79. [Google Scholar]
  19. Friedman C, & Leaper C (2010). Sexual-minority college women’s experiences with discrimination: Relations with identity and collective action. Psychology of Women Quarterly, 34(2), 152–164. doi: 10.1111/j.1471-6402.2010.01558.x [DOI] [Google Scholar]
  20. Frost DM, Lehavot K, & Meyer IH (2015). Minority stress and physical health among sexual minority individuals. J Behav Med, 38(1), 1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Frost DM, & Meyer IH (2012). Measuring community connectedness among diverse sexual minority populations. Journal of sex research, 49(1), 36–49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gattis MN, & Larson A (2016). Perceived racial, sexual identity, and homeless status-related discrimination among Black adolescents and young adults experiencing homelessness: Relations with depressive symptoms and suicidality. American Journal of Orthopsychiatry, 86(1), 79. [DOI] [PubMed] [Google Scholar]
  23. Gattis MN, & Larson A (2017). Perceived microaggressions and mental health in a sample of black youths experiencing homelessness. Social Work Research, 41(1), 7–17. [Google Scholar]
  24. Ghabrial M, & Andersen J (2020). Development and initial validation of the Queer People of Color Identity Affirmation Scale. Journal of Counseling Psychology. [DOI] [PubMed] [Google Scholar]
  25. Goldbach JT, Tanner-Smith EE, Bagwell M, & Dunlap S (2014). Minority stress and substance use in sexual minority adolescents: A meta-analysis. Prevention Science, 15(3), 350–363. [DOI] [PubMed] [Google Scholar]
  26. Hankin BL, & Abramson LY (2001). Development of gender differences in depression: An elaborated cognitive vulnerability–transactional stress theory. Psychological bulletin, 127(6), 773. [DOI] [PubMed] [Google Scholar]
  27. Hatzenbuehler ML (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological bulletin, 135(5), 707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Henri T, & Turner JC (1986). The social identity theory of intergroup behavior. Psychology of intergroup relations, 2, 7–24. [Google Scholar]
  29. Huebner DM, Thoma BC, & Neilands TB (2015). School victimization and substance use among lesbian, gay, bisexual, and transgender adolescents. Prevention Science, 16(5), 734–743. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Hurd NM, Varner FA, Caldwell CH, & Zimmerman MA (2014). Does perceived racial discrimination predict changes in psychological distress and substance use over time? An examination among Black emerging adults. Developmental psychology, 50(7), 1910. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Jackson SD, Mohr JJ, Sarno EL, Kindahl AM, & Jones IL (2020). Intersectional experiences, stigma-related stress, and psychological health among Black LGBQ individuals. Journal of Consulting and Clinical Psychology. [DOI] [PubMed] [Google Scholar]
  32. Lambe J, Cerezo A, & O’Shaughnessy T (2017). Minority stress, community involvement, and mental health among bisexual women. Psychology of Sexual Orientation and Gender Diversity, 4(2), 218. [Google Scholar]
  33. Lick DJ, Durso LE, & Johnson KL (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8(5), 521–548. [DOI] [PubMed] [Google Scholar]
  34. Lozano-Verduzco I, Castillo C. C. d., & Padilla-Gámez N (2019). Is mental health related to expressions of homonegative stigma and community connectedness in Mexican lesbian and bisexual women? Revista Latinoamericana de Psicología, 51(1), 19–29. [Google Scholar]
  35. Lozano-Verduzco I, Fernández-Niño JA, & Baruch-Domínguez R (2017). Association between internalized homophobia and mental health indicators in LGBT individuals in Mexico City. Salud Mental, 40(5), 219–225. [Google Scholar]
  36. Marshal MP, Sucato G, Stepp SD, Hipwell A, Smith HA, Friedman MS, . . . Markovic N. (2012). Substance use and mental health disparities among sexual minority girls: Results from the Pittsburgh girls study. Journal of Pediatric and Adolescent Gynecology, 25(1), 15–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. McCall L (2005). The complexity of intersectionality. Signs: Journal of women in culture and society, 30(3), 1771–1800. [Google Scholar]
  38. McConnell EA, Birkett M, & Mustanski B (2016). Families matter: Social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. Journal of Adolescent Health, 59(6), 674–680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. McConnell EA, Birkett MA, & Mustanski B (2015). Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT health, 2(1), 55–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. McLaren S (2009). Sense of belonging to the general and lesbian communities as predictors of depression among lesbians. Journal of Homosexuality, 56(1), 1–13. [DOI] [PubMed] [Google Scholar]
  41. McLaren S, Jude B, & McLachlan AJ (2008). Sense of Belonging to the General and Gay Communities as Predictors of Depression among Australian Gay Men. International Journal of Men’s Health, 7(1). [Google Scholar]
  42. McLean CP, & Anderson ER (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical psychology review, 29(6), 496–505. [DOI] [PubMed] [Google Scholar]
  43. Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Mohr JJ, & Kendra MS (2011). Revision and extension of a multidimensional measure of sexual minority identity: The Lesbian, Gay, and Bisexual Identity Scale. Journal of Counseling Psychology, 58(2), 234. [DOI] [PubMed] [Google Scholar]
  45. Ouch S, & Moradi B (2019). Cognitive and affective expectation of stigma, coping efficacy, and psychological distress among sexual minority people of color. Journal of Counseling Psychology, 66(4), 424. [DOI] [PubMed] [Google Scholar]
  46. Paceley MS, Fish JN, Conrad A, & Schuetz N (2019). Diverse community contexts and community resources for sexual and gender minority youth: A mixed-methods study. Journal of Community & Applied Social Psychology, 29(6), 445–460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Paceley MS, Hwu A, & Arizpe HD (2017). Nonmetropolitan sexual and gender minority youths’ friendships: Perceptions of social support among SGM and non-SGM peers. Journal of Gay & Lesbian Social Services, 29(4), 399–414. [Google Scholar]
  48. Petruzzella A, Feinstein BA, Davila J, & Lavner JA (2019). Moderators of the association between community connectedness and internalizing symptoms among gay men. Archives of Sexual Behavior, 48(5), 1519–1528. [DOI] [PubMed] [Google Scholar]
  49. Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D, & Group PC (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment, 18(3), 263–283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Puckett JA, Levitt HM, Horne SG, & Hayes-Skelton SA (2015). Internalized heterosexism and psychological distress: The mediating roles of self-criticism and community connectedness. Psychology of Sexual Orientation and Gender Diversity, 2(4), 426. [Google Scholar]
  51. Puckett JA, Woodward EN, Mereish EH, & Pantalone DW (2015). Parental rejection following sexual orientation disclosure: Impact on internalized homophobia, social support, and mental health. LGBT health, 2(3), 265–269. [DOI] [PubMed] [Google Scholar]
  52. Richards D, Gateri H, & Massaquoi N (2018). The effects of intersectional stigma and discrimination on the mental well-being of black, LBQ, female youth 18–25 years old. In Today’s youth and mental health (pp. 119–133). Springer, Cham. [Google Scholar]
  53. Riggle ED, Mohr JJ, Rostosky SS, Fingerhut AW, & Balsam KF (2014). A multifactor Lesbian, Gay, and Bisexual Positive Identity Measure (LGB-PIM). Psychology of Sexual Orientation and Gender Diversity, 1(4), 398. [Google Scholar]
  54. Riggle ED, Rostosky SS, Black WW, & Rosenkrantz DE (2017). Outness, concealment, and authenticity: Associations with LGB individuals’ psychological distress and well-being. Psychology of Sexual Orientation and Gender Diversity, 4(1), 54. [Google Scholar]
  55. Ryan C, Huebner D, Diaz RM, & Sanchez J (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352. [DOI] [PubMed] [Google Scholar]
  56. Sarno EL, Mohr JJ, Jackson SD, & Fassinger RE (2015). When identities collide: Conflicts in allegiances among LGB people of color. Cultural diversity and ethnic minority psychology, 21(4), 550. [DOI] [PubMed] [Google Scholar]
  57. Sarno EL, Swann G, Newcomb ME, & Whitton SW (2021). Intersectional minority stress and identity conflict among sexual and gender minority people of color assigned female at birth. Cultural Diversity and Ethnic Minority Psychology. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Schalet BD, Cook KF, Choi SW, & Cella D (2014). Establishing a common metric for self-reported anxiety: linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. Journal of anxiety disorders, 28(1), 88–96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Stets JE, & Burke PJ (2000). Identity theory and social identity theory. Social psychology quarterly, 224–237. [Google Scholar]
  60. Swann G, Forscher E, Bettin E, Newcomb ME, & Mustanski B (2019). Effects of victimization on mental health and substance use trajectories in young sexual minority men. Development and psychopathology, 31(4), 1423–1437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Swann G, Minshew R, Newcomb ME, & Mustanski B (2016). Validation of the Sexual Orientation Microaggression Inventory in two diverse samples of LGBTQ youth. Archives of Sexual Behavior, 45(6), 1289–1298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Swann G, Stephens J, Newcomb ME, & Whitton SW (2019). Effects of sexual/gender minority-and race-based enacted stigma on mental health and substance use in female assigned at birth sexual minority youth. Cultural diversity and ethnic minority psychology. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Tajfel H (1981). Human groups and social categories: Studies in social psychology: Cup Archive. [Google Scholar]
  64. Toomey RB, Anhalt K, & Shramko M (2016). An examination of the validity and reliability of a measure of sexual orientation identity exploration, resolution, and affirmation. Self and Identity, 15(4), 488–504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Willoughby BL, Doty ND, & Malik NM (2010). Victimization, family rejection, and outcomes of gay, lesbian, and bisexual young people: The role of negative GLB identity. Journal of GLBT Family Studies, 6(4), 403–424. [Google Scholar]
  66. Woulfe JM, & Goodman LA (2019). Weaponized oppression: Identity abuse and mental health in the lesbian, gay, bisexual, transgender, and queer community. Psychology of violence. [Google Scholar]

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