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. Author manuscript; available in PMC: 2025 Dec 12.
Published before final editing as: Psychol Sex Orientat Gend Divers. 2024 Dec 12:10.1037/sgd0000784. doi: 10.1037/sgd0000784

Positive sexual and gender identity experiences: Prospective associations with affect, internalized stigma, and perceived coping efficacy among sexual minority women and gender diverse young adults

Christina Dyar 1, Julia Curtis 1, Emily Herry 1
PMCID: PMC12571237  NIHMSID: NIHMS2024031  PMID: 41169750

Abstract

A handful of existing studies have examined positive sexual identity experiences at the daily level. However, these studies have focused predominately on concurrent associations, produced mixed results for most outcomes (e.g., anxious affect, internalized stigma), and have not examined positive gender identity experiences. The current study aims to address these limitations by examining prospective associations between positive sexual and gender identity experiences, affect, proximal stressors (i.e., internalized and anticipated stigma), and perceived coping efficacy. The study also aims to explore contextual factors that may increase the likelihood of these events. We used data from a 30-day ecological momentary assessment study with 429 sexual minority women and gender diverse sexual minorities assigned female at birth (SMWGD). Positive sexual and gender identity experiences prospectively predicted increases in perceived coping efficacy. Positive sexual identity experiences also prospectively predicted increases in positive affect and decreases in internalized stigma. Positive sexual and gender identity experiences were also associated with increases in anxious and depressed affect, but these effects did not persist into the next day. Finally, positive sexual identity experiences were more likely to occur when participants interacted with friends, partners, and sexual and gender minority individuals. Given that reduced perceived coping efficacy and increased internalized stigma link enacted stigma with subsequent increases in anxiety and depression, our findings suggest that positive identity experiences may help to interrupt these processes and build resilience to enacted stigma, although this should be tested by future research.

Keywords: sexual and gender minority, positive identity experiences, social context, affect

Introduction

Sexual minority individuals (e.g., lesbian, gay, bisexual, queer and other non-heterosexual individuals) are at elevated risk for mood and anxiety disorders compared to heterosexual individuals (Kerridge et al., 2017). These disparities are more pronounced for women compared to men (Ross et al., 2017). Sexual minority gender diverse individuals assigned female at birth (i.e., those who identify outside of the gender binary; e.g., nonbinary) may also be affected by larger disparities in depression and anxiety than sexual minority gender diverse individuals assigned male at birth, but this remains unclear given mixed findings across studies (Conn et al., 2023; Newcomb et al., 2020; Parodi et al., 2022). These disparities are also larger in young adulthood (ages 18-25) than they are after the age of 25 (Rice et al., 2019). These developmental differences in disparities have been linked to the lingering emotional effects of peer victimization in secondary school experienced by sexual and gender minority youth (Robinson et al., 2013). They have also been attributed to internalized stigma, stressors related to coming out, and dealing with negative reactions to disclosure (Russell & Fish, 2016). Young adult sexual and gender minority populations may also be less likely to have developed effective strategies to cope with experiences of bias than older individuals, amplifying the impact of minority stress experiences (Bränström et al., 2022; Fish et al., 2019; Meyer, 2015; Russell & Fish, 2016). Given that young adulthood appears to be a developmentally critical period for mental health among sexual and gender minority individuals alongside the more pronounced disparities experienced by some groups of sexual and gender minorities, the current paper focuses on young adult sexual minority cisgender women and sexual minority gender diverse individuals assigned female at birth (SMWGD).

Research has predominately focused on minority stress (i.e., the added stressors experienced by sexual and gender minority populations as a result of the stigmatization of non-heterosexuality and gender diversity) as a major contributor to these disparities. A substantial number of studies have examined associations between minority stress and anxiety and depression. However, less research has focused on positive experiences related to one’s sexual or gender identity (i.e., positive sexual and gender identity experiences). Positive sexual and gender identity experiences include both intrapersonal experiences, such as positive feelings about one’s own sexual or gender identity (i.e., identity affirmation) and interpersonal experiences related to one’s sexual or gender identity (i.e., microaffirmations). Studies that have examined positive sexual and gender identity experiences have been predominately cross-sectional (Chang et al., 2021; Conn et al., 2023; Doyle et al., 2021; Ghavami et al., 2011; Katz et al., 2023; Riggle et al., 2014; Sterzing & Gartner, 2020; Wilson et al., 2023).

At the daily level, a small number of ecological momentary assessment (EMA) studies have linked positive sexual identity experiences with higher same-day positive affect (Chong et al., 2023; Mohr & Sarno, 2016; Salim et al., 2019) and lower same-day negative affect (Flanders, 2015; Salim et al., 2019). Notably, these studies have rarely examined prospective associations between positive sexual identity experiences and affect, have not examined potential prospective effects of positive sexual identity experiences on mechanisms linking enacted stigma with mental health (e.g., internalized stigma), and have exclusively focused on positive sexual identity experiences, to the neglect of positive gender identity experiences (Pulice-Farrow et al., 2019). The current study aimed to address these limitations by utilizing EMA methods to examine prospective associations between positive sexual and gender identity experiences, affect, and mechanisms linking minority stress experiences with anxiety and depression (i.e., internalized stigma, anticipated stigma, and perceived coping efficacy) among a sample of SMWGD.

Cross-sectional Research on Positive Sexual and Gender Identity Experiences

Cross-sectional research has linked sexual and gender identity affirmation to fewer symptoms of anxiety and depression (Chang et al., 2021; Conn et al., 2023; Wilson et al., 2023), lower suicidal ideation (Katz et al., 2023), and greater well-being (Doyle et al., 2021; Ghavami et al., 2011). Further, identity affirmation has been linked with lower internalized and anticipated stigma (Bockting et al., 2020; Conn et al., 2023; Mohr & Kendra, 2011; Paul et al., 2014). Interventions that increase identity affirmation have also resulted in reductions in internalized stigma (Li et al., 2023) and symptoms of anxiety and depression (Chaudoir et al., 2023; Pachankis, Williams, et al., 2020). This suggests that identity affirmation may both directly reduce symptoms of anxiety and depression and may interfere in mechanistic processes linking enacted stigma to anxiety and depression.

Far less research has examined the effects of interpersonal positive sexual and gender identity experiences (e.g., microaffirmations) on mental health. In an exception, Sterzing and Gartner (2020) demonstrated cross-sectional links between experiencing more microaffirmations related to one’s sexual or gender identity from relatives and lower depressive symptoms, PTSD symptoms, and suicidal ideation. While microaffirmations have been under-studied, a broader related construct (i.e., identity related social support) has received more attention. Studies have linked sexuality-related social support with lower symptoms of anxiety and depression (Sheets & Mohr, 2009), higher well-being (Doty et al., 2010; Hambour et al., 2023), and lower internalized stigma (Liu et al., 2023; Snapp et al., 2015). Together, these cross-sectional findings suggest that identity affirmation and positive interpersonal experiences related to one’s sexual or gender identity may contribute better mental health.

Positive Sexual Identity Experiences at the Daily Level

The few studies that have examined identity affirmation and positive interpersonal experiences related to one’s sexual identity tend to examine interpersonal and intrapersonal experiences of affirmation as single construct – positive sexual identity experiences (Mohr & Sarno, 2016). Studies tend to link positive sexual identity experiences with higher positive affect and lower anxious and depressed affect on the same day (Chong et al., 2023; Dyar & London, 2018; Flanders, 2015; Mohr & Sarno, 2016), with one exception (Salim et al., 2019). Fewer studies have examined prospective associations between positive sexual identity experiences and subsequent changes in affect or symptoms. In an exception, Dyar and London (2018) found that positive sexual identity experiences predicted subsequent decreases in symptoms of anxiety, but not depression, one week later. The limited evidence for prospective effects of positive sexual identity experiences and the lack of research on positive gender identity experiences highlight the need for further research on the effects of positive identity experiences on affect.

Positive identity experiences have been proposed to act as potential sources of resilience for sexual and gender minority individuals due to their concurrent associations with higher positive affect and lower anxious and depressed affect. In addition to directly reducing anxious and depressed affect and symptoms, positive identity experiences may also contribute to resilience in the face of minority stress by reducing proximal minority stressors (e.g., internalized and anticipated stigma). Proximal stressors have been identified as mechanisms through which experiences of enacted stigma (e.g., discrimination, microaggressions) contribute to anxious and depressed affect at the daily level (Dyar, 2023; Puckett et al., 2023). Therefore, if positive identity experiences reduce proximal minority stressors, they may interfere in this pathway linking enacted stigma with anxious and depressed affect and, potentially, symptomology. To date, two studies have examined associations between positive sexual identity experiences, internalized stigma, and anticipated stigma. Mohr and Sarno (2016) found that positive sexual identity experiences were concurrently associated with lower internalized and anticipated stigma at the daily level. However, Dyar and London (2018) did not find significant associations among these variables at the weekly level. If positive events contribute to lower internalized and anticipated stigma, they may buffer the negative impact of enacted stigma. However, given mixed findings to date, more research is needed to understand the relationship between positive identity experiences and proximal stressors.

While studies examining associations between positive sexual identity experiences and affect at the daily level have tended to include individuals from a relatively broad age range (e.g., 18-58; Salim et al., 2019), their samples have been comprised largely of individuals in their 20s and 30s, with most studies having average ages between 24 and 29 (Chong et al., 2023; Dyar & London, 2018; Mohr & Sarno, 2016; Salim et al., 2019). Most of these studies were inclusive of diverse genders (i.e., included cisgender men, cisgender women, and transgender and gender diverse individuals; Chong et al., 2023; Flanders, 2015; Mohr & Sarno, 2016), but a couple focused exclusively on bisexual women (Dyar & London, 2018; Salim et al., 2019). Therefore, the focus of our current study on a specific developmental period when disparities in mental health are elevated for sexual and gender minorities and our focus on groups of sexual and gender minorities who may be most affected by these disparities helps to build upon the handful of existing studies examining these associations.

Perceived Coping Efficacy

Low perceived coping efficacy (i.e., feeling incapable of modulating one’s negative emotions in response to stress) is another mechanism implicated in associations between minority stress and anxious and depressive symptoms. This concept is similar to the construct of coping depletion proposed by Hatzenbuehler in the psychological mediation framework (Hatzenbuehler, 2009). Notably, perceived coping efficacy has not been examined in association with positive sexual or gender identity experiences. Positive experiences are theorized to help build coping resources for dealing with future stressors, including building resilience and social support networks (Folkman & Moskowitz, 2000). Drawing from this theory, we expect that positive events related to one’s sexual or gender identity may help to build resilience in part by increasing perceived coping efficacy and resources for dealing with future experiences of minority stress.

Context of Positive Identity Experiences

In what contexts are positive sexual and gender identity experiences most likely to occur? To date only one study has examined this question at the daily level, demonstrating that positive sexual identity experiences were more likely to occur when interacting with other sexual minority individuals (Mohr & Sarno, 2016). However, this study only examined sexual identity experiences and did not examine whether positive identity experiences are more likely to occur in contexts with close others (e.g., friends or partners) compared to with relatives, coworkers, or strangers. Research demonstrates that individuals who have close relationships (e.g., friendships, romantic relationships) with sexual and gender minority individuals tend to have more positive attitudes toward sexual and gender minority individuals broadly (de Bruin & Arndt, 2010; Lytle et al., 2017). Further, sexual minority individuals also tend to report receiving more sexuality related social support from friends than from family members and from other sexual minority individuals compared to from heterosexual individuals (Doty et al., 2010; Sheets & Mohr, 2009). Together, this suggests that interactions with friends, romantic partners, and sexual and gender minority individuals may be more likely to result in positive sexual and gender identity experiences than interactions with relatives, coworkers, strangers, and heterosexual cisgender individuals.

Current Study

The current study aims to address limitations in prior research by examining concurrent and prospective associations between positive sexual and gender identity experiences and affect (i.e., positive, anxious, and depressed) as well as mechanisms proposed to link minority stress with anxiety and depression (i.e., internalized stigma, anticipated stigma, and perceived coping efficacy). We also aimed to examine factors associated with an increased likelihood of experiencing positive sexual and gender identity experiences, including the duration of social interactions on the same day and characteristics of the people participants interacted with (i.e., relationship to and sexual orientations and gender identities of social interaction partners).

We utilized EMA data collected from 429 young adult (ages 18-25) SMWGD to accomplish these aims. We focused on SMWGD as they are at high risk for mood and anxiety disorders and have historically received limited research attention.

We proposed the following hypotheses:

  1. Experiencing positive sexual and gender identity experiences would concurrently and prospectively predict increases in positive affect and perceived coping efficacy and decreases in anxious and depressed affect, internalized stigma, and anticipated stigma at the within-person level.

  2. Positive sexual and gender identity experiences would be more likely to occur on days characterized by more social interaction and days in which participants interacted with people who are likely to be affirming of their identities, including friends, partners, and other sexual and gender minority individuals.

Method

Participants and Procedures

The current analyses used data from a longitudinal study of substance use among 429 SMWGD conducted between August 2020 and May 2021. Participants were recruited via paid advertisements on social media (e.g., Facebook, Instagram). Advertisements included images of same-gender couples and individuals with Pride colors and flags and asked members of the LGBTQ+ community to share their experiences by participating in the study. Ads were targeted to a range of interests relevant to the LGBTQ+ community (e.g., LGBTQ+ rights, media with LGBTQ+ characters, prominent LGBTQ+ individuals) and limited to individuals between age 18 and 25 in the United States. Eligible participants were 1) U.S. residents, 2) 18-25 years old, 3) assigned female at birth, 4) identified as women or under the nonbinary/gender diverse umbrella (e.g., nonbinary, genderqueer, agender, gender fluid), 5) identified as lesbian, bisexual, pansexual, or queer, and 6) met alcohol or cannabis use criteria (i.e., reported having four or more drinks at least twice and/or using cannabis on at least three days in the past month).1

Participants who appeared eligible based on their responses to the eligibility survey were text messaged by study team members to verify their eligibility and their access to a mobile phone with text message capabilities. To verify their eligibility, participants were asked to text demographic information (i.e., age, state of residence, email address), which was cross-checked with their responses in the eligibility survey. Participants who passed the eligibility verification were invited to participate and sent a link to the baseline assessment.

The study included a baseline assessment (e.g., demographics, stigma, substance use over the past 30 days; day 0), a 30-day EMA study (days 1-30), and a follow-up assessment. This study used data from the baseline assessment and the 30-day EMA study. During the EMA period, participants were asked to complete two surveys per day. Invitations for morning surveys were sent via email or text message (based on participant preference) at 8:00am in their time zone and participants had until 1:00pm to complete the survey. Invitations for evening surveys were sent at 6:00pm in their time zone and participants had until 12:00am to complete the survey. Participants who had not completed the survey by three hours after the survey invitation were sent a reminder. Those who missed more than three surveys in a row were contacted by study staff to check in and re-engage participants. Surveys were programmed in REDCap (Harris et al., 2009) and took approximately two minutes to complete. Participants were paid up to $150: $20 for baseline, $20 for follow-up, $1 for each EMA survey, and a $5 bonus for every six EMA surveys completed in a row. The study received IRB approval at IRB approval at Northwestern University (STU00208936; where data was collected) and Ohio State University (2021B0225; where data is stored). Informed consent was obtained from participants prior to beginning the baseline survey. See Dyar et al. (2022) for further details about the study.

The sample included 429 participants (Table 1) and was comprised predominately of people of color, with only 33.6% identifying as non-Latinx White. There was a sizeable number of gender diverse participants (26.8%).

Table 1.

Demographics of Analytic Sample at Baseline (N = 429)

Demographic Variable n %
Sexual Identity
  Lesbian 112 26.1%
  Bisexual 111 25.9%
  Pansexual 112 26.1%
  Queer 94 21.9%
Race/Ethnicitya
  White 235 54.8%
  Black 102 23.8%
  Latinx 129 30.1%
  Asian 53 12.4%
  Other Race/Ethnicity 34 7.9%
Gender Identity
  Cisgender Women 314 73.2%
  Gender Minority 115 26.8%
Age (M, SD) 22.27 (2.01)
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a

Percentages add up to more than 100% because participants could select multiple racial/ethnic identities.

Demographic Measures

Race and ethnicity

were assessed by asking participants to select all options that best described their race/ethnicity. Options included: American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino/Latina/Latinx/Latine, Native Hawaiian or Other Pacific Islander, White, and a different identity. Given the small number of individuals who identified as American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or with a different identity, these three categories were collapsed into a single “other race/ethnicity” category. White, Black, Latinx, Asian, and other race/ethnicity were entered as binary predictors of the outcome simultaneously.

Gender

was assessed by asking participants to indicate their current gender identity. Options included: man, woman, transgender, transgender man, transgender woman, gender non-conforming, genderqueer, nonbinary, and a different identity. Eligible participants identified as women, genderqueer, gender non-conforming, nonbinary, or wrote in an identity under the gender diverse umbrella. A binary variable was created from these response options with individuals who identified as women being coded as 0 and those who identified with any of the gender diverse identities being coded as 1.

Sexual identity

was assessed by asking participants to identify the term that best described their sexual orientation. Response options included: gay, lesbian, bisexual, queer, unsure/questioning, straight/heterosexual, pansexual, asexual, or provided a different identity. Eligible participants identified as lesbian, bisexual, queer, or pansexual. This variable was dummy coded and included as a control variable in analyses.

Age

was calculated by subtracting the participant’s date of birth from the date they completed the eligibility survey.

EMA Measures

Positive sexual identity experiences

were assessed by asking participants an item adapted from Mohr and Sarno (2016) during each morning survey: “Did you experience anything positive related to your sexual orientation since yesterday? This could be something that was relatively minor (e.g., feeling more comfortable with your sexual orientation today) or major (e.g., coming out to a family member who was accepting).” Participants were asked to indicate yes (1) or no (0).

Positive gender identity experiences

were assessed by asking gender diverse participants an item adapted from Mohr and Sarno (2016) during each morning survey: “Did you experience anything positive related to your gender identity since yesterday? This could be something that was relatively minor (e.g., feeling more comfortable with your gender identity today) or major (e.g., coming out to a family member who was accepting).” Participants were asked to indicate yes (1) or no (0).

Affect

was assessed using six items from the Profile of Mood States Short Form’s depressed (discouraged; sad), anxious (anxious; on edge), and positive (happy, cheerful) affect subscales (Cranford et al., 2006; Curran et al., 1995). Participants were asked to indicate how much they felt each emotion since the last survey. Response options ranged from 0 (not at all) to 4 (extremely). Affect was assessed prior to any other items on the daily survey to avoid order effects and was assessed in the morning and evening. Internal consistency was estimated using procedures recommended by Nezlek (2017) for longitudinal data and was acceptable (.76).

Internalized sexual identity stigma

was assessed by asking participants to indicate “since the last survey, how did you feel about being (lesbian/bisexual/pansexual/queer)?” on a sliding scale ranging from 0 (very negative) to 100 (very positive). This item was adapted from the measure developed by Puckett et al. (2023). Participants’ sexual identities were piped into the parentheses in the question. Scores were reversed and divided by 20 to obtain final scores ranging from 0 (low internalized stigma) to 5 (high internalized stigma).

Internalized gender identity stigma

was assessed by asking participants to indicate “since the last survey, how did you feel about being (nonbinary/genderqueer/gender nonconforming)?” on a sliding scale ranging from 0 (very negative) to 100 (very positive) (Puckett et al., 2023). Participants’ gender identities were piped into the parentheses in the question. Scores were reversed and divided by 20 to obtain final scores ranging from 0 (low internalized stigma) to 5 (high internalized stigma).

Anticipated stigma

was assessed by two items, similar to those utilized in diary studies conducted by Dyar and London (2018) and Feinstein et al. (2022). One item captured anxiety about potential biased treatment based on one’s sexual orientation since the last survey (“How worried or anxious were you about being rejected or treated negatively because of your sexual orientation since the last survey?”) and was assessed on a scale of 1 (not at all anxious) to 6 (very anxious). The second item captured expectations of biased treatment (“How likely did you think it was that you would be rejected or treated negatively because of your sexual orientation since the last survey?”) on a scale of 1 (very unlikely) to 6 (very likely). Items assessing anticipated stigma based on one’s gender identity replaced “sexual orientation” with “gender identity.” Consistent with other measures (Chan & Mendoza-Denton, 2008; Dyar & London, 2018; Feinstein et al., 2022; London et al., 2012; Mendoza-Denton et al., 2002; Pachankis et al., 2008), the responses for these two items were multiplied to create a total score. To avoid issues with convergence due to having measures on substantially different scales, these scores were divided by 6 to place the total score on a scale of 0.17–6.0.

Perceived coping efficacy

was assessed using two items adapted from the Coping Strategy Questionnaire (Rosenstiel & Keefe, 1983). These items have been used in previous daily diary studies (Keefe et al., 1997; Massey et al., 2009; Stappenbeck et al., 2015), including those with sexual and gender minorities (Dyar, Dworkin, et al., 2021). Participants were asked “Based on all the things you did to cope or deal with any negative thoughts or feeling since the last survey, how much control do you feel you had over the negative thoughts or feelings?” (0 [no control] to 6 [complete control]) and “How much were you able to decrease the negative thoughts or feelings?” (0 [couldn’t decrease them at all] to 6 [could completely decrease them]). These items were averaged and internal consistency was calculated using procedures recommended by Nezlek (2017) for longitudinal data and was strong (.91).

Social interactions and context

were assessed each morning by asking participants “How much time did you spend talking, texting, or messaging with others yesterday (in person, by phone, or online)?” Response options ranged from: 0 (I did not talk, text, or message with anyone today) to 5 (almost all day [more than 12 hours]). Participants who reported at least some level of social interaction on the prior day were then asked to describe their relationships with these individuals (options: friends, romantic or sexual partner, coworker, relative, stranger) and the sexual orientations and gender identities of the people they interacted with (options: LGBTQ+ women, LGBTQ+ men, nonbinary individuals, straight women, straight men). Participants could select more than one response option for each follow-up question.

Analytic Plan

Analyses were conducted in Mplus version 8.8. There were a total of 19,186 completed surveys from 429 participants. The median completion rate was 88.3% (M = 74%, SD = 28%). Within completed surveys, less than 1% of data were missing. Missing data were handled using Bayesian methods (Asparouhov & Muthén, 2010). Bayesian multilevel structural equation modeling (MSEM) with diffuse (non-informative) priors was used.2,3 The confidence/credible interval for the indirect effect was calculated within the context of the model using Bayesian estimation, as bootstrapping is not necessary in Bayesian models (Yuan & MacKinnon, 2009). Skew and kurtosis of variables were checked, and all variables (with the exception of anticipated stigma) had skew and kurtosis values within the acceptable range (−2 to 2 for skew and −7 to 7 for kurtosis; (Byrne, 2013). Skew and kurtosis were more elevated for anticipated sexual identity stigma (skew = 5.47, kurtosis = 16.45) and skew was elevated for anticipated gender identity stigma (skew = 7.23). Given that Bayesian MSEMs like those used in this manuscript are new, the consequences of violations of normality of this size are unclear and alternative approaches for handling violations of normality have yet to be developed (Hamaker et al., 2018). Therefore, we conducted sensitivity analyses in which these non-normal outcomes were square root transformed (which led to variables with acceptable skew and kurtosis) to determine whether the results were consistent across models.

We examined two sets of models. In models examining concurrent and prospective potential effects of positive identity experiences, within- and between-person components of a positive identity experience variable (sexual or gender identity) predicted within- and between-person components of affect, internalized stigma, anticipated stigma, or perceived coping efficacy. In unlagged models, positive identity experiences during the prior day (reported in morning survey; t) predicted affect, internalized stigma, anticipated stigma, or perceived coping efficacy reported during the same morning survey (t). In lagged models, positive identity experiences during the prior day (reported in morning survey; t) predicted affect, internalized stigma, or perceived coping efficacy reported during the evening survey later that day (t+1). Analyses of positive gender identity experiences were examined among the subsample of gender diverse individuals (n = 115), while analyses of positive sexual identity experiences were examined among the full sample (n = 429). Internalized gender identity stigma and anticipated gender identity stigma were examined in relation to positive gender identity experiences, and internalized sexual identity stigma and anticipated sexual identity stigma were examined in relation to positive sexual identity experiences.

In the second set of models, we examined concurrent associations between the duration of social interactions on the prior day, characteristics of the individuals that participants interacted with on the prior day, and the likelihood of experiencing a positive identity experience. Both social interaction and positive identity experiences covered the same timeframe (past day experiences reported in the morning survey). While positive identity experiences were not required to be interpersonal and social interactions other than those that may have contributed to any positive interpersonal identity experiences would also be included in the social interaction variable, these analyses allowed us to gain some insight into social factors and interactions that may contribute to positive identity experiences. As positive identity experiences were binary variables at the within-person level and treated as the outcome in these analyses, we used probit regression. Probit regression coefficients represent the variance shared by the predictor and the latent continuous response variables underlying each binary observed item (Agresti, 2012).

In all models, we controlled for day of assessment and assessment type (weekend/weekday) at the within-person level. Further, we included first-order autocorrelations for the outcome in lagged models (i.e., correlation between variable at t-1 with variable at t), which effectively controls for the prior timepoint of the outcome. Within-person associations among the main variables of interest and autocorrelations were allowed to vary across individuals. Age, sexual identity, gender identity, and race/ethnicity were included as covariates at the between-person level.

Results

On average participants reported experiencing positive sexual identity experiences on 18.9% of days and positive gender identity experiences on 17.7% of days. Table 2 includes means, standard deviations, and intraclass correlations for variables included in the current study.

Table 2.

Means, Variances, and Intraclass Correlations

Mean Standard
Deviation		 Range Intraclass
Correlation
Positive Sexual Identity Experiences .19 .39 0-1 .21
Positive Gender Identity Experiences .18 .38 0-1 .18
Positive Affect 1.94 1.08 0-4 .45
Anxious Affect 1.44 1.14 0-4 .41
Depressed Affect 1.21 1.09 0-4 .40
Internalized Sexual Identity Stigma 1.30 1.06 0-5 .81
Internalized Gender Identity Stigma 1.88 1.05 0-5 .74
Anticipated Sexual Identity Stigma 3.28 5.47 1-36 .69
Anticipated Gender Identity Stigma 4.95 7.23 1-36 .68
Perceived Coping Efficacy 3.19 1.56 0-6 .49
Duration of social interactions 3.65 1.37 1-6 .57
SI with friends .84 .36 0-1 .38
SI with partner .59 .49 0-1 .71
SI with co-worker .30 .46 0-1 .32
SI with family .50 .50 0-1 .32
SI with stranger .20 .40 0-1 .24
SI with sexual minority women .78 .42 0-1 .43
SI with sexual minority men .35 .48 0-1 .44
SI with nonbinary individuals .32 .47 0-1 .57
SI with straight women .76 .43 0-1 .31
SI with straight men .65 .48 0-1 .30
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Concurrent Associations

At the within-person level, positive sexual and gender identity experiences were significantly positively associated with positive affect and perceived coping efficacy and were significantly negatively associated with anxious and depressed affect and internalized stigma (Table 3). Specifically, on days when participants experienced a positive event related to their sexual or gender identity, they reported more positive affect, less anxious and depressed affect, lower internalized stigma, and more perceived coping efficacy than on days when they did not experience such an event. Positive sexual and gender identity experiences were not significantly associated with anticipated stigma. Given that within-person effects were of central interest, only these parameters are reported in text. However, between-person effects for each model are available in the supplementary materials for this manuscript.

Table 3.

Within-person associations with positive identity events

Unlagged Lagged
Predictor Outcome b 95% CI p b 95% CI p
Positive Sexual Identity Event Positive Affect .35 .29, .40 < .001 .09 .03, .14 .002
Anxious Affect −.15 −.21, −.09 < .001 .01 −.05, .07 .77
Depressed Affect −.17 −.23, −.11 < .001 −.001 −.06, .06 .97
Internalized Stigma −.22 −.26, −.18 < .001 −.05 −.09, −.01 .01
Anticipated Stigma .05 −.01, .10 .08 −.001 −.05, .05 .98
Anticipated Stigma (transformed) .06 .01, .11 .02 −.01 −.06, .04 .68
Perceived Coping Efficacy .34 .26, .42 < .001 .09 .01, .17 .02
Positive Gender Identity Event Positive Affect .41 .29, .53 < .001 .12 −.01, .24 .08
Anxious Affect −.16 −.29, −.04 .01 −.07 −.20, .05 .26
Depressed Affect −.23 −.37, −.10 .002 −.10 −.23, .03 .12
Internalized Stigma −.27 −.38, −.17 < .001 −.07 −.15, .01 .09
Anticipated Stigma −.01 −.10, .08 .87 .003 −.10, .10 .95
Anticipated Stigma (transformed) −.01 −.10, .11 .90 .03 −.10, .15 .68
Perceived Coping Efficacy .34 .18, .51 < .001 .19 .02, .36 .03
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Within-person covariates included day of EMA study (1-30) and whether it was a weekend or weekday. Between-person covariates included gender, race/ethnicity, sexual identity, and age. Sample sizes for sexual identity event analyses and gender identity analyses were 429 and 115, respectively.

Prospective Associations

Fewer within-person associations were significant in prospective analyses. Both positive sexual and gender identity experiences were significantly prospectively associated with perceived coping efficacy, but only positive sexual identity experiences were significantly prospectively associated with positive affect and internalized stigma. In other words, when participants had a positive sexual identity experience on one day, they experienced increases in positive affect and perceived coping efficacy as well as decreases in internalized stigma that persisted into the next day. Further, when gender diverse participants had a positive gender identity experience on one day, they experienced increases in perceived coping efficacy that persisted into the next day. Neither type of positive identity experience prospectively predicted anxious or depressed affect or anticipated stigma.

Sensitivity Models

Given the non-normal distributions of anticipated sexual and gender identity stigma, we also conducted sensitivity analyses in which these variables were transformed. Overall, the pattern of results were the same with one exception. The unlagged association between experiencing a positive sexual identity event and anticipated stigma was significant in sensitivity analyses, with anticipated stigma being more pronounced on days when positive sexual identity events occurred. However, given that the results for the original (untransformed) model diverged from this analysis and that the significant effect was in the opposite direction expected, we suggest interpreting this finding with caution.

Social Interactions

Both positive sexual and gender identity experiences were significantly more likely to occur on days when participants engaged in social interactions for a longer period of time (Table 4). However, results diverged for associations between characteristics of social interaction companions and the likelihood of having a positive sexual identity experience compared to a positive gender identity experience. Positive sexual identity experiences were significantly more likely to occur on days when participants interacted with their friends or partners and on days when they interacted with other sexual and gender minority individuals. Interacting with coworkers, relatives, strangers, or heterosexual individuals was not associated with the likelihood of having a positive sexual identity experience. On the other hand, none of the characteristics of social interaction companions significantly predicted the likelihood of having a positive gender identity experience.

Table 4.

Within-person associations between social context and positive identity experiences

Unlagged
Outcome Context b 95% CI p
Positive Sexual Identity Experience Duration of social interactions .14 .09, .19 < .001
SI with friends .22 .06, .38 .01
SI with partner .19 .02, .37 .03
SI with co-worker −.09 −.21, .03 .12
SI with family .06 −.07, .18 .39
SI with stranger .08 −.05, .21 .24
SI with sexual minority women .25 .11, .40 < .001
SI with sexual minority men .23 .10, .36 < .001
SI with nonbinary individuals .24 .07, .42 < .001
SI with straight women .09 −.05, .23 .21
SI with straight men −.02 −.14, .11 .77
Positive Gender Identity Experience Duration of social interactions .13 .02, .25 .02
SI with friends .04 −.36, .43 .85
SI with partner .07 −.27, .43 .67
SI with co-worker .19 −.11, .50 .20
SI with family .05 −.22, .31 .71
SI with stranger .01 −.32, .33 .94
SI with sexual minority women .07 −.26, .43 .65
SI with sexual minority men −.08 −.38, .23 .60
SI with nonbinary individuals .23 −.09, .54 .16
SI with straight women −.01 −.31, .33 .98
SI with straight men .11 −.14, .37 .38
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SI = social interaction. Within-person covariates included day of EMA study (1-30) and whether it was a weekend or weekday. Between-person covariates included gender, race/ethnicity, sexual identity, and age.

Discussion

The current study aimed to add to the small but growing literature on the effects of positive identity experiences among sexual and gender minority individuals at the daily level. Our findings replicate prior studies linking positive sexual identity experiences with same-day positive (Chong et al., 2023; Mohr & Sarno, 2016; Salim et al., 2019), anxious (Dyar & London, 2018; Flanders, 2015), and depressed affect (Salim et al., 2019), as well as internalized stigma (Mohr & Sarno, 2016). This study also expands upon prior research by examining associations with positive gender identity experiences among gender diverse individuals, exploring associations between positive identity experiences and perceived coping efficacy, and examining both concurrent and prospective associations with positive identity experiences. Our findings demonstrate that while positive identity experiences are associated with reduced negative affect, these effects were temporary. On the other hand, positive identity experiences continued to predict increases in positive affect and perceived coping efficacy, as well as decreases in internalized stigma into the next day. Future research should explore whether positive identity experiences increase sources of resilience to future experiences of enacted stigma events by bolstering positive feelings about one’s identity and perceived coping efficacy, which are known mediators of associations between enacted stigma and internalizing symptoms (Dyar, Feinstein, et al., 2021; Puckett et al., 2023). Results also demonstrate that certain aspects of one’s daily social interactions, such as the people with whom one interacts, may increase the likelihood of positive sexual identity experiences. However, these do not appear to generalize to positive gender identity experiences, highlighting the need for further research on positive gender identity experiences among gender diverse individuals.

The current set of findings provides added clarity to the often mixed literature on associations between positive sexual identity experiences, affect, and internalized stigma by shedding light on the temporality and directionality of these associations. Building on prior studies demonstrating associations between positive sexual identity experiences and same-day positive affect (Chong et al., 2023; Mohr & Sarno, 2016; Salim et al., 2019), we found that positive sexual identity experiences continued to predict increases in positive affect into the next day, providing the first evidence of the directionality of this association. The current study also demonstrated concurrent (but not prospective) associations between positive sexual identity experiences and reduced anxious and depressed affect (Chong et al., 2023; Dyar & London, 2018; Flanders, 2015; Mohr & Sarno, 2016). This may help to shed light on mixed evidence for these associations by indicating that these effects may be fleeting as they are no longer detectable on the next day. Contrary to limited evidence for associations between positive sexual identity experiences and internalized stigma (Dyar & London, 2018; Mohr & Sarno, 2016), we found that positive sexual identity experiences were not only concurrently associated with internalized stigma, but that this effect persisted into the next day. Together, these prospective findings suggest that positive sexual identity experiences precede subsequent increases in positive affect and decreases in internalized stigma that persist into the next day, while they are only concurrently associated with reductions in anxious and depressed affect.

The current study also examined associations between positive sexual identity experiences and perceived coping efficacy, possibly for the first time. Reductions in perceived coping efficacy are known to mediate associations between enacted stigma and subsequent increases in anxious and depressed affect at the daily level (Dyar, 2023), making it a potential target for future interventions aiming to reduce the effects of enacted stigma. Promisingly, we found that positive sexual and gender identity experiences were concurrently and prospectively associated with perceived coping efficacy. This demonstrates the directionality of this association, with positive identity experiences predicting subsequent increases in perceived coping efficacy. Future work should continue to investigate both positive sexual and gender identity experiences and perceived coping efficacy as potential intervention targets to determine if they may help to foster resilience to minority stress.

We also explored whether the duration of social interactions and characteristics of the people that participants interacted with were associated with the likelihood of having a positive identity experience. Both positive sexual and gender identity experiences were more likely to occur on days marked by more time engaged in social interactions. Consistent with prior work (Mohr & Sarno, 2016), we found that days characterized by social interactions with sexual and gender minorities were more likely to include a positive sexual identity experience. Further, we found that positive sexual identity experiences were more likely to occur on days when participants interacted with friends and partners, groups that may be more likely to support a sexual minority individual’s sexual identity. Notably, we examined all social interactions that occurred on a particular day, rather than focusing on the specific context of the positive sexual identity experience. Therefore, we cannot determine whether interactions with sexual and gender minority individuals or with partners or friends contributed directly or indirectly to the positive sexual identity experience. Instead, we can simply conclude that positive sexual identity experiences were more likely to occur on days characterized by social interactions with these individuals. It is possible that the likelihood of experiencing a positive identity event in contexts with individuals from specific groups (e.g., friends, family) may depend on whether the participant is out to those individuals and how accepting those individuals are. Future research should continue to explore the contexts and characteristics of positive sexual identity experiences and potential moderators of those effects (e.g., outness and acceptance).

One notable way in which our current study extended prior research is by examining positive gender identity experiences among gender diverse participants. In concurrent analyses, we found the same pattern of associations between positive sexual and gender identity experiences and affect, internalized stigma, and perceived coping efficacy. However, results diverged substantially for prospective analyses and analyses of social context. Overall, far fewer associations were significant for positive gender identity experiences compared to positive sexual identity experiences. One potential explanation for this lies in differences in sample size, and thus power, for these two sets of analyses. Analyses of positive gender identity experiences focused on the gender diverse subsample, which made up about one quarter of the total sample. This substantially reduced the total number of observations included in this set of analyses, resulting in reduced power. Studies with larger and more diverse samples of gender diverse individuals may detect significant prospective associations between positive gender identity experiences, internalized stigma, and positive affect.

However, power does not appear to explain the lack of significant associations between positive gender identity experiences and social context. Most associations between characteristics of social companions and positive gender identity experiences are much smaller in magnitude than for parallel analyses with positive sexual identity experiences, suggesting that power may not be at fault here. Another potential explanation for these divergent results may be that some characteristics of positive sexual and gender identity experiences may differ systematically. If for example, positive gender identity experiences are more likely to be intrapersonal, their associations with social context may differ markedly. Future research should explore potential factors that may influence the likelihood of positive gender identity experiences at the daily level to better our understanding of the content and context of these events.

Implications

Our findings indicate that positive sexual and gender identity experiences are prospectively associated with positive affect. This may suggest that positive sexual and gender identities experiences could provide a potential source of resilience to minority stress. We found that positive sexual and gender identity experiences were prospectively associated with increases in perceived coping efficacy and decreases in internalized stigma. Given that reduced perceived coping efficacy and increased internalized stigma link enacted stigma with subsequent increases in anxiety and depression, our findings suggest that positive identity experiences may help to interrupt these processes. However, future research should explicitly test this hypothesis as the current study did not examine minority stress experiences. Increasing the prevalence of positive sexual and gender identity experiences may be beneficial. These events can be either intrapersonal or interpersonal and thus may be amenable to multiple approaches to increasing their prevalence. Intrapersonal positive identity experiences (i.e., increasing identity affirmation or pride) is a central focus of one intervention that aims to reduce anti-bisexual internalized stigma and increase bisexual identity pride (Israel et al., 2018) and is a component of interventions that predominately focus on teaching skills for coping with minority stress (e.g., ESTEEM, EQuIP; Pachankis et al., 2015; Pachankis, McConocha, et al., 2020). Increasing interpersonal positive identity experiences can be more complicated as it requires another individual to be involved. However, building a social network of individuals who support one’s sexual and gender identity may be one route to doing so. Similarly, promoting the use of microaffirmations among groups working closely with sexual and gender minority individuals may be way to increase interpersonal positive identity experiences. Critically, individual-level interventions place the burden on sexual and gender minority individuals, while the origin of minority stress exists at social and structural levels and as such requires social and structural intervention.

Limitations

Study findings should be considered in light of their limitations. First, only individuals who used alcohol or cannabis regularly, lived in the US, and were between ages 18 and 25 were included in this study. As a result, it is unclear whether similar patterns will be found among sexual and gender minorities who live outside the US, older individuals or adolescents, or those who use alcohol or cannabis less frequently. While alcohol and cannabis use criteria may limit the generalizability of the study findings, monthly cannabis use and binge drinking are common in this age group, with 20-22% of 18-25 year old individuals living in the US engaging in cannabis use in the past 30 days from 2015-2019 (Palamar et al., 2021). Examination of 2021 data from NSDUH indicates that the majority of 18-25 year old individuals who used cannabis at least monthly, used on 3 or more days in the past month (24.3% used cannabis at least monthly and 19.6% used cannabis 3+ days per month; (Substance Abuse and Mental Health Services Administration, 2023b). Similarly, 29.2% of 18-25 year old individuals living in the US are also estimated to have engaged in binge drinking in the past month (Substance Abuse and Mental Health Services Administration, 2023a). These rates are consistently higher among SMWGD compared to heterosexual women (for review see Dyar, 2022). For example, 27.4% of 18-25 year old SMW reported using cannabis 3+ days in the past month, compared to only 13.5% of 18-25 year old heterosexual women (Substance Abuse and Mental Health Services Administration, 2023b). Therefore, while the alcohol and cannabis inclusion criteria used for this study limit the generalizability of these findings, they likely generalize to a large proportion of SMWGD between ages 18-25 who live in the US.

Research suggests that associations between minority stress experiences and mental health may be stronger among young adults than among older individuals (Robinson et al., 2013); however, it is unclear whether associations between positive identity experiences and affect also differ across development. We also only included gender diverse individuals assigned female at birth rather than including all transgender and gender diverse (TGD) individuals. Therefore, our findings for gender diverse participants may not generalize to all TGD individuals as positive gender identity experiences may differ across subgroups of TGD individuals. Future research should focus on the positive gender identity experiences of TGD individuals. Further, we did not assess the specific social context in which positive identity experiences occurred or whether they were intrapersonal or interpersonal in nature. Therefore, we could not examine potential differences in associations based on the inter/intra-personal nature of events or make conclusions about contexts in which positive identity experiences occurred. We also asked separately about participants’ relationships to the individuals they interacted with and the sexual orientations and gender identities of those individuals, so we were unable to examine whether the likelihood of positive sexual or gender identity experiences varied based on whether participants were interacting with sexual and gender minority friends compared to straight, cisgender friends. Future research should consider using items that allow for this level of nuance to be examined.

Conclusions

The current study builds upon the nascent literature on the potential effects of positive sexual identity experiences by exploring novel covariates (e.g., perceived coping efficacy), examining positive gender identity experiences among gender diverse individuals, and examining prospective effects of positive identity experiences. Results demonstrate that positive sexual and gender identity experiences prospectively predicted increases in perceived coping efficacy – a known mechanism linking minority stress and negative affect. Further, positive sexual identity experiences prospectively predicted increases in positive affect and decreases in internalized stigma. Although these effects were not significant for positive gender identity experiences, this was likely a result of reduced power for these analyses. Positive sexual and gender identity experiences were also associated with increases in anxious and depressed affect, but these effects did not persist into the next day. Finally, positive sexual identity experiences were more likely to occur on days when participants interacted with friends, partners, and sexual and gender minority individuals. Findings highlight the positive effects of positive sexual and gender identity experiences.

Supplementary Material

Supplementary Materials

Public Significance Statement:

Study findings indicate that positive events related to one’s sexual or gender identity are associated with increases in happiness and decreases in feelings of anxiety and depression among LGBTQ+ people. These positive events are also associated with decreases in negative feelings about one’s sexual or gender identity and with feeling more capable of coping with negative emotions.

Acknowledgements:

We would like to thank Shariell Crosby and Sophia Pirog for their invaluable work on this project. We also thank Project QuEST participants for their vital contributions to understanding substance use among sexual minority women and gender diverse individuals.

Role of Funding Sources

This research was supported by a grant from the National Institute on Drug Abuse (K01DA046716; PI: Dyar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Footnotes

The study received IRB approval at Northwestern University (STU00208936; where data was collected) and Ohio State University (2021B0225; where data is stored).

1

Cannabis use criteria were selected to provide adequate power (which increases as the expected number of alcohol and cannabis use days reported increases) while maintaining generalizability (by keeping the criteria for the minimum number of substance use days reported at baseline low) and to be broadly consistent with inclusion criteria of other EMA studies of cannabis use.

2

MSEM utilizes latent variables, rather than group- and grand-mean centering, to separate within- from between-person variance (Ludtke et al., 2008). By removing the between-person variance from the within-person variance, the within-person variables indicate the extent to which an individual was experiencing more/less of a construct than usual (above/below their person mean) on a particular day (e.g., experiencing more/less minority stress than usual).

3

We used Markov Chain Monte Carlo (MCMC) algorithms to generate a series of 10,000 random draws from the multivariate posterior distribution of our sample for each model. We thinned the distribution by a factor of 10 to reduce autocorrelations between sequential estimates. Trace plots and the Gelman-Rubin potential scaling reduction (PSR) were used to determine whether convergence was achieved (Depaoli & Clifton, 2015; Muthen, 2010).

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