Table 2.
General Psychosocial Processes as Mediators of the Association between Sexual Orientation and/or Stigma-related Stress and Psychopathology
| Between-Group Studies of LGB and Heterosexuals | |||||
|---|---|---|---|---|---|
| Citation | Design/Sample | Stressor/Status | Mediator(s) | Outcome | Results consistent with mediation? |
| Coping/Emotion Regulation | |||||
| Hatzenbuehler, McLaughlin, & Nolen-Hoeksema, 2008 | Longitudinal; 29 LGB and 1235 heterosexual adolescents (grades 6–8); representative, community-based sample | Sexual Minority Status (same-sex attraction) | Emotion dysregulation (rumination and emotional awareness) | Depressive and anxiety symptoms | Yes |
| Hatzenbuehler, Corbin, & Fromme, 2008b | Cross-sectional; 111 LGB and 2275 heterosexual young adults; representative, community-based sample | Stressor (Discrimination) | Coping motives | Alcohol-related problems | Yes |
| Matthews et al., 2002 | Cross-sectional; 583 lesbians and bisexuals, 270 heterosexual women; community-based sample from 3 urban cities | Sexual minority status (sexual attraction and behavior) | Coping (e.g., suppression, distraction), emotionality | Suicidality and depressive distress (treatment for depression) | No |
| Safren & Heimberg, 1999 | Cross-sectional; 56 LGB and 48 heterosexual youth; convenience sample | Sexual minority status (self-identification as LGB) | Acceptance coping (e.g., reappraisal) | Depressive symptoms, suicidality | Partial mediation for suicide; full mediation for depression |
| Social/interpersonal | |||||
| Eisenberg & Resnick, 2006 | Cross-sectional; 2,255 sexual minority and 19672 heterosexual adolescents; representative sample of Minnesota youth | Sexual minority status (sexual behavior) | Family connectedness, teacher & adult caring, school safety | Suicidality | Yes |
| Eisenberg & Wechsler, 2003 | Cross-sectional; 630 LGB college students; national random sample | Sexual minority status (self-identification as LGB) | Social norms, social support (campus LGB resources) | Alcohol use (binge drinking); tobacco use | Reduction in association between LGB status and substance use not tested. |
| Hatzenbuehler, Corbin, & Fromme, 2008a | Longitudinal; 111 LGB and 2109 heterosexual young adults; representative, community-based sample | Sexual minoritystatus (self-identification as LGB and sexual behavior) | Social norms | Alcohol use | Yes |
| Plöderl & Fartacek, 2005 | Cross-sectional; 358 LGB and 267 matched heterosexual comparison; convenience sample | Sexual minority Status (attraction, behavior and identification) | Social support (from family) | Suicidality | Yes |
| Safren & Heimberg, 1999 | Cross-sectional; 56 LGB and 48 heterosexual youth; convenience sample | Sexual minority status (self-identification as LGB) | Social support | Depressive symptoms, suicidality | Partial mediation for suicide; full mediation for depression |
| Wichstrom & Hegna, 2003 | Longitudinal; 190 sexual minority and 2,734 heterosexual adolescents; nationally representative study | Sexual minority status (sexual behavior) | Social support | Suicide attempts | No |
| Cognitive | |||||
| Austin et al., 2004 | Cross-sectional; 511 LGB and 9296 heterosexual adolescents; community-based population of adolescents living throughout U.S. | Sexual minority status (feelings of attraction) | Self-esteem | Tobacco use and dependence. | No. |
| Hatzenbuehler, Corbin, & Fromme, 2008b | Cross-sectional; 111 LGB and 2275 heterosexual young adults; representative, community-based sample | Stressor (Discrimination) | Positive alcohol expectancies | Alcohol-related problems | Yes |
| Plöderl & Fartacek, 2005 | Cross-sectional; 358 LGB and 267 matched heterosexual comparison; convenience sample | Sexual minority status (attraction, behavior and identification) | Hopelessness, self-esteem | Suicidality | Yes |
| Russell & Joyner, 2001 | Cross-sectional; 867 sexual minority and 11,073 heterosexual youth (grades 7–12); nationally representative survey (Add Health Study) | Sexual minority status (same-sex attraction) | Hopelessness | Suicide | Partial reduction in association between sexual minority status and suicidal thoughts and behaviors |
| Safren & Heimberg, 1999 | Cross-sectional; 56 LGB and 48 heterosexual youth; convenience sample | Sexual minority status (self-identification as LGB) | Hopelessness | Depressive symptoms, suicidality | Partial mediation for suicide; full mediation for depression |
| Wichstrom & Hegna, 2003 | Longitudinal; 190 sexual minority and 2,734 heterosexual adolescents; nationally representative study | Sexual minority status (sexual behavior) | Global self-worth | Suicide attempts | No |
| Ziyadeh et al., 2007 | Cross-sectional; 100 LGB adolescents; 9,631 heterosexual and “mostly heterosexual”; nationally representative study | Sexual minority status (attraction and identification) | Positive alcohol expectancies, self-esteem | Alcohol use behaviors | Partial (for girls, but not boys); results not consistent for all alcohol outcomes |
| Within-Group Studies of LGB individuals | |||||
| Citation | Design/Sample | Stressor | Mediator(s) | Outcome | Results consistent with mediation? |
| Diaz, Ayala, Bein, Henne, & Marin, 2001 | Cross-sectional; 912 adult Latino gay men; probability sample from 3 cities | Discrimination | Social isolation | Psychological distress (depression and anxiety) | Yes |
| Hatzenbuehler, Nolen-Hoeksema, & Dovidio, in press | Longitudinal (experience sampling study); 31 LGB young adults; convenience sample | Stigma-related stress (discrimination, rejection sensitivity, felt stigma) | Rumination, suppression, social isolation | Psychological distress | Support for rumination and social isolation; Suppression occurred more on days when stigma stressors were reported, but did not mediate the stigma-distress association |
| Hatzenbuehler, Hilt, & Nolen-Hoeksema, in press | Longitudinal; 74 bereaved gay men; convenience sample | Perceived danger | Rumination, social support, pessimism | Depressive and anxiety symptoms | Yes |
| Hershberger & D’Augelli, 1995 | Cross-sectional; 165 LGB young adults (aged 15–21); convenience sample | Victimization | Family support, self-acceptance (self esteem and comfort with gay identity) | Psychological distress and suicidality | Partial (support for psychological distress but not for suicidality) |
| Rosario, Rotheram-Borus, & Reid, 1996 | Cross-sectional; 136 gay and bisexual male youths; convenience sample | Gay-related stress | Self-esteem | Emotional distress; problem behaviors | No |
| Savin-Williams & Ream, 2003 | Cross-sectional; 681 sexual minority male youth; on-line convenience sample | Gay-related stressors and identity variables (victimization, disclosure, gender expression) | Self-esteem | Suicide attempts | Yes |