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. Author manuscript; available in PMC: 2022 Mar 1.
Published in final edited form as: Addict Behav. 2020 Oct 17;114:106718. doi: 10.1016/j.addbeh.2020.106718

Social interaction anxiety and perceived coping efficacy: Mechanisms of the association between minority stress and drinking consequences among sexual minority women

Christina Dyar 1, Emily R Dworkin 2, Sophia Pirog 1, Debra Kaysen 3
PMCID: PMC8009481  NIHMSID: NIHMS1677685  PMID: 33131969

Abstract

Sexual minority women (SMW; individuals who identify as women and as lesbian, bisexual, or with another sexual minority identity) are at increased risk for problematic alcohol use compared to their heterosexual counterparts. This increased risk has been attributed to minority stress. However, longitudinal research examining associations between minority stress and alcohol use outcomes is extremely limited and examinations of these associations at the daily level are nearly non-existent. Further, few longitudinal studies have examined mechanisms through which minority stress may impact alcohol use. We utilized data from a 14-day daily diary study of 98 SMW to examine daily-level associations between experiences of minority stress, alcohol consumption and consequences, and two proposed mediators of these associations (perceived coping efficacy, social interaction anxiety). Results indicated that on days when participants experienced minority stress events, they experienced lower coping efficacy, higher social interaction anxiety, and more drinking consequences than usual. Minority stress was not associated with same-day alcohol consumption. Perceived coping efficacy and social interaction anxiety mediated the same-day association between minority stress and drinking consequences. No prospective associations were significant, suggesting that studies with multiple assessments per day may be necessary to detect immediate effects of minority stress. Findings highlight the potential impact of daily experiences of minority stress on alcohol consequences and provide evidence that two general psychological processes may be mechanisms through which minority stress impacts alcohol consequences. These results provide evidence for a need for interventions that teach SMW skills for coping with minority stress and its psychological consequences.

Keywords: sexual minority, alcohol use, social anxiety, coping efficacy

1. Introduction

Sexual minority women (SMW) are at increased risk for alcohol use disorders compared to their heterosexual counterparts (Drabble et al., 2018; Kerridge et al., 2017), and this has been attributed to minority stress – unique stressors experienced by SMW due to stigmatization (Meyer, 2003). While a growing body of research has provided support for this theory (Kidd et al., 2018), this research has two major limitations. First, research has been predominately cross-sectional and few studies have examined day-to-day associations between minority stress and alcohol use (Livingston, 2017; Talley et al., 2016). Second, little research has examined psychological processes through which minority stress may contribute to problematic alcohol use (Kidd et al., 2018). The current study aims to address these limitations by examining associations between minority stress and alcohol consumption and consequences in a daily diary study of SMW and by testing two mechanisms through which minority stress may impact alcohol consumption and consequences (perceived coping efficacy, social interaction anxiety).

1.1. Minority Stress and Alcohol Use

While most research on associations between minority stressors and alcohol use has been cross-sectional (Kidd et al., 2018; Talley et al., 2016), a few recent semi-annual longitudinal studies have examined these associations among SMW. Findings indicate that when SMW experienced more sexual-orientation-based victimization, they concurrently drank more (Newcomb et al., 2012), experienced more concurrent alcohol consequences (Dyar et al., 2020), and experienced subsequent increases in binge drinking (Dermody et al., 2016). Another study found that, when SMW experienced more minority stressors, they experienced subsequent increases in alcohol consequences, but not greater consumption (Wilson et al., 2016). Together, these findings indicate that minority stress is associated with increased risk for drinking consequences, but evidence for a longitudinal association between minority stress and alcohol consumption is less clear.

While traditional longitudinal studies are critical for advancing our understanding of associations between minority stress and alcohol use, multi-month lags between assessments do not allow for examination of how these processes unfold in real or near-real time and may capture the cumulative impact of stressors rather than the effect of any specific stressful event. Daily diary studies can contribute to a more temporally precise and detailed understanding of associations between minority stress events and drinking in near-real time and can identify mechanisms by which minority stress events may confer risk for problematic alcohol use on a daily basis (Bolger & Laurenceau, 2013; Shiffman, 2009). Such methods are critical for identifying targets for just-in-time interventions that aim to reduce problematic alcohol use among SMW.

We are aware of only one study that has examined associations between minority stressors and alcohol use at the daily level among sexual minorities. Livingston et al. (2017) found that, when participants experienced minority stress, they were more likely to use substances at the same time or later that day. However, this study did not examine the number of drinks consumed or drinking consequences. More daily diary studies are needed to examine temporally proximal associations between minority stress and alcohol use and consequences as well as mechanisms through which minority stress may impact alcohol use.

1.2. Mechanisms of Associations between Minority Stress and Alcohol Use

Hatzenbuehler (2009) proposed that minority stress depletes sexual minorities’ coping resources, which is theorized to increase the likelihood of using substances to cope and developing problematic alcohol use (Hatzenbuehler et al., 2011). Consistent with Hatzenbuehler’s (2009) conceptualization of strained or overburdened coping resources, low perceived coping efficacy refers to perceptions that one is currently unable to effectively manage negative emotions arising from stressful experiences (Bandura et al., 1999; Chesney et al., 2006). Some cross-sectional evidence suggests that experiencing more discrimination is associated with lower perceived coping efficacy (Denton et al., 2014; Ouch & Moradi, 2019). Although we are unaware of any research linking perceived coping efficacy and alcohol use among sexual minorities, research with heterosexuals indicates that low coping efficacy mediates the association between stressful experiences and alcohol use disorder onset (Asselmann et al., 2016). This suggests that low coping efficacy may be one mechanism through which minority stress may contribute to problematic alcohol use.

Another potential mechanism through which minority stress may impact problematic alcohol use is social interaction anxiety – feelings of distress when interacting with other people. Pachankis and Goldfried (2006) proposed that experiences of stigma and awareness of stigma contribute to the development of social interaction anxiety and social anxiety more broadly among sexual minorities. Cross-sectional and longitudinal studies have provided support for this theory by demonstrating associations between minority stress and social interaction anxiety (Burns et al., 2012; Cathey et al., 2014; Pachankis et al., 2018). Although research with sexual minorities has not examined associations between social interaction anxiety and alcohol use, research with predominately heterosexual college students has demonstrated that higher social interaction anxiety is associated with more alcohol problems (Buckner et al., 2006; Schry & White, 2013; Terlecki et al., 2014). Evidence for a link between social anxiety and alcohol consumption is mixed (Buckner et al., 2006; Neighbors et al., 2007; Stewart et al., 2006). However, these mixed findings may be explained by contextual factors, with social interaction anxiety predicting higher alcohol consumption in negative emotional contexts but not necessarily in convivial social contexts (Terlecki et al., 2014). Given this evidence, it is possible that social interaction anxiety may act as a mediator of the association between minority stress and alcohol consumption/problems.

1.3. Current Study

The goals of the current study are to address gaps in the existing literature by: 1) examining associations between minority stress and alcohol consumption and consequences at the daily level and 2) testing two potential mechanisms through which minority stress may impact alcohol consumption and consequences: perceived coping efficacy and social interaction anxiety in a sample of SMW. We hypothesized that at the within-person level, SMW would consume more alcohol and report more alcohol consequences than usual on days when they experienced minority stress. We also hypothesized that on days when SMW experienced minority stress, they would also experience lower perceived coping efficacy and higher social interaction anxiety than usual, which we expected would predict more alcohol consumption and consequences than usual. We hypothesized that the indirect effects of minority stress on alcohol consumption and consequences through coping efficacy and social interaction anxiety would be significant. We aimed to examine both same-day (concurrent) and next-day (prospective) effects.

2. Methods

2.1. Participants and Procedures

Current analyses used data from a larger longitudinal study of substance use among young adult SMW (see Litt, Lewis, Rhew, Hodge, & Kaysen, 2015). Participants were recruited via online advertisements. Eligible participants were U.S. residents, 18 to 25 years old at recruitment, identified as lesbian or bisexual, and had been assigned female at birth.1 Participants were required to be female-assigned at birth due to the larger longitudinal study’s focus on alcohol consumption, which has sex-dependent cutoffs for patterns of use. 1057 eligible participants provided informed consent and completed the Wave 1 assessment. Participants received $25 for the Wave 1 assessment.

Participants who reported consuming 2+ drinks in a single drinking occasion 7+ times in the prior 30 days were invited to participate in the daily diary component. Of the 161 participants who met these eligibility criteria, 100 were randomly selected for the daily diary at Wave 1 and 98 of those completed at least one daily assessment. Links to assessments were emailed to participants each day and they had 24 hours to complete the assessment. The most common times for completion were between 7–11am. Daily assessments took 5–10 minutes to complete. The current study uses data from Wave 1 daily assessments, as all variables of interest were administered during this wave, and select variables from the Wave 1 annual assessment. Participants were paid $5 for each daily assessment and a $10 bonus if all assessments were completed.

The 98 participants who completed at least one daily diary during Wave 1 were included in current analyses. These participants had an average age of 22.0 years (SD=2.13) and ranged from 18.3 to 26.0 years old. The majority of participants (57.1%) identified as bisexual, with the remainder identifying as lesbian. Participants were mostly White (62.2%), with others identifying as Black/African American (11.2%), Asian American (4.1%), multiracial (17.3%), and another race/ethnicity (5.1%).

2.2. Daily Measures

2.2.1. Minority stress

was assessed using a single item, consistent with other daily diary studies of minority stress (Flanders, 2015; Mohr & Sarno, 2016). Participants were asked “Yesterday, did you experience anything stressful or negative related to your sexual orientation?” and could select yes or no.

2.2.2. Perceived coping efficacy

was assessed using two adapted items from the Coping Strategy Questionnaire (Rosenstiel & Keefe, 1983), which have been used in previous daily diary studies (Keefe et al., 1997; Massey et al., 2009; Stappenbeck et al., 2015). Participants were asked “Based on all the things you did to cope or deal with distress yesterday, how much control do you feel you had over the distress” and responded on a scale of 0 (no control) to 6 (complete control). They were also asked “How much were you able to decrease the distress?” on a scale of 0 (couldn’t at all) to 6 (could completely). Cronbach’s alpha ranged from .80-.96 across days.

2.2.3. Social interaction anxiety

was assessed using a 5-item version of the Social Interaction Anxiety Scale (Heimberg et al., 1992). Items were selected and adapted in consultation with anxiety experts to ensure appropriateness for daily administration. Participants were asked to indicate how much they had been bothered by each problem on the previous day on a scale from 1 (not at all) to 5 (extremely). Cronbach’s alpha ranged from .83-.95 across days.

2.2.4. Alcohol consumption

was assessed using a single item. Participants were provided with a definition of a standard drink and asked “How many standard drinks did you have yesterday?” Participants could indicate the specific number of drinks they consumed from 0 to 24 or indicate that they consumed 25 or more drinks.

2.2.5. Drinking consequences

were assessed using a 6-item adapted version of the negative consequences subscale of the Daily Alcohol-Related Consequences and Evaluations Measure for Young Adults (Lee et al., 2017). Participants were asked “Did any of the following things happen to you yesterday as a result of drinking?” and could indicate 1 (yes) or 0 (no) to a six negative consequences. In the current study, two items with low endorsement in the original measure were not assessed (i.e., “I was rude or obnoxious” and “I became aggressive”) and an item was added (i.e., “I felt sad or depressed”). See Table 2 for all items.

Table 2.

Bivariate Associations with Specific Consequences

Consequence Minority Stress Perceived Coping Efficacy Social Interaction Anxiety Mean ICC
I had a hangover 1.77 .96 1.15* .10 .24
I did something that embarrassed me 3.07* .96 1.14* .07 .30
I felt nauseated or vomited 1.31 .96 1.06 .07 .34
I hurt or injured myself by accident 1.04 .87 1.08 .02 .33
I couldn’t remember what I did while drinking 2.13 .96 1.04 .05 .35
I felt sad or depressed 2.00 .79* 1.16* .09 .37
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Within-person odds ratios are presented.

*

p < .05

**

p < .001

2.3. Baseline Measures

2.3.1. Generalized anxiety symptoms

were assessed at the Wave 1 annual assessment using the Generalized Anxiety Disorder 7 (Spitzer et al., 2006). Participants were asked, “How often during the past month have you felt bothered by…” each of the 7 symptoms (e.g., “Feeling nervous, anxious, or on edge”; α=.91) on a scale of 0 (not at all) to 4 (nearly everyday).

2.4. Data Analysis

Analyses were conducted in Mplus 8.1. There were a total of 1054 observations from 98 participants for a compliance rate of 76.8% (M=10.7 days completed; SD=3.7; range=1–14). Within completed assessments, 2.9% of data were missing and handled using full information maximum likelihood. Multilevel modeling with robust maximum likelihood estimation was used and predictors were separated into within- and between-persons components by person- (within-persons) and grand-mean centering (between-persons). Following procedures outlined by Preacher, Zyphur, and Zhang (2010), we estimated the full indirect effects model at both within- and between-person levels to disaggregate effects. Two within-day (concurrent) models were examined, one focused on each mediator (i.e., perceived coping efficacy or social interaction anxiety). At both levels, minority stress was entered as a predictor of the mediator, and both minority stress and mediator were predictors of the number of drinks consumed and drinking consequences. Number of drinks consumed and drinking consequences were treated as count variables using a negative binomial link. At the within-person level, whether the survey referred to a weekday (Monday-Friday) or a weekend (Saturday/Sunday) was included as a covariate. At the between-person level, age, sexual orientation, and race/ethnicity were controlled. Generalized anxiety symptoms were also included as a between-person covariate in models that included social interaction anxiety. The significance of the indirect effects was tested using the Monte Carlo Method for Assessing Mediation (MacKinnon et al., 2004), which is similar to the bootstrap approach and can be used with multilevel models (Bauer et al., 2006).

Two similar prospective models were examined. These models had the same general format, with two exceptions, lagged associations were examined (specifically, minority stress at time t was entered as a predictor of the mediator at t+1, which in turn predicted the number of drinks consumed and drinking consequences at t+2) and the mediator at t and drinking variables at t+1 were included as within-level covariates.

3. Results

Participants experienced minority stress events on 14.6% of days and reported drinking on 51.1% of days. They consumed an average of 4.36 drinks (SD=3.28) and experienced 0.72 drinking consequences (SD=1.20) on drinking days. Table 1 includes means, variances, intraclass correlations, and bivariate associations.

Table 1.

Means, Variances, Intraclass Correlations, and Bivariate Associations

Variable Minority Stress Perceived Coping Efficacy Social Interaction Anxiety Alcohol Consumption (RR) Drinking Consequences (RR)
Minority Stress - −.11* .16** 1.23 1.90*
Perceived Coping Efficacy −.14 - −.18** 1.00 .92*
Social Interaction Anxiety .09 −.54** - 1.01 1.12**
Alcohol Consumption (RR) 1.03 1.05 1.03 1.32**
Drinking Consequences (RR) 1.01 .97 1.11* 1.00 -
Mean .15 7.20 8.10 2.33 .46
Within-person variance .10 7.03 9.47 8.10 .78
Between-person variance .03 4.60 8.10 2.60 .20
Intraclass Correlation .23 .40 .46 - -
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Bivariate associations are Pearson correlation coefficients unless otherwise noted. Rate Ratios (RR) are presented for associations with alcohol consumption and consequences. Bivariate associations above the diagonal are within-person associations while those below the diagonal are between-person associations.

*

p < .05

**

p < .001

3.1. Bivariate Associations

On days when participants experienced minority stress, social interaction anxiety was higher and coping efficacy was lower than usual. On days when participants experienced minority stress, higher social interaction anxiety, or lower coping efficacy than usual, they experienced more drinking consequences, but did not consume more alcohol. To explore why these variables were associated with drinking consequences but not consumption, we examined bivariate associations between the likelihood of each consequence and these variables at the within-person level (Table 2). A Benjamini-Hochberg correction was conducted to control Type I error. On days when participants experienced minority stress, they were more likely to report doing something embarrassing while drinking. When participants reported higher coping efficacy, they were less likely to report experiencing depression as a result of drinking. Further, on days when participants had higher social interaction anxiety, they were more likely to have a hangover, report doing something embarrassing, or report feeling depressed as a result of drinking.

3.1. Multilevel Structural Equation Models

3.1.1. Within-Day (Concurrent) Coping Efficacy Model

The indirect effects model in which coping efficacy is the mediator is presented in Table 3. At the within-person level, participants reported lower coping efficacy on days when they experienced minority stress. Experiencing lower coping efficacy than usual was associated with experiencing more drinking consequences than usual, but not with number of drinks consumed. The indirect effect of minority stress on drinking consequences through coping efficacy was significant (estimate=0.06, 95% CI: 0.004, 0.13).

Table 3.

Multilevel Structural Equation Model: Coping Efficacy

Level Outcome Predictor RR b se p
Within Coping Efficacy Minority Stress - −.82 .29 .004
Weekend - −.35 .18 .06
Number of Drinks Minority Stress 1.27 .24 .14 .09
Coping Efficacy 1.01 .01 .02 .58
Weekend 2.05 .72 .10 < .001
Negative Alcohol Consequences Minority Stress 1.79 .58 .22 .01
Coping Efficacy .93 −.07 .03 .03
Weekend 1.77 .57 .17 .001
Between Coping Efficacy Minority Stress - −.12 .06 .04
Age - .03 .11 .80
Bisexual Identity - −.73 .43 .09
POC - −.19 .45 .67
Number of Drinks Minority Stress 1.03 .03 .02 .16
Coping Efficacy 1.05 .05 .05 .26
Age .96 −.04 .01 < .001
Bisexual Identity .81 −.21 .19 .27
POC 1.14 .13 .20 .51
Negative Alcohol Consequences Minority Stress 1.02 .02 .04 .50
Coping Efficacy 1.01 .01 .06 .96
Age .93 −.07 .01 < .001
Bisexual Identity 1.42 .35 .25 .16
POC 1.09 .09 .26 .71
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Note. Bisexual identity, POC (person of color), and weekend variables are dichotomous, dummy coded variables in which lesbian identity, non-Latinx, White identities, and weekday are the reference groups.

3.1.2. Within-Day (Concurrent) Social Interaction Anxiety Model

The indirect effects model in which social interaction anxiety is the mediator is presented in Table 4. At the within-person level, on days when participants experienced minority stress, they also experienced more social interaction anxiety than usual. Experiencing more social interaction anxiety than usual was associated with experiencing more drinking consequences, but not with number of drinks consumed. The indirect effect of minority stress on drinking consequences through social interaction anxiety was significant (estimate=0.14, 95% CI: 0.04, 0.27).

Table 4.

Multilevel Structural Equation Model: Social Interaction Anxiety

Level Outcome Predictor RR b se p
Within Social Interaction Anxiety Minority Stress - 1.43 .38 < .001
Weekend - .18 .20 .36
Number of Drinks Minority Stress 1.26 .23 .14 .11
Social Interaction Anxiety 1.00 .001 .02 .94
Weekend 2.05 .72 .10 < .001
Negative Alcohol Consequences Minority Stress 1.40 .34 .24 .15
Social Interaction Anxiety 1.11 .10 .03 < .001
Weekend 1.72 .54 .17 .002
Between Social Interaction Anxiety Minority Stress - .13 .08 .10
Age - −.04 .12 .77
Bisexual Identity - 1.12 .56 .04
POC - .43 .66 .51
Number of Drinks Minority Stress 1.02 .02 .03 .29
Social Interaction Anxiety 1.03 .03 .03 .29
Age .96 −.04 .01 < .001
Bisexual Identity .76 −.28 .20 .16
POC 1.12 .11 .20 .58
General Anxiety 1.00 .003 .01 .80
Negative Alcohol Consequences Minority Stress 1.03 .03 .03 .34
Social Interaction Anxiety 1.07 .07 .04 .06
Age .93 −.07 .02 < .001
Bisexual Identity 1.40 .34 .25 .18
POC .98 −.02 .27 .95
General Anxiety .99 −.01 .02 .71
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Note. Bisexual identity, POC (person of color), and weekend variables are dichotomous, dummy coded variables in which lesbian identity, non-Latinx, White identities, and weekday are the reference groups.

At the between-person level, bisexual participants tended to experience more social interaction anxiety on average compared to lesbian identified participants.2

3.1.3. Next-Day (Prospective) Models

In prospective indirect effects models, none of the lagged associations among minority stress, perceived coping efficacy, social interaction anxiety, number of drinks consumed, and drinking consequences were significant. Results are presented in Supplementary Tables 1 and 2.

4. Discussion

This study is one of the first to examine associations between minority stress and alcohol use at the daily level among SMW. Further, it is, to our knowledge, the first daily diary study to examine mechanisms through which minority stress may impact drinking behaviors. Results indicate that on days when SMW experienced minority stress, they experienced more drinking consequences, but did not necessarily consume more alcohol. These within-day associations were mediated by perceived coping efficacy and social interaction anxiety. Specifically, when SMW experienced minority stress, they reported lower perceived coping efficacy and more social interaction anxiety, which were associated with more drinking consequences, but not higher consumption. These findings highlight the potential impact of daily minority stress on alcohol consequences and provide evidence that two general psychological processes may be mechanisms through which minority stress impacts alcohol consequences.

4.1. Same-Day (Concurrent) Findings

At the daily level, we found that minority stress was associated with more drinking consequences but not with the amount of alcohol consumed. This same pattern has been found at the within-person level in semi-annual longitudinal studies (Wilson et al., 2016). However, Dyar et al. (2020) found that this pattern was only present for some types of minority stress (i.e., victimization) and not others (i.e., microaggressions, internalized stigma). While conclusions drawn from semi-annual longitudinal studies do not necessarily indicate the presence of associations at the daily level, the current study demonstrates that experiencing minority stress is associated with more drinking consequences on the same-day, advancing our understanding of the temporality of these associations. One potential explanation for this somewhat counterintuitive pattern of results is that minority stress may be associated with higher risk styles of drinking or reduced use of protective behavioral strategies aimed at reducing consequences. Another potential explanation is that minority stress may be associated with consequences but not necessarily consumption because minority stress triggers negative affect and coping motived drinking, which has been found to predict negative consequences independent of consumption (Merrill et al., 2014).

Hatzenbuehler (2009) posited that minority stress leads to problematic alcohol use by depleting sexual minorities’ coping resources, which in turn increases the likelihood of drinking to cope and problematic alcohol use. We tested this theory in the current manuscript by examining coping depletion as a mediator of the association between minority stress and alcohol consequences. Consistent with this proposed pathway, we found that participants reported lower perceived coping efficacy on days when they experienced minority stress and that perceived coping efficacy mediated the association between minority stress and alcohol consequences. The current study may be the first longitudinal study to examine perceived coping efficacy as a mediator of this association. However, existing research has provided some convergent support for the mechanistic role of perceived coping efficacy, with one longitudinal study indicating that perceived coping efficacy mediates the association between stressful life events and problematic substance use in a heterosexual sample (Asselmann et al., 2016). It is possible that our measure of perceived coping efficacy may have captured both coping depletion and situational constraints that may also affect perceived coping efficacy. Future research should utilize more precise measures of coping depletion.

We also found evidence for another potential mechanism of this association: social interaction anxiety. On days when participants experienced minority stress events, they reported higher social interaction anxiety, and this mediated the association between minority stress and drinking consequences. While prior studies have demonstrated that higher minority stress is associated with higher social interaction anxiety cross-sectionally and longitudinally (Burns et al., 2012; Cathey et al., 2014; Pachankis et al., 2018), this is the first study we are aware of demonstrating these associations at the daily level. Consistent with existing cross-sectional findings (Buckner et al., 2006; Terlecki et al., 2014), we found that social interaction anxiety was associated with drinking consequences but not the amount of alcohol consumed at the daily level. As recent cross-sectional research with heterosexual college students suggests that social anxiety may increase alcohol consumption in specific contexts (e.g., negative affect) (Terlecki & Buckner, 2015; Terlecki et al., 2014), future research should explore whether context-specific heavy alcohol consumption helps to explain the link between social anxiety and drinking consequences among SMW at the daily level. As prior research has suggested that other types of anxiety (e.g., generalized anxiety) may mediate the association between minority stress and problematic alcohol use (Allan et al., 2015; Dyar et al., 2020; Goldsmith et al., 2009), future research should examine whether this mediating role is unique to social interaction anxiety or characteristic of anxiety more broadly.

4.2. Next-Day (Prospective) Findings

When looking at the lagged indirect effects model, the prospective associations among minority stress, mediators, and drinking variables were not significant. It is possible that these next-day effects were not significant as a result of the day-long lag between assessments and current approaches to modeling lagged effects. Consistent with current recommendations, we controlled for the outcome and mediator on the prior day in lagged analyses. This means that results are interpreted as, for example: minority stress experiences on one day (t) predict a decrease in perceived coping efficacy from that day to the next (t to t+1). In other words, perceived coping would need to be lower the day after the minority stress experience than the day of the experience. It is likely that changes in anxiety, coping efficacy, and drinking occur closer to the stressful event than the next day. Therefore, a day-long gap between assessments may be too long to detect the changes in these variables arising from minority stress. Future studies using multiple assessments per day may more effectively capture the immediate effects of minority stress on mood and drinking behavior.

4.1. Clinical Implications

The results of this study have several clinical implications. First, policies and system-level interventions that aim to increase sexual orientation equity and reduce discrimination and marginalization are needed to reduce minority stress. Second, clinicians working with SMW should assess experiences of minority stress and work to develop a shared understanding with clients of how these experiences affect their alcohol use. For example, when conducting a chain analysis of alcohol use, clinicians could probe for experiences of minority stress and associated cognitions regarding coping and social interactions that may have preceded drinking, and work to restructure these cognitions or identify alternative coping strategies. Third, interventions that aim to teach SMW effective skills for coping with both minority stress and downstream psychological consequences are needed, consistent with calls to tailor substance use interventions for sexual minorities (Talley, 2013).

4.2. Limitations

The results of the current study should be considered in light of its limitations. First, while the daily diary methods used were a major strength of the current study and provided rare insight into daily experiences of minority stress, psychological processes, and drinking among SMW, the day long lags between assessments may have been too long to determine the directionality of these associations. Future studies, with multiple assessments per day, would be well suited to examine the temporality of these associations. Second, we did not ask about the types and severity of minority stress that participants’ experienced. Third, drinking to cope is another mechanism that is theorized to play a role in the process through which minority stress impacts alcohol use and consequences. However, we did not examine this mechanism in the current study. Fourth, the sample only included SMW, and therefore, it is unclear to what extent these findings extend to sexual minority men and sexual minority individuals with non-binary gender identities. Fifth, participants were predominately White, identified as lesbian or bisexual, lived in the United States, and drank regularly, making it unclear to what extent these findings generalize to all SMW. Sixth, our measure of minority stress could have captured experiences of biased treatment by others as well as negative feeling related to one’s sexual identity. Future research should examine the effects of different types of minority stressors separately.

4.3. Conclusion

Despite limitations, the current study extends our understanding of daily processes through which minority stress may impact alcohol consequences among SMW. Findings demonstrate that minority stress is associated with elevations in drinking consequences at the daily level, but not with alcohol consumption. Results provide initial support for reduced coping efficacy and elevated social interaction anxiety as potential mechanisms through which minority stress may impact drinking consequences. Future research using ecological momentary assessment methods is needed to examine the temporality of these processes. Our findings suggest that interventions which target minority stress and teach effective skills for coping with minority stress and downstream psychological consequences are likely to be effective in reducing drinking consequences among SMW.

Supplementary Material

Supplementary Tables_Social interaction anxiety and perceived coping efficacy

Acknowledgments

Role of Funding Sources

This research was supported by a grant from the National Institute of Alcohol Abuse and Alcoholism (R01AA018292; PI: Kaysen). Manuscript preparation was supported by grants from the National Institute on Drug Abuse (K01DA046716; PI: Dyar) and the National Institute on Alcohol Abuse and Alcoholism (R00AA026317; PI: Dworkin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Footnotes

1

We refer to participants as women because all participants identified as women at the time they enrolled in the study. Some women (e.g., transgender women) are not reflected in the sample due to enrollment criteria about sex assigned at birth. Other participants may have primarily identified with other sexual identity labels (e.g., genderqueer).

2

To determine whether models differed based on sexual identity, sensitivity analyses were conducted in which all major pathways in the mediation models were moderated by sexual orientation. Results indicated that pathways did not differ significantly between lesbian and bisexual women (ps > .24).

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Supplementary Materials

Supplementary Tables_Social interaction anxiety and perceived coping efficacy
NIHMS1677685-supplement-Supplementary_Tables_Social_interaction_anxiety_and_perceived_coping_efficacy.docx (18.1KB, docx)

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