Stigma experiences are robustly connected to poor health outcomes. However, stigma itself is contextually dependent. Comparing recent data (collected in 2022-2023) to a previous data set (collected 2004-2005), we examined changes in cultural and anticipated stigma for 13 concealable stigmatized identities (CSIs). Moreover, we tested if the relationship between anticipated stigma and poor mental health had changed over time. By comparing viewpoints from a single community, a generation apart, we take a historical perspective to investigate if-and for whom-stigma has improved. Results show that both cultural and anticipated stigma have gotten better and that neither are as strongly associated with distress as they once were. These improvements, however, are not enjoyed equally among all identities. Moreover, distress levels have not changed for people with CSIs, indicating that other factors are contributing to poor mental health. Potential reasons for these changes are discussed.

Introduction Sexual minority emerging adults in Appalachia face multiple sources of stigma and discrimination.Methods We conducted four focus groups and five one-on-one interviews with sexual minority young adults and community stakeholders.Results Themes emerged from qualitative analysis: (1) Appalachian culture engenders discrimination and isolation; (2) A need to identify safe spaces; (3) Lack of access to identity-affirming health services; and (4) participants draw strength from limited but persistent resistance, advocacy, and visibility.Conclusion Sexual minority emerging adults experience intersectional stigma in a socially conservative Appalachian setting. Attention to their unique experiences points toward specific service and community support needs.

Despite the ascendancy of intersectionality, the preponderance of quantitative research in psychology has continued to examine links between stigma and illness symptoms with methodological approaches that examine only one or two identities while ignoring other relevant social categories. The present study deploys intersectional approaches to estimate the stigma illness link among those living with multiple concealable stigmatized identities. In a convenience sample of 1,450 college-aged emerging adults, we found that those living with one or more concealable stigmatized identities reported greater symptoms of depression, anxiety, and physical illness than those living without stigmas. Of the subgroup reporting one or more concealable stigmatized identities, number of stigmas predicted greater symptoms of depression, anxiety, and physical illness while accounting for the severity of stigma-related cultural-level conditions and individual-level stress exposures. These results suggest that individuals living in multiply marginalized 4 social positions may bear more of the illness-generating effects of marginalization.

A limited number of studies have examined mechanisms undergirding interventions that mitigate mental health problems or health-risk behaviors that disproportionately burden sexual minorities. A recent trial of expressive writing and self-affirmation writing found that these brief interventions had salubrious effects on mental health and health-risk behaviors; the present research examines the putative mechanisms underlying these effects. Sexual minority emerging adults (N = 108) completed a brief online expressive writing, self-affirmation writing, or neutral control writing intervention and, at baseline and 3-month follow-up, completed measures of mental health, health-risk behaviors, stress, and self-regulation. Expressive writing yielded improvements in mental health and these effects were mediated by reductions in perceived stress. Self-affirmation caused improvements in health-risk behaviors, though neither stress nor self-regulation mediated these effects. This finding provides preliminary novel evidence regarding a mechanism underlying a widely used psychological intervention with documented mental health benefits for sexual minorities and other populations disproportionately affected by stress. Public Significance Statement This study found that writing about difficult or painful sexual identity-related experiences reduced perceived stress which, in turn, improved mental health among LGBTQ+ young adults in a high-stigma, low-resource context. This finding may be helpful to psychologists, practitioners, policymakers, and funders who aim to design and disseminate programs capable of addressing mental health inequities among sexual minority and other stress-exposed communities.

Background: Personal disclosure of opioid use disorder (OUD) recovery can lead to relationship outcomes such as social support, which is associated with greater treatment retention, or stigma, which is associated with risk of treatment dropout. Although disclosure may have important impacts on the relationships and ensuing recovery trajectories of people with OUD, disclosure processes remain understudied in the context of OUD. Methods: Guided by the Disclosure Process Model, this longitudinal study explored the disclosure goals of people in treatment for OUD and examined associations between disclosure goals and relationship outcomes. Data were collected at baseline (N = 146) and three months later (n = 124) from participants who were in treatment for OUD and planning to disclose their OUD history and/or treatment to someone new. Results: Qualitative baseline data were analyzed to identify disclosure goals. Approach goals (i.e., reasons for disclosure) included support, honesty, amends, set an example, and logistics; avoidance goals (i.e., reasons against disclosure) included judgment, worry, and privacy. Quantitative data suggested that approach goals at baseline were associated with greater likelihood of disclosure within three months (OR=2.16, 95% CI=1.04-4.49) as well as with greater social support [B(SE)= 0.35(0.16), p = 0.03] and relationship closeness [B (SE)= 0.29(0.17), p = 0.01] following disclosures. In contrast, avoidance goals at baseline were associated with greater enacted stigma following disclosures [B(SE)= 0.30(0.14), p = 0.04]. Conclusions: Findings draw attention to the potentially important role of disclosures in relationship outcomes among people in recovery from OUD. Disclosure may represent a promising intervention target to improve relationship outcomes and recovery trajectories of people in recovery from OUD.

Purpose: In the current study, stuttering was conceptualized as a concealable stigmatized identity (CSI). The purpose of this investigation was to determine if four specific stigma-identity constructs that contribute to variability in psychological distress among people in other CSI groups also contribute among adult who stutter (AWS). Method: 505 AWS completed an online survey that included measures of four stigma-identity constructs in addition to general demographics and measures of self-rated stuttering severity, distress, and adverse impact of stuttering on quality of life. Hierarchical regression was performed to determine the extent that stigma-identity constructs explained variability in psychological health outcomes among AWS. Self-rated stuttering severity was investigated as a moderator in these relationships. Results: The stigma-identity constructs accounted for a significant proportion of the variability in distress (-25 %) and adverse impact of stuttering on quality of life (-30 %) among AWS. Further, the constructs of salience, centrality, and concealment were positively predictive of distress and adverse impact of stuttering after controlling for demographics and neuroticism. Compared to the other predictor variables (self-rated stuttering severity, demographic characteristics, neuroticism, and the three other stigma-identity constructs), concealment was the strongest predictor of adverse impact of stuttering on quality of life. Finally, self-rated stuttering severity was a moderating variable. Conclusions: The results from this study suggest that there are useful applications in conceptualizing stuttering as a type of CSI. Speech-language pathologists should be aware of the relationships that stigma has with psychological health outcomes among AWS and should consider the implications for intervention.

OBJECTIVETo identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee.METHODIn consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up.RESULTSCompared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control.CONCLUSIONBrief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

To address sexual assault, many universities are implementing Bringing in the Bystander™ (BitB) training, a prevention program that aims to improve participants’ bystander self-efficacy and reduce rape myth acceptance. Although growing evidence supports the efficacy of BitB, data primarily have been amassed at one large public university, the University of New Hampshire, limiting the generalizability of intervention effectiveness. To address this gap, we made modifications to training structure and assessed BitB effectiveness among first-year students at a private Jesuit Catholic liberal arts college in Massachusetts. Using a within-subjects pre-/post-test survey design, we found that students’ (N = 164) bystander self-efficacy significantly increased and rape myth acceptance significantly decreased following training. Results indicate that BitB implementation is feasible and effective on a new campus despite modest modifications to training delivery and despite differences in religious affiliation, median income, and class size between the two campuses.

Although stigma has been linked to suboptimal psychological and physical health outcomes in marginalized communities such as persons of color, sexual minorities, and people living with HIV/AIDS, no known research has examined these effects among deaf individuals. In the present research, we examine the associations between anticipated, enacted, and internalized stigma and psychological well-being (i.e., depressive symptoms, anxiety) and physical well-being (i.e., quality of life, alcohol use) among a sample of 171 deaf emerging adults. Furthermore, we consider whether trait resilience and benefit-finding moderate these effects. Enacted stigma, but not anticipated or internalized stigma, was related to worse depressive symptoms, anxiety, and quality of life. However, none of these variables predicted alcohol use and neither resilience nor benefit-finding moderated these effects. These findings are consistent with other research among marginalized populations, though they are also the first to suggest that experiences of discrimination are related to suboptimal well-being among deaf emerging adults. The discussion considers how these findings may illuminate the potential causes of disparities in well-being between hearing and deaf emerging adults.

Relational processes (i.e., disclosure, stigma, social support) experienced by youth with substance use disorders (SUDs) and their caregivers may act as barriers to, or facilitators of, recovery but are understudied. Single-session qualitative semi-structured interviews were conducted with 19 patients and 15 caregivers recruited by clinicians from a SUD program. There was variability in disclosure experiences, including how many people knew about patients’ SUD diagnosis and treatment, whether patients or caregivers primarily disclosed to others, and feelings about others knowing about one’s or one’s child’s SUD treatment. After disclosing, patients and caregivers experienced stigmatizing (e.g., social rejection) and supportive (e.g., understanding, advice) reactions from others. Disclosures may have important implications for relationship and recovery-related outcomes. Moreover, some child-caregiver pairs have significant disagreements regarding disclosure of SUD treatment. Addressing relational processes within treatment by encouraging patients and caregivers to share the disclosure decision-making process may support the recovery of youth with SUDs.

Abstract HIV/AIDS is one of the most devastating public health threats facing the modern world, and its eradication relies heavily on the performance of individual risk-reduction and treatment behaviors. In this chapter, a bidirectional lens is applied to consider how stigma systematically and synergistically constrains individual ability to perform behaviors critical to the effective prevention and treatment of HIV (e.g., sexual risk reduction and medication adherence), which ultimately compromises physical health. In addition to producing increased stigma, compromised physical health may further inhibit HIV risk-reduction and treatment behaviors. Interventions capable of mitigating these bidirectional effects are then discussed. Finally, the chapter discusses the implications of the conceptual model in illuminating the causes of persistent disparities in HIV incidence and treatment outcomes.

Although rejection sensitivity has been shown to predict altered psychological and relational well-being, a surprising dearth of research has examined physiological effects of this individual difference measure during childhood and adolescence. In the present research, we investigated the relationship between rejection sensitivity, negative affect, and sympathetic nervous system (SNS) response to laboratory performance stressors among youth. Thirty-two normally developing youth completed a modified version of the Trier Social Stress Task. Self-report measures of negative affect and salivary alpha amylase were collected over the course of the stress session. Controlling for gender, rejection sensitivity was related to greater negative affect and blunted alpha amylase reactivity. These data are the first to demonstrate that rejection sensitivity is associated with altered physiological stress response among youth. These findings also identify a plausible psychobiological mechanism that could provide new insight into why rejection sensitivity is a vulnerability factor for suboptimal academic performance in childhood and adolescence.

Sexual orientation health disparities are rooted in sexual minorities' exposure to stress and challenges to effective coping. This paper reviews the "toolkit" of psychosocial interventions available to reduce sexual minority stress effects. A systematic search uncovered 44 interventions that both seek to reduce sexual minority stress at its source in unjust and discriminatory social structures as well as bolster sexual minorities' stigma-coping abilities. These interventions were implemented in a variety of contexts (e.g., education, health care delivery) and utilized heterogeneous modalities to create change (e.g., policy implementation, role-playing activities). They were designed to affect change across structural, interpersonal, and individual levels. The interventions reviewed here, while in early stages of efficacy testing, possess potential for meeting the needs and resources of mental and medical health care providers, policy makers, and other stakeholders who aim to lessen the burden of sexual minority stress and the health disparities it generates.

BACKGROUND AND OBJECTIVES:The degree to which a traumatic event is seen as central to one's sense of self (trauma centrality) has been associated with posttraumatic stress disorder (PTSD) symptoms. Based on cognitive models of PTSD that highlight the role that maladaptive appraisals play in generating PTSD symptoms, we hypothesized that appraising a trauma as violating one's core beliefs and goals mediates the link between trauma centrality and PTSD symptoms. Further, we reasoned that coping ability moderates the direct and indirect link as those with better coping ability will have more adaptive appraisals.DESIGN:Hypotheses were examined in a cross-sectional sample of 367 undergraduates who have experienced a traumatic event.METHODS:Data were collected via an online survey.RESULTS:Overall, results of the moderated mediation analysis were consistent with the hypothesized mediating role for appraised violations and moderating role for coping ability.CONCLUSIONS:Findings highlight the importance of considering individual differences and trauma appraisals in understanding the relationship between trauma centrality and PTSD - trauma centrality may be related to PTSD symptoms more so among people with poorer coping ability who appraise a trauma as violating their core beliefs and goals.

People living with concealable stigmatized identities are vulnerable to experiencing greater depressive symptoms as a result of occupying a lower social status. In the present research, we examine the effect of changes in enacted stigma and changes in anticipated stigma on trajectories of depressive symptoms over time. A sample of 192 college-aged emerging adults (81.0% female, 81.9% Caucasian, Mage = 18.82 years) living with a concealable stigmatized identity (e.g., mental illness and sexual minority status) completed measures of enacted stigma, anticipated stigma, and depressive symptoms at two time points across eight weeks. Hierarchical linear modeling analyses indicate that increases in anticipated stigma, but not enacted stigma, predicted poorer trajectories of depressive symptoms, controlling for the effect of baseline rumination and other identity-related variables. These data are among the first to demonstrate that worries about future devaluation predict poorer depressive symptom trajectories over time among college-aged emerging adults.

We examined the association between two dimensions of maternal parenting style (care and overprotection) and cortisol response to an acute laboratory-induced stressor in healthy youth. Forty-three participants completed the Parental Bonding Instrument and an adapted version of the Trier Social Stress Test-Child (TSST-C). Nine cortisol samples were collected to investigate heterogeneity in different phases of youth's stress response. Multiphase growth-curve modeling was utilized to create latent factors corresponding to individual differences in cortisol during baseline, reactivity, and recovery to the TSST-C. Youth report of maternal overprotection was associated with lower baseline cortisol levels, and a slower cortisol decline during recovery, controlling for maternal care, puberty, and gender. No additive or interactive effects involving maternal care emerged. These findings suggest that maternal overprotection may exert a unique and important influence on youth's stress response.