Members of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and expansive (LGBTQIA+) community face higher levels of discrimination than the general public. Social marginalization has a corrosive impact on mental health, including increased rates of anxiety disorders, depression, substance use disorders, and suicide behaviors. Anti-LGBTQIA+ laws and policies have a demonstrable, negative impact on the mental health of LGBTQIA+ people. Mental health professionals refer to the collective effect of identity-based societal mistreatment as “minority stress.” Numerous research studies over the last 20 years have identified the link between higher levels of minority stress and worse mental health outcomes, including for LGBTQIA+ communities. Less research, however, has investigated “Intersectional Minority Stress” – how intersecting identities such as racial and LGBTQIA+ identity overlap and interact to influence one’s exposure to societal mistreatment.
We know that protective factors – activities and resources that may reduce the effects of stress – can mitigate the impact of social oppression on marginalized communities. For instance, an LGBTQIA+-affirming family or workplace can help individuals negotiate the cumulative negative impact of social marginalization.
The figure below lists protective factors across multiple systems, from the individual level to the public policy level.
Figure 1. This figure was adapted from Lee et al., 2017.
One protective factor with promising evidence is community connectedness. Community connectedness refers to an individual’s degree of emotional engagement and affiliation with other members of the LGBTQIA+ community. Community connectedness includes wanting to belong to a community of LGBTQIA+ people, developing important relationships within that community, sharing emotional connections with other members of that community, and deriving benefits from connection to that community. Community connectedness can be assessed in research studies through qualitative interviews as well as quantitative questionnaires about belonging, connection, meaning, and pride in the LGBTQIA+ community.
Researchers have found community connectedness to be a protective factor against minority stress, but we know less about how overlapping systems of oppression – such as anti-LGBTQIA+ discrimination and racism – impact the effect of community connectedness.
Does Community Connectedness Improve Mental Health for LGBTQ+ People of Color?
To better understand how community connectedness influences Intersectional Minority Stress, I and my research mentors Dr. Shmuel Lissek and Dr. Lynette Renner, conducted a study aimed at examining the impact of Intersectional Minority Stress on anxiety disorder facets.
We sought to investigate the relationship between Intersectional Minority Stress exposure, measured by the LGBT People of Color Microaggressions Scale, several posited protective factors (including LGBTQIA+ community connectedness, assessed by the Collective Self-Esteem Scale and the LGBT Community Connectedness Scale), and avoidance behaviors, measured by total score on self-reported responses to the Multidimensional Experiential Avoidance Questionnaire. Avoidance behaviors refer to actions people take to avoid uncomfortable situations or feelings. Avoidance behaviors are considered a central feature, and potentially a risk factor, in the development of anxiety disorders. Although it’s natural to avoid things that might pose a danger to us, high levels of general avoidance can prevent us from learning that something avoided is safe and can also interfere with access to meaningful opportunities. For example, someone who feels anxious about an upcoming party and chooses to avoid this event will not be able to learn that the party was safe (and possibly even fun) and will also miss out on the chance to socialize with others in attendance. If this person continues to avoid future social events, they would be at an increased risk for social anxiety disorder because decisions to avoid parties prevent them from learning that they can handle these potentially stressful social situations.
Our quantitative study required 97 participants, all of whom identified as Black, Indigenous, Asian, and People of Color (BIAPoC) and as members of the LGBTQIA+ community, to complete the questionnaires online. We tested whether higher levels of minority stress predicted higher levels of avoidance, and whether or not proposed protective factors predicted avoidance behaviors. The aim was to improve our understanding of the known link between minority stress and anxiety disorder risk, due to the central importance of avoidance behaviors to anxiety pathology. We predicted that higher levels of Intersectional Minority Stress would result in higher levels of avoidance, and higher levels of protective factors such as community connectedness would result in lower levels of avoidance.
Remarkably, we found that higher levels of community connectedness within our sample predicted higher levels of avoidance. In other words, BIAPoc LGBTQ+ participants who had closer ties to the LGBTQIA+ community were more likely to engage in avoidance behaviors designed to escape or avoid situations, thoughts, people, things, places, or sensations that were uncomfortable or unpleasant.
This finding was unanticipated because community connectedness has been frequently proposed to be a protective factor against the development of mental health concerns. This finding is significant as previous research suggests that higher levels of avoidance are associated with increased risk for anxiety disorders, OCD, and PTSD.
It is difficult to fully explain the association between increased community connectedness and increased avoidance. One possible explanation could be racism within the LGBTQ+ community pushing BIAPoC people to the margins. Intra-community marginalization may feel especially painful and interfere with the protective effects of community connectedness. Rather than general community connectedness promoting well-being, BIAPoC LGBTQIA+ people may derive greater benefits from connectedness with other BIAPoC LGBTQIA+ people, including material and emotional support.
Our study was correlational, not causational, so it’s also possible that LGBTQIA+ BIAPoC people who are prone to avoid unpleasant and uncomfortable experiences may also be more likely to seek out community connectedness as a more comfortable form of social engagement. Additional research is needed to clarify the relationship between community connectedness and avoidance behaviors amongst BIAPoC LGBTQIA+ people.
Addressing Minority Stress Through Intersectional Mental Health Policy
Our study underscores the importance of adopting an intersectional approach to policymaking on LGBTQIA+ issues. It’s undeniable that political attacks on LGBTQIA+ communities – in tandem with entrenched racism across social institutions, including healthcare, education, and the criminal legal system – lead to negative mental health outcomes for BIAPoC LGBTQ+ people. The effects of societal mistreatment on mental health and well-being in the LGBTQIA+ community necessitate a public health response. When societally sanctioned mistreatment interferes with the ability of a group to thrive, public policy interventions must take place.
The present study, as well as past research, suggests that posited protective factors for the LGBTQIA+ community at large may not serve BIAPoC LGBTQIA+ people in the same ways that they serve white LGBTQIA+ people.
This poses an important challenge for LGBTQIA+ advocacy organizations and policymakers: policies aimed at improving the lives of LGBTQIA+ people must consider whether these policies will serve members of the community with intersecting marginalized identities, along lines of race, class, disability, and so on. State and federal lawmakers can improve mental and social well-being for BIAPoc LGBTQ+ people by:
· Alleviating disproportionate rates of poverty in LGBTQIA+ communities, which are particularly high for Black LGBTQIA+ people.
· Increasing access to gender-affirming health care, including for transgender youth. Efforts to pass “trans refuge” laws in progressive states are laudable but more can be done to address the expense and lack of access to gender-affirming care amongst both the uninsured and insured.
· Requiring licensed health providers to demonstrate cultural competence in working with LGBTQIA+ people and BIAPoC people and expanding access to health care services. These policies should be aimed at easing the often overlapping effects of Medical Racism and anti-LGBTQIA+ biases in the healthcare system.
· Allocating additional funding to increase school-based resources for LGBTQIA+ youth and BIAPoC youth, with the understanding that schools that proactively affirm marginalized people can help increase overall well-being and decrease mental health concerns for affected students.
· Incentivizing research that employs an intersectional lens in studies of mental health.
Public policy can endanger the mental health of LGBTQIA+ people, but public policy also has the potential to positively impact the lives of LGBTQIA+ people. Policies that consider intersectional perspectives have the best potential to help the largest number of people in need.
