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Try out PMC Labs and tell us what you think. Learn More. Using social stress perspective, we studied the mental health effects of added burden related to socially disadvantaged status being African-American or Latino, female, young, and identifying as bisexual versus gay or lesbian in a community sample of self-identified lesbian, gay, and bisexual LGB adults.
Mental health outcomes were social and psychological well-being contrasted with depressive symptoms. When mental health deficiencies by disadvantaged social status were detected, we examined if LGB community connectedness and positive sexual identity valence played a mediating role, reducing the social status disparity in outcome. We found different patterns when looking at social vs. In bisexuals, this relationship was mediated by community connectedness and sexual identity valence. Though no differences in social or psychological well-being were found by gender, female gender was associated with depressed mood.
We conclude that there is limited support for an additive stress model. These stressors may be thought of as constituting minority stress, a specific type of social stress to which individuals from stigmatized groups are exposed as a result of their minority position Meyer, ; Meyer, Although not well studied in LGB populations, social well-being may be especially relevant to understanding minority stress effects on mental health. The concept of social well-being as developed by Keyes draws on the work of DurkheimSeemanand Antonovsky in emphasizing the fit between individuals and their social worlds.
Social well-being encompasses the extent to which individuals feel they make valued social contributions, view society as meaningful and intelligible, experience a sense of social belonging, maintain positive attitudes towards others, and believe in the potential for society to evolve positively. A focus on social well-being in LGB lives is also germane to the study of processes mitigating Seeking bi fem with a Columbia impact of minority stress.
In general, coping processes related to minority stressors are those that foster a positive re-evaluation of stigmatized identity for example, by providing a favorable basis for social comparisons and make available social support resources. Functional well-being constitutes an important dimension of positive mental health and, as such, contributes to a two continua model of negative and positive mental health that provides a more complete picture of mental health with implications for psychosocial functioning and resilience Keyes, A two continua model of mental health has particular relevance to LGB mental health for several reasons.
LGB persons have elevated rates of psychiatric disorders as noted above, but this does not provide information about how positive mental health is achieved despite co-existent psychiatric morbidity. For the majority of LGB persons without a psychiatric diagnosis, t assessment of negative and positive mental more fully captures the implications of minority stress for psychosocial functioning. As Hughes and Thomas suggested, research should focus on issues related to well-being in addition to studying the effects of stigma on mental disorder.
A two continua perspective is also well suited to an examination of the effect of co-existent disadvantaged statuses on stress among LGB adults. The interplay between these stressors and coping resources determine the net mental health effect of added socially disadvantaged status. There is evidence to suggest additive social stress associated with gender among LGB persons. Szymanski found that heterosexism, sexism, and internalized heterosexism were associated with psychological distress in lesbians and bisexual women, and that the interaction of heterosexist and sexist events further contributed to levels of psychological distress.
Bisexuals may avoid participating in the LGB community because of this stigmatization, yet may have difficulty finding a supportive community of other bisexual persons Fox, ; McLean, We also consider mixed evidence for the effect of age cohort among LGB persons in terms of socially disadvantaged status. However, despite liberalization of social attitudes toward homosexuality, young LGB persons may be disadvantaged relative to older LGB persons in having less time to establish social networks and a variety of social roles that, in composite, create a greater sense of social integration and purpose.
In addition, older LGB adults with co-existent disadvantaged statuses may experience a heightened sense of ageism. In contrast to findings of decreased social status associated with aging, there is some evidence to suggest that LGB adults in their thirties and subsequent middle-aged years expand their portfolio of social roles related to commitments expressed in Seeking bi fem with a Columbia friendships and relationships, and commitments to members of future generations; these roles include parenting, caretaking, teaching, and leadership or participation in community agencies Cohler et.
The engagement of these social roles may ify that as LGB persons enter the fourth and later decades of life they experience an increased sense of social capital defined by Keyes and Waterman as comprising feelings of trust, a sense of social responsibility, and reciprocal social ties. We examined the mental health outcome of social and psychological well-being in a diverse cohort of LGB adults.
We contrasted these findings with depression, an indicator of mental health that is more commonly used in studies of stress and mental health in LGB as well as in general populations. We also hypothesized that social and psychological well-being would be enhanced by, and depression decreased by, positive attitudes toward one's sexual identity and by increased connectedness to the LGB community.
Furthermore, we hypothesized that where disadvantaged social status is related to lower social and psychological well-being and greater depression, this relationship would be mediated, at least in part, by coping resources: positive attitudes toward one's sexual identity and connectedness to the LGB community. Three hundred and ninety-six lesbian, gay, and bisexual respondents completed a comprehensive face-to-face interview that included interviewer- and self-administered measures using computer assisted interview CAPI and paper and pencil methods.
Respondents were sampled from venues selected to ensure a wide diversity of cultural, political, ethnic, and sexual representation within the demographics of interest. Over the course of 11 months, 25 outreach workers visited a total of venues in 32 different New York City zip codes. Outreach workers received training regarding the geographic and ethnographic aspects of the types of venues targeted for recruitment before beginning work in the field. Recruitment venue types included: a bars i. As recruitment proceeded the researchers monitored quotas from venues to ensure that no venue type was overrepresented in the overall sample.
Also, to prevent bias by recruitment place, no more than four respondents were recruited from any one specific venue at any particular recruitment effort.
To further reduce selection bias, venues were excluded from our venue-sampling frame if they were likely to over-represent people receiving support for mental health problems e. Respondents were eligible if they were years-old, resided in New York City for two years or more and self-identified as: a lesbian, gay, or bisexual; b male or female and their gender identity matched sex at birth ; and c white, African-American or Latino. Eligible respondents were contacted by an interviewer and invited to complete the research interview.
Response and cooperation rates were 0. Sample characteristics are described separately by sample subgroups in Table 1.
Respondents could have used any identity labels referring to themselves e. For the purpose of group analysis, responses were later coded into : gay, lesbian, or bisexual, and Black, Latino, or white. Participants also self-reported their gender i. In recognition of multiple age cohorts in our sample, we classified respondents in one of three age : 18 — 29 years of age, 30 — 44, and 45 — While each of these is likely to include a broad range of life experiences and developmental trajectories, we felt that they approximate periods of post-adolescent entry into and exploration of the LGB community; the subsequent and greater assumption of social roles related to partnership, child-care responsibilities, work, or community activities in young adulthood; and the deepening or broadening commitment of these roles in midlife, particularly as they relate to the well-being of future generations.
We created a dichotomous variable that distinguished participants who had obtained less than or equal to a high school diploma from the rest of the sample. We created an unemployment category, defined as nonstudent individuals who were seeking work. We assessed net worth by asking participants to calculate how much money they would have or owe after converting all assets to cash and paying all debts Conger et al.
Participants rated each identity that they nominated on a set of 70 descriptive attributes that varied in their valence. We defined identity valence as the percentage of positive attributes associated with one's sexual identity in one's HICLAS identity model.
Scores were recoded so that higher scores indicated more connectedness. Scores on this measure in the current study had a Cronbach's alpha of. As formulated by Keyesthis item scale examines respondents' perception of their social environment and includes five dimensions of social coherence, integration, acceptance, contribution, and actualization. This portion of the interview was self-administered. Internal consistency reliabilities alpha for the total scale was 0. Given low to moderate internal consistency coefficients of some of the subscales we did not analyze each subscale as a separate outcome.
Instead, we created a score for each participant on social well-being by computing the participant's total score on the items and dividing it by the of items in the scale. Higher scores indicate greater social well-being. We used an item assessment of psychological well-being developed by Ryff and Ryff and Keyes This measure assesses psychological well-being across six domains: self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth.
This portion of the interview was also self-administered. The internal consistency reliability of the total scale was 0.
As with social well-being, we did not analyze each subscale as a separate outcome because of low reliability of the subscales, but computed an overall score based on dividing the total score by the of items in the scale. Scores on this measure in the current study resulted in a Cronbach's alpha of. We used multiple regression analysis in which the dependent variables were social and psychological well-being and levels of depressive symptoms, and the independent variables were dummy variables for each of the tested social status groups.
However, to ensure we did not miss important differences between Latino and African-American respondents we also tested for such differences and report them when ificant differences were found. In Model 1 we assessed the social statuses differences adjusted for socioeconomic variables education, net worth, and employment status. In Model 2 we added identity valence and connectedness to the LGB community to test the impact of each of these factors on social and psychological well-being and levels of depressive symptoms. If we found social status differences in the outcome in Model 1, we tested whether the social status group differences were explained by the ameliorating impact of identity valence and connectedness to the LGB community.
In this test, identity valence and connectedness to the LGB community were mediators of the association between group status and the outcome. We used Baron and Kenny's approach to mediation detection: a the predictor must be related to the outcome of interest; b the predictor must be related to the mediator variable; c the mediator must be related to the outcome; and d the relationship between the predictor and the outcome must be reduced when the mediator is added to the equation. The means, standard deviations, and correlations of the study variables are presented in Table 2.
All variables were approximately normally distributed. of our regression analyses are presented in Table 3 and below for each outcome variable. After adjusting for socioeconomic variables our hypothesis was supported for two of the four social statuses we tested. Bisexual as compared with gay or lesbian identity and being a member of the youngest cohort, years of age, were associated with lower levels of social well-being. The effect of disadvantaged social status on social well-being observed for bisexual identity was ificantly diminished when valence and connectedness were entered into the model, demonstrating complete mediation.
Although Seeking bi fem with a Columbia difference between the youngest and oldest age cohorts in social well-being was somewhat diminished in Model 2, Barron and Kenny's condition for mediation was not met because age cohort was not related to identity valence or connectedness Table 2. In contrast to our findings regarding social well-being, we did not find support for any of the hypotheses regarding psychological well-being.
Adding these mediators in Model 2 of our analysis did not affect the difference between Latino and white participants in psychological well-being. As expected, women reported ificantly more depressive symptoms than men but there were no differences in depressive symptoms based on age group or sexual identity. Positive sexual identity valence but not community connectedness was associated with decreased depressive symptoms. The addition of sexual identity valence in Model 2 did not reduce the effect of being female or Latino on depressive symptoms.
A dual assessment of well-being and depression suggests that minority stress has inconsistent effects on LGB mental health as reflected in several of our findings. We found that bisexual and young respondents had lower levels of social well-being than their counterparts even when they did not differ on measures of psychological well-being and depressive symptoms suggesting that social well-being is a distinct outcome related to socially disadvantaged status.
The finding that community connectedness predicted social well-being almost twice as strongly as did identity valence and, conversely, that identity valence was more predictive of psychological well-being than social well-being, is consistent with the notion that psychological well-being is focused on individual rather than social resources.
This is in keeping with the observation by Ryff et al. Similarly, our finding that identity valence but not community connectedness predicted depression suggests that depression is more strongly rooted in individual Seeking bi fem with a Columbia than social resources. We identified two groups of LGB respondents with disadvantaged social well-being, bisexuals and young adults, 18 - 29 years of age.
Our findings underscore the relative difficulty these groups have in achieving social integration relative to other LGB persons.
Bisexual status was associated with lower levels of LGB community connectedness, consistent with reports of stigmatization of bisexual identity among lesbians and gay men and limited social support available from other bisexuals Fox, ; Herek, ; McLean, Moreover, the disadvantage in social well-being associated with bisexual identity was fully mediated by levels of community connectedness and identity valence, underscoring the importance of these factors in determining bisexual men and women's perception of their relation to their social environment.
This pattern of mediation is echoed in treatment goals of psychotherapy with bisexual clients that emphasize the provision of social confirmation of bisexual identity; therapists, for example, attempt to support an understanding of bisexuality as a natural phenomenon and encourage clients to identify bisexual role models, cultivate support networks, and disclose bisexual identity to appropriate others Matteson, We interpret this finding as reflecting the greater ability of older LGB persons to find or create social environments that are accommodating and accepting of LGB identity and that provide greater opportunity for the engagement of a variety of social roles.
In this regard, social accommodation and engagement connote a broader sense of social fit than connectedness to LGB community which, in contrast, did not differ by age cohort. In contrast, we found that Latino respondents reported more depressive symptoms and lower levels of psychological well-being than whites, suggesting that the mental health effect of the dually stigmatized status of Latino LGB persons is consistent with an added burden stress hypothesis.
We found no evidence for a mediating role of sexual identity valence and community connectedness on disadvantage associated with Latino status, lending support to the examination of other mediators that influence Latino LGB mental health such as immigration and acculturation status, and level of family acceptance Diaz et al. The evidence from other researchers for poorer mental health in Latino LGB persons is mixed. Diaz et al. As Cochran Seeking bi fem with a Columbia al. As suggested by Greenelesbians and bisexual women may be at increased risk for psychological distress because of their multiple jeopardy status in which stress associated with race, gender, and sexual orientation discrimination is compounded.
Although our findings are consistent with an added burden stress model, we note that increased rates of psychiatric morbidity have been observed for both genders of LGB persons Cochran et al. Overall, our findings highlight the importance of attending to both negative and positive mental health indicators. We showed, for example, that although women have more depressive symptoms than men, they do not have lower levels of psychological well-being, and although bisexuals had lower levels of social well-being, they did not have more depressive symptoms.
That is, psychological distress and impaired well-being cannot be thought of as synonymous. The contrast in findings between negative and positive mental health also calls attention to coping mechanisms such as community connectedness and enhanced self-esteem that mitigate the adverse mental health effects of stress. Several considerations frame discussion of our findings. To our knowledge, this is the first study of LGB mental health to utilize functional measures of social and psychological well-being.
It is thus possible that some of our null findings could reflect a limited sensitivity of the psychological well-being measure to capture variability in how well individuals with different social statuses manage multiple sources of stigma in unique sexual minority contexts. We make no generalization to non-LGB identified men and women who have same-sex sexual behavior.
Such individuals, who include those sometimes referred to as men who have sex with men and women who have sex with women or MSM and WSWare important to study. For example, it would make little sense to ask non-gay identified individuals about their regard of gay identity or connectedness to the community—both central elements of our investigation. Our study is also limited in that we assessed the association of stress and well-being among white, Black, and Latino men and women.
Because we used nonrandom sampling strategies, we are limited in our confidence of generating prevalence estimates for the level of well-being in the gay community. But our purpose was not to estimate the level of well-being, which is vulnerable to potential sampling biases in the representativeness of the entire sample external validitybut to examine differences and relationships among subgroups in the LGB community.
To limit bias in comparing subgroups in our sample we followed a strict recruitment procedure that was equal across subgroups and statistically controlled for potentially confounding demographic variables by which the groups differed. That our response and cooperation rates do not vary much by subgroup suggests that the former strategy may have been successful. But clearly, because we used a nonrandom methodology we cannot exclude the possibility of bias.
Also, our conclusions are limited in their implications for social stress theory.Seeking bi fem with a Columbia
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