Minority Stress and Mental Health in Gay Men

Author(s): Ilan H. Meyer

Source: Journal of Health and Social Behavior, Vol. 36, No. 1 (Mar., 1995), pp. 38-56
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2137286 .
Accessed: 19/10/2014 07:10

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .
http://www.jstor.org/page/info/about/policies/terms.jsp

.
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of
content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact support@jstor.org.

American Sociological Association is collaborating with JSTOR to digitize, preserve and extend access to
Journal of Health and Social Behavior.

http://www.jstor.org

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MinorityStressand Mental Health in Gay Men*

ILAN H. MEYER
ofNew York
and The CityUniversity
ColumbiaUniversity

of Healthand Social Behavior1995, Vol. 36 (March):38-56

Journal

Thisstudydescribesstressas derivedfromminority statusand exploresitseffect

onpsychologicaldistressingaymen.Theconceptofminority stressis basedon the
societyare subjectedto chronicstress
premisethatgay people in a heterosexist
Minoritystressorswere conceptualizedas:
related to their stigmatization.
homophobia,
internalized whichrelatestogaymen'sdirection ofsocietalnegative
attitudestowardtheself; stigma,whichrelatesto expectations of rejectionand
and actualexperiences
discrimination; ofdiscrimination and violence.Themental
ofthethreeminority
healtheffects stressorsweretestedin a community sampleof
741 New YorkCitygay men. The resultssupportedminority stresshypotheses:
each of thestressorshad a significant
independent associationwitha varietyof
mentalhealthmeasures.Odds ratiossuggestedthatmenwho had highlevelsof
minoritystressweretwiceto threetimesas likelyto sufferalso fromhighlevelsof
distress.

Four years before he killed himself, he was homosexual,BobbyGriffith struggled

16-year-oldBobby Griffith wrotein his diary: to accepthimselfand findsome comfortin
"I can't let anyone find out that I'm not his Californiasuburbancommunity and fam-
straight. It would be so humiliating. My ily. But to his family,friends,and religion,
friendswould hate me, I just know it. They beinggaywas evil andperverted. At theend,
mighteven want to beat me up. . . . I guess societal attitudesand stigma proved too
I'm no good to anyone . . . not even God. powerful: hopelessly,Bobbyenvisioneda life
Life is so cruel, and unfair.Sometimes I feel of loneliness and condemnation.In the
like disappearingfromthe face of this earth" predawnhours of August 27, 1983, two
(Miller 1992:88-9). Since he had realized that monthsafterhis twentieth birthday, Bobby
Griffithkilled himselfby jumping off a
freewayoverpassintothe pathof a passing
truck(Miller1992).
* The authoracknowledges theinvaluablecon- The cause of BobbyGriffith's suicidewas
of thelate JohnL. Martin,who was the
tribution a homophobicsocial environment that he
principalinvestigatorof the studyused in this
couldno longertolerate.BobbyGriffith is not
paper, and whose vision and insightmade this
possible.The authorthanksBruceG.
investigation alone. Like membersof otherstigmatized
Link, Sharon Schwartz,Suzanne C. Ouellette, minority groups,gay men and lesbiansmust
Mary Clare Lennon,Eugene Litwak,and Laura contendwithnegativesocietalattitudesand
Dean. This researchwas supportedin partby a stigma.The purposeofthispaperis todiscuss
grantfromtheNationalInstitute of MentalHealth theeffects of thissocialenvironmentwithina
(ROlMH39557; Laura Dean, PI), and by a stressdiscourse. I describe minoritystress as
NationalResearchServiceAward(NRSA) predoc- psychosocialstress derived from minority
grantin psychiatric
toralresearchtraining epidemi- status(Brooks 1981). This conceptis based
ology(5T32MH13043)and a NRSA postdoctoral on thepremisethatgaypeople,likemembers
research traininggrant in health psychology
(5T32MH19382)to theauthor.Addresscorrespon-
of otherminoritygroups,are subjectedto
dence to the authorat: Columbia University, chronicstressrelatedto theirstigmatization.
Schoolof PublicHealth,Divisionof Sociomedical Consistentwith a social stress discourse
Sciences, 600 West 168thSt., New York, NY (Mirowsky andRoss 1989;Pearlin1989),and
10032; tel (212) 928-7411, or send e-mail to the evidencefor social causalityof distress
IM15@columbia.edu. (Dohrenwend et al. 1992), it is proposedthat
38

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 39
such stressleads to adverse mentalhealth minorityperson's experiencein dominant
outcomes. society.At thecenterof thisexperienceis the
The conceptof minority stressis notbased incongruence betweenthe minority person's
on one congruoustheory, butis inferred from culture,needs, and experience,and societal
several social and psychologicaltheoretical structures.
orientations.In general,minority stresscan Many studieshave attempted to studythe
be describedas beingrelatedto thejuxtaposi- effectsof minority status(especiallyethnic-
tionof minority and dominant valuesand the ity)on mentalhealth.The mostwidelyused
resultantconflictwiththesocial environmentapproachcomparesratesof psychopathology
experiencedby minoritygroup members and distressbetweenminority and nonminor-
(Mirowskyand Ross 1989; Pearlin 1989). ity groups. It has been predictedthat, if
Lazarusand Folkman(1984) describesucha minority andifthisstress
positionis stressful,
conflictbetweenindividualsand theirexperi- is related to psychologicaldistress,then
ence of societyas the essence of all social minority groupsmusthave higherrates of
stress. Several theoriesdescribe alienation distressthannonminority groups.But studies
and incongruence betweenindividualneeds thatcomparedratesof distressand disorder
andsocialstructures (Durkheim1951;Merton between Blacks and Whites, women and
[1957] 1968; Moss 1973). Certainly,when men,and homosexualsand heterosexuals did
the individualis a minorityperson in a not confirmsuch predictions, leadingsome
stigmatizing and discriminating society,the researchers to refuteminoritystressconceptu-
conflictbetweenhimor herand thedominant alizations(see Hirschfeldand Cross 1983;
culturecan be onerous, and the resultant McCarthy andYancey1971;Neighbors1984;
minority stresssignificant. Symbolicinterac- Robinsand Regier1991; Thomasand Sillen
tion and social comparisontheoriesgive a [1972] 1991; Warheit,Holzer, and Arey
differentperspective. Thesetheoriesviewthe 1975; and Williams 1986, on Black-White
social environment as providingpeople with differences;see Dohrenwendand Dohren-
meaningto theirworldand organization to wend 1976; Schwartz1991; and Robinsand
theirexperiences(Pettigrew1967; Stryker Regier1991,on men-women differences;see
and Statham1985). Negativeregardfrom Gonsiorek1991; Hart et al. 1978; Marmor
otherstherefore leads to negativeself-regard 1980; Martin1990; Pillard1988; Reiss 1980;
(Rosenberg1979) and adversementalhealth Saghirand Robins 1973; Tross et al. 1987;
outcomes(Crockerand Major 1989; Joneset and Williams et al. 1991, on gay-straight
al. 1984). differences).For example, Mirowskyand
Societalreactiontheorydirectlyaddresses Ross (1989) concludethateconomiccondi-
theeffectsof stigmaand negativesocial atti- tions,ratherthan stigmatization and preju-
tudeson stigmatized individuals.According to dice, are relatedto adverse mentalhealth
societalreaction,deviancemaylead to label- outcomes(among ethnicminorities).Their
ing and negativesocietalreaction.In conse- conclusionchallengesminority stressconcep-
quence,stigmatized individualsdevelopadap- tualizationsas describedhere, as it posits
tiveandmaladaptive responses thatmayinclude socioeconomic status-whetherrelated to
mentalhealthsymptoms termed"secondary minoritystatus or not-as the cause of
deviance." (Lemert1967; Link and Cullen distress.This suggeststhatat higherSES,
1990; Schur1971). Similarly, Allport(1954) minoritystatusshould have no deleterious
describes"traitsdue to victimization" as the mental health effects.The presentstudy
defensivereactionof stigmatized individuals. disputesthisconclusion.
These may be caused by introverted mecha- I suggest that we must reexamineour
nisms,including self-hateandingroupaggres- relianceon evidencefromintergroup compar-
sion,and/orextroverted mechanisms, includ- isonsof ratesof distress.Despitetheintuitive
ing shyness, obsessive concern with the appeal of thisapproach,numerousmethodo-
stigmatizing characteristic,and rebellion. logical problemslead to bias, making it
Minority groupmembersare also exposed difficult to interpret
theevidencefromstudies
to negative life events related to their using this approach(Hirschfeldand Cross
stigmatization and discrimination (Brooks 1983; Kessler, Price, and Wortman1985;
1981; Dohrenwendand Dohrenwend1969). Meyer1993). A centralproblem,pertinent to
However,minority stressarisesnotonlyfrom the study of gay-straight differences,is
negativeevents,but fromthe totalityof the selectionbias in sampling.For example,

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
40 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
individualswho do not accept themselves, and formulates hypothesesthatdirectlytest
and who have not successfully "come out," theserelationships. Using this approachwe
are less likelyto participate in studiesof gay avoid themethodological in com-
difficulties
menthanindividualswho acceptthemselves paring rates betweengroups. Instead, we
(Joseph 1986; Meyer 1993). Since self- studyingroupvariability, and examinethe
acceptanceis relatedto betterpsychological differentialeffect of minoritystress on
adjustment and less distress(e.g., Bell and minoritymembers.For this purpose, the
Weinberg1978), thisselectionbias leads to generalconceptualizations of minority stress
overrepresentation of healthiermembersof discussed above must be transformed into
theminority group,thusunderestimating rates concrete stress processes. I discuss such
of distressin that group (Meyer 1993). processesas theyapplyto gay men,butthe
Black-White differences aresimilarly affected generalapproachis suitedforstudying other
by selectionbias due to thedisproportionately stigmatizedgroups as well. I posit three
greaterinstitutionalization of AfricanAmeri- processes of minoritystress: internalized
cans in theUnitedStatesbecause institution-homophobia,expectationsof rejectionand
alized individualsare likelyto have higher discrimination (perceivedstigma),and actual
ratesof distressand disorder.Othermethod- prejudiceevents.
ological problemsthatoftenplagueresearch
on minority stressincludebias due to cultural Internalized Homophobia
(or gender)differences in responseto stan-
dardized measuresof distressthat present Internalizedhomophobia refers to the
strongcompeting explanations forintergroupdirection of societalnegativeattitudes toward
differences (e.g., Dohrenwendand Dohren- the self. Long beforetheybegin to realize
wend 1969; Mirowskyand Ross 1980; Sowa their own homosexuality,homosexually-
and Lustman1984). orientedpeopleinternalize societalantihomo-
Supportforminority stressformulations is sexual attitudes.When as adolescentsor
providedby some research.For example,a youngadultstheyrecognizesame-sexattrac-
reviewof studiesof differences betweengay tion,theybegin to questiontheirpresumed
and straightmen in psychologicaltests heterosexuality and apply the label "homo-
suggeststhat,althoughoverallgay men are sexual" or "gay" to themselves. Such
not moredistressed,when theydo become self-labeling occursbeforeanypublicdisclo-
distressedit is usually in areas that are sure of theirhomosexuality.But as self-
consistent withminority stressconceptualiza- labeling begins, individualsalso begin to
tionssuchas self-acceptance, alienation,and apply negativeattitudesto themselves,and
paranoidsymptoms(Meyer 1993). Support the psychologically-injurious effectsof soci-
for minoritystress conceptualizationsin etal homophobiatake effect.Thoits (1985:
studiesof Black-Whitedifferences is pro- 222) describessuch a processand explains
videdby Kesslerand Neighbors(1986), who that"role-taking abilitiesenable individuals
reanalyzedeightepidemiological surveysthat to view themselvesfrom the imagined
hadconcludedthatracedifferences in distress perspectiveof others."Link (1987:97) de-
are entirelyexplainedby social class. The scribesa similarprocessin individualswho
reanalysisshowedthat,whileoverallhigher becomelabeled as mentalpatientsand notes
levels of distressforAfricanAmericansare that societal negativeattitudesthat "once
explainedby SES, the hypothesized direct seemedto be an innocuousarrayof beliefs
minority stresseffectis at workat low SES. . . . now become applicablepersonallyand
The authorscalled on researchersnot to [are]no longerinnocuous."
acceptthepremature conclusionthatminority Thus, along withtherecognition of same-
statusis unrelated to distress,and to reinvest sex attraction, a deviantidentity(Goffman
themselvesin studyingthe issue. They 1963) begins to emergethat threatensthe
suggestedthatunderstanding themechanisms psychologicalwell-beingof the homosexu-
throughwhichminority positionaffectsdis- ally-orientedperson (Hetrick and Martin
tress will help to clarifyfindingson rate 1984; Stein and Cohen 1984). Although
differences. internalized
homophobiais likelyto be most
Such an approachis takenby the present acute earlyin the coming-out process,it is
study.Thisapproachspecifiescausalrelation- unlikelythatinternalized homophobiacom-
shipsbased on theoretical conceptualizations,pletelyabateseven whenthepersonaccepts

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 41
his or her homosexuality (Cass 1984; Cole- notethat"individualsin sucha positionmust
man 1982; Troiden 1989). Because of the constantlymonitortheir behavior in all
strengthofearlysocialization
experiences and circumstances:how one dresses, speaks,
continuedexposureto antihomosexual atti- walks,and talksbecomeconstantsourcesof
tudes, internalizedhomophobiaremainsan possiblediscovery."
important factorin thegay person'spsycho- The stress experiencedby the vigilant
logical adjustmentthroughout life (Hetrick personleads to a generalexperienceof fear
and Martin1984; Gonsiorek1988; Malyon andmistrust in interactions
withthedominant
1982; Nungesser1983). culture,and a sense of disharmonyand
alienation with general society. Warren
(1980:130) notesthatthestruggle toreconcile
PerceivedStigma one's gay identitywith societal stigma
"involve[s] a considerableinvestmentof
The negativeeffects of stigmaandlabeling emotionalenergy,and . . . a considerable
have been discussed in psychologicaland psychictoll." This hypervigilance may also
sociologicalliterature (e.g., Goffman1963; lead to taxing"costsofcoping"(Cohenet al.
Joneset al. 1984; Link and Cullen 1990; 1986), and to copingfatigue.High levels of
Warren1980). For example,stigmatization is perceivedstigma,then,will lead gay mento
related to adverse effectsin self-esteem, chronically experiencestressas theyfeelthat
employment, and social acceptanceamong they must remainvigilantto avoid being
thementally ill (Link 1987; Link and Cullen harmed.
1990; Link et al. 1987). Goffman(1963:7)
discussestheanxietywithwhichthestigma-
tized individualapproachesinteractions in Discrimination and Violence
society.Such an individual"may perceive, (PrejudiceEvents)
usuallyquite correctly, thatwhateverothers
profess,theydo notreally'accept' him and In theUnitedStates,homosexuality is still
are not readyto make contactwithhim on criminalized in 24 states,and in moststates
'equal grounds.'" Goffman(1963:13) cites gay peoplehave no protection underthelaw.
Sullivan (in Perry, Gawell, and Gibbon Gay peoplearetherefore legallydiscriminated
1956:145) to explain that "[t]he fear that against in housing, employment,entitle-
otherscan disrespecta personbecause of ments,andbasiccivilrights.As gaymenand
something he showsmeansthathe is always lesbiansbecome morevisible,theyincreas-
insecurein his contactwithotherpeople;and ingly become targetsof antigayviolence,
this insecurityarises . . . from something prejudice,and discrimination (AmericanPsy-
whichhe knowshe cannotfix." chologicalAssociation1986; Dean, Wu, and
Similarly,Allport(1954) describesvigi- Martin1992; Herekand Berrill1992; Herek
lance as one of the "traits"thattargetsof and Glunt 1988; NationalGay and Lesbian
prejudicemightdevelopin defensivecoping Task Force 1991; Wilson1992).
withtheirminority status.This concepthelps The mostexplicitsourcesofminority stress
to explainthe stressful effectof stigma.A are rejection,discrimination, and violence
high level of perceivedstigmawould lead thatminority personsexperiencebecause of
minority groupmembersto maintaina high theirstigmatized minorityposition(Garnets,
degree of vigilance-expectationsof rejec- Herek, and Levy 1990). Garnetsand col-
tion,discrimination, and violence-withre- leagues describe the mechanismsfor the
gard to the minoritycomponentsof their effect of victimizationon psychological
identityin interactions withdominantgroup distress.They note thatvictimization inter-
members.By definitionsuch vigilance is feres with perceptionof the world as
chronicin thatit is repeatedlyandcontinually meaningful and orderlyand leads people to
evokedin the everydaylife of the minority self-devaluation (Garnetset al. 1990). Per-
person.This vigilanceis stressful in thatit haps the most critical aspect of antigay
requiresthe exertionof considerableenergy violence and discrimination is its meaning
andresourcesin adaptingto it(Allport1954). withinthe contextof societal heterosexism
HetrickandMartin(1987:35) describe"learn- and minorityoppression.Prejudice events
ing to hide" as the most commoncoping have a powerfulimpactmorebecause of the
strategy of gay and lesbianadolescents,and deep culturalmeaning they activate than

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
42 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
because of the ramifications
of the events predisposesone to self-blameattributions,
themselves(Brooks 1981). A seemingly itis predicted
thattheeffectsof stigmaand
minorevent,suchas a slurdirectedat a gay prejudiceeventson distresswillbe exacer-
man, may evoke deep feelingsof rejection bated at higher levels of internalized
and fearsof violencedisproportionate
to the homophobia.
eventthatprecipitated
them. In all analyses,theeffectsof gay identity
andinvolvement withthegaycommunity will
be considered.This paper will examinean
Hypotheses alternative hypothesis; namely,thatthe mi-
noritystressorsaffectdistressindirectly by
Togetherthesethreestressorsrepresent a diminishing socialnetworks andaffiliations in
matrix thatdefinesthedifferent dimensions of the gay community. If minority stresswere
minority stressin gay men for the present foundto affectdistressonlythrough itseffect
investigation.The effectsof these stressors on social networks, it could be arguedthatit
willbe testedon fivemeasuresof psycholog- is social support,ratherthanminority stress
ical distress-demoralization, guilt, suicide per se, thatis relatedto distress.In a similar
ideation and behavior,AIDS-relatedtrau- vein,theeffectof minority stresson African
maticstressresponse,and sex problems.The Americanshas been "explainedaway" by
differentdistress domains have either a attributing it wholly to lower SES, even
generalor more specificrelationship to the though lower SES can be conceivedas an
threeminority stressconstructs. Demoraliza- intervening variablein thecausal association
tionis a generalizeddistressmeasure,analo- between minority status and distress
gous to body temperature in somaticillness (Mirowskyand Ross 1989). The inclusionof
(Dohrenwendet al. 1980). Guilt mightbe these "gay identity"variablesrepresentsa
moredirectly relatedto minority stressin that conservative approachin detecting theassoci-
a manwho feelsthathis sexualorientation is ationsof minority stress.A less conservative
condemnable(indicatedby highinternalized approachwould claim that, even if these
homophobia),or thatit is in factcondemned variablesadd to the associationof minority
and debased(indicatedby highstigmaand/or stressand distress,theyare notextraneous to
prejudice),may be especiallyvulnerableto this association, and their "contribution"
guiltfeelings.Similarly, sex problems,which shouldtherefore notbe extracted.But while
are directlyrelatedto expressionof intimacy both direct and indirectfactorsmay be
withothermen,mightbe closelyrelatedto considered minority stresseffects, I setoutto
internalizedhomophobia,as internalized ho- testthedirecteffectsof minority stress,and
mophobiawillevokeconflict andanxietythat therefore includethesevariablesas potential
could inhibitachievement of satisfying inti- confounders.Controllingfor the effectsof
mate relationships(Coleman, Rosser, and gay identityvariablesmakes it possible to
Strapko1992; Friedman1991). attributedistresseffectsdirectlyto minority
stressprocesses.
(HI) It is predictedthat each minority
stressorwill have an independent effecton
each distressdomain.
(H2) Further, it is predicted that,whenthe SAMPLE
effectsof thestressors are combined,each
will maintainan independenteffecton Gay menwho livedin New YorkCityand
distress,so thattheircombinedeffectwill did not have a diagnosisof AIDS in 1985
be greaterthantheirindividualeffects. were eligiblefora longitudinal studyabout
the psychologicaland behavioralimpactof
In addition,I will examine interactions
theAIDS epidemic.The samplewas assem-
amongthethreeminority stressorsto describe
bledfroma widevariety of sourcesin thegay
morecomplexassociations.In particular, it
community. Thirty-nine percentof the men
has been suggestedthat self-blameattribu-
were recruitedfrom a stratifiedrandom
tionslead to moredeleteriousmentalhealth
sampleof 100 gay organizations and groups,
effectsthanattributions of blameto external
and 61 percent were recruitedusing a
agents(Brewin1985; Joneset al. 1984). snowballtechnique to includeunaffiliated gay
(H3) Because internalizedhomophobia men. This approachwas takento reach a

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 43
diversity of samplingsourcesthatreflectthe MEASURES
community of urbangay men in New York
City (Martinand Dean 1990). The recruit- Independent Variables
ment method and characteristicsof the
originalsamplehave beendescribedin detail InternalizedHomophobia(IHP) is a 9-item
elsewhere(Martin1987; Martin1988; Martin scale (alpha = .79) thatinquiresaboutthe
and Dean 1990; Martinet al. 1989). Data extent to which gay men are uneasyabout
in theirhomosexuality and seek to avoid homo-
were collected by trainedinterviewers
sexual feelings.Items include:"How often
face-to-face interviews.
have you wishedyou weren'tgay?"; "Have
The presentanalysisused a sampleof 741 you thoughtthatbeing gay was a personal
menwho wereinterviewed in 1987, thefirst shortcoming?"; and "How oftenhave you
yearthatinternalized homophobiawas mea- triedto become more sexuallyattractedto
sured.This samplereflectsan attrition of 13 womenin general?"Respondentsratedthe
percentfromthe851 menrecruited in 1985. frequency withwhichtheyexperiencedsuch
The respondentswere 21-76 years old in thoughts intheyearpriortotheinterview on a
1987, and theirmean age was 38 (s.d. = 4-pointLikertscale rangingfrom"often"to
8.4). Theyhad a meaneducationof 16 years "never" (Martinand Dean 1987). As ex-
(s.d. = 1.7), and theirmedianincomewas pected for this communitysample of gay
$35,000. Eleven percentwere non-White. men, the distribution of internalizedho-
in
Men the sample were strongly connected to mophobia was positively skewed,indicating
the gay community: most(85%) considered thatmostmenhad low scoresof internalized
themselves to be completely ormostly"outof homophobia.Nevertheless, about70 percent
thecloset," most(59%) belongedto at least reported some self-directed homophobic atti-
one gay organization, and many(48%) read tudes.
Stigmais an 11-itemscale (alpha = .86)
gay newspapersregularly. Abouthalf(45%)
thatinquiresabout expectations of rejection
of themenwerecoupled. and discrimination regarding homosexuality.
It is impossibleto assess the degree to The scale was originallydesignedby Link
which the presentsample representsthe (1987) to tap expectationsof rejectionand
populationof gay men,because thispopula- discrimination regardingbeing a psychiatric
tion has not been describedor enumerated. patient,and was adaptedby Martinand Dean
The similarity of thesampleto two indepen- (1987). Itemsinclude:"Most people would
dentsamplesobtainedby randomprobability willingly accepta gaymanas a close friend,"
samplingin San Francisco (Research and "Most people feel thathomosexuality is a
DecisionCorporation 1984; Winkelstein, Ly- signof personalfailure,"and "Most employ-
man, and Padian 1987; Martinand Dean erswillpass overtheapplication ofa gayman
1990) suggeststhatthe samplesrepresent a in favorof anotherapplicant."Respondents
cohesivegroupof gay-identified urbangay ratedtheirresponseson a 6-pointLikertscale
men who are oftenreferred to as the "gay rangingfrom"stronglyagree" to "strongly
community."It is important to note, how- disagree." The distribution of stigma was
ever,thattherepresentativeness ofthesample close to normal.
is not a majorlimitation here,because this Prejudiceis scored 1 forrespondents who
investigation does not attemptto describe experienced any event of antigay violence
and/ordiscrimination in theyearpriorto the
populationparameters. By contrast,because
interview. Antigayviolencewas measuredby
thissamplerepresents a sectionof gay men
asking:"In thepastyear,have you been the
who are self-accepting, and who cope with victimof antigayviolence?That
is, was an
theirminoritystatusmore effectively than attemptmade to harm you or were you
thosemenwhoserepresentation in thesample harmedbecauseyou weregay?" Antigay(or
is lacking,thesamplemaypresenta bias for AIDS-related)discrimination was assessedby
internal validity.Thisis a bias ofthe"healthy asking: "In the past year, have you been
worker"type(Kelsey,Thompson,and Evans discriminated againstin any way because of
1986) against findingthe hypothesizedasso- being gay or because of fear of AIDS?"
ciationsbetweenminority stressand mental AIDS-related discrimination was included
health. because perpetrators of antigayviolenceand

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
44 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
discriminationoftenassociatebeinggay with al. 1980) were used. Demoralizationis a
havingAIDS. Ninety-one (12%) of themen 27-itemscale (alpha = .92) consistingof
reportedat least one event of antigay eighthighly-intercorrelated subscalesthattap
violence,and 116 (16%) of themenreported dread,anxiety,sadness,helplessness,hope-
at leastone eventof discrimination relatedto lessness,psychophysiological symptoms, per-
beinggayor to AIDS, in theyearpriorto the ceived physicalhealthproblems,poor self-
interview.There was littleoverlap in the esteem,and confusedthinking. OtherPERI
reportingof violence and discriminationdistressmeasuresare guilt, a measureof
events(only 20 men reportedboth);overall rationalor irrational feelingsofguilt(4 items,
187 (25%) of the sample reportedany alpha = .79); sex problems,a measureof
discriminationor violenceevent(Dean et al. problemsrelatedto inhibitedsexual desire,
1992). This combinedmeasureis referred to excitement,or orgasm (4 items,alpha =
as prejudiceevents. .72); and suicide, a measure of suicidal
Interrelationships of minority stressmea- ideationand/orbehavior(4 items,alpha =
sures. The associationsamong the three .52). AIDS-Related TraumaticStress Re-
minority stressmeasureswereweak.Internal- sponse(AIDS-TSR) is a 17-itemscale (alpha
ized homophobiawas somewhatrelatedto = .89) thatmeasuressymptoms of psycho-
stigma(r = .09, p = .01), butreporting of logical distressrelatedto the effectsof the
actualeventsofprejudicewas notassociated AIDS epidemic, such as preoccupation,
witheitherinternalized homophobia orstigma avoidance, nightmares,problemsin daily
(r = -.03, p = .20; r = .05, p = .10; functioning, and panic attacks.ManyAIDS-
respectively).These findingssupportthe TSR items were adapted fromHorowitz's
validityof thisobjectivemeasure;significant Impactof EventsScale (Horowitz,Wilner,
associationswithstigmaor internalized ho- and Alvarez1979).
mophobiawouldhaveraisedoursuspicionof
a reportingbias due to subjectiveexpectations
of rejectionand discrimination. The associa- PotentialConfounding Variables
tion betweeninternalizedhomophobiaand
stigmasuggestssomeoverlap,buttherewere Demographic characteristics. Included
important divergencesin the validationof were age, ethnicity, education,income,and
these scales that indicatedthat these are religiousaffiliation.Age is age in years;
indeeddifferent constructs. Internalizedho- ethnicity is coded 1 for Whitemen, 0 for
mophobia,being directedtowardthe self, non-Whitemen; education is a scale of
was associatedwitha widerangeof functions highestgradecompleted;incomeis a scale of
of gay men withinthe gay community and annual income clusters in varyingsized
with theirpartners:Men who had higher increments rangingfrom1 (less than$3000)
levels of internalized homophobiawere less to 19 (more than $150,000); religious is
likelyto be open abouttheirhomosexuality,coded 1 = yes, 0 = notreligiousor religious
to read gay newspapers,to be membersof but in a gay church.(Because gay religious
gay organizations, and to be coupledwitha groups are distinctfromnongay religious
partner.Among coupled men, internalized groups in their positive attitudestoward
homophobiawas relatedto less stablerela- homosexuality, men who were religiousbut
tionships.By contrast,stigma,which con- who practicedin a gay churchor synagogue
cernsexternalnongaysourcesof homopho- were grouped togetherwith nonreligious
bia, was associatedwiththeextentto which men.)
gay men disclose their homosexualityto Gay identity/involvement withthecommu-
others,butnotwiththeirrelationships within nity.Gay identity was measuredas thedegree
thegay community (Meyer1993). to whicha mandefineshimselfas in oroutof
the"closet." Closetis an itemranging from0
(definitelyin thecloset)to 4 (completely out
DependentVariables of the closet). Involvementin the gay
community was measuredas (a) whether men
Psychological distressmeasuresreferred to participated in gay groupsand organizations
distressduringtheyearpriorto theinterview. (gay organization:1 = yes, 0 = no); (b)
Scales from the PsychiatricEpidemiology whethermen regularly read gay newspapers
ResearchInstrument (PERI; Dohrenwendet (read gay: 1 = yes, 0 = no); and (c) the

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 45
proportion of gay men or lesbiansin their (Table 2), and prejudice events (Table
social network (gay network). 3)-significantly predictsthefivepsycholog-
Intimaterelationships. Men were defined ical distressoutcomeswhentheyare consid-
as beingcoupledbased on threeself-reportederedsimultaneously.
criteria:(a) duration-relationship lasts at The tablesalso showresultsofthemultiple
least six months;(b) reciprocity-eachman regression analysestestingtherelationship of
sees the otheras his partner;and (c) social each minority stressorwitheach of the five
recognition-others considerthemen a cou- distressmeasuresconsideredseparately.In
ple (coupled: 1 = yes, 0 = no). thetables,foreach distressmeasure,thefirst
AIDS status.AIDS-relatedComplex(ARC) column shows standardizedbetas for the
andAIDS statuswerereported byrespondentsbivariateassociationof the minority stressor
whoindependently testedforHIV, orwhowere and distress,and the second columnshows
diagnosedby a physicianafterAIDS-related betas of the multipleregression,with the
symptoms appeared(ARC/AIDS:1 = yes,0 = minoritystressorand the controlvariables
no).1 includedin theequation.Table 1 showsthat
the bivariateassociationsdemonstrate a sig-
nificantassociationof internalizedhomopho-
STATISTICAL ANALYSIS bia with all the distressmeasures. The
multipleregressionsconfirmthese associa-
I beginby assessingthe individualeffects tionsforall thedistressmeasures,and show
of each minority stressoron thefivepsycho- that internalizedhomophobiaretainedits
logical distressmeasures consideredin a associationwith distressaftercontrolfor
multivariate test and thenon each distress possibleconfounders. Table 2 showsthatthe
measurein separatemultiple regressions.The bivariateassociationsdemonstrate a signifi-
multivariate procedurediffersfromordinary cant associationof stigmawithfourof the
multiple regression in thatitprovidesa testof fivedistressmeasures(sex problemswas not
the effectof the independentvariable on associatedwithstigma).The multipleregres-
severaldependent variablesconsideredsimul- sions demonstrate thatforall the significant
taneouslywhile holdingconstantpotential bivariateassociations,stigma remaineda
confoundingvariables (Bray and Maxwell significant predictor whentheassociationsof
1985; Norusis/SPSS1990:chap. 3). In all possible confounderswere partialed out.
analyses,potentialconfounders are consid- Similarly,thebivariateassociationsofpreju-
ered,and theireffectpartialedout. Once the dice eventsanddistress(Table 3) demonstrate
associationsof each minoritystressorare a significant associationof prejudiceevents
examined,theinteractions amongtheminor- and fourof the distressmeasures(prejudice
ity stressors,and theircombinedeffecton eventswerenotrelatedto sexproblems),and
distress,are assessed. Cases with missing themultipleregressions demonstrate thatfor
data were excluded listwise within each all the significantbivariate associations,
analysis,leadingto variation in thenumber of prejudice remaineda significantpredictor
cases as indicatedin the tables. Data were whentheassociationsofpossibleconfounders
analyzedusingthe SPSS statisticalpackage werepartialedout.
forpersonalcomputers. The findingsthat stigma and prejudice
eventswerenotassociatedwithsexproblems
werenotpredicted, butare notsurprising. It
RESULTS appearsthatstigmaand prejudice-both of
whichrelateto discrimination and rejection
Minority StressEffects by externalnongaysources-have littleto do
withgaymen'srelationswithothergay men,
Tables 1-3 show resultsof theregression andthuswiththeirsex problems.By contrast,
of each minority stressoron thefivepsycho- as has been suggestedby others(Colemanet
logical distressmeasures.In each table,the al. 1992; Friedman1991), internalized ho-
last columnpresentsthemultivariate regres- mophobia,whichis concernedwithinternal
sion of the effectof minoritystress on processes, showed a directeffecton gay
psychologicaldistress.As predicted,these men's intimate relations.
resultsshow that each minoritystressor- In summary,the findingssupportthe
internalizedhomophobia(Table 1), stigma hypothesized prediction abouttheassociation

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
TABLE 1. DistressMeasures Predictedby InternalizedHomophobiaAlone and by InternalizedHomophob

Dependent4 DEMORALIZATION GUILT SUICIDE AIDS-TSR

Independent I"P With HIP With IHP With IHP W
Variables: Alone Confounders Alone Confounders Alone Confounders Alone Conf
N 731 665 737 671 719 655 734 6
R2 .06 .11 .10 .11 .02 .06 .06 .1
Internalized
Homophobia(1HP) .25*** .27*** .31*** .31*** .15*** .21*** .24*** .3
Age -.04 -.08* -.05 -.12
Ethnicity .03 .03 .07 .0
Education -.11** -.02 -.003 -.08
Income -.06 .02 -.04 .0
Religious .01 .04 -.03 -.00
Closet .03 -.007 .09* .1
Gay Organization .08* .09* .07 .1
Gay Network .09* .05 .07 .1
Read Gay .04 -.006 -.02 .0
Coupled -.02 .05 -.03 .1
ARC/AIDS .09* .009 .06 .1
*p < .05; ** p < .01; **p < .001; t ApproximatedF-values.
Notes.Table displaysstandardized regressioncoefficients is coded 1 = non-White,
(betas).Age is age in years.Ethnicity 0 =
Incomeis a scale of annualincomeclustersin varyingincrementsrangingfrom1 (less than$3000) to 19 (morethan$150,000). R
butin gaychurch.Closetis a 5-pointscale rangingfrom0 (definitelyin thecloset)to 4 (completelyoutof thecloset).Gay organ
nonmembers. Gay network of gaypersonsin therespondent's
is thepercentage supportnetwork.Read gay is coded 1 = menwh
Coupledis coded 1 = coupledmen,0 = singlemen.ARC/AIDSis coded 1 = menwho werediagnosedwithARC or AIDS, 0

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
 TABLE2.Ditres Measres
Pediced
byStigaAloeandbySigmandPssibl Confundig
Varab

2.aDistressMAsures PredictdedrystimAloneCoaondebystimAlnd P onossib

TABLepedn er
Confo ndinVariabl

Depenenta Stigma With* Stigma With* Stigm With Stigma W

Age -.06 -.11** -.07 .1

Ethnicity .02 .02 .07 .0
Education - . 13*** - .04 - .02 -.10
Income - .04 .03 - .03 .1
Religious .05 .07 - .01 .0
Closet - .04 - . 10** .03 .0
Gay Organization .05 .06 .05 .0
Gay Network .06 .03 .05 .0
Read Gay .004 - .05 - .04 - .0
Coupled - .04 .02 - .05 .0
ARC/AIDS .09* .01 .06 .1
* p < .05; ** p < .01; * p < .001; t ApproximatedF-values.
Notes.Table displaysstandardized regressioncoefficients is coded 1I non-White,
(betas).Age is age in years.Ethnicity 0 =
Incomeis a scale of annualincomeclustersin varyingincrements rangingfrom1 (less than$3000) to 19 (morethan$150,000). R
butin gaychurch.Closetis a 5-pointscale rangingfrom0 (definitely in thecloset)to 4 (completely
outof thecloset).Gayorga
nonmembers. Gay network is thepercentageof gaypersonsin therespondent's support Read gay is coded 1 = menw
network.
Coupledis coded 1 = coupledmen,0 = singlemen.ARC/AIDSis coded 1 = menwho werediagnosedwithARC or AIDS,

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
TABLE 3. DistressMeasures Predictedby Prejudice and Possible ConfoundingVariables

DEMORALIZATION GUILT SUICIDE AIDS-TSR

Dependent-> Prejudice With Prejudice With Prejudice With Prejudice W

Variables:
Independent Alone Confounders Alone Confounders Alone Confounders Alone Con
N 731 665 737 671 720 655 734
R2 .03 .08 .01 .05 .01 .04 .03
Prejudice .16*** .19*** .07* .11** .12** .11** .17***
Age -.03 -.09* -.05 -.1
Ethnicity .03 .03 .07
Education -.13** -.03 -.01 -.0
Income -.05 .02 -.03
Religious .05 .07 -.01
Closet -.10** -.13*** -.002 -.0
Gay Organization .04 .05 .04
Gay Network .08* .04 .06
Read Gay .01 -.04 -.04
Coupled -.05 .01 -.05
ARC/AIDS .06 -.006 .05
*p < .05; ** p < .01; *** p < .001; t ApproximatedF-values.
Notes.Table displaysstandardized regressioncoefficients is coded I = non-White,
(betas).Age is age in years.Ethnicity 0 =
Incomeis a scale of annualincomeclustersin varyingincrementsrangingfrom1 (less than$3000) to 19 (morethan$150,000). R
butin gaychurch.Closetis a 5-pointscale rangingfrom0 (definitelyin thecloset)to 4 (completelyoutof thecloset).Gay orga
nonmembers. Gay network of gaypersonsin therespondent's
is thepercentage supportnetwork.Read gay is coded 1 = menw
Coupledis coded 1 = coupledmen,0 = singlemen.ARC/AIDSis coded I = menwho werediagnosedwithARC or AIDS,

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 49
of internalizedhomophobia,stigma, and threeminority stressorson the fivepsycho-
prejudice events on distressand do not logicaldistressmeasuresconsidered individu-
supportthe alternative hypothesis-thatthe ally. The table shows associations(betas),
effectof thesestressorsis indirect,through significance levels,andR2 forfourmodels:In
reduction ofparticipation in andidentificationColumn1 theeffectof internalized homopho-
withthegay community. bia alonewas entered,in Column2 theeffect
of stigmawas added,in Column3 theeffect
of prejudice events was added, and in
TheCombinedEffectofMinority Stress Column4 thiscombinedeffectwas controlled
by the confounding variables.Resultsshow
To test the combinedeffectof minority that,withtheexceptionofsexproblems,each
stress,thethreeminority stressors
wereadded of the minoritystress measures had a
to regression modelstogether. A multivariatesignificant independent associationwithdis-
regression of thecombinedeffectof minority
tress,as indicatedby thesignificant betasin
stress predicting psychological distress
each of the models and by the increasein
showedthateach of thethreestressors has an
independent associationwiththefivepsycho- explainedvariancewiththeadditionof each
logicaldistressoutcomesconsideredsimulta- minority stressmeasureto the model. The
neously (IHP: Pillai's value = .1424, effectsof minority stresson sexproblemswas
approx. F = 20.62, p = .001; stigma: mixed.While internalized homophobiacon-
Pillai's value = .0271, approx.F = 3.46, sistently showedsignificant associationswith
p = .004; prejudice: Pillai's value = .0311, sex problems,neitherstigmanor prejudice
approx.F = 3.99, p = .001). showed a main effectfor sex problems
Table 4 showsthecombinedeffectof the (Tables 2 and 3), andtherefore did notadd to
TABLE 4. RegressionModels IncludingInternalizedHomophobia, Stigma, and Prejudice and
ControlVariableSa
MODELtS> 1 2 3 4
DependentVariables
DEMORALIZATION
IHP .25*** .24*** .25*** .25***
Stigma .16*** 15*** 14***
Prejudice .16*** .17***
R2 .06 .09 .12 .15
GUILT
IHP .31*** .30*** .30*** .30***
Stigma .13*** .12*** .10**
Prejudice .08* .09*
R2 .10 .11 .12 .13
SUICIDE
1HP .15*** .15*** .15*** .20***
Stigma .09* .08* .09*
Prejudice .12*** 10**
R2 .02 .03 .05 .08
AIDS-TSR
IHP .24*** .23*** .24*** .31***
Stigma .12*** .11***3***
Prejudice .18*** .15***
R2 .06 .07 .11 .20
SEX PROBLEMS
1HP .12** .1*.1**.15***
Stigma .06 .05 .05
Prejudice .05 .05
R2 .01 .02 .02 .07
* p < .05; ** p < .01; * p < .001; t Model 1 = IHP Alone; Model 2 = IHP and Stigma;Model 3 = IHP,
Stigma,and Prejudice;Model 4 = IHP, Stigma,Prejudice,and ControlVariables.
level,and R2.
a Betas, significance

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
50 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
thecombinedeffectof minority stressin this distress"definition).Overall, men who re-
analysis. portedhighminority stressweretwoto three
The resultsso far suggesta significanttimesmorelikelyto havereported "high"and
effectfor minoritystresson psychological "very high" levels of distressthan their
distress.Judgingfromthe R2 reported,the counterparts, suggestingthatminority stress
contribution of minority stressis moderate. is associatedwitha two-to threefold increase
This would be expected, consideringthe in risk for high levels of psychological
myriadof additionalfactors-bothendoge- distress.
nous and exogenous-thataffectpsychologi-
cal distress.It shouldbe notedthat,at least
with respectto demoralization,guilt, and Interactions AmongMinority Stressors
AIDS-TSR,theeffectsize is comparable to,or
largerthan,theeffectsize typicallydetected In additionto assessingtheadditiveeffect
forstressfullifeevents(RabkinandStruening of the three minoritystress measures on
1976). To providean additional assessment of distress,I assessedtheirinteractive effects.I
the importanceof the effectof minority suggested earlier that self-blameattribu-
stress,I also estimatedthe relativeriskfor tions-indicatedbyhighlevelsofinternalized
distressof menwithhigh,comparedto low, homophobia -would exacerbate theeffects of
levels of minority stressby calculatingthe expectations of stigmaand actualprejudice
oddsratio(Kelseyet al. 1986). Men whohad eventson psychologicaldistress.This was
experiencedany discrimination or violence testedby introducing theinteraction termsof
eventsor who scored above the mean of internalized homophobia bystigmaand inter-
either internalizedhomophobiaor stigma nalized homophobiaby prejudiceto regres-
wereclassifiedas havinghighminority stress. sionequationstesting theeffectofstigmaand
Men who had experiencedno discriminationprejudice (respectively)on distress.It was
or violenceeventsand who scoredbelowthe predicted thathighstigmaorprejudicealong
mean of both internalized homophobiaand withhigh internalized homophobiawill be
stigmawereclassifiedas havinglow minority moredamagingthanhighstigmaorprejudice
stress.Most men (N = 553, 75%) were with low internalizedhomophobia.This is
classifiedas scoringhighon thiscombined becauseself-blame attributions
are implicated
minority stressmeasure.The relativeriskfor in theformer case, wheremenseemtojustify
highdistressof thosehighin minority stress theirvictimization(or expected victimiza-
was thenestimated.High levels of distress tion)-literally"addinginsultto injury."
were definedin two ways: (1) "high dis- Internalizedhomophobiainteractions were
tress,"representing distressscoresabove the significantin three of the ten regression
sample'smean,and (2) "veryhighdistress," models(Table 6). The multivariate analysis
representing distressscores above one stan- ofinternalized homophobia bystigmainterac-
darddeviationabove the mean. Using these tion was not significant (Pillai's value =
definitions,two odds ratioswere calculated .0120, approx. F = 1.51, p = .18),
foreach of thefivedistressmeasures(Table indicatingthat, overall, internalizedho-
5). Minoritystresswas associatedwithhigh mophobia does not modifythe effectof
levelsofdistressbybothdefinitions (withthe stigmaon psychologicaldistress.The multi-
exceptionof sex problemsin the "veryhigh variateanalysisof internalized homophobia
by prejudiceinteraction was significant (Pil-
TABLE 5. Risk for High and Very High lai's value = .0212, approx. F = 2.69, p =
DistressLevels AssociatedwithMi-
.02). The significantindividualinteractions
norityStressOdds Ratios (and 95%
ConfidenceIntervals)Estimates were those predictingdemoralizationand
guilt,andtherewas a trendtowardpredicting
1 2 suicide (Table 6). These interactionswere
Definitionof HighDistress VeryHighDistress
>X >X+ 1SD
consistentwith the self-blameattributions
Distress4
hypothesis.They suggestthatexperiencing
DistressMeasure:
DEMORALIZATION 2.00 (1.41, 2.84) 1.98 (1.19, 3.28)
eventsof discriminationor violenceis more
GUILT 3.08 (2.11, 4.51) 2.61 (1.43, 4.73) painfulwhenone agreeswiththehomophobic
SUICIDE 1.77 (1.15, 2.72) 2.12 (1.08, 4.18) attitudesconveyedbythevictimization event.
AIDS-TSR 2.53 (1.77, 3.61) 3.02 (1.67, 5.47) By stigmatizingtheir own condition,it
SEX PROBLEMS 1.44 (1.03, 2.03) 1.71 (.93, 3.04)
seems,suchgay men "join theiraggressors"

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 51
TABLE 6. RegressionAnalysesPredictingPsychologicalDistressInteractionsof IHP by Stigma
and IHP by Prejudicea

InteractionTerrn> IHP x Stigma IHP x Prejudice

Dependent: N Beta p N Beta p
DEMORALIZATION 662 -.20 .38 665 .28 .02
GUILT 668 -.49 .04 671 .27 .02
SUICIDE 652 .23 .34 655 .21 .09
AIDS-TSR 667 -.21 .36 669 -.06 .59
SEX PROBLEMS 667 -.38 .11 670 .14 .25
a
In fully-controlled
models.

and sufferfurther pain-feelingmoreguilty is plausiblethatinternalized homophobiais

and moredemoralized. caused by distress, but this is a less
convincing explanationforstigma,andhardly
a viable explanationforobjectivereportsof
DISCUSSION AND CONCLUSIONS prejudiceevents(cf. Watsonand Pennebaker
1989). This is especiallyilluminating when
I set out to studythe effectof minority we considerthattherewere no associations
stresson the mentalhealthof gay men by between reportsof prejudice events and
specifying and testingexplicitminority stress internalized homophobiaor stigma,and only
processes.As predicted, theresultsindicated a weak association between internalized
thatinternalized homophobia, expectations of homophobiaand stigma.If minority stressors
rejectionand discrimination (stigma), and wereindeedcaused by distress,a significant
actualeventsof discrimination and violence associationamong them would have been
(prejudice)-considered independently and as inevitablebecauseof theunderlying common
a group-predictpsychological distressin gay cause. While it is plausible that different
men. Relativerisk estimatessuggestedthat causal relationships explaindifferent partsof
minority stressis associatedwitha two-to the results,the interpretation that minority
threefold increasein riskforhighlevels of stressis the causal agentleadingto distress
distress-clearlya substantialrisk. Further- allows a moreparsimonious explanation, and
more,I ruled out an alternative hypothesis is therefore morecompelling(cf. Link 1987).
that minoritystressorsaffect distressby These findingscontrastwith previous
diminishing in
affiliations the gay commu- evidence compiledon minority stress.When
nity,thussupporting thehypothesized direct studiescomparedratesof disorderor distress
effectforminority stress. betweenminorityand nonminority groups,
Nevertheless, thiscross-sectional analysis we foundlittleevidencethatminority stressis
limitsourabilityto testthepostulated causal relatedto adversementalhealth.Now thatwe
roleofminority stress.A plausiblealternative have looked at specific,theoretically-driven,
explanation is thatthecausalrelationships are minoritystress processes, we do find an
reversed:thatpsychological distressincreases adverserole forminority stressprocessesin
internalizedhomophobia, perceptions of thementalhealthof gay men. Althoughthe
stigma, and reports of prejudice events minority stressprocessesdescribedhere are
(McCrae 1990; Watson and Pennebaker specificto gay men,theyare clearlyapplica-
1989). The multioperationalism of minority ble to otherminorities as well. Further studies
stressand distress,however,allowsdetection need to explicateminoritystressprocesses
of divergencesand convergencesin the and describetheirrelationship to distressin
resultsthathelp interpret causal relationships otherminority groups.Certainly, theissue of
(Cook andCampbell1979). Reversedcausal- rates of disorderand distresscannot be
ityarguments are moreconvincing regarding sidestepped,and will have to be addressed
some findingsthanothers.For example,it too. But if thepresentfindingsare convinc-
can be arguedthatdemoralization increases ing, we must addressthe questionof rate
theexperience ofminority stress,butitis less differences withthisevidencein mind.The
convincing thatthedomain-specific measures issue thus becomes one of explainingwhy
(e.g., suicidalideationand behavior,or sex thereare no differences in ratesof disorder
problems)cause minority stress.Similarly, it betweenminorityand nonminority popula-

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
52 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
tions, and how such findingscould be becauseof theoppressivesocial environment
consistentwith the evidence that noxious of the minorityperson, but because of
social conditionsdo in fact have adverse economic disadvantagesto which ethnic
mentalhealtheffects. minoritypersonsaretypically subjected.This
One clear path for reconcilingthe evi- argument, articulatedby Mirowskyand Ross
dence, which has been suggestedby most (1980; 1989) amongothers(cf. Kesslerand
researcherswho addressthe issue, may be Neighbors1986), statesthatit is economic
termed "minoritycoping." It has been inequality,ratherthanprejudiceand discrim-
suggestedthat, by actively coping with ination,that is at the source of minority
stigmatization,some-perhaps most-minor- stress.But this argumentdefies a host of
itygroupmembersare protected fromtheill theoreticalformulations (discussed earlier)
effectsof minoritystress (Allport 1954; that quite clearly specify an oppressive
Garnetset al. 1990; Kessler et al. 1985; stigmatizing environment at the source of
Neighbors1984; Shade 1990; Weinbergand minority stress.The findingspresentedhere
Williams 1974). In fact, this argumentis suggestthata strong minority stresseffect can
implicit in the rationale of the present be detectedevenin a sampleof socioeconom-
investigation,whichpresumesingroupvaria- icallyadvantagedmen.
tionin theexperienceand effectof minority Throughout thepaperI have discussedthe
stressors.Minoritycoping may work in a issue of minority stressas it applies to gay
varietyof ways: by providingopportunitiesmen. It is likelythatsimilarminority stress
forsocialsupport, byaffirming andvalidating processesplayan important rolein themental
minority persons'cultureand values,and by healthof lesbiansas well (cf. Brooks 1981;
allowingreappraisaland devaluationof the de Montefloresand Schultz 1978; Sophie
stigmatizing values of the dominantculture 1987). Nevertheless,generalizationsfrom
(Crocker and Major 1989; Garnets and gay men to lesbians should be made with
Kimmel1991;Joneset al. 1984; Shade 1990; some caution. This is primarilybecause
Smithand Siegel 1985; Thoits 1985). Con- lesbians are subjectedto social stressand
ceptually,it is important to rememberthat oppressionrelatedto both the homosexual
minority coping mustbe consideredat the and the gender aspects of their identity
group-rather than the individual-level. (Brooks1981). The issueofdual stigmatizing
Individualsmaydiffer in thedegreeto which identities also appliesto gaymenandlesbians
theymobilizeminority coping,butthecoping of ethnicminorities(Garnetsand Kimmel
optionsavailabletothemarepredetermined at 1991). Furtherresearch is necessary to
thecommunity level. Preliminary worksug- exploretheeffectsof suchmultiplestigmati-
gests that even a generalized sense of zations.In addition,it is necessaryto assess
connectednessto the gay communitycan therole of minority stresswithinthecontext
provean important factorin ameliorating and of other stressors. General life events,
buffering minority stressin gay men (Meyer role-related stress,and gay-specific stressors
1993). Furtherwork on minoritycoping interactas individualsoccupy increasingly
needs to specifymechanismsthatalleviate complexrolesin society(cf. Pearlin1989).
minority stress,and to develop appropriate Stressresearchorganizesourunderstanding
measures. In addition,the presentstudy of the individualand society,and pointsto
demonstrates intragroup variationin minority pathogenic factors(Young 1980). The minor-
stress,butdoes notexplainwhataccountsfor ity stress perspective,which views social
the abilityof many gay people to accept conditionsas the source of morbidity and
themselvesand thrivein theface of societal distressfor minoritypersons,advances an
oppression.Once therole of minority stress ideological agenda that promotes social
on mentalhealthhas beendemonstrated, our changetowarda moreegalitarian society.It is
attention mustturnto studying environmentalnecessaryto identifysuch socially-induced
and personalfactorsthataccountfor such stressfulconditionsbecause "the eventual
variability. controlofdiseasecausedbystressdependson
This studyalso helpsto shedsomelighton understanding the social etiology of the
the associationof minority statusand socio- stress"(Pearlin1982:368). But thereis great
economicstatus,and theireffecton distress. resistance to identifyingsocially-induced
It has been arguedthat minoritystatusis sourcesof stress(Adams 1990) because of
relatedto adversementalhealtheffects,not publicpolicyimplications that"oftenencoun-

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 53
terthe angryresistanceof the powerforces Gay Men. Statementof Gregory Herek Before
thatget real benefitfromthe values being the United States House of Representatives,
criticized"(Albee 1982:1046).Froma public Committee on the Judiciary,Subcommittee on
policy perspective,cumulativeevidence of Criminal Justice.
thenegativeeffectsof prejudiceand discrim- Bell, Allan P. and Martin S. Weinberg. 1978.
Homosexualities: A Studyof DiversityAmong
inationmay help mobilize social forcesto Men and Women. New York: The Free Press.
abolishoppressivepolicies.Indeed,theargu- Berrill, Kevin T. and Gregory M. Herek. 1992.
ment that psychologicaldisabilitiesresult "Primaryand Secondary Victimizationin Anti-
from racial prejudice and discrimination Gay Hate Crimes: Official Response and Public
played an important part in the evidence Policy." Pp. 289-305 in Hate Crimes: Confront-
presented to theU.S. SupremeCourtpreced- ing ViolenceAgainstLesbians and Gay Men,
ing the 1954 school segregationdecision edited by G.M. Herek and K.T. Berrill.
(McCarthy andYancey 1971). Identifyingthe Newbury Park, CA: Sage.
stressfulconditionsthatarerelatedto antigay Bray, James H. and Scott E. Maxwell. 1985.
attitudeshighlightstheneed forgay-affirma- Multivariate Analysis of Variance. Newbury
tive programsin dealingwithpsychological Park, CA: Sage.
distressin lesbians and gay men, and for Brewin, Chris R. 1985. "Depression and Causal
Attributions:What is Their Relation?" Psycho-
publiceducationandlegislationin preventing logical Bulletin 98:297-309.
antigayviolenceand discrimination (Berrill Brooks, Virginia R. 1981. Minority Stress and
and Herek1992). Further researchon minor- Lesbian Women. Lexington, MA: Lexington
itystressmustaddressthesepublicpolicyand Books, D.C. Heath and Co.
public healthrecommendations as well as Cass, Vivian C. 1984. "Homosexual Identity
barriersto theirimplementation. Formation: Testing a Theoretical Model." The
Journal of Sex Research 20: 143-67.
Cohen, Sheldon, Gary W. Evans, Daniel Stokols,
NOTES and David S. Krantz. 1986. Behavior, Health,
and EnvironmentalStress. New York: Plenum
1. The now-obsolete diagnosisof ARC was used Press.
in 1987 in the presenceof immunodeficiency
Coleman, Eli, Brian R.S. Rosser, and Nancy
symptoms butbefore
(e.g., lymphadenopathy),
Strapko. 1992. "Sexual and IntimacyDysfunc-
the emergenceof any of the diseases that
tion Among Homosexual Men and Women."
qualifiedfor diagnosisof full-blownAIDS.
Psychiatric Medicine10:257-71.
ARC/AIDS statusis includedbecause of the
Coleman, Eli. 1982. "Developmental Stages of the
importance of ARC or AIDS diagnosisand its
Coming Out Process." Journal of Homosexual-
on distress.By 1987,whenthe
plausibleeffects
ity7:31-43.
data werecollected,249 of themenhad been
Cook, Thomas D. and Donald T. Campbell. 1979.
independently testedforHIV and 75 of them
Quasi-Experimentation: Design and Analysis
wereHIV-positive;43 menof thetotalsample
Issues for Field Settings. Boston, MA: Hough-
were diagnosedwith ARC or AIDS. ARC/
ton Mifflin.
AIDS status,ratherthanHIV status,was used
in the analyses because it more strongly Crocker, Jennifer and Brenda Major. 1989.
"Social Stigma and Self-Esteem: the Self-
predictedrelevantvariables than did HIV
ProtectivePropertiesof Stigma." Psychological
status,thus representinga strongerpotential
confounder. Bulletin96:608-30.
Dean, Laura, Shanyu Wu, and John L. Martin.
1992. "Trends in Violence and Discrimination
REFERENCES Against Gay Men in New York City: 1984-
1990." Pp. 46-64 in Hate Crimes:Confronting
Adams,Paul L. 1990. "PrejudiceandExclusionas ViolenceAgainstLesbiansand Gay Men,edited
Social Traumata."Pp. 362-93 in Stressorsand by G.M. Herek and K. T. Berrill. Newbury
the AdjustmentDisorders, edited by J.D. Park, CA: Sage.
Noshpitzand R.D. Coddington.New York: Dohrenwend, Bruce P., PatrickE. Shrout,Gladys
Wiley. Egri, and Frederick S. Mendelsohn. 1980.
Albee,GeorgeW. 1982. "Preventing Psychopath- "Nonspecific Psychological Distress and Other
ologyand Promoting HumanPotential."Ameri- Dimensions of Psychopathology: Measures for
37:1043-50.
can Psychologist Use in the General Population." Archives of
Allport,GordonW. 1954. The Natureof Preju- GeneralPsychiatry 37:1229-36.
dice. Reading,MA: Addison-Wesley. Dohrenwend, Bruce P. and Barbara S. Dohren-
AmericanPsychologicalAssociation.1986. APA wend. 1969. Social Statusand Psychological
Testimony on ViolenceAgainstLesbians and Disorder: A Causal Inquiry. New York: Wiley.

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
54 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
. 1976. "Sex Differences and Psychiatric Hirschfeld,RobertM.A. and Christine K. Cross.
Disorders." AmericanJournal of Sociology 1983. "PsychosocialRisk FactorsforDepres-
81:1447-54. sion." Pp. 55-67 in RiskFactorsResearchin
Dohrenwend, BruceP., ItzhakLevav, PatrickE. the Major MentalDisorders,by the National
Shrout, Sharon Schwartz, Guedalia Naveh, Instituteof Mental Health. Rockville, MD:
Bruce Link, AndrewE. Skodol, and Anne Departmentof Health and Human Services
Stueve. 1992. "SocioeconomicStatusand Psy- Publications.
chiatricDisorders:the Causation-Selection Is- Horowitz,Maddi J., NancyWilner,and William
sue." Science255:946-52. Alvarez.1979. "ImpactofEventScale: A Study
Durkheim,Emile. 1951. Suicide: A Study in of SubjectiveStress."Psychosomatic Medicine
Sociology.New York:The FreePress. 41:209-18.
Friedman,RichardC. 1991. "Couple Therapy Jones,Edward E., AmerigoFarina, AlbertH.
withGay Couples." Psychiatric Annals21:485- Hestrof,Hazel Markus,Dale T. Miller, and
90. Robert A. Scott. 1984. Social Stigma: The
Garnets, Linda and Douglas Kimmel. 1991. Psychologyof Marked Relationships.New
"Lesbian and Gay Male Dimensionsin the York:W.H. Freeman& Co.
PsychologicalStudyof HumanDiversity."Pp. Joseph, Harry. 1986. "Sampling Gay Men."
143-92 in PsychologicalPerspectiveson Hu- JournalofSex Research22:21-34.
manDiversity inAmerica,editedbyL. Garnets, Kelsey,Jennifer L., W. Douglas Thompson,and
J.M. Jones,D. Kimmel,S. Sue, andC. Tavris. AlfredS. Evans. 1986. Methodsin Observa-
Washington,D.C.: American Psychological tionalEpidemiology.New York: OxfordUni-.
Association. versity Press.
Garnets,Linda, GregoryM. Herek, and Barrie Kessler,RonaldC., RichardH. Price,andCamille
Levy. 1990. "Violence and Victimizationof B. Wortman.1985. "Social Factorsin Psycho-
Lesbiansand Gay Men: MentalHealthConse- pathology:Stress,Social Support,and Coping
quences." Journalof InterpersonalViolence Processes." AnnualReviewof Psychology36:
5:366-83. 531-72.
Goffman,Erving. 1963. Stigma: Notes on the Kessler, Ronald C. and Harold W. Neighbors.
Managementof Spoiled Identity.Englewood 1986. "A New Perspective on theRelationship
Cliffs,NJ:Prentice-Hall. AmongRace, Social Class, and Psychological
Gonsiorek,JohnC. 1988. "MentalHealthIssues Distress."JournalofHealthand Social Behav-
of Gay and Lesbian Adolescents."Journalof ior 27:107-15.
Adolescent HealthCare 9:114-22. Lazarus, RichardS. and Susan Folkman. 1984.
. 1991. "The Empirical Basis for the Stress, Appraisal, and Coping. New York:
DemiseoftheIllnessModelofHomosexuality." Springer Publishing Company.
Pp. 115-36 in Homosexuality: ResearchImpli- Lemert,EdwinM. 1967. HumanDeviance,Social
cations for Public Policy, edited by J.C. Problems, and Social Control. Englewood
Gonsiorekand J.D. Weinrich.NewburyPark, Cliffs,NJ:Prentice-Hall.
CA: Sage. Link, Bruce G. 1987. "Understanding Labeling
Hart,Maureen,HowardRoback,BennettTittler, Effectsin the Area of Mental Disorders:An
Larry Weitz, Barbara Walston, and Embry Assessmentof the Effectsof Expectationsof
McKee. 1978. "PsychologicalAdjustmentof Rejection."AmericanSociologicalReview52:
Nonpatient Homosexuals:CriticalReviewofthe 96-112.
ResearchLiterature."The Journalof Clinical Link, Bruce G. and FrancisCullen. 1990. "The
Psychiatry 39:604-608. LabelingTheoryofMentalDisorders:A Review
Herek,GregoryM. and Kevin T. Berrill.1992. of theEvidence."Pp. 75-105 in MentalIllness
Hate Crimes: Confronting Violence Against in Social Context,edited by J. Greenley.
Lesbian and Gay Men. NewburyPark, CA: Greenwich, CT: JAIPress.
Sage. Link,BruceG., FrancisT. Cullen,JamesFrank,
Herek,Gregory M. andErikK. Glunt.1988. "An and John F. Wozniak. 1987. "The Social
Epidemicof Stigma:PublicReactionsto Aids." Rejectionof FormerMental Patients:Under-
AmericanPsychologist 43:886-91. standingWhyLabels Matter."AmericanJour-
Hetrick,EmeryS. and A. DamienMartin.1984. nal ofSociology92:1461-1500.
"Ego-dystonic Homosexuality: A Developmen- Malyon,Alan K. 1982. "Psychotherapeutic Impli-
tal View." Pp. 2-21 in Innovationsin Psycho- cations of InternalizedHomophobiain Gay
therapywith Homosexuals, edited by E.S. Men." JournalofHomosexuality 7:59-69.
Hetrickand T.S. Stein. WashingtonD.C.: Marmor,Judd. 1980. "Epilogue: Homosexuality
AmericanPsychiatric AssociationPress. andtheIssueofMentalIllness."Pp. 391-401 in
. 1987. "Developmental Issues and Their HomosexualBehavior:A ModernReappraisal,
ResolutionforGay and LesbianAdolescents." editedby J. Marmor.New York:Basic Books.
JournalofHomosexuality 14:25-43. Martin,JohnL. 1987. "The Impactof AIDS on

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
MINORITY STRESS AND MENTAL HEALTH 55
Gay Male Sexual Behavior Patternsin New Anti-Gay/Lesbian Violence, Victimization&
YorkCity."AmericanJournalofPublicHealth Defamationin 1990. Washington, DC: NGLTF
77:578-81. PolicyInstitute.
. 1988. "Psychological Consequences of Neighbors, HaroldW. 1984. "The Distribution of
AIDS-RelatedBereavement AmongGay Men." Psychiatric Morbidityin Black Americans:A
Journalof Consulting and ClinicalPsychology Review and SuggestionsforResearch." Com-
56:856-62. munity MentalHealthJournal20:169-81.
. 1990. "Drinking Patterns and Drinking Norusis,MarijaJ. 1990. SPSS AdvancedStatistics
Problemsin a CommunitySample of Gay User's Guide. Chicago,IL: SPSS Inc.
Men." Pp. 32-47 in Alcohol,Immunomodula-Nungesser,Lon G. 1983. Homosexual Acts,
tion,and AIDS, editedby D. Seminaraand A. Actors,and Identities.New York:Praeger.
Pawlowski.Washington,DC: NationalAcad- Pearlin,LeonardI. 1982. "The Social Contextof
emyPress. Stress." Pp. 367-79 in Handbookof Stress:
Martin,JohnL. andLauraDean. 1987. "Summary Theoreticaland ClinicalAspects,editedby L.
of Measures:MentalHealthEffectsof AIDS on Goldbergerand S. Breznitz.New York: Aca-
At-RiskHomosexualMen." Divisionof Socio- demicPress.
medicalSciences,ColumbiaUniversity, School . 1989. "The Sociological Study of Stress.
of PublicHealth.Unpublished manuscript. JournalofHealthand Social Behavior30:241-
. 1990. "Developing a CommunitySample 56.
of Gay Men for an EpidemiologicStudy of Perry,Helen S., Mary L. Gawel, and Martha
AIDS." AmericanBehavioralScientist33:546- Gibbon. 1956. Clinical Studiesin Psychiatry.
61. New York:W.W. Norton& Company.
Martin,JohnL., LauraDean, MarkA. Garcia,and Pettigrew, Thomas F. 1967. "Social Evaluation
WilliamE. Hall. 1989. "The ImpactofAIDS on Theory:Convergencesand Applications."Ne-
a Gay Community: Changesin SexualBehavior, braskaSymposium on Motivation 241-304.
SubstanceUse, and MentalHealth." American Pillard,RichardC. 1988. "Sexual Orientation and
Journalof Community Psychology17:269-93. MentalDisorder. " PsychiatricAnnals18:52-56.
McCarthy, JohnD. andWilliamL. Yancey. 1971. Rabkin,Judith G. and ElmerL. Struening.1976.
"Uncle Tom and Mr. Charlie: Metaphysical "Life Events, Stress, and Illness. Science
Pathos in the Studyof Racism and Personal 194:1013-20.
Disorganization." AmericanJournalof Sociol- Reiss, BernardF. 1980. "PsychologicalTests in
ogy76:648-72. Homosexuality."Pp. 296-311 in Homosexual
McCrae, RobertR. 1990. "Controlling Neuroti- Behavior:A ModernReappraisal,editedby J.
cism in the Measurementof Stress." Stress Marmor.New York:Basic Books.
Medicine6:237-41. ResearchandDecisionCorporation. 1984. Design-
Merton,RobertK. [1957] 1968.Social Theoryand ing an EffectiveAIDS PreventionCampaign
Social Structure.New York:The Free Press. Strategy for San Francisco.ReportfortheSan
Meyer, Ilan H. 1993. "Prejudice and Pride: FranciscoAIDS Foundation.
MinorityStress and Mental Health in Gay Robins, Lee N. and Darrel A. Regier. 1991.
Men." Ph.D. dissertation, Division of Socio- Psychiatric DisordersinAmerica:TheEpidemi-
medical Sciences, School of Public Health, ologic Catchment Area Study.New York: The
ColumbiaUniversity, New York,NY. FreePress.
Miller,B. Jaye.1992. "FromSilenceto Suicide: Rosenberg,Morris. 1979. Conceivingthe Self.
Measuringa Mother's Loss." Pp. 79-94 in New York:Basic Books.
Homophobia:How WeAll Pay thePrice,edited Saghir,MarcelT. andEli Robins.1973. Male and
by W.J. Blumenfeld.Boston, MA: Beacon FemaleHomosexuality: A Comprehensive Inves-
Press. tigation.Baltimore,MD: Williams& Wilkins
Mirowsky,Johnand CatherineE. Ross. 1980. Company.
"Minority Status,EthnicCulture,and Distress: Schur,Edwin. 1971. LabelingDeviantBehavior:
A Comparisonof Blacks, Whites,Mexicans, ItsSociologicalImplications. New York:Harper
and MexicanAmericans."AmericanJournalof & Row.
Sociology86:479-95. Schwartz,Sharon. 1991. "Women and Depres-
. 1989. Social Causes of Psychological sion: a Durkheimian Perspective."Social Sci-
Distress.Hawthorne, NY: Aldinede Gruyter. ence and Medicine32:127-40.
de Monteflores, Carmenand StephenJ. Schultz. Shade,BarbaraJ. 1990. "CopingwithColor:The
1978. "Coming Out: Similaritiesand Differ- Anatomyof Positive Mental Health." Pp.
ences forLesbiansand Gay Men." Journalof 273-89 in Handbook of Mental Health and
Social Issues 34:59-72. Mental Disorder Among Black Americans,
Moss, GordonE. 1973. Illness, Immunity, and editedby D.S. Ruiz. New York: Greenwood
Social Interaction.New York:Wiley. Press.
National Gay and Lesbian Task Force. 1991. Smith,AdrienneJ. and Ruth F. Siegel. 1985.

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions
56 JOURNALOF HEALTH AND SOCIAL BEHAVIOR
"FeministTherapy:RedefiningPower for the the ThirdInternational Conferenceon AIDS.
Powerless. " Pp. 13-21 inHandbookofFeminist Washington, DC: June1-5.
Therapy: Women'sIssues in Psychotherapy,Warheit,George,CharlesE. Holzer, and Sandra
editedby L.R. Rosewaterand L.E.A. Walker. S. Arey. 1975. "Race and MentalIllness:An
New York:Springer. EpidemiologicalUpdate." Journalof Health
Sophie, Joan. 1987. "InternalizedHomophobia and Social Behavior16:243-56.
and LesbianIdentity." Journalof Homosexual- Warren, Carol. 1980. "Homosexuality and
ity14:53-65. Stigma."Pp. 123-41 in HomosexualBehavior:
Sowa, Claudia J. and Patrick J. Lustman. 1984. A ModernAppraisal,editedbyJ.Marmor.New
"GenderDifferences Events,
in RatingStressful York:Basic Books.
Depression,and DepressiveCognition."Jour- Watson,David and JamesW. Pennebaker.1989.
nal of ClinicalPsychology 40:1334-37. "HealthComplaints,Stress,and Distress:Ex-
Stein, Terry S. and Carol J. Cohen. 1984. ploring the CentralRole of NegativeAffectiv-
withGay Men and Lesbians: ity."PsychologicalReview96:234-54.
"Psychotherapy
MartinS. and Colin Williams. 1974.
An Examination of Homophobia,Coming-Out, Weinberg,
Male Homosexuals:TheirProblemsand Adap-
and Identity."Pp. 59-73 in Innovationsin
tations.New York:OxfordUniversity Press.
Psychotherapy with Homosexuals,edited by
Williams,Janet,JudithRabkin,RobertRemien,
E.S. Hetrick and T.S. Stein.Washington, D.C.:
JackM. Gorman,and AnkeA. Ehrhardt. 1991.
AmericanPsychiatric AssociationPress. "MultidisciplinaryBaselineAssessmentof Ho-
Stryker,S. and A. Statham.1985. "Symbolic mosexual Men With and Without Human
Interaction and Role Theory."Pp. 311-78 in Immunodeficiency VirusInfection:
II. Standard-
Handbookof Social Psychology,editedby G. ized ClinicalAssessmentof Currentand Life-
Lindzeyand E. Aronson.New York: Random time Psychopathology." Archivesof General
House. Psychiatry 48:124-30.
Thoits,PeggyA. 1985. "Self-LabelingProcesses Williams,DonaldH. 1986. "The Epidemiology of
in Mental Illness: The Role of Emotional MentalIllnessin Afro-Americans." Hospital&
Deviance." AmericanJournal of Sociology Community Psychiatry37:42-49.
91:221-49. Wilson, James D. 1992. "Gays Under Fire."
Thomas, Alexanderand Samuel Sillen. [1972] Newsweek,September14, pp. 35-40.
1991. Racism and Psychiatry.New York: Winkelstein, WarrenJr.,David M. Lyman,and
CitadelPress. NancyS. Padian. 1987. "Sexual Practicesand
Troiden,RichardR. 1989. "The Formationof Risk of Infectionby the AIDS-Associated
HomosexualIdentities."Journalof Homosexu- Retrovirus:The San FranciscoMen's Health
ality17:43-73. Study." Journal of the American Medical
Tross, Susan, Dan Hirsch,B. Rabkin,C. Berry, Association257:321-25.
and J.C.B. Holland. 1987. "Determinants of Young,Allen. 1980. "The Discourseof Stressand
Current Psychiatric Disordersin AIDS Spectrum theReproduction of ConventionalKnowledge."
Patients."P. 60 in Programsand Abstractsof Social Scienceand Medicine14:133-46.

Ilan H. Meyeris assistantclinicalprofessorin publichealthat ColumbiaUniversityand a postdoctoral

researchfellowin healthpsychology at thesocial/personality
psychology programat theGraduateCenter
of The CityUniversity of New York. The paper"Minority Stressand MentalHealthin Gay Men" has
won theBarbaraSnell Dohrenwend awardfordistinguished researchin SociomedicalSciences.

This content downloaded from 198.0.229.73 on Sun, 19 Oct 2014 07:10:48 AM

All use subject to JSTOR Terms and Conditions