Over the past three decades, social scientists have found that minority individuals suffer from mental and physical health disparities compared to their peers in majority groups.
[6] Lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals face higher rates of suicide, substance abuse, and cancer relative to non-queer people.
[7][8][9] More recent data suggest the association of minority stressors with higher rates of migraine headaches,[10] stroke,[11] and functional neurological disorder among LGBTQ+ people.
[18][19] While the social selection hypothesis is still debated, it is clear that genetic and dispositional factors do not fully explain the health disparities observed in minority groups.
Together, distal and proximal stressors accrue over time, leading to chronically high levels of stress that cause poor health outcomes.
Indeed, despite significant improvement over the past several decades, numerous studies have confirmed that minority individuals continue to face high rates of distal stressors.
[41] Thus, collectively, research suggests that minority individuals face frequent exposure to distal stressors compared to their majority group counterparts.
[1][23] Most research on this topic focuses on either sexual minorities or African Americans, and it is unclear whether the proximal stress processes are conceptually similar between these two groups.
[45][46][47] Concealing such personal information causes significant psychological distress, including intrusive thoughts about the secret, shame and guilt, anxiety, and isolation from other members of the minority group.
[51][52] As predicted by minority stress theory, internalized homophobia is associated with exposure to distal stressors, insofar as it only occurs because LGB individuals are exposed to negative societal attitudes toward same-sex attraction.
[54][55] Thus, previous experiences with prejudice are associated with proximal stress among LGBTQ+ individuals, including concealment of their sexual identity, internalized homophobia, and rejection sensitivity.
In comparison to cis (non-transgender) individuals, gender variant minorities face a higher rate of distal stressors, including exclusion, verbal trans bashing, as well as physical and sexual violence.
[56][57][58] The more distal stressors are sourced in family, friends, partners, neighbors, co-workers, acquaintances, strangers, and even the police, the more likely it is for gender variant people to experience proximal stress, including internalized transphobia.
[56][58][59] Internalized transphobia may initially appear as anxiety and depression, marked by a severe decrease in self-tolerance or self-empathy, yet needs to be understood diagnostically within the context of minority stress.
For example, Erving Goffman observed that racial minorities approach social interactions with a high degree of anxiety, because they have been discriminated against in the past.
[60] Similarly, Gordon Allport asserted that African American individuals display vigilance after exposure to prejudice, actively scanning the social environment for potential threats.
[61][62] Researchers have shown that, when African Americans are reminded of their racial minority status in an academic context, they face a high degree of anxiety, causing their intellectual performance to suffer.
For example, population-based studies have shown that LGBTQ+ people are at risk for increased rates of substance abuse, suicide attempts, depression, anxiety, and somatoform disorders across the lifespan.
[30][75] Multiple studies have also established an association between same-sex marriage legalization and reduced suicidality of youth and adolescents, indicating that the structural stigma embedded in denying equivalent rights to sexual minorities mediates part of the relationship between distal stressors and mental health.
A 2013 study suggests similar links between proximal stressors and physical health disparities in LGBTQ+ communities, including cardiovascular disease, asthma, diabetes, and some cancers.
[82] In terms of mental health, African Americans report lower rates of overall life satisfaction, as well as heightened depressive symptoms and substance abuse compared to Whites.
For example, one study showed that perceived prejudice was associated with irregular blood pressure throughout the day, which has been linked to long-term cardiovascular disease.
[37][87] Indeed, a 2009 meta analysis of 36 empirical studies revealed consistent effects of prejudice and discrimination on physical health (e.g., cardiovascular disease, hypertension, diabetes) among racial minorities.
For example, researchers have found that African Americans have a sense of inferiority and low self-worth due to experiences with prejudice, which are associated with emotional distress.
[91] Similarly, internalized racism has been linked to psychiatric symptoms, including high rates of alcohol consumption, low self-esteem, and depression.
J. Michael Bailey, best known for his research on sexual orientation, argues that the minority stress model deserves reconsideration since it fails to take temperament and genetics into account.
Bailey argues that there is a biological component to increased stress among non-heterosexual populations, and says that "it would be a shame—most of all for gay men and lesbians whose mental health is at stake—if sociopolitical concerns prevented researchers from conscientious consideration of any reasonable hypothesis".
This information has been used by law enforcement, policymakers, and social organizations to target and minimize the occurrence of distal stressors and, thus, to improve minority health on a large scale.
[23] In the future, the minority stress concept can be used to advocate for federal funding for nationwide campaigns and interventions that aim to reduce intergroup prejudice.