In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress-explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM;American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating-even equating-claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999).However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental disorder (American Psychiatric Association, 1994). To use postmodernist understanding of scientific knowledge, such a debate on classification concerns the social construction of mental disorder-what we as a society and as scientists agree are abnormal behaviors, cognitions, and emotions. The answer, therefore, depends on scientific and social consensus that evolves and is subject to the vicissitudes ...

Research in various populations has shown that, starting early in childhood, individuals often demonstrate resilience in the face of stress and adversity. Against the experience of minority stress, LGBT people mount coping responses and most survive and even thrive despite stress. But research on resilience in LGBT populations has lagged. In this commentary, I address 2 broad issues that I have found wanting of special exploration in LGBT research on resilience: First, I note that resilience, like coping, is inherently related to minority stress in that it is an element of the stress model. Understanding resilience as a partner in the stress to illness causal chain is essential for LGBT health research. Second, I explore individual-versus community-based resilience in the context of minority stress. Although individual and community resilience should be seen as part of a continuum of resilience, it is important to recognize the significance of community resilience in the context of minority stress.

We examined the associations between internalized homophobia, outness, community connectedness, depressive symptoms, and relationship quality among a diverse community sample of 396 lesbian, gay, and bisexual (LGB) individuals. Structural equation models showed that internalized homophobia was associated with greater relationship problems both generally and among coupled participants independent of outness and community connectedness. Depressive symptoms mediated the association between internalized homophobia and relationship problems. This study improves current understandings of the association between internalized homophobia and relationship quality by distinguishing between the effects of the core construct of internalized homophobia and its correlates and outcomes. The findings are useful for counselors interested in interventions and treatment approaches to help LGB individuals cope with internalized homophobia and relationship problems.Keywords internalized homophobia; relationship quality; community connectedness; outness; depression; gay men; lesbians; bisexuals Internalized homophobia represents "the gay person's direction of negative social attitudes toward the self" (Meyer & Dean, 1998, p. 161) and in its extreme forms, it can lead to the rejection of one's sexual orientation. Internalized homophobia is further characterized by an intrapsychic conflict between experiences of same-sex affection or desire and feeling a need to be heterosexual (Herek, 2004). Theories of identity development among lesbians, gay men, and bisexuals (LGB) suggest that internalized homophobia is commonly experienced in the process of LGB identity development and overcoming internalized homophobia is essential to the development of a healthy self-concept (Cass, 1979; Fingerhut, Peplau, & Hgavami, 2005;Mayfield, 2001;Rowen & Malcolm, 2002;Troiden, 1979;. Furthermore, internalized homophobia may never be completely overcome, thus it could affect LGB individuals long after coming out (Gonsiorek, 1988). Research has shown that internalized homophobia has a negative impact on LGBs' global self-concept including mental health and well being (Allen & Oleson, 1999;Herek, Cogan, Gillis, & Glunt, 1998;Meyer & Dean, 1998;Rowen & Malcolm, 2002 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptRecent research on internalized homophobia and mental health has adopted a minority stress perspective (DiPlacido, 1998;Meyer 1995;2003a). Stress theory posits that stressors are any factors or conditions that lead to change and require adaptation by individuals (Dohrenwend, 1998;Lazarus & Folkman, 1984; Pearlin, 1999). Meyer (2003a, b) has extended this to discuss minority stressors, which strain individuals who are in a disadvantaged social position because they require adaptation to an inhospitable social environment, such as the LGB person's heterosexist social environment (Meyer, Schwartz, & Frost, 2008). In a meta-analytic review of the epidemiology of mental health disorders among heterosexual and LGB indiv...