Many assume that individuals with a hidden stigma escape the difficulties faced by individuals with a visible stigma. However, recent research has shown that individuals with a concealable stigma also face considerable stressors and psychological challenges. The ambiguity of social situations combined with the threat of potential discovery makes possessing a concealable stigma a difficult predicament for many individuals. The increasing amount of research on concealable stigmas necessitates a cohesive model for integrating relevant findings. This article offers a cognitive-affective-behavioral process model for understanding the psychological implications of concealing a stigma. It ends with discussion of potential points of intervention in the model as well as potential future routes for investigation of the model.

Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted.

Objectives We tested the preliminary efficacy of a transdiagnostic cognitive behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks (i.e., alcohol use, sexual compulsivity, condomless sex) among young adult gay and bisexual men. Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. Method Young gay and bisexual men (n=63; M age=25.94) were randomized to immediate treatment or a three-month waitlist. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of past-90-day risk behavior. Results Compared to waitlist, treatment significantly reduced depressive symptoms (b=−2.43, 95% CI: −4.90, 0.35, p<0.001), alcohol use problems (b =−3.79, 95% CI: −5.94, −1.64, p<0.001), sexual compulsivity (b =−5.09, 95% CI: −8.78, −1.40, p<0.001), and past-90-day condomless sex with casual partners (b =−1.09, 95% CI: −1.80, −0.37, p<0.001), and improved condom use self-efficacy (b =10.08, 95% CI: 3.86, 16.30, p<0.001). The treatment yielded moderate and marginally significant greater improvements than waitlist in anxiety symptoms (b =−2.14, 95% CI: −4.61, 0.34, p=0.09) and past-90-day heavy drinking (b =−0.32, 95% CI: −0.71, 0.07, p=0.09). Effects were generally maintained at follow-up. Minority stress processes showed small improvements in the expected direction. Conclusion This study demonstrated preliminary support for the first intervention adapted to address gay and bisexual men’s co-occurring health problems at their source in minority stress. If found to be efficacious compared to standard evidence-based treatments, the treatment will possess substantial potential for helping clinicians translate LGB-affirmative treatment guidelines into evidence-based practice. Public Health Significance Sexual orientation-related disparities in depression and anxiety co-occur with alcohol use, sexual compulsivity, and risky sexual behavior to form a syndemic health threat surrounding young gay and bisexual men. Clear and consistent evidence suggests that a major source of this syndemic is minority stress—the stress associated with stigma-related social disadvantage that compounds general life stress. This study represents the first test of an adapted cognitive behavioral intervention designed to alleviate minority stress among young gay and bisexual men to improve the co-occurring health conditions facing this population.

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