The relationship between minority stress and biological outcomes: A systematic review

Abstract

Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the Annesa Flentje

Differences in Health-Related Quality of Life and Health Behaviors Among Lesbian, Bisexual, and Heterosexual Women Surviving Cancer from the 2013 to 2018 National Health Interview Survey

“…Prolonged distress can negatively affect health behaviors, 88 gene and immune function, 89 chronic inflammation, 89 tumor progression, 89 and survival. 90 Bisexual women's disparate distress after cancer diagnosis may be complicated by minority stress, 91 which is associated with worse physical health 92 and participation in health risk behaviors. 93,94 Although existing support services may facilitate minority stress, 95 resilience 50 and involvement of social support (e.g., partners, family, and friends) 82 may protect LGBT individuals in the cancer setting.…”

The Legal Vulnerability Model for Same-Sex Parent Families: A Mixed Methods Systematic Review and Theoretical Integration

“…Our empirical evidence base and the theoretical foundations of our model would allow for a focus on mental health. We chose to use the general term “health” for two reasons: First, physical health disparities and physical health correlates of minority stress are commonly conceptualized as sequelae of heightened (minority) stress exposure (Lick et al, 2013 ; Flentje et al, 2020 ). Second, lacking access to legally recognized parental relationships can lead to material and financial disadvantages for same-sex couples (e.g., lack of partner insurance or fiscal benefits), which are well-established health-related risk factors (Pampel et al, 2010 ; Phelan et al, 2010 ).…”

Sexual Orientation Disparities in Risk Factors for Adverse COVID-19–Related Outcomes, by Race/Ethnicity — Behavioral Risk Factor Surveillance System, United States, 2017–2019

“…Non-Hispanic Black and Hispanic populations have been disproportionately affected by the COVID-19 pandemic in the United States, and the increased prevalence of certain risk factors among sexual minority members of these racial/ethnic minority populations is of particular concern. Because of their sexual orientation, sexual minority persons experience stigmatization and discrimination (1) that can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being through meaningful work and economic security, routine and critical health care, and relationships in which sexual orientation and gender identity can be openly expressed (5). Persons who are members of both sexual minority and racial/ethnic minority groups might therefore experience a convergence of distinct social, economic, and environmental disadvantages that increase chronic disease disparities and the risk for adverse COVID-19-related outcomes.…”