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ViewAttendees 4

Symposia

LGBTQ+

Session: Population-based Insights into How Stigma “Gets Under the Skin”: Moving Towards a Biopsychosocial Mediation Framework of Sexual Minority Wellbeing

3 - (SYM 7) the Role of Shame in the Sexual Orientation Disparity in Mental Health: A Prospective Population-based Study of Multimodal Emotional Reactions to Stigma

Friday, November 17, 2023
12:30 PM – 2:00 PM PST
Location: Snohomish (605), Level 6

Background: Because shame represents the emotional experience of seeing oneself as morally transgressive and socially inferior, it represents a candidate marker, if not a pathognomonic sign, of stigma processes at work. Given sexual minorities’ pervasive exposure to stigma and its interpersonal manifestations, this population might be particularly likely to experience shame and its characteristic outcomes—namely depression, social anxiety, and suicidal thoughts. Yet, despite the prominence of shame in stigma theories, its role in explaining population-level mental health disparities between the stigmatized (e.g., sexual minorities) and non-stigmatized (e.g., heterosexuals) has not been investigated.

Methods: To address this gap, we assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a prospective, representative sample of sexual minority and heterosexual young adults (N=2,222 at baseline). This study also included comprehensive assessments of early and ongoing stigma experiences (e.g., internalized and interpersonal stigma) as well as multiple mental health outcomes (e.g., depression, social anxiety, suicidal thoughts).

Results: Compared to heterosexuals, sexual minorities evidenced higher explicit and implicit shame, which mediated sexual orientation disparities in depression, social anxiety, and suicidal thoughts. Among sexual minorities, there was a significant indirect effect of shame in the association between interpersonal stigma (i.e., past-year family rejection and childhood bullying) and later experiences of adverse mental health; an indirect effect did not exist for the related construct, internalized stigma.

Conclusions: Study results emphasize the central role of shame in explaining sexual orientation disparities in depression, social anxiety, and suicidal thoughts and its indirect role linking family and peer mistreatment to these subsequent outcomes. Further supporting the central role of shame in sexual minority individuals’ experiences, shame exerted a stronger indirect effect on the association between interpersonal stigma and adverse mental health than the more commonly measured cognitive experience of internalized stigma. These findings suggest the potential benefit of extending existing stigma theories to consider the role of emotions like shame as characteristic reactions to stigma, which can guide the search for treatment targets focused on reducing the mental health sequelae of stigma among sexual minorities and other stigmatized groups.