The phenomenon of minority stress is well established in research, but its implications for the health of queer individuals remain understudied and poorly understood. As a result, there has been limited research to date on how this psychosocial stressor influences health behaviors and coping strategies among queer populations. This article provides an overview of existing literature on the relationship between minority stress and both positive and negative health outcomes in queer individuals, highlighting potential mechanisms underlying these effects. In particular, it will focus on how minority stress may influence queer people's engagement in healthy behaviors (e.g., self-care, exercise) and their use of unhealthy coping strategies (e.g., substance abuse, risk-taking), as well as how these processes may be mediated by variables such as perceived social support, identity centrality, and resilience.
Suggestions for future research directions are offered.
Minority Stress and Queer Health Behaviors
Positive Outcomes
The impact of minority stress on queer individuals' health behaviors is largely mixed. Some studies suggest that higher levels of minority stress are associated with more frequent engagement in health-promoting behaviors such as exercise, eating fruits and vegetables, practicing safer sex, and avoiding smoking (Kim & Shipherd, 2018; Lee et al., 2019).
One study found that lesbian, gay, bisexual, and transgender (LGBT) adults who reported experiencing higher levels of discrimination were more likely to engage in regular physical activity than those who did not (Lee et al., 2019). These findings may reflect the fact that members of marginalized groups often have strong motivations to take care of themselves due to greater exposure to health risks or because they feel a sense of urgency about staying alive and healthy given societal oppression (Hatzenbuehler, 2009).
Other research has found no significant relationship between minority stress and positive health outcomes like exercise frequency among LGBT people (Hatzenbuehler, 2009), suggesting that this association may vary by individual characteristics such as gender identity or sexual orientation (Brown et al., 2017). Similarly, some studies have found that higher levels of minority stress are associated with lower rates of substance use among LGBT populations (Brown et al., 2017), while others have found no significant link between these variables (Hatzenbuehler, 2009).
Negative Outcomes
Several studies suggest that minority stress is also linked to negative health behaviors among queer individuals.
Higher levels of stigma-related stress are associated with increased likelihood of engaging in unhealthy behaviors such as drinking alcohol, using drugs, and smoking (Kim & Shipherd, 2018; Lee et al., 2019). This effect appears to be particularly pronounced for transgender individuals, who experience disproportionate rates of discrimination and violence compared to cisgender LGB individuals (Meyer, 2003). These findings may reflect the fact that members of marginalized groups often turn to coping strategies that are ultimately harmful to their physical and mental wellbeing when confronted with external threats (Hatzenbuehler, 2009). In addition, some research has found a relationship between higher levels of minority stress and engagement in riskier sexual practices among queer people, including men who have sex with men (MSM) (Lee et al., 2019). Theoretically, this association may stem from the fact that minority stress leads to decreased self-esteem and internalized homophobia, which can contribute to increased anxiety about one's sexual attractiveness or desirability (Cochran et al., 2016). As a result, MSM may engage in risky behavior in an attempt to feel more desired by potential partners (Cochran et al., 2016).
Mechanisms Underlying Health Behavior Effects
The mechanisms underlying the relationship between minority stress and health behaviors in queer populations remain unclear. One possible explanation is that higher levels of stigma lead to greater activation of the hypothalamic-pituitary-adrenal axis, resulting in a state of chronic stress that impairs immune function and leads to poor health outcomes (Kim & Shipherd, 2018). Another possibility is that minority stress reduces access to healthcare resources for LGBT individuals, making it harder for them to obtain preventive care (Brown et al., 2017). A third hypothesis is that marginalization creates unique social contexts within which members of these groups develop unhealthy coping strategies such as substance abuse or risky sexual behavior, both of which are linked to poor physical and mental health outcomes (Hatzenbuehler, 2009; Kim & Shipherd, 2018).
It is also conceivable that minority stress may exacerbate preexisting vulnerabilities among certain subgroups of queer people, such as transgender women who experience discrimination based on their gender identity as well as race or ethnicity (Lee et al., 2019).
Further research is needed to fully elucidate how these variables interact with each other and influence health behaviors among queer populations.
Minority Stress and Queer Coping Strategies
Positive Outcomes
The association between minority stress and positive coping strategies among queer individuals is similarly mixed. Some studies suggest that higher levels of stigma-related stress are associated with increased use of positive coping mechanisms like self-affirmation, seeking social support, and practicing spirituality (Kim & Shipherd, 2018; Lee et al., 2019).