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Gender Minority Stress

From EverybodyWiki Bios & Wiki


Gender Minority Stress[edit]

Gender Minority Stress describes the stress response of an individual to the distinct types of stressors encountered by individuals of gender minority groups.[1] Gender minority in this context is referring to any individual whose gender identity is not cisgender. The term "minority stress" was originally used and conceptualized in the book "Minority Stress and Lesbian Women.[2]". Later the concept of minority stress was expanded and applied to other minority groups, including gay men[3][4], bisexual men[4], people of color, and transgender individuals[5]. While individuals within gender minority groups may face the same or similar stressors as other minorities such as sexual minorities, some research suggests that they encounter stressors which place them at uniquely increased risk for experiencing negative health outcomes [1][6][7], as well as being marginalized while in institutions.[8] Gender minority stress comes in the form of verbal harassment, sexual harassment, social alienation[9], being "misgendered" (being addressed with inappropriate Gender pronouns) [10], bullying, physical violence or threat of violence [11], intimate partner violence, exclusion from access to appropriate restroom facilities [12], exclusion from access to necessary and appropriate healthcare treatment [7], discriminatory treatment while in institutional/long-term care facilities[8], and more recently, exclusion from participation in military service.[13] Developmental considerations for gender minority youth and adolescents currently have limited research as well.[14] There is now a considerable body of literature which suggests that transgender individuals are at higher risk of both physical and mental health disparities, and that gender minority stress may be responsible for this disparity.[5][15][16][17][18][19][20]

Discrimination[edit]

Discrimination is often experienced by those who identify with the gender minority. In 2017 alone there have been 23 violent deaths of Transgender people in the United States[21]. One way the discrimination is applied to this population of people is through misgendering[10]. Misgendering is when someone is identified with the wrong gender pronoun than the one in which they identify. Misgendering can have psychological effects on the individual because it can affect their ability to identify with a certain group and make the individual feel misunderstood and not accepted by other[10]. When you take away someone’s ability to identify with a group then you take away their ability to relate and contribute to group needs. Misgendering someone can lead them to believe that the world is unpredictable and uncontrollable[10]. Individuals need to feel a sense of security about the world in order to thrive. Being unable to meet this need can lead individuals to be unable to meet other needs as illustrated in Maslow’s hierarchy of needs. Along with misgendering another form of discrimination that gender minority individual’s face is negative stereotypes. Misgendering can lead to the belief that the group individuals do identify with is stigmatized. If individuals think their group is stigmatized it can lead to the belief that the individual themselves is stigmatized[10]. There is little research on how these stigmatized beliefs effect the psyche of gender minority individuals but those who identify as belonging to the gender minority group report that they are limited in their employment and educational opportunities due to their identity or presentation[6]

Along with discrimination there are concerns about how well society’s institutions serve gender minority individuals. In the United States there have been controversial laws about bathroom use for gender minority individuals. A study conducted in Washington D.C. reported that 70% of gender minority individuals surveyed had experienced verbal harassment or assault while using a public bathroom, or had been denied use of a public bathroom[22]. Bathrooms are not the only places where a binary gender classification is problematic. Places like school, work, jails, prisons, locker rooms, religious buildings and shelters do not adequately meet the needs of gender minority individuals through a lack of awareness for the needs of this group of individuals. Research into the impact of institutional discrimination against gender minority individuals has not been conducted[22]

Developmental Considerations[edit]

Adolescents, under the age of 18, who identify with the gender minority group are at risk for developing anxiety, depression, self-harm behaviors, and suicidality due to the psychological stressors from how society treats this group of individuals.[23] This group is also at risk for high levels of substance use and bullying.[24][23] Also is reported that this group of individuals is under-served despite their high risk.[23]

One controversial treatment available to gender minority youth who are not ready to make a decision about their gender identity is puberty suppression.[25] Puberty suppression is when someone takes gonadotropin releasing hormones (GnRH) in order to stop puberty from occurring.[25] This treatment is primarily used for adolescents who are diagnosed with Gender Dysphoria (previously known as Gender Identity Disorder in the DSM-IV). Gender Dysphoria according to the DSM-5 is when there is a conflict between a person’s assigned gender and the gender with which they identify. An adolescent who engages in puberty suppression until a later age may eventually choose which gender with which they identify without the pressure of the physical changes associated with puberty.[25]

Older adults who have faced stigma due to their gender identity are more likely than non-gender minority adults to rate their health as negative later in life.  These negative health outcomes include cancer, HIV, asthma, diabetes and mental distress.[1] Not all older adults who identify with the gender minority will rate their well being as poor in older adulthood. Some older adults see the adversity and stigma that they faced as making them stronger than they would have been without a gender minority identity.[1]

Proximal stressors among sexual minorities[edit]

A growing body of research indicates that exposure to distal stressors leads to proximal stressors in sexual minority populations. While sexual minority stress and gender minority stress both use Meyer's Minority Stress Model as a framework, and share some characteristics with gender minority stress, sexual minority stress is distinct from the minority stress experienced by transgender, gender non-conforming, and gender non-binary individuals[26]. For example, LGB youth and adults who have experienced prejudice about their sexual orientation sometimes choose to conceal their sexual identity from others.[27][28][29] Concealing such personal information causes significant psychological distress, including intrusive thoughts about the secret, shame and guilt, anxiety, and isolation from other members of the minority group.[28][30][31][32] Internalized homophobia is another proximal stressor prevalent among LGBT individuals. It refers to the internalization of negative social views about homosexuality, which leads to self-hatred and poor self-regard.[33][4] As predicted by minority stress theory, internalized homophobia is associated with exposure to distal stressors, insofar as it only occurs because LGB individuals are exposed to negative societal attitudes toward same-sex attraction.[34] Rejection sensitivity represents a third proximal stress among sexual minority individuals. Rejection sensitivity refers to chronic, anxious expectations of rejection based on one's stigmatized status. Among sexual minority individuals, rejection sensitivity emerges from experiences of rejection from parents and is associated with internalized homophobia, unassertiveness, depression, and anxiety.[35][36] Thus, previous experiences with prejudice are associated with proximal stress among LGB individuals, including concealment of their sexual identity, internalized homophobia, and rejection sensitivity.

Mental Health[edit]

Misgendering is a frequent occurrence causing stress for an individual and feelings of devaluation. Studies have found correlations between the experience of being a member of a gender minority and various mental health concerns. Misgendering is associated with psychological stress including felt stigma, depression, anxiety, stress[37], [38] and social anxiety.[39] These associations have been further supported in an online study of transgender individuals who reported depression, anxiety, and somatization.[40] In a convenience sample conducted through an online survey, high rates of suicidal ideation, suicide attempts, and serious consideration of suicide were reported within the transgender nonconforming population.[41] Aside from impacting individuals, gender minority stress can impact the mental health of individuals in a relationship. In mixed gender relationships (i.e., transgender and cisgender couple), dyadic crossover effects related to relationship stigma can impact the health of relationship partners.[42]

Substance Use[edit]

Gender minority stress is associated with higher rates of substance use in the transgender and nonconforming population. Studies have investigated the effects of gender minority stress as it relates to substance use in adult and adolescent populations. A study assessing alcohol, cannabis, and illicit drug use in the past three months among transgender men and women found that sexuality and gender components were related to substance use more than minority stressors. However, the study also found that excessive alcohol use among transgender men and cannabis use among transgender women was associated with gender minority stressors.[43] High gender minority stress in the form of transphobic discrimination has been linked to increased rates of binge drinking.[44] For youth, gender minority adolescents are more likely to have used alcohol, marijuana, and nonmarijuana illicit drugs in the past 12 months when compared to their cisgender peers. Bullying mediated this association.[45]

Protective Factors[edit]

Protective and resiliency factors provide safety and support for individuals experiencing gender minority stress. The importance of individual- and community-based resiliency factors is best seen on a continuum.[46] Resiliency factors include interpersonal, community, and organizational. Individuals who have access to supportive family members[18][47], peers, friends, or community members[47][48][49], may experience less gender minority stress. According to one study, the level of psychological distress may still remain clinically significant, even though social support reduces the effect of the minority stressors.[49] Identity pride, while not necessarily a causal factor, was associated with lower levels of psychological distress among gender minority individuals.[49] For LGBT youth, supportive school environments that enforce antibullying initiatives, organize nongender conforming student associations, and inclusive curriculum create welcoming and supportive environments for adolescents.[50] Adults could benefit from similar approaches at their place of employment. For both adults and youth, they may be further supported at the community level through government organizations, religious institutions, and other community level organizations. The final factor which may decrease the incidence of minority stress is access to appropriate and affirmative health care.[8][7][6][49] Some researchers have suggested ways that healthcare professionals[48][18] and others[18] may be able to help support gender minority individuals they interact with. These include supporting the individual’s identity[18], supporting access to a community of similar others[18][51], challenging social structures and beliefs which support minority stressors, fostering an environment where individuals can feel safe to disclose their identity[18], improving access and removing barriers to appropriate health care [47], and not making assumptions about an individual’s gender identity [48], or that clients identify within a gender binary.[48]

Assessment Measures[edit]

In order to assess gender minority stress and resilience more effectively, the Gender Minority Stress and Resilience (GMSR) measure was developed. It assesses nine constructs: gender-related discrimination, gender-related rejection, gender-related victimization, nonaffirmation of gender identity, internalized transphobia, negative expectations for future events, nondisclosure, community connectedness, and pride. The measure can help understand the correlates of gender minority stress and resiliency factors.[52] This tool is a useful addition to the field of gender minority stress.

References[edit]

  1. ↑ 1.0 1.1 1.2 1.3 de Vries, Brian (2015). Stigma and LGBT aging: Negative and positive marginality. pp. 55–71. doi:10.1037/14436-003. ISBN 978-1-4338-1763-2. Search this book on
  2. ↑ Brooks, Virginia R. (1981). Minority Stress and Lesbian Women. United States of America: D.C. Health and Company. pp. 69–89. ISBN 978-0-66903953-5. Search this book on
  3. ↑ Meyer, I. (1995). "Minority stress and mental health in gay men" (PDF). Journal of Health and Social Behavior. 36 (1): 38–56. PMID 7738327 – via JSTOR.
  4. ↑ 4.0 4.1 4.2 Meyer, I. H., & Dean, L. (1998). Internalized homophobia, intimacy, and sexual behavior among gay and bisexual men. In Herek, G. M. (Ed.) Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals. Thousand Oaks, CA: Sage, pp. 160-186.
  5. ↑ 5.0 5.1 Hendricks, Michael L.; Testa, Rylan J. (2012). "A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model". Professional Psychology: Research and Practice. 43 (5): 460–467. doi:10.1037/a0029597.
  6. ↑ 6.0 6.1 6.2 Bockting, W.O.; Robinson, B. E.; Forberg, J.; Scheltema, K. (2005-04-01). "Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community". AIDS Care. 17 (3): 289–303. doi:10.1080/09540120412331299825. ISSN 0954-0121. PMID 15832877.
  7. ↑ 7.0 7.1 7.2 "When healthcare isn't caring: Transgender and gender-nonconforming people; Results from Lambda Legal's Health Care Fairness Survey" (PDF). Lambda Legal. 2014.
  8. ↑ 8.0 8.1 8.2 NSCLC; NGLFT; SAGE; Lambda Legal; NCLR; NCTE (2010). "Stories from the Field: LGBT older adults in long-term care facilities" (PDF).
  9. ↑ Miller, L.; Grollman, E. (2015). "The social costs of gender nonconformity for transgender adults: Implications for discrimination and health" (PDF). Sociological Forum. 30 (3): 809–831. doi:10.1111/socf.12193. PMC 5044929. PMID 27708501.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 McLemore, Kevin A. (2015). "A Minority Stress Perspective on Transgender Individuals' Experiences With Misgendering". Stigma and Health. 3: 53–64. doi:10.1037/sah0000070.
  11. ↑ Testa, R.; Sciacca, L.; Wang, F.; Hendricks, M.; Goldblum, P.; Bradford, J.; Bongar, B. (2012). "Effects of violence on transgender people". Professional Psychology: Research and Practice. 43: 452–459.
  12. ↑ Seelman, K (2016). "Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity". Journal of Homosexuality. 63: 1378–1399.
  13. ↑ Hirschfeld Davis, Julie (July 26, 2017). "Trump Says Transgender People Will Not Be Allowed in the Military". The New York Times.
  14. ↑ Reisner, S. L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., & Mimiaga, M. J. (2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 56(3), 274–279. http://doi.org/10.1016/j.jadohealth.2014.10.264
  15. ↑ Breslow, Aaron S.; Brewster, Melanie E.; Velez, Brandon L.; Wong, Stephanie; Geiger, Elizabeth; Soderstrom, Blake (2015). "Resilience and collective action: Exploring buffers against minority stress for transgender individuals". Psychology of Sexual Orientation and Gender Diversity. 2 (3): 253–265. doi:10.1037/sgd0000117.
  16. ↑ Lombardi, Emilia (2007). "Public Health and Trans-People: Barriers to Care and Strategies to Improve Treatment". The Health of Sexual Minorities. Springer, Boston, MA. pp. 638–652. doi:10.1007/978-0-387-31334-4_26. ISBN 9780387288710. Search this book on
  17. ↑ Bradford, Judith; Reisner, Sari L.; Honnold, Julie A.; Xavier, Jessica (2012-11-15). "Experiences of Transgender-Related Discrimination and Implications for Health: Results From the Virginia Transgender Health Initiative Study". American Journal of Public Health. 103 (10): 1820–1829. doi:10.2105/ajph.2012.300796. ISSN 0090-0036. PMC 3780721. PMID 23153142.
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 Bockting, Walter O.; Miner, Michael H.; Swinburne Romine, Rebecca E.; Hamilton, Autumn; Coleman, Eli (2013-03-14). "Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population". American Journal of Public Health. 103 (5): 943–951. doi:10.2105/ajph.2013.301241. ISSN 0090-0036. PMC 3698807. PMID 23488522.
  19. ↑ Logie, Carmen H.; Newman, Peter A.; Chakrapani, Venkatesan; Shunmugam, Murali (2012). "Adapting the minority stress model: Associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India". Social Science & Medicine. 74 (8): 1261–1268. doi:10.1016/j.socscimed.2012.01.008. PMID 22401646.
  20. ↑ McCarthy, Molly A.; Fisher, Christopher M.; Irwin, Jay A.; Coleman, Jason D.; Pelster, Aja D. Kneip (2014-10-02). "Using the Minority Stress Model to Understand Depression in Lesbian, Gay, Bisexual, and Transgender Individuals in Nebraska". Journal of Gay & Lesbian Mental Health. 18 (4): 346–360. doi:10.1080/19359705.2014.908445. ISSN 1935-9705.
  21. ↑ "Violence Against the Transgender Community in 2017". Human Rights Campaign. Retrieved October 24, 2017.
  22. ↑ 22.0 22.1 "Gendered Restrooms and Minority Stress: The Public Regulation of Gender and its Impact on Transgender People's Lives - Williams Institute". Williams Institute. 2013-06-03. Retrieved 2017-11-20.
  23. ↑ 23.0 23.1 23.2 Reisner, Sari L.; Greytak, Emily A.; Parsons, Jeffrey T.; Ybarra, Michele L. (2015-03-24). "Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity". The Journal of Sex Research. 52 (3): 243–256. doi:10.1080/00224499.2014.886321. ISSN 0022-4499. PMC 4201643. PMID 24742006.
  24. ↑ Goldbach, Jeremy T.; Tanner-Smith, Emily E.; Bagwell, Meredith; Dunlap, Shannon (2014-06-01). "Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis". Prevention Science. 15 (3): 350–363. doi:10.1007/s11121-013-0393-7. ISSN 1389-4986. PMID 23605479.
  25. ↑ 25.0 25.1 25.2 Cohen-Kettenis, Peggy T.; Schagen, Sebastiaan E. E.; Steensma, Thomas D.; Vries, Annelou L. C. de; Waal, Henriette A. Delemarre-van de (2011-08-01). "Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up". Archives of Sexual Behavior. 40 (4): 843–847. doi:10.1007/s10508-011-9758-9. ISSN 0004-0002. PMC 3114100. PMID 21503817.
  26. ↑ Hendricks, M.; Testa, R. (2012). "A conceptual framework for clinical work with transgender and gender nonconforming clients". Professional Psychology: Research and Practice. 43: 460–467.
  27. ↑ Croteau, J. M. (1996). Research on the work experience of lesbian, gay, and bisexual people: an integrative review of methodology and findings. Journal of Vocational Behavior, 48, 195-209.
  28. ↑ 28.0 28.1 D’Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual/gender orientation, victimization, and mental health among lesbian, gay, bisexual and transgender older adults. Journal of Interpersonal Violence, 16, 1008-1027.
  29. ↑ Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133, 328-345.
  30. ↑ Smart, L., & Wegner, D. M. (1999). Covering up what can’t be seen: Concealable stigma and mental control. Journal of Personality and Social Psychology, 77, 474-486.
  31. ↑ Bucci, W. (1995). The power of the narrative: A multiple code account. In Pennebaker, J. W. (Ed.) Emotion, disclosure, & health. American Psychological Association, Washington, DC, pp. 93-122.
  32. ↑ Frable, D. E. S., Platt, L., & Hoey, S. (1998). Concealable stigmas and positive self-perceptions: feeling better around similar others. Journal of Personality and Social Psychology, 74, 909-922.
  33. ↑ Maylon, A. (1982). Psychotherapeutic implications of internalized homophobia in gay men. In Gonsiorek, J. (Ed.) Homosexuality and psychotherapy: A practitioner’s handbook of affirmative models. New York: Haworth Press, pp. 59-70.
  34. ↑ Smith, J. (1980). Ego-dystonic homosexuality. Comprehensive Psychology, 21, 119-127.
  35. ↑ Feinstein, Brian A., Marvin R. Goldfried, and Joanne Davila. "The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms." Journal of Consulting and Clinical Psychology 80.5 (2012): 917-927.
  36. ↑ Pachankis, J.E., Goldfried, M.R., & Ramrattan, M. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76, 306-317.
  37. ↑ McLemore, Kevin A. (2016). "A Minority Stress Perspective on Transgender Individuals' Experiences With Misgendering". Stigma and Health. 3: 53–64. doi:10.1037/sah0000070.
  38. ↑ Puckett, Jae A.; Maroney, Meredith R.; Levitt, Heidi M.; Horne, Sharon G. (2016). "Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men". Psychology of Sexual Orientation and Gender Diversity. 3 (4): 489–498. doi:10.1037/sgd0000201.
  39. ↑ Puckett, Jae A.; Maroney, Meredith R.; Levitt, Heidi M.; Horne, Sharon G. (2016). "Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men". Psychology of Sexual Orientation and Gender Diversity. 3 (4): 489–498. doi:10.1037/sgd0000201.
  40. ↑ Bockting, Walter O.; Miner, Michael H.; Swinburne Romine, Rebecca E.; Hamilton, Autumn; Coleman, Eli (May 2013). "Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population". American Journal of Public Health. 103 (5): 943–951. doi:10.2105/AJPH.2013.301241. PMC 3698807. PMID 23488522.
  41. ↑ Testa, R.J.; Michaels, M.S.; Bliss, W.; Rogers, M.L.; Balsam, K.F.; Joiner, R. "Suicidal Ideation in Transgender People: Gender Minority Stress and Interpersonal Theory Factors". Journal of Abnormal Psychology. 126 (1): 125–136.
  42. ↑ Reisner, Sari L.; Greytak, Emily A.; Parsons, Jeffrey T.; Ybarra, Michele L. (24 March 2015). "Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity". The Journal of Sex Research. 52 (3): 243–256. doi:10.1080/00224499.2014.886321. ISSN 0022-4499. PMC 4201643. PMID 24742006.
  43. ↑ Gonzalez, Cesar A.; Gallego, Joseph D.; Bockting, Walter O. (1 August 2017). "Demographic Characteristics, Components of Sexuality and Gender, and Minority Stress and Their Associations to Excessive Alcohol, Cannabis, and Illicit (Noncannabis) Drug Use Among a Large Sample of Transgender People in the United States". The Journal of Primary Prevention. 38 (4): 419–445. doi:10.1007/s10935-017-0469-4. PMC 5516932. PMID 28405831.
  44. ↑ Arayasirikul, Sean; Wilson, Erin C.; Raymond, Henry F. (20 February 2017). "Examining the Effects of Transphobic Discrimination and Race on HIV Risk Among Transwomen in San Francisco". AIDS and Behavior. 21 (9): 2628–2633. doi:10.1007/s10461-017-1728-3. PMC 5563490. PMID 28220311.
  45. ↑ Reisner, Sari L.; Greytak, Emily A.; Parsons, Jeffrey T.; Ybarra, Michele L. (24 March 2015). "Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity". The Journal of Sex Research. 52 (3): 243–256. doi:10.1080/00224499.2014.886321. ISSN 0022-4499. PMC 4201643. PMID 24742006.
  46. ↑ Meyer, Ilan H. (2015). "Resilience in the study of minority stress and health of sexual and gender minorities". Psychology of Sexual Orientation and Gender Diversity. 2 (3): 209–213. doi:10.1037/sgd0000132.
  47. ↑ 47.0 47.1 47.2 Budge, S.; Adelson, J.; Howard, K. (2013). "Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping". Journal of Consulting and Clinical Psychology. 81: 545–557.
  48. ↑ 48.0 48.1 48.2 48.3 Singh, Anneliese A.; Hays, Danica G.; Watson, Laurel S. (2011-01-01). "Strength in the Face of Adversity: Resilience Strategies of Transgender Individuals". Journal of Counseling & Development. 89 (1): 20–27. doi:10.1002/j.1556-6678.2011.tb00057.x. ISSN 1556-6676.
  49. ↑ 49.0 49.1 49.2 49.3 Bockting, W.; Miner, M.; Swinburn Romine, R.; Hamilton, A.; Coleman, E. (2013). "Stigma, mental health, and resilience in an online sample of the US transgender population". American Journal of Public Health: e1–e8.
  50. ↑ Russell, Stephen T.; Fish, Jessica N. (28 March 2016). "Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth". Annual Review of Clinical Psychology. 12: 465–487. doi:10.1146/annurev-clinpsy-021815-093153. PMC 4887282. PMID 26772206.
  51. ↑ Scandurra, Cristiano; Amodeo, Anna Lisa; Valerio, Paolo; Bochicchio, Vincenzo; Frost, David M. (2017-09-01). "Minority Stress, Resilience, and Mental Health: A Study of Italian Transgender People". Journal of Social Issues. 73 (3): 563–585. doi:10.1111/josi.12232. ISSN 1540-4560.
  52. ↑ Testa, Rylan J.; Habarth, Janice; Peta, Jayme; Balsam, Kimberly; Bockting, Walter (2015). "Development of the Gender Minority Stress and Resilience Measure". Psychology of Sexual Orientation and Gender Diversity. 2 (1): 65–77. doi:10.1037/sgd0000081.


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