TESTING THE MODERATING ROLE OF COLLECTIVE IDENTITY IN THE LINK OF HETEROSEXIST DISCRIMINATION WITH MENTAL HEALTH By BRANDON LOUIS VELEZ A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIA L FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2014
2014 Brandon Louis Velez
To Lirio, Bonnie, and Nancy.
4 ACKNOWLEDGMENTS I thank my adviser, Bonnie Moradi, for her unwavering belief in my potential. I thank my family for their constant support. Finally, I thank my friends for all the laughs, hugs, and incredible memories.
5 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ . 4 LIST OF TABLES ................................ ................................ ................................ ........... 7 LIST OF FIGURES ................................ ................................ ................................ ........ 8 ABSTRACT ................................ ................................ ................................ .................... 9 CHAPTER 1 REVIEW OF THE LITERATURE ................................ ................................ ........... 11 Heterosexist Discrimination and Outcomes ................................ ........................... 13 Collective Identity ................................ ................................ ................................ .. 18 Collec tive Identity as a Moderator of the Link of Discrimination with Mental Health ................................ ................................ ................................ ................. 19 Identity Prominence ................................ ................................ ........................ 19 Identity Valence ................................ ................................ ............................... 22 Identity Integration ................................ ................................ ........................... 26 Behavioral Involvement ................................ ................................ ................... 29 The Proposed Study ................................ ................................ .............................. 30 2 METHODS ................................ ................................ ................................ ............ 32 Participants ................................ ................................ ................................ ............ 32 Procedures ................................ ................................ ................................ ............ 33 Instruments ................................ ................................ ................................ ............ 35 Predictor Variable ................................ ................................ ............................ 35 Moderator Variables ................................ ................................ ........................ 36 Criterion Variables ................................ ................................ ........................... 40 3 RESULTS ................................ ................................ ................................ .............. 43 Preliminary Analyses ................................ ................................ ............................. 43 Factor Structure and Validity of the SIIS ................................ .......................... 43 Distinctiveness of Positive and Negative Regard ................................ ............. 44 Primary An alyses ................................ ................................ ................................ ... 45 Relations of Discrimination and Collective Identity with Mental Health ............ 45 Moderating Role of Collective Identity in Disc rimination Mental Health Link .... 48 4 DISCUSSION ................................ ................................ ................................ ........ 55 Limitations ................................ ................................ ................................ ............. 63 Imp lications for Future Research and Practice ................................ ...................... 65
6 Summary ................................ ................................ ................................ ............... 69 APPENDIX A HETEROSEXIST HARASSMENT, REJECTION, AND DISCRIMINATION SCALE ................................ ................................ ................................ .................. 71 B COLLECTIVE SELF ESTEEM SCALE ................................ ................................ .. 73 C INTERNALIZED HOMONEGATIVITY SCALE ................................ ....................... 74 D STIGMA CONSCIOUSNESS QUESTIONNAIRE ................................ .................. 75 E SEXUAL IDENTITY INTEGRATION SCALE ................................ ......................... 76 F INVOLVEMENT IN SEXUAL MINORITY ACTIVITIES SCALE .............................. 77 G HOPKINS SYMPTOM CHECKLIST 21 ................................ ................................ . 78 H PSYCHOLOGICAL WELL BEING SCALE ................................ ............................. 79 LIST OF REFERENCES ................................ ................................ .............................. 80 BIOGRAPHICAL SKETCH ................................ ................................ ........................... 93
7 LIST OF TABLES Table page 3 1 Principle axis factor analysis of Sexual Identity Integration Scale items using promax rotation ................................ ................................ ................................ . 50 3 2 Principle axis factor analysis of Sexual Identity Conflict Scale items using promax rot ation ................................ ................................ ................................ . 50 3 3 Correlations and Descriptive Statistics for Variables of Interest ......................... 51 3 4 Unique Relations of Discrimination and Colle ctive Identity with Mental Health .. 52 3 5 Multiplicative Relations of Predictors with Mental Health Indicators ................... 53
8 LIST OF FIGURES Figure page 3 1 Heterosexist discrimination by private regard interaction for psychological distress. ................................ ................................ ................................ ............. 54
9 Abstract of Dissertation Presented to the Graduate School of the Univer sity of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy TESTING THE MODERATING ROLE OF COLLECTIVE IDENTITY IN THE LINK OF HETEROSEXIST DISCRIMINATION WITH MENTAL HEALTH By Brandon Louis Velez Augu st 2014 Chair: Bonnie Moradi Major: Counseling Psychology Synthesizing the literature on minority stress theory Meyer, 2003 and collective identity (Ashmore, Deaux, & McLaughlin Volpe, 2004 , the present study tested five aspects of collective identity (identity prominence, private regard, public regard, identity integration, and behavioral involvement) as moderators of the links of heterosexist discrimination with psychological distress and psychological well being. The sample consisted of 517 sexual m inority individuals who ranged in age from 18 to 77 M = 31.47, SD = 12.98, Mdn = 26.00). It was hypothesized that greater discrimination and lower private regard, public regard, and identity integration would be related to poorer mental health (i.e., high er psychological distress and lower psychological well being). In addition, it was hypothesized that identity prominence would strengthen whereas private regard, identity integration, and behavioral involvement would weaken the association of discriminatio n with poorer mental health. The moderating effect of public regard in the discrimination mental health link was examined exploratorily given prior mixed findings. Bivariate correlations and results of regression analyses largely supported the predicted li nks of discrimination and collective identity with mental health. In addition, there was a
10 significant discrimination by private regard interaction in relation to psychological distress. Specifically, at low levels of discrimination, higher provide regard was associated with lower psychological distress, but the mental health benefit of higher private regard diminished as levels of discrimination increased. No other interactions were significant. These findings underscore the importance of developing interv entions that target both individual factors (e.g., collective identity) and contextual factors (e.g., discrimination) when working to enhance the mental health of sexual minority people.
11 CHAPTER 1 REVIEW OF THE LITERATURE Minority stress theory Meyer, 2003) postulates that the stigma, prejudice, and discrimination to which sexual minority people (e.g., lesbian, gay, bisexual, transgender, queer) are exposed are stressors that contribute to mental health concerns in this population. Building on prior wor k (e.g., Brooks, 1981; DiPlacido, 1998; Meyer, 1995), Meyer (2003) described four types of minority stressors which may impact sexual minority people: perceived heterosexist discrimination, expectations of stigma or rejection, internalized homophobia/heter osexism, and concealment of identity. Perceived discrimination is conceptualized as stressful events (e.g., harassment, rejection, differential treatment) that are external to the individual. Other scholars have called perceived discrimination enacted stig ma that is, behavioral manifestations of prejudice toward sexual minority people (e.g., Herek, 2009). Similarly, expectations of heterosexist attitudes or behavior heterosexist prejudice. Finally, concealment of sexual minority identity from others may be an attempt to reduce exposu re to discrimination (Anderson, Croteau, Chung & Grossman, 2001). Regardless of these potential roots, the onus of continued self ntity is thought to be psychologically taxing (Meyer, 2003). Researchers have tested the links of these sources of minority stress with various psychosocial, health, and vocational outcomes with samples of sexual minority
12 people (e.g., Lewis, Derlega, Cla rke, & Huang, 2006; Hatzenbuehler, Nolen Hoeksema, & Erickson, 2008; Szymanski, Kashubeck West, & Meyer, 2008; Waldo, 1999). However, perceived discrimination is notable in that it has also been researched in reference to other societally marginalized gro ups particularly women and racial/ethnic minority people (e..g., Klonoff, Landrine, & Campbell, 2000; Landrine, Klonoff, Corral, Fernandez, & Roesch, 2006; Moradi & Hasan, 2004; Moradi & Risco, 2006). In addition, prior research with women and racial/ethni c minority individuals has tested the ability of aspects of collective identity to moderate the links of discrimination with psychosocial outcomes (e.g., Liang & Fassinger, 2008; McCoy & Major, 2003; Sellers, Caldwell, Schmeelk Cone, & 2003; Sellers, Copel and Linder, Martin, & Lewis, 2006). Thus, focusing on discrimination provides the opportunity to integrate theory and research regarding perceived discrimination and collective identity across marginalized populations with the already growing body of liter ature exploring the role of heterosexist discrimination in the mental health of sexual minority individuals. Such integration is particularly useful given that the roles of dimensions of collective identity and group level coping are posited in minority s tress theory Meyer, 2003), but have not received substantial empirical attention. Specifically, Meyer (2003) proposed that multiple aspects of collective identity (prominence, valence, and integration) and group level coping (sometimes operationalized as behavioral involvement, another dimension of collective identity) may exacerbate or attenuate the impact of minority stress on mental health. However, to date no study has tested the moderating roles of multiple dimensions of collective identity in the dis crimination mental health association with a sample of sexual minority people. In order to better
13 understand factors which may weaken or strengthen the links of discrimination with negative and positive mental health outcomes, the present study will test d imensions of collective identity as moderators of these relations. Heterosexist Discrimination and Outcomes Data from national surveys suggest that attitudes toward sexual minority people in the United States have become less negative over the past two dec ades (e.g., Herek, 2009). However, a meta analysis of 386 studies conducted between 1992 and 2009 that examined the victimization experiences (situations in which harm individuals are harmed by others who violate social norms) of sexual minority people yie lded evidence that this population is still exposed to substantial levels of harassment, assault, abuse, and discrimination (Katz Wise & Hyde, 2012). For example, an analysis of studies with samples from the United States indicated that 56% of participants had experienced verbal harassment, 44% had experienced general discrimination, 32% had experienced harassment or bullying in school, 28% had experienced physical assault, and 24% had experienced discrimination in the workplace (Katz Wise & Hyde, 2012). In addition, relative to heterosexual people, sexual minority individuals reported greater rates of 11 of the 13 forms of victimization examined in the study (significant d s ranged from .11 to .76). Importantly, the effect size for the difference in rates of general discrimination between sexual minority and heterosexual individuals was near the high end of this range d = .53). The remarkably high rates of discrimination reported by sexual minority individuals are important because a growing body of resear ch suggests that sexual minority populations are at higher risk for a range of mental health concerns and that perceived heterosexist discrimination is linked with such disparities (e.g., Herek, Gillis, &
14 Cogan, 1999; Huebner & Davis, 2007; Huebner, Nemero ff, & Davis, 2005; Mays & Cochran, 2001; Meyer, 1995; Szymanski, 2006). For example, a meta analysis of studies that compared the lifetime prevalence of psychiatric disorders among lesbian, gay, and bisexual (LGB) individuals with heterosexual individuals using random sampling procedures demonstrated that LGB people had significantly higher rates of mood, anxiety, and substance use disorders Meyer, 2003). In a meta analysis of studies comparing suicidality among sexual minority and heterosexual youth, Mars hall and colleagues (2011) found that sexual minority youth had higher rates of suicidality than heterosexual youth, and the magnitude of this difference increased with the severity of suicidality [e.g., odds ratio OR) = 1.96 for ideation, OR = 4.17 for s uicide attempts requiring medical attention]. Notably, Mays and Cochran (2001) found that differences between LGB and heterosexual people in prior year prevalence of psychiatric disorders (mood, anxiety, and substance use), current mental health, and psych ological distress were attenuated after controlling for perceived discrimination (Mays & Cochran, 2001). Thus, the poorer mental health outcomes among LGB people relative to heterosexual people may have been due, in part, to the greater levels of discrimin ation reported by LGB people. Within group studies of sexual minority populations have also yielded evidence supporting the links of heterosexist discrimination with a variety of outcomes. In one cross sectional study, recent sexual orientation based hat e crime victimization was associated with significantly higher levels of depression, traumatic stress, anxiety, and anger among lesbian women and gay men (Herek, Gillis, & Cogan, 1999). More general experiences of heterosexist discrimination have yielded s ignificant links with indicators
15 of poor mental health such as psychological distress, depression, general anxiety, social anxiety, substance use, and post traumatic stress disorder in cross sectional studies of sexual minority people (e.g., Burns, Kamen, Lehman, & Beach, 2012; Lehavot & Simoni, 2011; Meyer, 1995; Szymanski, 2006; Szymanski & Balsam, 2011). Notably, in a sample of sexual minority men, the positive link of discrimination with symptoms of depression remained significant even after controlling for potentially confounding personality variables such as neuroticism and hostility (Huebner, Nemeroff, & Davis, 2005). Moreover, in a sample of bisexual individuals, anti bisexual discrimination from heterosexual people and LG people were both associated with psychological distress, although only discrimination from heterosexual individuals yielded significant unique links with distress after controlling for impression management, expectations of rejection based on sexual orientation, concealment of sexua l orientation, and internalized biphobia (Brewster & Moradi, 2010). Nonetheless, these results suggest that sexual orientation based discrimination from a variety of sources may be associated with adverse mental health. Heterosexist discrimination has als o yielded significant associations with physical health indicators. In one study of physical health outcomes among gay and bisexual men, heterosexist discrimination was associated with the number of days missed from work due to sickness (Huebner & Davis, 2 007). In addition, education level interacted with discrimination such that for highly educated individuals, higher discrimination was associated with more physician visits and more nonprescription medication use, whereas for individuals with less educatio n, physician visits and nonprescription medication use were highest at low and high levels of discrimination (Huebner & Davis,
16 2007). Heterosexist discrimination was also negatively associated with self reported physical health and satisfaction with physi cal health in a sample of sexual minority employees Waldo, 1999). Furthermore, in a representative sample of people living in the Netherlands, heterosexist discrimination was positively associated with sexual d for sexual healthcare, even after controlling for relationship status and number of sexual partners (Kuyper & Vanwesenbeeck, 2011). With regard to educational outcomes, in a racially and ethnically diverse sample of sexual minority youth, homophobic bull ying yielded significant negative links with sense of school belonging, grades, and perceived importance of graduating and yielded a significant positive link with truancy Poteat, Mereish, DiGiovanni, & Koenig, 2011). In addition, in a sample of sexual mi nority college students, heterosexist discrimination was negatively associated with adjustment to college (Schmidt, Miles, & Welsch, 2011). Also, discrimination interacted with perceived social support to predict career indecision such that individuals who experienced high levels of discrimination and low levels of social support had the highest levels of career indecision (Schmidt et al., 2011). Results are similar for vocational outcomes among sexual minority employees. Workplace heterosexist discriminati on has yielded negative links with job satisfaction, perceived fit intentions to quit (e.g., Lyons, Brenner, & Fassinger, 2005; Ragins & Cornwell, 2001; Smith & Ingram, 20 04; Velez & Moradi, 2012; Waldo, 1999). Interpersonal functioning appears to be another important correlate of heterosexist discrimination. In a sample of older (55 85 years) Dutch sexual minority
17 people, heterosexist discrimination was associated with lo neliness, even after controlling for relationship status, physical health, self esteem, and number of LGB people in their social network (Kuyper & Fokkema, 2010). In a sample of sexual minority women, heterosexist discrimination yielded a negative associat ion with perceived social support (Lehavot & Simoni, 2011). With regard to relationship functioning, lifetime heterosexist discrimination yielded significant positive associations with lifetime intimate partner violence perpetration and victimization in a sample of sexual minority women (Balsam & Szymanski, 2005). In a sample of gay men, the first order association of heterosexist discrimination with relationship satisfaction was nonsignificant (Kamens, Burns, & Beach, 2011). However, heterosexist discrimin ation interacted with relational trust such that discrimination yielded a significant negative link with relationship satisfaction when participants had low levels of trust in their partners (Kamen et al., 2011). Although the preceding review has document ed the association of heterosexist discrimination with a variety of outcomes, one area that has received relatively less attention is psychological well being or positive mental health outcomes. Counseling psychologists have called for increased emphasis o n human strengths and positive life outcomes in research in general (e.g., Lopez et al., 2006) and with research focused on the experiences of minority populations in particular (Goodman et al., 2004). Some prior research has examined the links of heterose xist discrimination with aspects of psychological well being. For instance, heterosexist discrimination has been linked with lower self esteem defined as positive affect toward and acceptance of oneself (Rosenberg, 1965 in several studies with sexual mino rity individuals (e.g., Kuyper &
18 Fokkema, 2010; Huebner, Rebchook, & Kegeles, 2004; Szymanski, 2009; Szymanski & Balsam, 2011; Waldo, 1999). In addition, Waldo (1999) found a negative association of workplace heterosexist discrimination with life satisfact ion, which has been defined as cognitive appraisal of well being (Pavot & Diener, 1993). However, less empirical attention has been devoted to examining the links of heterosexist discrimination with other aspects of psychological well being, such as positi ve affect, positive relations with others, autonomy, environmental mastery, purpose in life, or personal growth (e.g., Diener & Emmons, 1984; Ryff, 1989). Collective Identity Social identity theory (e.g., Tajfel, 1978, 1981) postulates that identity may be divided into two aspects: personal and social. Personal identity derives from characteristics particular to the individual, such as sociability or competence. In concept which derive s from his sic ) knowledge of his sic ) membership of a social group together with the Social identity theory also holds that individuals are naturally motivated to mainta in a positive self image, which involves maintaining a positive image of the groups to which they belong (Tajfel & Turner, 1986). In their review and consolidation of the literature on social identity, Ashmore, Deaux, and McClaughlin Volpe (2004) use the t erm collective identity in order to separate the concept from particular theoretical assumptions, such as the ingroup versus outgroup comparison process that is fundamental to social identity theory (Tajfel, 1978, 1981). Ashmore and colleagues (2004) argue that collective identity is a multidimensional concept involving, for instance, a belief in categorical group membership (categorization); endorsement of stereotypes thought to
19 itions in group specific practices (behavioral involvement). Notably, Meyer (2003) suggests that characteristics of minority identity may be related to mental health directly or via their interactions with minority stressors such as discrimination. Although, as previously discussed, there are numerous dimensions of collective identity, Meyer (2003) specifically postulates that prominence, valence, and integration may moderate the links of minority stressors with mental health outcomes. Thus, subsequent sections focus on prior research with these constructs. In addition, Meyer (2003) suggests that group level coping may also buffer the association of discrimination with mental health outcomes. Individuals from minority groups engage in group enhancing attitudes, level coping among sexual minorit y people has been operationalized with another dimension of collective identity, behavioral involvement. Thus, behavioral involvement will also be examined as a moderator of the discrimination mental health link. Collective Identity as a Moderator of the L ink of Discrimination with Mental Health Identity Prominence acknowledgment of the centrality of identities to their overall self concepts (Ashmore et al., 2004). Scholars operati ng from a social identity theoretical perspective have hypothesized that encountering discrimination may motivate minority individuals to become more identified with their group in order to increase access to positive group information, which may buffer th e effects of subsequent discrimination (e.g.,
20 Branscombe, Schmidt, & Harvey, 1999). Conversely, others have argued that identity more an individual identifies with, is com mitted to, or has developed self schemas in a (Thoits, 1999, p. 352). Thus, discrimination experienced due to a more prominent identity may be perceived as more hurtf ul. With regard to the direct link of identity prominence with mental health, with two samples of sexual minority people, Mohr and Kendra (2011) found that identity prominence was unrelated to life satisfaction, depression, and negative affect; it also yie lded a significant positive correlation with self assurance (feeling proud, strong, confident, and bold) in one sample (but not the other), and a significant negative correlation with interpersonal self esteem in one sample (but not the other). Thus, the l ink between prominence and mental health variables was nonsignificant or inconsistent across samples in this study. Empirical tests of the moderating role of identity prominence in the associations of discrimination with mental health outcomes across popu lations have yielded mixed results. In the only study that has examined identity prominence as a moderator of the discrimination mental health link with a sample of sexual minority people, higher identity prominence strengthened the prospective links of da discrimination, e.g., exposure to jokes or stereotypes, exclusion from conversations) with daily changes in depressed mood and self esteem (Swim, Johnston, & Pearson, 2009). However, the generalizability of these findin gs to more severe forms of discrimination (e.g., verbal or physical harassment) is unclear. Similarly, McCoy and Major (Study 1; 2003) found that pretest identity prominence was positively associated
21 with negative affect and negatively associated with self esteem for female European American college students experimentally exposed to a sexist evaluation. However, identity prominence was unrelated to negative affect and positively related to self esteem in a control condition. Also, in a sample of Latino Ame rican college students, pretest identity prominence was positively related to subsequent negative affect after reading a story about prejudice and discrimination against Latino American college students (Study 2; McCoy & Major, 2003). However, in the same study, for participants who read a story about prejudice and discrimination against Inuit people in Canada, pretest identity prominence was negatively related to subsequent negative affect. Thus, exacerbated the negative effect of discrimination on mental health. In addition, in a sample of African American doctoral students and doctoral graduates, identity prominence exacerbated the associations of daily racist discrimination with subsequent days affect and depression (Burrow & Ong, 2010). In contrast, in a sample of African American first year college students, identity prominence buffered the prospective link of racist discrimination experienced during their first semester with anxiety and depression at the end of their second semester (Neblett, Shelton, & Sellers, 2004). However, in a sample of African American young adults, the cross sectional associations of racist discrimination with depression, perceived stress, and we ll being were not significantly moderated by identity prominence (Sellers et al., 2006). Also, identity prominence did not moderate the cross sectional associations of racist discrimination with career problems, self esteem, and interpersonal difficulties in a sample of Asian American college students (Liang & Fassinger, 2008). Thus, across
22 these studies, identity prominence has been found to exacerbate, buffer, or not moderate the links of racist or sexist discrimination with various indicators of psychoso cial functioning. However, relatively stronger support for the exacerbating role of identity prominence was found when longitudinal or experimental rather than cross sectional designs were used. Identity Valence Identity valence (also referred to as eval uation or regard) is the second dimension of collective identity postulated by Meyer (2003) to moderate the discrimination mental health link. Valence refers to positive or negative attitudes toward an identity (Ashmore et al., 2004). Notably, developing l ess negative and more positive Cass, 1979, 1984; Troiden, 1989). Although Meyer (2003) specifically refers to sexual dentities, it is possible that another form of identity valence may also be important to consider. Specifically, Ashmore and colleagues (2004) divide valence into private and public regard. Private regard refers to dentities (as per Meyer, 2003), whereas public Another layer of complexity is that valence has been assessed in both positive and negative terms. Interestingly, in the cas e of sexual minority people, internalized heterosexism (a proximal stressor in minority stress theory [Meyer, 2003]) can be conceptualized as a form of negative private regard. Similarly, expectations of stigma (also a proximal stressor in minority stress theory) and similar constructs such as stigma consciousness (Pinel, 1999) and rejection sensitivity (e.g., Mendoza Denton, Downey, Purdie, Davis, & Pietrzak, 2002; Pachankis, Goldfried, & Ramrattan, 2008) can be
23 conceptualized as forms of negative public r egard. With regard to the relation of positive sexual minority identity (i.e., positive private regard) was highly negatively correlated with internalized heterosexism (i.e ., negative private regard) in two samples of sexual minority people r = .60 and .63). Instruments assessing positive and negative public regard have yielded similar correlations with one another (Brewster & Moradi, 2010). The magnitudes of these correl ations suggest that positive and negative regard are highly overlapping but potentially non redundant constructs. This is consistent with research in positive psychology that suggests that positive and negative constructs (e.g., affect) may be related but distinctive (e.g., Watson, Clark, & Tellegen, 1988). Positive private and public regard have demonstrated links with better mental health, whereas negative private and public regard have yielded links with poorer mental health in samples of sexual minority people Brewster & Moradi, 2010; Lewis, Derlega, Clarke, & Kuang, 2006; Mohr & Kendra, 2011. Empirical tests of the moderating effects of valence on the discrimination mental health link in samples of people with marginalized identities have yielded mix ed results. Fingerhut, Peplau, and Gable (2010) found that a measure that assessed both positive private regard and a sense of belonging in the LGB community did not moderate the link of heterosexist discrimination with depression in a sample of sexual min ority people. However, no study of sexual minority individuals could be identified that tested this moderation effect with a pure measure of positive private regard. In cross sectional, longitudinal, and experimental studies with samples of female European American women and racial/ethnic minority individuals, positive private regard did not moderate
24 the relations of sexist or racist discrimination with psychosocial outcomes (e.g., Burrow & Ong, 2010; Liang & Fassinger, 2008; McCoy & Major, 2003; Sellers et al., 2003; Sellers et al., 2006). However, in a large N = 881) cross sectional study of Mexican American adolescents, positive private regard buffered the links of racist discrimination with self esteem (Romero & Roberts, 2003). In another cross sectiona l study, positive private regard buffered the association of peer racist discrimination with depression for African American adolescents n = 119), but not for Chinese American adolescents n = 84; Rivas Drake, Hughes, & Way, 2008). Thus, most studies iden tified have not found support for the moderating role of positive private regard, but two cross sectional studies with varying sample sizes have found that positive private regard buffered the links of racist discrimination on mental health for some groups of racial/ethnic minority adolescents. This may indicate that positive private regard is a more effective psychological resource for some minority and age groups than others. With regard to negative private regard, Meyer (1995) hypothesized that internali zed heterosexism minority identity would exacerbate the impact of discrimination on mental health because it may predispose individuals to self blaming attributions. That is, sexual minority indi viduals with high levels of internalized heterosexism may blame themselves for their experiences of discrimination, which makes the discrimination more impactful. Consistent with prediction, Meyer (1995) found that the links of heterosexist discrimination with some aspects of psychological distress (demoralization and guilt, but not sexual problems, suicidal ideation/behavior, and AIDS related traumatic stress) were stronger for those with higher levels of internalized heterosexism in a large sample
25 N = 74 1) of sexual minority men. Another study N = 326) found that internalized heterosexism strengthened the relation of workplace heterosexist discrimination with psychological distress among sexual minority women but not sexual minority men (Velez, Moradi, & Brewster, 2013). However, internalized heterosexism did not moderate the association of heterosexist discrimination with psychological distress in a modest sample N = 143) of sexual minority women (Szymanski, 2006). Notably, across studies with sexual mi nority samples, measurement of heterosexist discrimination, internalized heterosexism, and psychological distress varied from single items to multidimensional scales. In a sample of African American women, internalized racism (i.e., negative private regard of an African American identity) moderated the association of racist discrimination with psychological distress (Szymanski & Stewart, 2010). Specifically, psychological distress was higher at greater levels of internalized racism than at lower levels when racist discrimination was low, but this buffering effect gradually decreased as discrimination increased (Szymanski & Stewart, 2010). In contrast, with the same sample, internalized sexism (i.e., negative valence of a female identity) did not moderate the link of sexist discrimination with psychological distress. However, with a sample of predominantly European American women, internalized sexism exacerbated the association of discrimination with psychological distress (Szymanski, Gupta, Carr, & Stewart, 2 009). In sum, with regard to the exacerbating role of negative private regard for sexual minority people, disparate results may be due to variations in sample size and power to detect significant interactions and measurement of key constructs. With regard to other groups, there is some evidence that negative private regard exacerbates the discrimination mental health link, although for people
26 with multiple marginalized identities (e.g., African American women) negative private regard toward one identity may make one more susceptible to discrimination than negative private regard toward another identity. No studies have examined positive or negative public regard as moderators of the discrimination mental health link with sexual minority people. Results are mixed with regard to the role of positive public regard as a moderator in research with other groups. In two samples of African American adolescents, positive public regard exacerbated the links of racist discrimination with depression and stress (Rivas D rake et al., 2008; Sellers et al., 2006). In contrast, positive public regard buffered the link of racist discrimination with depression in a sample of Chinese American adolescents (Rivas Drake et al., 2008). In yet other studies, positive public regard di d not moderate the links of racist discrimination with psychosocial outcomes in samples of Asian American college students and African American doctoral students and graduates (Burrow & Ong, 2010; Liang & Fassinger, 2008). Thus, the moderating effect of po sitive public regard may vary according to minority and age group. With regard to negative public regard, higher race related rejection sensitivity did not significantly moderate the associations of racist discrimination with depression, psychological dist ress, self esteem, and physical health in a sample of Latina/o, Asian, and European American adolescents Huynh & Fuligni, 2010). However, the generalizability of these findings to sexual minority people is unclear. Identity Integration The next construct proposed as a moderator by Meyer (2003) is identity identity synthesis is characterized in part by integration of a sexual minority identity
27 with all other aspects of i concepts (e.g., gender, race/ethnicity, religion). Thus, higher identity integration is theorized to be related to better health outcomes. Stirratt, Meyer, Ouellette, and Gara (2008) empirically assessed identity integration with a sample of sexual minority people using an approach called Hierarchical Classes Analyses (HICLAS). HICLAS requires participants to list their various identities and describe characteristics they associate with each of them. Subsequently, researchers describe relat Notably, this complex methodological approach assesses an aspect of collective identity called implicit importance, the unconscious hierarchical organization (from low to high impo colleagues (2004) suggest that identity prominence (i.e., explicit importance) and implicit importance are positively related, but that this relation is likely modest. However, Stirratt and colleagues (2008) found that the correlation of sexual orientation identity integration with identity prominence was positive and nonsignificant. Moreover, identity integration did not yield significant relations with psychological well being (Stirratt et al., 2008). In addition, identity integration was not tested as a moderator of the discrimination mental health link. Scholars have used different approaches to assess integration of race, ethnicity, and culture. Benet Martinez and Haritatos 2005) developed the Bicultural Identity Scale the values and norms of their cultures are in conflict (Conflict) and 2) their cultures are separate from one another (Dist ance). Higher scores on these two subscales indicate lower bicultural identity integration. In a sample of racial/ethnic minority college
28 students, Conflict and Distance were negatively correlated with life satisfaction and Conflict was positively correlat ed with depression (David, Okazaki, & Saw, 2009). Notably, researchers have suggested that the process of bicultural identity integration may generalize to other identities, such as sexual identities (Huynh, Nguyen, & Benet Martinez, 2011). In a sample of Deaf women, Moradi and Rottenstein (2007) found that perceived conflict between Deaf and Hearing cultures was associated with poor body image and eating disorder symptoms. Cheng and Lee (2009) adapted the BIS for use with Multiracial individuals. In a samp le of Multiracial individuals, Multiracial Identity Conflict (but not Distance) was positively related to psychological distress and negative affect (Jackson, Yoo, Guevarra, & Harrington, 2012). Thus, using this approach to identity integration, there is s ome support for its association with better mental health. To my knowledge, no empirical study has tested identity integration as a moderator of the discrimination mental health link with a sample of sexual minority individuals. However, in a sample of pr edominantly European American college women, synthesis self concept) buffered the link of sexist discrimination with symptoms of disordered eating (Sabik & Tylka, 20 06). Similarly, with a sample of Multiracial individuals, Jackson and colleagues (2012) found that the positive link of racist discrimination with negative affect was significant when multiracial identity Conflict was high (i.e., when multiracial identity integration was low), but this link was nonsignificant when Conflict was low (i.e., when multiracial identity integration was high). Thus, more integration of multiracial identities buffered the link of discrimination with negative affect. However, Conflic t did not moderate the links of racist discrimination with psychological distress or positive
29 affect, and Distance did not moderate the link of discrimination with any mental health outcome (Jackson et al., 2012). Thus, there is some support that integrate d identities buffer the relation of discrimination with some mental health outcomes. Behavioral Involvement Meyer (2003) postulated that group level coping (i.e., utilization of group social and psychological resources) may buffer the link of discriminat ion with mental health outcomes. Notably, prior research has operationalized group level coping with measures of behavioral involvement. In their review of collective identity dimensions, Ashmore and colleagues (2004) defined behavioral involvement as the sample of predominantly European American sexual minority women, Szymanski and Owens (2009) tested the ability of feminist behavioral involvement to moderate the links of sexist and heterosexist discrimination with psychological distress. Feminist behavioral (e.g., being a member of a feminist organization, donating money to feminist causes, participating in demonstrations or rallies). Although feminist involvement was not directly related to distress, it moderated the link of sexist discrimination (but not heterosexist discrimination) with psychological distress. Spe cifically, sexual minority women with high levels of feminist involvement reported lower distress than those with low involvement when sexist discrimination was low, but this buffering effect decreased as discrimination increased. Along a similar vein, wit h a sample of sexual minority racial/ethnic minority women, DeBlaere and colleagues (2014 ) tested racial/ethnic minority, feminist, and sexual minority behavioral involvement as moderators of the links of racist, sexist, and heterosexist discrimination, re spectively, with psychological
30 distress. Results indicated that no form of involvement was directly related to distress. Furthermore, the only significant interaction was found for heterosexist discrimination and sexual minority behavioral involvement. Spe cifically, sexual minority behavioral involvement buffered the relation of heterosexist discrimination with psychological distress such that discrimination was significantly positively related to distress at low levels of sexual minority involvement, but u nrelated to distress at high levels of involvement. In a sample of HIV positive gay Latino men, involvement in HIV/AIDS and gay organizations and activities was related to lower depression and loneliness and higher self esteem (Ramirez Valles, Fergus, Reis en, Poppen, & Zea, 2005). Moreover, behavioral involvement moderated the link of heterosexist discrimination with self esteem such that the heterosexist discrimination self esteem link was significant and negative at low levels of behavioral involvement bu t significant and positive at high levels of behavioral involvement. In addition, at high levels of heterosexist discrimination, individuals with high levels of behavioral involvement actually experienced a self esteem boost relative to individuals with lo w levels of behavioral involvement. However, behavioral involvement did not moderate the links of heterosexist discrimination with depression or loneliness. The Proposed Study The primary goal of the present study is to test the posited moderating roles o f multiple dimensions of collective identity in the relation of heterosexist discrimination with mental health among sexual minority individuals. The dimensions of collective identity examined are prominence, valence (including positive and negative privat e and public regard), integration, and behavioral involvement. Furthermore, given the aforementioned tendency to focus on negative mental health outcomes in the minority
31 stress literature, both positive and negative mental health outcomes (psychological di stress and psychological well being, respectively) will be examined in the current investigation. A number of direct relations are hypothesized. In light of prior theory and research, it is predicted that heterosexist discrimination will be associated wit h poorer mental health (i.e., high distress, low psychological well being; Hypothesis 1. In addition, it is predicted that positive private and public regard will be related to better mental health, whereas negative private and public regard will be relat ed to poorer mental health (Hypothesis 2). In addition, identity integration is predicted to be related to better mental health (Hypothesis 3). However, in light of mixed prior research, no predictions are made about the direct associations of identity pro minence and behavioral involvement with mental health outcomes. A number of moderated relations are also hypothesized. It is predicted that the discrimination mental health relations will be exacerbated by identity prominence (Hypothesis 4). It is expecte d that negative private regard will exacerbate the discrimination mental health association, whereas positive private regard will attenuate this association (Hypothesis 5); however, given limited and equivocal prior research, the moderating effects of nega tive and positive public regard on the discrimination mental health links are tested more exploratorily. It is also predicted that identity integration will attenuate the discrimination mental health associations (Hypothesis 6). Finally, sexual minority in volvement is predicted to attenuate the discrimination mental health links (Hypothesis 7).
32 CHAPTER 2 METHODS Participants Data were analyzed from 517 participants who confirmed that they were 18 years of age or older, identified as a sexual minority (e. g., lesbian, gay, bisexual, queer, questioning), and resided in the United States. Participants ranged in age from 18 to 77 M = 31.47, SD = 12.98, Mdn = 26). Some of the following descriptive data may not sum to 100% due to small proportions of missing de mographic data. With regard to sexual orientation, approximately 47% of participants identified as exclusively lesbian or gay, 16% as mostly lesbian or gay, 22% identified as bisexual, 1% identified as mostly heterosexual, 2% identified as asexual, and 10% pansexual). In terms of gender, approximately 47% of participants identified as men, 40% identified as women, 5% identified as genderqueer, 2% identified as transgender men, 2% identified as transgender women, and 3% id androgynous, questioning). Approximately 77% of participants identified as European American/White, 7% identified as Latina/o/Hispanic American, 5% identified as Multiracial, 4% identified as African American/Black, 4% identified as Asian American, less than 1% each identified as Native American/American Indian and Pacific Islander With regard to highest level of education attained, approximately 33% of participant high school diploma, and less than 1% completed some high school; no participants completed less than som e high school education. Approximately 50% of participants
33 were employed full time, 26% were employed part time, 19% were currently unemployed, and 4% were retired. In terms of social class, approximately 38% of participants identified as middle class, 28% identified as lower middle class, 24% identified as upper middle class, 9% identified as lower class, and 1% identified as upper class. With regard to yearly household income, approximately 13% of participants earned between 0 and $20,000, 25% earned betw een $20,001 and $40,000, 15% earned between $40,001 and $60,000, 16% earned between $60,001 and $80,000, 9% earned between $80,001 and $100,000, 8% earned between $100,001 and $120,000, region classification, most participants resided in the South (43%), followed by the Northeast (20%), Midwest (17%), and West (17%). Procedures Participation was solicited via electronic messages sent to Internet communities (e.g., yahoo and Facebook group s), message boards (e.g., reddit), and listservs that catered to sexual minority people. The use of Internet based data collection for samples of sexual minority people has become increasingly popular in recent years (Moradi, Mohr, Worthington, & Fassinger , 2009). In addition to facilitating participation from geographically diverse regions, Internet recruitment allows participation from sexual minority individuals who do not feel comfortable being out in person but feel reassured by the anonymity of the In ternet (Mustanski, 2001). Moreover, Internet based data yield results similar to those attained with data collected via traditional pen and paper methods (e.g., Gosling, Vazire, Srivastava, & John, 2004). e brought to a webpage with a
34 identifying as a sexual minority, residing in the U .S.), and providing consent, participants were allowed to proceed to the survey. At the beginning of the survey, participants were informed that they would be occasionally asked to select specific responses (e.g., ticipants who responded incorrectly to more than three (i.e., more than 50%) of these validity check items, were removed from the data set because of potential inattentive responding. Instruments were presented in random order, with the exception of the de mographics questionnaire, which always appeared last. Participants received no incentives or compensation for their participation. A total of 799 individuals confirmed the informed consent. Of these cases, 270 (34%) were removed from the data set because t hey were missing more than 20% of the data analyzed in this study, which exceeds the level of tolerable missingness recommended in prior rese arch (Dodeen, 2003; Parent, 201 3 ). Of these 270 removed cases, 175 (65%) were missing all data, indicating that the y quit the survey after providing consent. An additional 79 of these 260 removed cases (29%) were missing at least 50% of the data. These levels of missingness resemble levels reported in prior samples of sexual minority individuals recruited online (e.g., Szymanski & Gupta, 2009a, 2009b; Brewster, DeBlaere, Moradi, & Velez, 2013). An additional nine participants were removed from the data set because they resided outside of the U.S. Finally, three participants were removed from the data set because they re sponded incorrectly to three or more of the validity check items.
35 These data cleaning procedures resulted in a final sample of 517 participants (i.e., 65% of all individuals who provided informed consent). Of these participants, approximately 76% were mis sing no data, and an additional 22% were missing between one and ten items. Moreover, no item analyzed in this study was missing for more than 2% of participants. A number of parsimonious procedures exist for handling item level missing data for multi item measures e.g., Dodeen, 2003; Parent, 201 3 ). One such approach, item level missing data imputation from Expectation Maximization parameters using the SPSS statistical package, was used to impute missing items before computation of scale or subscale scores . Instruments Predictor Variable Perceived heterosexist discrimination . The perceived frequency of heterosexist discrimination within the last year was assessed using the 14 item Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS; Szymans ki, 2006). Participants indicated the frequency of various instances of sexual orientation based discrimination on a 6 point scale (1 = the event has never happened to you to 6 = the event happened almost all the time [more than 70% of the time]). An examp le item with higher scores indicating more frequent heterosexist discrimination. With samp les of sexual minority individuals, the validity of HHRDS scores was supported with significant associations with measures of depression, anxiety, somatization, and overall psychological distress (e.g., Szymanski, 2006, 2009). In samples of sexual minority
36 Moderator Variables Identity prominence . The importance of a sexual minority identity to partic concepts was assessed with the four item Identity subscale of the Collective Self esteem Scale (CSES; Luhtanen & Crocker, 1992). Participants responded to items using a 7 point scale (1 = Strongly disagree to 7 = Strongly agree ). Per L items group specific, participants were asked to consider their sexual orientation group (e.g., lesbian, gay, bisexual, or queer people) when responding to items. An example item is scored). Responses were averaged to derive an overall score, with higher scores indicating higher identity prominence. With two samples of sexual minority co llege students, the construct validity of the Identity subscale was supported via positive correlations with another measure of identity prominence Mohr & Kendra, (Mohr & Private regard toward their sexual minority identity were assessed with the four item Private subscale of the CSES (Luhtanen & Crocker, 1992). Participants res ponded to items using a 7 point scale (1 = Strongly disagree to 7 = Strongly agree ). Participants were asked to consider their sexual be a member of my sexual orientati scored and items were averaged to derive overall subscale scores, with higher scores
37 validity, Private subscale scores were nega tively related to depression and positively related to self esteem in a sample of Latina/o sexual minority individuals (Zea, Reisen, & Poppen, 1999). In a sample of predominantly European American sexual minority or Private subscale items across seven days with the three item Internalized Homonegativity IH) subscale of the Lesbian, Gay, and Bisexual Identity scale (Mohr & Kendra, 2011). Participants respond to IH items on a 6 point scale (1 = Disagree strongly to 6 = Agree strongly d to derive overall scores, with higher scores indicating more negative feelings toward sexual minority identities. Validity of IH scores was supported via positive associations with other measures of internalized heterosexism, depression, and negative aff ect and via negative associations with esteem (Mohr & alphas for IH items ranged from .86 to .93 (Mohr & Kendra, 2011). In addition, the six week test alpha for IH items in the present sample was .87. Public regard xual minority people were assessed with the four item Public subscale of the CSES (Luhtanen & Crocker, 1992). Participants responded to items using a seven point scale (1 = Strongly disagree to 7 = Strongly agree ). Participants were instructed to respond t o
38 scored and all responses were averaged, with higher scores indicating more positi ve public regard. In support of validity, perceived experiences of daily heterosexist harassment predicted decreases in Public subscale scores in a sample of sexual alpha for Public subscale items across seven days was .80 (Swim et al., 2009). associated personal impact of this stigma was assesse d with the 10 item Stigma Consciousness Questionnaire (SCQ; Pinel, 1999). Participants responded to SCQ items on a seven point scale (1 = Disagree strongly to 7 = Agree strongly ). SCQ items have been modified for use with sexual minority individuals in pas t research (Brewster & Moradi, 2010; Pinel, 1999). In the present study a version of the SCQ that is inclusive of heterosexuals have a reverse scored and responses were averaged to derive an overall score, with higher scores indicating greater awareness of negative attitudes towards sexual minority people and oneself. With samples of sexual minority people, the validity of SCQ scores has been supported via positive correlations with perceived experiences of heterosexist discrimination (Brewster & Moradi, 2010; Pinel, 1999). In samples of gay and lesbian
39 sample was .82. Identity integration . Integration of a sexual minority id entity with other dimensions of identity was assessed with an instrument based on the Multiracial Identity Integration Scale MIIS; Cheng & Lee, 2009). The MIIS was developed to assess integration of a multiracial identity along two dimensions: the perceiv ed distance between racial identities and the perceived conflict between racial identities. In the present study, MIIS items were reworded to refer to integration of sexual minority ut my different (SIIS) items on a five point scale (1 = Completely disagree to 5 = Com pletely agree ). The two factor structure of the MIIS was supported with EFAs with two samples of multiracial individuals (Cheng & Lee, 2009; Jackson et al., 2012). In support of validity, Distance scores correlated negatively with Multiracial pride (Cheng & Lee, 2009). Although nonsignificant, Conflict scores yielded modest correlations with Multiracial pride r s ranged from .11 to .21 across measurement occasions; Cheng & Lee, 2009). and Conflict items ranged from .65 to .80 and .74 to .81, respectively (Cheng & Lee, 2009; Jackson et al., 2012). Given that the SIIS was developed based on another measure and has not been used in prior research with sexual minority individuals, the facto r structure, reliability, and validity of data from this measure in the present sample will be examined before conducting the primary analyses.
40 Sexual minority behavioral involvement . Engagement in behaviors related to sexual minority identities were asse ssed with a modified version of the 17 item Involvement in Feminist Activities Scale (IFAS; Szymanski, 2004) that has been used in prior research with sexual minori ty people (DeBlaere et al., 2014 ). Items in the original nt in activities such as being a member of a feminist organization, donating money to feminist causes, or participating in feminist demonstrations, boycotts, marches, or rallies. For the modified scale, items were adapted to refer to involvement in sexual minority related activities. Participants indicated the extent to which they engaged in these activities on a seven point scale (1 = Very untrue of me to 7 = Very true of me ). Responses were averaged to derive overall scores, with higher scores indicating higher involvement. The validity of IFAS scores was supported via significant, conceptually consistent correlations with feminist self identification, attitudes toward feminism, and feminist identity attitudes (Szymanski, 2004). In a sample of predominantl y European American sexual minority women, sexual minority version used in the present study was .94 in a sample of racial/ethnic minority sexual minor ity women (DeBlaere e t al., 2014 sample was .95. Criterion Variables Psychological distress . Psychological distress was measured with the 21 item Hopkins Symptom Checklist 21 (HSCL 21; Green, Walkey, McCormick, & Taylor, 1988), which is an abb reviated version of the Hopkins Symptom Checklist (Derogatis, Lipman, Rickets, Uhlenhuth, & Covi, 1974). The HSCL 21 assesses psychological distress along three dimensions: general distress, somatic distress, and performance
41 difficulty. Participants rated the frequency with which they experienced symptoms during the prior week using a four point scale (1 = Not at all to 4 = Extremely ). Sample items averaged to derive an ov erall score, with higher scores indicating greater psychological distress. With regard to validity, HSCL 21 scores were positively correlated with other measures of anxiety and psychological distress in a sample of adult therapy patients (Deane, Leathem, & Spicer, 1992). In a sample of Asian American sexual minority individuals, HSCL Psychological well being . Positive psychological functionin g was assessed with the 18 item Psychological Well Being scale (PWBS; Ryff, 1989; Ryff & Keyes, 1995). The PWBS measures positive psychological functioning along six dimensions: self tions with others, autonomy belief in self determination), environmental mastery (belief that one can of continuing development as a person). Items were rated on a 6 point scale (1 = Completely disagree to 6 = Completely agree score d and items were averaged to derive an overall score, with higher scores indicating greater psychological well being. With a nationally representative sample of adults aged 25 or older, a confirmatory factor analysis CFA) supported a six factor structure representing the six content areas and a single higher order factor (Ryff & Keyes, 1995). However,
42 CFAs performed in more recent studies suggest the use of total scale scores representing a single dimension rather than separate subscale scores (Springer & Hauser, 2006). PWBS scores correlated in expected directions with measures of affective balance, positive and negative affect, life satisfaction, and depression (Ryff & Keyes, 1995). In a racially and ethnically diverse sample of sexual minority people, PW
43 CHAPTER 3 RESULTS Preliminary Analyses Factor Structure and Validity of the SIIS Because the SIIS was developed for thi s study and has not been used in prior research with sexual minority individuals, it was necessary to explore the underlying factor structure of its items before using them in the primary analyses. An exploratory factor analysis (EFA) was conducted on SIIS items to determine the appropriate factor structure of the SIIS items in the present sample. First, principle axis factoring (PAF) without rotation was conducted to identify potential factor solutions for further examination and rotation. The data were su itable for EFA, as indicated by an adequate sample size N = 517), significant Bartlett 2 (28, N = 517) = 1360.59, p < .001], and a Kaiser Meyer Olkin measure of sampling adequacy of .79 (Tabachnick & Fidell, 2007). Factor retention was informed by eigenvalues, scree plots, and parallel analysis, which holds that the ei genvalues for retained factors should be greater than the eigenvalues generated by a random data set with the same sample size and number of items (Hayton, Allen, and Scarpello, 2004). The PAF with no rotation indicated that two factors yielded eigenvalu es greater than one, and the scree plot suggested retention of two factors. Moreover, the parallel analysis also suggested the retention of two factors. Thus, the two factor solution was explored in a second PAF using promax rotation to accommodate interfa ctor correlations. The pattern matrix for the two factor solution is presented in Table 3 1. The two factor solution accounted for 59.26% of the total variance in items. However, three items (1, 3, and 4) yielded communalities below .40, the cutoff for ite m retention
44 suggested in prior research Worthington & Whittaker, 2006). Thus, these items were removed and a third PAF with promax rotation was conducted. Results indicated that only one factor yielded an eigenvalue greater than one. The one factor soluti on accounted for 61.94% of the total variance in items. However, item 2 yielded a communality below .40; thus, this item was dropped from the scale. A final PAF with promax rotation was conducted on the remaining four items. One factor yielded an eigenvalu e greater than one, and the one factor solution accounted for 70.12% of the total variance in items. Factor loadings are presented in Table 3 2. Notably, these remaining four items correspond to the Identity Conflict MIIS subscale. Items in the Sexual Id entity Conflict Scale (SICS) reflect perceived conflict or alpha for SICS items was .85 in the present sample. To provide preliminary evidence for the construct validity of the SICS, participants were asked in the demographics questionnaire to indicate the extent to which they agreed with a face five point scale (1 = Co mpletely disagree to 5 = Completely agree (1992) benchmarks for small r = .10), medium r = .30), and large r = .50) correlations, Conflict scores yielded a near large negative association r = .49, p < .001 with the single sexual ident ity integration item. Distinctiveness of Positive and Negative Regard Correlations between positive and negative aspects of private regard (Private and IH scores) and between positive and negative aspects of public regard Public and SCQ scores) were exam ined to determine the degree of overlap in positive and negative forms of regard. The positive and negative private regard scales yielded a
45 significant large negative correlation, r = .74, p < .001, indicating substantial overlap. The positive and negativ e public regard scales yielded a significant near large negative correlation, r = .49, p < .001. Notably, the relatively smaller correlation between public regard indicators may reflect the fact that some SCQ items assess the personal impact of heterosexi concept underlying public regard. Given the observed redundancy between the positive and negative regard indicators and the more precise item content of the Public items than the SCQ items, the subsequent analyses were performed with only the Private and Public subscales, which assess positive private and public regard of sexual minority identities, re spectively. Primary Analyses Relations of Discrimination and Collective Identity with Mental Health Bivariate correlatio ns and descriptive statistics for the variables of interest are presented in Table 3 3 . Consistent with Hypothesis 1, heterosexist discr imination yielded a significant positive correlation with psychological distress and a significant negative correlation with psychological well being. In addition, consistent with Hypothesis 2, positive private and public regard each yielded significant ne gative correlations with psychological distress and significant positive correlations with psychological well being. Similarly, consistent with Hypothesis 3, identity conflict (i.e., lower identity integration) yielded a significant positive correlation wi th psychological distress and a significant negative correlation with psychological well being. Although not hypothesized, the correlations of identity prominence and behavioral involvement with mental health outcomes were examined. Identity prominence yie lded a significant
46 positive correlation with psychological distress, whereas behavioral involvement yielded a significant negative correlation with psychological distress and a significant positive correlation with psychological well being. The magnitudes of the aforementioned correlations ranged from small to medium. As an additional test of Hypotheses 1, 2, and 3, the unique relations of heterosexist discrimination and the five dimensions of collective identity with mental health were examined in two mult iple regression analyses one with psychological distress as the criterion and another with psychological well being as the criterion (Table 3 4). Before interpreting the results, however, data were screened to determine if they met the assumptions of the analysis. Data met guidelines for univariate normality (i.e., skewness < 3; kurtosis < .10; Weston & Gore, 2006). In addition, the absolute values of suggest that no case s were univariate outliers that unduly influenced the regression analyses (Field, 2009). Multicollinearity was also assessed. Guidelines suggest that absolute correlations below .90, condition indices below 30, and variance inflation factors (VIFs) below 1 0 indicate that multicollinearity is not problematic Myers, 1990; Tabachnick & Fidell, 2007). Analyses indicated that the largest absolute interpredictor correlation was .45, the largest condition index was 23.54, and the largest VIF was 1.65; thus, multi collinearity was not deemed problematic. With psychological distress as the criterion, the set of variables (i.e., heterosexist discrimination, identity prominence, private regard, public regard, identity conflict, and behavioral involvement) accounted for 20% of the variance (Table 3 4) a medium effect size (Cohen, 1992). Moreover, each variable yielded significant unique links with
47 psychological distress. Specifically, heterosexist discrimination, identity prominence, and identity conflict were associat ed positively with psychological distress, whereas private regard, public regard, and behavioral involvement were associated negatively with psychological distress. As indicated by the squared semi partial correlation coefficients sr 2 ), the proportion of unique variance in psychological distress accounted for by the variables ranged from 1% (identity prominence, private regard, public regard, and behavioral involvement) to 4% (heterosexist discrimination). With psychological well being as the criterion, th e set of variables accounted for 26% of the variance (Table 3 4) a large effect size (Cohen, 1992). With the exception of public regard, each variable yielded significant unique links with psychological well being. Specifically, heterosexist discriminati on, identity prominence, and identity conflict were associated negatively with psychological well being, whereas private regard and behavioral involvement were associated positively with psychological well being. The proportion of variance in psychological well being accounted for by the variables ranged from 0% (public regard) to 4% (private regard and behavioral involvement). In sum, these results were largely consistent with prediction, with higher heterosexist discrimination and identity conflict (i.e., lower identity integration) and lower private and public regard being associated with poorer mental health (i.e., higher psychological distress and lower psychological well being). In addition, although not hypothesized specifically, these results suggest that higher identity prominence and lower behavioral involvement are related to poorer mental health (i.e., higher psychological distress and lower psychological well being).
48 Moderating Role of Collective Identity in Discrimination Mental Health Link To t est the moderating roles of the five dimensions of collective identity in the heterosexist discrimination mental health link, two hierarchical multiple regressions were performed one for psychological distress and another for psychological well being. Be fore conducting these analyses, predictors were centered and used to compute interaction terms (Aiken & West, 1991). Per recommendation for tests of multiple interaction terms, the predictors were entered in the first step of both regression analyses, and the five interaction terms were entered in the second step (Hayes, 2005). Significant changes in R 2 and significant regression coefficients for the interaction terms signify significant interaction effects. With 11 variables (i.e., six predictors and five interaction terms), the present sample N = 517) yielded power of .94 to detect significance of small effects R 2 = .02; Cohen, 1992). Before conducting these moderator regression analyses, multicollinearity was evaluated again to take into account the add ition of the interaction terms. The highest interpredictor absolute correlation was .64 (between the heterosexist discrimination by public regard interaction and the heterosexist discrimination by identity conflict interaction), the highest condition index was 3.27, and the highest VIF was 2.23; thus, multicollinearity was not deemed problematic. The results of these moderator regression analyses are presented in Table 3 5. With psychological distress as the criterion, the set of predictors and interactions terms was significant and accounted for 23% of the variance. In addition, the proportion of incremental variance accounted fo r by the set of interaction terms in step 2 was R 2 = .02. Of the individual interaction terms, only the heterosexist discrimination by private regard interaction was significant. With psychological well -
49 being as the criterion, the set of pred ictors and interaction terms was significant and accounted for 27% of the variance. However, the proportion of incremental variance in psychological well being contributed by the set of predictors in step 2 was R 2 = .01. None of the indivi dual interaction terms was significant. To decompose the significant heterosexist discrimination by private regard interaction predicting psychological distress, the PROCESS SPSS macro Hayes, 2012) was used to examine the relation of heterosexist discrimi nation with psychological distress at low (i.e., one SD below the mean) and high (one SD above the mean) levels of private regard. For this analysis, identity prominence, public regard, behavioral involvement, and identity conflict were included as covaria tes; the interaction terms that yielded nonsignificant associations with psychological distress were not included as covariates. The nature of the heterosexist discrimination by private regard interaction is depicted in Figure 3 1. When private regard was low, heterosexist discrimination yielded t (508) = 4.59, p < .001. When private regard was high, heterosexist discrimination also yielded a significant positive link with psychological distre t (509) = 6.17, p < .001. However, as indicated by the significant interaction coefficient (Table 3 5 ), the magnitude of the relation between heterosexist discrimination and psychological distress was significantly larger at higher than at lowe r levels of private regard. Thus, contrary to prediction, greater private regard strengthened rather than weakened the relation of heterosexist discrimination with psychological distress.
50 Table 3 1 . Principle axis factor analysis of Sexual Identity Integ ration Scale items using promax rotation Abbreviated item Loadings 1 2 7. I feel torn between my lesbian/gay/bisexual identity and my other identities or aspects of who I am. .89 .05 5. There is a conflict between my lesbian/gay/bisexual identity and my other identities or aspects of who I am. .84 .01 8. I do not feel any tension between my lesbian/gay/bisexual identity and my other identities or aspects of who I am. (R .74 .09 6. I feel like someone moving between a lesbian/gay/bisexual identity and other identities or aspects of who I am. .70 .01 4. In any given context, I am best described by a single identity or aspect of who I am. .04 .54 1. I am best described as a blend of my lesbian/gay/bisexual identity with my other identities and p arts of who I am. (R .12 .51 3. I have a multifaceted identity and there are many different aspects to who I am. (R .19 .46 2. I keep everything about my lesbian/gay/bisexual identity separate from my other identities and parts of who I am. .37 .40 N ote . R = reverse scored. Factor loadings > .30 are in bold. Factor 1 = Conflict; Factor 2 = Distance. The correlation between the two factors was r = .43 p < .001). Item numbers reflect the order in which the items appeared in the survey. Table 3 2. Pr inciple axis factor analysis of Sexual Identity Conflict Scale items using promax rotation Abbreviated item Loadings 7. I feel torn between my lesbian/gay/bisexual identity and my other identities or aspects of who I am. .78 5. There is a conflict betwe en my lesbian/gay/bisexual identity and my other identities or aspects of who I am. .75 8. I do not feel any tension between my lesbian/gay/bisexual identity and my other identities or aspects of who I am. (R .67 6. I feel like someone moving between a lesbian/gay/bisexual identity and other identities or aspects of who I am. .64 Note . R = reverse scored. Item numbers reflect the order in which the items appeared in the survey.
51 Table 3 3. Correlations and Descriptive Statistics for Variables of Inte rest Variable 1 2 3 4 5 6 7 Possible Range M SD 1. Heterosexist Discrimination -1 6 1.60 0.65 2. Prominence .15** -1 7 4.52 1.27 3. Private Regard .22*** .28*** -1 7 5.57 1.23 4. Public Regard .28*** .07 .32*** -1 7 3.94 1.24 5. Identity Conflict .23*** .00 .45*** .31*** -1 5 2.37 1.13 6. Behavioral Involvement .10* .31*** .40*** .06 .21*** 1 7 3.73 1.57 7. Psychological Distress .32*** .09* .27*** .27*** .32*** .13** -1 4 1.83 0.54 8. Psychological Wel l being .25*** .06 .40*** .24*** .31*** .29*** .58*** 1 6 4.57 0.69 Note . * p < .05; ** p < .01; *** p < .001.
52 Table 3 4. Unique Relations of Discrimination and Collective Identity with Mental Health Variable B t sr 2 R 2 F df Criterion: Psychological Distress Heterosexist Discrimination . 18 . 22 5.13*** . 04 . 20 21.45*** (6, 510 Prominence . 05 . 11 2.55* . 01 Private Regard .04 .10 1.98* . 01 Public Regard .05 .11 2.40* . 01 Identity Conflict . 08 . 17 3.65*** . 02 Behavioral Involvement .04 .10 2.31* . 01 Criterion: Psychological Well being Heterosexist Discrimination .16 .15 3.53*** . 02 . 26 29.89*** (6, 510 Prominence .10 .18 4.28*** . 03 Private Regard . 15 . 27 5.43*** .04 Public Regard . 03 . 05 1.27 .00 Identity Conflict .06 .10 2.17* .01 Behavioral Involvement . 10 . 23 5.27*** .04 * p < .05; ** p < .01; *** p < .001.
53 Table 3 5. Multiplicative Relations of Predictors with Mental Health Indicators Step Variab le B t R 2 R 2 F df Criterion: Psychological Distress 1 Heterosexist Discrimination .23 .28 5.48*** .20 .20 21.45*** (6, 510 Prominence .05 .11 2.63** Private Regard .06 .14 2.72** Public Regard .04 .09 2.14* Identity Confli ct .07 .16 3.43** Behavioral Involvement .04 .11 2.43* 2 Discrimination Prominence .03 .04 0.88 .23 .02 3.07* (11, 505 Discrimination Private Regard .08 .20 3.42** Discrimination Public Regard .01 .02 0.41 Discriminati on Identity Conflict .05 .09 1.53 Discrimination Behavioral Involvement .01 .01 0.26 Criterion: Psychological Well being 1 Heterosexist Discrimination .17 .16 3.17** .26 .26 29.89*** (6, 510 Prominence .10 .19 4.45*** Pr ivate Regard .15 .27 5.39*** Public Regard .03 .05 1.07 Identity Conflict .06 .10 2.15* Behavioral Involvement .10 .23 5.33*** 2 Discrimination Prominence .07 .08 1.78 .27 01 1.10 (11, 505 Discrimination Private Regard .01 .01 0.18 Discrimination Public Regard .06 .07 1.34 Discrimination Identity Conflict .01 .01 0.18 Discrimination Behavioral Involvement .04 .06 1.47 Note . B t reflect values from Step 2 of the regression equation. Steps 2 R 2 may R 2 due to rounding. * p < .05; ** p < .01; *** p < .001.
54 Figure 3 1. Heterosexist discrimination by private regard interaction for psycholo gical distress. Heterosexist discrimination and psychological distress scores are standardized, with 0 mean, 1 = one standard deviation below the mean, and 1 = one standard deviation above the mean.
55 CHAPTER 4 DISCUSSION The present study extends prior research regarding the links of experiences of heterosexist discrimination, collective identity, and mental health among sexual minority people in several respects. First, consistent with the perspective that collective identity is comprised of multiple, independent but related constructs (Ashmore et al. 2004), the present study tested the unique links of several aspects of collective identity prominence, valence, integration, and behavioral involvement with mental health outcomes. Second, following Me theory, the dimensions of collective identity were tested as moderators of the relation of position that mental heal th is more than the absence of psychopathology, the present study utilized both positive (psychological well being) and negative (psychological distress) indicators of psychological functioning. Within the limitations of its design, the findings of this in vestigation may inform future and research and practice with sexual minority people. The bivariate correlations between heterosexist discrimination and dimensions collective with mental health were largely consistent with prediction and prior research (Tab le 3 3 ). Specifically, greater discrimination, lower private regard, lower public regard, and greater identity conflict (i.e., lower identity integration) were related to poorer mental health (i.e., greater psychological distress and lower psychological we ll being). I made no hypotheses regarding the associations of identity prominence and behavioral involvement with mental health outcomes given mixed findings in prior resea rch (e.g., DeBlaere et al., 2014 ; Mohr & Kendra, 2011; Ramirez Valles et al.,
56 2005; Szymanski & Owens, 2009). However, in the present sample identity prominence was positively related to psychological distress, and behavioral involvement was negatively related to psychological distress and positively related to psychological well being. U ranged from small (identity prominence with psychological distress, r = .09) to medium (private regard with psychological well being, r = .40). Overall, this pattern of correlations indicates that poorer mental health is associated with greater perceived positive personal attitudes toward sexual minority people, less positive views of how others related activities. With few exceptions, the pattern of relations evident in bivariate correlations was similar to the pattern of unique relations yielded in the regression analyses (Table 3 4). Thus, heterosexist discrimination, identity prominence, and identity conflict yielded significant positive unique relations with psychological dist ress, whereas private regard, public regard, and behavioral involvement yielded significant negative unique relations with psychological distress. Similarly, heterosexist discrimination and identity conflict yielded significantly negative unique relations with psychological well being, whereas private regard and behavioral involvement yielded significant positive unique relations with psychological well being. In a departure from bivariate correlations, public regard was not uniquely related to psychologica l well being. In addition, after controlling for the other variables of interest, identity prominence emerged as uniquely, negatively related
57 to psychological well being. This suggests a suppressor effect, whereby the other predictor variables removed crit erion irrelevant variance from identity prominence, which revealed the variance shared uniquely by identity prominence and psychological well being (Paulhus, Robins, Trzesniewski, & Tracy, 2004). The positive link of heterosexist discrimination with psych ological distress is empirical support (Brewster & Moradi, 2010; Burns et al., 2012; Herek et al., 1999; Huebner et al., 2005; Lehavot & Simoni, 2011; Mays & Cochran, 2001 ; Szymanski, 2006). Importantly, in addition to linking heterosexist discrimination with psychological distress, this study yielded support for the negative link of heterosexist discrimination with an indicator of psychological well being that encompasses autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self acceptance (Ryff & Keyes, 1995). These results are consistent with prior research documenting the negative associations of heterosexist discriminati on with other indicators of well being, such as self esteem, job satisfaction, and global life satisfaction (Ramirez Valles et al., 2005; Toomey, Ryan, Diaz, Card, & Russell, 2013; Waldo, 1999). Taken together, these findings underscore the importance of a ttending to distress as well as positive psychological outcomes in research with minority populations (e.g., Goodman et al., 2004). Notably, however, these dimensions of well being are largely personal rather than interpersonal, relational, or social justi ce oriented (e.g., Yoder, Snell, & Tobias, 2012). A fruitful avenue for future research may be to test the links of heterosexist discrimination with well being indicators beyond the personal sphere, such as sense of belonging, interpersonal harmony, and be liefs regarding
58 & Tougas, 2001; Markus & Kitayama, 1991). The unique relations of collective identity dimensions with mental health support (2004) contention that these dimensions are related but distinct constructs. Indeed, absolute correlations between collective identity dimensions ranged from trivial (identity prominence with identity conflict, r = .00) to medium (private regard with ident ity conflict, r = .45). Taken together, these findings highlight the importance of attending to multiple dimensions of collective identity and their distinct links with mental health outcomes when conducting research or clinical work with sexual minority i ndividuals. Beyond exploration of direct links, the present study also tested the moderating roles of collective identity dimensions in the links of heterosexist discrimination with psychological distress and well being (Table 3 5). Results indicated that none of the collective identity dimensions moderated the heterosexist discrimination psychological well being relation. In addition, identity prominence, public regard, identity conflict, and behavioral involvement did not moderate the relation of heteros exist discrimination with psychological distress. These findings contradict significant heterosexist discrimination by identity prominence and heterosexist discrimination by behavioral involvement interactions found in prior research with sexual minority p eople (DeBlaere et al., 2014 ; Ramirez Valles et al., 2005; Swim et al., 2009). Importantly, it is possible that inconsistent results between the present study and past studies are due to differing designs or sample compositions. For example, Swim and colle agues (2009 found that the prospective relation of daily heterosexist hassles with subsequent increases in
59 depression and decreases in self esteem were stronger for individuals with greater identity prominence (averaged across data collections). Notable m ethodological differences between Swim (2009) study and the present study include sectional design and its use of a measure that assesses relatively less severe, subtle forms of heterosexist discr imination (most reported incidents in Swim  involved experiences of exclusion) reported over a shorter period of time (seven days rather than one year, as assessed in the current study). Disparate findings across studies may sug gest that greater identity prominence strengthens discrimination related changes in mental health over relatively brief periods of time, but such fluctuations may not be apparent over longer periods. In addition, identity prominence may play a stronger rol e when discrimination incidents are more subtle or ambiguous because greater identification with sexual minority people facilitates recognition and labeling of mistreatment due to With regard to the heterosexist discrimi nation by behavioral involvement interaction in prior researc h, DeBlaere and colleagues (2014 ) found that greater sexual minority behavioral involvement weakened the relation of heterosexist discrimination with psychological distress in a sample of racial/ ethnic minority sexual minority women. Similarly, in a sample of HIV positive Latino gay men, the heterosexist discrimination self esteem association was negative at low levels of involvement in HIV and gay related organizations, but this association was positive at high levels of involvement (Ramirez Valles et al., 2005). In addition, at high levels of involvement, greater discrimination was associated with a self esteem boost. In contrast to these prior
60 studies, the present sample was predominantly Europ ean American, and the measure of behavioral involvement solely assessed engagement in sexual minority related activities and did not assess other dimensions of identity (e.g., HIV status). It is possible that the buffering effect of sexual minority behavio ral involvement in the relation of heterosexist discrimination with mental health is particularly robust in samples with multiple stigmatized identities (e.g., sexual orientation identity, race/ethnicity, gender, HIV status). Future research may explore if varying data collection strategies, time interval and intensity of reported heterosexist discrimination, and sample composition varies the significance and nature of such interactions in relation to mental health. In contrast to the aforementioned null f indings, the heterosexist discrimination by positive private regard interaction in relation to psychological distress was significant. Follow up simple slopes analyses clarified the nature of this interaction. Specifically, the positive relation of heteros exist discrimination with psychological distress was significant at both low (one SD below) and high one SD above) levels of private regard; however, this association was significantly stronger at high levels of private regard. Figure 3 1 further articula tes the nature of the interaction: at low levels of heterosexist discrimination, individuals with higher private regard experienced less psychological distress than individuals with lower private regard. Thus, at low levels of heterosexist discrimination, private regard buffers psychological distress. However, the greater slope of the discrimination distress link for individuals with high levels of private regard indicates that the buffering effect of private regard dissipates as levels of heterosexist disc rimination increase. This dissipating buffering effect was also evinced in a sample of African American women (Szymanski & Stewart, 2010). That is, at lower levels of racist
61 discrimination, African American women with lower internalized racism (i.e., highe r positive private regard of racial identity) reported lower psychological distress than African American women with higher internalized racism; however, the buffering effect of lower internalized racism decreased as racist discrimination increased. Taken together, these findings may indicate that for individuals with more positive and less negative feelings toward their stigmatized identities, increasing levels of discrimination may feel particularly hurtful and thus increase distress at relatively steeper rates. The nature of the heterosexist discrimination by private regard interaction contributes to a complex pattern of findings regarding this interaction in prior research. For example, in large a sample N = 741) of sexual minority men, Meyer (1995) fou nd that higher internalized heterosexism (i.e., lower positive private regard) strengthened the link of heterosexist discrimination with some aspects of psychological distress (demoralization and guilt) but not with other aspects of psychological distress (suicidal ideation, sexual problems, AIDS related traumatic stress). In addition, in a sample of sexual minority employees N = 326), internalized heterosexism strengthened the association of workplace heterosexist discrimination with psychological distres s for women but not for men (Velez et al., 2013). In another study with a modest sample N = 143) of sexual minority women, internalized heterosexism did not moderate the link of heterosexist discrimination with psychological distress among a sample of sex ual minority women (Szymanski, 2006). Similarly, a measure that assessed both positive private regard and a sense of belonging did not moderate the link of heterosexist discrimination with discrimination in a large sample N = 449) of sexual minority peopl e (Fingerhut et al., 2010). Notably, across these studies, measurement of both
62 heterosexist discrimination and private regard/internalized heterosexism has varied from single item responses to multidimensional scales. Thus, prior research has been characte rized by variations in sample size and power to detect significant interactions as well as by variation in measurement of key constructs. In light of such variability in het erosexist discrimination by private regard interaction in relation to psychological distress is warranted, with an emphasis on ensuring sufficient statistical power to detect significant effects and optimal operationalization of constructs of focus. Anoth er contribution of the study was the development and preliminary test of validity of the Sexual Identity Conflict Scale (SICS). Prior instruments of identity integration among bicultural and Multiracial individuals (Benet Martinez & Haritatos, 2005; Cheng & Lee, 2009; Jackson et al., 2012) included two dimensions, Conflict and Distance, with higher scores on each dimension indicating lower identity integration. In contrast, the identity integration items tested in the current study were best represented by concept. SICS scores yielded a near large correlation with a face valid item of sexual orientation identity integration and small and n ear medium correlations with psychological distress and well being, respectively. In addition, SICS scores were related to greater heterosexist discrimination and lower private regard, public regard, and behavioral involvement; effect sizes ranged from sma structural and construct validity in new samples of sexual minority individuals.
63 Limitations The findings of the present study must be interpreted in light of its methodological li mitations. First, it is important to acknowledge issues of generalizability in the current sample. Online data collection allows researchers a cost efficient method of sampling geographically diverse samples of sexual minority individuals. Moreover, the gr eater anonymity of online data collection may facilitate recruitment of sexual minority recruitment Mustanski, 2001). However, online data collection limits participation to individuals who possess the resources to access computers and the Internet, which may influence the demographic characteristics of the sample. Specifically, 77% of the current sample identified as European American/White, 38% identified as middle class, a population benchmarks (as in the U.S. Census) are not available for sexual orientation identity, it is difficult to determine to what extent any given sample of sexual minority peo ple is representative of the population as a whole (Meyer & Wilson, 2009). Regardless, in order to support the generalizability of the present findings, it is important to replicate them with samples that are more diverse with regard to race/ethnicity, soc ial class, and education. It is also important to acknowledge that levels of heterosexist discrimination and psychological distress were relatively low and levels of positive private regard and psychological well being were relatively high in the current s ample. Notably, such levels of discrimination and identity related attitudes are typical in samples of sexual minority people recruited online (e.g., Brewster & Moradi, 2010; Lehavot & Simoni, 2011; Mohr & Kendra, 2011; Szymanski & Ikizler, 201 3 ). However, such range restriction may
64 attenuate relations between variables of interest (Sackett & Yang, 2000), which raises the possibility that samples with a wider range of responses would yield larger effect sizes. It is important to note, however, that despite the possibility of such attenuation, meta analyses support the robustness of small to medium sized associations of discrimination and dimensions of collective identity with mental health across studies (e.g., Newcomb & Mustanski, 2010; Pascoe & Smart Rich man, 2009). Another limitation to acknowledge is that self report was the sole source of data in the current study. Self report is a valuable point of inquiry reports are often the sole source of data available to clinicians. How ever, specific to experiences of discrimination, prior research suggests that self reports are shaped by perpetrator (e.g., Feldman & Swim, 1998; Major & Sawyer, 2009 . Thus, a fruitful alternative sources of data, such as the presence of sexual minority supportive or discriminatory state laws or workplace and school policies, public re cord of bias related incidents, or implicit measures that tap collective identity attitudes (Hatzenbuehler, 2011; Hatzenbuehler, Dovidio, Nolen Hoeksema, & Phills, 2009; Rostosky, Riggle, Horne, & Miller 2009). A final consideration is the cross sectional nature of the data. Minority stress theory (Meyer, 2003) assumes that experiences of heterosexist discrimination lead to mental health concerns among sexual minority people. Likewise, conceptual frameworks for counseling with sexual minority clients assum e that developing healthy sexual orientation identity development (characterized, for example, by higher positive
65 private regard and greater identity integration) improves mental health Matthews, 2007; Pachankis & Goldfried, 2013). Although the findings o f the present study are consistent with these frameworks, the cross sectional nature of the data precludes conclusions regarding temporal precedence or causation. Thus, although it is possible, for instance, that high positive regard leads to lower psychol ogical distress and higher psychological well being, it is also possible that lower distress and higher well being lead to more positive feelings toward sexual minority people. Prior longitudinal research with sexual minority samples has yielded support fo r the prospective links of heterosexist discrimination and identity related attitudes with subsequent mental health (Hatzenbuehler, McLaughlin, Keyes, & Hasin, 2010; Hatzenbuehler et al., 2009; Rostosky et al., 2009; Swim et al., 2009). However, no study t o date has tested the Implications for Future Research and Practice with sexual minority clients. Consistent wit h prior research (Brewster & Moradi, 2010; findings suggest that experiences of heterosexist discrimination are related to poorer mental health among sexual minority individual s. Thus, psychologists providing experiences of heterosexist discrimination and explore potential associations with psychological distress and well being. Notably, this recom mendation is consistent with understand the effects of stigma (i.e., prejudice, d iscrimination, and violence) and its
66 experiences of heterosexist discrimination (e.g., F assinger, 2000). For example, clinicians may draw from person centered approaches to provide clients with unconditional positive regard to foster feelings of self worth despite prior experiences of rejection. Clinicians influenced by feminist multicultural critical consciousness of systems of oppression (e.g., heterosexism, sexism, racism), the ways they may interact, and their links with the mental health of people from marginalized backgrounds. Lastly, cognitive behavioral str ategies may include challenging self xism and does not The findings regarding the associations of dimensions of collective identity with psychological distress and well being may also inform clinical practice. Facilitating ty development is emphasized in numerous models of counseling and psychotherapy with sexual minority individuals (e.g., Matthews, 2007; Pachankis & Goldfried, 2013). The findings of the present study suggest that such models may need to be refined. Given t he modest overlap in dimensions of sexual orientation collective identity and their unique relations with psychological distress and well being, conceptual frameworks may benefit from articulating how clinicians may llective identity; identity prominence, private
67 regard, public regard, identity conflict, and behavioral involvement may each be targets of intervention. In addition, the significant heterosexist discrimination by private regard interaction in relation to psychological distress indicates that the association of minority people. That is, positive private regard may be an internal psychological resource from which clients m ay draw to resist psychological distress; however, the beneficial associations of private regard with better mental health may gradually dissipate as clients are faced with increasing levels of external stressors that is, greater heterosexist discriminat ion. The fact that the buffering effect of high private regard is less effective as discrimination increases underscores the importance of meso and macro level interventions that seek to reduce societal heterosexism (e.g., Rostosky & Riggle, 2011). Psycho logists may act as social justice agents by engaging in outreach and consultation at college campuses, community centers, and workplace organizations that inform the public about the history of heterosexism and the antecedents and consequences of heterosex ist discrimination. Similarly, psychologists may lobby state and federal legislators to pass laws that protect sexual minority people from heterosexist discrimination at the interpersonal and structural levels. Future research may also build upon the findi ngs of the present study. Results indicated that heterosexist discrimination, identity prominence, private regard, public regard, identity conflict, and behavioral involvement largely yielded unique links with psychological distress and well being, and pri vate regard moderated the link of heterosexist discrimination with psychologist. However, it remains to be seen if
68 heterosexist discrimination and multiple dimensions of collective identity yield unique or interactive links with other important domains, su ch as academic performance (e.g., grades, truancy, motivation), vocational functioning (job satisfaction, turnover intentions), social well being (sense of belonging, romantic relationship satisfaction), or physical health (e.g., sexual risk behaviors, phy siological stress response). Another fruitful avenue may be to employ an intersectional perspective (Cole, 2009; Fassinger & Arseneau, 2007; Moradi & Subich, 2003) in future tests of the interactions of discrimination and collective identity. The present s experiences of discrimination and collective identity attitudes related to their sexual minority identities. However, individuals possess numerous sociocultural identities, including race/ethnicity, gender identity, religion, ability status, and social class. An intersectional perspective may warrant tests of different interactions, such as discrimination experiences related to one identity (e.g., heterosexist discrimination) by collective identity attitudes related to another identity (e.g., race related private regard). Another direction for future research may be to explore mechanisms that explain the links of experiences of discrimination with mental health. Hatzenbuehler (2009) that is, leads to mental health outcomes such as depression, anxiety, and substance use disorders via general psychosocial processes (e.g., rumination, hopelessness, seeking social support, substance use expectancies) and minority spec ific processes (e.g., internalized heterosexism, expectations of rejection, concealment of sexual orientation). As of yet, no published study has tested this full model. An ideal research design would test the prospective links of heterosexist discriminati on with subsequent general and minority -
69 specific processes (i.e., predictor mediator links), as well as the links of such processes with subsequent mental health outcomes (i.e., mediator criterion links). Moreover, tress framework and the rationale for the current study, dimensions of collective identity may moderate the predictor mediator, predictor criterion, or mediator criterion links. Summary Building upon minority stress theory Meyer, 2003) and conceptual lite rature regarding the multidimensional nature of collective identity (Ashmore et al., 2004), the present study tested the direct and interactive links of heterosexist discrimination, identity prominence, private regard, public regard, identity integration, and behavioral involvement with psychological distress and well being in a sample of sexual minority people. Results largely supported the bivariate and unique links of heterosexist discrimination and collective identity dimensions with negative and positi ve mental health outcomes. In addition, a significant heterosexist discrimination by private regard interaction indicated that positive attitudes toward sexual minority people was associated with lower distress when levels of discrimination were low. Howev er, this buffering effect diminished as levels of discrimination increased. These results suggest the importance of assessing heterosexist discrimination, multiple dimensions of collective identity, and their potential interactions in clinical work and res earch with sexual minority people. Future studies may explore the limits of generalizability of the present findings to more diverse samples and other research designs e.g., longitudinal data, external indicators of discrimination, implicit collective ide ntity attitudes). Moreover, the interactions tested in the present study may be tested in relation to domains of functioning beyond mental health; interactions that acknowledge
70 d minority specific processes may be tested as mediators of the link of discrimination with mental health.
71 APPENDIX A HETEROSEXIST HARASSMENT, REJECTION, AND DISCRIMINATION SCALE INSTRUCTIONS : Please think carefully about your life as you answer the q uestions below. Read each question and then circle the number that best describes events in the PAST YEAR, using these rules: Circle 1 If the event has NEVER happened to you Circle 2 If the event happened ONCE IN A WHILE ( less than 10% of the time C ircle 3 If the event happened SOMETIMES (10 25% of the time Circle 4 If the event happened A LOT (26% 49% of the time Circle 5 If the event happened MOST OF THE TIME (50 70% of the time Circle 6 If the event happened ALMOST ALL OF THE TIME (more than 70% of the time 1. In the past year, how many times have you been treated unfairly by teachers or professors because you are a LESBIAN/GAY/BISEXUAL PERSON? 2. In the past year, how many times have you been treated unfairly by your emplo yer, boss or supervisors because you are a LESBIAN/GAY/BISEXUAL PERSON? 3. In the past year, how many times have you been treated unfairly by your co workers, fellow students or colleagues because you are a LESBIAN/GAY/BISEXUAL PERSON? 4. In th e past year, how many times have you been treated unfairly by people in service jobs (by store clerks, waiters, bartenders, waitresses, bank tellers, mechanic and others) because you are a LESBIAN/GAY/BISEXUAL PERSON? 5. In the past year, how many times h ave you been treated unfairly by strangers because you are a LESBIAN/GAY/BISEXUAL PERSON? 6. In the past year, how many times have you been treated unfairly by people in helping jobs (by doctors, nurses, psychiatrists, caseworkers, dentists, school couns elors, therapists, pediatricians, school principals, gynecologists, and others) because you are a LESBIAN/GAY/BISEXUAL PERSON? 7. In the past year, how many times were you denied a raise, a promotion, tenure, a good assignment, a job, or other such thing at work that you deserved because you are a LESBIAN/GAY/BISEXUAL PERSON? 8. In the past year, how many times have you been treated unfairly by your family because you are a LESBIAN/GAY/BISEXUAL PERSON?
72 9. In the past year, how many times have you been c alled a HETEROSEXIST name like dyke, lezzie, faggot, sissy, or other names? 10. In the past year, how many times have you been made fun of, picked on, pushed, shoved, hit, or threatened with harm because you are a LESBIAN/GAY/BISEXUAL PERSON? 11. In the past year, how many times have you been rejected by family members because you are a LESBIAN/GAY/BISEXUAL PERSON? 12. In the past year, how many times have you been rejected by friends because you are a LESBIAN/GAY/BISEXUAL PERSON? 13. In the past year, how many times have you heard ANTI LESBIAN/ANTI GAY/ANTI BISEXUAL remarks from family members ? 14. In the past year, how many times have you been verbally insulted because you are a LESBIAN/GAY/BISEXUAL PERSON?
73 APPENDIX B COLLECTIVE SELF ESTEEM SCALE INS TRUCTIONS: We are all members of different social groups or social categories. We would like you to consider your sexual orientation group (e.g., gay, lesbian, bisexual) in responding to the following statements. There are no right or wrong answers to any of these statements; we are interested in your honest reactions and opinions. Please read each statement carefully, and respond by using the following scale from 1 to 7: 1 = Strongly Disagree 2 = Disagree 3 = Disagree Somewhat 4 = Neutral 5 = Agree Somew hat 6 = Agree 7 = Strongly Agree 1. I am a worthy member of my sexual orientation group. 2. I often regret that I belong to my sexual orientation group. 3. Overall, my sexual orientation group is considered good by others. 4. Overall, my sexual orientation group has very little to do with how I feel about myself. 5. I feel I don't have much to offer to my sexual orientation group. 6. In general, I'm glad to be a member of my sexual orientation group. 7. Most people consider my sexual orientation group, on the average, to be mo re ineffective than other groups. 8. The sexual orientation group I belong to is an important reflection of who I am. 9. I am a cooperative participant in the activities of my sexual orientation group. 10. Overall, I often feel that my sexual orientation is not wort hwhile. 11. In general, others respect my sexual orientation. 12. My sexual orientation is unimportant to my sense of what kind of a person I am. 13. I often feel I'm a useless member of my sexual orientation group. 14. I feel good about the sexual orientation group I bel ong to. 15. In general, others think that my sexual orientation group is unworthy. 16. In general, belonging to my sexual orientation group is an important part of my self image.
74 APPENDIX C INTERNALIZED HOMONEGATIVITY SCALE INSTRUCTIONS: For each of the fol lowing questions, please mark the response that best indicates your current experience as an LGB person. Please be as honest as possible: Indicate how you really feel now, not how you think you should feel. There is no need to think too much about any one question. Answer each question according to your initial reaction and then move on to the next. Some of you may prefer to LGB in this survey as a convenience, and we ask for your understanding if the term does not completely capture your sexual identity. 1 = Disagree Strongly 2 = Disagree 3 = Disagree Somewhat 4 = Agree Somewhat 5 = Agree 6 = Agree Strongly 1 . If it were p ossible, I would choose to be straight. 2 . I wish I were heterosexual. 3 . I believe it is unfair that I am attracted to people of the same sex.
75 APPENDIX D STIGMA CONSCIOUSNESS QUESTIONNAIRE INSTRUCTIONS: Please indicate the extent to which you agree or disagree with each of the statements below using the rating scale provided. 0 = strongly disagree 1 2 3 = neither agree nor disagree 4 5 6 = strongly agree 1. Stereotypes about lesbian/gay/bisexual people have not affected me personally. (R 2. I ne ver worry that my behaviors will be viewed as stereotypical of lesbian/gay/bisexual people. (R 3. When interacting with heterosexuals who know of my sexual preference, I feel like they interpret all my behaviors in terms of the fact that I am lesbian/gay/ bisexual. 4. Most heterosexuals do not judge lesbian/gay/bisexual people on the basis of their sexual orientation. (R 5. My being lesbian/gay/bisexual does not influence how heterosexuals act with me. (R 6. I almost never think about the fact that I am l esbian/gay/bisexual when I interact with heterosexuals. (R 7. My being lesbian/gay/bisexual does not influence how people act with me. (R 8. Most heterosexuals have a lot more homophobic/biphobic thoughts than they actually express. 9. I often think that heterosexuals are unfairly accused of being homophobic/biphobic. (R 10. Most heterosexuals have a problem viewing lesbian/gay/bisexual people as equals.
76 APPENDIX E SEXUAL IDENTITY INTEGRATION SCALE INSTRUCTIONS: Please read the statements below and ra te the extent to which they describe your experience. Please put the appropriate number in the box. completely somewhat not somewhat completely disagree disagree sure agree agree 1 --------------------2 -------------------3 ---------------------4 ---------------------5 1. I am best described as a blend of my lesbian/gay/bisexual identity with my other identities. 2. I keep everything about my lesbian/gay/bisexual identity and other identitie s separate. 3. I am a person with a complex identity. 4. In any given context, I am best described by a single identity. 5. There is a conflict between my lesbian/gay/bisexual identity and my other identities. 6. I feel like someone moving between a lesbia n/gay/bisexual identity and other identities. 7. I feel torn between my lesbian/gay/bisexual identity and my other identities. 8. I do not feel any tension between my lesbian/gay/bisexual identity and my other identities.
77 APPENDIX F INVOLVEMENT IN SEXU AL MINORITY ACTIVITIES SCALE INSTRUCTIONS: For each of the following statements, indicate to what degree it statement is rated on a 7 point Likert scale from 1 very untrue of me ) to 7 very true of me ). 1. I write to politicians and elected officials concerning LGBT issues. 2. I educate others about LGBT issues. 3. I participate in LGBT demonstrations, boycotts, marches, and/or rallies. 4. I attend conferences/lectures/clas ses/training on LGBT issues. 5. I attend LGBT organizational, political, social, community, and/or academic activities and events. 6. I am involved in antiracist work. 7. I am active as an LGBT person in political activities. 8. I am involved in resear ch, writing, and/or speaking about LGBT issues. 9. I am involved in organizations that address the needs of other minority groups (e.g., women, people of color, people with disabilities). 10. I am involved in planning/organizing LGBT events and activities . 11. I vote for political candidates that support LGBT issues. 12. I donate money to LGBT groups or causes. 13. I am involved in LGBT teaching and/or mentoring activities. 14. I am a member of one or more LGBT organizations and/or groups. 15. I read L GBT literature. 16. I am a member of one or more LGBT listserves. 17. I actively participate in LGBT organizational, political, social, community, and/or academic activities and events.
78 APPENDIX G HOPKINS SYMPTOM CHECKLIST 21 INSTRUCTIONS: Below is a list of problems and complaints that people sometimes have. Please read each one carefully. After you have done so, please fill in one of the numbered spaces to the right that best describes HOW MUCH THAT PROBLEM HAS BOTHERED OR DISTRESSED YOU DURING THE P AST WEEK INCLUDING TODAY. Mark only one numbered space for each problem and do not skip any items. 1 = Not at all 2 = Somewhat 3 = Moderately 4 = Extremely 1. Difficulty in speaking when you are excited 2. Trouble remembering things 3. Worried about s loppiness or carelessness 4. Blaming yourself for things 5. Pains in the lower part of your back 6. Feeling lonely 7. Feeling blue 8. Your feelings being easily hurt 9. Feeling others do not understand you or are unsympathetic 10. Feeling that people are unfriendly or dislike you 11. Having to do things very slowly in order to be sure you are doing them right 12. Feeling inferior to others 13. Soreness of your muscles 14. Having to check and double check what you do 15. Hot or cold spells 16. Your mind go ing blank 17. Numbness or tingling in parts of your body 18. A lump in your throat 19. Trouble concentrating 20. Weakness in parts of your body 21. Heavy feelings in your arms or legs
79 APPENDIX H PSYCHOLOGICAL WELL BEING SCALE Instructions: Please indica te which answer best describes your present agreement or disagreement with each statement below. 1 = Completely Disagree 2 = Disagree 3 = Slightly Disagree 4 = Slightly Agree 5 = Agree 6 = Completely Agree 1. I tend to be influenced by people with stron g opinions. 2. I have confidence in my opinions, even if they are contrary to the general consensus. 3. I judge myself by what I think is important, not by the values of what others think is important. 4. In general, I am in charge of the situation in whic h I live. 5. The demands of everyday life often get me down. 6. I am quite good at managing the many responsibilities of my daily life. 7. I think it is important to have new experiences that challenge how you think about yourself and the world. 8. For me, life has been a continuous process of learning, changing, and growth. 9. I gave up trying to make big improvements or changes in my life a long time ago. 10. Maintaining close relationships has been difficult and frustrating for me. 11. People would descr ibe me as a giving person, willing to share my time with others. 12. I have not experienced many warm and trusting relationships with others. 14. Some people wander aimlessly throug h life, but I am not one of them. 16. When I look at the story of my life, I am pleased with how things have turned out. 17. I like most parts of my personality. 18. In many ways I feel disap pointed about my achievements in life.
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93 BIOGRAPHICAL SKETCH Brandon Louis Velez was born in Bronx, New York and raised in Orlando Florida. He completed his undergraduate education at the University of Florida (UF , where he majored in Psychology and R eligion and minored in Anthropology. He completed his doctoral degree in counseling psychology at UF , and he completed his pre doctoral research focuses on the links of exp eriences discrimination and aspects of identity with mental health and vocational outcomes among stigmatized groups, such as women, racial/ethnic minority people, and sexual minority individuals. His research also examines the additive and interactive link s of multiple forms of oppression with the mental health of people with multiple stigmatized identities (e.g., sexual minority people of color). His research has received numerous awards and recognitions, including Outstanding Counseling Psychology Gr aduate Student Award, Outstanding Graduate Student Awar ds from two separate sections of the A merican P sychological A (APA) Socie ty of Counseling Psychology Sectio n on Lesbian, Gay, Bisexual, and Transgender Issues and Section on Vocatio nal Psy chology , honorable mention from the competitive Ford Foundation Fellowship, and Alliance Award for Student Lesbian, Gay, Bisexual, Transgender, and Queer Research. In the f all 2014 semester, Brandon will join the faculty of the APA accredited counseling psychology doctoral program at Teachers College, Columbia University as a tenure track assistant professor.