Lesbian and bisexual women are at a higher risk for mental health issues and substance use disorders when compared to their heterosexual peers. In general, sexual minority women engage in substance use including alcohol, tobacco and illicit drug use more often. This population also reports higher rates of depression and anxiety than their counterparts. Although the reason for these increased rates remains unknown, there is one possible explanation - minority stress - that helps begin the process of understanding the unique health and mental health needs of this population. Minority stress theory explains and predicts how stressors related to one’s minority identity status impacts lesbian and bisexual women in deleterious ways. These stressors are thought to then impact mental health and substance use outcomes such as the ones described.

Minority stressors can be separated into two categories. The first type is distal stress. Distal stressors are stressors that are present in one’s environment and tend to occur at the social or interpersonal level. Examples include - discrimination, real or perceived stigma, harassment or any type of violence involving or thought to be involving one’s sexual identity. The second category of stressors are proximal stressors. These stressors manifest internally and include feelings of rejection, internalized homophobia or identity shame. The two types of stressors work in tandem impacting one’s mental health and substance use behaviors.

According to the minority stress theory, distal and proximal stressors can be moderated by the presence of social support. Social support has been shown to decrease the magnitude in which stressors are internalized thereby decreasing the likelihood of adverse mental health and substance use issues from developing or worsening. Increasing social support is seen as one of the primary intervention techniques in reducing the risk of mental health issues and substance use disorders among lesbian and bisexual women as explained using the minority stress theory. It is therefore critical for medical providers to ask their patients who identity as a lesbian or bisexual about their experiences with minority stressors to assess risk, as well as to provide support in the form of a provider-patient relationship and/or social resources. Open conversation helps develop meaningful relationships and fosters a supportive environment where these women can disclose their identity comfortably and receive the support and resources to help mitigate the presence of minority stressors.

  • Lehavot, Keren, and Simoni, Jane M. "The Impact of Minority Stress on Mental Health and Substance Use among Sexual Minority Women." Journal of Consulting and Clinical Psychology 79, no. 2 (2011): 159-70.
  • Meyer, Ilan H. "Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. (Author Abstract)." Psychological Bulletin 129, no. 5 (2003): 674-697.

 Luke Schmidt                                                                                                                                                      DUCOM 2018

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