Multilayered stigma-based experiences and mental health among U.S. sexual minority adults: A socioecological longitudinal investigation

While research suggests that structural sexual minority stigma exposure, including discriminatory legislation, policies, norms, and attitudes, may drive interpersonal stigma that in turn fosters intrapersonal stigma to jeopardize sexual minority mental health, few studies have examined these cross-level effects longitudinally. The current longitudinal study aimed to explore whether intrapersonal stigma (i.e., internalized stigma; identity concealment) mediates the associations between interpersonal stigma (i.e., adulthood and childhood victimization; everyday discrimination; perceived external stigma) and mental health outcomes (i.e., psychological distress; suicidal ideation; suicide attempts) among sexual minority adults, and as a function of two moderators: structural climate and generation. Data from 600 sexual minorities across three generations (i.e., ages 18–26, 34–42, 50–60) who completed all three annual waves of the 2016–2019 Generations Study were merged with Census division data on legal climate (2016 Human Rights Campaign State Equality Index). A series of three-wave time-lagged simplex moderated mediation models were estimated for each independent, moderator, mediator, and dependent variable combination. While full mediation was not supported, several cross-sectional and longitudinal cross-level associations were found between interpersonal and intrapersonal stigma, as well as a function of structural stigma or generation cohort. Reversed sensitivity analyses revealed how identity concealment’s positive effect on psychological distress and suicidal ideation may be suppressed through lower exposure to everyday discrimination, but only among younger generations and in lower-stigma divisions. Identity concealment may represent a salient mechanism through which sexual minorities navigate structural climates and the harmful effects of everyday discrimination on distress and suicidal ideation. Yet, concealment itself may also jeopardize their mental health. While the findings provide some support for the cross-level interplay of sexual minority stigma-related factors, further advanced time-lagged studies are warranted to examine the socioecology of such stigma and its mental health effects.