Why Mental Wellness Initiatives Aren’t One-Size-Fits-All: Minority Stress Theory’s Role in Therapeutic Interventions

The effectiveness of standardized mental and physical health interventions will continue to be blunted within minority communities until continuous social reform eliminates the stressors that are unique to these minority groups. The existing relationship connecting increased severity of minority stress experiences to an increased likelihood of experiencing poor mental and physical health highlights the importance of an integrated approach to therapeutic and medical interventions within these communities. This principle is the basis of minority stress theory.

Minority stress theory has been studied most frequently in the context of racial and sexual minority groups (1). Factors unique to one’s minority status (such as objective discrimination events, expectations of rejection, and the internalization of negative societal attitudes) are hypothesized to be a main cause of the increased prevalence of substance abuse and mental illness among minorities, as well as lower physical health on average (1). Minority stress is theorized to lead to escape/avoidance behaviors such as substance abuse as a means of coping, and repeated exposure to long-term minority stress is thought to result in feelings of hopelessness, potentially leading to depressive symptoms (1).

A study following a cohort of gay men who were caregivers of partners or close friends living with AIDS from 1989 to 1991, leading up to and following the death of those being cared for from AIDS-related complications, found that all of the assessed factors relating to minority stress were viable predictors for substance abuse, risk-taking behaviour (evaluated as HIV-risk behaviour), and depressive episodes in the context of a major life stressor (1). As an aside, it is important to note that this study was conducted before the advent of effective antiretroviral treatments (1). Current treatments available to those living with HIV can not only prevent death, but reduce the risk of HIV transmission through unprotected sex to 0% as well (2).

Participants who reported higher values of internalized homophobia engaged in unprotected sex an average of .75 more times and had an average of .11 more unprotected partners than those who reported lower values (1). For each unit increase in reported number of discrimination experiences, participants used their drug of highest use .92 times more often (1). For each unit increase in expectations of rejection, mean depression scores on the Inventory to Diagnose Depression (IDD) scale increased by 1.02 points post-loss (1). While the study revealed a positive relationship between minority risk factors and poor mental wellness, demographic variables (age, race, income, time since first coming out, nature of relationship to the men for whom they were caregivers) were found to have no significant effect on the results (1). However, 86.5 % of men in the cohort were white and the mean level of education achieved was a college degree, which reflects the limited generalizability of these results (1).

Despite its limitations, this study confirms the reliability of minority stress factors as predictors of adverse mental health, even in the context of a major life stressor. These findings reaffirm the need for medical and therapeutic interventions targeting sexual minorities to take into account the effects of these unique factors, as well as the overall need for continuing social change to eliminate them.

References

1. Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychology [Internet]. 2008 [cited 2017Nov4];27:455–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18643003
2. Senthilingam M. More evidence treatment zeroes HIV transmission during sex [Internet]. CNN. Cable News Network; 2017 [cited 2017Nov4]. Available from: http://www.cnn.com/2017/07/25/health/hiv-zero-transmission-prevention-vaccine-study/index.html