Minority stress describes high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status; well understood causes of minority stress are interpersonal prejudice and discrimination. Indeed, numerous scientific studies have shown that when minority individuals experience a high degree of prejudice, this can cause stress responses (e.g., high blood pressure, anxiety) that accrue over time, eventually leading to poor mental and physical health.Meyer, I. H., & Northridge, M. E. (Eds.). (2007). The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual and transgender populations. New York: Springer. Minority stress theory summarizes these scientific studies to explain how difficult social situations lead to chronic stress and poor health among minority individuals.
Theoretical development Emergence Over the past three decades, social scientists have found that minority individuals suffer from mental and physical health disparities compared to their peers in majority groups. This research has focused primarily on racial and sexual minorities. For example, Black Americans have been found to suffer elevated rates of hypertension compared to whites.McNeilly, M., Anderson, N. B., Robinson, E. F., McManus, C. F., Armstead, C. A., Clark, R., Pieper, C. F., Simons, C, & Saulter, T. D. (1996). The convergent, discriminant, and concurrent criterion validity of the perceived racism scale: A multidimensional assessment of White racism among African Americans. In R. L. Jones (Ed.), Handbook of tests and measurements for Black populations (Vol. 2, pp. 359-374). Hampton: Cobb and Henry. Lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals face higher rates of suicide, substance abuse, and cancer relative to non-queer people.Bowen, D. J., Boehmer, U., & Russo, M. (2003). Cancer and sexual minority women. In I. H. Meyer and M. E. Northridge (Eds.), The Health of Sexual Minorities. Washington, DC: APA. More recent data suggest the association of minority stressors with higher rates of migraine headaches, stroke, and functional neurological disorder among LGBTQ+ people. Newer hypotheses propose that intersections of multiple minority stigmata increase experiences of stress. Researchers have also suggested that the LGBTQ+ community itself may be a source of minority stress for sexual minority men.
Social selection hypothesis One causal explanation for minority health disparities is the social selection hypothesis, which holds that there is something inherent to being in a minority group (e.g., genetics) that makes individuals susceptible to health problems. In general, this view has not been supported by empirical research. Instead, research suggests that environmental factors explain minority health disparities better than do genetic factors. While the social selection hypothesis is still debated, it is clear that genetic and dispositional factors do not fully explain the health disparities observed in minority groups.
Social causation hypothesis A second hypothesis regarding the causes of minority health disparities suggests that minority group members face difficult social situations that lead to poor health. This hypothesis has received broad empirical support. Indeed, social psychologists have long recognized that minority individuals have different social experiences compared to majority individuals, including prejudice and discrimination, unequal socioeconomic status, and limited access to health care.Allport, G. W. (1954). The nature of prejudice. New York: Anchor. According to the social causation hypothesis, such difficult social experiences explain health differences between minority and majority individuals.
Overview of minority stress theory Minority stress theory extends the social causation hypothesis by suggesting that social situations do not lead directly to poor health for minority individuals, but that difficult social situations cause stress for minority individuals, which accrues over time, resulting in long-term health deficits.Meyer, I. H. (2007). Prejudice and discrimination as social stressors. In I. H. Meyer and M. E. Northridge (Eds.), The Health of Sexual Minorities. Washington, DC: APA.
When being applied to sexual and gender minorities, the term minority stress first appeared in the 1981 book Minority Stress in Lesbian Women by Virginia Rae Brooks, later known as Winn Kelly Brooks.
Minority Stress Theory, as it is currently referenced, was coined by Illan Meyer in his 1995 research study "Minority stress and mental health in gay men.". Meyer's version of minority stress theory distinguishes between distal and proximal stress processes. Distal stress processes are external to the minority individual, including experiences with rejection, prejudice, and discrimination. Proximal stress processes are internal, and are often the byproduct of distal stressors; they include concealment of one's minority identity, vigilance and anxiety about prejudice, and negative feelings about one's own minority group. Together, distal and proximal stressors accrue over time, leading to chronically high levels of stress that cause poor health outcomes. Thus, minority stress theory has three primary tenets:
Minority status leads to increased exposure to distal stressors. Minority status leads to increased exposure to proximal stressors, due to distal stressors. Minority individuals suffer adverse health outcomes, which are caused by exposure to proximal and distal stressors.
These three tenets of the minority stress theory have been tested in over 134 empirical studies, most of which examined racial and sexual minority populations. Generally, the studies have confirmed that difficult social situations are associated with stress among minority individuals, and that minority stress helps to explain health disparities.
Evidence of key concepts Minority status and distal stressors
The first tenet of minority stress theory holds that being in a minority group is associated with increased exposure to distal stressors, such as prejudice and discrimination. Indeed, despite significant improvement over the past several decades, numerous studies have confirmed that minority individuals continue to face high rates of distal stressors. For example, in large-scale national surveys, LGBTQ+ individuals report high rates of prejudice and discrimination across the lifespan.Herek, G. M., & Berrill, K. T. (1992). Hate crimes: Confronting violence against lesbian and gay men. Thousand Oaks, CA: Sage.Human Rights Watch. (2001). Hatred in the hallways: Violence and discrimination against lesbian, gay, bisexual, and transgender students in U.S. schools. New York: Human Rights Watch.Safe Schools Coalition of Washington. (1999). Eighty-three thousand youth: Selected findings of eight population-based studies as they pertain to anti-gay harassment and the safety and well-being of sexual minority students. Seattle: Safe Schools Coalition of Washington. One survey found that one-fourth of LGBT adults have experienced victimization related to their sexual orientation, and another found that as many as 90% of LGBTQ+ youth report hearing prejudiced remarks at school.GLSEN. (1999). GLSEN's national school climate survey: Lesbian, gay, bisexual and transgender students and their experiences in school. New York: GLSEN. Similarly, up to 60% of African Americans report experiencing distal stressors throughout their lives, ranging from social rejection at school to housing discrimination and employment discrimination.Sigelman, L., & Welch, S. (1991). Black Americans' views of racial inequality: The dream deferred. New York: Cambridge University Press.Yinger, J. (1995). Closed doors, opportunities lost: The continuing costs of housing discrimination. New York: Sage.Kirschenman, J., & Neckerman, K. M. (1991). We'd love to hire them, but... The meaning of race for employers. In C. Jenkins & P. E. Peterson (Eds.), The urban underclass (pp. 203-232). Washington, DC: Brookings Institution. In one study, 37 African American respondents recalled over 100 discrete experiences with racist prejudice in a two-year period. In another study, 98% of Black participants reported experiencing at least one incidence of prejudice in the past year.
Rates of exposure to distal stressors are much higher among racial and sexual minorities than among majority individuals. For example, LGBTQ+ adults are twice as likely to recall experiencing prejudice throughout their lives compared to heterosexuals, and LGBTQ+ youth report significantly higher rates of prejudice and discrimination compared to their heterosexual and cisgender peers. In one carefully controlled study, researchers compared rates of victimization among LGBTQ+ youth and their heterosexual siblings, and they found significantly higher rates of abuse among the LGBTQ+ individuals. Comparing rates of perceived discrimination among African American and White individuals, researchers have found large differences in reports of discrimination: 30.9% of Whites reported experiencing "major discrimination" throughout their lives compared to 48.9% of African Americans. Similarly, 3.4% of Whites reported experiencing discrimination "often" in their lives, compared to 24.8% of African Americans. Thus, collectively, research suggests that minority individuals face frequent exposure to distal stressors compared to their majority group counterparts.Bell, D. (1992). Faces at the bottom of the well: The permanence of racism. New York: Basic Books.Dovidio, J. F. and Gaertner, S.L. (Eds.) (1986) Prejudice, discrimination and racism. New York: Academic Press.
Minority status and proximal stressors Proximal stressors are internal processes that are presumed to occur following exposure to distal stressors. Examples of proximal stressors include fear of rejection, rumination on previous experiences with prejudice, and distaste for one's own minority group following a prejudice event. Most research on this topic focuses on either sexual minorities or African Americans, and it is unclear whether the proximal stress processes are conceptually similar between these two groups. Thus, it is necessary to review proximal stress processes separately for sexual minority and African American populations.
Proximal stressors among sexual minorities