Resilience Through Relational Connection: A Relational Model to Sexual Minority Mental and Physical Health

Resilience Through Relational Connection: A Relational Model to Sexual Minority Mental and Physical Health Ethan H. Mereish Dissertation Director: V. Paul Poteat, Ph.D. Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for mental and physical health disparities than heterosexuals, and research has related some of these disparities to minority stressors such as institutional heterosexism, sexual prejudice, and discrimination. Yet, there is a dearth of research elucidating factors that predict the development of these health risks, and factors that protect and promote resiliency against them. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health disparities within a relational framework. Specifically, the study examined the mediating and moderating factors between the deleterious effects of distal stressors (i.e., heterosexist relational disconnections such as discrimination and victimization) and proximal stressors (i.e., self-disparaging relational images such as internalized homophobia, sexual orientation concealment) on mental and physical health for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test three models of: the relations between minority stressors and health; mediating effects of diminished agency, loneliness, and shame on the relations between minority stressors and health; and the moderated-mediation effects of growth-fostering relationships with peers, mentors, and community on the mediating pathways between minority stressors and health. Results indicated that heterosexist distal and proximal minority stressors predicted poor mental health (i.e., depression, anxiety, and suicidality) and physical health (i.e., SEXUAL MINORITY MENTAL AND PHYSICAL HEALTH 4 cardiovascular disease risk, distressing physical symptoms). The relations between proximal minority stressors and health were mediated by diminished sense of agency, loneliness, and shame, and there were mixed results for the relations between distal stressors and health. Although the direct effects of growth-fostering relationships were significant in predicting lower levels of diminished agency, loneliness, and shame, these factors had mixed moderating effects. Findings have research, practice, and policy implications that underscore the possible mechanisms by which sexual minority stressors lead to poor health. Researchers and practitioners need to addresses and advocate against societal forces contributing to heterosexist relational disconnections and for sexual minority health policies and research. SEXUAL MINORITY MENTAL AND PHYSICAL HEALTH 5 ACKNOWLEDGEMENTS This dissertation would not have been possible without the support, generosity, and kindness of many people and organizations. I want to express much gratitude to my dissertation chair, advisor, mentor, and friend, Dr. Paul Poteat, for his support, patience, invaluable and critical feedback, and empowering me to complete this study. I would like to acknowledge my wonderful dissertation committee members, Drs. Janet Helms, Belle Liang, and Elizabeth Sparks for their insightful suggestions and wisdom. I would like to thank my Boston College community, which includes my wonderful friends, classmates, faculty, mentors and colleagues for their support. I would like to thank my clinical training supervisors for deepening my practice and helping me use my clinical work to improve my thinking about my dissertation and research. I am also indebted to all the participants who completed my dissertation survey and provided me comments on their experience. I want to acknowledge the Lynch School of Education for their Summer Dissertation Development Grant, the American Psychological Association’s Division 44 for their Malyon-Smith Scholarship Award, and the Boston College Graduate Student Association for their Research Grant; these organizations’ generous monetary support made this project possible. Finally, I also have heartfelt and sincere gratitude to my friends, family, and mentors for offering me their love and encouragement, which kept me grounded and inspired throughout this process. Shukran! SEXUAL MINORITY MENTAL AND PHYSICAL HEALTH 6