The Role of Shame in the Sexual-Orientation Disparity in Mental Health: A Prospective Population-Based Study of Multimodal Emotional Reactions to Stigma
Abstract
Despite the prominence of shame in stigma theories, its role in explaining population-level mental-health disparities between the stigmatized and nonstigmatized has not been investigated. We assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a prospective, representative cohort of sexual-minority and heterosexual young adults in Sweden (baseline n = 2,222). Compared with heterosexuals, sexual minorities evidenced higher explicit and implicit shame, which explained sexual-orientation disparities in depression, social anxiety, and suicidal thoughts. Among sexual minorities, there was an indirect effect of shame in the association between interpersonal stigma (i.e., past-year family rejection and childhood bullying) and later experiences of adverse mental health; an indirect effect did not exist for the related construct, internalized stigma. Results suggest extending existing stigma theories to consider emotions such as shame as characteristic reactions to stigma and guide the search for treatment targets focused on reducing the mental-health sequelae of stigma.
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Author Contribution(s)
John E. Pachankis: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Supervision; Writing – original draft; Writing – review & editing.
Mark L. Hatzenbuehler: Conceptualization; Data curation; Funding acquisition; Investigation; Methodology; Project administration; Supervision; Writing – original draft; Writing – review & editing.
Daniel N. Klein: Conceptualization; Investigation; Methodology; Software; Validation; Writing – review & editing.
Richard Bränström: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Validation; Visualization; Writing – original draft; Writing – review & editing.
References
Allport G. W., Clark K., Pettigrew T. (1954). The nature of prejudice. Addison-Wesley.
Austin S. B., Jun H. J., Jackson B., Spiegelman D., Rich-Edwards J., Corliss H. L., Wright R. J. (2008). Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses’ Health Study II. Journal of Women’s Health, 17(4), 597–606. https://doi.org/10.1089/jwh.2007.0450
Bilevicius E., Single A., Bristow L. A., Foot M., Ellery M., Keough M. T., Johnson E. A. (2018). Shame mediates the relationship between depression and addictive behaviours. Addictive Behaviors, 82, 94–100. https://doi.org/10.1016/j.addbeh.2018.02.023
Blythin S. P. M., Nicholson H. L., Macintyre V. G., Dickson J. M., Fox J. R. E., Taylor P. J. (2020). Experiences of shame and guilt in anorexia and bulimia nervosa: A systematic review. Psychology and Psychotherapy, 93(1), 134–159. https://doi.org/10.1111/papt.12198
Bőthe B., Bartók R., Tóth-Király I., Reid R. C., Griffiths M. D., Demetrovics Z., Orosz G. (2018). Hypersexuality, gender, and sexual orientation: A large-scale psychometric survey study. Archives of Sexual Behavior, 47(8), 2265–2276. https://doi.org/10.1007/s10508-018-1201-z
Bränström R. (2017). Minority stress factors as mediators of sexual orientation disparities in mental health treatment: A longitudinal population-based study. Journal of Epidemiology and Community Health, 71, 446–452. https://doi.org/10.1136/jech-2016-207943
Bränström R., Fellman D., Pachankis J. (2023). Structural stigma and sexual minority victimization across 28 countries: the moderating role of gender, gender nonconformity, and socioeconomic status. Journal of interpersonal violence, 38(3–4), 3563–3585. https://doi.org/10.1037/sgd0000335
Brem M. J., Shorey R. C., Anderson S., Stuart G. L. (2017). Experiential avoidance as a mediator of the relationship between dispositional mindfulness and compulsive sexual behaviors among men in residential substance use treatment. Sexual Addiction & Compulsivity, 24(4), 257–269. https://doi.org/10.1080/10720162.2017.1365315
Brem M. J., Shorey R. C., Anderson S., Stuart G. L. (2018). Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behaviour among women in substance use treatment? Clinical Psychology & Psychotherapy, 25(5), 692–700. https://doi.org/10.1002/cpp.2300
Burke T. A., Connolly S. L., Hamilton J. L., Stange J. P., Abramson L. Y., Alloy L. B. (2016). Cognitive risk and protective factors for suicidal ideation: A two year longitudinal study in adolescence. Journal of abnormal child psychology, 44, 1145–1160. https://doi.org/10.1007/s10802-015-0104-x
Campbell D. T., Fiske D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81–105. https://doi.org/10.1037/h0046016
Cardona N. D., Madigan R. J., Sauer-Zavala S. (2022). How minority stress becomes traumatic invalidation: An emotion-focused conceptualization of minority stress in sexual and gender minority people. Clinical Psychology: Science and Practice, 29(2), 185–195. https://doi.org/10.1037/cps0000054
Chen Q., Gelman A., Tracy M., Norris F. H., Galea S. (2015). Incorporating the sampling design in weighting adjustments for panel attrition. Statistics in Medicine, 34(28), 3637–3647. https://doi.org/10.1002/sim.6618
Clark K. A., Cochran S. D., Maiolatesi A. J., Pachankis J. E. (2020). Prevalence of bullying among youth classified as LGBTQ who died by suicide as reported in the National Violent Death Reporting System, 2003-2017. JAMA Pediatrics, 174(12), 1211–1213. https://doi.org/10.1001/jamapediatrics.2020.0940
Clark K. A., Hatzenbuehler M. L., Bränström R., Pachankis J. E. (2022). Sexual orientation-related patterns of 12-month course and severity of suicidality in a longitudinal, population-based cohort of young adults in Sweden. Social Psychiatry and Psychiatric Epidemiology, 57(9), 1931–1934. https://doi.org/10.1007/s00127-022-02326-7
Cohen J. M., Norona J. C., Yadavia J. E., Borsari B. (2021). Affirmative dialectical behavior therapy skills training with sexual minority veterans. Cognitive and Behavioral Practice, 28(1), 77–91. https://doi.org/10.1016/j.cbpra.2020.05.008
Corliss H. L., Cochran S. D., Mays V. M. (2002). Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults. Child Abuse & Neglect, 26(11), 1165–1178. https://doi.org/10.1016/s0145-2134(02)00385-x
Dearing R. L., Stuewig J., Tangney J. P. (2005). On the importance of distinguishing shame from guilt: Relations to problematic alcohol and drug use. Addictive Behaviors, 30(7), 1392–1404. https://doi.org/10.1016/j.addbeh.2005.02.002
Derry P. A., Kuiper N. A. (1981). Schematic processing and self-reference in clinical depression. Journal of Abnormal Psychology, 90(4), 286–297. https://doi.org/10.1037/0021-843X.90.4.286
Diamond G. M., Diamond G. S., Levy S., Closs C., Ladipo T., Siqueland L. (2012). Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings. Psychotherapy, 49(1), 62–71. https://doi.org/10.1037/a0026247
Dickerson S. S., Gruenewald T. L., Kemeny M. E. (2004). When the social self is threatened: Shame, physiology, and health. Journal of Personality, 72(6), 1191–1216. https://doi.org/10.1111/j.1467-6494.2004.00295.x
Dobson K. S., Shaw B. F. (1987). Specificity and stability of self-referent encoding in clinical depression. Journal of Abnormal Psychology, 96(1), 34–40. https://doi.org/10.1037//0021-843x.96.1.34
Earnshaw V. A., Chaudoir S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160–1177. https://doi.org/10.1007/s10461-009-9593-3
Espelage D. L., Swearer S. M. (2003). Research on school bullying and victimization: What have we learned and where do we go from here? School Psychology Review, 32(3), 365–383. https://doi.org/10.1080/02796015.2003.12086206
Feldman M. B., Meyer I. H. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3), 218–226. https://doi.org/10.1002/eat.20360
Friedman M. S., Marshal M. P., Guadamuz T. E., Wei C., Wong C. F., Saewyc E. M., Stall R. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481–1494. https://doi.org/10.2105/ajph.2009.190009
Fruzzetti A. E., Shenk C., Hoffman P. D. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17(4), 1007–1030. https://doi.org/10.1017/s0954579405050479
Goffman E. (1963). Stigma: Notes on the management of spoiled identity. Prentice Hall.
Goldstein B. L., Hayden E. P., Klein D. N. (2015). Stability of self-referent encoding task performance and associations with change in depressive symptoms from early to middle childhood. Cognition and Emotion, 29(8), 1445–1455. https://doi.org/10.1080/02699931.2014.990358
Green K. E., Feinstein B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278. https://doi.org/10.1037/a0025424
Greene D. C., Britton P. J. (2012). Stage of sexual minority identity formation: The impact of shame, internalized homophobia, ambivalence over emotional expression, and personal mastery. Journal of Gay & Lesbian Mental Health, 16(3), 188–214. https://doi.org/10.1080/19359705.2012.671126
Harder D. W., Greenwald D. F. (1999). Further validation of the shame and guilt scales of the Harder Personal Feelings Questionnaire-2. Psychological Reports, 85(1), 271–281. https://doi.org/10.2466/pr0.1999.85.1.271
Hatzenbuehler M. L., Bränström R., Pachankis J. E. (2018). Societal-level explanations for reductions in sexual orientation mental health disparities: Results from a ten-year, population-based study in Sweden. Stigma and Health, 3(1), 16–26. https://doi.org/10.1037/sah0000066
Hatzenbuehler M. L., Keyes K. M. (2013). Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth. Journal of Adolescent Health, 53(1), S21–S26. https://doi.org/10.1016/j.jadohealth.2012.08.010
Hatzenbuehler M. L., Nolen-Hoeksema S., Dovidio J. (2009). How does stigma “get under the skin”?: The mediating role of emotion regulation. Psychological Science, 20(10), 1282–1289. https://doi.org/10.1111/j.1467-9280.2009.02441.x
Hatzenbuehler M. L., Phelan J. C., Link B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. https://doi.org/10.2105/ajph.2012.301069
Hayes A. F. (2013). Mediation, moderation, and conditional process analysis - A regression-based approach. The Guilford Press.
Herek G. M. (2009). Contemporary perspectives on lesbian, gay, and bisexual identities. Springer.
Hinshaw S. P. (2007). The mark of shame: Stigma of mental illness and an agenda for change. Oxford University Press.
International Lesbian, Gay, Bisexual, Trans, and Intersex Association. (2017). State-sponsored homophobia: A world survey of sexual orientation laws: Criminalisation, protection and recognition. https://ilga.org/map-sexual-orientation-laws-overview-2017
Kessler R. C., Amminger G. P., Aguilar-Gaxiola S., Alonso J., Lee S., Ustün T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c
Keyes K. M., Hatzenbuehler M. L., Alberti P., Narrow W. E., Grant B. F., Hasin D. S. (2008). Service utilization differences for Axis I psychiatric and substance use disorders between white and black adults. Psychiatric Services, 59(8), 893–901. https://doi.org/10.1176/ps.2008.59.8.893
Kim S., Thibodeau R., Jorgensen R. S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68–96. https://doi.org/10.1037/a0021466
Lambert H. K., King K. M., Monahan K. C., McLaughlin K. A. (2017). Differential associations of threat and deprivation with emotion regulation and cognitive control in adolescence. Development and Psychopathology, 29(3), 929–940. https://doi.org/10.1017/S0954579416000584
Landolt M. A., Bartholomew K., Saffrey C., Oram D., Perlman D. (2004). Gender nonconformity, childhood rejection, and adult attachment: A study of gay men. Archives of Sexual Behavior, 33(2), 117–128. https://doi.org/10.1023/b:aseb.0000014326.64934.50
Lefevor G. T., Larsen E. R., Golightly R. M., Landrum M. (2023). Unpacking the internalized homonegativity–health relationship: How the measurement of internalized homonegativity and health matter and the contribution of religiousness. Archives of Sexual Behavior, 52(3), 921–944. https://doi.org/10.1007/s10508-022-02436-y
Lewis R. J., Derlega V. J., Berndt A., Morris L. M., Rose S. (2002). An empirical analysis of stressors for gay men and lesbians. Journal of Homosexuality, 42(1), 63–88. https://doi.org/10.1300/j082v42n01_04
Lindner P., Martell C., Bergström J., Andersson G., Carlbring P. (2013). Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS). Health and Quality of Life Outcomes, 11, Article 209. https://doi.org/10.1186/1477-7525-11-209
Link B. G., Phelan J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363–385. https://doi.org/10.1146/annurev.soc.27.1.363
Major B., O’Brien L. T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393–421. https://doi.org/10.1146/annurev.psych.56.091103.070137
Martin J. L., Dean L. (1992). Summary of measures: Mental health effects of AIDS on at-risk homosexual men [Unpublished manuscript]. Mailman School of Public Health, Columbia University.
Mattick R. P., Clarke J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36(4), 455–470. https://doi.org/10.1016/s0005-7967(97)10031-6
McDanal R., Schleider J. L., Fox K. R., Eaton N. R. (2023). Loneliness in gender-diverse and sexual orientation–diverse adolescents: Measurement invariance analyses and between-group comparisons. Assessment, 30(3), 706–727. https://doi.org/10.1177/10731911211065167
McDermott E., Roen K., Scourfield J. (2008). Avoiding shame: Young LGBT people, homophobia and self-destructive behaviours. Culture, Health & Sexuality, 10(8), 815–829. https://doi.org/10.1080/13691050802380974
Mendoza-Denton R., Downey G., Purdie V. J., Davis A., Pietrzak J. (2002). Sensitivity to status-based rejection: Implications for African American students’ college experience. Journal of Personality and Social Psychology, 83(4), 896–918. https://doi.org/10.1037/0022-3514.83.4.896
Mereish E. H., Cox D. J., Harris J. C., Anderson Q. R., Hawthorne D. J. (2021). Emerging ideas. Familial influences, shame, guilt, and depression among sexual minority adolescents. Family Relations, 70(5), 1546–1555. https://doi.org/10.1111/fare.12514
Mereish E. H., Peters J. R., Yen S. (2019). Minority stress and relational mechanisms of suicide among sexual minorities: Subgroup differences in the associations between heterosexist victimization, shame, rejection sensitivity, and suicide risk. Suicide and Life-Threatening Behavior, 49(2), 547–560. https://doi.org/10.1111/sltb.12458
Mereish E. H., Poteat V. P. (2015). A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health. Journal of Counseling Psychology, 62(3), 425–437. https://doi.org/10.1037/cou0000088
Merriam-Webster. (n.d.). Stigma. Merriam-Webster.com dictionary. https://www.merriam-webster.com/dictionary/stigma
Meyer I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Meyer I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209–213. https://doi.org/10.1037/sgd0000132
Meyer I. H., Frost D. M., Hammack P. L., Lightfoot M., Russell S. T., Wilson B. D. M. (2016). Generations study baseline questionnaire and measure sources. Los Angeles, CA: The Williams Institute. https://static1.squarespace.com/static/54f4cc0be4b0014ec19fcbab/t/5b845e68c2241b8b623239f3/1535401577846/Generations+Study+Baseline+Questionnaire+and+Measure+Sources_WEB.pdf
Meyer I. H., Luo F., Wilson B. D., Stone D. M. (2019). Sexual orientation enumeration in state antibullying statutes in the United States: Associations with bullying, suicidal ideation, and suicide attempts among youth. LGBT Health, 6(1), 9–14. https://doi.org/10.1089/lgbt.2018.0194
Mohr J. J., Kendra M. S. (2011). Revision and extension of a multidimensional measure of sexual minority identity: The Lesbian, Gay, and Bisexual Identity Scale. Journal of Counseling Psychology, 58, 234–245. https://doi.org/10.1037/a0022858
Muthén L. K., Muthén B. O. (2017). Mplus user’s guide (8th ed.).
Newcomb M. E., Mustanski B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(8), 1019–1029. https://doi.org/10.1016/j.cpr.2010.07.003
Niedenthal P. M., Tangney J. P., Gavanski I. (1994). “If only I weren’t” versus “if only I hadn’t”: Distinguishing shame and guilt in counterfactual thinking. Journal of Personality and Social Psychology, 67(4), 585–595. https://doi.org/10.1037//0022-3514.67.4.585
Odets W. (2019). Out of the shadows: Reimagining gay men’s lives. Penguin UK.
Orcutt H. K., Reffi A. N., Ellis R. A. (2020). Experiential avoidance and PTSD. In Tull M. T., Kimbrel N. A. (Eds.), Emotion in posttraumatic stress disorder (pp. 409–436). Elsevier.
Pachankis J. E., Bränström R. (2019). How many sexual minorities are hidden? Projecting the size of the global closet with implications for policy and public health. PLOS ONE, 14(6), Article e0218084. https://doi.org/10.1371/journal.pone.0218084
Pachankis J. E., Harkness A., Maciejewski K. R., Behari K., Clark K. A., McConocha E., Winston R., Adeyinka O., Reynolds J., Bränström R., Esserman D. A., Hatzenbuehler M. L., Safren S. A. (2022). LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men’s mental and sexual health: A three-arm randomized controlled trial. Journal of Consulting and Clinical Psychology, 90(6), 459–477.
Pachankis J. E., Hatzenbuehler M. L., Bränström R., Schmidt A. J., Berg R. C., Jonas K., Pitoňák M., Baros S., Weatherburn P. (2021). Structural stigma and sexual minority men’s depression and suicidality: A multilevel examination of mechanisms and mobility across 48 countries. Journal of Abnormal Psychology, 130(7), 713–726. https://doi.org/10.1037/abn0000693
Pachankis J. E., Hatzenbuehler M. L., Wang K., Burton C. L., Crawford F. W., Phelan J. C., Link B. G. (2018). The burden of stigma on health and well-being: A taxonomy of concealment, course, disruptiveness, aesthetics, origin, and peril across 93 stigmas. Personality & Social Psychology Bulletin, 44(4), 451–474. https://doi.org/10.1177/0146167217741313
Pachankis J. E., Mahon C. P., Jackson S. D., Fetzner B. K., Bränström R. (2020). Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychological Bulletin, 146(10), 831–871. https://doi.org/10.1037/bul0000271
Pachankis J. E., McConocha E. M., Clark K. A., Wang K., Behari K., Fetzner B. K., Brisbin C. D., Scheer J. R., Lehavot K. (2020). A transdiagnostic minority stress intervention for gender diverse sexual minority women’s depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(7), 613–630. https://doi.org/10.1037/ccp0000508
Pachankis J. E., Sullivan T. J., Feinstein B. A., Newcomb M. E. (2018). Young adult gay and bisexual men’s stigma experiences and mental health: An 8-year longitudinal study. Developmental Psychology, 54, 1381–1393. https://doi.org/10.1037/dev0000518
Pachankis J. E., Williams S. L., Behari K., Job S., McConocha E. M., Chaudoir S. R. (2020). Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context. Journal of Consulting and Clinical Psychology, 88(5), 429–444. https://doi.org/10.1037/ccp0000497
Pellicane M. J., Ciesla J. A. (2022). Temporal trends in rates of depression, anxiety, and suicidality among cisgender sexual minority and heterosexual college students. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. https://doi.org/10.1037/sgd0000563
Phelan J. C., Link B. G., Dovidio J. F. (2008). Stigma and prejudice: One animal or two? Social Science & Medicine, 67(3), 358–367. https://doi.org/10.1016/j.socscimed.2008.03.022
Plöderl M., Wagenmakers E.-J., Tremblay P., Ramsay R., Kralovec K., Fartacek C., Fartacek R. (2013). Suicide risk and sexual orientation: A critical review. Archives of Sexual Behavior, 42(5), 715–727. https://doi.org/10.1007/s10508-012-0056-y
Poteat V. P., Mereish E. H., DiGiovanni C. D., Koenig B. W. (2011). The effects of general and homophobic victimization on adolescents’ psychosocial and educational concerns: The importance of intersecting identities and parent support. Journal of Counseling Psychology, 58(4), 597–609. https://doi.org/10.1037/a0025095
Prieto S. L., Cole D. A., Tageson C. W. (1992). Depressive self-schemas in clinic and nonclinic children. Cognitive Therapy and Research, 16(5), 521–534. https://doi.org/10.1007/BF01175139
Radloff L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Raifman J., Charlton B. M., Arrington-Sanders R., Chan P. A., Rusley J., Mayer K. H., Stein M. D., Austin S. B., McConnell M. (2020). Sexual orientation and suicide attempt disparities among US adolescents: 2009–2017. Pediatrics, 145(3), Article e20191658. https://doi.org/10.1542/peds.2019-1658
RAND. (n.d.). Basic guidelines for translating surveys. https://www.rand.org/health/surveys_tools/about_translations.html
Rice C. E., Vasilenko S. A., Fish J. N., Lanza S. T. (2019). Sexual minority health disparities: An examination of age-related trends across adulthood in a national cross-sectional sample. Annals of Epidemiology, 31, 20–25. https://doi.org/10.1016/j.annepidem.2019.01.001
Rizvi S. L., Fitzpatrick S. (2021). Changes in suicide and non-suicidal self-injury ideation and the moderating role of specific emotions over the course of dialectical behavior therapy. Suicide and Life-Threatening Behavior, 51(3), 429–445. https://doi.org/10.1111/sltb.12691
Rizvi S. L., Linehan M. M. (2005). The treatment of maladaptive shame in borderline personality disorder: A pilot study of “opposite action.” Cognitive and Behavioral Practice, 12(4), 437–447. https://doi.org/10.1016/S1077-7229(05)80071-9
Roberts A. L., Rosario M., Corliss H. L., Koenen K. C., Austin S. B. (2012). Childhood gender nonconformity: A risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics, 129(3), 410–417. https://doi.org/10.1542/peds.2011-1804
Rüsch N., Corrigan P. W., Todd A. R., Bodenhausen G. V. (2010). Implicit self-stigma in people with mental illness. The Journal of Nervous and Mental Disease, 198(2), 150–153. https://doi.org/10.1097/NMD.0b013e3181cc43b5
Ryan C., Huebner D., Diaz R. M., Sanchez J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352. https://doi.org/10.1542/peds.2007-3524
Sandfort T. G., de Graaf R., Bijl R. V., Schnabel P. (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58(1), 85–91. https://doi.org/10.1001/archpsyc.58.1.85
Scheer J. R., Harney P., Esposito J., Woulfe J. M. (2020). Self-reported mental and physical health symptoms and potentially traumatic events among lesbian, gay, bisexual, transgender, and queer individuals: The role of shame. Psychology of Violence, 10(2), 131–142. https://doi.org/10.1037/vio0000241
Scheff T. J. (2001). Shame and community: Social components in depression. Psychiatry: Interpersonal and Biological Processes, 64(3), 212–224. https://doi.org/10.1521/psyc.64.3.212.18457
Schibalski J. V., Mueller M., Ajdacic-Gross V., Vetter S., Rodgers S., Oexle N., Corrigan P. W., Rössler W., Ruesch N. (2017). Stigma-related stress, shame and avoidant coping reactions among members of the general population with elevated symptom levels. Comprehensive Psychiatry, 74, 224–230. https://doi.org/10.1016/j.comppsych.2017.02.001
Schmader T., Lickel B. (2006). Stigma and shame: Emotional responses to the stereotypic actions of one’s ethnic ingroup. In Levin S., van Laar C. (Eds.), Stigma and group inequality (pp. 275–300). Psychology Press.
Schope R. D., Eliason M. J. (2004). Sissies and tomboys: Gender role behaviors and homophobia. Journal of Gay & Lesbian Social Services: Issues in Practice, Policy & Research, 16(2), 73–97. https://doi.org/10.1300/J041v16n02_05
Sheridan M. A., McLaughlin K. A. (2016). Neurobiological models of the impact of adversity on education. Current Opinion in Behavioral Sciences, 10, 108–113. https://doi.org/10.1016/j.cobeha.2016.05.013
Shidlo A. (1994). Internalized homophobia: Conceptual and empirical issues in measurement. In Greene B., Herek G. M. (Eds.), Lesbian and gay psychology: Theory, research, and clinical applications (pp. 176–205). Sage. https://doi.org/10.4135/9781483326757.n10
Sznycer D., Sell A., Lieberman D. (2021). Forms and functions of the social emotions. Current Directions in Psychological Science, 30(4), 292–299. https://doi.org/10.1177/09637214211007451
Szymanski D. M., Ikizler A. S. (2013). Internalized heterosexism as a mediator in the relationship between gender role conflict, heterosexist discrimination, and depression among sexual minority men. Psychology of Men & Masculinity, 14(2), 211–219. https://doi.org/10.1037/a0027787
Tangney J. P. (1995). Shame and guilt in interpersonal relationships. In Tangney J. P. (Ed.), Self-conscious emotions: The psychology of shame, guilt, embarrassment, and pride (pp. 114–139). The Guilford Press.
Thoma B. C., Eckstrand K. L., Montano G. T., Rezeppa T. L., Marshal M. P. (2021). Gender nonconformity and minority stress among lesbian, gay, and bisexual Individuals: A meta-analytic review. Perspectives on Psychological Science, 3(4), 301–304. https://doi.org/10.1111/j.1745-6924.2008.00080.x
Tilghman-Osborne C., Cole D. A., Felton J. W., Ciesla J. A. (2008). Relation of guilt, shame, behavioral and characterological self-blame to depressive symptoms in adolescents over time. Journal of Social and Clinical Psychology, 27(8), 809–842. https://doi.org/10.1521/jscp.2008.27.8.809
Timbremont B., Braet C. (2004). Cognitive vulnerability in remitted depressed children and adolescents. Behaviour Research and Therapy, 42(4), 423–437. https://doi.org/10.1016/S0005-7967(03)00151-7
van Spijker B. A., Batterham P. J., Calear A. L., Farrer L., Christensen H., Reynolds J., Kerkhof A. J. (2014). The Suicidal Ideation Attributes Scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide and Life-Threatening Behavior, 44(4), 408–419. https://doi.org/10.1111/sltb.12084
Villarreal L., Charak R., Schmitz R. M., Hsieh C., Ford J. D. (2021). The relationship between sexual orientation outness, heterosexism, emotion dysregulation, and alcohol use among lesbian, gay, and bisexual emerging adults. Journal of Gay & Lesbian Mental Health, 25(1), 94–115. https://doi.org/10.1080/19359705.2020.1809588
Wang K., Maiolatesi A. J., Burton C. L., Scheer J. R., Pachankis J. E. (2022). Emotion regulation in context: Expressive flexibility as a stigma coping resource for sexual minority men. Psychology of Sexual Orientation and Gender Diversity, 9(2), 214–221. https://doi.org/10.1037/sgd0000503
Wild D., Grove A., Martin M., Eremenco S., McElroy S., Verjee-Lorenz A., Erikson P. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2), 94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x
Winkielman P., Berridge K. C. (2004). Unconscious emotion. Current Directions in Psychological Science, 13(3), 120–123. https://doi.org/10.1111/j.0963-7214.2004.00288.x
Wood L., Byrne R., Burke E., Enache G., Morrison A. P. (2017). The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem. Psychiatry Research, 255, 94–100. https://doi.org/10.1016/j.psychres.2017.05.016
Zajonc R. B. (2000). Feeling and thinking: Closing the debate over the independence of affect. In Forgas J. P. (Ed.), Feeling and thinking: The role of affect in social cognition (pp. 31–58). Cambridge University Press.
Zupan B. A., Hammen C., Jaenicke C. (1987). The effects of current mood and prior depressive history on self-schematic processing in children. Journal of Experimental Child Psychology, 43(1), 149–158. https://doi.org/10.1016/0022-0965(87)90056-7
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