The Indirect Effects of Proximal Stressors Associated with Posttraumatic Stress Symptoms Severity among Sexually Victimized Sexual Minority Women: A Cross-Sectional Path Analysis

Abstract

Sexual minority women (SMW) are at risk for sexual victimization and stressors specifically related to their minority identity (e.g., discrimination). However, SMW experience posttraumatic stress disorder (PTSD) at rates beyond what may be explained by elevated risk for sexual victimization alone. This study aimed to examine the impact of stigma on PTSD symptoms among SMW survivors of sexual victimization. Results indicate that in relation to minority-specific distal stressors (i.e., heterosexist experiences), both minority-specific and general proximal stressors (i.e., internalized heterosexism, negative posttraumatic cognitions) indirectly affected PTSD symptom severity among this cross-sectional sample of sexually victimized SMW.

Keywords

sexual assault sexual minority women PTSD heterosexism minority stress

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References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed).

Balsam

K. F.

Beadnell

Molina

(2013). The daily heterosexist experiences questionnaire: Measuring minority stress among lesbian, gay, bisexual, and transgender adults. Measurement and Evaluation in Counseling and Development, 46(1), 3–25. https://doi.org/10.1177/0748175612449743

Bisexual Resource Center (2018). What it means to be a b(ee): Bi + 101 [Brochure]. https://biresource.org/wp-content/uploads/2019/02/Bi-101-Brochure.pdf.

Blevins

C. E.

Marsh

E. L.

Stein

M. D.

Schatten

H. T.

Abrantes

A. M.

(2020). Project CHOICE: Choosing healthy options in coping with emotions, an EMA/EMI plus in-person intervention for alcohol use. Substance Abuse, 1–8. https://doi.org/10.1080/08897077.2020.1806182

Bostwick

W. B.

Boyd

C. J.

Hughes

T. L.

West

(2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. The American Journal of Orthopsychiatry, 84(1), 35–45. https://doi.org/10.1037/h0098851

Browne

M. W.

Cudeck

(1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21(2), 230–258. https://doi.org/10.1177/0049124192021002005

Cecil

Matson

S. C.

(2006). Sexual victimization among African American adolescent females: Examination of the reliability and validity of the sexual experiences survey. Journal of Interpersonal Violence, 21(1), 89–104. https://doi.org/10.1177/0886260505281606

Dworkin

E. R.

Gilmore

A. K.

Bedard-Gilligan

Lehavot

Guttmannova

Kaysen

(2018). Predicting PTSD severity from experiences of trauma and heterosexism in lesbian and bisexual women: A longitudinal study of cognitive mediators. Journal of Counseling Psychology, 65(3), 324–333. https://doi.org/10.1037/cou0000287

Dworkin

E. R.

Weaver

(2020). The impact of sociocultural contexts on mental health following sexual violence: A conceptual model. Psychology of Violence, 11(5), 476–487. https://doi.org/10.1037/vio0000350

10.

Ehlers

Clark

D. M.

(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0

11.

Feinstein

B. A.

Goldfried

M. R.

Davila

(2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80(5), 917–927. https://doi.org/10.1037/a0029425

12.

Flood

Pease

(2006). The Factors Influencing Community Attitudes in Relation to Violence Against Women: A Critical Review of the Literature. VicHealth.

13.

Foa

E. B.

Ehlers

Clark

D. M.

Tolin

D. F.

Orsillo

S. M.

(1999). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological Assessment, 11(3), 303–314. https://doi.org/10.1037/1040-3590.11.3.303

14.

Foa

E. B.

Rauch

S. A.

(2004). Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 72(5), 879–884. https://doi.org/10.1037/0022-006X.72.5.879

15.

Gold

S. D.

Dickstein

B. D.

Marx

B. P.

Lexington

J. M.

(2009). Psychological outcomes among lesbian sexual assault survivors: An examination of the roles of internalized homophobia and experiential avoidance. Psychology of Women Quarterly, 33(1), 54–66. https://doi.org/10.1111/j.1471-6402.2008.01474.x

16.

Gray

M. J.

Litz

B. T.

Hsu

J. L.

Lombardo

T. W.

(2004). Psychometric properties of the life events checklist. Assessment, 11(4), 330–341. https://doi.org/10.1177/1073191104269954

17.

Hatzenbuehler

M. L.

(2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441

18.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

19.

Katz-Wise

S. L.

Hyde

J. S.

(2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. The Journal of Sex Research, 49(2/3), 142–167. https://doi.org/10.1080/00224499.2011.637247

20.

Koss

M. P.

Abbey

Campbell

Cook

Norris

Testa

Ullman

West

White

(2007). Revising the SES: A collaborative process to improve assessment of sexual aggression and victimization. Psychology of Women Quarterly, 31(4), 357–370. https://doi.org/10.1111/j.1471-6402.2007.00385.x

21.

Lehavot

Simoni

J. M.

(2011). The impact of minority stress on mental health and substance use among sexual minority women. Journal of Consulting and Clinical Psychology, 79(2), 159–170. https://doi.org/10.1037/a0022839

22.

Łyś

A. E.

Bargiel-Matusiewicz

Krasuski

Studzińska

(2021). Psychometric properties of the polish updated Illinois rape myth acceptance scale. Current Psychology. https://doi.org/10.1007/s12144-020-01249-3

23.

MacCallum

R. C.

Browne

M. W.

Sugawara

H. M.

(1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149. https://doi.org/10.1037/1082-989X.1.2.130

24.

Maercker

Horn

A. B.

(2013). A socio-interpersonal perspective on PTSD: The case for environments and interpersonal processes: Socio-interpersonal perspective on PTSD. Clinical Psychology & Psychotherapy, 20(6), 465–481. https://doi.org/10.1002/cpp.1805

25.

Major

Kaiser

C. R.

McCoy

S. K.

(2003). It’s not my fault: When and why attributions to prejudice protect self-esteem. Personality & Social Psychology Bulletin, 29(6), 772–781. https://doi.org/10.1177/0146167203029006009

26.

Mcmahon

Farmer

(2011). An updated measure for assessing subtle rape myths. Social Work Research, 35, 71–81. https://doi.org/10.1093/swr/35.2.71

27.

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

28.

Mohr

J. J.

Kendra

M. S.

(2012). Revision and extension of a multidimensional measure of sexual minority identity: The Lesbian, Gay, and Bisexual Identity Scale. Journal of Counseling Psychology, 58(2), 234–245. https://doi.org/10.1037/a0022858

29.

Newins

A. R.

Wilson

L. C.

Kanefsky

(2021). Does sexual orientation moderate the relationship between posttraumatic cognitions and mental health outcomes following sexual assault? Psychology & Sexuality, 12(1–2), 115–128. https://doi.org/10.1080/19419899.2020.1729846

30.

Pantalone

D. W.

Valentine

S. E.

Shipherd

J. C.

(2017 (Eds.)Working with survivors of trauma in the sexual minority and transgender and gender nonconforming populations. In K. A. DeBord, A. R. Fischer, K. J. Bieschke, & R. M. Perez (Eds.), Handbook of sexual orientation and gender diversity in counseling and psychotherapy (pp. 183–211). American Psychological Association. https://doi.org/10.1037/15959-008

31.

Paul

L. A.

Gray

M. J.

Elhai

J. D.

Davis

J. L.

(2009). Perceptions of peer rape myth acceptance and disclosure in a sample of college sexual assault survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 1(3), 231–241. https://doi.org/10.1037/a0016989

32.

Peer

Brandimarte

Samat

Acquisti

(2017). Beyond the Turk: Alternative platforms for crowdsourcing behavioral research. Journal of Experimental Social Psychology, 70, 153–163. https://doi.org/10.1016/j.jesp.2017.01.006

33.

Plöderl

Tremblay

(2015). Mental health of sexual minorities: A systematic review. International Review of Psychiatry, 27(5), 367–385. https://doi.org/10.3109/09540261.2015.1083949

34.

R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/

35.

Roberts

A. L.

Austin

S. B.

Corliss

H. L.

Vandermorris

A. K.

Koenen

K. C.

(2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100(12), 2433–2441. https://doi.org/10.2105/AJPH.2009.168971

36.

Robinson

J. L.

Rubin

L. J.

(2016). Homonegative microaggressions and posttraumatic stress symptoms. Journal of Gay & Lesbian Mental Health, 20(1), 57–69. https://doi.org/10.1080/19359705.2015.1066729

37.

Rosseel

(2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02

38.

Schwendinger

J. R.

Schwendinger

(1974). Rape myths: In legal, theoretical, and everyday practice. Crime and Social Justice, 1, 18–26.

39.

Szymanski

D. M.

Balsam

K. F.

(2011). Insidious trauma: Examining the relationship between heterosexism and lesbians’ PTSD symptoms. Traumatology, 17(2), 4–13. https://doi.org/10.1177/1534765609358464

40.

Szymanski

D. M.

Kashubeck-West

Meyer

(2008). Internalized heterosexism: A historical and theoretical overview. The Counseling Psychologist, 36(4), 510–524. https://doi.org/10.1177/0011000007309488

41.

Szymanski

D. M.

Mikorski

(2016). External and internalized heterosexism, meaning in life, and psychological distress. Psychology of Sexual Orientation and Gender Diversity, 3(3), 265–274. https://doi.org/10.1037/sgd0000182

42.

Walters

M. L.

Chen

Breiding

M. J.

(2013). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 findings on victimization by sexual orientation. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

43.

Weathers

F. W.

Blake

D. D.

Schnurr

P. P.

Kaloupek

D. G.

Marx

B. P.

Keane

T. M.

(2013). The Life Events Checklist for DSM-5 (LEC-5) – Standard. [Measurement instrument]. https://www.ptsd.va.gov/.

44.

Weiss

B. J.

Garvert

D. W.

Cloitre

(2015). PTSD and trauma-related difficulties in sexual minority women: The impact of perceived social support. Journal of Traumatic Stress, 28(6), 563–571. https://doi.org/10.1002/jts.22061