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Impact of Stress and Strain on Current LGBT Health Disparities

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Trauma, Resilience, and Health Promotion in LGBT Patients

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) individuals experience chronic stress, or “minority stress,” that increases the risk of developing poor psychological, physical, and behavioral health outcomes. In addition to demonstrating the multifaceted impact of minority stress on health, recent research has outlined underlying psychological mechanisms by which stigma-related stressors are associated with negative health outcomes. To date, however, little is known about these underlying physiological mechanisms or how stress biomarkers may function clinically to mediate/moderate the relationship between stigma and health outcomes among LGBT individuals. One biomarker, the stress hormone cortisol, is believed to play an important role in the experience of minority stress. When individuals experience chronic stress, as in the experience of minority stress, cortisol exerts significant strain on multiple biological systems known as allostatic load. This chapter aims to provide healthcare providers with an understanding of allostatic load and the mechanisms underlying its impact on interconnected biological systems in the context of a growing body of research addressing the psychological and behavioral effects of minority stress experienced by LGBT individuals. Also outlined are implications for public policy reform and community advocacy, as well as strategies healthcare providers can use to help LGBT clients manage the effects of minority stress and foster resilience.

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References

  1. IOM. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: The National Academies Press; 2011.

    Google Scholar 

  2. Beauchamp D. Sexual orientation and victimization, 2004. In: Statistics CCfJ, editor. . Ottawa: Statistics Canada. p. 2004.

    Google Scholar 

  3. Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001;91(11):1869–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. National Coalition of Anti-Violence Programs. 2013 report on lesbian, gay, bisexual, transgender, queen and HIV-affected hate violence. 2014. Accessed 6 April 2017. Available at: http://www.avp.org/storage/documents/2013_ncavp_hvreport_final.pdf.

  5. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.

    Article  CAS  PubMed  Google Scholar 

  6. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Grossman AH, D’Augelli AR, Hershberger SL. Social support networks of lesbian, gay, and bisexual adults 60 years of age and older. J Gerentol. 1999;55:171–9.

    Article  Google Scholar 

  8. Meyer IH. Prejudice and discrimination as social stressors. In: Meyer IH, Northridge ME, editors. The health of sexual minorities: public health perspectives on lesbian, gay, bisexual, and transgender populations. New York: Springer; 2007. p. 242–67.

    Chapter  Google Scholar 

  9. Abercrombie HC, Speck NS, Monticelli RM. Endogenous cortisol elevations are related to memory facilitation only in individuals who are emotionally aroused. Psychoneuroendocrinology. 2006;31(2):187–96.

    Article  CAS  PubMed  Google Scholar 

  10. Bjorkman M, Malterud K. Lesbian women coping with challenges of minority stress: a qualitative study. Scand J Public Health. 2012;40(3):239–44.

    Article  PubMed  Google Scholar 

  11. Frost DM, Lehavot K, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med. 2015;38(1):1–8.

    Article  PubMed  Google Scholar 

  12. Lingiardi V, Baiocco R, Nardell N. Measures of internalized sexual stigma for lesbians and gay men: a new scale. J Homosex. 2012;59:1191–210.

    Article  PubMed  Google Scholar 

  13. Mason TB, Lewis RJ. Minority stress and binge eating among lesbian and bisexual women. J Homosex. 2015;62(7):971–92.

    Article  PubMed  Google Scholar 

  14. Szymanski DM, Chung YB. The lesbian internalized homophobia scale: a rational/theoretical approach. J Homosex. 2001;41(2):37–52.

    Article  CAS  PubMed  Google Scholar 

  15. Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943–51.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gamarel KE, Reisner SL, Laurenceau JP, Nemoto T, Operario D. Gender minority stress, mental health, and relationship quality: a dyadic investigation of transgender women and their cisgender male partners. J Fam Psychol. 2014;28(4):437–47.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stuenkel D, Wong V. “Stigma” 8thChronic illness: Impact and interventions. 2013.

    Google Scholar 

  18. Stueknel DL, Wong VK. Stigma. In: Larsen PD, Lubkin IM, editors. Chronic illness: impact and intervention. Boston: Jones and Bartlett; 2009.

    Google Scholar 

  19. Herek GM, Chopp R, Strohl D. Sexual stigma: putting sexual minority health issues in context. In: Meyer IH, Northridge ME, editors. The health of sexual minorities: public health perspectives on lesbian, gay, bisexual, and transgender populations. New York: Springer Science and Business Media; 2007. p. 171–208.

    Chapter  Google Scholar 

  20. Weiss JM. GL vs. BT: the archaeology of biphobia and trans-phobia within the U.S. gay and lesbian community. J Bisexuality. 2004;3:25–55.

    Article  Google Scholar 

  21. Worthen M. An argument for separate analyses of attitudes towards lesbian, gay, and bisexual women, MtF and Ftm transgender individuals. Sex Roles. 2013;68:703–23.

    Article  Google Scholar 

  22. Warriner K, Nagoshi CT, Nagoshi JL. Correlates of homophobia, transphobia, and internalized homophobia in gay or lesbian and heterosexual samples. J Homosex. 2013;60:1297–314.

    Article  PubMed  Google Scholar 

  23. Hatzenbuehler ML. How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychol Bull. 2009;135(5):707–30.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Levine S. Developmental determinants of sensitivity and resistance to stress. Psychoneuroendocrinology. 2005;30(10):939–46.

    Article  PubMed  Google Scholar 

  25. Levine S, Ursin H. What is stress? In: Brown MR, Koob GF, Rivier C, editors. Stress neurobiology and neuroendocrinology. New York: Marcel Dekker; 1991. p. 3–21.

    Google Scholar 

  26. Dickerson SS, Kemeny ME. Acute stressors and cortisol reactivity: a meta-analytic review. Psychosom Med. 2002;54:105–23.

    Google Scholar 

  27. Lupien SJ, Ouelle-Morin, I., Hupback, A., Walker, D., Tu, M.T., Buss, C., Pruessner, J, McEwen, B.S. Beyond the stress concept: allostatic load – a developmental biological and cognitive perspective. In: Cicchetti D, editor. Handbook series on developmental psychopathology. Wisconsin 2006. p. 784–809.

    Google Scholar 

  28. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev. 2000;21(1):55–89.

    CAS  PubMed  Google Scholar 

  29. McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine. Horm Behav. 2003;43:2–15.

    Article  PubMed  Google Scholar 

  30. McEwen BS, Weiss JM, Schwartz LS. Selective retention of corticosterone by limbic structures in rat brain. Nature. 1968;220(5170):911–2.

    Article  CAS  PubMed  Google Scholar 

  31. Gray TS, Bingaman EW. The amygdala: corticotropin-releasing factor, steroids, and stress. Crit Rev Neurobiol. 1996;10(2):155–68.

    Article  CAS  PubMed  Google Scholar 

  32. Reul JM, de Kloet ER. Two receptor systems for corticosterone in rat brain: microdistribution and differential occupation. Endocrinology. 1985;117(6):2505–11.

    Article  CAS  PubMed  Google Scholar 

  33. Sanchez MM, Young LJ, Plotsky PM, Insel TR. Distribution of corticosteroid receptors in the rhesus brain: relative absence of glucocorticoid receptors in the hippocampal formation. J Neurosci. 2000;20(12):4657–68.

    CAS  PubMed  Google Scholar 

  34. Thayer JF, Lane RD. Claude Bernard and the heart-brain connection: further elaboration of a model of neurovisceral integration. Neurosci Biobehav Rev. 2009;33(2):81–8.

    Article  PubMed  Google Scholar 

  35. McEwen BS. Protection and damage from acute and chronic stress: allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Ann N Y Acad Sci. 2004;1032:1–7.

    Article  PubMed  Google Scholar 

  36. Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10(6):434–45.

    Article  CAS  PubMed  Google Scholar 

  37. Gould E, McEwen BS, Tanapat P, Galea LA, Fuchs E. Neurogenesis in the dentate gyrus of the adult tree shrew is regulated by psychosocial stress and NMDA receptor activation. J Neurosci. 1997;17(7):2492–8.

    CAS  PubMed  Google Scholar 

  38. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171–9.

    Article  CAS  PubMed  Google Scholar 

  39. Herek GM. Sexual stigma and sexual prejudice in the United States: a conceptual framework. In: Hope DA, editor. Contemporary perspectives on lesbian, gay, and bisexual identities. New York: Springer Science + Business Media; 2009. p. 65–111.

    Chapter  Google Scholar 

  40. Huebner DM, Davis MC. Gay and bisexual men who disclose their sexual orientations in the workplace have higher workday levels of salivary cortisol and negative affect. Ann Behav Med. 2005;30(3):260–7.

    Article  PubMed  Google Scholar 

  41. Leserman J, Petitto JM, Golden RN, Gaynes BN, Gu H, Perkins DO, et al. Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. Am J Psychiatry. 2000;157(8):1221–8.

    Article  CAS  PubMed  Google Scholar 

  42. Kertzner RM, Goetz R, Todak G, Cooper T, Lin SH, Reddy MM, et al. Cortisol levels, immune status, and mood in homosexual men with and without HIV infection. Am J Psychiatry. 1993;150(11):1674–8.

    Article  CAS  PubMed  Google Scholar 

  43. Hengge UR, Reimann G, Schafer A, Goos M. HIV-positive men differ in immunologic but not catecholamine response to an acute psychological stressor. Psychoneuroendocrinology. 2003;28(5):643–56.

    Article  CAS  PubMed  Google Scholar 

  44. Greeson JM, Hurwitz BE, Llabre MM, Schneiderman N, Penedo FJ, Klimas NG. Psychological distress, killer lymphocytes and disease severity in HIV/AIDS. Brain Behav Immun. 2008;22(6):901–11.

    Article  CAS  PubMed  Google Scholar 

  45. Antoni MH, Schneiderman N, Klimas N, LaPerriere A, Ironson G, Fletcher MA. Disparities in psychological, neuroendocrine, and immunologic patterns in asymptomatic HIV-1 seropositive and seronegative gay men. Biol Psychiatry. 1991;29(10):1023–41.

    Article  CAS  PubMed  Google Scholar 

  46. Gorman JM, Kertzner R, Cooper T, Goetz RR, Lagomasino I, Novacenko H, et al. Glucocorticoid level and neuropsychiatric symptoms in homosexual men with HIV infection. Am J Psychiatry. 1991;148(1):41–5.

    Article  CAS  PubMed  Google Scholar 

  47. Manuck SB. Cardiovascular reactivity in cardiovascular disease: "once more unto the breach". Int J Behav Med. 1994;1(1):4–31.

    Article  CAS  PubMed  Google Scholar 

  48. Lovallo WR. Cardiovascular responses to stress and disease outcomes: a test of the reactivity hypothesis. Hypertension. 2010;55(4):842–3.

    Article  CAS  PubMed  Google Scholar 

  49. Lovallo WR, Gerin W. Psychophysiological reactivity: mechanisms and pathways to cardiovascular disease. Psychosom Med. 2003;65(1):36–45.

    Article  PubMed  Google Scholar 

  50. Brosschot JF, Pieper S, Thayer JF. Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology. 2005;30(10):1043–9.

    Article  PubMed  Google Scholar 

  51. Brosschot JF. Markers of chronic stress: prolonged physiological activation and (un)conscious perseverative cognition. Neurosci Biobehav Rev. 2010;35(1):46–50.

    Article  PubMed  Google Scholar 

  52. Rutledge T, Linden W, Paul D. Cardiovascular recovery from acute laboratory stress: reliability and concurrent validity. Psychosom Med. 2000;62(5):648–54.

    Article  CAS  PubMed  Google Scholar 

  53. Earle TL, Linden W, Weinberg J. Differential effects of harassment on cardiovascular and salivary cortisol stress reactivity and recovery in women and men. J Psychosom Res. 1999;46(2):125–41.

    Article  CAS  PubMed  Google Scholar 

  54. Linden W, Earle TL, Gerin W, Christenfeld N. Physiological stress reactivity and recovery: conceptual siblings separated at birth? J Psychosom Res. 1997;42(2):117–35.

    Article  CAS  PubMed  Google Scholar 

  55. Stewart JG, Mazurka R, Bond L, Wynne-Edwards KE, Harkness KL. Rumination and impaired cortisol recovery following a social stressor in adolescent depression. J Abnorm Child Psychol. 2013;41(7):1015–26.

    Article  PubMed  Google Scholar 

  56. Hatzenbuehler ML, McLaughlin KA, Nolen-Hoeksema S. Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. J Child Psychol Psychiatry. 2008;49(12):1270–8.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Hatzenbuehler ML, Nolen-Hoeksema S, Dovidio J. How does stigma “get under the skin”?: the mediating role of emotion regulation. Psychol Sci. 2009;20(10):1282–9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Brondolo E, Monge A, Agosta J, Tobin JN, Cassells A, Stanton C, et al. Perceived ethnic discrimination and cigarette smoking: examining the moderating effects of race/ethnicity and gender in a sample of Black and Latino urban adults. J Behav Med. 2015;38(4):689–700.

    Article  PubMed  Google Scholar 

  59. Hatzenbuehler, M.L. and McLaughlin, K.A., 2014. Structural stigma and hypothalamic–pituitary–adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Ann Behav Med, 47(1), pp.39–47.

    Google Scholar 

  60. Fries E, Hesse J, Hellhammer J, Hellhammer DH. A new view on hypocortisolism. Psychoneuroendocrinology. 2005;30(10):1010–6.

    Article  CAS  PubMed  Google Scholar 

  61. Juster RP, Hatzenbuehler ML, Mendrek A, Pfaus JG, Smith NG, Johnson PJ, et al. Sexual orientation modulates endocrine stress reactivity. Biol Psychiatry. 2015;77(7):668–76.

    Article  CAS  PubMed  Google Scholar 

  62. Kirschbaum C, Wust S, Hellhammer D. Consistent sex differences in cortisol responses to psychological stress. Psychosom Med. 1992;54(6):648–57.

    Article  CAS  PubMed  Google Scholar 

  63. Hatzenbuehler ML, McLaughlin KA. Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Ann Behav Med. 2013;47:39–47.

    Article  Google Scholar 

  64. Gunnar MR, Frenn K, Wewerka SS, Van Ryzin MJ. Moderate versus severe early life stress: associations with stress reactivity and regulation in 10–12-year-old children. Psychoneuroendocrinology. 2009;34(1):62–75.

    Article  PubMed  Google Scholar 

  65. MacMillan HL, Georgiades K, Duku EK, Shea A, Steiner M, Niec A, et al. Cortisol response to stress in female youths exposed to childhood maltreatment: results of the youth mood project. Biol Psychiatry. 2009;66(1):62–8.

    Article  PubMed  Google Scholar 

  66. Yehuda R, Halligan SL, Golier JA, Grossman R, Bierer LM. Effects of trauma exposure on the cortisol response to dexamethasone administration in PTSD and major depressive disorder. Psychoneuroendocrinology. 2004;29(3):389–404.

    Article  CAS  PubMed  Google Scholar 

  67. Pruessner JC, Wolf OT, Hellhammer DH, Buske-Kirschbaum A, von Auer K, Jobst S, et al. Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity. Life Sci. 1997;61(26):2539–49.

    Article  CAS  PubMed  Google Scholar 

  68. Clow A, Hucklebridge F, Stalder T, Evans P, Thorn L. The cortisol awakening response: more than a measure of HPA axis function. Neurosci Biobehav Rev. 2010;35(1):97–103.

    Article  CAS  PubMed  Google Scholar 

  69. Loucks E, Juster RP, Pruessner JC. Neuroendocrine biomarkers, allostatic load, and the challenge of measurement: a commentary on Gersten. Soc Sci Med. 2008;66:525–30.

    Article  Google Scholar 

  70. Chida Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol. 2009;80(3):265–78.

    Article  PubMed  Google Scholar 

  71. Marchand A, Juster RP, Durand P, Lupien SJ. Burnout symptom sub-types and cortisol profiles: what’s burning most? Psychoneuroendocrinology. 2014;40:27–36.

    Article  CAS  PubMed  Google Scholar 

  72. Juster RP, Sindi S, Marin MF, Perna A, Hashemi A, Pruessner JC, et al. A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers. Psychoneuroendocrinology. 2011;36(6):797–805.

    Article  CAS  PubMed  Google Scholar 

  73. Muhtz C, Zyriax BC, Klahn T, Windler E, Otte C. Depressive symptoms and metabolic risk: effects of cortisol and gender. Psychoneuroendocrinology. 2009;34(7):1004–11.

    Article  CAS  PubMed  Google Scholar 

  74. Deuschle M, Schweiger U, Weber B, Gotthardt U, Korner A, Schmider J, et al. Diurnal activity and pulsatility of the hypothalamus-pituitary-adrenal system in male depressed patients and healthy controls. J Clin Endocrinol Metab. 1997;82(1):234–8.

    Article  CAS  PubMed  Google Scholar 

  75. Benibgui M. Mental health challenges and resilience in lesbian, gay, and bisexual young adults: biological and psychological internalization of minority stress and victimization. Montreal: Concordia University; 2010.

    Google Scholar 

  76. Tejeda M. Nondiscrimination policies and sexual identity disclosure: do they make a difference in employee outcomes? Empl Responsib Rights J. 2006;18(1):45–59.

    Article  Google Scholar 

  77. Juster RP, Smith NG, Ouellet E, Sindi S, Lupien SJ. Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosom Med. 2013;75(2):103–16.

    Article  PubMed  Google Scholar 

  78. Sterling P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fisher S, Reason J, editors. Handbook of life stress, cognition and health. New York: Wiley; 1988. p. 629–49.

    Google Scholar 

  79. Cicchetti D. Annual Research Review: resilient functioning in maltreated children – past, present, and future perspectives. J Child Psychol Psychiatry. 2013;54(4):402–22.

    Article  PubMed  Google Scholar 

  80. McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993;153(18):2093–101.

    Article  CAS  PubMed  Google Scholar 

  81. Juster RP, Bizik G, Picard M, Arsenault-Lapierre G, Sindi S, Trepanier L, et al. A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development. Dev Psychopathol. 2011;23(3):725–76.

    Article  PubMed  Google Scholar 

  82. Seeman E, Singer BH, Rowe J, Horwitz RI, McEwen B. Price of adaptation – allostatic load and its health consequences. Arch Intern Med. 1997;157:2259–68.

    Article  CAS  PubMed  Google Scholar 

  83. Singer B, Ryff CD, Seeman T. Operationalizing allostatic load. In: Schulkin J, editor. Allostasis, homeostasis, and the costs of psychological adaptation. New York: Cambridge University Press; 2004. p. 113–49.

    Chapter  Google Scholar 

  84. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev. 2010;35(1):2–16.

    Article  PubMed  Google Scholar 

  85. Juster RP, Ouellet E, Lefebvre-Louis JP, Sindi S, Johnson PJ, Smith NG, et al. Retrospective coping strategies during sexual identity formation and current biopsychosocial stress. Anxiety Stress Coping. 2016;29(2):119–38

    Google Scholar 

  86. DiFulvio GT. Sexual minority youth, social connection and resilience: from personal struggle to collective identity. Soc Sci Med. 2011;72(10):1611–7.

    Article  PubMed  Google Scholar 

  87. Snapp S, Watson RJ, Russell ST, Diaz RM, Ryan C. Social support networks for LGBT young adults: low cost strategies for positive adjustment. Fam Relat. 2015;64:420–30.

    Article  Google Scholar 

  88. D’Augelli AR, Hershberger SL, Pilkington NW. Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. Am J Orthopsychiatry 1998;68(3):361–371; discussion 72–5.

    Google Scholar 

  89. Wright ER, Perry BL. Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth. J Homosex. 2006;51(1):81–110.

    Article  PubMed  Google Scholar 

  90. Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, et al. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS. 2015;29(10):1239–46.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Fisher J, editor. The work stabilization in trauma treatment. Paper presented at Trauma Center Lecture Series, Boston; 1999.

    Google Scholar 

  92. Howard JM, Goelitz A. Psychoeducation as a response to community disaster. Brief Treat Crisis Intervent. 2004;4:1–10.

    Article  Google Scholar 

  93. Johnson JL, Greaves L, Repta R. Better science with sex and gender: a primer of health research. Ottawa: Canadian Institutes for Health Research Institute of Gender and Health; 2007.

    Google Scholar 

  94. Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3:353–75.

    Article  PubMed  Google Scholar 

  95. Hatzenbuehler ML. Social factors as determinants of mental health disparities in LGB populations: implications for public policy. Soc Issues Policy Rev. 2010;4(1):31–62.

    Article  Google Scholar 

  96. Hatzenbuehler ML, Keyes KM, Hasin DS. State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. Am J Public Health. 2009;99(12):2275–81.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Hatzenbuehler ML, Bellatorre A, Lee Y, Finch BK, Muennig P, Fiscella K. Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med. 2014;103:33–41.

    Article  PubMed  Google Scholar 

  98. Hatzenbuehler ML, McLaughlin KA, Keyes KM, Hasin DS. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health. 2010;100:452–9.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Hatzenbuehler ML, O’Cleirigh C, Mayer K, Safren SA, Bradford J. Effects of same-sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment. Am J Public Health. 2012;102(2):285–91.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Program for the Study of LGBT Health, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th Street, Room 337, New York, NY, 10031, USA

    Robert-Paul Juster PhD & Philip Jai Johnson PhD

  2. Program in Human Sexuality, Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

    Jennifer A. Vencill PhD

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Correspondence to Robert-Paul Juster PhD .

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Editors and Affiliations

  1. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Kristen L. Eckstrand

  2. William B. Castle Society, Harvard Medical School, Boston, Massachusetts, USA

    Jennifer Potter

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Juster, RP., Vencill, J.A., Johnson, P.J. (2017). Impact of Stress and Strain on Current LGBT Health Disparities. In: Eckstrand, K., Potter, J. (eds) Trauma, Resilience, and Health Promotion in LGBT Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-54509-7_4

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