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Minority Stress and Cardiovascular Disease Risk Among Sexual Minorities: Mediating Effects of Sense of Mastery

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Abstract

Background

Sexual minority adults are at greater risk for cardiovascular disease (CVD) risk factors than heterosexual adults. There is a dearth of research identifying factors that are associated with CVD risk among sexual minorities. This study examined the associations between distal and proximal minority stressors and CVD risk. We also tested a sense of mastery as one mechanism that might explain the link between minority stressors and CVD risk.

Methods

Participants were 670 sexual minority adults (53.6% male; 76% White), ages 18 to 76 years (M = 41.19, SD = 14.73), obtained from a non-probability sample. Using an online survey, participants self-reported family history of CVD risk, physiological conditions (diabetes mellitus, high cholesterol, hypertension), and health behaviors (e.g., tobacco use, diet, exercise) that confer or protect against CVD risk. A weighted CVD risk index was computed. Linear and logistic regressions were conducted to test the effects of minority stressors on the CVD risk index and its specific indicators and to examine mediation.

Results

Minority stressors were associated with a sense of mastery, and mastery was associated with lower CVD risk index scores. Proximal and distal minority stressors were not directly associated with the overall CVD risk index but were associated with some specific risk indicators. Mediation analyses revealed that both distal and proximal minority stressors were indirectly associated with the CVD risk index through mastery.

Conclusions

Research and interventions should aim to reduce CVD risk factors and target minority stressors and mastery to improve the cardiovascular health of sexual minorities.

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Notes

  1. We tested differences in sociodemographic and key variables between participants who were excluded due to endorsing a past heart attack, stroke, or heart failure versus participants who did not endorse any of these conditions and were included in this study. Results indicated that participants with these conditions had higher CVD risk index scores, F(1)=61.13, p < .001, η2p = .08 (M = 7.49, SD = 2.94 versus M = 3.94, SD = 3.02, respectively), and were older in age, F(1) = 49.19, p < .001, η2p = .06 (M = 56.02, SD = 12.40 versus M = 41.26, SD = 14.84, respectively), than participants who did not have these conditions. The two groups did not differ on any of the sociodemographic variables or on their scores of distal minority stress, proximal minority stress, or sense of mastery.

  2. We also conducted the mediation analyses with the sample including participants with an established heart condition (i.e., heart attack, stroke, or heart failure) and found consistent patterns of results.

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Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (K08AA025011; PI: Mereish) and the National Heart, Lung, and Blood Institute (K23HL136845; PI: Goldstein) of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Health Studies, American University, Washington, DC, USA

    Ethan H. Mereish

  2. Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA

    Carly M. Goldstein

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  1. Ethan H. Mereish
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Correspondence to Ethan H. Mereish.

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Mereish, E.H., Goldstein, C.M. Minority Stress and Cardiovascular Disease Risk Among Sexual Minorities: Mediating Effects of Sense of Mastery. Int.J. Behav. Med. 27, 726–736 (2020). https://doi.org/10.1007/s12529-020-09919-z

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