Understanding and intervening to address health disparities is part of the expanding role of psychologists (Johnson, 2013). We drew on Hatzenbuehler's (2009) psychological mediation framework and Lick, Durso, and Johnson's (2013) conceptual pathways to lesbian, gay, and bisexual (LGB) physical health disparities to test a serial mediation model in which 2 types of cognitive appraisals (proximal minority stressors and coping self-efficacy) partially account for the association between perceived discrimination and prejudice (distal minority stressor) and self-reported physical health symptoms in a nationally recruited sample of 564 LGB individuals (270 women, 294 men) who participated in a web-based survey. Results indicated that perceived experiences of discrimination and prejudice were associated with expectations of rejection and internalized homonegativity. These 2 proximal stressors were associated with lower coping self-efficacy, and the combined cognitive appraisal pathways were associated with higher levels of self-reported physical symptom severity. The pathway through emotion-focused coping self-efficacy was particularly salient in accounting for the overall mediation. Interventions to address distal and proximal minority stressors and improve emotion-focused coping self-efficacy may be particularly helpful in reducing the negative effects of stigma on physical health.

Political campaigns to deny same-sex couples the right to civil marriage have been demonstrated to increase minority stress and psychological distress in lesbian, gay, and bisexual (LGB) individuals (S. S. Rostosky, E. D. B. Riggle, S. G. Horne, & A. D. Miller, 2009). To further explicate the psychological reactions of LGB individuals to marriage amendment campaigns, a content analysis was conducted of open-ended responses from 300 participants in a national online survey that was conducted immediately following the November 2006 election. LGB individuals indicated that they felt indignant about discrimination; distressed by the negative rhetoric surrounding the campaigns; fearful and anxious about protecting their relationships and families; blaming of institutionalized religion, ignorance, conservative politicians, and the ineffective political strategies used by LGBT organizers; hopeless and resigned; and, finally, hopeful, optimistic, and determined to keep fighting for justice and equal rights. These 7 themes are illustrated and discussed in light of their implications for conceptualizing and intervening to address discrimination and its negative psychological effects.

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The United States Department of Veterans Affairs (VHA) is the largest provider of Hepatitis C Virus (HCV) care and has made considerable effort in facilitating multidisciplinary medical and mental health care for Veterans with HCV. Those with HCV are at high risk for psychiatric and substance use disorders that often negatively impact selection for and completion of traditional antiviral treatments. Interferon-based treatments, which were difficult to tolerate due to toxicity and the high occurrence of side effects, were the previous standard for HCV treatment. New interferon-free agents with minimal side effect profiles and improved treatment responses have been developed, which results in more patients being treated for HCV. The VHA’s emphasis on multidisciplinary integration and person-centered care highlights the importance of integrating mental health care within HCV clinical care and provides a rich environment for expanding the role of the clinical health psychologist in hepatology settings. This paper will describe the role of the clinical health psychologist in the past and new era of HCV clinical care, with special consideration placed on the expanding role of the clinical health psychologist given the latest advancements in antiviral treatment for HCV. A review of the clinical health psychologist’s role in the following areas will be provided: assessment of treatment candidacy, treatment of mental health and substance use disorders, promotion of adherence, and work with specialty hepatology populations.