Objective: Gay and bisexual men have significantly higher rates of depression than heterosexual men. The minority stress theory (Meyer, 2003) proposed that distal minority stressors, like interpersonal discrimination, contribute to this disparity. The psychological mediation framework (Hatzenbuehler, 2009) posited several psychosocial mechanisms through which distal minority stress creates elevations in depression among sexual minorities. Despite accumulating support for this framework, there are a number of limitations to existing research, including largely relying on cross-sectional designs; focusing on a small subset of mechanisms and moderators; and using nonprobability samples. Method: We recruited a sample of gay and bisexual men (N = 502) obtained from a population-based data set of U.S. adults. Participants completed validated measures of distal minority stress (i.e., interpersonal discrimination), psychosocial mechanisms (i.e., rumination, emotional clarity, and social support), identity-related moderators (i.e., identity centrality, stigma consciousness, and sexual orientation identity), and depressive symptoms at baseline, 6-month follow-up, and 1-year follow-up. Results: Rumination (b = 0.38, 95% CI [0.13, 0.84]), lack of emotional clarity (b = 0.43, 95% CI [0.11, 0.83]), and lack of social support (b = 0.21, 95% CI [0.04, 0.45]) each individually mediated the prospective relationship between interpersonal discrimination and depressive symptoms, controlling for initial symptoms, age, and education. These indirect effects were not moderated by identity-related characteristics or sexual identity. Conclusion: Our study provides some of the strongest empirical evidence for the psychological mediation framework to date and suggests targets for interventions focused on reducing the mental health consequences of minority stress for sexual minority men.

Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States.Factors associated with variability in transgender-specific mental health provider availability across states-especially at the macro-social level-have yet to be identified, hindering efforts to address these shortages. To remedy this gap, we queried whether transgender-specific adolescent mental health provider availability varied by states' transgender-specific policy climate. Method:We quantified states' policy climate by factor-analyzing tallies of the presence/absence of 33 transgender-specific state laws/policies in six domains: parental/relationship recognition, nondiscrimination, education, healthcare, criminal justice, and identity documentation. We then tested whether states' transgender-specific policy climate was associated with rates of transgender-specific adolescent mental health providers-identified via Psychology Today-per transgender adolescent in all 50 states and the District of Columbia.Results: Transgender-specific adolescent mental health provider availability was substantially lower in states with more restrictive laws/policies for transgender people (rate ratio=0.65, 95% CI [0.52, 0.81], p=0.00017), controlling for state-level conservatism, religiosity, and urbanicity.States' transgender-specific policy climate was unrelated to rates of adolescent Attention-Deficit/Hyperactivity Disorder-specialty providers, Oppositional Defiant Disorder-specialty providers, and youth mental health provider shortages broadly, providing evidence for result specificity. Conclusions:Transgender adolescents appear to have access to considerably fewer transgenderspecific mental health providers in states with more restrictive laws/policies for transgender people, which may compound their already high mental health burden in these contexts.State Policy Climate and Trans-specific Adolescent Mental Health Provider Availability 3 Intervention and policy efforts are needed to address these shortages, particularly in states with increasingly prohibitive laws/policies targeting transgender adolescents.

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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Hypervigilance is often theoretically invoked as a psychological mechanism linking stigma to internalizing psychopathology among sexual minorities. Empirically, however, hypervigilance is rarely explicitly assessed but is instead commonly conflated with putatively related constructs, including sexual-orientation-related rejection sensitivity and rumination, hindering conceptual and mechanistic understandings of this process. We therefore embedded a hypervigilance measure in a longitudinal, population-based study of 811 Swedish sexual-minority young adults (ages 17–34). Hypervigilance—but neither sexual-orientation-related rejection sensitivity nor rumination, with which it was only weakly correlated ( rs = .23–.24)—uniquely mediated prospective associations between perceived discrimination and internalizing symptoms 2 years later, explaining up to 40% of these effects. Sexual-orientation-related rejection sensitivity and rumination prospectively predicted hypervigilance on these paths. Findings suggest that hypervigilance represents a distinct construct and transdiagnostic mechanism through which stigma-related experiences and processes undermine sexual-minority mental health. We discuss implications for enhancing psychological interventions for sexual minorities by addressing hypervigilance.