Objectives. Recent studies suggest that lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons. We examined the possible role of perceived discrimination in generating that risk.Methods. The National Survey of Midlife Development in the United States, a nationally representative sample of adults aged 25 to 74 years, surveyed individuals self-identifying as homosexual or bisexual (n = 73) or heterosexual (n = 2844) about their lifetime and day-to-day experiences with discrimination. Also assessed were 1-year prevalence of depressive, anxiety, and substance dependence disorders; current psychologic distress; and self-rated mental health.Results. Homosexual and bisexual individuals more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination.Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity in the total sample. Controlling for differences in discrimination experiences attenuated observed associations between psychiatric morbidity and sexual orientation.Conclusions. Higher levels of discrimination may underlie recent observations of greater psychiatric morbidity risk among lesbian, gay, and bisexual individuals.

Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.Perspectives on the prevalence of mental health disorders and the need for treatment services among lesbians and gay men have undergone remarkable changes over the last century (Bailey, 1999;Friedman, 1999). Although researchers long ago documented that "illness" models (Gonsiorek, 1996) of homosexuality lacked sufficient empirical support for theoretical predictions (Hooker, 1993), there is increasing concern that lesbians and gay men may be at elevated risk for some psychological disorders because of the harmful effects of social stigma (Fife & Wright, 2000;Kessler, Mickelson, & Williams, 1999;Markowitz, 1998;Meyer, 1995;Otis & Skinner, 1996;Wright, Gronfein, & Owens, 2000). Researchers have shown that some forms of mental disorders, particularly affective, anxiety, and substance use disorders, are likely to be influenced by the effects of social stress (Dohrenwend, 2000;Kendler et al., 1995;Mazure, 1995). In this regard, homosexuality is still widely stigmatized despite greater acceptance evident in recent opinion polls of the American population (Butler, 2001). Lesbians and gay men commonly report positive histories of victimization and discrimination (Herek, Gillis, & Cogan, 1999;Hershberger & D'Augelli, 1995;Krieger & Sidney, 1997), particularly in adolescence or young adulthood (D'Augelli, Hershberger, & Pilkington, 1998;Lock & Steiner, 1999). As a consequence, homosexuality may be a risk indicator for higher rates of psychological distress and some mental disorders.Much of the recent population-based research in this area (Bloomfield, 1993;Cochran, Keenan, Schober, & Mays, 2000;Cochran & Mays, 2000a, 2000bFaulkner & Cranston, 1998;Fergusson, Horwood, & Beautrais, 1999;Garofalo, Wolf, Wissow, Woods, & Goodman, 1999;Gilman et al., 2001;Herrell et al., 1999;Lock & Steiner, 1999;Remafedi, French, Story, Resnick, & Blum, 1998;Saewyc, Bearinger, Heinz, Blum, & Resnick, 1998;Sandfort, de Graaf, Bijl, & Schnabel, 2001;Stall & Wiley, 1988) was made possible by the serendipitous inclusion of questions concerning genders of sexual partners in large healthrelated studies of the gen...

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Persistent and vexing health disadvantages accrue to African Americans despite decades of work to erase the effects of race discrimination in this country. Participating in these efforts, psychologists and other social scientists have hypothesized that African Americans' continuing experiences with racism and discrimination may lie at the root of the many well-documented racebased physical health disparities that affect this population. With newly emerging methodologies in both measurement of contextual factors and functional neuroscience, an opportunity now exists to cleave together a comprehensive understanding of the ways in which discrimination has harmful effects on health. In this article, we review emerging work that locates the cause of racebased health disparities in the external effects of the contextual social space on the internal world of brain functioning and physiologic response. These approaches reflect the growing interdisciplinary nature of psychology in general, and the field of race relations in particular. Keywords racism; Blacks; allostatic load; social exclusion; brain; residential segregation; social cognition; cognitive appraisal; self-regulation The ways in which race, racial prejudice, and race discrimination shape the human experience have long been of interest in psychology and the other social sciences. The purpose of this review is threefold. First, we briefly examine the disconcerting evidence for increasing Black/White disparities in health despite the radical changes over the past 50 years in race-based civil rights in the United States (Walker et al. 2004). Next, we explore the notion that African Americans' continuing experiences with racism, discrimination, and possibly social exclusion may account for some proportion of these health disparities (Clark & Adams 2004;Everson-Rose & Lewis 2005;Guyll et al. 2001;Harrell et al. 2003;Massey 2004;Walker et al. 2004;Williams et al. , 2003. Finally, we focus on three emerging perspectives that locate health disparities in the external influences of social space and the internal effects of body and brain functioning. These latter approaches reflect the growing interdisciplinary nature of research models that attempt to explain the continuing legacy of NIH Public Access

Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of antihomosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually.

Most surveys of the prevalence of psychiatric disorders among lesbians and gay men find no increased risk in comparison with heterosexuals. However, the majority of this work has relied on convenience samples drawn from the visible lesbian and gay community. The authors examined differences in 1-year prevalence of six psychiatric syndromes among sexually active individuals in the 1996 National Household Survey of Drug Abuse who reported either exclusive heterosexuality (n = 9,714) or having any same-gender sex partners (n = 194) in the prior year. Although nearly three quarters of homosexually active individuals did not meet criteria for any of the six syndromes assessed, in multivariate logistic regression analyses, homosexually active men were more likely than other men to evidence major depression and panic attack syndromes. In contrast, homosexually active women were more likely than other women to be classified with alcohol or drug dependency syndromes. Both men and women reporting any same-gender sex partners were more likely than others to have used mental health services in the year prior to interview. These findings suggest a small increased risk among homosexually active populations in 1-year psychiatric morbidity and use of mental health care services. Keywords health surveys; homosexuality; mental disorders; psychiatry; substance-related disorders Perspectives on possible relations between homosexuality and psychiatric disorders have changed remarkably over the last half of this century (1). While homosexuality was once viewed as a psychiatric disorder or as a strong indicator of one, beginning in the late 1950s, empirical studies using small, nonclinical samples repeatedly found no elevation in rates of general psychiatric morbidity among lesbians or gay men when they were compared with similar heterosexuals (2-8). More recently, however, research examining psychiatric symptoms among gay men and lesbians has emphasized the role of social stigmatization in creating a chronic social stressor in the lives of many gay men and lesbians (9)(10)(11)(12)(13)(14). Over the last decade in particular, research focusing on the possible psychiatric sequelae of social stigmatization and, for gay men, the stress of coping with the human immunodeficiency virus (HIV) epidemic, increasingly has found evidence that lesbians and gay men may be at greater-than-expected risk for several stress-related disorders, including drug and/or alcohol abuse (9,(15)(16)(17), suicide attempts during adolescence and young adulthood (18)(19)(20) One or the difficulties in interpreting the body of empirical evidence in this arena is that the majority of the studies carried out to date have used convenience-based samples drawn from the visible lesbian and gay community. As a result, findings may have been distorted by the selection bias inherent in using highly motivated volunteer samples (24). Population-based psychiatric surveys that identify individuals who may differ in terms of sexual orientation are extremely rare. To our...

Lesbians and bisexual and homosexually experienced heterosexual women reported a greater variety of health conditions and limitations compared with exclusively heterosexual women; however, these differences mostly disappeared when distress levels were taken into account. Among men, differences in health complaints appeared to reflect the ongoing burden of HIV and other sexually transmitted diseases in the gay male community.

In 1984, a task force of the American Psychological Association (APA) Committee on Lesbian and Gay Concerns was charged with investigating bias in psychotherapy with lesbians and gay men. The task force surveyed a large and diverse sample of psychologists to elicit information about specific instances of respondent-defined biased and sensitive psychotherapy practice. Open-ended responses were used to separately identify major themes of biased and sensitive practice and to illustrate each with concrete examples. Results suggest that psychologists vary widely in their adherence to a standard of unbiased practice with gay men and lesbians. To bring individual practice into accord with APA policy will require continued and expanded efforts to educate practitioners about sexual orientation.