Stress proliferation in ethnoracial disparities of mental health among U.S. sexual minority adults.

OBJECTIVE: Non-White sexual minorities experience disproportionate adverse childhood experiences (ACEs) and adulthood discrimination, as compared to their White or heterosexual counterparts. These stressors lead to increased psychological distress and worsened clinical outcomes, including suicidality. Minority stress theory posits that systemic marginalization, as experienced by minoritized individuals, leads to distress. Intersectionality theory suggests that marginalization compounds over time for individuals with intersectional minority identities. Yet, the mechanisms underlying the stress proliferation process for individuals with intersectional minority identities remain largely unexamined. METHOD: The present study used nationally representative data of sexual minority individuals (n = 1,518, Mage = 31 years, ethnoracial minority = 38.7%, female and gender minority = 50.6%) to investigate the relations among ethnoracial minoritization, ACEs, discrimination, distress, and self-injurious/suicidal outcomes. We proposed a novel integration of minority stress, intersectionality, and stress proliferation theories. Via longitudinal mediation, we tested models of stress persistence, stress accumulation, and stress sensitization. RESULTS: Our results confirmed disparities between White versus non-White sexual minorities on ACEs, discrimination experiences, and psychological distress. We found support for the stress persistence and the stress accumulation models, but not the stress sensitization model. Moreover, we found distress and discrimination were associated with future nonsuicidal self-injurious behaviors and suicidal outcomes, highlighting the deleterious consequences of intersectional minority stress proliferation. CONCLUSION: Our results support our proposed theory of intersectional minority stress proliferation where ethnoracial and sexual minoritization intersect and beget disproportionate ACEs, which in turn contribute to accumulation and persistence of psychological distress and discrimination experiences in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intraindividual phenotyping of depression in high-risk youth: An application of a multilevel hidden Markov model.

BACKGROUND: Traditionally, depression phenotypes have been defined based on interindividual differences that distinguish between subgroups of individuals expressing distinct depressive symptoms often from cross-sectional data. Alternatively, depression phenotypes can be defined based on intraindividual differences, differentiating between transitory states of distinct symptoms profiles that a person transitions into or out of over time. Such within-person phenotypic states are less examined, despite their potential significance for understanding and treating depression. METHODS: The current study used intensive longitudinal data of youths (N = 120) at risk for depression. Clinical interviews (at baseline, 4, 10, 16, and 22 months) yielded 90 weekly assessments. We applied a multilevel hidden Markov model to identify intraindividual phenotypes of weekly depressive symptoms for at-risk youth. RESULTS: Three intraindividual phenotypes emerged: a low-depression state, an elevated-depression state, and a cognitive-physical-symptom state. Youth had a high probability of remaining in the same state over time. Furthermore, probabilities of transitioning from one state to another did not differ by age or ethnoracial minority status; girls were more likely than boys to transition from a low-depression state to either the elevated-depression state or the cognitive-physical symptom state. Finally, these intraindividual phenotypes and their dynamics were associated with comorbid externalizing symptoms. CONCLUSION: Identifying these states as well as the transitions between them characterizes how symptoms of depression change over time and provide potential directions for intervention efforts.

Linking self-disgust, negative affect, and PTSD in sexual assault: An ecological momentary assessment approach.

OBJECTIVE: Although self-disgust has been implicated in sexual assault-related posttraumatic stress disorder (PTSD), empirical evidence of this association is limited. METHOD: Participants with sexual assault-related PTSD (n = 19), sexual assault without PTSD (n = 20), and healthy controls (n = 21) completed "trait" measures of disgust proneness, self-disgust, and negative affect (NA; i.e., anxiety and depression). An ecological momentary assessment approach was also employed, where participants reported "state" levels of PTSD symptoms, self-disgust, and NA in the morning, afternoon, and evening for 1 week. RESULTS: Those with PTSD reported more trait disgust proneness, self-disgust, and NA than those who experienced sexual assault without PTSD and controls. However, those experiencing sexual assault without PTSD and controls did not differ from each other. Participants with a history of sexual assault also experienced higher self-disgust and NA during the week than controls. Those with higher PTSD symptoms during the week also experienced more self-disgust and NA. Similarly, changes in PTSD symptoms were associated with changes in self-disgust and NA during the week. Although a temporal association was found where NA predicted subsequent PTSD symptoms (and vice versa) during the week, a temporal link between self-disgust and PTSD symptoms (or vice versa) was not found. CONCLUSIONS: These findings suggest that the link between self-disgust and sexual assault-related PTSD is more correlational than causal. The implications of these findings for understanding how trait and state self-disgust fits within the broader emotional network of sexual assault-related PTSD are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).