遭受歧視對男同志身心健康關係之研究： 以復原力為調節變項、內化污名與憂思反芻為中介變項

Perceived Discrimination, Resilience, and Health in Male Sexual Minorities in Taiwan: A Moderated Mediation Model

本研究旨在探討遭受歧視對男同志身心健康的影響，並分析內化污名、憂思反芻對其關係之中介效果，以及復原力對其關係之調節效果。研究採用問卷調查法，蒐集242位男同志的資料，以調節式中介效果路徑分析進行假設驗證。研究結果發現：（1）遭受歧視與內化污名、憂思反芻對男同志身心健康有顯著的負向影響，復原力對男同志身心健康有顯著的正向影響；遭受歧視與復原力對內化污名、憂思反芻有顯著的正向影響；（2）內化污名、憂思反芻在遭受歧視與男同志身心健康間有顯著的完全負向中介效果；（3）遭受歧視與復原力的交互作用會顯著影響內化污名，但不顯著影響憂思反芻；（4）復原力顯著調節內化污名在遭受歧視與男同志身心健康間的中介效果。研究結論如下：外在環境的歧視、個體內在的內化污名與憂思反芻會對男同志身心健康有著負面影響。內化污名與憂思反芻對遭受歧視與男同志身心健康有著完全中介效果。復原力可對男同志身心健康進行調節，尤其可減少遭受歧視透過內化污名的負面影響。不過，復原力可能沒辦法減少歧視透過憂思反芻對男同志身心健康的負面影響。本研究根據以上所述，提出相關的討論與建議。

 

Background and Purpose

Sexual minority individuals are at a higher risk of developing several negative health outcomes, such as substance abuse, depression, and anxiety. Meyer’s minority stress theory is popularly employed to understand how social stigma and constructed sexual minority communities’ unfriendly social conditions affect the health of sexual minority individuals. Based on heteronomativity, sexual minority individuals’ desires or identities are silenced, ignored, denied, or labelled as abnormal. Therefore, they may develop tendencies toward self-denial or selfsuppression. These conditions lead to different types of minority stressors for sexual minorities. According to this theory, minority stressors include general, distal, and proximal stressors. However, Meyer suggested that sexual minority individuals develop resilience to buffer the influence of minority stressors. In summary, it is essential to investigate the relationships among perceived discrimination, resilience, internalized sexual stigma (ISS), rumination, and physical or psychological health among male sexual minority individuals.

This study examined the joint and interactive effects of perceived discrimination and resilience on ISS, brooding rumination, and physical and psychological health among male sexual minorities in Taiwan. This study also examined the role of ISS and brooding rumination as mediators between perceived discrimination and health and resilience as a moderator of the relationship between perceived discrimination and ISS, rumination, and health.

Methods

This study administered a cross-sectional online survey distributed on social networking pages and sexual minority community groups between January and June 2021. The respondents were recruited through online advertisements and an online survey. This survey assessed discrimination using the Discrimination/Harassment subscale of the Daily Heterosexist Experiences Questionnaire. ISS was measured using the short version of the Measure of Internalized Sexual Stigma for Lesbians and Gay Men. Further, brooding rumination was assessed using the short version of the Ruminative Response Scale. Furthermore, resilience was measured using the Resilience Scale, and health was assessed using four questions from a questionnaire designed to determine physical and mental health problems in sexual minority communities. Pearson’s correlation coefficient was used to calculate the correlations between distal and proximal minority stressors, brooding rumination, resilience, and health. We used a series of path analyses to test the relationships hypothesized in the moderated mediation model to determine the significance of the direct and indirect effects.

Result

A total of 242 male sexual minority individuals aged 18–70 years (M = 34.47, SD = 9.84) participated in this survey. The average Daily Heterosexist Experiences Questionnaire score was 0.78 (out of 6). The average score on the Internalized Sexual Stigma is 2.57 (out of 5). Moreover, the average score on the Brooding Ruminative Response Scale’s short version was 2,49 (out of 4). The average score on the resilience Scale was 5.17 (out of 7), and the average health score was 3.32 (out of 5), respectively. Regression analyses indicated that (1) discrimination experience, internalized sexual stigma, and rumination were negatively related to physical or psychological health, (2) resilience was positively related to physical or psychological health, (3) discrimination experience was positively related to internalized sexual stigma and rumination, and (4) resilience was negatively related to internalized sexual stigma and rumination. The mediating roles of internalized sexual stigma and rumination in the relationship between discrimination and health, as well as the moderating role of resilience, were partly significant.

Conclusions

The findings demonstrate that relationships among discrimination, resilience, internalized sexual stigma, rumination, and physical or psychological health among male sexual minorities did exist. The findings also showed that the mediators and moderators used to evaluate the effects of minority stress on health were useful. Some issues and suggestions were discussed to help mental health practitioners provide more appropriate services to male sexual minority individuals. Furthermore, culturally sensitive research in the field of sexual minority health is required.