This study examined associations between minority stress and depression among cisgender sexual minority individuals, focusing on nonaffirmation, a distal stress process originally developed for gender minority populations. Data were obtained from a cross-sectional survey of gender and sexual minority populations in Germany, Austria, and Switzerland (2015–2016). Minority stress was assessed using an adapted version of the Gender Minority Stress and Resilience Measure, and depressive symptoms were measured using the Allgemeine Depressionsskala (ADS-K).
Spearman rank correlations assessed associations between minority stressors and depression. Hierarchical multiple regression estimated the incremental contribution of nonaffirmation beyond established minority stressors and resilience factors, and moderated mediation analyses examined associations among proximal, distal stressors and depression. The sample comprised 473 participants categorized into four sexual identity groups.
All distal and proximal minority stress factors, including nonaffirmation, were positively associated with depressive symptoms. Nonaffirmation remained independently associated with depressive symptoms in regression analyses. Proximal stressors partially mediated the association between distal stressors and depressive symptoms, whereas resilience factors did not moderate this association.
These findings suggest that nonaffirmation is a distinct distal minority stress process among cisgender sexual minority individuals and may complement the Minority Stress Hypothesis by capturing subtle identity invalidation beyond indicators of overt stigmatization. The authors thank the investigators of the Trans*Swiss Study—Tiziana Jäggi, Lena Jellestad, Salvatore Corbisiero, Dirk J. Schaefer, Josef Jenewein, Andres Schneeberger, and Annette Kuhn—for their valuable work and for laying the foundation for this research.
These authors contributed equally: Jana S. Psychiatric University Clinic (UPK Basel), University of Basel, Basel, Switzerland Center for Gender Variance, Basel University Hospital, University of Basel, Spitalstrasse 21, Basel, 4031, Switzerland The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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