Introduction

Despite recent increases in their acceptance in several countries around the world [1, 2], sexual minorities continue to experience high rates of minority stress (i.e., unique stress related to their minoritized identity that heterosexuals do not experience; e.g., sexual orientation-related discrimination, victimization) [3–6]. Minority stress, and expectations thereof, can impair sexual minorities’ physical and mental health by potentially hindering sexual orientation disclosure [7, 8]. Disclosure, or “coming out” as a sexual minority, represents a critical component of adaptive minority identity development, and allows individuals access to sexual minority communities through which they can further explore their emerging identity [9]. However, because of pervasive discrimination, many sexual minorities may not feel safe disclosing their sexual orientation to family, friends, colleagues, and healthcare providers, particularly in the absence of explicit safety cues [10–12]. Indeed, concealment of identity-relevant information (as well as negative responses to such disclosure) is associated with cognitive, affective, and behavioral challenges, including hyper-vigilance, shame, and interpersonal avoidance [13, 14], although it is important to acknowledge that these constructs are closely intertwined and behavioral and affective inhibition are also thought to generate concealment [15].

Because sexual orientation disclosure in a safe context has the potential to offer sexual minorities significant social and emotional benefits, understanding potentially modifiable environmental determinants of disclosure represents an important public health concern. For example, understanding the impact of discriminatory press coverage of sexual minorities might enable news organizations to modify their reporting guidelines in order to minimize harm to this vulnerable population. Numerous survey-based studies have shown that sexual minorities who live in high-stigma environments (e.g., places with homophobic laws and policies) are less likely to disclose their sexual orientation [16, 17], and in so doing, they may protect themselves from experiencing even more minority stress (e.g., interpersonal rejection or violence) than would be expected in a high stigma environment. Indeed, some studies find a positive relationship between sexual orientation disclosure and minority stress [18], such that sexual minorities who disclose their sexual orientation are more likely to experience discrimination.

Importantly, none of these studies have utilized experimental methods to demonstrate a causal link between minority stress and concealment. This is an important gap in the literature that precludes causal inference, in that self-reports of concealment might be conflated with self-reports of minority stress through same-source reporting bias or a tendency for people who are more likely to conceal to also be more likely to perceive and report minority stress—possibilities that current non-experimental research cannot rule out. Consequently, this study’s primary goal was to elucidate previous correlational findings by experimentally investigating whether minority stress has a direct and immediate effect on disclosure decisions among sexual minority adults, and if so, in which direction. Importantly, we sought to examine the impact of minority stress on day-to-day decisions to disclose one’s sexual orientation—for example, choosing whether to disclose that your “wife” is actually a husband when a work colleague invites said wife to a company event. Our rationale is that while “major” disclosures (e.g., to parents, siblings) have been shown to have a substantial impact on mental health [19], there is less research on how these more frequent, arguably “smaller” disclosures are impacted by minority stress.

A secondary goal was to identify personal coping strategies that might buffer against the association between minority stress and concealment. Emotion regulation refers to the processes by which individuals modulate characteristics of their emotions (e.g., type, timing, expression) [20]. Because minority stress is associated with negative mood reactivity [21], as well as negative emotions like shame and sadness [22–24], which are in turn associated with social withdrawal [25], being able to effectively down-regulate one’s negative emotions after leaving a discriminatory context (i.e., when the individual is in a safer situation) may increase the likelihood of disclosure in the service of seeking social support to cope with the minority stress experience. As such, emotion regulation may represent an important coping strategy to consider when examining the impact of minority stress on sexual orientation disclosure [26]. Importantly, given the very real threat to sexual minorities’ physical safety in many instances of minority stress (e.g., discrimination, victimization), it is likely adaptive for these individuals to socially withdraw and to conceal their identities while the discriminatory experience is ongoing. However, once the environment is more affirming, it may be useful to down-regulate the emotional and behavioral sequalae of the discriminatory experience in order to increase social connection and coping.

Some emotion regulation strategies are likely more helpful than others in the context of minority stress. For instance, one of the few experimental studies in this area compared the utility of two strategies, rumination and distraction, in response to an idiographic discrimination induction [27]. While discrimination increased self-reported psychological distress across participants, individuals instructed to distract themselves from their distress showed greater reductions in self-reported negative affect compared to those instructed to ruminate. In line with this finding, work by Kross and colleagues demonstrated that individuals who are better able to distance themselves from their emotions and thoughts tend to experience less intense emotional reactions and ruminate less, as compared to individuals who immerse themselves in their emotional experiences [28–30]. Indeed, cross-sectional research has found that sexual minorities who use cognitive change strategies, like distancing, might be protected against the adverse behavioral outcomes of discrimination [31]. Distancing refers to the process of mentally removing oneself from a given situation and is associated with shorter emotion duration and reduced emotional reactivity compared to strategies like immersion (i.e., the process of fully engaging oneself in a given situation [30]). Yet, to our knowledge, no studies have examined the effect of experimentally induced emotion regulation strategies on behavioral responses to sexual orientation-related minority stress. Such research can help inform whether certain emotional regulation strategies might have a socially adaptive benefit in the face of minority stress.

In the present study, we predicted that participants who watched a minority stress film would be less likely, and take longer, to spontaneously disclose their sexual orientation in a written reflection task than those who watched an affirming film. To examine the potentially protective role of emotion regulation, we also predicted that this main effect of film would be qualified by a two-way interaction with emotion regulation, such that among those who viewed the minority stress film, distancing would be associated with more disclosure than immersion.

Materials and methods

Participants

Lesbian, gay, and bisexual adults (LGB; N = 217) were recruited via targeted postings in social media, Craigslist, listservs, and emails to special interest groups. Postings indicated that the study was about “sexuality and emotions,” and were accompanied by rainbow-related images. Sample size was determined based on previous studies examining similar constructs in sexual minorities (scaled up for number of between-subjects conditions [27, 32]), as well as high expected rates of data loss due to the online nature of the study (i.e., incomplete surveys, repeat completions, ineligible participants). Eligible participants needed to: 1) be over the age of 18, 2) self-identify as a sexual minority (i.e., lesbian, gay, or bisexual), and 3) reside in the United States (due to U.S.-centric film stimuli). All study participation was completed online via Qualtrics. Given that online data collection affords less experimental control, we took numerous measures to ensure maximal data integrity. We removed 21 participants for incomplete task data (e.g., did not write reflection), 13 participants for responses consistent with inattentive responding (i.e., all answers given were “1” and/or incorrect responses to attention questions), three participants for problematic open-response reflections (e.g., off-topic, low-effort), and 12 participants for failing to follow emotion regulation instructions (operationalized as answering 1 “not at all” in response to a question about whether they used their assigned strategy while watching the film clip).

The final sample (n = 168) had a mean age of 24.6 years (SD = 7.3 years). A total of 82.1% identified as White; 26.2% identified as men, 57.1% as women, 11.3% as genderqueer, and 5.4% as having another gender identity; and 43.5% identified as bisexual (69.9% female), 26.8% as lesbian, 17.9% as gay, and 11.9% as having another non-heterosexual orientation. Participants were relatively well-educated, with 41.6% indicating that they had obtained at least a four-year college degree. Furthermore, they came from a diverse range of locations, with 42.9% living in a large city, 30.4% living in a small city, 15.5% living in a suburban area, 9.5% living in a small town, and 1.8% living in a rural area, and. See Table 1 for additional demographic characteristics.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Demographic characteristics of the sample.

https://doi.org/10.1371/journal.pone.0267810.t001

Results

Likelihood of disclosure

We found a significant main effect of film, OR = 3.21, 95% CI [1.14, 9.05], p = .027, such that participants in the minority stress condition were 3.2 times less likely to disclose their sexual orientation during the reflection task than those in the affirming condition. Contrary to expectations, we found no effect of emotion regulation condition, OR = 0.63, 95% CI [0.26, 1.50], p = .29, and the interaction was non-significant, OR = 0.78, 95% CI [0.20, 3.05], p = .72. See Table 2 for descriptive characteristics. Although we were underpowered to statistically examine differences by sexual orientation group (lesbian/gay, bisexual, other), descriptive characteristics show that much fewer bisexual participants (34.8%) disclosed in the minority stress/distancing conditions than lesbian/gay participants (76.5%), suggesting that there may be differences by sexual orientation in how participants responded to these manipulations (see S1 Table).

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 2. Descriptive characteristics of disclosure variables by film and emotion regulation condition.

https://doi.org/10.1371/journal.pone.0267810.t002

Discussion

This study sought to examine whether 1) minority stress has a causal effect on sexual orientation concealment, and 2) emotion regulation can buffer against negative effects of minority stress on disclosure. Indeed, participants exposed to minority stress content were less likely to spontaneously disclose their orientation than those who viewed affirming content. This experimental finding clarifies the correlational findings found in previous research by identifying a causal direction from minority stress to disclosure. This finding also supports the notion that sexual minorities exposed to environments in which minority stress is common might be more likely to conceal their sexual orientation. In fact, previous research has shown associations between discriminatory national laws, policies, and community attitudes and reduced odds of sexual orientation disclosure, with negative implications for health [16, 17, 44, 45]. Given that the minority stress content in this study consisted of video clips from commonly watched television and online media sources, our findings also point to the importance of developing and following media guidelines for accurate, inclusive, and affirming reporting on sexual minorities and their experiences in order to minimize harm [46]. As societies make progress toward these types of structural and institutional reductions in discrimination, clinical health interventions with sexual minorities can address the role of minority stress on disclosure and related outcomes. Indeed, psychosocial interventions that affirm marginalized identities and help sexual minorities to cope with minority stress can promote not only greater sexual orientation disclosure (in safe contexts) [47], but also ultimately influence broader societal change by empowering sexual minority individuals to be the agents of that change [48]. Interventions that promote disclosure specifically have been argued to perpetuate civil rights gains of this historically marginalized population [49, 50].

We did not find evidence for our hypothesis that emotion regulation would buffer against minority stress and facilitate disclosure. Although successful manipulation checks suggest that participants understood and tried to follow the emotion regulation instructions, perhaps the manipulation (i.e., immersion vs. distancing) was not strong enough to alter participants’ emotional responses. Future studies should employ different emotion regulation strategies (e.g., cognitive reappraisal, suppression), as well as a no-instructions control, to determine whether a different strategy can buffer the impact of minority stress on disclosure behavior. It could also be interesting to combine this affective science approach with Miller and Kaiser’s theoretical model of stigma coping [51]. For example, a future study could compare primary control coping strategies like regulating emotion expression with secondary control coping strategies like cognitive restructuring. Another possible explanation for these results could be that the instructions for the written reflection task overrode the emotion regulation instructions for the distancing group. Although participants in the distancing condition may have followed regulation instructions while watching the film clip (as indicated by the manipulation check), they likely also followed the written reflection task instructions (delivered a couple minutes later), which directed participants to explore their “very deepest emotions and thoughts.” Thus, participants may have been more likely to disclose than if they had been encouraged to continue distancing themselves from their emotions. Future research should consider changing the instructions for the written reflection task (e.g., by removing any language that may conflict with the emotion regulation instructions) to determine if doing so reveals an effect of emotion regulation on disclosure.

We also did not find support for our predictions related to the timing of sexual orientation disclosure in the written reflection task. While descriptive statistics (Table 2) were in line with our hypotheses (i.e., the minority stress clip was associated with more words until disclosure than the affirming clip; the distancing condition was associated with more words until disclosure than the immersion condition), it is likely that a larger sample size is needed in order to reach statistical significance.

Our study provides initial insight into the frequency of sexual orientation disclosure in the context of minority stress and affirmation. Given our findings, future research could take a closer look at the depth, breadth, and duration of participants’ disclosure to see whether these qualities predict wellbeing over time. A large body of literature has shown that self-disclosure about personal information can play an important role in facilitating intimacy and relationship development (for a review, see [52]); however, less is known about how these features of disclosure play out in stigmatized populations and for other outcomes, including mental and physical health.

Future studies should also expand their minority stress analogues to include not only film clips, but also interactive paradigms (e.g., online chat interface, in-person interactions). Given that many of the minority stress experiences LGB individuals face in their lives occur interpersonally (e.g., in schools and workplaces; [3, 53]), it is critical that future work captures this additional dimension in order to better understand the real-life experiences of LGB individuals and thus their full affective repertoire during times of adversity. In addition to interpersonal minority stress experiences, recent work has shown that structural stigma (i.e., characteristics of a social environment that oppress LGB individuals such as policies excluding sexual minorities from institutions like marriage) may have a significant impact on the lives and wellbeing of LGB individuals [54]. As such, it is crucial that future investigations consider the role of structural stigma and the affective and biological processes related to it.

Although this study has a number of strengths, including its use of innovative experimental methods and the ecological validity of the film clips, there are also several limitations that should be addressed in future studies. First, participants who were recruited knew that the study was about sexuality, which may have influenced their responses (e.g., participants may have felt more comfortable disclosing their sexual orientation if they assumed the research team were LGBTQ-affirming). Given this limitation, it is a testament to the strength of the effect of minority stress that although participants had already disclosed their orientation to the research team, they then chose, consciously or unconsciously, to withhold the information after viewing the minority stress clip. Nonetheless, the paradigm should be repeated with naïve samples with a wide range of sexual minority identities (including questioning individuals) to confirm the results. Similarly, this study was underpowered to examine differences among individuals with different sexual minority identities. Since descriptive results seemed to suggest differences in the effects of the manipulations on lesbian/gay vs. bisexual participants, it is crucial that future studies with larger samples of diverse sexual identities investigate these possibilities. Next, it is possible that participants did not identify with the film clip they viewed, and thus did not write about their sexual orientation in relation to the clip (rather than avoiding disclosing their sexual orientation as a result of the minority stress content). While the film clips purposefully included a montage of smaller clips in order to minimize this possibility, future work should consider matching minority stress analogues to participants’ experience (e.g., using an idiographic approach involving prescreening minority stress experiences and selecting a relevant film clip). Relatedly, due to power constraints, this study did not examine the potential moderating effects of individual differences (e.g., prior sexual orientation disclosure, internalized stigma) on the relationship between minority stress exposure and disclosure. Future studies should recruit larger samples with a high degree of variation in these individual difference variables in order to determine whether and how these factors influence the strength of the minority stress-disclosure relationship. This study also did not assess participants’ explicit motivations for disclosing their sexual orientation during the reflection task. As such, it is unclear whether participants would respond the same way in a real-life conversation, or if the decision to disclose was related to some feature of the study paradigm. Additional studies with different minority stress analogues and more diverse samples of LGB individuals are needed to determine the generalizability of this finding. Finally, due to the difficulty of creating an ecologically valid stimulus that is “neutral” regarding sexual minority individuals, this study did not employ a neutral control condition that would allow for conclusions to be made about whether results reflect a reduction in spontaneous disclosure after minority stress exposure versus an increase in disclosure after affirmation. Future research should consider including such a control so that this can be assessed.

This is the first known study to experimentally demonstrate a causal link between minority stress and sexual orientation disclosure. Although additional research is needed to examine the parameters under which this effect operates, this finding highlights an important mechanism potentially underlying minority stress’s effects on sexual minority identity development and ultimate wellbeing. These findings can support public policy and psychosocial interventions to advance the public visibility of this historically marginalized population, whose members face frequent pressures to conceal an important aspect of their identity. In so doing, these findings may help reduce the mental health burden that sexual minority individuals disproportionately experience.

Supporting information

Acknowledgments

The authors would like to thank Jennifer Cheavens, Kara Christensen, Lisa Cravens-Brown, and Jennifer Crocker for their feedback on previous versions of this manuscript. They would also like to thank Thomas Parsons and Sarah Gobrial for their aid during data collection.