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Sexual orientation concealment and mental health: A conceptual and meta-analytic review.

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Pachankis, John E., Mahon, Conor P., Jackson, Skyler D., Fetzner, Benjamin K., Bränström, Richard·2020·Psychological Bulletin
DOI 10.1037/bul0000271PMC PMC8011357
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Abstract

= 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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  • Gay, bisexual, and other sexual minority men experience substantial minority stress, which raises their risk for multiple health outcomes.

    “Gay, bisexual, and other sexual minority men experience considerable minority stress, which leads to elevated risks for a range of health outcomes.”

    From Mindfulness for Reducing Minority Stress and Promoting Health Among Sexual Minority Men: Uncovering Intervention Principles and Techniques (2022) · cites this paper as Pachankis et al., 2020

    The Discussion (Implications for Internalizing Versus Externalizing Mental Health Problems; page unavailable) links the minority stress of concealment to internalizing mental health problems, supporting part of the claim. But the review addresses sexual minorities broadly rather than establishing this specifically for men, and it does not establish that minority stress causes elevated risk across a range of health outcomes; it reports a negative association between concealment and substance use problems. (LLM, conf=0.87)

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  • Distal minority stress (such as discrimination and prejudice) and proximal minority stress (such as internalized stigma and concealment) increase vulnerability to poor psychological health and behavioral health problems linked to HIV/STI risk.

    “Experiences of distal minority stress (e.g., discrimination and prejudice) along with appraisal of such experiences, also referred to as proximal minority stress (e.g., internalized stigma, concealment), confer vulnerability to poor psychological health and behavioral health issues associated with human immunodeficiency virus (HIV)/sexually transmitted infections (STI) risk (Newcomb & Mustanski, 2”

    From Mindfulness for Reducing Minority Stress and Promoting Health Among Sexual Minority Men: Uncovering Intervention Principles and Techniques (2022) · cites this paper as Pachankis et al., 2020

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  • Proximal stressors arise from a socialization process in which sexual and gender minority people learn to reject themselves (internalized stigma), develop expectations of rejection, and/or conceal their LGBT identity.

    “Proximal stressors arise from a socialization process in which sexual and gender minority people learn to reject themselves for being LGBT (internalized stigma) [12,13], develop expectations to be stigmatized due to awareness of prevailing social stigma (expectations of rejection) [14], and/or hide their LGBT identity as a way to protect themselves against distal minority stressors (identity Conce”

    From Minority stress theory: Application, critique, and continued relevance (2023) · cites this paper as [15]

    The Study Location section (page unavailable) reports that concealing sexual orientation protected sexual minorities against discrimination and victimization in structurally homophobic contexts, supporting the concealment clause. The paper addresses sexual orientation, not concealment of gender identity, and does not establish that this protective effect applies to all LGBT people or settings. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • These adaptations include identity concealment, internalized stigma, and rejection hypervigilance.

    “These adaptations include psychosocial processes such as identity concealment, internalized stigma, and rejection hypervigilance (Hollinsaid et al., 2022; Newcomb & Mustanski, 2010; Pachankis, Mahon, et al., 2020).”

    From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pachankis, Mahon, et al., 2020

  • Concealment may be protective in some environments, but it also limits access to social support and affirmation, complicating its role in minority stress theory.

    “Concealment may be protective in some environments, but it also limits access to social support and affirmation, complicating its role in minority stress theory [15].”

    From Minority stress theory: Application, critique, and continued relevance (2023) · cites this paper as [15]

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Authors
Pachankis, J. E., Mahon, C. P., Jackson, S. D., Fetzner, B. K., & Bränström, R.
ORCID
Venue
Psychological Bulletin
Publisher
American Psychological Association (APA)
Published
2020-10
Volume
146
Issue
10
Pages
831-871
ISSN
  • 0033-2909 (ISSN-L)
  • 1939-1455
DOI
10.1037/bul0000271
PMC
PMC8011357
OpenAlex
W3044954344
Cited by
433
References
155
Citations by year
2026: 59 · 2025: 85 · 2024: 99 · 2023: 76 · 2022: 79 · 2021: 32 · 2020: 3
FWCI
51.92
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychological Bulletin (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (T32 MH020031)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Social Sciences › Gender Studies › Gender and Feminist Studies
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Keywords
concealment of sexual orientation, sexual minority mental health, internalizing problems, depression, anxiety, distress, problematic eating, problematic substance use, stigma, bisexuals, life course
MeSH terms
Sexual and Gender Minorities, Adult, Anxiety, Anxiety Disorders, Mental Disorders, Bisexuality, Confidentiality, Cross-Sectional Studies, Defense Mechanisms, Female, Humans, Male, Risk Factors, Sexual Behavior, Comorbidity, Substance-Related Disorders, Social Stigma

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