A Critical and Intersectional Model of LGBTQ Microaggressions: Toward a More Comprehensive Understanding

Microaggressions Toward Sexual and Gender Minority Emerging Adults: An Updated Systematic Review of Psychological Correlates and Outcomes and the Role of Intersectionality

Purpose: Quantitative data on the psychological effects of microaggressions toward sexual and gender minority individuals have grown substantially. Sexual orientation-based and transgender and gender-diverse (trans+) identity-based microaggressions have been thematically identified in prior research. In addition, combined lesbian, gay, bisexual, transgender and gender-diverse, queer/questioning, and other non-heterosexual (LGBTQ) microaggressions can be examined intersectionally with other marginalized identities. This systematic review synthesizes research on the relationships among these microaggressions and psychological correlates and outcomes. Methods: Forty-five quantitative studies examining sexual orientation-, trans+ identity-, or intersectional identity-based microaggressions and various psychological outcomes were identified from systematic searches of PsycINFO, PsycARTICLES, MEDLINE, and PubMed databases. Data regarding microaggressions were extracted, synthesized, and grouped by mental health outcome or correlate. Results: Sexual orientation-based microaggressions were risk factors for depression, anxiety, and internalized stigma and were positively associated with psychological distress, traumatic stress symptoms, alcohol use and abuse, cannabis use and problems, suicidal ideation, and suicide attempt. Trans+ identity-based microaggressions were positively associated with depression, suicide attempt, and cannabis use. LGBTQ intersectional identity-based microaggressions concerning race/ethnicity were associated with depression, anxiety, and suicidal ideation. Research on other intersectional identity-based microaggressions is scarce. Conclusion: These findings emphasize the psychological harm inflicted by various microaggressions on LGBTQ late adolescents and early adults. Future work should focus on microaggressions toward individuals with trans+ and intersectional identities and protective factors for these experiences. This review also highlights the distinct need for community-based research on implementing microintervention strategies in family, school, and work environments to mitigate the harmful effects of these microaggressions.

LGBTQIA+ Cultural Competence in Physical Therapy: An Exploratory Qualitative Study From the Clinician's Perspective

OBJECTIVE

The purpose of this study was to understand the lesbian, gay, bisexual, transgender, queer, intersex, agender, and other gender and sexually diverse identities (LGBTQIA+) health care experience and associated cultural competence from the physical therapist perspective (physical therapist and physical therapist assistant).

METHODS

An exploratory qualitative approach implementing semi-structured focus groups and private interviews was utilized. To further anonymity, researchers allowed subjects to keep their camera off on Zoom. An interview protocol included questions guided by Campinha-Bacote domains of cultural competence (cultural awareness, skill, knowledge, encounter, and desire) to collect individual experiences, stories, discussions, thoughts, and opinions. Physical therapist clinicians were recruited from the clinical education affiliation lists of Regis University and Thomas Jefferson University. Seventy-one practicing physical therapists from the USA agreed to be part of the study.

RESULTS

Themes were organized using the Social Ecological Model Framework. Themes are in parentheses following each level of the Social Ecological Model and include intrapersonal level (psychological stress and implicit and explicit biases), interpersonal (acceptance and competency), organizational (experience), community (advocacy), and society and policy (explicit biases and policy).

CONCLUSION

Cultural competence in physical therapy is influenced by intrapersonal, interpersonal, organizational, community, and social and policy factors. Themes of psychological stress, limited awareness, decreased acceptance, and competency as well as limited exposure and experience, and a lack of advocacy and broader societal and policy issues prevent adequate LGBTQIA+ cultural competency of physical therapist providers. Further research in the physical therapist profession is needed to elaborate on the student, educator, and patient perspectives and how this information informs the LGBTQIA+ cultural competence of clinicians.

IMPACT

This project may have a significant impact on suggestions for the delivery of content for health profession education to best impact health equity goals and save lives. Implementation of this content may have a direct impact on health disparities in LGBTQIA+ populations by reducing stigma and discrimination from health care providers, thus improving quality of health care and decreasing rates of patient mortality for LGBTQIA+ individuals.

Microaggression toward LGBTIQ people and implications for mental health: A systematic review

BACKGROUND

Research suggests that microaggressions detrimentally impact the mental health of members of marginalized social groups.

AIMS

The aim of this systematic review was to assess the exposure to microaggressions and related implications on mental health of Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) people.

METHOD

Medline, Scopus, PsycINFO, CINAHL, and EMBASE were searched until January 2023. Studies reporting data on the exposure to microaggressions toward LGBTIQ people were identified. Meta-analyses of rates of exposure to microaggression and of the association between microaggressions and mental health outcomes were based on odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI), estimated through inverse variance models with random effects.

RESULTS

The review process led to the selection of 17 studies, involving a total of 9036 LGBTIQ people, of which 6827 identifying as cisgenders, and 492 as heterosexuals, were included in the quantitative synthesis. Overall, LGBTIQ people showed an increased risk of microaggression (SMD: 0.89; 95% CI [0.28, 1.50]), with Transgender people having the highest risk (OR: 10.0; 95% CI [3.08, 32.4]). Microaggression resulted associated with risk of depression (SMD: 0.21; 95% CI [0.05, 0.37]), anxiety (SMD: 0.29; 95% CI [0.17, 0.40]), suicide attempts (OR: 1.13; 95% CI [1.08, 1.18]), alcohol abuse (OR: 1.32; 95% CI [1.13, 1.54]), but not to suicidal ideation (OR: 1.56; 95% CI [0.64, 3.81]) and cannabis abuse (OR: 1.44; 95% CI [0.82, 2.55]). The quality of the evidence was limited by the small number of studies.

CONCLUSIONS

LGBTIQ people are at higher risk of microaggressions compared with their cisgender/heterosexual peers, which may lead to mental health consequences. This evidence may contribute to public awareness of LGBTIQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs and destigmatizing efforts) as parts of tailored health-care planning aimed to reduce psychiatric morbidity in this population.

Building a model of navigational strategies for queer undergraduate students in STEM

Introduction

There is a critical need to foster inclusive educational spaces for Queer identifying students and to resist oppressive structures that seek to marginalize and inflict trauma on students because of their gender or sexual identity.

Methods

Drawing on thematic analysis and Queer theory, we interviewed 11 Queer identifying STEM students to understand the navigational strategies they leveraged within higher education environments related to their Queer identity.

Results

We developed a cyclical model of navigational strategies employed by Queer STEM students that involved evaluating the environments, performing psychological identity calculations, and engaging in behavioral actions. Students evaluated the environment by attending to the diversity of gender representation, presence of other Queer individuals, and contextual factors conveyed based on disciplinary expectations. Students engaged in psychological identity calculations whereby they assessed beliefs about the relevance, importance, and fears related to their Queer identity, with few perceiving any benefits. Behavioral actions resulted in students building a chosen community, disclosing or shelving their queer identity, and advocating for representation.

Discussion

In order to support Queer students to thrive in educational contexts, researchers and practitioners should examine ways to increase representation, use inclusive pedagogical strategies, and understand the relevance of Queerness within disciplinary fields. Questioning the relevance or presence of Queerness in higher education environments only further serves to oppress, inflict trauma, and marginalize Queer students.

Lateral Violence and Microaggressions in the LGBTQ+ Community: A Scoping Review

Violence and microaggressions against the LGBTQ+ community from those outside of the community is commonly known and understood within academic literature. However, there is limited comprehensive knowledge about violence and microaggressions that occur within LGBTQ+ communities. This scoping review helps to fill this gap in knowledge, analyzing and synthesizing 18 research articles published in English language scholarly journals all of which have been published between 2010 and 2020. Online databases ProQuest, SAGE Journals, Google Scholar, Taylor and Francis Journals, Scopus, Informit, Project MUSE, PubMed, and EBSCOhost were utilized to search for existing literature on ingroup LGBTQ+ microaggression. The found literature focused on power dynamics within the LGBTQ+ community and how that power has enabled subgroups within the community to enact microaggression on one another. We found that ingroup microaggressions experienced by members of the LGBTQ+ community are a result of dominant norms that give certain groups power over another.

A Scoping Review on the Role of Sexual Orientation and Gender Identity Microaggressions in Substance Use

Objectives

Disparities in substance use patterns and outcomes are evident among sexual and gender minority groups. Sexual orientation and gender identity (SOGI) microaggression, or the subtle forms of aggression experienced by lesbian, gay, bisexual, transgender, gender non-conforming/non-binary, and gender diverse individuals, has recently been explored as a mechanism that leads to negative adjustment outcomes, including substance use. In this study we examined extant literature on the association between SOGI microaggression and substance use, and the intermediary factors that mediate or moderate this relationship.

Method

Scoping review method was used to systematically map the literature base using database aggregators (e.g., Scopus, EBSCO) following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results

We found that SOGI microaggression is positively associated with substance use and negative consequences, and this relationship is mediated or moderated by motivational, relational, and identity processes.

Conclusion

These findings suggest the need to consider microaggression experience when working with clients of diverse sexual and gender identities. Likewise, additional studies are needed on other intermediary factors and effects of microaggression on substances other than alcohol. Most importantly, this study underscores the need for understanding the link between microaggression and substance use in greater efforts to promote sexual well-being and building competence in fostering the trifecta of sexual health, sexual rights, and sexual pleasure.

Factors influencing LGBTQ+ disclosure decision-making by Canadian health professionals: A qualitative study

Disclosure of LGBTQ+ identities at work may reap benefits, but may also exacerbate harms. Faced with ambiguous outcomes, people engage in complex concealment/disclosure decision-making. For health professionals, in contexts of pervasive heteronormativity where disclosure to patients/clients is deemed to violate professional boundaries, stakes are high. This qualitative study with 13 LGBTQ+ health professionals across Canada used semi-structured interviews to explore factors affecting disclosure decision-making, particularly attending to power structures at multiple levels. Most participants engaged in constant risk-benefit assessment, disclosing strategically to colleagues, rarely to clients/patients. At the individual level they were affected by degree of LGBTQ+ visibility. At the institutional level they were affected by the culture of particular professional fields and practice settings, including type of care and type of patients/clients, as well as colleague interactions. Professional power-held by them, and held by others over them-directly affected disclosures. Finally, intersections of queer identities with other privileged or marginalized identities complicated disclosures. Power relations in the health professions shape LGBTQ+ identity disclosures in complex ways, with unpredictable outcomes. Concepts of professionalism are infused with heteronormativity, serving to regulate the gender and sexual identity expression of queer professionals. Disrupting heteronormativity is essential to forge more open professional cultures.

"You're not gay; You're a child of god": Microaggressions experienced by LGBTQ+ teens and their parents in the Church of Jesus Christ of Latter-day saints

Like other teens in conservative religious environments, LGBTQ+ teens raised in the Church of Jesus Christ of Latter-day Saints (CJCLDS) likely experience unique microaggressions. Furthermore, like other conservatively religious parents of LGBTQ+ teens, active Latter-day Saint (LDS) parents who openly support their LGBTQ+ teens likely both witness microaggressions toward their teens and may personally experience microaggressions. The present study sought to understand parents' and teens' experiences of microaggressions in conservative religious contexts by focusing specifically on the microaggressions experienced by (a) LGBTQ+ teens raised in the CJCLDS and (b) their active LDS parents. Thematic analysis of separate interviews with 19 dyads of LGBTQ+ teens and their active LDS parents (38 total interviews) revealed various ways in which they experienced verbal, nonverbal, and environmental microaggressions. We highlight parents' and teens' shared experiences of microaggressions that may be uniquely related to their religious contexts, such as assumptions that LGBTQ+ teens or their parents are not faithful and exclusionary Church policies. Additionally, we identified microaggressions that specifically targeted parents of LGBTQ+ teens, such as comments suggesting parents should limit their support for their teens. Finally, we found that parents had vicarious experiences with microaggressions through witnessing or learning about microaggressions that targeted their teens. Findings highlight the ways that the religious contexts in which microaggressions occur can influence the way that microaggressions are communicated to and experienced by LGBTQ+ teens - and their parents.

Post-migration psychosocial experiences and challenges amongst LGBTQ+ forced migrants: A meta-synthesis of qualitative reports

AIMS

Synthesize qualitative research to illuminate the post-migration psychosocial experiences amongst LGBTQ+ forced migrants.

DESIGN

Meta-synthesis of qualitative reports.

DATA SOURCES

Systematic searches in seven databases and manual screenings were performed in July 2021 (21,049 entries screened in total). The final sample included 29 English-language reports containing empirical qualitative findings about post-migration experiences and published 10 years prior to the searches, based on migrants as the primary source.

REVIEW METHODS

Methodological quality was appraised using the CASP and JBI checklists. Through a collaborative process involving nurse-midwife researchers and experienced clinical professionals, reports were analysed with a two-stage qualitative meta-synthesis including an inductive qualitative content analysis.

RESULTS

The methodological quality was high and the reports included 636 participants in total. Two themes were identified through the meta-synthesis. The first theme illustrates the psychological distress and numerous challenges and stressors forced migrants face after arrival, including challenges encountered as an LGBTQ+ forced migrant, psychological reactions and manifestations, and practical issues related to resettlement and living conditions. The second theme highlights the resilience and strength they find through various internal processes and external resources, including resilience and strengthening resources, identity formation and establishing and maintaining social relationships.

CONCLUSION

After arrival in the host country, forced migrants identifying as LGBTQ+ face numerous societal and personal challenges whilst being at risk of experiencing significant psychological distress. These migrants utilize a wide range of resources that may strengthen their resilience. Peer support stands out as a highly appreciated and promising resource that needs further attention in experimental research.

IMPACT

Forced migrants identifying as LGBTQ+ need access to adequate and sufficient support. The findings emphasize several strength-building resources that may inform nurses, midwives, researchers and other professionals when providing psychosocial support for these persons.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

"Ah, it's best not to mention that here:" Experiences of LGBTQ+ health professionals in (heteronormative) workplaces in Canada

Introduction

Despite human rights protections for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, LGBTQ+ professionals may continue to experience discrimination working in heteronormative systems and spaces.

Methods

In this qualitative study 13 health professionals (nurses, occupational therapists, and physicians) from across Canada participated in in-depth qualitative interviews to explore their experiences with work-related microaggressions and heteronormativity.

Results

Heterosexist microaggressions from both patients/clients and colleagues were the norm, perpetuating and bolstered by heteronormative workplace and professional cultures. In turn, LGBTQ+ professionals navigated disclosure-decision-making, in power-laden contexts where all options carried potential negative consequences.

Discussion

Drawing on the notion of "heteroprofessionalism," we argue that the concept of professional carries encoded within it demands that the occupant of that category be-or present as-heterosexual, an unmarked status that can be readily desexualized. Acknowledging sex and sexuality disrupts "professionalism." We argue that such disruption, indeed dissention, is necessary to open (hetero)professional spaces to LGBTQ+ workers.

A quantitative exploration of Queer-spectrum students' experiences in introductory undergraduate mathematics courses

Research into the experiences of students in mathematics with a marginalized sexual identity has remained largely underexplored, relegating these experiences and individuals to remain invisible. In this study, we leverage Queer Theory to address this gap in research by reporting on the experiences of Queer-spectrum undergraduate students (n = 2,454) enrolled in introductory mathematics courses (Precalculus, Calculus 1, and Calculus 2) across the United States. Drawing on student data (n = 24,327) from the Student Post-Secondary Instructional Practices Survey, we examine reported outcomes of math learning experiences and access to learning environments. Overall, within introductory math courses, sexual identity had a significant relationship with accessing learning environments and mathematical learning experiences. Asexual students were among those that reported higher levels of interactions with peers and instructors, a greater sense of community & participation, positive math affect, and were more likely to access learning environments external to the course yet anticipated receiving a lower course grade when compared to straight students. Bisexual students reported lower levels of interactions with instructors, a diminished sense of community & participation, math engagement, positive math affect, and were less likely to access learning environments compared to straight students. These findings suggest that Queer-spectrum students experience mathematical learning in a different manner than their straight peers and in relation to other Queer spectrum identities. Queer-spectrum students with a sexualized identity perceive that mathematics environments are not normative places to be a part of the community, resulting in negative dispositions, reduced interactions, and lower academic success. The impact of sexual identity, although small, contributes to negative indicators of positive mathematical experiences and suggests that the normative discourses in mathematics that are identity neutral, heteronormative, and aligned with binary thinking are differentially impacting Queer-spectrum students.

Doubly Marginalized: Addressing the Minority Stressors Experienced by LGBTQ+ Researchers Who Do LGBTQ+ Research

Lesbian, gay, bisexual, transgender, and nonbinary, and queer people (LGBTQ+) experience significantly higher levels of stressors due to discrimination, stigma, and marginalization than do cisgender heterosexual people. These high levels of stressors have impacts on health and well-being as well as career impacts. Limited research suggests that within higher education LGBTQ+ faculty experience bullying, discrimination, and harassment within the workplace. There is also data to suggest that research on marginalized populations is perceived to be less objective and valuable than research on majority populations. Research on the challenges of being a member of a marginalized population who conducts research on the same population suggests potentially negative career and personal impacts. To my knowledge, there has been little to no research on the double marginalization related to being an LGBTQ+ researcher doing research within the LGBTQ+ community. To describe the potential impacts of being an LGBTQ+ researcher who does LGBTQ+ research, I apply the extant literature on marginalized researchers who do research among marginalized populations to LGBTQ+ researchers. I also describe the potential minority stressors that LGBTQ+ researchers may face and how that may impact careers. Finally, I offer multiple recommendations for improvements for our research community and argue that senior faculty, leadership, and mentors can take specific actions to lessen stressors for LGBTQ+ researchers studying LGBTQ-related topics.

Exploring the microaggression experiences of LGBTQ+ community for a culturally safe care: A descriptive qualitative study

BACKGROUND

Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices.

OBJECTIVE

The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care.

DESIGN

A qualitative descriptive study was conducted between September to November 2021.

SETTINGS

This study was conducted at the University of Almeria with LGBTQ+ community members.

PARTICIPANTS

Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old.

METHODS

Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations.

RESULTS

Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community.

CONCLUSIONS

This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.

"Brown girls can't be gay": Racism experienced by queer South Asian women in the Toronto LGBTQ community

The absence of scholarship on South Asian discrimination in Western queer discourse contributes to a narrative that South Asians are not subjected to racially charged forms of discrimination in the LGBTQ community, which is fundamentally untrue. This article presents narrative-based accounts of nine queer South Asian women in Toronto, Canada, to examine the ways in which they experience racial discrimination in the LGBTQ community, and the impact that this mistreatment has on identity formation and connectivity to queer spheres. It finds that queer South Asian women experience racial discrimination in the form of racially charged microaggressions, which are evidenced through expectations of assimilation to Western-normative performances of queer identity and erasure of South Asian culture in the LGBTQ community. Further, it reveals that Toronto's LGBTQ community perpetuates a culture of White privilege that discredits the intersectional identity of queer South Asian women, and consequently invisibilizes, alienates, and revokes agency from these women who do not fit the majority's conceptualizations about what a queer woman looks like.

A Decade of Microaggression Research and LGBTQ Communities: An Introduction to the Special Issue

Though the Supreme Court of the U.S. legalized same-sex marriage in 2015, heterosexism and transphobia has continued to manifest through many systems in the US - from lack of federal protection in employment non-discrimination laws to polices that prohibit transgender people from using bathroom and public facilities that match their gender identities. Heterosexist and transphobic discrimination have also persisted through interpersonal interactions - ranging from more overt forms (e.g., hate crimes, bullying) to more subtle forms of discrimination, otherwise known as microaggressions. Since 2008, there have been hundreds of articles written on microaggressions, with dozens focusing specifically on experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. Qualitative and quantitative studies have revealed that LGBTQ people who experience microaggressions have reported negative outcomes like depression, low self-esteem, and trauma. This special issue aims to further Microaggression Theory by providing theoretical and empirical papers that focus on the manifestation and impact of microaggressions on LGBTQ people. Using an interdisciplinary approach, articles range in topic from intersectional identities, to health and psychological outcomes, to advancing research methods. Future studies regarding microaggressions and LGBTQ people are discussed- highlighting the influence of the changing landscape of heterosexism and transphobia within general society, as well as new dynamics that have formed and developed within LGBTQ communities.