(PS8-36) Coping Strategies as Moderator of the Association Between Sexual Minority Stress and Mental Health: A Systematic Review

Minority stress theory posits that sexual and gender minorities (SGM) are exposed to unique, stigma-based social stress, leading to disparities in mental health problems compared to their cisgender heterosexual counterparts (Meyer et al., 2003). Coping strategies may be an appropriate intervention target, as they can have a stress-buffering effect on mental health (Coyne & Downey, 1991). However, existing research in this area has documented only simple associations between coping strategies and mental health, including lacking systematic review. This review will (1) evaluate which coping strategies weaken the association between minority stress and mental health outcomes, and (2) provide recommendations for future research and clinical practice.

Articles were included in the systematic review if: (1) they were empirical studies published in a peer-reviewed journal that employed quantitative methods, and used (2) samples that included sexual minorities and/or gender minorities, (3) one or more measures of coping, (4) one or more measures of sexual minority and/or gender minority stress, and (5) outcome measure(s) of mental health (i.e., global psychological distress, internalizing symptoms, suicidality, and/or psychological well-being). The initial database search yielded 429 articles published between 1983 and 2022. A total of 248 titles and abstracts were screened after removal of duplicate records, resulting in 149 articles that were full-text reviewed by the author. This yielded 17 studies that were eligible and included in the systematic review.

Across articles, there were twenty-nine tests of the moderating effects of adaptive coping on the association between minority stress and mental health. Eight of these were significant, all indicating stress-buffering effects. Three studies found protective effects of individual coping strategies: mindfulness, self-compassion, and focusing on positive aspects of one’s SGM identity. Five found protective effects of coping strategies performed with other people. For example, involvement in activism, emotion-focused dyadic coping, and problem-focused dyadic coping moderated the relationship between minority stress and mental health.

However, the majority of the studies did not find moderating effects of coping strategies. There was no clear pattern in the null findings, with both adaptive and maladaptive coping strategies represented. The lack of moderating effects observed may point toward methodological limitations of the literature: most studies had insufficient or unspecified power, suggesting that the studies may have failed to detect true effects. Consequently, it would be premature to conclude that coping strategies do not moderate the relationship between minority stress and mental health outcomes. Future research should be more sensitive to the methodological issues that reduce ability to detect moderating effects (e.g., sample size, distribution of the moderator). This review demonstrates the need for further rigorous investigation to identify factors that may protect SGM individuals from mental health problems resulting from stigma-related stress.