Faculty Proceedings, Presentations, Speeches and Lectures


Internalized Heterosexism Mediates the Association between Adverse Childhood Experiences and Well-Being among Sexual Minority Women

Event Title

National LGBTQ Health Conference: Bridging Research and Practice

Event Location


Document Type


Presentation Date


Date Range

2021-05-20 to 2021-05-21


Background. Sexual minority women (SMW) are at increased risk for sexual-based stigmatization and victimization compared to heterosexual women (Mereish & Poteat, 2015). Mereish et al. (2014) found that SMW are also more likely to report adverse childhood experiences (ACEs). ACEs predict mental and physical health disparities across the lifespan in large national samples (CDC, 2013). These disparities perpetuate a greater risk for depression, anxiety, PTSD, suicidal ideation, substance abuse, and various physical health conditions (Mustanski et al., 2016). Internalized heterosexism (IH) is one stigma-related minority stressor unique to sexual minorities that is defined as one's negative attitudes about oneself pertaining to sexual orientation and identity (Meyer & Dean, 1998). IH stems from negative stereotypes, stigmatization, and myths about homosexuality in one's culture (Mason et al., 2015). Kaysen et al. (2015) found that IH and shame were associated with more psychological distress and maladaptive coping strategies such as denial and isolation. Other studies found links between IH and diminished social support, poorer quality relationships and loneliness, and physical health distress (Chow & Cheng, 2010; Spencer & Patrick, 2009). IH creates a barrier between a sexual minority person and prominent sources of coping and resilience that buffer the negative effects of childhood adversity. Although numerous studies have examined the prevalence and various outcomes of adversity in the LGBTQIA+ community, there has yet to be a study that specifically examines the association between ACEs, IH, and psychological well-being among adult sexual minority women. It is hypothesized that IH will mediate the association between ACEs and well-being.

Method. In the present study, N=2,281 self-identified adult women of the LGBTQIA+ community were recruited via social media outlets and completed an anonymous online survey during December 2020 and January 2021. Participants answered demographic questions and completed self-report measures including the ACEs (Finkelhor et al., 2015), IHP Scale (Herek & Glunt, 1995), and Mental Health Continuum-Short Form (Keyes, 2009).

Results. ACEs was positively correlated with IH and negatively correlated with well-being. IH was negatively correlated with wellbeing. Hayes' (2018) PROCESS macro was used to test the hypothesized mediation model (v3.5.3; model 4). As expected, IH significantly mediated the association between ACEs and wellbeing, b = -0.10, SE = .02, 95% CI [-0.1430, -.0538], even when controlling for age, gender identity, sexual identity, race/ethnicity, and childhood religion. The model accounted for 15% of the variance in well-being, F(7, 2281) = 56.01, p < .0001.

Conclusions/Implications. Results of this study provide greater understanding of how childhood adversity perpetuates IH in adulthood and negatively impacts psychological wellbeing. It is advisable for health professionals to be aware of the association between ACEs and well-being among SMW, particularly in conjunction with levels of IH. Because IH negatively impacts wellbeing, health professionals need to be informed on how to provide LGBTQ+ affirming care in the best interest of their patients. This study also illuminates a need for future research to examine the intersecting role of racial discrimination on ACEs, IH, and the impact of the COVID-19 pandemic.