Direct and Indirect Effects of Perceived Stigma on Posttraumatic Growth in Gay Men and Lesbian Women in Chile

Texto completo

(1)Journal of Traumatic Stress February 2018, 31, 5–13. Direct and Indirect Effects of Perceived Stigma on Posttraumatic Growth in Gay Men and Lesbian Women in Chile Manuel Cárdenas,1 Jaime Barrientos,2 Ilan Meyer,3 Fabiola Gómez,4 Mónica Guzmán,5 and Joaquı́n Bahamondes6 1 Escuela de Psicologı́a, Universidad de Valparaı́so, Valparaı́so, Chile Escuela de Psicologı́a, Universidad de Santiago de Chile, Santiago, Chile 3 The Williams Institute, School of Law, University of California, Los Angeles, California, USA 4 Escuela de Psicologı́a, Pontificia Universidad Católica de Chile, Santiago, Chile 5 Escuela de Psicologı́a, Universidad Católica del Norte, Antofagasta, Chile 6 School of Psychology, University of Auckland, Auckland, New Zealand 2. This study examined the direct and indirect effects of perceived stigma on posttraumatic growth (PTG) in a sample of gay men and lesbian women in Chile, with coping strategies (positive reappraisal, social support seeking, and active coping strategies) as intermediate variables. Data from 467 gay men (57.4%) and lesbian women (42.6%) were analyzed. A respondent-driven sampling (RDS) method was used. The hierarchical regression analysis indicated the important predictive role of active coping, β = .23, and positive reappraisal, β = .45, in PTG, R2 = .31, p < .001, f2 = 0.16. Results revealed that, in the presence of positive reappraisal coping as an intermediate variable, partial indirect effects are detected between perceived stigma and PTG. Seeking instrumental social support did not produce indirect effects between perceived stigma and PTG, whereas active coping produced partial indirect effects. These findings suggest that the positive reappraisal of a traumatic experience is essential for reporting personal growth. Implications of these more complex relations for counseling interventions and further research are discussed.. The legal and social situations of gay men and lesbians in Latin America has improved in the past decade (Barrientos, 2015). Specifically, Chile passed an antidiscrimination law in 2012 and a law regulating the civil union between same-sex partners in 2015. In addition, available data from 1990 to 2016 indicate a positive change in attitudes toward gay men and lesbians in recent years (Barrientos, 2015, 2016). However, despite improved legal and social conditions, gay men and lesbians are still discriminated against in Chile (Barrientos, 2015; Homosexual Liberation and Integration Movement [MOVILH]), 2016). For example, a recent study showed that 74.5% of respondents had experienced at least one discrimination event due to their sexual orientation or gender identity during their. lifetime, and 30.4% of respondents had experienced at least one discrimination event in a one-month period prior to the interview (MOVILH, 2013). Another study conducted during the 2011 Chilean lesbian, gay men, bisexual, and transgender (LGBT) pride parade showed that about 80% of gay men and lesbian women interviewed reported that they had been discriminated against (Barrientos & Bozon, 2014). Moreover, slurs and threats that had occurred in the respondent’s own neighborhood, religious environment, or school were reported (Barrientos & Bozon, 2014). Prejudice and discrimination toward gay men and lesbians are based on perceived stigma. Stigma is a socially devalued mark or aspect of the self (Goffman, 1963). It stems from social interactions and relations around which a mark is constructed as a reflection of its owner’s character (Earsnshaw & Chaudoir, 2009). Minority stress theory posits that stigma, prejudice, and discrimination produce stress, which, in turn, leads to adverse health outcomes (Meyer, 2003). Minority stress processes include distal stressors, or stressful events, including violence and discrimination related to one’s perceived sexual identity (also referred to as enacted stigma). In addition, Meyer described proximal stressors, which operate through the internalization of social stigma by gay men and lesbian women, including internalized homophobia, concealment of sexual identity or sexual orientation, and expectations of rejection and discrimination. This study was funded by the National Fund for Science and Technology of Chile (Fondo Nacional de Ciencia y Tecnologı́a), Proyecto FONDECYT Regular No. 1140887, titled “Beyond Homophobia: Quality of Life and Posttraumatic Growth (PTG) as a Response to Gay and Lesbian Minority Stress in Chile” and, Proyectos Basal USA 1555 – Vridei 031793BD MOV, Universidad de Santiago de Chile. Correspondence concerning this article should be addressed to Jaime Barrientos, Escuela de Psicologı́a, Universidad de Santiago de Chile, Chile. E-mail: jaime.barrientos@usach.cl C 2018 International Society for Traumatic Stress Studies. View Copyright this article online at wileyonlinelibrary.com DOI: 10.1002/jts.22256. 5.

(2) 6. Cárdenas et al.. (also referred to as “felt stigma”). Some of the consequences of stigma involve feelings of devaluation and a sense of isolation, fear, insecurity, and exclusion from the target group and its members (Schmitt, Branscombe, Postmes, & Garcı́a, 2014; Wirth & Williams, 2009). Faced with stressors, gay men and lesbian women activate various coping responses, including individual and community coping and social support, which reduce the impact of stress on health outcomes (Meyer, 2003). Coping and social support can lead to resilience in some gay men and lesbian women, who can even thrive in spite of the stress resulting from these stigmas and prejudice (Meyer, 2015). Health is impacted by the total effect of the negative (stressors) and ameliorative (social support and coping) processes. The process of thriving in the face of stress is described by the posttraumatic growth (PTG) approach (Calhoun & Tedeschi, 1991; Tedeschi & Clahoun, 1995; Tedeschi, Park, & Calhoun, 1998). According to the PTG approach, perceived stigma would be a significant stressful event to the extent that it causes a deep impact on a person’s belief systems and their basic assumptions about themselves, others, and the world (Janoff-Bulman, 2006). However, the negative impact of perceived stigma and discrimination experiences is reversible, and the belief system that was damaged by a traumatic experience can, in the medium and long term, be reestablished through “reappraisal” of these experiences (Cárdenas, Arnoso, & Faúndez, 2016; Arnoso et al., 2011). The PTG approach refers to positive psychological changes experienced as a result of the struggle with highly challenging life circumstances (Joseph & Linley, 2008; Tedeschi & Calhoun, 2004). Despite its relevance to the minority stress process, to date, scant research has assessed PTG after an experience of perceived stigma in the gay men and lesbian women population. Studies that have looked at posttraumatic stress in gay men and lesbians have evaluated posttraumatic stress symptoms (Nielsen, Tangen, Idsoe, Matthiesen, & Magerøy, 2015; Dragowski, Halkitis, Grossman, & DÁugelli, 2011; Lu, Chen, Ye, Li, & Lin, 2016), rather than PTG. A study by Vaughan and Waehler (2010) is one of the few that examined the impact of the coming-out process (as a minority stress phenomenon) on growth in sexual minorities (2010). Posttraumatic growth research has only recently begun to be considered regarding sexual minority stress (Vaughan, 2007). For example, Moradi, Mohr, Worthington, and Fassinger (2009) suggested that experiences of stress-related growth may provide sexual minorities with important strengths that are useful in effectively managing stress related to their minority status. According to PTG, people often describe how their coping strategies (individual or collective) allow them to experience growth in certain areas of their lives, reconstruct meaning in life, and productively resume their social relations and daily activities (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009). Researchers have shown that cognitive strategies associated with deliberate review of a traumatic experience are relevant (Gul, & Karanci, 2017; Tripplet, Tedeschi, Cann, Calhoun, & Reeve, 2012). Some studies have shown the role of positive reappraisal. (Prati & Pietrantoni, 2009; Scrignaro, Barni, & Magrin, 2011; Zoellner & Maercker, 2006) and active coping strategies as intermediate variables between events and PTG (Park, Aldwin, Fenster, & Snyder, 2008). Other studies have shown that seeking social support can mediate the relationship of stressful life situations and PTG (Prati & Pitrantoni, 2009). Additional studies have shown that optimism is linked to positive reinterpretation strategies (Prati & Pietrantoni, 2009; Solberg & Segerstrom, 2006). These studies suggest that following exposure to minority stressors such as perceived stigma and prejudice, deliberate rumination involving a positive reappraisal of events and their consequences may lead to PTG (Cárdenas et al., 2016). In the present study, our objective was to examine the direct and indirect effects of perceived stigma on PTG in a sample of gay men and lesbian women in Chile. In addition, we analyzed the mediation effect of coping strategies, including positive reappraisal, seeking instrumental social support, and active coping, in experiencing stressful events. Reappraisal requires people to review their experience in a systematic and controlled way, but they can also elaborate on this experience and reassess it from a more optimistic perspective, connecting it to the present and providing a new story about themselves. Thus, perceived stigma may be related to reports of PTG in the presence of some coping strategies, particularly those related to active coping, seeking social support, and positive reappraisal of an experience.. Method Participants and Procedure Sexual minorities are a hard-to-reach population due to their stigmatized identity. Because there is no clear framework for recruiting a probability sample from this population, we used a type of respondent-driven sampling (RDS), which is a sampling strategy designed for cases where universe size is unknown. Respondent-driven sampling (RDS) is useful in studies with hidden or hard-to-reach populations whose size is unknown, and where the minority condition of the group may make them reluctant to provide information, given their stigmatized behaviors, which can be socially viewed as bad or even considered illegal (Heckathorn, 1997, 2002). This sampling method was designed to correct some of the methodological gaps of classical snowball sampling methods, and it does so through the elaboration of a mathematical procedure that makes it possible to estimate the representativeness of the sample obtained (through network analysis), without ruling out that the members of the group themselves are best suited to recruit other members of the population. This sampling method makes it possible to calculate unbiased estimators and the standard error of confidence intervals. These calculations are performed on the basis of information given by participants about their relationship with the recruits and according to each participant’s estimation of the size of his/her social network (people with. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(3) Coping, Stigma, and Posttraumatic Growth in Chile. the same characteristics that he or she knows; Abdul-Quader, Heckathorn, Sabin & Saidel, 2006; Heckathorn, 2002). With RDS, during the sampling process, the sample framework is constructed on the basis of the estimations of the size of each participant’s network. To start the procedure, the profile of an initial participant who begins the recruitment process is defined. This participant acts as a researcher seed. Thus, in this study, a profile of the target gay men and lesbian women group was defined, and participants with this profile were selected to act as researcher seeds. Selection criteria for the recruitment of participants acting as seeds were: (a) defining themselves as gay men or lesbians; (b) having a large social network (how many gay men/lesbian women do you know who know you and live in this city?); (c) place of residence in one of four largest Chilean cities (Antofagasta, Santiago, Valparaı́so, or Concepción); and (d) being over 18 years of age. In each city other than Santiago, three gay men and three lesbians were selected as researcher seeds; in Santiago, the largest, and capital, city, six gay men and six lesbians were selected as researcher seeds. These initial participants were selected with input from key informants in each city as the starting point for recruitment. After completing the survey, each initial participant was asked to invite three gay men and/or lesbians who met the eligibility criteria to participate in the study. Participants were also invited to refer people they knew directly, who met requirements for inclusion in the sample. This process was repeated until the desired sample size was achieved. Each participant was rewarded with a cash payment (approximately $10 USD) for his or her participation (participants were not rewarded for their successful references). A field coordinator in each region supervised the process, and a group of advisors administered a questionnaire. Advisors were male and female psychology and sociology students, and included gay men, lesbian women, and heterosexual people. The questionnaire was administered in a face-to-face session that took about 45 min to complete. Participants were informed about the objectives of the study, and they signed a letter of consent that guaranteed data confidentiality. An ethical review was conducted and approved by University of Santiago institutional Ethics Board and the National Fund for Scientific and Technological Development (FONDECYT). The final sample included 467 gay men and lesbian women; 57.4 % (n = 268) were men, and 42.6 % (n = 199) were women. Gay men were 18 to 67 years of age (M = 27.6, SD = 7.6), and lesbian women were 18 to 60 years of age (M = 28.1, SD = 8.2). Measures Sociodemographic measures. Sociodemographic measures included: (a) sexual orientation: participants were asked to report their sexual self-identification as either gay man or lesbian; (b) city of residence: Antofagasta, Santiago, Valparaı́so, or Concepción; (c) highest educational level on five response options from “incomplete secondary school” to “graduate degree”; and (d) socioeconomic status, assessed using the European Society for Opinion and Marketing Research. 7. (ESOMAR; Reif, Marbeau, Quatresooz, & Vancraeynest, 1991), adapted to the Chilean context. The ESOMAR combines the highest educational level and occupational category of the head of household into one matrix and categorizes socioeconomic status in three levels: low, medium, and high. Posttraumatic growth. The outcome measure was the Posttraumatic Growth Inventory–Short Form (Cann et al., 2010), using a version adapted and validated in Chile (Cárdenas, Barrientos, Ricci, & Páez, 2015). It consists of 10 Likert-type items from 1 (completely disagree) to 6 (completely agree). Higher scores indicate higher growth reports. Participants were asked to think of or remember the situation in terms of their negative perception of stigma to later fill out the scale (example of an item: “I changed my priorities about what is important in life”). Cronbach’s alpha was .86 and item-total correlations were between .47 and .70. Perceived stigma. The predictor measure was the Subjective Scale of Stigma and Discrimination (SISD), which was created in Chile to assess perceived stigma and discrimination toward gay men and male-to-female transgender population (Barrientos & Cárdenas, 2014). For this population, we used a version adapted for use with lesbian women. The scale consists of 23 Likert-type items, with responses ranging from 1 (completely disagree) to 5 (completely agree), grouped together to represent six dimensions, including stigma and discrimination experiences (“In our society, many homosexuals are insulted in the street due to their sexual orientation”), disadvantages in the presence of authorities (“If a homosexual files a complaint about an aggression, his/her account might be questioned”), discrimination at work (“I think I could be fired from a job because of my sexual orientation”), expression of sexual identity (“In a society like ours, a homosexual will always see the expression of his/her ideas restricted”), and institutional exclusion and denial of rights (“In our society, a homosexual person can miss the opportunity to access social benefits due to his/her sexual orientation”). Cronbach’s alpha for the reliability of the scale was .86. The reliability coefficients for the dimensions ranged between .71 and .89. Coping styles. The mediator measure was the Coping Styles Scale (Páez, Campos & Velasco, 2004). The scale consists of 28 items with response options from 1 (completely disagree) to 6 (completely agree). The version was validated for Spanish use. This scale measures different coping styles. Our study only used dimensions of this scale referring to (a) active coping, relating to the process of taking active steps to remove or circumvent the stressor or decrease its effects; (b) seeking instrumental social support, relating to seeking advice, assistance, or information, seeking social support for emotional reasons, getting moral support, sympathy, or understanding; and (c) positive reappraisal strategies, relating to attempts to change the perspective about a stressful situation to view it more positively. Cronbach’s alpha was .85. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(4) 8. Cárdenas et al.. (item-total correlation between .39 and .65) for the measure; for the subscales, Cronbach’s alpha values were .68 (active coping), .67 (seeking instrumental social support) and .83 (positive reappraisal). Data Analysis Data were analyzed using the RDS Analysis Tool, version 7.1.3 (RDSAT). The RDS population estimates and confidence intervals calculated by RDSAT are reported. The homophily index describes the extent of in-group ties. A homophily index (H) of 1 reflects perfect homophily, indicating that ties are formed with other members of the same group. By contrast, −1 reflects perfect heterophily, indicating that ties are formed completely outside of the group (the results from this study are reported in the section on recruitment). A partition analysis was defined as a set of data (in this case, the variable “sexual orientation” was used). This analysis makes it possible to observe the probabilities that each group (gay men and lesbians) recruits members of its own group and the other group. We used SPSS to analyze partial correlations, hierarchical multiple regressions, and direct and indirect effects. The hierarchical regression analysis shows the relative importance of each variable introduced as a predictor in the successive models, as well as the progressive improvement or variation of the explanatory capacity of the overall model. We used the SPSS PROCESS macro to bootstrap indirect effects, which provided indirect effect estimates for multiple intermediate variables, standard errors (SEs), and confidence intervals (CIs) derived from the bootstrap distribution with 10,000 bootstrap estimates. Bootstrapped confidence intervals are superior to the standard forms of the estimating standard errors of indirect effects (Hayes, 2013). An indirect effect is significant if the CI does not include the 0 value. The stressful event (perceived stigma) was a predictor variable, whereas active coping, seeking social support, and positive reappraisal were used as intermediate variables; PTG was an outcome in the model. Analyses (correlations, direct effects, and indirect effects) were conducted by controlling for gender and socioeconomic level, which means that significant results found cannot be explained by these variables. The effect size was calculated with the completely standardized indirect effect and mediation index (k2 ) offered by the SPSS PROCESS macro (see Preacher & Kelley, 2011).. Results Network Sizes and Recruitment As part of RDS methodology, respondents were asked about the size of their personal networks. The pattern of network sizes differed by sex. Average social network sizes were larger for gay men than for lesbian women, and each group had larger networks of people of their own sex. Lesbian women reported a mean of 16.03 gay men and 20.67 lesbian women in their. network. Gay men reported a larger personal network size than lesbians, with an average of 62.39 gay men and 17.43 lesbian women. The equilibrium sample population did not change the population ratio by a significant amount after the sixth recruitment wave. We conducted a partition analysis, using sex as an attribute (the confidence interval was 95%, the number of resamples for bootstrap was 15,000, and pull-in outliers of network sizes made up 5.0%), with the recommended enhanced data-smoothing algorithm (Spiller et al., 2012). Results indicated that the probability that lesbian women would recruit gay men was 39%, whereas the probability that they would recruit other lesbian women was 61%. The probability that gay men would recruit other gay men was 71%, and the probability that they would recruit lesbian women was 29%. Gender affiliation patterns indicated a strong level of homophily in both groups. The homophily index indicated that gay men mainly recruited members of their own group, H = 0.35, and lesbian women often recruited other lesbian women, H = 0.29. The standard bootstrapping error was 0.04 for both groups, and the estimated population ratios were 0.55, 95% CI [0.46, 0.61] for gay men and 0.45, 95% CI [0.38, 0.53] for lesbian women. The estimated population proportion was calculated using the data-smoothing algorithm (which adjusted recruitments across groups, providing tighter confidence intervals).. Perceived Stigma and PTG Participants reported moderate levels of perceived stigma (M = 3.83, SD = 0.83), and the presence of PTG (M = 3.83, SD = 1.42). In addition, participants reported high levels of positive reappraisal coping (M = 5.28, SD = 1.66) and moderate levels of seeking social support coping (M = 4.39, SD = 1.70) and active coping (M = 4.46, SD = 1.96). Table 1 shows the percentages for socioeconomic status and highest educational level of gay men and lesbian women.. PTG Predictors Hierarchical multiple regression was used to predict PTG. We progressively incorporated the following variables; perceived stigma (step 1), active coping (step 2), seeking social support (step 3), and positive reappraisal (step 4). Table 2 shows results that confirm the important role of positive reappraisal, β = .45, p < .001, as a predictor of PTG reports. When positive reappraisal was introduced in step 4, there was an increase in the explained variance. Similarly, the inclusion of this variable significantly contributed to the variance explained by the model, R2 = .14. Active coping also significantly contributed to PTG prediction, β = .19, p < .001, although less than positive reappraisal, β = .43. Seeking social support was not a significant predictor of PTG and therefore it was not included in step 4.. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(5) 9. Coping, Stigma, and Posttraumatic Growth in Chile. Table 1 Summary of Hierarchical Regression Analysis for Variables Predicting Posttraumatic Growth Predictor Step 1 Perceived Stigma Step 2 Perceived Stigma Active Coping Step 3 Perceived Stigma Active Coping Seeking Instrumental Social Support Step 4 Perceived Stigma Active Coping Positive Reappraisal. β. SE β. t. R2 .007a. .08. .08. 1.62 .160***b. .06 .41. .07 .03. 1.24 9.00*** .002c. .05 .38 .05. .76 .40 .47. 1.06 6.83*** 0.99 .140***d. .02 .19 .45. .07 .06 .04. 0.42 3.95*** 8.91***. Note. N = 407. a Step 1: degrees of freedom (df) for R2 (.007) = 1, 402. b Step 2: df for R2 (.16) = 2, 401. c Step 3 df for R2 (.002) = 3, 401. d Step 4 df for R2 (.14) = 3, 401. ***p < .001.. indirect effect, B = 0.089, z = 2.31, p = .021, which shows that the indirect effect through active coping and seeking social support is not significant. Considering the effect of the positive reappraisal variable in the model illustrated in Figure 1, we conducted a second analysis of the direct and indirect effects to examine reverse intermediation effects. To do so, PTG was proposed as the intermediary variable and positive reappraisal coping as the outcome. Results indicated that there was no significant direct effect between perceived stigma and PTG, B = 0.15, SE = 0.08, 95% CI [0.006, 0.320], or positive reappraisal, B = 0.13, SE = 0.08, 95% CI [−0.029, 0.297], but the analysis, R2 = 0.01, F(1, 402) = 5.81, p = .016, showed that the possibility was quite high that PTG explains the positive reappraisal of the experience, B = 0.62, SE = 0.05, 95% CI [0.524, 0.720]. The completely standardized indirect effect, B = 0.042, 95% CI [−0.006, 0.095], indicated that the partial indirect effect (effect size) was about 4.2% of the possible maximum value, which is a fairly small effect. The mediation index, k2 = 0.042, 95% CI [−0.006, 0.095], expressed the maximum possible indirect effect; that is, 7.1%. In addition, the Sobel test indicated that positive reappraisal had a significant indirect effect, B = 0.082, SE = 0.051, z = 2.31, p = .021. The effect size in the reverse intermediation model was significant, lower than that in the originally proposed model.. PTG Through Coping Strategies The results of partial correlations, after we controlled for the effects of sex and socioeconomic status, indicated that perceived stigma was associated with positive intermediary variable reappraisal, r(405) = .12, p = .016, and seeking social support, r(408) = .11, p = .011, but it was not associated with active coping, r(408) = .06, p = .182. Posttraumatic growth was associated with positive intermediary variable reappraisal, coping strategies, r(404) = .55, p < .001, seeking instrumental social support, r(407) = .29, p < .001, and active coping, r(407) = .49, p < .001. Active coping was associated with seeking social support, r(388) = .57, p < .001, and positive reappraisal, r(388) = .51, p < .001. Finally, positive reappraisal was associated with seeking social support, r (388) = .49, p < .001. Figure 1 shows that the total effect of perceived stigma on PTG is significant and positive. This effect decreased when we included positive reappraisal in the model as an intermediate variable; this supports our hypothesis concerning partial indirect effects on perceived stigma through coping strategies, R2 = .02, F(3,399) = 3.14, p = .025. The bootstrap analysis yielded a significant partial indirect effect of perceived stigma on PTG only through positive reappraisal coping, B = 0.09, SE = 0.04, 95% CI [0.016, 0.179]. The completely standardized indirect effect, B = 0.058, SE = 0.024, 95% CI [0.003, 0.114], indicated that the effect size was about 5.8% of the possible maximum value, which is a fairly small effect. The mediation index, k2 = 0.071, 95% CI [0.015, 0.131], expressed the maximum possible indirect effect; that is, 7.1%. In addition, a Sobel test indicated that positive reappraisal had a significant. Discussion The objective of our study was to examine the direct and indirect effects of perceived stigma on PTG in a sample of gay men and lesbian women in Chile. In addition, this study focused on some coping strategies as partial intermediate variables between perceived stigma and PTG in this sample. Weiss, Garvert, and Cloitre (2015) suggested that, for example, gay men and lesbian women tend to experience PTSD more than straight people as a result of greater trauma exposure to discrimination experiences. However, PTSD research on gay men and lesbian women is scarce and relatively recent (Deagowski, Halkitis, Grossman, & DÁugelli, 2011; Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010; Yu, Chen, Ye, Li, & Lin, 2016). Furthermore, studies on probable growth after a traumatic event, such as an episode of perceived stigma and/or discrimination toward sexual minorities, are even more limited. For this reason, our study makes a contribution to a developing field. In spite of previous limitations, this paper makes a valuable contribution to the existing literature on LGBT studies and research. Until very recently, studies on the LGBT population focused on the negative stigma and discrimination effects on health. A shift to studies focusing on the well-being and quality of life has recently been observed. An example of this is the current use of the concept of resilience (Meyer, 2015). According to Meyer, resilience is not in any way antithetical to or an alternative approach to stress theory, but rather a very important aspect of stress theory and an essential part of. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(6) 10. Cárdenas et al.. Figure 1. The effect of the perceived stigma on posttraumatic growth, through the coping strategies. Path coefficients are unstandardized estimates. Total and direct (in parenthesis) effects of life impact on posttraumatic growth. **p < .05. ***p < .001.. minority stress. Indeed, resilience has meaning in facing stress and, therefore, it is an essential part of minority stress understanding. The concept of resilience implies that people can reach the level of functioning they had prior to a trauma or stressful experience. By contrast, PTG involves the possibility of discovering new strengths (nonexistent or unknown at the time of the trauma) that go beyond the mere capacity to adapt or return to previous levels. These two concepts are not necessarily related to each other and may even be inversely related (Levine, Laufer, Stein, Hamama-Raz, & Solomon, 2009). Resilience involves the possibility of withstanding a traumatic event and recovering from it (Bonanno & Kaltman, 2001) while maintaining a stable equilibrium without one’s performance and daily life being affected (Bonano, 2004). The basic difference between resilience and the concept of PTG is that the latter involves the possibility of learning and growing from adverse experiences, obtaining benefits from the struggle with the sudden changes the traumatic event has caused in life (Tedeschi & Calhoun, 2000). The main contributions of this study are showing how the PTG concept can be applied to gay men and lesbian women, and showing the process for achieving PTG reports through certain coping strategies. Posttraumatic growth is a concept that shows how negative events can produce positive results; in our study, we emphasize the process by which this is achieved. Our results showed an association between perceived stigma and PTG, mediated by positive reappraisal and, to a lesser degree, active coping strategies. Perceived stigma was not a predictor of PTG itself, even though they are related, but it was a predictor when intermediated by positive reappraisal and, to a lesser degree, active coping strategies. This result suggests that PTG emerges when individuals are able to both systematically review their experiences and analyze past events more positively, and make an effort to take action to manage conflict directly. This finding is relevant, especially considering that LGBT people regularly face perceived stigma throughout their lives. Thus, these psychological mechanisms are used to face a hostile context, their relevance being shown in this study. Regression analyses indicated that PTG is predicted by positive reappraisal and active coping strategies, but not by perceived stigma. Results are also consistent with previous research on the indirect effect of general maladaptive coping. in the relationship between heterosexist discrimination and psychological distress in women belonging to sexual minorities (Bandermann & Szymanski, 2014; Szymansky & HenrichsBeck, 2014). However, future studies should more closely examine the types of coping strategies used to face discrimination. In addition, they should identify processes that underlie the potential association between perceived stigma and PTG. These findings are important because positive reappraisal and active coping strategies could have relevant implications in clinical work with LGBT people. For example, they highlight spaces of contention and psychosocial support as important elements that give meaning to experience, and work on the construction of new ways to interpret traumatic and stressful events from the past through a process of the positive reappraisal of certain aspects of the experience. In the context of therapy, it is essential to create spaces for a systematic review of experiences, listen to harm caused by discrimination, and work toward elaborating on these experiences. This study also revealed that using direct actions to manage discrimination events is a relevant strategy for changing growing perceived stigma. People feel better when they look at events through a new prism or when they are able to perform actions that help them take control of their own lives and contribute to reducing prejudice and discrimination. Any actions related to strengthening civil associations, building a repertoire of protest actions, and joining minority rights movements might be important elements in reducing the effects of prejudice and discrimination on the LGBT population. However, this study is subjected to certain limitations. One of the main limitations is the type of data. Data were crosssectional, which enabled us to draw conclusions about associations, but not about causation. Therefore, this study was unable to test whether the independent variables precede dependent variables, because all the variables were measured at the same time. Moreover, cross-sectional studies on the mediation of some variables will generate biased estimates of longitudinal mediation parameters (Maxwell & Cole, 2007). In addition, it is necessary to more closely analyze the association between PTG and positive reappraisal because, as our results show, the inverse relationship between them is theoretically possible. In other words, perceived stigma can have indirect effects on positive reappraisal through PTG.. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(7) 11. Coping, Stigma, and Posttraumatic Growth in Chile. This effect could be explained by the amount of time that had elapsed since exposure to the perceived stigma, which we did not control for in this study. Future studies should test these associations longitudinally because PTG reports must be specifically linked to coping strategies. Otherwise, it could be explained by almost any other event throughout life. The use of self-reports also has several limitations related to the fact that people differ in their capacity to be aware of their own internal states (Nisbett & Wilson, 1977); they are not always willing to show their attitudes publicly due to their apprehension about being evaluated (Rosenberg, 1969); and they try to correct their impressions (Tedeschi, Schlenker, & Bonoma, 1971) or opinions as they occur in order to make them more acceptable (Petty & Wegener, 1998). We attempted to mitigate these concerns at the beginning of the questionnaire by building rapport, asking respondents to give honest responses, and assuring respondents’ confidentiality. This study focused on gay men and lesbian women populations. Thus, future research on this phenomenon should explore other types of sexual minorities (Vaughan & Waehler, 2010). For example, since various national studies show that levels of perceived stigma and discrimination are higher in the transgender population than in gay men and lesbian women (Barrientos, 2015), future studies should analyze these variables in this population to evaluate possible PTG reports. Posttraumatic growth research has only recently begun to be considered in terms of sexual minority stress (Vaughan, 2007). Our study dealt with the perception of social stressors, but not of a traumatic event as such. In our context, these direct or indirect experiences make up what is called “minority stress.” This is cumulative stress which, as indicated in other studies, (Barrientos, Gómez, & Cárdenas, 2016) has much more persistent and harmful effects on this population than several other serious and acute events described as traumatic. For example, Barrientos, Cárdenas, and Gómez (2016) showed that repeated mockery and rejection of identity in their primary groups had a more serious effect on the lives of gay men than did an event of physical aggression. Certainly, this type of situation must be analyzed in further detail to make a substantive contribution to the concept of PTG, which should show stressful vital situations and stress accumulation processes that minority groups must live with daily, in a context of hostility and rejection. Our findings represent an approach to the study of PTG in gay men and lesbian women. They make it possible to direct future psychosocial interventions, public policies, and future research that will allow for a better emotional regulation of experiences. From a clinical viewpoint, professionals should help LGBT patients develop positive coping strategies in the context of perceived stigma and discrimination. In addition, the identification of factors that mediate prejudice and growth reports will allow therapists to develop more targeted interventions.. References Abdul-Quader, A., Heckathorn, D., Sabin, K., & Saidel, T. (2006). Implementation and analysis of respondent driven sampling: Lesson learned from the field. Journal of Urban Health, 83(7), 1–5. https://doi.org/10.1007/s11524006-9108-8 Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2009). Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38, 1001–1014. https://doi.org/10.1007/s10964-009-9397-9 Arnoso, M., Bilbao, M. A., Páez, D., Iraurgi, I., Kanyangara, P., Rimé, B., Sales, P. P., & Martı́n-Beristain, C. (2011). Violencia colectiva y creencias básicas sobre el mundo, los otros y el yo. Impacto y reconstrucción. [Collective violence and basic beliefs about the world, others and the self. Impact and reconstruction]. En D. Páez, C. Martin, J. L. González & J. de Rivera (Eds.). Superando la violencia colectiva y construyendo cultura de paz. [Overcoming collective violence and building a culture of peace]. Madrid: Fundamentos. Bandermann, K. M., & Szymanski, D. M. (2014). Exploring coping mediators between heterosexist oppression and posttraumatic stress symptoms among lesbian, gay, and bisexual persons. Psychology of Sexual Orientation and Gender Diversity, 1(3), 213–224. https://doi.org/10.1037/sgd0000044 Barrientos, J. (2015). Violencia homofóbica en América Latina y Chile. [Homophobic Violence in Latin America and Chile]. Santiago de Chile: Ediciones y Publicaciones El Buen Aire S.A. Barrientos, J. (2016). Situación social y legal de gays, lesbianas y personas transgénero y la discriminación contra estas poblaciones en América Latina [The social and legal status of gay men, lesbians and transgender persons, and discrimination against these populations in Latin America]. Sexualidad, Salud y Sociedad, 22, 331–354. https://doi.org/10.1590/19846487.sess.2016.22.15.a Barrientos, J., & Bozon, M. V. (2014). Victimization against gay men and lesbians in Chile in the context of the XIII Sexual Diversity Pride Parade –Santiago 2011: Two types of discrimination or just one? Revista Interdisciplinaria, 31, 323–339. Barrientos, J., & Cárdenas, M. (2014). Construction and Validation of a Subjective Scale of Stigma and Discrimination (SISD) for the Gay Men and Transgender Women Population in Chile. Sexuality Research and Social Policy, 14, 187–198. https://doi.org/10.1007/s13178-014-0150-0 Barrientos, J., Cárdenas, M., Gómez, F., & Guzmán, M. (2016). Gay men and male-to-female transgender persons in Chile: An exploratory quantitative study on stigma, discrimination, victimization, happiness and social wellbeing. In Th. Köllen (Ed), Sexual orientation and transgender issues in organizations: Global perspectives on LGBT workforce diversity (Chapter 15). Switzerland: Springer International Publishing. https://doi.org/10.1007/9783-319-29623-4_15 Barrientos, J., Gómez, F., & Cárdenas, M. (2016). Subjective well-being and levels of clinical symptomatology in a transwomen sample and men who have a sex with men in Chile. Journal of Homosexuality, 63, 1502–1516. https://doi.org/10.1080/00918369.2016.1223346 Barros, A. N., Dias, S. F., & Martins, M. R. (2015). Hard-to-reach populations of men who have sex with men and sex workers: A systematic review on sampling methods. Systematic Reviews, 4, 141–148. https://doi.org/10.1186/s13643-015-0129-9 Bonanno, G. A. (2004). Loss, trauma and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20–28. https://doi.org/10.1037/0003-066X.59. 1.20 Bonanno, G. A., & Kaltman, S. (2001). The varieties of grief experience. Clinical Psychology Review, 21, 705–734. https://doi.org/10.1016/S02727358(00)00062-3. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(8) 12. Cárdenas et al.. Calhoun, L. G., & Tedeschi, R. G. (1991). Perceiving benefits in traumatic events: Some issues for practicing psychologists. The Journal of Training and Practice in Professional Psychology, 5, 45–52.. Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209–213. https://doi.org/10.1037/sgd0000132. Cann, A., Calhoun, L. G., Tedeschi, R. G., Taku, T., Vishnevsky, T., Tripplet, K. N., & Danhauer, S. (2010). A short form of the Posttraumatic Growth Inventory. Anxiety, Stress & Coping, 23(2), 127–137. https://doi.org/10.1080/10615800903094273. Moradi, B., Mohr, J. J., Worthington, R. L., & Fassinger, R. E. (2009). Counseling psychology research on sexual (orientation) minority issues: Conceptual and methodological challenges and opportunities. Journal of Counseling Psychology, 56(1), 5–22. https://doi.org/10.1037/a0014572. Cárdenas, M., Arnoso, M., & Faúndez, X. (2016). Deliberate rumination and positive reappraisal as serial mediators between life impact and posttraumatic growth in victims of state terrorism in Chile (1973–1990). Journal of Interpersonal Violence, 088626051664229. https://doi.org/10.1177/0886260516642294.. Movimiento de Integración y Liberación Homosexual (MOVILH) (2013). XI Informe Anual de Derechos Humanos de la Diversidad Sexual en Chile, Hechos 2012. Historia anual de las minorı́as sexuales chilenas. [Eleventh Annual Report: Human Rights of Sexual Diversity in Chile]. Santiago, Chile: Author. Retrieved from: http://www.movilh.cl/documentacion/XI_Informe_de_DHH_Movilh_ Hechos_2012.pdf. Cárdenas, M., Barrientos, J., Ricci, E., & Páez, D. (2015). Spanish adaptation and validation of the Posttraumatic Growth Inventory–Short Form. Violence & Victims, 30, 756–769. https://doi.org/10.1891/0886-6708.VVD-13-00165 Dragowski, E., Halkitis, P., Grossman, A., & DÁugelli, A. (2011). Sexual orientation victimization and posttraumatic stress symptoms among lesbian, gay, bisexual youth. Journal of Gay & Lesbian Social Services, 23, 226–249. https://doi.org/10.1080/10538720.2010. 541028 Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177. https://doi.org/10.1007/s10461-0099593-3 Goffman, E. (1963). Stigma. London, England: Penguin. Gul, E., & Karanci, N. (2017). What determines posttraumatic stress and growth following various traumatic events? A study in a Turkish community sample. Journal of Traumatic Stress, 30, 54–62. https://doi.org/10.1002/jts.22161 Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: The Guilford Press. Heckathorn, D. (1997). Respondent driven sampling: A new approach to the study of hidden populations. Social Problems, 44(2), 174–199. https://doi.org/10.2307/3096941 Heckathorn, D. (2002). Respondent driven sampling II: Deriving population estimates from chain-referral samples of hidden populations. Social Problems, 49, 11–34. https://doi.org/10.1525/sp.2002.49.1.11 Janoff-Bulman, R. (2006). Schema-change perspectives on posttraumatic growth. In L. G. Calhoun & R. G. Tedeschi (Eds.), The handbook of posttraumatic growth: Research and practice (pp. 81–99). Mahwah, NJ: Lawrence Erlbaum.. Movimiento de Integración y Liberación Homosexual [MOVILH] (2016). XIV Informe Anual de Derechos Humanos de la Diversidad Sexual en Chile, Hechos 2015. Historia anual de las minorı́as sexuales chilenas. [Fourteenth Annual Report: Human Rights of Sexual Diversity in Chile]. Santiago, Chile: Author. Retrieved from: http://www.movilh.cl/documentacion/2014/XIII%20Informe%20de%20 DDHH%202014-web.pdf Nielsen, M. B., Tangen, T., Idsoe, T., Matthiesen, S. B., & Magerøy, N. (2015). Post-traumatic stress disorder as a consequence of bullying at work and at school. A literature review and meta-analysis. Aggression and Violent Behavior, 21, 17–24. https://doi.org/10.1016/j.avb.2015.01.001 Nisbett, R., & Wilson, T. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, 84, 231–259. https://doi.org/10.1037/0033-295X.84.3.231 Páez, D., Velasco, C., & Campos, M. (2004). Formas de afrontamiento, mecanismos de defensa e inteligencia emocional: comparación teórica y evaluación empı́rica de su frecuencia y funcionalidad [Forms of coping. Defense mechanism and emotional intelligence: theoretical comparison and empirical assessment of frequency and functionality]. Revista de Psicoterapia, XV(60), 23–46. Park, C. L., Aldwin, C. M., Fenster, J. R., & Snyder, L. B. (2008). Pathways to posttraumatic growth versus posttraumatic stress: Coping and emotional reactions following the September 11, 2001, terrorist attacks. American Journal of Orthopsychiatry, 78, 300–312. https://doi.org/10.1037/ a0014054 Petty, R. E., & Wegener, D. T. (1998). Attitude change. In D. Gilbert, S. Fiske, & G. Lindzey (Eds.), The handbook of social psychology (4th ed., pp. 323–390). New York, NY: McGraw-Hill. Prati, G., & Pietrantoni, L. (2009). Optimism, social support and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of Loss and Trauma: International Perspectives on Stress & Coping, 14(5), 364–388. https://doi.org/10.1080/15325020902724271. Joseph, S., & Linley, P. A. (2008). Psychological appraisal of growth following adversity: A review. In Authors (Eds.), Trauma, recovery, and growth: Positive psychological perspectives on posttraumatic stress (pp. 21–36). Hoboken, NJ: Wiley.. Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115. Https://doi.org/10.1037/a0022658.. Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., & Solomon Z. (2009). Examining the relationship between resilience and posttraumatic growth. Journal of Traumatic Stress, 4, 282–286. https://doi.org/10.1002/ jts.20409. Reif, K., Marbeau, Y., Quatresooz, J., & Vancraeynest, D. (1991). Harmonization of demographic: Progress report of the ESOMAR working party. In: ESOMAR Congress (pp. 1–41). Luxembourg: European Society for Opinion and Marketing Research.. Maxwell, S. E. & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods,12(1), 23–44. https://doi.org/10.1037/1082-989X.12.1.23. Roberts, A. L., Austin, B., Corliss, H. L., Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100, 2433–2441. https://doi.org/10.2105/AJPH.2009.168971. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/00332909.129.5.674. Rosemberg, R. J. (1969). The conditions and consequences of evaluation apprehension. In R. Rothenthal & R. L. Rosnow (Eds.), Artifact in behavioral research (pp. 280–348). New York, NY: Academic Press.. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(9) Coping, Stigma, and Posttraumatic Growth in Chile Schmitt, M. T., Branscombe, N. R., Postnes, T., & Garcı́a, A. (2014). The consequences of perceived discrimination for psychological wellbeing: a meta-analytic review. Psychological Bulletin, 140, 921–948. https://doi.org/10.1037/a0035754 Scrignaro, M., Barni, S., & Magrin, M. E. (2011). The combined contribution of social support and coping strategies in predicting post-traumatic growth: A longitudinal study on cancer patients. Psycho-Oncology, 20, 823–831. https://doi.org/10.1002/pon. 1782 Solberg, L., & Segerstrom, S. (2006). Dispositional optimism and coping: A meta-analytic review. Personality and Social Psychology Review, 10(3), 235–251. https://doi.org/10.1207/s15327957pspr1003_3 Spiller, M. W., Cameron, C., & Heckathorn, D. D. (2012). RDSAT 7.1 user manual: RDS analysis tool 7.1. Ithaca, NY: Cornell University Szymanski, D. M., & Henrichs-Beck, C. (2014). Exploring sexual minority women’s experiences of external and internalized heterosexism and sexism and their links to coping and distress. Sex Roles, 70, 28–42. https://doi.org/10.1007/s11199-013-0329 Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma & transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage Publications. Tedeschi, R. G., & Calhoun, L. G. (2000). Posttraumatic growth: A new focus in psycho traumatology (April, 2000). Psy-talk, Newsletter of the British Psychological Society Student Members Group. Tedeschi, R., & Calhoun, L. (2004). Posttraumatic growth: Conceptual foundation and empirical evidence. Psychological Inquiry, 15(1), 1–18. https://https://doi.org/10.1207/s15327965pli1501_01 Tedeschi, R. G., Park, C. L., & Calhoun, L. G. (1998). Posttraumatic growth: Positive transformations in the aftermath of crisis. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.. 13. Tedeschi, J., Schlenker, B., & Bonoma, T. (1971). Cognitive dissonance: Private ratiocination or public expectacle? American Psychologist, 26, 685– 695. https://doi.org/10.1037/h0032110 Triplett, K. N., Tedeschi, R. G., Cann, A., Calhoun, L. G., & Reeve, C. L. (2012). Posttraumatic growth, meaning in life, and life satisfaction in response to trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 400–410. https://doi.org/10.1037/a0024204 Vaughan, M. (2007). Coming out growth: Conceptualizing and assesing experiences of stress-related growth associated with coming out as lesbians or gay (Doctoral dissertation). Retrieved from https://etd.ohiolink.edu/ Vaughan, M. D., & Waehler, C. A. (2010). Coming out growth: Conceptualizing and measuring stress-related growth associated with coming out to others as a sexual minority. Journal of Adult Development, 17, 94–109. https://doi.org/10.1007/s10804-009-9084-9 Weiss, B., Garvert, D., & Cloitre, M. (2015). PTSD and trauma-related difficulties in sexual minority women: The impact of perceived social support. Journal of Traumatic Stress, 28(6), 563–571. https://doi.org/10.1002/jts.22061 Wirth, J. H., & Williams, K. D. (2009). “They don’t like our kind”: Consequences of being ostracized while possessing a group membership. Group Processes Intergroup Relations, 12(1), 111-127. https://doi.org/10.1177/1368430208098780 Yu, N. X., Chen, L., Ye, Z., Li, X., & Lin, D. (2016). Impacts of making sense of adversity on depression, posttraumatic disorder, and posttraumatic growth among a sample of mainly newly diagnosed HIV-positive Chinese young homosexual men: the mediating role of resilience. AIDS CARE, 29, 79–85. https://doi.org/10.1080/09540121.2016.1210073 Zoellner, T., & Maercker, A. (2006). Posttraumatic growth in clinical psychology—A critical review and introduction of a two component model. Clinical Psychology Review, 26(5), 626–653. https://doi.org/10.1016/j.cpr.2006.01.008. Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies..

(10)