Within and between person effects of structural stigma, support, and concealment on internalized stigma: A 7-year longitudinal study in a sample of same-sex couples

Background: Sexual minority individuals continue to experience significantly higher levels of mental ill health than heterosexual people due to ongoing exposure to sexual minority stressors. Internalized sexual stigma is a key driver of negative mental health outcomes among sexual minority individuals and couples, yet few longitudinal studies have examined how internalized stigma changes over time and its antecedents. This study examined (1) the seven-year trajectory of internalized stigma, and (2) the effect of structural discrimination, friend and family support for relationship, and concealment on changes in internalized stigma at both within-person and between-person levels. Methods: We used linear mixed effects models in a sample of 660 sexual minority adults (n = 330 same-sex couples; Mage = 39.5 years, SD = 10.8) who were assessed annually over seven years. Results: Results showed that internalized stigma remained stable over time. There were significant between-person effects of structural stigma, friend support, and concealment on internalized stigma over time, suggesting that those who, on average, report greater structural stigma and concealment, and lower support from friends, tend to report higher internalized stigma over time. There were significant within-person effects of concealment on internalized stigma at the same timepoint, indicating that when individuals conceal their sexual identity more than usual, they are also more likely to report higher internalized stigma. There was no lagged within-person association between concealment and internalized stigma. There were no within-person effects of friend or family support on internalized stigma at the same or following timepoint. Conclusions: These findings highlight the importance of examining individual, social and structural drivers of internalized stigma over time. This research has important implications for developing effective interventions to reduce minority stress and improve mental health among sexual minority individuals.