The price of shame: A scoping review examining the effects of shame on sexual and gender minority populations in the United States

Purpose: Sexual and gender minority (SGM) people experience a higher prevalence of adverse health outcomes compared to their heterosexual and cisgender counterparts due, in part, to shame related to sexual orientation and gender identity. The purpose of this scoping review was to identify and synthesize empirical evidence of the effects of shame on SGM populations in the United States. Methods: Following PRISMA-ScR guidelines, we systematically searched for studies that were (1) peer-reviewed; (2) original research; (3) written in English; (4) quantitatively measuring shame; (5) among groups identifying as sexual minority, gender minority, or both; (6) within the United States. Results: We identified 22 studies meeting inclusion criteria, most of which were cross-sectional and focused on sexual minority men. Across studies, shame was consistently associated with exposure to distal and proximal stressors, general psychological processes (e.g., affective, social, and cognitive), health-compromising behaviors (e.g., substance use, sexual compulsivity), and adverse health outcomes. Notably, few studies focused on gender minority individuals, and subgroup or intersectional analyses were uncommon. Conclusion: The literature supports shame as an important correlate of health-related outcomes among SGM populations, but is limited by cross-sectional designs, heterogenous measurement approaches, and limited attention to subgroup differences. Future research should prioritize longitudinal and mechanistic studies, improve measurement harmonization, and evaluate established shame-reduction approaches with SGM-affirming adaptations and scalable delivery strategies to improve reach and advance health equity.