Sexual orientation microaggressions and mental health concerns: a conditional process modeling of protective effects of microaffirmations

Abstract

Background: Mental health disparities existed globally for sexual minority populations compared to heterosexuals. Experiences of subtle discrimination called microaggressions contributed to poor mental health outcomes. Conversely, microaffirmations may buffer these negative effects. To further study these processes among lesbian, gay, bisexual, queer/questioning (LGBQ+) Thais, culturally validated tools were needed to quantify microaggression and microaffirmation experiences within Thailand's high-context culture. Objectives: This two-part study aimed to: 1) develop and validate Thai language scales measuring microaggressions and microaffirmations related to sexual orientation; and 2) test a conceptual moderated mediation model elucidating relationships between microaggressions, microaffirmations, sexual orientation concealment, internalized heterosexism, and mental health concerns (stress, anxiety, depression). Study Summary: Study One - Utilizing a three-phase mixed-methods approach involving a literature review, expert consultation, and in-depth interviews with LGBQ+ Thais, scale items were developed to reflect the cultural context. Rigorous psychometric analyses, including exploratory and confirmatory factor analyses, refined the item pools and confirmed the factor structures of the Thai Sexual Orientation Microaggressions Scale (T-SOMG) and the Thai Sexual Orientation Microaffirmations Scale (T-SOMF) (total N = 384). The final 18-item T-SOMG contains two subscales assessing Interpersonal and Environmental Microaggressions (McDonald's omega; ωT = 0.92 for both). The 13-item T-SOMF comprises two subscales: Interpersonal and Environmental Microaffirmations (ωT = 0.90 and 0.92, respectively). All of these findings exhibit strong psychometric properties, characterized by excellent reliability, robust convergent validity, clear discriminant validity, and a well-fitting model. Study Two - Using a separate community sample of 307 Thai sexual minorities, distinct from the participants in Study One, the newly developed scales were completed, along with standardized measures of internalized heterosexism, concealment, depression, anxiety, and stress. Advanced statistical modeling using serial mediation and conditional process analysis was conducted to test the hypothesized conceptual model. Results support the hypothesized model wherein microaggressions both directly and indirectly (via increased sexual orientation concealment) impacted mental health concerns. Microaggressions accounted for 31.6% of the variance in mental health. The path from microaggressions to concealment was mediated by internalized heterosexism. Microaffirmations mitigate the direct connection between microaggressions and mental health problems. As levels of microaffirmations increase, this relationship becomes less significant. Conclusion: This two-part study provides rigorous evidence for the reliability and validity of the T-SOMG and T-SOMF as culturally appropriate tools for assessing experiences among Thai LGBQ+ individuals. Findings also contribute significantly to the scientific understanding of minority stress processes and the protective effects of microaffirmations in this population.