How does the brain adapt to stressful events experienced by minorities, especially members of the 2SLGBTQIA+ community?
This question is at the heart of a study on minority stress led by Dr. Andrew Nicholson, clinical research director at the Atlas Institute for Veterans and Families, and his research team.
Minority stress refers to the stress that people face when they're part of a minority group or are marginalized in society. This can stem from holding a socially stigmatized sexual orientation, gender, racial or ethnic minority identity, and includes exposure to experiences of discrimination, violence, hate crimes, and microaggressions. People dealing with minority stress may internalize negative stereotypes, hide their identities, or develop harmful thoughts, emotions, behaviours, and coping mechanisms in response to rejection.
“What has been found repeatedly in the literature is that these experiences of minority stress, across the board, for sexual orientation minorities, gender minorities, racial and ethnic minorities, have significant implications for mental health outcomes,” explains Nicholson.
While it is well established that minority stress is associated with increased rates of mental health challenges, including but not limited to posttraumatic stress disorder, anxiety, depression, substance use, and suicidality, the neurobiological mechanisms underlying this connection are less understood. In other words, how does minority stress create functional changes in the brain?
“What we’re trying to explore is how we get from A to B in terms of these experiences being associated with either increased risk or resiliency for mental health disorders. That's what we are trying to uncover with this project,” explains Nicholson. “How is the brain adapting to these experiences? What are the changes in brain activity and connections, and how are these changes associated with stress exposure and mental health outcomes?”
Dubbed the “Minority Mosaic Study,” Nicholson and his team are currently conducting research to explore the impact of minority stress on the brain and body from an intersectional perspective. This work originated from a systematic review that revealed past brain imaging studies of 2SLGBTQIA+ populations often incorrectly attributed findings to the neurobiological basis of sexual orientation or gender.
“When I was actually looking at the brain imaging data from our systematic review, there were many parallels to what we see in trauma-related disorders. Yet studies were attributing all of those findings to the neurobiological basis of sexual and gender orientation. There's a huge problem there,” explains Nicholson.
The team spent three years in a qualitative research phase, collecting and analyzing information to gain a deeper understanding of minority stress-related lived experiences from the participants' perspectives. Through extensive interviews, ranging from three to four hours in length and involving discussions about people's experiences as a multidimensional minority, the researchers have begun to develop tools, such as novel questionnaires and theoretical frameworks. These new developments can help foster a better understanding of the complex aspects of minority stressors.
How is minority stress measured?
Minority stress can be classified into two types: distal and proximal stressors. Distal minority stressors refer to external events such as discrimination, microaggressions, hate crimes, or violence. Proximal minority stressors relate to more internal processes such as anxiety about being judged, fear of rejection, and internalized stigma.
As Nicholson explains: “Proximal stressors are about how you internalize stigma associated with your identity, how that may affect your emotions, behaviours, and thoughts, and how you might conceal aspects of your identity as a result.”
Participants in the Minority Mosaic Study complete clinical assessments, fill out questionnaires about their experiences with minority stress and mental health, and work with researchers to create personalized event-related scripts that are read out to them during their brain scan. Then, using imaging at The Royal’s Brain Imaging Centre, the team investigates how brain activity and functional connectivity are affected while participants listen to minority stress-related moral injury scripts. Blood samples are also analyzed for hormone indicators and inflammatory markers of stress.
“The goal of the study is to examine how the brain and body respond to these adverse experiences. So we're really looking at inflammatory markers of chronic stress that might be associated with those minority stressors.”
Funding for this study is provided in part by the Mobilizing Insights in Defence and Security (MINDS) program and the LGBT Purge Fund. The LGBT Purge Fund is a Canadian not-for-profit organization established in 2018, managing a multimillion-dollar settlement from a class action lawsuit against the Government of Canada. The case involved advocacy for justice by survivors of systemic discrimination and institutional persecution of 2SLGBTQIA+ individuals working in the military, Royal Canadian Mounted Police, and federal public service from the 1950s to the mid-1990s – a historical event known as the "LGBT Purge."
Michelle Douglas, executive director of the LGBT Purge Fund, says the Atlas Institute is helping to amplify the voices of LGBT Purge survivors, whose perspectives have often been excluded from Canada's history. “The research being done at the Institute shows how minority stress and discrimination impact the brain and well-being,” she says. “It reveals the profound cost of marginalization experienced by minoritized groups, including LGBT Purge survivors. The Institute is also advancing new approaches to care and healing for these extraordinary veterans and public servants.”
Nicholson emphasizes that it’s not sexual orientation, gender, or race that inherently causes negative mental health outcomes. Rather, it’s the chronic exposure to minority stress from constant social stigmatization of these identities that adversely affects mental well-being. That distinction is essential, especially when it comes to developing effective treatment and support systems and fostering societal understanding of the harsh realities these minoritized groups must contend with daily.
When there’s a shared understanding that mental health conditions and changes to the brain can stem from how we treat minorities in society, it can reduce stigma towards these groups and make it more likely that affected individuals will seek help.
For more information about the Atlas Institute for Veterans and Families, go to atlasveterans.ca.