Abstract
We utilize an additive intersectionality framework in the present study to examine the relations among perceived racism, sexism, and heterosexism and the psychological distress of self-identified sexual minority women of color. Participants (N = 134) aged 19 to 75 recruited through electronic mailing lists, discussion groups, and virtual communities aimed toward sexual minority women of color completed online surveys. When each form of discrimination was examined in a single multiple regression analysis, only perceived heterosexism explained significant and positive variance in psychological distress. In addition, collective action was tested as a moderator of the effects of racism, sexism, and heterosexism on psychological distress; specifically, the potential attenuating roles of three forms of collective action (race and ethnicity, feminist, and sexual minority) in the respective racism → distress, sexism → distress, and heterosexism → distress links were investigated. Sexual minority collective action buffered the heterosexist experiences → psychological distress link. More specifically, in the context of lower collective action, perceived heterosexism positively predicted distress; however, perceived heterosexism did not predict psychological distress at higher levels of collective action. No other significant interaction effects were found. Our results suggest that discrimination experiences continue to be important to assess in research and practice with marginalized individuals. Also, encouraging clients to engage in collective action could represent a useful intervention tool for counselors.
Keywords
With notable and accumulating exceptions (Moradi & Subich, 2003; Szymanski & Owens, 2009; Thomas, Witherspoon, & Speight, 2008), most empirical psychological research has tended to focus on a single marginalized identity (Bowleg, 2008; Fukuyama & Ferguson, 2000). For example, much of the scholarship pertaining to people of color focuses on the experiences of men and assumes heterosexuality, studies with women tend to highlight the experiences of White women and neglect sexual orientation diversity, and research with sexual minority people rarely center on the experiences of women of color (Greene, 2000; Harper, Jernewall, & Zea, 2004; Phillips, Ingram, Smith, & Mindes, 2003; Reid & Kelly, 1994). Increasingly, however, the importance of examining multiple marginalized identities in the experiences of women is being acknowledged (Bowleg, 2008; Cole, 2009).
Sexual minority women of color represent intersections of oppressed race and ethnicity, gender, and sexual orientation identities (Bowleg, Craig, & Burkholder, 2004; Phillips et al., 2003). The term sexual minority women was selected for use in our study to be inclusive of the multiple self-identifications of sexual orientation present within our sample (e.g., lesbian, bisexual, queer, same-gender loving; Fassinger & Arseneau, 2007). With these multiple marginalized identities comes the recognition that sexual minority women of color may be the targets of multiple types of discrimination (e.g., racism, sexism, heterosexism; Cole, 2009), and various theoretical approaches have been proposed to explain the ways in which multiple discrimination experiences may operate in their lives. For instance, the additive model argues that women experience distinct forms of discrimination associated with each marginalized identity they possess and that each experience “has direct effects that combine additively to negatively affect psychological health” (Szymanski & Moffitt, 2012, p. 13). An assumption of this approach is that individuals with multiple marginalized identities are able to discern which marginalized identity is the target of their discrimination experience. Indeed, qualitative research seems to support the ability of sexual minority women of color to distinguish between forms of oppression and subjectively appraise the specific identity they believe elicited the discrimination (Bowleg, Brooks, & Ritz, 2008). For instance, in a study of Black lesbian women’s experiences in the workplace, one participant recounted being fired from multiple jobs for being out as lesbian (Bowleg et al., 2008).
However, some scholars have criticized the additive model for this assumption and argue that identification with more than one marginalized group constructs novel experiences, including discrimination experiences, which are inimitable and not divisible into the individual identities that originally composed them (Cole, 2009). This conceptualization has been termed the intersectionality model. Importantly, both the additive and the intersectionality models have received empirical support in recent studies (Buchanan & Fitzgerald, 2008; DeBlaere & Bertsch, 2013; Szymanski, 2005), and each approach has been argued to offer plausible assertions about the ways in which multiple identities may be experienced (Cole, 2009).
In the current study, we utilized an additive framework to investigate the relationship between multiple discrimination experiences and psychological distress. Additive approaches have been argued to provide important foundational understanding of intersecting identities (Bowleg, 2008). Also, scholars have consistently noted the methodological challenges associated with effective assessment of intersectionality concepts, including the lack of psychometrically supported measures and relevant statistical analyses (Bowleg, 2008; Shields, 2008; Szymanski & Stewart, 2010). To our knowledge, ours is the first quantitative investigation to examine racism, sexism, and heterosexism simultaneously in relation to distress with a sample of sexual minority women of color. Additionally, given that a published, psychometrically sound measure assessing the intersection of racism, sexism, and heterosexism experiences is not currently available, an additive approach aimed at elucidating the unique and additive relations of these discrimination variables to psychological distress seemed appropriate.
Discrimination Experiences and Psychological Distress
A growing body of research with marginalized groups suggests that perceived discrimination experiences are related to mental health concerns for racial and ethnic minority persons, women, and members of sexual minority populations (Klonoff & Landrine, 1995; Landrine & Klonoff, 1996; Mays & Cochran, 2001). More specifically, perceived racist experiences, conceptualized as race-specific stressors that are associated with adverse psychological and physical health symptoms (Harrell, 2000; Landrine & Klonoff, 1996), have been found to be related positively to psychological distress and poorer health with samples of African American (Kwate, Valdimarsdottir, Guevarra, & Boybjerg, 2003; Landrine & Klonoff, 1996), Arab American (Moradi & Hasan, 2004), Asian/Asian American (Iyer & Haslam, 2003; Lee, 2003), and Latina/Latino American women and men (Moradi & Risco, 2006). Similarly, literature supports the link between perceived sexist experiences (i.e., gender-specific stressors; Klonoff & Landrine, 1995) and psychological distress with predominately White sexual minority women (Szymanski, 2005; Szymanski & Owens, 2009) and subsamples of racial and ethnic minority women (Landrine, Klonoff, Gibbs, Manning, & Lund, 1995). Finally, the relation between perceived heterosexist experiences (i.e., sexual-orientation-specific stressor; Meyer, 1995) and psychological distress has been supported with samples of predominately White (Meyer, 1995; Szymanski, 2009), Asian American (Szymanski & Sung, 2010), African American (Battle & Lemelle, 2002), Latina/Latino American (Zea, Reisen, & Díaz, 2003), and Native American (Gilley & Co-Cké, 2005) sexual minority women and men.
Although independent examinations of the associations of racism, sexism, and heterosexism with psychological distress continue to be important, as discussed previously, several authors have begun to move beyond examinations of single forms of discrimination to investigations of the relationships between multiple oppressions and psychological distress (Moradi & Subich, 2003; Szymanski & Owens, 2009). In one of the few known studies to focus on a sample of sexual minority women of color, Szymanski and Meyer (2008) found that racist experiences and heterosexist experiences were each correlated positively with psychological distress. However, when psychological distress was regressed on these variables and their internalized counterparts (e.g., internalized racism), racist experiences—but not heterosexist experiences—accounted for significant and positive variance in distress with their sample of African American sexual minority women.
Findings have been similarly complex when perceived racism and sexism have been examined in conjunction. Both racist and sexist experiences were correlated positively with psychological distress with a sample of African American women, but when racism, sexism, and their interaction were examined simultaneously as predictors of distress, only sexism accounted for unique and positive variance in psychological distress (Moradi & Subich, 2003). Analogous results were obtained with another sample of African American women (Szymanski & Stewart, 2010). Concepts of gendered racism (Thomas et al., 2008) and ethgendered prejudice (King, 2003), or the intersection of racism and sexism, have been introduced to represent multidimensional models of discrimination for women of color. Gendered racism has been found to be associated with increased psychological distress with samples of African American women (King, 2003; Thomas et al., 2008).
Finally, the links of perceived sexism and heterosexism with distress have also been examined simultaneously with samples of predominately White sexual minority women (Szymanski, 2005; Szymanski & Owens, 2009). Szymanski (2005) found that perceived sexism and heterosexism were related positively to psychological distress, even when these variables were examined as simultaneous predictors of distress with other relevant variables (e.g., internalized heterosexism). Similar to the concept of gendered racism, gendered heterosexism, or discrimination that is concurrently sexist and heterosexist, has been proposed to represent the intersecting gender and sexual orientation experiences of sexual minority women (Friedman & Leaper, 2010). Although we are unaware of published studies that have examined the relation between gendered heterosexism and psychological distress, some prior research suggests that gendered heterosexism may be an important variable to consider in the lives of sexual minority women. More specifically, with their sample of sexual minority women, Friedman and Leaper (2010) conducted a principle component analysis with items from their measures of perceived sexism, heterosexism, and gendered heterosexism, and found that gendered heterosexism was a unidimensional factor distinct from perceived sexism and heterosexism. Additional studies are needed to further elucidate the function of gendered heterosexism in the lives of sexual minority women and to examine its links to mental health outcomes.
Notably, the studies investigating multiple discrimination experiences reviewed here examine two forms of externalized discrimination. Furthermore, these examinations demonstrate that the additive approach has yielded meaningful results with women of color, predominately White sexual minority women, and sexual minority women of color. Each investigation has provided key insights into the ways in which multiple forms of discrimination are related to mental health. A necessary extension of these studies would be to acknowledge and assess, within an additive framework, additional discrimination experiences associated with other salient marginalized identities. Because scholars have identified race and ethnicity, gender, and sexual orientation identities as salient oppressed identities for sexual minority women of color (Greene, 2000), in the current study we will investigate independent and additive relations of racism, sexism, and heterosexism to psychological distress with a sample of sexual minority women of color.
Collective Action as a Moderator
Beyond attending to the direct relations between multiple perceived discrimination experiences and psychological distress, researchers have also asserted that it is important to examine theoretically grounded moderating or buffering variables in this link (Szymanski & Moffitt, 2012). One such construct that has been identified in prior literature as a potential intervening variable in the discrimination → distress link is collective action (Szymanski & Owens, 2009). A recent review of multiple oppression research identified collective action as an important mechanism through which women and sexual minority individuals can counter oppression (Szymanski & Moffitt, 2012). Collective action has been defined as a group member “acting as a representative of the group” and engaging in action that “is directed at improving the condition of the entire group” (Wright, Taylor, & Moghaddam, 1990, p. 995). Collective action is thought to promote aspects of well-being such as personal agency (Friedman & Leaper, 2010). For instance, feminist collective action, or actions intended to enhance women’s status (Foster, 2000), was found to be related positively to self-acceptance, with a sample of predominately White lesbian and bisexual women (Leavy & Adams, 1986).
Some authors have also conceptualized collective action to be a proactive form of coping with discrimination at the group level (Friedman & Leaper, 2010). For example, feminist collective action was found to be related positively to healthy coping strategies and unrelated to avoidant coping strategies in a study of sexist discrimination among college women (Foster, 2000). In addition, the minority stress framework (Meyer, 1995, 2003; Szymanski & Owens, 2009) posits that group-level coping strategies may lessen the negative mental health consequences associated with oppression for sexual minority persons. In apparent support of this assertion, Szymanski and Owens (2009) found that involvement in feminist group-level activities (i.e., feminist collective action) attenuated the link between perceived sexist experiences and psychological distress with their sample of primarily White sexual minority women. Specifically, in the context of lower levels of sexist experiences, women more involved in feminist activities reported lower levels of psychological distress than women less involved in feminist activities. These authors suggested that participation in collective action may empower sexual minority women to feel that they are able to “do something” in response to their experiences of sexist discrimination and may provide opportunities to critically evaluate oppressive systems, subsequently mitigating the relationship between perceived discrimination experiences and distress. Indeed, DeBlaere and Bertsch (2013) found that womanism, an identity that acknowledges the historical and cultural contexts of oppression for women of color, attenuated the sexism → distress relationship for sexual minority women of color.
However, in the same study, Szymanski and Owens (2009) also investigated the potential moderating role of feminist collective action in the heterosexist experiences → distress link and found no significant interaction. These findings suggest that collective action may be group- or identity-specific (i.e., collective action related to a particular identity most effectively buffers the effects of the form of discrimination targeted by that same identity). If this is the case, similar to the ways in which feminist collective action moderates the sexism → distress link, collective action related to sexual orientation identity (rather than feminist identity or being a woman) could be a mitigating factor in the link of heterosexism to distress.
Thus, in accordance with the assertions of the minority stress framework (Meyer, 1995, 2003) and as an extension of Szymanski and Owens’ (2009) study, in the current investigation we will examine feminist collective action as a moderator in the relationship between perceived sexist experiences and psychological distress with a sample of sexual minority women of color. Furthermore, we will explore both race-/ethnicity-related and sexual minority-related collective action as moderators in the racist experiences → distress and heterosexist experiences → distress links, respectively.
The Present Study
The present study, informed by prior research, aims to examine (a) the independent and additive links of perceived racism, sexism, and heterosexism to psychological distress and (b) the potential moderating role of three forms of collective action in these links. To address these aims, we tested two major hypotheses. First, we predict that perceived racism, sexism, and heterosexism will each be related significantly and positively to psychological distress. Second, we hypothesize that collective action pertaining to each marginalized identity will moderate the relationship between each corresponding form of discrimination and psychological distress.
Specifically then, we expect (a) race and ethnicity collective action to moderate the relationship between perceived racist experiences and psychological distress, such that greater perceived racist experiences will be related to higher distress for women reporting less participation in collective action. Perceived racist experiences will not be related to psychological distress for women reporting higher levels of race and ethnicity collective action participation. Similarly, we anticipate that (b) feminist collective action will moderate the relationship between perceived sexist experiences and psychological distress, such that greater perceived sexist experiences will be related to higher distress for women reporting less participation in collective action. Perceived sexist experiences will not be related to psychological distress for women reporting higher levels of feminist collective action participation. Finally, we predict that (c) sexual minority collective action will moderate the relationship between perceived heterosexist experiences and psychological distress, such that greater perceived heterosexist experiences will be related to higher distress for women reporting less participation in collective action. Perceived heterosexist experiences will not be related to psychological distress for women reporting higher levels of sexual minority collective action participation.
Consistent with the additive model, the moderation effects will be examined simultaneously in a single analysis that will allow us to discern the unique and additive contributions of each variable and interaction, accounting for the others. Pragmatically, this approach also most closely approximates the lived experiences of sexual minority women of color whose identity-relevant experiences, although distinct, are likely interrelated and simultaneous (Cole, 2009). In addition, to assess the additive links of perceived racism, sexism, and heterosexism to psychological distress, all three forms of discrimination will be examined as simultaneous predictors of distress. In light of the fact that prior studies investigating the links of multiple oppressions to distress have yielded mixed findings, no specific hypotheses are offered.
Method
Participants
We analyzed data from a sample of 134 self-identified sexual minority women for the present study. It should be noted that approximately 10% of the respondents did not complete the demographic questionnaire (so that the percentages cited in the following necessarily describe only those participants who responded to demographic questions). However, all the 134 cases were retained in our analyses because all participants affirmed their identification as sexual minority women of color prior to consenting to participate in the survey.
Responding participants ranged in age from 19 to 75 (mean [M] = 32.53, standard deviation [SD] = 11.07). With regard to race and ethnicity, 53 (40%) identified as African American/Black, 19 (14%) as Asian/Asian American/Pacific Islander, 19 (14%) as Hispanic/Latina, 18 (13%) as multiracial, 9 (7%) as “other race/ethnicities” (e.g., Cuban, Iranian), and 3 (2%) as American Indian/Native American. Most of the sample identified as women (117, 88%), and 3 (2%) identified as “other genders” (e.g., two-spirited, boi). A plurality identified as exclusively lesbian/gay (44, 33%), with the remainder identifying as mostly lesbian/gay (27, 20%), as bisexual (29, 22%), as “other sexual orientations” (e.g., fluid, pansexual, queer; 16, 12%), and as mostly but not exclusively heterosexual (5, 4%). In all, 11 (23%) were single; 26 (19%) in committed partnerships (nonlegal); 17 (13%) in long-term dating relationships; 14 (10%) in legal marriages; 13 (10%) in casual dating relationships; and 8 (6%) in legal domestic partnerships. Many had a professional/graduate degree (60, 45%); 25 (19%) a college degree; 17 (13%) some professional/graduate education; 15 (11%) some college education, and 4 (3%) a high school diploma. Almost half the sample identified their socioeconomic status as middle (63, 47%), with the remainder as working (29, 22%), as upper middle (23, 17%), and as lower (4, 3%) socioeconomic status. Finally, reported residence of participants suggests good regional and population-density diversity: Northeast (41, 31%), Midwest (22, 16%), Northwest (19, 14%), Southwest (22, 16%), and Southeast (7, 13%); urban (74, 55%), suburban (38, 28%), and rural (9, 7%).
Procedure
Data for our study were collected via an online survey that took approximately 25 minutes to complete. Online surveys have been shown to yield responses similar to traditional pen-and-paper methods while being more cost efficient (Gosling, Vazire, Srivastava, & John, 2004). A recruitment e-mail detailing the study’s purpose (i.e., “conducting a study on the life experiences and well-being of lesbian and bisexual women of color”), inclusion criteria (i.e., 18 years of age or older, residing in North America, identify as a lesbian or bisexual woman of color), and the study’s survey link was widely distributed to electronic mailing lists (e.g., Yahoo lists), discussion groups, and virtual communities aimed toward sexual minority women of color (e.g., Queer People of Color Google Group). Directors of counseling and clinical psychology training programs were also contacted via e-mail and asked to distribute the study’s recruitment e-mail to any appropriate program and/or student listservs. Upon clicking on the link provided, participants were redirected to the survey that included an informed consent reiterating the study’s inclusion criteria, the study measures, and a debriefing form.
To ensure that participants were responding attentively throughout the survey, four validity questions asking participants to mark a particular response (e.g., “Please mark strongly agree”) were included. A total of 302 individuals responded to at least one survey item, but 162 entries were not usable because they were missing more than 25% of survey data (excluding demographic questions). The proportion of these individuals who may have returned to complete the survey at a later time cannot be determined due to the anonymity of the survey. These data were screened to identify participants who did not meet inclusion criteria or missed more than one validity check item. These data cleaning procedures resulted in a final sample of the 134 participants we included in our analyses; all αs for the following measures are reported in Table 1.
Descriptive Statistics and Bivariate Correlations for All Study Variables.
Note. Numbers in parentheses on the diagonal of the correlation matrix represent Cronbach’s αs.
* p < .05. **p < .01. ***p < .001.
Measures
Perceived racism experiences
Perceived racism experiences were measured with the Daily Life Experience (DLE) subscale of the Racism and Life Experiences Scales (RaLES; Harrell, Merchant, & Young, 1997). The DLE is a 20-item, Likert-type, self-report scale that assesses the frequency with which certain discriminatory experiences occurred because of race and ethnicity. A sample item is “Being observed or followed while in public places.” Participants respond to the items experienced on the 6-point continuum from 0 (the event has never happened due to my race) to 5 (the event always happened due to my race). Item ratings are averaged, with higher scores indicating greater perceived racism. With a sample of predominately racial and ethnic minority women and men, Cronbach’s α for items on the DLE scale was .92 (Harrell et al., 1997). With regard to validity, DLE scores have been found to be correlated positively with racial identity salience and negatively with the perception of how others view one’s racial and ethnic group (Harrell et al., 1997).
Perceived sexist experiences
Perceived sexist experiences were assessed with the Schedule of Sexist Events–Recent (SSE-R; Klonoff & Landrine, 1995). The SSE-R is a 20-item, Likert-type, self-report measure that assesses the frequency of perceived sexist experiences. A sample item is, “How many times have you been treated unfairly by your family because you are a woman?” Participants respond to the items on the 6-point continuum from 1 (the event has never happened) to 6 (the event happened almost all [i.e., more than 70%] of the time). We averaged all items to obtain each individual’s score; higher scores indicate greater perceived sexism. Cronbach’s α reliability estimates for items on the SSE-R with separate samples of racial and ethnic minority women (Landrine & Klonoff, 1997) and lesbian women (Szymanski, 2005) were .90, and .93, respectively. In terms of validity, SSE-R scores correlated positively with the frequency of daily hassles and stressful life experiences for racially and ethnically diverse women (Klonoff & Landrine, 1995) and with psychological distress for a sample of predominately White sexual minority women (Szymanski & Owens, 2009).
Perceived heterosexist experiences
Perceived heterosexist experiences were measured with the Lesbian and Bisexual Women (LBW) version of the Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS; Szymanski, 2006, Szymanski & Meyer, 2008). The HHRDS is a 14-item, Likert-type, self-report measure that assesses the frequency of perceived heterosexist experiences. A sample item is “How many times have you been rejected by family members because you are a lesbian/bisexual woman?” Participants respond to the items on the 6-point continuum from 1 (the event has never happened) to 6 (the event happened almost all [i.e., more than 70%] of the time). Ratings were averaged such that higher scores indicate greater perceived heterosexism. Cronbach’s α reliability estimates for HHRDS items have been .83 and .91 with samples of African American sexual minority women (Szymanski & Meyer, 2008) and Asian American sexual minority persons (Szymanski & Sung, 2010), respectively. With regard to validity, the HHRDS has been found to be related positively to psychological distress with predominately White (Szymanski & Owens, 2009), African American (Szymanski & Meyer, 2008) and Asian American (Szymanski & Sung, 2010) sexual minority individuals.
Collective action
Collective action was measured with a modified version of the Involvement in Feminist Activities Scale (IFAS; Szymanski, 2004). The IFAS is a 17-item, Likert-type, self-report measure that was originally developed to assess involvement in a variety of activities related to the support of feminist ideologies. For the present study, the IFAS was adapted to assess participants’ involvement in activities designed to promote action to address inequalities on the basis of race and ethnicity, gender, and sexual orientation. Participants describe their involvement in the stated activity three times: first for feminist/women’s group issues, then for racial and ethnic minority group issues, and lastly for sexual minority group issues. For instance, the sample item, “I participate in feminist demonstrations, boycotts, marches, and/or rallies,” was modified to read “I participate in … ” followed by a series of three responses: “(a) feminist demonstrations boycotts, marches, and/or rallies, (b) demonstrations, boycotts, marches, and/or rallies related to racial/ethnic issues, and (c) LGBT demonstrations, boycotts, marches, and/or rallies.” Each of the three responses was rated on a 7-point continuum from 1 (very untrue of me) to 7 (very true of me). Mean scores were calculated such that higher scores indicate greater involvement in each form of collective action (feminist, race and ethnicity, sexual minority). In terms of reliability, items on the IFAS had a Cronbach’s α of .94 with the scale development sample of predominately White sexual minority women (Szymanski, 2004). Support for validity of the IFAS has been noted through positive correlations with other indicators of feminist activity involvement and support of feminist ideologies (Szymanski, 2004).
Psychological distress
Psychological distress was assessed with the Hopkins Symptom Checklist-21 (HSCL-21; Green, Walkey, McCormick, & Taylor, 1988), an abbreviated version of the 58-item Hopkins Symptom Checklist (Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974). Sample items include “Feeling lonely” and “Feeling blue.” HSCL-21 items are rated on a 4-point continuum from 1 (not at all) to 4 (extremely); participants rate the items to reflect their endorsement of specific symptoms. To score the measure, item ratings were averaged, with higher scores indicating greater psychological distress. The HSCL-21 yielded excellent internal reliability consistency with prior samples of predominately White sexual minority women (α = .91; Szymanski & Owens, 2009) and Asian American sexual minority individuals (α = .91; Szymanski & Sung, 2010). In terms of validity, HSCL-21 scores were correlated as expected with other measures of psychological distress with predominately White college students (Moller, Fouladi, McCarthy, & Hatch, 2003) and correlated positively with multiple minority stressors (e.g., race-related dating) with a sample of Asian American sexual minority persons (Szymanski & Sung, 2010). The HSCL-21 has also yielded equivalent factor structures across diverse racial groups (e.g., African American, Latina/Latino; Cepeda-Benito & Gleaves, 2000).
Results
Before proceeding with the analyses, missing data were examined. Among our participants, analysis of the patterns of missing data indicated that 2.59% of all items for all cases were missing, and 33.08% of the items were not missing data for any case. With regard to individual cases, 108 (80.60%) participants were missing three or fewer items; 70 (52.20%) participants were missing no data. Additionally, no item had more than 11.19% missing values. Excluding demographic variables, the range of missing data for items composing our variables of interest was 0% (e.g., HSCL, item 1) to 8.96% (SSE-R, item 15). Women missing more than 20% of items on an instrument were removed from analyses that involved scores on that instrument. For the remaining cases, ipsative (or valid) mean substitution (Dodeen, 2003) was utilized to replace missing data points on a particular measure with the participant’s mean of nonmissing data points on that measure. Recent scholarship indicates that at low levels of missing data (i.e., 10% per measure), ipsative mean substitution performs comparably to multiple imputation and available case analysis (Parent, 2012).
Discrimination Experiences and Psychological Distress
Descriptive statistics, internal consistency reliabilities, and intercorrelations obtained with the current sample for the variables of interest are reported in Table 1. Overall, the present sample’s average scores on these variables were observed to be generally comparable to average scores obtained in prior studies with predominately or entirely racial and ethnic and/or sexual minority samples utilizing the same measures (SSE: Friedman & Leaper, 2010; DLE: Harrell et al., 1997; IFAS: Szymanski, 2004; HHRDS: Szymanski, 2006; HSCL-21: Szymanski & Sung, 2010). To test the hypothesis that all three forms of perceived discrimination would be related significantly and positively to psychological distress, bivariate correlations between perceived racist experiences, perceived sexist experiences, and perceived heterosexist experiences and psychological distress were examined. 1 To provide some context for the magnitudes of the associations obtained, Cohen’s (1992) guidelines were used to interpret small (r = .10), medium (r = .30), and large (r = .50) effect sizes. As hypothesized, each measure of perceived discrimination was related significantly and positively to psychological distress with small-to-medium effects. Each form of discrimination was also related significantly and positively to one another.
To investigate the additive links between perceived racism, sexism, and heterosexism with psychological distress, we conducted a multiple regression analysis with psychological distress regressed on all three forms of perceived discrimination. Based on the number of comparisons being made, an α value of p < .005 was utilized. Prior to conducting the regression analyses, we examined the demographic variables to determine whether any covariates should be included in the regression models. Results indicated that no demographic variables were related significantly to psychological distress (Tabachnick & Fidell, 2007). Thus, no covariates were included in subsequent analyses. As indicated in Table 2, the overall result of the regression was significant, explaining 17% of the variance in psychological distress. When perceived racism, sexism, and heterosexism were considered together, only perceived heterosexism itself accounted for significant and unique variance in the outcome variable with our sample of sexual minority women of color.
Simultaneous Multiple Regression and Moderated Analyses Linking Discrimination Experiences With Psychological Distress.
Note. df = degrees of freedom. The criterion variable in these analyses is psychological distress.
**p < .01. ***p < .001.
Beyond our hypothesis testing, significant and positive correlations were found among the three forms of collective action (race and ethnicity, feminist, and sexual minority), but not between the collective action variables and psychological distress. In addition, to provide supplementary data about our sample and the measures of collective action, mean levels of involvement in the three forms of collective action were compared (see Table 1). Paired samples t tests indicated that our sample reported lower feminist collective action than race and ethnicity collective action, t(133) = −5.78, r 2 = .20, p < .001, and sexual minority collective action, t(133) = −6.57, r 2 = .24 p < .001. Mean levels of participation in race and ethnicity collective action and sexual minority collective action were not significantly different from one another.
Collective Action as a Moderator
To test the second series of hypothesis—whether participation in race and ethnicity, feminist, and sexual minority collective action moderates the links of perceived racist experiences, perceived sexist experiences, and perceived heterosexist experiences with psychological distress, respectively—we performed a single hierarchical multiple regression. As discussed previously, we chose to conduct a single hierarchical multiple regression, rather than three separate regression analyses, because this approach not only mitigates Type 1 error (Hayes, 2005), but also is consistent with the additive approach utilized in our study.
Following recommendations by Aiken and West (1991), predictor and moderator variables were centered (i.e., mean deviation scores were computed). The centered predictors (perceived racist experiences, perceived sexist experiences, or perceived heterosexist experiences) and centered moderators (race and ethnicity collective action, feminist collective action, or sexual minority collective action) were entered in Step 1 predicting psychological distress. The interactions between the relevant predictors and moderators were entered in Step 2. Significant moderation or interaction is indicated if adding the interaction terms results in a significant change in R 2 and the β weight for the interaction term is significant. According to Aiken and West’s (1991) analyses of power and sample size, when predictor and moderator variables have reliabilities of .80, their correlations are zero and the variance accounted for by the main effects is .20; sample sizes of 59, 122, and 841 are required to achieve power of .80 to detect large, medium, and small effects, correspondingly. Sample size requirements decrease incrementally as correlations between predictors and moderators become greater than zero, as is the case with the present sample. Thus, our sample size of 134 surpassed criteria for detecting large and medium effects, but not small effects.
As shown in Table 2, the interaction between perceived heterosexist experiences and sexual minority collective action was significant above and beyond the other variables, indicating that sexual minority collective action moderated the link of perceived heterosexist experiences with psychological distress. No other significant interactions were obtained. Thus, our hypotheses about the moderating role of collective action were supported only for heterosexist experiences. The adjusted R 2 value for the regression equation focused on heterosexism indicates that the main and interaction effects accounted for 24% of the variance in psychological distress. The interaction term of perceived heterosexist experiences and sexual minority collective action accounted for 11% of the variance in psychological distress.
Patterns underlying the significant interaction were explored using simple slope analysis recommended by Aiken and West (1991). In this procedure, psychological distress was regressed on all predictors, sexual minority collective action at a conditional value (e.g., lower or higher), and the interaction of heterosexist experiences and sexual minority collective action at a conditional value. Results indicated that perceived heterosexist experiences positively predicted psychological distress for sexual minority women of color with lower participation in sexual minority collective action (β = .57, t = 5.07 p < .001; see Figure 1); heterosexist experiences did not predict distress at higher levels of sexual minority collective action participation (β = −.06, t = −.42, p = .676). Moreover, the significance of the interaction terms in the tests of the moderator effects indicated that the difference between the regression lines for participants with lower versus higher sexual minority collective action was also significant (Aiken & West, 1991).

Interaction of perceived heterosexism and sexual minority collective action on psychological distress. Higher and lower values were defined as one standard deviation above (higher) and below (lower) the mean.
Discussion
In the present investigation, we extend the literature on the link between perceived discrimination experiences and mental health in a number of important ways. First, our study focuses on the experiences of sexual minority women of color, a population whose experiences have received limited attention in prior research on discrimination and mental health (Szymanski & Meyer, 2008). Second, our investigation is, to our knowledge, the first quantitative study to examine perceived racist, sexist, and heterosexist experiences simultaneously with a sample of sexual minority women of color. Third, beyond the potential direct and additive links of perceived discrimination experiences to psychological distress, our study also examined the potential moderating role of collective action in the experienced discrimination → distress link.
Mounting evidence supports the relations of perceived racist, sexist, and heterosexist experiences with psychological distress in samples of racial and ethnic minority persons, predominately White women, and African American sexual minority women (Klonoff & Landrine, 1995; Landrine & Klonoff, 1996; Moradi & Subich, 2003; Szymanski & Meyer, 2008). The findings from the present study support such links with our sample as well. Bivariate correlation analyses indicated that perceived racist experiences, sexist experiences, and heterosexist experiences were each related positively to psychological distress. All three forms of discrimination were also correlated positively with one another, suggesting that perceived racism, sexism, and heterosexism are not entirely distinct constructs and/or that individuals who perceive one form of discrimination are more likely to perceive other forms as well. However, the overlapping variance among these constructs (R 2 = .03–.22) also denotes that the majority of the variance within each variable is unique. These findings are consistent with Cole’s (2009) supposition that both additive and intersectional models offer plausible explanations for concurrent experiences of discrimination. Our results would suggest that the multiple discrimination experiences of sexual minority women of color involve a combination of both overlapping/intersectional and unique/additive aspects. No matter the model, these findings contribute to the amassing literature which indicates that it is important to attend to multiple perceived discrimination experiences in samples with multiple marginalized identities. Given the perniciousness of the discrimination → distress link, future studies that investigate ways in which discrimination experiences may be reduced from both the perpetrator’s and the target’s perspectives are warranted.
In addition to singular correlations of perceived discrimination experiences with psychological distress, we also examined the concomitant links of perceived racist experiences, sexist experiences, and heterosexist experiences with psychological distress. When psychological distress was regressed on all three perceived discrimination variables simultaneously, only perceived heterosexism was found to be a positive and unique predictor of psychological distress. Fukuyama and Ferguson (2000) assert that the visibility or invisibility of a person’s minority status can influence aspects of identity development and group association. Because race, ethnicity, and gender are often more visible aspects of an individual’s identity, it may be that individuals are able to develop coping strategies and mechanisms for resisting the types of overt and covert oppression for which they are more visible targets (Fukuyama & Ferguson, 2000; Greene, 2000). Consequently, sexual minority women of color may be more susceptible to singular oppression related to their sexual orientation, or less visible, identity. Additionally, sexual minority women of color may experience heterosexism from friends, family, and other communities that are otherwise supportive (Fukuyama & Ferguson, 2000). These experiences may exacerbate the effects of heterosexism for sexual minority women of color in particular because not only may these women have a diminished ability (compared to race, ethnicity, and gender oppression) to address sexual minority oppression, but they also may experience heterosexism from within and outside their visible minority status communities.
The results obtained and described herein underscore the complex nature of multiple minority identities and the importance of examining multiple discrimination variables individually and in combination. We found that similar to our findings, the pattern that has generally emerged in prior studies that have examined two forms of perceived discrimination simultaneously in relation to psychological distress is of a single emerging discrimination variable explaining unique variance in distress (i.e., racism, sexism, or heterosexism; e.g., Moradi & Subich, 2003; Szymanski & Gupta, 2009; Szymanski & Meyer, 2008; Szymanski & Stewart, 2010). It is important to highlight that our results indicate that heterosexist experiences accounted for additional significant variance in psychological distress while controlling for the relations of perceived racist and sexist experiences with distress, not that perceived racist and sexist experiences are unimportant variables. These findings further support the position that the construct of perceived discrimination for sexual minority women likely combines overlapping and unique aspects of racism, sexism, and heterosexism discussed previously. Studies that explicitly examine the intersection or fused experiences of multiple discrimination (e.g., gendered racism) are also needed to elucidate the complexity of experiences related to possessing multiple marginalized identities. Accumulating research utilizing additive and intersectional approaches will provide a more comprehensive understanding of these multifarious concepts. Shields (2008, p. 307) suggests that future studies of multiple identities and experiences should adopt a “both/and strategy … comparing individual identities to each other as well as considering intersections and their emergent properties.”
In addition to the examination of the links of multiple perceived discrimination experiences to psychological distress, the current study also answered calls to examine variables with the potential to alleviate the negative health consequences of minority stress and promote well-being (DiPlacido, 1998; Meyer, 1995). In partial support of our hypotheses, collective action related to sexual minority issues was found to moderate the link of perceived heterosexist experiences with psychological distress such that perceived heterosexist experiences positively predicted psychological distress for sexual minority women of color with low levels of sexual minority collective action. Heterosexist experiences did not predict distress for women reporting high levels of these activities. This general pattern of results is consistent with prior work that has also identified a mitigating effect of feminist collective action in the link of perceived sexist experiences with distress (Szymanski & Owens, 2009). However, unlike Szymanski and Owens (2009), we did not find a buffering effect of feminist collective action in the sexism → distress link (or race and ethnicity collective action in the racism → distress link). It is important to note that the prior study’s sample of sexual minority women was predominately White (87%). Consequently, although collective action was found to be an important variable in both samples, it is possible that variations in the intersectional experiences of the marginalized identities for these two samples contributed to differing results. More specifically, it appears that with our sample of sexual minority women of color, heterosexist experiences were perceived to be the more prominent form of discrimination in relation to psychological distress. It may be that within the context of this particularly salient discrimination → distress link, the collective action associated with sexual minority issues emerged as significant.
Furthermore, the interaction between perceived heterosexist experiences and collective action related to sexual minority issues accounted for 11% of the variance in psychological distress. This is well beyond the values typically observed in nonexperimental research (i.e., 1%–3%; McClelland & Judd, 1993) portending that this variable may represent a particularly promising protective factor for this population. Additional studies are needed to investigate the buffering role of collective action in the discrimination → mental health link with other marginalized samples. Also, we acknowledge the within-group diversity of our sample with regard to race, ethnicity, and sexual orientation and recognize that examination of their combined experiences may obfuscate important between-group differences. Thus, future investigations should replicate our study with specific samples of interest. Szymanski and Moffitt (2012) highlight that examinations of the relationship between multiple forms of oppression and distress with Native American and Latina/Latino women and sexual minority samples are needed.
Although not part of our original hypotheses, we found that race and ethnicity collective action, feminist collective action, and sexual minority collective action were significantly and positively correlated with one another. These results suggest that individuals who participate in collective action activities related to one marginalized identity are also more likely to participate in collective action related to their other marginalized identities. However, the fact that mean differences were found in the level of participation indicates that, similar to their reports of racism, sexism, and heterosexism, our participants’ reports of collective action participation related to their multiple identities likely represent both overlapping and unique aspects. Additionally, consistent with previous research (Szymanski & Owens, 2009), we found that collective action was not correlated with psychological distress. Prior scholarship, which has reported a positive relationship between collective action and well-being indicators (e.g., self-acceptance; Leavy & Adams, 1986), could imply that collective action’s direct links with mental health are to well-being. Additional research is needed to further explicate collective action’s role as a mental health-promoting variable with diverse samples.
The findings of the present study should be considered in light of a number of limitations. First, although our sample represented good variability on several demographic variables (e.g., race and ethnicity, residence), consistent with prior studies of sexual minority persons that utilized Internet surveys (Szymanski & Owens, 2009), our sample was well educated and willing to identify their sexual orientation. Further studies are needed to determine the replicability of the present findings with other samples of sexual minority women of color who vary in levels of education and outness. In addition, reliability and validity data with samples representing racial and ethnic and sexual orientation diversity were not available a priori for all measures utilized in the present study (e.g., RaLES-DLE: Harrell et al., 1997; IFAS: Szymanski, 2004). However, the high internal consistency reliability values and significant results obtained with the current sample lend support to the reliability and validity of these measures for use in future studies, which has been called for in the prior literature (e.g., Szymanski, 2006). Finally, the present cross-sectional, correlational design does not allow for causal inferences. Experimental and longitudinal studies would help to clarify the directionality of the posited relations between perceived discrimination and mental health indicators.
Practice Implications
Despite the limitations just discussed, the findings of the current study can provide helpful guidelines for practice. First, our study found a consistent perceived discrimination → distress link, underscoring the importance of considering discrimination experiences in counseling with sexual minority women of color. For instance, it may be helpful for counselors to purposefully assess and explore multiple forms of oppression when working with this population. Others have discussed the need to directly inquire about the discrimination experiences of sexual minority women in therapy (Szymanski, 2005; Szymanski & Owens, 2009) and identifying individual-level factors that may ameliorate the link between discrimination experiences and psychological distress (Brondolo, Brady ver Halen, Pencille, Beatty, & Contrada, 2009). Our finding that sexual minority collective action buffered the relationship between perceived heterosexist experiences and psychological distress could inform this process.
In particular, our results suggest that it may be important for counselors, as well as school/university administrators and other individuals who work to promote the well-being of populations with marginalized identities, to be aware of activities and organizations relevant to sexual minority women of color. Counselors should also be prepared to facilitate participation when appropriate (e.g., provide information about relevant organizations). Involvement in collective action activities has been argued to promote feelings of agency (Friedman & Leaper, 2010), and prior research has found that perceived discrimination experiences act indirectly, through sense of personal control, on mental health for individuals with marginalized identities (Fischer & Holz, 2010; Moradi & Hasan, 2004). It may be then, that collective action, with its ability to promote a sense of empowerment (Szymanski & Owens, 2009), can help clients feel more in control, which, in turn, could improve mental health.
Similarly, participation in collective action will likely facilitate other mechanisms that have been identified as helpful in resisting the harmful effects of oppression for marginalized groups. These include providing a sociocultural lens through which to better understand systems of oppression (DeBlaere & Bertsch, 2013) and opportunities to develop or maintain supportive social support networks (Williams, 2005). Fundamentally, collective action offers the opportunity for women to be active in the face of oppression; drawing on a legacy of social activism has been identified to be particularly important for women of color in therapy (Williams, Frame, & Greene, 1999). Finally, we would like to highlight that the items composing the collective action measures used in the current study represented a wide range of activities (e.g., reading feminist literature, mentoring, writing to elected officials about issues affecting people of color). With myriad options for participation in collective action, counselors can easily involve clients at a level that is commensurate with and appropriate to their needs.
Conclusion
In the current study, we utilized an additive perspective to examine both direct and indirect relations between multiple discrimination experiences and psychological distress. We found that, when distress was regressed on perceived racist, sexist, and heterosexist experiences, only heterosexism emerged as a significant and positive predictor of psychological distress. We also found that sexual minority collective action moderated the heterosexism → psychological distress link. In particular, we found that heterosexism predicted distress for women with lower levels of collective action involvement. However, at higher levels of involvement in collective action, heterosexism was no longer a predictor of psychological distress. These results suggest that discrimination experiences continue to be important to assess in research and practice with diverse women. Moreover, collective action may represent an important intervention tool for counselors, and additional research with this variable is needed with other marginalized groups.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
