Coming out under fire: The role of minority stress and emotion regulation in sexual orientation disclosure.

Minority stress is hypothesized to interfere with sexual orientation disclosure and sexual minority wellbeing. In this study, we investigated whether minority stress is causally linked to reduced disclosure in sexual minorities, and whether emotion regulation, a potentially adaptive form of stigma coping, can intervene to promote disclosure even following exposure to minority stress. Sexual minority adults in the US (N = 168) were recruited online and randomized to a 2 x 2 between-subjects experimental design, where they: 1) received either emotion regulation instructions that asked them to either distance themselves from an emotionally evocative film clip or immerse themselves in the clip, and then 2) viewed either an affirming or a minority stress film clip. Following the film clip, participants completed a written reflection task in which they reflected on the film clip they viewed, which allowed research assistants to subsequently code for participants' spontaneous disclosures of sexual orientation. Participants who viewed the minority stress clip were significantly less likely to spontaneously disclose their sexual orientation in the written task compared to those who viewed the affirming film clip, OR = 3.21, 95% CI [1.14, 9.05], p = .03. Although the emotion regulation manipulation was successful, there was no effect on sexual orientation disclosure. To our knowledge, this is the first study to demonstrate a causal link between minority stress and disclosure in sexual minorities, and thus highlights an important mechanism underlying minority stress's effects on sexual minority wellbeing. Results demonstrate the importance of interventions that affirm marginalized identities and promote safe sexual orientation disclosure. Future research is needed to determine the circumstances under which effective emotion regulation can buffer against the negative emotional effects of minority stress to promote healthy approach behaviors like disclosure in safe contexts.

Introduction

Despite recent increases in their acceptance in several countries around the world [1, 2], sexual minorities continue to experience high rates of minority stress (i.e., unique stress related to their minoritized identity that heterosexuals do not experience; e.g., sexual orientation-related discrimination, victimization) [3-6]. Minority stress, and expectations thereof, can impair sexual minorities’ physical and mental health by potentially hindering sexual orientation disclosure [7, 8]. Disclosure, or “coming out” as a sexual minority, represents a critical component of adaptive minority identity development, and allows individuals access to sexual minority communities through which they can further explore their emerging identity [9]. However, because of pervasive discrimination, many sexual minorities may not feel safe disclosing their sexual orientation to family, friends, colleagues, and healthcare providers, particularly in the absence of explicit safety cues [10-12]. Indeed, concealment of identity-relevant information (as well as negative responses to such disclosure) is associated with cognitive, affective, and behavioral challenges, including hyper-vigilance, shame, and interpersonal avoidance [13, 14], although it is important to acknowledge that these constructs are closely intertwined and behavioral and affective inhibition are also thought to generate concealment [15].

Because sexual orientation disclosure in a safe context has the potential to offer sexual minorities significant social and emotional benefits, understanding potentially modifiable environmental determinants of disclosure represents an important public health concern. For example, understanding the impact of discriminatory press coverage of sexual minorities might enable news organizations to modify their reporting guidelines in order to minimize harm to this vulnerable population. Numerous survey-based studies have shown that sexual minorities who live in high-stigma environments (e.g., places with homophobic laws and policies) are less likely to disclose their sexual orientation [16, 17], and in so doing, they may protect themselves from experiencing even more minority stress (e.g., interpersonal rejection or violence) than would be expected in a high stigma environment. Indeed, some studies find a positive relationship between sexual orientation disclosure and minority stress [18], such that sexual minorities who disclose their sexual orientation are more likely to experience discrimination.

Importantly, none of these studies have utilized experimental methods to demonstrate a causal link between minority stress and concealment. This is an important gap in the literature that precludes causal inference, in that self-reports of concealment might be conflated with self-reports of minority stress through same-source reporting bias or a tendency for people who are more likely to conceal to also be more likely to perceive and report minority stress—possibilities that current non-experimental research cannot rule out. Consequently, this study’s primary goal was to elucidate previous correlational findings by experimentally investigating whether minority stress has a direct and immediate effect on disclosure decisions among sexual minority adults, and if so, in which direction. Importantly, we sought to examine the impact of minority stress on day-to-day decisions to disclose one’s sexual orientation—for example, choosing whether to disclose that your “wife” is actually a husband when a work colleague invites said wife to a company event. Our rationale is that while “major” disclosures (e.g., to parents, siblings) have been shown to have a substantial impact on mental health [19], there is less research on how these more frequent, arguably “smaller” disclosures are impacted by minority stress.

A secondary goal was to identify personal coping strategies that might buffer against the association between minority stress and concealment. Emotion regulation refers to the processes by which individuals modulate characteristics of their emotions (e.g., type, timing, expression) [20]. Because minority stress is associated with negative mood reactivity [21], as well as negative emotions like shame and sadness [22-24], which are in turn associated with social withdrawal [25], being able to effectively down-regulate one’s negative emotions after leaving a discriminatory context (i.e., when the individual is in a safer situation) may increase the likelihood of disclosure in the service of seeking social support to cope with the minority stress experience. As such, emotion regulation may represent an important coping strategy to consider when examining the impact of minority stress on sexual orientation disclosure [26]. Importantly, given the very real threat to sexual minorities’ physical safety in many instances of minority stress (e.g., discrimination, victimization), it is likely adaptive for these individuals to socially withdraw and to conceal their identities while the discriminatory experience is ongoing. However, once the environment is more affirming, it may be useful to down-regulate the emotional and behavioral sequalae of the discriminatory experience in order to increase social connection and coping.

Some emotion regulation strategies are likely more helpful than others in the context of minority stress. For instance, one of the few experimental studies in this area compared the utility of two strategies, rumination and distraction, in response to an idiographic discrimination induction [27]. While discrimination increased self-reported psychological distress across participants, individuals instructed to distract themselves from their distress showed greater reductions in self-reported negative affect compared to those instructed to ruminate. In line with this finding, work by Kross and colleagues demonstrated that individuals who are better able to distance themselves from their emotions and thoughts tend to experience less intense emotional reactions and ruminate less, as compared to individuals who immerse themselves in their emotional experiences [28-30]. Indeed, cross-sectional research has found that sexual minorities who use cognitive change strategies, like distancing, might be protected against the adverse behavioral outcomes of discrimination [31]. Distancing refers to the process of mentally removing oneself from a given situation and is associated with shorter emotion duration and reduced emotional reactivity compared to strategies like immersion (i.e., the process of fully engaging oneself in a given situation [30]). Yet, to our knowledge, no studies have examined the effect of experimentally induced emotion regulation strategies on behavioral responses to sexual orientation-related minority stress. Such research can help inform whether certain emotional regulation strategies might have a socially adaptive benefit in the face of minority stress.

In the present study, we predicted that participants who watched a minority stress film would be less likely, and take longer, to spontaneously disclose their sexual orientation in a written reflection task than those who watched an affirming film. To examine the potentially protective role of emotion regulation, we also predicted that this main effect of film would be qualified by a two-way interaction with emotion regulation, such that among those who viewed the minority stress film, distancing would be associated with more disclosure than immersion.

Materials and methods

Participants

Lesbian, gay, and bisexual adults (LGB; N = 217) were recruited via targeted postings in social media, Craigslist, listservs, and emails to special interest groups. Postings indicated that the study was about “sexuality and emotions,” and were accompanied by rainbow-related images. Sample size was determined based on previous studies examining similar constructs in sexual minorities (scaled up for number of between-subjects conditions [27, 32]), as well as high expected rates of data loss due to the online nature of the study (i.e., incomplete surveys, repeat completions, ineligible participants). Eligible participants needed to: 1) be over the age of 18, 2) self-identify as a sexual minority (i.e., lesbian, gay, or bisexual), and 3) reside in the United States (due to U.S.-centric film stimuli). All study participation was completed online via Qualtrics. Given that online data collection affords less experimental control, we took numerous measures to ensure maximal data integrity. We removed 21 participants for incomplete task data (e.g., did not write reflection), 13 participants for responses consistent with inattentive responding (i.e., all answers given were “1” and/or incorrect responses to attention questions), three participants for problematic open-response reflections (e.g., off-topic, low-effort), and 12 participants for failing to follow emotion regulation instructions (operationalized as answering 1 “not at all” in response to a question about whether they used their assigned strategy while watching the film clip).

The final sample (n = 168) had a mean age of 24.6 years (SD = 7.3 years). A total of 82.1% identified as White; 26.2% identified as men, 57.1% as women, 11.3% as genderqueer, and 5.4% as having another gender identity; and 43.5% identified as bisexual (69.9% female), 26.8% as lesbian, 17.9% as gay, and 11.9% as having another non-heterosexual orientation. Participants were relatively well-educated, with 41.6% indicating that they had obtained at least a four-year college degree. Furthermore, they came from a diverse range of locations, with 42.9% living in a large city, 30.4% living in a small city, 15.5% living in a suburban area, 9.5% living in a small town, and 1.8% living in a rural area, and. See Table 1 for additional demographic characteristics.

Table 1

Demographic characteristics of the sample.

Demographic characteristic	n	%
Sex assigned at birth
Female	124	73.8
Male	44	26.2
Gender identity
• Woman	96	57.1
• Man	44	26.2
• Genderqueer	19	11.3
• Other	9	5.4
Sexual orientation
• Lesbian	45	26.8
• Gay	30	17.9
• Bisexual	73	43.5
• Other	20	11.9
Race
• White/Caucasian	138	82.1
• Asian	13	7.7
• Black/African American	1	0.6
• American Indian/Alaska Native/First Nations	5	3.0
• Native Hawaiian/Other Pacific Islander	2	1.2
• Other	9	5.4
Ethnicity
• Hispanic or Latino	23	13.7
Highest education attained
• Some high school	5	3.0
• High school diploma/GED	18	10.7
• Some college	66	39.3
• 2-year degree/certificate	9	5.4
• 4-year college degree	33	19.6
• Some post-graduate/professional school	14	8.3
• Post-graduate/professional degree	23	13.7
Occupation
• Student	79	47.0
• Employed full-time (> = 35 hours/week)	47	28.0
• Employed part-time (<35 hours/week)	27	16.1
• Unemployed	11	6.5
• Homemaker	4	2.4
Region
• Large city	72	42.9
• Small city	51	30.4
• Suburban area	26	15.5
• Small town	16	9.5
• Rural area	3	1.8

N = 168. Participants were on average 24.6 years old (SD = 7.3; range: 18–66). “Other” gender identities included agender (n = 2), demigirl (n = 1), demigirl/non-binary (n = 1), non-binary (n = 3), queer (n = 1), and Two-Spirit/genderqueer (n = 1). “Other” sexual orientations included asexual (n = 1), asexual/biromantic (n = 1), homoflexible/queer (n = 1), pansexual (n = 8), and queer (n = 9).

Procedure

All study procedures were approved by The Ohio State University Institutional Review Board under protocol # 2014B0539. After providing informed consent electronically via Qualtrics (documentation of written consent was waived by the IRB given the online nature of the study), participants completed a battery of questionnaires, including demographic questions (see S1 Appendix). We then randomized participants to a 2 x 2 between-subjects design, where they: 1) received either immersion or distancing emotion regulation instructions and 2) viewed either a minority stress or an affirming film clip. Next, participants completed attention questions related to the film clip, and then completed a written reflection task designed to capture spontaneous sexual orientation self-disclosure. At the end of the study, participants were debriefed, linked to an LGB-affirming film clip, and paid $15 for their time (~60 minutes).

Emotion regulation manipulation

Participants randomly received either immersion (n = 82)—fully engaging with the evocative stimulus—or distancing (n = 86)—mentally removing oneself from an emotionally evocative stimulus—instructions directly prior to their assigned film clip. Immersion instructions were adapted from prior experimental paradigms on perspective-taking [33, 34]:

As you watch this video, try to embrace the thoughts and feelings you are having. Concentrate on the way you would feel if you were experiencing the events in this video, or if the people in this video were talking to you. Think about how the things you are seeing and hearing relate to who you are as a person, and how you would feel during the rest of your day if you had experienced these events. Imagine as clearly and vividly as possible everything that you would experience—the thoughts, the feelings, everything.

Distancing instructions followed the same format and length:

As you watch this video, try to be as mentally removed as possible about the events and people you see. Remind yourself that you are not being spoken to by the people in the video. Remind yourself that the opinions and events you are seeing and hearing have no bearing on who you are as a person, on your relationships and friendships, or on how you view yourself. Whatever emotions you are experiencing right now will come and go—they are only temporary and will have no impact on how you feel for the rest of the day.

Following the film, participants rated their compliance with their assigned emotion regulation instructions on 1 “not at all” to 9 “completely” scale. To assess immersion, participants were asked, “To what extent did you think about the events in the video as though they were happening to you?” To assess distancing, participants were asked “To what extent did you think about the events in the video as though they were happening to someone else?” All participants answered both questions, regardless of emotion regulation condition.

Film clips

Participants viewed either a minority stress (n = 83) or an LGB-affirming (n = 85) film clip. The discriminatory film clip has been validated in several LGB samples as a reliable induction of both negative affect and sexual orientation-related minority stress [35]. Briefly, it is a two-minute clip consisting of a montage of videos (e.g., TV shows, movies, news programs) depicting LGB people in a negative light in the media, at school and/or work, and at home (e.g., homophobic comments by political commentators, LGB parents being refused service at a restaurant, familial rejection of LGB child). The affirming film clip, which was found online [36], was the same length and consisted of positive depictions of LGB people in the aforementioned settings (e.g., marriage equality victory, familial support of LGB children, proud LGB individuals). Montages were used, rather than using longer clips containing single subjects, in order to broaden the appeal of the clips to different genders and sexual orientations, as well as to increase the likelihood of each participant personally identifying with some part of the film clip. The montage approach also helped ensure adequate stimulus sampling [37]. Prior research on the minority stress clip demonstrates that it elicits self-relevant thoughts about five different minority stress domains in LGB adults who view it [35]; thus, we posit that the clip is a valid induction of sexual orientation-related minority stress.

Written reflection task

Participants completed a four-minute written reflection task in which they reflected on their thoughts and feelings about the film they watched. We adapted instructions for this task from a previous study investigating differences in self-disclosure between face-to-face interactions and those executed more remotely (e.g., through the internet) [38]. We also asked participants to write about how they did or did not identify with the film. In order to minimize demand characteristics, we asked participants distracter questions (e.g., “What parts of the video (if any) made you feel physical sensations in your body?”). To minimize priming, this task occurred roughly 30 minutes after participants completed the demographic question about sexual orientation. Participants were presented with all question prompts at the top of the page, and then were asked to respond to them in one continuous essay. The full instructions were:

Try to be as honest as possible and describe exactly what you were feeling and thinking as you watched the video. As you write, we would like you to really let go and explore your very deepest emotions and thoughts. You may write about how you identified with different parts of the video, or about similar experiences in your life. Everyone responds differently to this video—we want to know what this video means to you. For example, you might consider the following: What positive or negative feelings (if any) did you experience while watching this video? What parts of the video (if any) shocked or surprised you? Which of your thoughts about the video stand out most to you? What parts of the video (if any) made you feel physical sensations in your body? If at any time you draw a blank, or run out of things to write, just relax and give yourself time to think about something else related to the topic. Remember: there are no right or wrong answers in this task—all we ask is that you try your best and write from the heart.

To determine whether participants spontaneously disclosed their sexual orientation during the reflection task, two undergraduate research assistants coded each written reflection. Research assistants were blind to film and emotion regulation condition, and were not involved in study design or analyses. A reflection was identified as including disclosure if the participant included their sexual orientation in the text (e.g., “As a lesbian…” or “I am very proud to be part of the LGBT community”). Research assistants also coded the number of words until disclosure (calculated as the minimum number of words in the reflection needed to determine the participant’s sexual orientation). Discrepancies were resolved by the first author during a consensus meeting.

This paradigm was chosen over a forced choice disclosure paradigm (e.g., asking participants whether they would disclose their sexual orientation to a friend or family member after viewing the film clip) in order to maximize ecological validity. As no other experimental studies of sexual orientation disclosure exist, we developed this approach as an analogue of a sexual minority individual’s spontaneous behavior after being exposed to discriminatory media content on social media or television (which is where the film clips were drawn from).

Attention questions

Attention questions were used to catch automated responding [39, 40]. Participants completed two film-specific multiple-choice questions that focused on the visual (e.g., “One man in the video talked about building fences. Where was he located during this clip?”) and auditory (e.g., “In the clip where the son comes out to his mother in the kitchen, what does the mother say in response?”) content of the clips in order to ensure that participants were fully engaged with the task. Nine participants from the original 217 were excluded for incorrect responses to attention questions.

Statistical analyses

All analyses were conducted using SPSS version 26 [41], and the threshold for significance (i.e., α) was set at 0.05. As our data cleaning procedure removed participants who did not complete the experimental task (see Participants), we did not have missing data. All continuous data variables met assumptions of normality. First, as a manipulation check, we ran one-way ANOVAs predicting reported emotion regulation use during the film from the assigned emotion regulation condition. Next, we used logistic regression to examine main and interactive effects of film (minority stress vs. affirming) and emotion regulation (immersion vs. distancing) conditions on sexual orientation disclosure during the reflection task (i.e., dichotomous outcome variable). Post-hoc sensitivity analyses in G*Power [42] using Hsieh et al.’s procedure [43] indicated the obtained sample provided 80% power to detect effects as small as OR = 0.23 with an α-level of .05 in a logistic regression of this kind. Finally, we ran a negative binomial regression predicting number of words until disclosure from emotion regulation and film conditions.

Results

Manipulation check

We found a significant difference between the immersion and distancing conditions in the degree to which participants thought about events depicted in the film as though they were happening to themselves (i.e., immersion), F(1, 166) = 25.97, p < .001, Hedges’ g = 0.79, such that those in the immersion condition reported greater immersion than those in the distancing condition. We also found a significant difference between the immersion and distancing conditions in the degree to which participants thought about events depicted in the film as though they were happening to someone else (i.e., distancing), F(1, 166) = 10.57, p = .001, Hedges’ g = 0.50, such that those in the distancing condition reported greater distancing than those in the immersion condition.

Likelihood of disclosure

We found a significant main effect of film, OR = 3.21, 95% CI [1.14, 9.05], p = .027, such that participants in the minority stress condition were 3.2 times less likely to disclose their sexual orientation during the reflection task than those in the affirming condition. Contrary to expectations, we found no effect of emotion regulation condition, OR = 0.63, 95% CI [0.26, 1.50], p = .29, and the interaction was non-significant, OR = 0.78, 95% CI [0.20, 3.05], p = .72. See Table 2 for descriptive characteristics. Although we were underpowered to statistically examine differences by sexual orientation group (lesbian/gay, bisexual, other), descriptive characteristics show that much fewer bisexual participants (34.8%) disclosed in the minority stress/distancing conditions than lesbian/gay participants (76.5%), suggesting that there may be differences by sexual orientation in how participants responded to these manipulations (see S1 Table).

Table 2

Descriptive characteristics of disclosure variables by film and emotion regulation condition.

	Minority Stress		Affirming
	Distancing	Immersion	Distancing	Immersion
n	44	39	42	43
Disclosure (%)	50.0	61.5	71.4	83.7
Average total word count	142.50 (58.91)	147.62 (59.97)	136.95 (64.19)	142.93 (69.93)
Average word count until disclosure	72.59 (54.57)	66.33 (40.82)	58.00 (51.58)	51.75 (41.53)

Mean (Standard deviation). Average word count until disclosure includes only participants who disclosed their sexual orientation during the reflection task.

Words to disclosure

Although descriptive results (see Table 2) were in line with hypotheses, there was no significant main effect of film condition, OR = 1.25, 95% CI [0.82, 1.92], p = .30, or emotion regulation, OR = 0.89, 95% CI [0.61, 1.30], p = .55, on number of words until disclosure and the interaction was non-significant, OR = 1.02, 95% CI [0.57, 1.84], p = .94. See S1 Table for descriptive characteristics by sexual orientation group.

Discussion

This study sought to examine whether 1) minority stress has a causal effect on sexual orientation concealment, and 2) emotion regulation can buffer against negative effects of minority stress on disclosure. Indeed, participants exposed to minority stress content were less likely to spontaneously disclose their orientation than those who viewed affirming content. This experimental finding clarifies the correlational findings found in previous research by identifying a causal direction from minority stress to disclosure. This finding also supports the notion that sexual minorities exposed to environments in which minority stress is common might be more likely to conceal their sexual orientation. In fact, previous research has shown associations between discriminatory national laws, policies, and community attitudes and reduced odds of sexual orientation disclosure, with negative implications for health [16, 17, 44, 45]. Given that the minority stress content in this study consisted of video clips from commonly watched television and online media sources, our findings also point to the importance of developing and following media guidelines for accurate, inclusive, and affirming reporting on sexual minorities and their experiences in order to minimize harm [46]. As societies make progress toward these types of structural and institutional reductions in discrimination, clinical health interventions with sexual minorities can address the role of minority stress on disclosure and related outcomes. Indeed, psychosocial interventions that affirm marginalized identities and help sexual minorities to cope with minority stress can promote not only greater sexual orientation disclosure (in safe contexts) [47], but also ultimately influence broader societal change by empowering sexual minority individuals to be the agents of that change [48]. Interventions that promote disclosure specifically have been argued to perpetuate civil rights gains of this historically marginalized population [49, 50].

We did not find evidence for our hypothesis that emotion regulation would buffer against minority stress and facilitate disclosure. Although successful manipulation checks suggest that participants understood and tried to follow the emotion regulation instructions, perhaps the manipulation (i.e., immersion vs. distancing) was not strong enough to alter participants’ emotional responses. Future studies should employ different emotion regulation strategies (e.g., cognitive reappraisal, suppression), as well as a no-instructions control, to determine whether a different strategy can buffer the impact of minority stress on disclosure behavior. It could also be interesting to combine this affective science approach with Miller and Kaiser’s theoretical model of stigma coping [51]. For example, a future study could compare primary control coping strategies like regulating emotion expression with secondary control coping strategies like cognitive restructuring. Another possible explanation for these results could be that the instructions for the written reflection task overrode the emotion regulation instructions for the distancing group. Although participants in the distancing condition may have followed regulation instructions while watching the film clip (as indicated by the manipulation check), they likely also followed the written reflection task instructions (delivered a couple minutes later), which directed participants to explore their “very deepest emotions and thoughts.” Thus, participants may have been more likely to disclose than if they had been encouraged to continue distancing themselves from their emotions. Future research should consider changing the instructions for the written reflection task (e.g., by removing any language that may conflict with the emotion regulation instructions) to determine if doing so reveals an effect of emotion regulation on disclosure.

We also did not find support for our predictions related to the timing of sexual orientation disclosure in the written reflection task. While descriptive statistics (Table 2) were in line with our hypotheses (i.e., the minority stress clip was associated with more words until disclosure than the affirming clip; the distancing condition was associated with more words until disclosure than the immersion condition), it is likely that a larger sample size is needed in order to reach statistical significance.

Our study provides initial insight into the frequency of sexual orientation disclosure in the context of minority stress and affirmation. Given our findings, future research could take a closer look at the depth, breadth, and duration of participants’ disclosure to see whether these qualities predict wellbeing over time. A large body of literature has shown that self-disclosure about personal information can play an important role in facilitating intimacy and relationship development (for a review, see [52]); however, less is known about how these features of disclosure play out in stigmatized populations and for other outcomes, including mental and physical health.

Future studies should also expand their minority stress analogues to include not only film clips, but also interactive paradigms (e.g., online chat interface, in-person interactions). Given that many of the minority stress experiences LGB individuals face in their lives occur interpersonally (e.g., in schools and workplaces; [3, 53]), it is critical that future work captures this additional dimension in order to better understand the real-life experiences of LGB individuals and thus their full affective repertoire during times of adversity. In addition to interpersonal minority stress experiences, recent work has shown that structural stigma (i.e., characteristics of a social environment that oppress LGB individuals such as policies excluding sexual minorities from institutions like marriage) may have a significant impact on the lives and wellbeing of LGB individuals [54]. As such, it is crucial that future investigations consider the role of structural stigma and the affective and biological processes related to it.

Although this study has a number of strengths, including its use of innovative experimental methods and the ecological validity of the film clips, there are also several limitations that should be addressed in future studies. First, participants who were recruited knew that the study was about sexuality, which may have influenced their responses (e.g., participants may have felt more comfortable disclosing their sexual orientation if they assumed the research team were LGBTQ-affirming). Given this limitation, it is a testament to the strength of the effect of minority stress that although participants had already disclosed their orientation to the research team, they then chose, consciously or unconsciously, to withhold the information after viewing the minority stress clip. Nonetheless, the paradigm should be repeated with naïve samples with a wide range of sexual minority identities (including questioning individuals) to confirm the results. Similarly, this study was underpowered to examine differences among individuals with different sexual minority identities. Since descriptive results seemed to suggest differences in the effects of the manipulations on lesbian/gay vs. bisexual participants, it is crucial that future studies with larger samples of diverse sexual identities investigate these possibilities. Next, it is possible that participants did not identify with the film clip they viewed, and thus did not write about their sexual orientation in relation to the clip (rather than avoiding disclosing their sexual orientation as a result of the minority stress content). While the film clips purposefully included a montage of smaller clips in order to minimize this possibility, future work should consider matching minority stress analogues to participants’ experience (e.g., using an idiographic approach involving prescreening minority stress experiences and selecting a relevant film clip). Relatedly, due to power constraints, this study did not examine the potential moderating effects of individual differences (e.g., prior sexual orientation disclosure, internalized stigma) on the relationship between minority stress exposure and disclosure. Future studies should recruit larger samples with a high degree of variation in these individual difference variables in order to determine whether and how these factors influence the strength of the minority stress-disclosure relationship. This study also did not assess participants’ explicit motivations for disclosing their sexual orientation during the reflection task. As such, it is unclear whether participants would respond the same way in a real-life conversation, or if the decision to disclose was related to some feature of the study paradigm. Additional studies with different minority stress analogues and more diverse samples of LGB individuals are needed to determine the generalizability of this finding. Finally, due to the difficulty of creating an ecologically valid stimulus that is “neutral” regarding sexual minority individuals, this study did not employ a neutral control condition that would allow for conclusions to be made about whether results reflect a reduction in spontaneous disclosure after minority stress exposure versus an increase in disclosure after affirmation. Future research should consider including such a control so that this can be assessed.

This is the first known study to experimentally demonstrate a causal link between minority stress and sexual orientation disclosure. Although additional research is needed to examine the parameters under which this effect operates, this finding highlights an important mechanism potentially underlying minority stress’s effects on sexual minority identity development and ultimate wellbeing. These findings can support public policy and psychosocial interventions to advance the public visibility of this historically marginalized population, whose members face frequent pressures to conceal an important aspect of their identity. In so doing, these findings may help reduce the mental health burden that sexual minority individuals disproportionately experience.

Contents of questionnaire battery.

(DOCX)

Click here for additional data file.

Descriptive characteristics of disclosure variables by film, emotion regulation condition, and sexual orientation.

(DOCX)

Click here for additional data file.

7 Feb 2022

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5. Review Comments to the Author

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Reviewer #1: This was a well-written manuscript that demonstrated greater spontaneous disclosure of sexual minority status (coming out) after group affirming rather than discriminatory filmclips. It would have been interesting to include a neutral film clip (perhaps a montage of facts and figures about sexual minorities in the US that is neither affirming nor discriminatory) to examine whether results reflect a reduction in disclosure after discrimination versus an increase in spontaneous disclosure after affirmation - and perhaps the authors could speculate about this in the discussion. Moreover, I wonder if N of 168 would be sufficient power to get a 2X2 interaction (the original hypothesis re: emotion regulation) on a measure like spontaneous disclosure. In general though, this was a well done study with an interesting ecologically valid measure of disclosure.

Reviewer #2: This manuscript details the results of an online experimental study assessing the impact of viewing a sexual-minority-affirming or sexual-minority-discriminatory film clip, as well as the impact of receiving emotion regulation instruction (either immersion or distancing), on the likelihood of spontaneously disclosing a sexual minority orientation. The research is well designed and the experimental approach provides novel insights. Thus, the manuscript represents an important contribution to the literature. I have two minor concerns; I believe that if the authors address these concerns, it will strengthen the manuscript.

First, the study is framed as an experimental discrimination induction design. “Discrimination” is not defined in the literature review and the reader is left to use the common usage understanding of discrimination, which is more interpersonal in nature (e.g., another person commits a discriminatory act toward someone because of their sexual orientation). However, the study design includes exposure to discriminatory stimuli. Rewording the literature review and discussion sections to replace “discrimination” with “exposure to discriminatory stimuli” would be more precise, but would be excessively wordy and make the manuscript difficult to read. However, a broader discussion in the literature review of what constitutes discrimination, including specific mention of exposure to discriminatory stimuli such as the video clip used in the current study, would help to make the paper clearer. There is discussion of how the video clip is a useful minority stress induction tool in the methods section; however, similar information needs to be included in the literature review section to more fully frame the construct of discrimination being studied in the present research.

Second, the authors note in the discussion section that the emotion regulation intervention did not impact disclosure. However, the distancing instructions speak to being mentally removed but the written reflection instructions speak of exploring “very deepest emotions and thoughts;” these appear to be at odds with one another. Given that the timing between the emotion regulation instructions and the written reflection instructions appears to only be a couple minutes, it is quite possible that the reflection instructions cancelled out any emotion regulation induction for those in the distancing group. This seems to be an important limitation that should be explored in the discussion.

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Reviewer #2: Yes: Nathan Grant Smith

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15 Mar 2022

Please see attached file for better formatted responses.

Response to Reviewers

March 14, 2022

RE: PONE-D-21-20910

Dear Dr. Ruben and reviewers,

Thank you for the opportunity to revise our manuscript entitled “Coming out under fire: The role of minority stress and emotion regulation in sexual orientation disclosure.” We are grateful for the thoughtful feedback provided by both the editor and the reviewers, and we believe that the suggested adjustments have substantially strengthened the manuscript. In response to your comments, we now: (1) clarify our language when discussing the film clip manipulations by reframing the “discriminatory” stimulus as a “minority stress” stimulus; (2) include a post-hoc sensitivity analysis to address reviewer concerns about power; (3) provide additional details in the method regarding the length of the study, use of attention questions, how disclosure was operationalized; (4) address the lack of a control condition in this experiment and discuss the difficulties associated with designing this kind of “neutral” stimulus in research about sexual minorities; and (5) review several limitations in the discussion section including the potential conflict between the emotion regulation instructions and the written reflection instructions. In this document, we highlight the reviewers’ comments in italics and then provide our detailed responses below. All edits to the manuscript have been highlighted in yellow for ease of review.

Thank you again for your valuable feedback and your time.

Editor comments:

Comment 1: Reviewer 1 astutely asked why you didn’t include a neutral clip about sexual minorities (and potentially heterosexual couples) with facts, images, and figures that was neither positively or negatively valenced. This would allow you to make claims about whether disclosure increases or decreases compared to these neutral clips. While material is rarely perceived as neutral and may have been why you didn't include this type of "control" condition, it would be nice to know whether disclosure increases or decreases compared to this control condition rather than that there is a difference between affirming and discriminatory stimuli (two extreme cases). I think it is a good question for you to consider and pose for future work. While I know this type of study takes time and resources in terms of data collection, cost, and coding of the spontaneous disclosure, I wonder whether you could conduct a Study 2 with this type of clip.

Response: Thank you for this important suggestion. We agree that a future study that includes some kind of “neutral” control clip would be informative. As you anticipated, we elected not to use a neutral control condition because of the difficulty of creating such a clip, as well as our focus on using ecologically valid stimuli that participants might encounter in their daily lives. Although the reviewer suggests that we include perhaps a montage of facts and figures about sexual minorities in the US that is neither affirming nor discriminatory, in the current climate it is unclear what facts and figures about sexual minorities could be included in such a clip that would be considered neutral. Statistics about the number of individuals identifying as sexual minorities could be viewed as affirming (i.e., a sign that a sexual minority is not alone), as could simply depicting same-sex couples, given the continued lack of representation of LGB people in some areas of the media. Facts about the fairly unchangeable nature of sexual orientation have been vociferously debated by anti-LGBTQ groups like the Family Research Council who promote so-called “conversion” practices — thus inclusion of such facts could be considered affirming and not neutral. Facts about the impact of discrimination and stigma on sexual minorities has also been debated by these same anti-LGBTQ groups, so any stimuli related to this area (e.g., news clips) could be considered non-neutral. Even definitional information (such as the notion that bisexuality means an individual is attracted to more than one gender) could be considered not neutral, by virtue of affirming sexual minorities’ rights to self-identify. Indeed, the Family Research Council encourages its members to “avoid using the terms “gay,” “lesbian,” or “bisexual” as solo nouns because this tends to imply that some people’s intrinsic, inborn, immutable identity as gay, lesbian, etc. is who they are… We instead say “people who engage in homosexual conduct” or “people who identify as homosexual.”” Thus, even using identity labels could be considered affirming. Importantly, since sexual orientation is a concealable identity, it is necessary for identity labels to be used in the video stimuli. Otherwise, it would be unclear that the stimulus is supposed to be related to sexual orientation. Of note, both discriminatory and affirming clips included videos from news broadcasts (affirming: about marriage equality; discriminatory: about banning LGBTQ content in schools), which could be considered more “neutral” stimuli, in that news broadcasts could be considered more objective than for example, the more “extreme” views expressed in online commentary and editorials. A note regarding the need for additional research that includes a more neutral control condition has been added to the limitations section on page 20, lines 402-407.

Family Research Council, How to Respond to the LGBT Movement. URL: https://www.frc.org/get.cfm?i=BC18B01

Comment 2: Reviewer 1 also brings up whether you’re powered to detect an interaction in your model. Please address this question in your method or discussion.

Response: We have added a post-hoc sensitivity analysis addressing this concern to the statistical analysis section on page 13, lines 263-265.

Post-hoc sensitivity analyses in G*Power (42) using Hsieh et al.’s procedure (43) indicated the obtained sample provided 80% power to detect effects as small as OR = 0.23 with an �  -level of .05 in a logistic regression of this kind.

Comment 3: Reviewer 2 brings up a very important point about the clarity of the language you use to describe the video manipulations. I agree that what you use as discrimination/discriminatory is really exposure to discriminatory or disconfirming stimuli. I liked the idea that Reviewer 2 posed that this could potentially be a minority stress induction used in the lab. It had me thinking about the Trier Social Stress Test and how that’s a stress induction in the lab that is commonly used. I would like you to carefully reconsider what you call your manipulation with an eye towards being as clear and true to what your stimuli actually presented and what scenario/experience your participants were in when they were assigned to one condition vs. the other. This is not an issue with just this study, but an issue with the field at large in being clear on language so that studies in the future can be compared against each other as this is not the same as discrimination experiences that one would complete on a survey. It is as if you’re priming people in a way and I would urge you to look into other literature that manipulates these types of identity cues (e.g., Cipollina, R., & Sanchez, D. T. (2021). Identity cues influence sexual minorities’ anticipated treatment and disclosure intentions in healthcare settings: Exploring a multiple pathway model. Journal of health psychology, 1359105321995984.)

Response: Thank you for this important suggestion. We agree that language is important, especially when operationalizing constructs in experimental studies. Since the discriminatory film clip has been validated as a minority stress induction more broadly (see citation 35 in the manuscript), we have decided to instead refer to this clip throughout the manuscript (and in the title) as the “minority stress” clip. We think this is a more precise description of this manipulation, since the clip validation study found that participants who view this film clip describe thinking about multiple different types of minority stress (including discrimination, violence, internalized homophobia, concealment, expectations of rejection), not just discrimination. Thank you also for drawing our attention to the Cipollina & Sanchez study — we have added reference to it on page 3.

Comment 4: Finally, Reviewer 2 has comments about how your distancing manipulation may be at odds with exploring inner emotions/thoughts. Please comment on this in your revision letter and in the manuscript.

Response: Thank you for highlighting this potential conflict between the instructions for the emotion regulation manipulation, and the instructions for the written reflection task. We agree that this may explain our emotion regulation results, and have added the following text to the discussion on page 17, lines 336-346.

Another possible explanation for these results could be that the instructions for the written reflection task overrode the emotion regulation instructions for the distancing group. Although participants in the distancing condition may have followed regulation instructions while watching the film clip (as indicated by the manipulation check), they likely also followed the written reflection task instructions (delivered a couple minutes later), which directed participants to explore their “very deepest emotions and thoughts.” Thus, participants may have been more likely to disclose than if they had been encouraged to continue distancing themselves from their emotions. Future research should consider changing the instructions for the written reflection task (e.g., by removing any language that may conflict with the emotion regulation instructions) to determine if doing so reveals an effect of emotion regulation on disclosure.

Comment 5: On p3, first paragraph you introduce how pervasive discrimination may impact disclosure to various groups and leave out healthcare providers- one area of work that has received much attention and where disclosure is important (with training by providers on how to respond and appropriate care). In this same paragraph you lay out a very causal path by which concealment induces processes and feelings (hypervigilance and shame) yet it could go the other way as well. Can you dampen the language in the causal paths here and acknowledge these processes are intricately tied. It’s actually a strength of your research, is that you’re trying to disentangle these effects.

Response: This is an excellent point. We have amended this paragraph to include healthcare providers, as well as to acknowledge the complex relationships between concealment and other cognitive, behavioral, and affective processes. This paragraph now reads as follows:

However, because of pervasive discrimination, many sexual minorities may not feel safe disclosing their sexual orientation to family, friends, colleagues, and healthcare providers, particularly in the absence of explicit safety cues (10–12). Indeed, concealment of identity-relevant information (as well as negative responses to such disclosure) is associated with cognitive, affective, and behavioral challenges, including hyper-vigilance, shame, and interpersonal avoidance (13,14), although it is important to acknowledge that these constructs are closely intertwined and behavioral and affective inhibition are also thought to generate concealment (15).

Comment 6: Which brings me to another question- did you measure any individual differences that impacted the strength of your manipulations (i.e. moderators) on disclosure? For example, ability to perspective take or outness, internalized homophobia etc…

Response: Given the primary aim of this study (to examine main and interactive effects of film clip and emotion regulation on disclosure), as well as concerns about being underpowered to detect moderation effects in addition to our predicted effects, we do not include moderation analyses in this manuscript. While we did collect questionnaires related to outness and internalized stigma as well as other relevant sexual minority identity variables (see S1 Appendix), due to the sheer number of relevant variables, we do not wish to inadvertently conduct a fishing expedition by running and reporting all possible results. However, we do think that this is an important direction for future research, and we have added the following comment to this effect in the discussion on page 19, lines 392-396.

Relatedly, due to power constraints, this study did not examine the potential moderating effects of individual differences (e.g., prior sexual orientation disclosure, internalized stigma) on the relationship between minority stress exposure and disclosure. Future studies should recruit larger samples with a high degree of variation in these individual difference variables in order to determine whether and how these factors influence the strength of the minority stress-disclosure relationship.

Comment 7: I appreciated that you acknowledged your sample was already out enough to join a study on LGBTQ issues. I wonder if you included questioning individuals what your effects would look like.

Response: We think this would be an interesting future study as well! Since our operationalization of disclosure (as described on page 12, lines 235-236) required participants to in some way indicate their non-heterosexual sexual orientation in their written reflection task response (e.g., “As a gay man…” or “When I came out…”), we imagine it may be challenging to capture this kind of casual disclosure in quite the same way with questioning individuals (beyond participants responding “As someone who is questioning their sexual orientation…”). To our knowledge, there are few studies that specifically focus on questioning individuals, likely due to recruitment challenges. Hollander (2000) also posits that questioning youth may be less likely to explicitly disclose their questioning status for two main reasons:

1. In line with several developmental models of sexual identity development, questioning youth have yet to find an identity label that fits their experience, so do not have words to describe their experience when asked, and

2. Anti-LGBTQ stigma and discrimination likely prompt questioning youth to assume a heterosexual identity when asked to disclose in order to avoid maltreatment.

We have added a brief note to the discussion about the need for more research on this topic (see page 19, line 381).

Comment 8: On p4 last paragraph, you start discussing the non-adaptive effects of emotion regulation when experiencing discrimination, however, if I read this right, I would disagree. I think it’s very adaptive for individuals who experience discrimination in their environment to conceal and withdraw because their environment is not safe. Can you explain what you mean here if I’ve misinterpreted and clarify for your reader and also balance this view. You only briefly note this perspective middle of p5.

Response: Thank you for highlighting the need for additional clarity in this section. We have revised this section to reflect the importance of considering the adaptiveness of concealment and avoidance in situations where disclosing one’s sexual minority status could increase safety concerns. Specifically, we rephrased as follows (see page 5, lines 85-97):

Because minority stress is associated with negative mood reactivity (21), as well as negative emotions like shame and sadness (22–24), which are in turn associated with social withdrawal (25), being able to effectively down-regulate one’s negative emotions after leaving a discriminatory context (i.e., when the individual is in a safer situation) may increase the likelihood of disclosure in the service of seeking social support to cope with the minority stress experience. As such, emotion regulation ¬may represent an important coping strategy to consider when examining the impact of minority stress on sexual orientation disclosure (26). Importantly, given the very real threat to sexual minorities’ physical safety in many instances of minority stress (e.g., discrimination, victimization), it is likely adaptive for these individuals to socially withdraw and to conceal their identities while the discriminatory experience is ongoing. However, once the environment is more affirming, it may be useful to down-regulate the emotional and behavioral sequalae of the discriminatory experience in order to increase social connection and coping.

Comment 9: On p4, line 82-83, I don’t understand this sentence, “being able to effectively down-regulate one’s negative emotions in discriminatory contexts may increase the likelihood of disclosure, as a form of prosocial behavior.”….what does this have to prosocial behavior/helping behavior?

Response: Thanks for this catching this error. In line with the previous comment, we have rephrased this paragraph to be clearer.

Comment 10: While I appreciate your sample size is small, can you present results on whether disclosure differed by sexual minority identity?

Response: Thank you for this suggestion. While our small sample size and subsequent low power precludes adding a condition x sexual orientation group interaction term to our models, we have added a supplemental table (S1 Table) that includes the descriptive characteristics of our outcome variables broken down by sexual orientation group (lesbian/gay, bisexual, and other), as well as by film and emotion regulation conditions. We included a brief description of the most notable observation in the results section on page 14-15:

Although we were underpowered to statistically examine differences by sexual orientation group (lesbian/gay, bisexual, other), descriptive characteristics show that much fewer bisexual participants (34.8%) disclosed in the minority stress/distancing conditions than lesbian/gay participants (76.5%), suggesting that there may be differences by sexual orientation in how participants responded to these manipulations (see S1 Table).

We also noted the importance of investigating differences in disclosure by sexual orientation in future studies in the discussion on page 19, lines 382-386:

Similarly, this study was underpowered to examine differences among individuals with different sexual minority identities. Since descriptive results seemed to suggest differences in the effects of the manipulations on lesbian/gay vs. bisexual participants, it is crucial that future studies with larger samples of diverse sexual identities investigate these possibilities.

Comment 11: How long, on average, did the study last? Please include this when you say participants were paid $15 for their time.

Response: The study took participants around 60 minutes to complete. This detail was added to page 9, line 166.

Comment 12: For transparency, please include what the battery of questionnaires included.

Response: We have added the list of questionnaires included in the study to S1 Appendix.

Comment 13: P9 line 170-173, please clarify that both groups answered the two questions. I didn’t understand this until your results.

Response: Thank you for this suggestion. We have clarified that all participants answered both questions, regardless of emotion regulation condition on page 10, lines 189-190.

Comment 14: How many participants were excluded based on your “attention questions”, you list excluded earlier but not here.

Response: Nine participants were excluded based on incorrect responses to attention questions. We have added this information to page 7, line 136, and page 13, lines 252-253.

Comment 15: Please interpret your odds ratios for the reader.

Response: Thank you for this suggestion. We have made this adjustment to the results section.

Comment 16: While I know this is not a qualitative paper, can you give a few examples of how people disclosed?

Response: We have included examples of how participants disclosed in our description of the coding process on page 12, lines 235-236.

Reviewers' comments:

Comment 17: Reviewer #1: This was a well-written manuscript that demonstrated greater spontaneous disclosure of sexual minority status (coming out) after group affirming rather than discriminatory film clips. It would have been interesting to include a neutral film clip (perhaps a montage of facts and figures about sexual minorities in the US that is neither affirming nor discriminatory) to examine whether results reflect a reduction in disclosure after discrimination versus an increase in spontaneous disclosure after affirmation - and perhaps the authors could speculate about this in the discussion.

Response: Thank you for raising these important points. As described in our response to Comment 1, we agree that a future study that includes some kind of “neutral” control clip would be informative. We elected not to use a neutral control condition because of the difficulty of creating such a clip, as well as our focus on using ecologically valid stimuli that participants might encounter in their daily lives. As described in more detail in our response to Comment 1, it is unclear what facts and figures about sexual minorities could be included in such a clip that would be considered neutral, and indeed even definitional information (such as the notion that bisexuality means an individual is attracted to more than one gender) could be considered not neutral, by virtue of affirming sexual minorities’ rights to self-identify. Of note, both discriminatory and affirming clips included videos from news broadcasts (affirming: about marriage equality; discriminatory: about banning LGBTQ content in schools), which could be considered more “neutral” stimuli, in that news broadcasts could be considered more objective than for example, the more “extreme” views expressed in online commentary and editorials. A note regarding the need for additional research that includes a more neutral control condition has been added to the limitations section on page 20, lines 402-407.

Comment 18: Moreover, I wonder if N of 168 would be sufficient power to get a 2X2 interaction (the original hypothesis re: emotion regulation) on a measure like spontaneous disclosure. In general though, this was a well done study with an interesting ecologically valid measure of disclosure.

Response: Thank you for your kind words about our study. As noted in response to Comment 2, we have added a post-hoc sensitivity analysis addressing this concern to the statistical analysis section on page 13, lines 263-265.

Post-hoc sensitivity analyses in G*Power (42) using Hsieh et al.’s procedure (43) indicated the obtained sample provided 80% power to detect effects as small as OR = 0.23 with an �  -level of .05 in a logistic regression of this kind.

Comment 19: Reviewer #2: This manuscript details the results of an online experimental study assessing the impact of viewing a sexual-minority-affirming or sexual-minority-discriminatory film clip, as well as the impact of receiving emotion regulation instruction (either immersion or distancing), on the likelihood of spontaneously disclosing a sexual minority orientation. The research is well designed and the experimental approach provides novel insights. Thus, the manuscript represents an important contribution to the literature. I have two minor concerns; I believe that if the authors address these concerns, it will strengthen the manuscript.

First, the study is framed as an experimental discrimination induction design. “Discrimination” is not defined in the literature review and the reader is left to use the common usage understanding of discrimination, which is more interpersonal in nature (e.g., another person commits a discriminatory act toward someone because of their sexual orientation). However, the study design includes exposure to discriminatory stimuli. Rewording the literature review and discussion sections to replace “discrimination” with “exposure to discriminatory stimuli” would be more precise, but would be excessively wordy and make the manuscript difficult to read. However, a broader discussion in the literature review of what constitutes discrimination, including specific mention of exposure to discriminatory stimuli such as the video clip used in the current study, would help to make the paper clearer. There is discussion of how the video clip is a useful minority stress induction tool in the methods section; however, similar information needs to be included in the literature review section to more fully frame the construct of discrimination being studied in the present research.

Response: Thank you for your kind words about our study, and for these useful suggestions. After reflecting on your comment, we decided to change our language throughout the manuscript by referring to the discriminatory film clip as the “minority stress” clip. We think this is a more precise description of this manipulation, since a study validating this film clip as a minority stress induction (citation 35 in the manuscript) found that participants who view this film clip describe thinking about multiple different types of minority stress (including discrimination, violence, internalized homophobia, concealment, expectations of rejection), not just discrimination.

Comment 20: Second, the authors note in the discussion section that the emotion regulation intervention did not impact disclosure. However, the distancing instructions speak to being mentally removed but the written reflection instructions speak of exploring “very deepest emotions and thoughts;” these appear to be at odds with one another. Given that the timing between the emotion regulation instructions and the written reflection instructions appears to only be a couple minutes, it is quite possible that the reflection instructions cancelled out any emotion regulation induction for those in the distancing group. This seems to be an important limitation that should be explored in the discussion.

Response: Thank you for highlighting this potential conflict between the instructions for the emotion regulation manipulation, and the instructions for the written reflection task. We agree that this may explain our emotion regulation results, and have added the following text to the discussion on page 17, lines 336-346.

Another possible explanation for these results could be that the instructions for the written reflection task overrode the emotion regulation instructions for the distancing group. Although participants in the distancing condition may have followed regulation instructions while watching the film clip (as indicated by the manipulation check), they likely also followed the written reflection task instructions (delivered a couple minutes later), which directed participants to explore their “very deepest emotions and thoughts.” Thus, participants may have been more likely to disclose than if they had been encouraged to continue distancing themselves from their emotions. Future research should consider changing the instructions for the written reflection task (e.g., by removing any language that may conflict with the emotion regulation instructions) to determine if doing so reveals an effect of emotion regulation on disclosure.

Submitted filename: Response to Reviewers_03.14.22.docx

Click here for additional data file.

18 Apr 2022

Coming out under fire: The role of minority stress and emotion regulation in sexual orientation disclosure

PONE-D-21-20910R1

Dear Dr. Seager van Dyk,

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Additional Editor Comments (optional):

I think this is a wonderful contribution to the field. Thank you for doing responding to all of the editor's and reviewers' comments so thoughtfully and doing such important rigorous research on these topics. It was a real pleasure reading the manuscript the first time and even more so now with the clarity of the revisions. Best, Mollie

22 Apr 2022

PONE-D-21-20910R1

Coming out under fire: The role of minority stress and emotion regulation in sexual orientation disclosure

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