Resilience Linked to Less Distress in Lesbian and Bisexual Breast Cancer Survivors

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Breast cancer can have a pervasive effect on a woman’s psychological functioning, but sexual minority (ie, lesbian and bisexual) breast cancer survivors are underrepresented in studies of psychological distress, according to Charles Kamen, PhD, a clinical psychologist at the University of Rochester Medical Center in Rochester, New York.

Minority stress is defined as the chronic stress that minorities are exposed to as a result of stigma and discrimination. The minority stress model suggests that discrimination increases distress in sexual minorities and that the effects of discrimination could be mediated by positive and negative psychological factors.

Dr. Kamen and his co-investigators sought to assess the association of minority stress and adaptive psychosocial resources with distress among sexual minority breast cancer survivors and to examine whether or not psychological resources can mediate the impact of minority stress. They presented their results in a poster at the 2017 American Psychosocial Oncology Society Annual Conference in Orlando, Florida.1

Study Design

A total of 201 sexual minority women with ductal carcinoma in situ or stage I to IV breast cancer completed self report questionnaires on demographic/clinical factors, depression, anxiety, minority stress, discrimination, minority identity development (development of a negative sense of oneself as a sexual minority woman), “outness” (openness about one’s sexuality with others), and psychosocial resources (resilience, coping mechanisms, and social support). These factors were included in a model that tested psychosocial resources as mediators between minority stress and psychological distress.

The study sample was mostly white (88%) and included 172 lesbian and 29 bisexual women, with an average age of 53 years. About half were married (42%) and had more than a college education (42%), and 63% of participants had stage I or II breast cancer.

‘Outness’ Linked to More Distress

“Despite the fact this was a well-educated sample, over half (50.2%) reported experiencing some level of discrimination based on their sexuality,” said Dr. Kamen. Fifteen percent of women in the study reported elevated depression, and 29% reported elevated anxiety.

Interestingly, more ‘outness’ was associated with more distress. We would have predicted that people who are out and open would be less distressed, but that was not true here.
— Charles Kamen, PhD

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Even controlling for race, age, education, and time since diagnosis, the investigators observed a significant positive association between outness and negative minority identity. “Interestingly, more outness was associated with more distress,” he noted. “We would have predicted that people who are out and open would be less distressed, but that was not true here.”

Social support was associated with less distress. Although less resilience was associated with more discrimination, and more resilience was associated with less distress, resilience was found to fully mediate the association between discrimination and psychological distress in this sample, he reported.

The researchers found that higher minority stress and fewer psychosocial resources are associated with higher distress among sexual minority breast cancer survivors. “Exposure to discrimination is common in this population, but the impact is buffered by resilience, so enhancing resilience could be a promising theme for interventions to reduce distress in this population,” said Dr. Kamen. ■

Disclosure: Dr. Kamen reported no potential conflicts of interest.


1. Kamen C, Jabson J, Mustian K, et al: Psychological distress, minority stress, and psychosocial resources among sexual minority breast cancer survivors. 2017 American Psychosocial Oncology Society Annual Conference. Abstract T25.