Resumen
Antecedentes: Estudios señalan que la internalización de creencias, prejuicios y actitudes existentes en la sociedad sobre las personas de la diversidad sexual afectan fuertemente su salud mental y podrían constituirse en una barrera de acceso a la ayuda psicológica y terapéutica en personas LGB. Objetivo: Determinar la asociación entre los niveles de internalización de estigma sexual (ESI) en personas autoidentificadas como lesbianas, gay y bisexuales (LGB) con la presencia de malestar subjetivo, sintomatología depresiva y ansiosa, suicidalidad, y asistencia a psicoterapia. Método: Un cuestionario aplicado de manera online que incluía preguntas sobre haber asistido o estar asistiendo a psicoterapia, además de escalas que evaluaban estigma sexual internalizado, malestar-bienestar subjetivo, depresión y suicidalidad fue respondido por 669 personas cisgenero autoidentificadas como lesbianas, gay y bisexuales. Resultados: Los resultados muestran una asociación positiva entre el nivel de ESI en personas LGB con sus niveles de malestar subjetivo, sintomatología depresiva y ansiosa, y suicidalidad, y una asociación negativa con estar asistiendo o haber asistido a psicoterapia. Conclusiones: Se discuten las implicancias de los resultados presentados para el desarrollo de intervenciones psicoterapéuticas culturalmente competentes para pacientes pertenecientes a la diversidad sexual y de género.
Citas
Agrupación Lésbica Rompiendo el Silencio. (2019). Ser lesbiana en Chile 2018. Estudio exploratorio. https://tinyurl.com/2bw65re4
Amadio, D. M. (2006). Internalized heterosexism, alcohol use, and alcohol-related problems among lesbians and gay men. Addictive Behaviors, 31(7), 1153–1162. https://doi.org/d5rsw5
Austin, A., & Goodman, R. (2017). The impact of social connectedness and internalized transphobic stigma on self-esteem among transgender and gender non-conforming adults. Journal of Homosexuality, 64(6), 825-841. https://doi.org/10.1080/00918369.2016.1236587
Avery, A., Hellman, R., & Sudderth, L. (2001). Satisfaction with mental health services among sexual minorities with major mental illness. American Journal of Public Health, 91(6), 990-1000. https://doi.org.10.2105/ajph.91.6.990
Beck, A.T., Steer, R.A. & Brown, G.K. (1996). Beck Depression Inventory (2nd ed.). Psychological Corporation.
Berg, R. C., Munthe-Kaas, H. M., & Ross, M. W. (2016). Internalized Homonegativity: A Systematic Mapping Review of Empirical Research. Journal of homosexuality, 63(4), 541–558. https://doi.org/10.1080/00918369.2015.1083788
Bidell, M. & Stepleman, L. (2017). An interdisciplinary approach to lesbian, gay, bisexual and transgender clinical competence, professional training, and ethical care: Introduction to special issue. Journal of homosexuality, 64 (10), 1305-1329. https://doi.org/gjgz2p
Bockting, W. O. (2015). Internalized transphobia. En P. Whelehan & A. Bolin (Eds.), The International Encyclopedia of Human Sexuality (pp. 583–625). Wiley. https://doi.org/hqwg
Calton, J., Bennett, L., Gebhard, K. (2016). Barriers to Help Seeking for Lesbian, Gay, Bisexual, Transgender, and Queer Survivors of Intimate Partner Violence. Trauma, Violence& Abuse, 17(5), 585-600. https://doi.org/10.1177/1524838015585318
Calvo, A. (2018). Gesto suicida y resiliencia en un grupo de jóvenes gays y lesbianas de Costa Rica. Revista Pensamiento Actual, 18(30), 01-12. https://tinyurl.com/2ex45h22
Chakraborty, A., McManus, S., Brugha, T.S., Bebbington, P., King, M., 2011. Mental health of the non-heterosexual population of England. The British Journal of Psychiatry, 198 (2), 143–148. http://dx.doi.org/10.1192/bjp.bp.110.082271.
Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of psychiatric disorders, psychological distress, and treatment utilization among lesbian, gay, and bisexual individuals in a sample of the U. S. population. Journal of Consulting and Clinical Psychology, 71(1), 53-61. https://doi.org/10.1037/0022-006X.71.1.53
D’Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence, 16(10), 1008–1027. https://doi.org/10.1177/088626001016010003
Errázuriz P, Opazo S, Behn A, Silva O and Gloger S (2017) Spanish Adaptation and Validation of the Outcome Questionnaire OQ-30.2. Frontiers in Psychology, 8,673. https://doi.org/f98b6r
Ferrando, P. J., & Lorenzo-Seva, U. (2014). El análisis factorial exploratorio de los ítems: algunas consideraciones adicionales. Anales de Psicología, 30(3), 1170–1175. https://doi.org/cdrw
García Cueto, E. & Gallo Álvaro, P. & Miranda, R. (1998). Bondad de ajuste en el análisisfactorial confirmatorio. Psicothema, 10(3),717-723 https://tinyurl.com/3vecv6jk
Grella, C.E., Greenwell, L., Mays, V.M., Cochran, S.D. (2009). Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: findings from the California quality of life Survey. BMC Psychiatry, 9, 52. https://doi.org/dgzrfr
Gerbing, D & Hamilton, J. (1996). Viability of exploratory factor analysis as a precursor to confirmatory factor analysis, Structural Equation Modeling: A Multidisciplinary Journal, 3(1), 62-72. https://doi.org/10.1080/10705519609540030
Hatzenbuehler, M., Phelan, J., & Link, B. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813-821. https://doi.org/gfkqp8
Herek, G.M. (2000). Sexual prejudice and gender: do heterosexuals' attitudes to- wards lesbians and gay men differ? Journal of Social Issues, 56(2), 251–266. https://doi.org/b3hkh6
Herek, G. M., Gillis, J. &Cogan, J. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56 (1), 32-43. https://doi.org/10.1037/a0014672
Iguartua, K. J., Gill, K., & Montoro, R. (2003). Internalized homophobia: A factor in depression, anxiety, and suicide in the gay and lesbian population. Canadian Journal of Community Mental Health, 22(2), 15–30. https://doi.org/ 10.7870/cjcmh-2003-0011
Lagazzi, I. M. (2016). Construcción subjetiva de adolescentes y jóvenes lesbianas y gays acerca del rol de la familia en sus procesos suicidas (Tesis Magíster en Estudios sistémicos Relacionales de la Familia y la Pareja). Universidad Alberto Hurtado, Facultad de Psicología. https://tinyurl.com/yckvsrvk
Lambert, M. J., Gregersen, A. T., & Burlingame, G. M. (2004). The Outcome Questionnaire-45. En M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (pp. 191–234). Lawrence Erlbaum Associates Publishers.
Layland, E., Carter, J., Perry, N., Cienfuegos-Szalay, C., Nelson, K., Peasant Bonner, C., Rendina, J. (2020) A systematic review of stigma in sexual and gender minority health interventions, Translational Behavioral Medicine, 10(5), 1200–1210. https://doi.org/10.1093/tbm/ibz200
Lingiardi, V., Nardelli, N., &Drescher, J. (2015) New Italian lesbian, gay and bisexual psychotherapy guidelines: A review. International Review of Psychiatry, 27(5), 405-415. https://doi.org/gm2kf2
Martínez, C., Tomicic, A., and del Pino, S. (2019). Disparidades y barreras de acceso a la salud mental en personas LGBTI+: el derecho a una atención culturalmente competente. En F. Vargas (Ed.). Informe Anual sobre Derechos Humanos en Chile 2019. (pp. 397–446). Ediciones Universidad Diego Portales. https://tinyurl.com/28jmkymu
Martínez, C., Tomicic, A., Rodríguez, J., Gálvez, C., Leyton, F., Aguayo, F., Rosenbaum, C. (June, 2017). Our daily trauma: Subjective construction of suicide experiences of young trans people. 48th International Annual Meeting of the Society for Psychotherapy Research. Toronto, Canada.
Mayfield, W. (2001) The Development of an Internalized Homonegativity Inventory for Gay Men. Journal of Homosexuality, 41(2), 53-76. https://doi.org/10.1300/J082v41n02_04
McIntyre, J., Daley, A., Rutherford, K., & Ross, L.E. (2011). Systems-level Barriers in Accessing Supportive Mental Health Services for Sexual and Gender Minorities: Insights from the Provider's Perspective. Canadian Journal of Community Mental Health, 30(2),173-186. https://doi.org/10.7870/cjcmh-2011-0023
Melipillán Araneda, R., Cova Solar, F., Rincón González, P., & Valdivia Peralta, M. (2008). Propiedades Psicométricas del Inventario de Depresión de Beck-II en Adolescentes Chilenos. Terapia psicológica, 26(1), 59-69. https://dx.doi.org/10.4067/S0718-48082008000100005
Meyer, I. H., (2003). Prejudice, social stress and mental health in lesbian, gay and bisexual population: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697. https://doi.org/10.1037/0033-2909.129.5.674
Meyer, I. H. (2013). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychology of Sexual Orientation and Gender Diversity, 1(S), 3–26. https://doi.org/10.1037/2329-0382.1.S.3
Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209–213. https://doi.org/10.1037/sgd0000132
Michaels, M., Parent, M., & Torrey, C. (2016). A minority stress model for suicidal ideation in gay men. Suicide and life-threatening behavior, 46 (1), 23-34. https://doi.org/10.1111/sltb.12169
Morrison, M. A. (2011). Psychological health correlates of perceived discrimination among Canadian gay men and lesbian women. Canadian Journal of Community Mental Health, 30(2), 81–98. https://doi.org/10.7870/cjcmh-2011-0018
Moore, S., Jones, M., Smith, J. C., Hood, J., Harper, G. W., Camacho-Gonzalez, A., Del Rio, C., & Hussen, S. A. (2019). Homonegativity Experienced over the Life Course by Young Black Gay, Bisexual and Other Men Who Have Sex with Men (YB-GBMSM) Living with HIV in Atlanta, Georgia. AIDS and behavior, 23(S3), 266–275. https://doi.org/gpr989
Newcomb, M. & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(8), 1019–1029. https://doi.org/10.1016/j.cpr.2010.07.003
Okasha A, Lotaif F, & Sadek A. (1981). Prevalence of suicidal feelings in a sample of non-consulting medical students. Acta Psychiatrica Scandinavica, 63(5), 409-415. https://doi.org/db45q2
Ortiz-Hernández, L. (2005). Influencia de la opresión internalizada sobre la salud mental de bisexuales, lesbianas y homosexuales de la Ciudad de México. Salud mental, 28(4), 49-65. https://tinyurl.com/ybxkfnvx
Pereira, H. & Rodrigues, P. (2015). Internalized homophobia and suicidal ideation among LGBT youth. Journal of Psychiatry, 18(2), 2-6. https://tinyurl.com/yvu4cyd8
Pérez Gil, J. A., Chacón Moscoso, S. & Moreno Rodríguez, R. (2000). Validez de constructo: el uso de análisis factorialexploratorio-confirmatorio para obtener evidencias de validez. Psicothema, 12(S2), 442-446. https://tinyurl.com/2xcfv44x
Pineda-Roa, C. (2019). Factores de riesgo de ideación suicida en una muestra de adolescentes y jóvenes colombianos autoidentificados como homosexuales. Revista Colombiana de Psiquiatría, 48(1), 2-9. https://doi.org/10.1016/j.rcp.2017.06.001
Pinto-Cortez, C., Fuentes, O., Quijada, M. d. l. Á., Salazar, C., Vio, C. G. & Rodríguez, R. S. R. (2018). Malestar psicológico como mediador entre la homofobia interiorizada y el riesgo suicida en hombres chilenos. Psicología Conductual, 26(3), 529-546. https://tinyurl.com/2p82vayp
Platt, L., Kay, J., & Scheitle, C. (2018). Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups. Journal of Homosexuality, 65(2), 135-153. https://doi.org/10.1080/00918369.2017.1311552
Rosseel, Y., Jorgensen, T., Rockwood, N., Oberski, D., Byrnes, J., Vanbrabant, L., Savalei, V., Merkle, E., Hallquist, M., Rhemtulla, M., Katsikatsou, M., Barendse, M., & Scharf, F. (2020). cran.r-project.org. https://tinyurl.com/3cu846py
Rossman, K., Salamanca, P., Macapagal, K. (2017) Qualitative Study Examining Young Adults' Experiences of Disclosure and Non-Disclosure of LGBTQ Identity to Healthcare Providers. Journal of Homosexuality, 64(10), 1390-1410. https://doi.org/10.1080/00918369.2017.1321379
Qureshi, R., Zha, P., Kim, S., Hindin, P.,Naqvi, Z., Holly, Ch., Dubbs, W., & Ritch, W. (2018). Health care needs and care utilization among lesbian, gay, bisexual, and transgender populations in New Jersey. Journal of Homosexuality, 65(2), 167–180 https://doi.org/hqxh
Rutter, T.M., Flentje, A., Dilley, J.W., Barakat, S., Liu, N.H., Gross, M.S., Muñoz, R.F., & Leykin, Y. (2016). Sexual orientation and treatment-seeking for depression in a multilingual worldwide simple. Journal of Affective Disorders, 206, 87-93. https://doi.org/f89xwj
Skerven; K., & De St. Aubin; (2015). Internalized homonegativity and the double bind for lesbians: those with higher need perceive more barriers to mental health treatment. Journal of LGBT Issues in Counseling, 9(1), 17–35. https://doi.org/10.1080/15538605.2014.997331
Szymanski, D. M., & Chung, Y. B. (2003). Internalized homophobia in lesbians. Journal of Lesbian Studies, 7(1), 115–125. https://doi.org/10.1300/J155v07n01_08
Tomicic, A., Immel, N., & Martínez, C. (2021). Experiencias de ayuda psicológica y psicoterapéutica de jóvenes LGBT sobrevivientes a procesos de suicidio. Revista Interamericana de Psicología, 55(1), 1-24. https://doi.org/10.30849/ripijp.v55i1.1453
Tomicic, A., Martínez, C., Rosenbaum, C., Aguayo, F., Leyton, F., Rodríguez, J., Galvez, C., &Lagazzi, I. (2021b). Adolescence and Suicide: Subjective Construction of Suicide Process in Young Gay and Lesbian Chileans. Journal of Homosexuality, 68(13), 2122-2143. https://doi.org/g6x7
Tomicic, A., Gálvez, C., Quiroz, C., Martínez, C., Fontbona, J., Rodríguez, J., Aguayo, F., Rosenbaum, C., Leyton, F., Lagazzi, I. (2016). Suicidio en poblaciones lesbiana, gay, bisexual y trans: Revisión sistemática de una década de investigación (2004-2014). Revista Médica de Chile, 144(6), 723-733. http://dx.doi.org/10.4067/S0034-98872016000600006
Weber, G. N. (2008). Using to numb the pain: Substance use and abuse among lesbian, gay, and bisexual individuals. Journal of Mental Health Counseling, 30(1), 31–48. https://doi.org/10.17744/mehc.30.1.2585916185422570