The Impact of Internalised Homophobia and Coping Strategies on Psychological Distress Following the Experience of Sexual Prejudice A thesis submitted in partial fulfilment of the requirements of the University of Hertfordshire for the degree of Doctor of Clinical Psychology Michael Cornish Student Number: 09212277 June 2012 Word Count: 28,842 100 Table of Contents List of Tables ....................................................................................................................................... 105 List of Figures ...................................................................................................................................... 108 1. Abstract....................................................................................................................................... 109 2. Introduction ................................................................................................................................ 110 2.1. Homosexuality and mental health .................................................................................... 112 2.2. Minority stress .................................................................................................................... 113 2.3. Sexual prejudice ................................................................................................................. 115 2.3.1. Definition of sexual prejudice ..................................................................................... 115 2.3.2. Sexual prejudice in families ......................................................................................... 116 2.3.3. Sexual prejudice in schools ......................................................................................... 117 2.3.4. Sexual prejudice at work ............................................................................................. 118 2.3.5. Sexual prejudice in the community ............................................................................ 118 2.3.6. Impact of sexual prejudice on mental health ............................................................. 119 2.4. Internalised homophobia ................................................................................................... 121 2.4.1. Development of internalised homophobia ................................................................. 122 2.4.2. Impact of internalised homophobia ........................................................................... 123 2.4.3. Critique of internalised homophobia .......................................................................... 123 2.5. Openness of sexuality ........................................................................................................ 124 2.6. Coping ................................................................................................................................. 124 2.6.1. Impact of coping strategies ......................................................................................... 126 2.6.2. Coping with minority stress ........................................................................................ 127 2.7. Rationale for project .......................................................................................................... 128 2.7.1. Research questions ..................................................................................................... 129 3. Method ....................................................................................................................................... 130 3.1. Design ................................................................................................................................. 130 3.2. Measures ............................................................................................................................ 130 3.2.1. Demographic information ........................................................................................... 131 3.2.2. Experience of sexual prejudice ................................................................................... 131 3.2.3. Coping strategies ......................................................................................................... 132 3.2.4. Psychological distress .................................................................................................. 133 101 3.2.5. Internalised homophobia ............................................................................................ 135 3.2.6. Responses to sexual prejudice .................................................................................... 136 3.3. Recruitment ........................................................................................................................ 136 3.3.1. Power calculation and sensitivity analysis .................................................................. 137 3.4. Procedures .......................................................................................................................... 138 3.5. Ethical issues ....................................................................................................................... 139 4. Results ......................................................................................................................................... 140 4.1. Response rate ................................................................................................................. 140 4.2. Participant characteristics .................................................................................................. 140 4.2.1. Age and gender ........................................................................................................... 140 4.2.2. Ethnicity, nationality and religion ............................................................................... 141 4.2.3. Employment and educational level ............................................................................ 142 4.2.4. Sexuality ...................................................................................................................... 143 4.2.5. Relationship status ...................................................................................................... 145 4.3. Sexual prejudice ................................................................................................................. 146 4.3.1. Prevalence rates .......................................................................................................... 146 4.3.2. Disclosure of sexual prejudice .................................................................................... 147 4.4. Coping strategies ................................................................................................................ 149 4.5. Internalised homophobia ................................................................................................... 151 4.6. Psychological distress ......................................................................................................... 152 4.6.1. Trauma ........................................................................................................................ 152 4.6.2. Depression .................................................................................................................. 153 4.6.3. Anxiety ........................................................................................................................ 154 4.6.4. Creating an overall psychological distress index......................................................... 155 4.7. Additional variables ........................................................................................................... 157 4.7.1. Diagnoses of Depression and Anxiety ......................................................................... 157 4.7.2. Openness..................................................................................................................... 158 4.7.3. Disclosure of experiences of sexual prejudice ............................................................ 159 4.8. Multiple regression analysis .............................................................................................. 160 4.8.1. Predicting psychological distress ................................................................................ 160 4.8.2. Moderating effects of gender and sexuality ............................................................... 161 4.9. Path analysis ....................................................................................................................... 163 4.9.1. A path analysis to investigate coping and internalised homophobia as mediators ... 163 102 4.9.3. Testing a partial mediation model .............................................................................. 165 4.9.4. Adding to the path analysis ......................................................................................... 167 5. Discussion ................................................................................................................................... 168 5.1. Overview of the study’s aims ............................................................................................. 168 5.2. Discussion of main findings ................................................................................................ 168 5.2.1. Predicting psychological distress ................................................................................ 168 5.3. Discussion of additional findings