Inconcealable: A Cognitive-Behavioral Model of Concealment of Gender and Sexual Identity and Associations With Physical and Mental Health

Concealment of gender and sexual identity constitutes a key proximal stress process in the minority stress model, and disparate literature indicates the presence of cognitive, affective, and behavioral components of concealment. There may be utility in testing these components as predictors of health disparities for gender and sexual minority (GSM) individuals. We hypothesized that greater engagement in concealment across these 3 components would be associated with worse physical health, more severe depression and anxiety, and higher rates of substance use among GSM individuals. Also, we hypothesized that each concealment component would predict depression and anxiety symptoms, whereas behavioral concealment, but neither cognitive nor affective concealment, would be associated with substance use. GSM adults (N = 640, Mage = 24.36, SD = 7.51) were recruited nationally. A measure was developed to assess the 3 components of concealment, and participants completed this measure as well as queries of current physical health, current depression and anxiety symptoms, and recent alcohol and drug use via an online survey. Multivariate hierarchical regressions demonstrated no relationship between concealment and physical health; however, concealment positively predicted depression, anxiety, and substance use symptoms. Varied relationships between the components of concealment and the response variables were found, including relationships between internalizing-externalizing symptoms and behaviors. Concealment and its constitutive components relate to a broad range of mental health symptomatology and behaviors among GSM individuals. This study is particularly timely in the current political context, as individuals in this sample appear to be more likely to conceal because of the increasing tenuousness of GSM rights. Public Significance Statement In the current study, we found evidence that concealment of gender and sexual identity has key cognitive, affective, and behavioral components and related these components to physical and mental health outcomes. Collectively, these components are associated with higher levels of depression and anxiety symptomatology and substance use, but do not relate to physical health, and individually, they make various contributions to internalizing-externalizing symptoms among GSM individuals.