For Better and Worse? The Divergent Associations of LGBTQ+ Identity Importance and Salience on Mental Ill-Health in the Context of Discrimination

Lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) individuals experience disproportionate levels of mental ill-health, with elevated levels of discrimination being a key contributor. While it is well documented that group-based discrimination is strongly related to poorer health among LGBTQ+ individuals, research also suggests that strongly identifying and/or connecting with a marginalized identity group can mediate this relationship and, in turn, relate to better health outcomes. Drawing from social identity (e.g., rejection identification, social cure) and minority stress frameworks, this cross-sectional study explored the theorized mechanisms through which group-based discrimination and marginalized identity relate to mental ill-health among 1,060 LGBTQ+ Australians. Using structural equation modeling, we found evidence that LGBTQ+ discrimination relates to greater identity centrality (conceptualized as dimensions of identity importance and identity salience). Centrality was further associated with better mental health via increased LGBTQ+ community connectedness, and, simultaneously, worse mental health via increased stigma sensitivity (R_{mental health} 2 =.23). Importantly, we found evidence that indirect associations with better health outcomes were only observed via identity importance, while indirect associations with worse health outcomes were only observed via identity salience, despite a strong positive correlation between identity importance and salience (r =.65). Model results also remained consistent after controlling for key demographic factors. Results from this study provide important preliminary insights on how LGBTQ+ identification can be simultaneously indirectly related to better and worse psychological health via distinct strength and stressor constructs. We discuss implications for the conceptualization of identity centrality, particularly in marginalized groups, where importance and salience relate to divergent outcomes.