Identity concealment affects all sexual minority individuals, with potentially complex
mental health implications. Concealing a sexual minority identity can simultaneously
generate the stress of hiding, protect against the stress of discrimination, and keep
one apart from sexual minority communities and their norms and supports. Not surprisingly,
existing studies of the association between sexual orientation concealment and mental
health problems show contradictory associations-from positive to negative to null.
This meta-analysis attempts to resolve these contradictions. Across 193 studies (n
= 92,236) we find a small positive association between sexual orientation concealment
and internalizing mental health problems (i.e., depression, anxiety, distress, problematic
eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between
concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The
association between concealment and internalizing mental health problems was larger
for those studies that assessed concealment as lack of open behavior, those conducted
recently, and those with younger samples; it was smaller in exclusively bisexual samples.
Year of data collection, study location, and sample gender, education, and racial/ethnic
composition did not explain between-study heterogeneity. Results extend existing theories
of stigma and sexual minority mental health, suggesting potentially distinct stress
processes for internalizing problems versus substance use problems, life course fluctuations
in the experience of concealment, distinct experiences of concealment for bisexual
individuals, and measurement recommendations for future studies. Small overall effects,
heavy reliance on cross-sectional designs, relatively few effects for substance use
problems, and the necessarily coarse classification of effect moderators in this meta-analysis
suggest future needed methodological advances to further understand the mental health
of this still-increasingly visible population. (PsycInfo Database Record (c) 2020
APA, all rights reserved).