Rumination, Sexual Orientation Uncertainty, and Psychological Distress in Sexual Minority University...

The Counseling Psychologist2014, Vol. 42(4) 497 –523

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Rumination, Sexual Orientation Uncertainty, and Psychological Distress in Sexual Minority University Students

Ashley Borders1, Luis A. Guillén1, and Ilan H. Meyer2

AbstractThis study examined associations between uncertainty about sexual orientation, rumination, and psychological distress in university students. We hypothesized that increased rumination would mediate associations between higher sexual orientation uncertainty and greater psychological distress. Furthermore, we hypothesized that these associations might differ for self-identified lesbian, gay, and bisexual (LGB) versus heterosexual emerging adults. A sample of 207 university students completed questionnaires assessing sexual orientation uncertainty, rumination, depressive symptoms, perceived stress, and aggression. Path analyses indicated that higher sexual orientation uncertainty was associated with greater rumination, depressive symptoms, and perceived stress. Furthermore, rumination mediated associations between sexual orientation uncertainty and all measures of psychological distress across the entire sample. However, multi-group analyses indicated that these associations emerged for LGB participants but not for heterosexuals. Results suggest that rumination may constitute a common but maladaptive coping response for sexual minorities facing sexual

1The College of New Jersey, Ewing, NJ, USA2University of California, Los Angeles, Los Angeles, CA, USA

Corresponding Author:Ashley Borders, PhD, The College of New Jersey, 2000 Pennington Rd., P.O. Box 7718, Ewing, NJ 08628, USA. Email: [email protected]

527002 TCPXXX10.1177/0011000014527002The Counseling PsychologistBorders et al.research-article2014

498 The Counseling Psychologist 42(4)

orientation uncertainty. Interventions for this population should focus on decreasing rumination.

Keywordssexual orientation, uncertainty, rumination, stress, depressive symptoms

Sexual orientation is an important aspect of individuals’ sexual identity (Worthington, Savoy, Dillon, & Vernaglia, 2002). Although the development of sexual orientation identity likely starts at a young age, sexuality becomes increasingly important during adolescence and young adulthood (Carver, Egan, & Perry, 2004; Patterson, 1995). Most theories of sexual orientation identity development include a period of uncertainty during which individu-als question their presumed orientation, reflect on attractions and fantasies, and/or experiment with same- or other-sex partners (Hollander, 2000). Research with youth suggests that uncertainty about sexual orientation is associated with psychological distress (Carver et al., 2004; Espelage, Aragon, Birkett, & Koenig, 2008; Poteat, Aragon, Espelage, & Koenig, 2009; Williams, Connolly, Pepler, & Craig, 2005). However, researchers have not explored this association in emerging adults or described potential mecha-nisms. In this study, we examined whether rumination constitutes one path-way by which sexual orientation uncertainty is associated with several indices of psychological distress (i.e., depressive symptoms, perceived stress, and aggression). We also explored whether there is a difference between hetero-sexual and lesbian, gay, and bisexual (LGB) emerging adults in the effect of sexual orientation uncertainty on rumination and distress. Below, we review the limited empirical literature linking sexual orientation uncertainty with psychological distress and suggest that rumination constitutes a likely coping response to sexual orientation uncertainty. We then propose that sexual ori-entation uncertainty has a greater impact on rumination and subsequent psy-chological distress among LGB as compared with heterosexual individuals.

Sexual Orientation Uncertainty

Uncertainty in general is associated with strong emotions (Bar-Anan, Wilson, & Gilbert, 2009) and psychological maladjustment (Luyckx et al., 2008; Weary, Marsh, & McCormick, 1994). Periods of exploration during general identity development are characterized by psychological distress (Berman, Montgomery, & Kurtines, 2004). In line with this, children and adolescents who were uncertain about their sexual orientation or who self-labeled as

Borders et al. 499

“questioning” reported greater depressive symptoms, suicidal thoughts, and lower self-esteem than did their peers who identified as or felt more certain about being heterosexual (Carver et al., 2004; Espelage et al., 2008; Poteat et al., 2009; Williams et al., 2005). Two studies found that adolescents who were uncertain reported higher psychological distress than their LGB-identified peers (Espelage et al., 2008; Poteat et al., 2009). Uncertain adoles-cents also reported more externalizing problems (e.g., delinquency, aggressive behavior) than did heterosexual peers (Williams et al., 2005). No research has examined whether these associations also occur in emerging adults. Emerging adulthood (Arnett, 2000) is a developmental period between ages 18 and 25 characterized by identity exploration and uncertainty in many areas of life (e.g., career, relationships). This exploration, although important and meaningful, is associated with depressive and anxious symptoms in emerg-ing adults (Luyckx et al., 2008). Moreover, less adaptive approaches to handling identity exploration are associated with physical and relational aggressive behavior in this age group (Smits, Doumen, Luyckx, Duriez, & Goossens, 2011). Thus, it seems likely that sexual orientation uncertainty in emerging adults will be associated with similar outcomes.

In understanding the effect of sexual orientation uncertainty, it is impor-tant to consider both group-specific minority stress and general psychologi-cal processes (Hatzenbuehler, 2009). Prejudice and stigma predispose sexual minorities to greater exposure to minority stressors, which include external events like discrimination and violence, as well as more internal processes such as internalized homophobia, expectations of rejection, and concealment versus disclosure of sexual identity (Meyer, 2003). In turn, maladaptive cop-ing—and in particular rumination—mediate the associations between sexual minority stressors and increased psychopathology (Hatzenbuehler, 2009). We propose that rumination may also be a likely coping response to the stressor of sexual orientation uncertainty and that because of the unique exposure of LGB individuals to minority stress, uncertainty may affect them more severely than it would affect heterosexually-identified individuals.

Rumination as a Coping Strategy

Rumination is defined as the tendency to passively perseverate on negative feelings and problems (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Rather than actively and effectively responding to unwanted situations, rumi-nators spend time brooding about questions such as “What does it mean that I feel this way?” and “What if I don’t snap out of this quickly?” (Ward, Lorie Sousa, & Nolen-Hoeksema, 2003). Rumination is associated with a weak problem-solving orientation and high levels of mental and behavioral


disengagement (Nolen-Hoeksema et al., 2008), suggesting that it constitutes a form of passive coping. An extensive literature has found that rumination is associated with symptoms of depression and anxiety (for reviews, see Nolen-Hoeksema et al., 2008; Watkins, 2008). Rumination may contribute to these internalizing symptoms because it prolongs and intensifies existing negative moods, increases negative thinking about the past and future, decreases moti-vation, and reduces social support (Nolen-Hoeksema et al., 2008). In both survey and experimental studies, rumination is also associated with increased anger, hostility, and aggressive behavior (Borders, Earleywine, & Jajodia, 2010; Bushman, Pederson, Vasquez, Bonacci, & Miller, 2005; Rusting & Nolen-Hoeksema, 1998). Miller, Pederson, Earleywine, and Pollock (2003) suggested that rumination about angering events maintains the activation of anger-related associative networks over time, which in turn makes hostile thoughts more accessible and subsequent aggressive behavior more likely. Thus, rumination contributes to both internalizing (e.g., depression, anxiety) and externalizing (e.g., aggression) symptoms of psychological distress.

Rumination increases following both chronic stress (Nolen-Hoeksema, Larson, & Grayson, 1999) and specific stressful events (e.g., Spasojević & Alloy, 2002). Hatzenbuehler (2009) proposed that sexual minority stress may contribute to increased rumination because it engenders hypervigilance of future discrimination, preoccupation with being discovered, and/or constant questioning about whether and when to disclose one’s sexual identity. Increased rumination in sexual minorities may in turn explain higher rates of psychological distress. In support of this theory, stigma consciousness, or the expectation of prejudice and discrimination, was associated with rumination (measured as intrusive thoughts) for lesbians who felt alienated from their social network (Lewis, Derlega, Clarke, & Kuang, 2006). Bereaved gay male caregivers who experienced a perceived danger because of being gay showed increased rumination tendencies and, in turn, increased depressive and anx-ious symptoms over time (Hatzenbuehler, Hilt, & Nolen-Hoeksema, 2010). Similarly, in an experience-sampling study, sexual and ethnic minority indi-viduals reported more rumination and subsequent negative affect on days when they experienced stigma-related stressors (Hatzenbuehler, Nolen-Hoeksema, & Dovidio, 2009). In a follow-up experimental study, partici-pants who were induced to ruminate following the recall of an autobiographical discrimination event displayed prolonged negative affect compared with par-ticipants who were induced to distract themselves (Hatzenbuehler et al., 2009). Thus, initial research supports the mediating role of rumination in sexual minorities who experience a range of stigma-related stressors.

There are several reasons why rumination may also constitute a natural coping response to the stress of sexual orientation uncertainty. First,

Borders et al. 501

rumination is associated with the exploration phase of identity development in emerging adults (Luyckx et al., 2008), a period that involves general uncertainty about one’s sense of self. Rumination also occurs following fail-ure to progress toward goals that are personally important and meaningful, such as happiness or romantic relationships (McIntosh & Martin, 1992). Theorists propose that individuals will ruminate until they feel that an unmet goal has been either attained or abandoned (e.g., Watkins, 2008). If individu-als perceive their sexual orientation uncertainty as a failure to achieve a firm sense of identity, they might ruminate in a misguided attempt to “solve” their uncertainty. Especially if individuals feel societal pressure to choose and/or conform to a particular sexual orientation, failure to achieve that certainty may prompt substantial rumination and emotional distress. Drawing on Hatzenbuehler’s (2009) reasoning, individuals who are uncertain about their sexual orientation may exhibit heightened hypervigilance of their own fanta-sies and attractions, preoccupation with how others might respond, and con-stant questioning about causes of their uncertainty and potential consequences for their lives, all of which characterize the repetitive mental cycles of rumi-nation. This rumination, in turn, may lead to internalizing and externalizing symptoms. Thus, rumination is a likely mechanism of the association between sexual orientation uncertainty and psychological distress.

Sexual Orientation Uncertainty in LGB and Heterosexual Individuals

In the sexual minority research literature, there is lack of clarity in how sex-ual orientation uncertainty is defined, operationalized, and measured, as well as examined in relationship to self-identified sexual orientation. Of the stud-ies reviewed previously, some included “questioning” as a distinct category of sexual orientation (e.g., Williams et al., 2005). Other researchers assessed degree of uncertainty or confusion about sexual orientation and subsequently categorized participants as straight, LGB, or sexually uncertain for data anal-yses (e.g., Espelage et al., 2008; Poteat et al., 2009). However, treating uncer-tainty as a category implies that individuals who identify with other categories of sexual orientation are not uncertain or questioning. This assumption con-flicts with evidence that sexual orientation uncertainty occurs in self-identified LGB and heterosexual individuals (Morgan, Steiner, & Thompson, 2010; Morgan & Thompson, 2011; Worthington, Navarro, Savoy, & Hampton, 2008). Moreover, the degree of sexual orientation uncertainty varies within self-identified heterosexual and sexual minority individuals (Worthington & Reynolds, 2009). Thus, sexual orientation uncertainty is better conceptual-ized as a dimensional construct that is separate from, albeit related to, sexual orientation.


If sexual orientation uncertainty can occur among individuals who iden-tify as heterosexual and LGB, what is the meaning of this uncertainty? Most models of lesbian and gay identity development describe an early period of confusion and uncertainty, when individuals become aware of feeling differ-ent than others and begin to question the assumption of a heterosexual iden-tity (Cass, 1979; McCarn & Fassinger, 1996; Troiden, 1989). In these models, uncertainty eventually makes way for identification with and commitment to a stable sexual minority identity. However, empirical evidence suggests that some self-identified lesbian and gay individuals endorse meaningful levels of sexual orientation uncertainty (Worthington et al., 2008; Worthington & Reynolds, 2009). In their bisexual developmental model, Weinberg, Williams, and Pryor (1994) proposed that bisexual identity development not only starts with confusion but also that individuals experience continued uncertainty after choosing a bisexual identity. Research suggests that although bisexuals as a group do experience more sexual orientation uncertainty than lesbian or gay individuals (Worthington et al., 2008), there is meaningful variability in uncertainty within self-identified bisexual men and women (Worthington & Reynolds, 2009). Thus, some individuals who have chosen LGB identities may experience sexual orientation uncertainty. Sexual orientation uncer-tainty in sexual minorities may reflect normal curiosity and exploration. However, it may also be a natural but adverse reaction to living in a hetero-sexist, homophobic, and biphobic society. Higher sexual orientation uncer-tainty in this population is in fact associated with less internalized self-affirmation and support of LGB civil rights (Worthington & Reynolds, 2009). We therefore hypothesize that uncertainty in LGB individuals is a complex phenomenon that arises from healthy curiosity as well as self-doubts related to belonging to a minority group (McCarn & Fassinger, 1996), inter-nalized homophobia, and/or past experiences of discrimination and victim-ization (Meyer, 2003).

Worthington and colleagues (2002) suggested that uncertainty can also be a normal part of heterosexual identity development. They argue that although many heterosexuals foreclose on a heterosexual identity without any con-scious exploration, some heterosexuals do engage in cognitive exploration of their orientation and attractions, as well as actual behavioral exploration. Consistent with this, research suggests that two thirds of self-identified het-erosexual women and half of heterosexual men have questioned their sexual orientation at some point (Morgan et al., 2010; Morgan & Thompson, 2011). Such questioning appears to be motivated by same-sex attractions and behaviors, evaluations of different-sex experiences (or lack of), exposure to sexual minority individuals, and other people asking whether the individuals were gay (Morgan et al., 2010; Morgan & Thompson, 2011). Thus, sexual

Borders et al. 503

orientation uncertainty among heterosexuals may primarily reflect curiosity and exploration.

Because of the potential differences between heterosexual and LGB indi-viduals in the experience of uncertainty, we hypothesize that sexual orienta-tion uncertainty among heterosexuals may be less troubling than it is among LGB individuals. Accordingly, the effect of sexual orientation uncertainty on rumination and resultant psychological distress might vary by self-identified sexual identity.

The Current Study

We examined the associations between sexual orientation uncertainty, rumi-nation, and several measures of psychological distress in a sample of univer-sity students. In line with previous research with younger participants, we hypothesized as follows:

Hypothesis 1: Greater sexual orientation uncertainty would be associated with more psychological distress, measured as depressive symptoms, per-ceived stress, and aggression.Hypothesis 2: More uncertain individuals would report greater rumina-tion than would less uncertain individuals.Hypothesis 3: Increased rumination would mediate the associations between uncertainty and psychological distress.Hypothesis 4: Based on our exploration of different meanings of sexual orientation uncertainty in LGB versus heterosexual individuals, we tested whether the effects of sexual orientation uncertainty varied by sexual identity (LGB vs. heterosexual). We hypothesized that greater sexual ori-entation uncertainty would be more strongly associated with rumination and subsequent psychological distress for self-identified LGB individuals compared with heterosexuals.

Method

Participants

The sample consisted of 207 participants (76% female, 22.5% male, 1.5% transgender). Approximately 76.5% of participants identified as European American/White, 8.5% as Asian/Asian American, 6% as African American/Black, 4.5% as Hispanic/Latino/Latina, and 4.5% as another race/ethnicity (including 1% as Pacific Islander and 0.5% as American Indian). Participants’ mean age was 19.70 years (SD = 1.63, range = 18-26). Approximately 75%


of participants self-identified as heterosexual, 15.5% as lesbian or gay, 6% as bisexual, 2% as queer, and 1.5% as pansexual. Finally, 23% of participants were first-year, 26% second-year, 25% third-year, 21% fourth-year under-graduates, and 5% were graduate students.

Procedure

Participants provided informed consent before beginning the study. Participants then completed the study questionnaires using an online survey. The order of measures was randomized. At the end of the survey, participants reported their age, race/ethnicity, gender (male, female, or transgender), sex-ual identity (heterosexual, LGB, or other), and year in school (freshman, sophomore, junior, senior, graduate student, not applicable). The survey took 20 to 25 min to complete. The college’s Institutional Review Board approved all research and recruitment procedures.

Participants were recruited from three sources. Approximately 69% (n = 143) of participants were recruited from the psychology subject pool at a public liberal arts college in the Northeast. These participants completed the online survey in a psychology classroom and received course credit. Another 23 participants (11%) were students at the same college who responded to posted campus flyers. They completed the online survey in a setting of their choosing and had the opportunity to win a US$50 Amazon gift card in a lottery for their participation. Finally, 41 participants (20%) were recruited using the listserv of the Consortium of Higher Education LGBT Resource Professionals, representing colleges and universities all over the United States. These participants also had the opportunity to win a US$50 Amazon gift card in a lottery.

As expected, participants recruited from the LGBT (lesbian, gay, bisex-ual, and transgender) listserv were more likely to identify as lesbian, gay, bisexual, queer, or pansexual than participants recruited from the psychology subject pool or campus flyers, χ2(8, N = 207) = 172.30, p < .0001, V = .64. There were also significant differences by method of recruitment in gender, χ2(4, N = 207) = 27.15, p < .001, V = .26, and age, F(2, 169) = 20.56, p < .001, ηp2 = .20. Participants recruited from the LGBT listserv were more likely to

be male or transgender and were on average 1.8 years older than participants from the psychology subject pool. There were no differences in race or eth-nicity by method of recruitment.

Measures

Sexual orientation uncertainty. The Measure of Sexual Identity, Experience, and Commitment (MoSIEC; Worthington et al., 2008) assesses four distinct

Borders et al. 505

factors that are common across all sexual identities: exploration, sexual ori-entation uncertainty, commitment, and synthesis-integration. Only the three-item Uncertainty subscale was used for this study. The items were “I sometimes feel uncertain about my sexual orientation,” “My sexual orienta-tion is not clear to me,” and “My sexual orientation is clear to me” (reverse scored). Participants indicated their level of agreement with each item on a 6-point Likert-type scale ranging from 1 (very uncharacteristic of me) to 6 (very characteristic of me). Higher averaged subscale scores indicate greater uncertainty. Participants recruited via the psychology subject pool were mis-takenly given a 5-point scale on this questionnaire, rather than the intended 6-point scale. Therefore, all participants’ scores on these three items were converted to z scores before being averaged so that scores could be compared across the entire sample. This subscale reliably differentiates both men and women who describe themselves as questioning their sexual orientation from non-questioning individuals (Morgan et al., 2010; Morgan & Thompson, 2011), suggesting convergent validity. Cronbach’s alpha for the uncertainty subscale for this sample was good, α = .88.

Rumination. The 12-item Rumination subscale of the Rumination and Reflec-tion Questionnaire (Trapnell & Campbell, 1999) assesses the tendency to engage in self-focused repetitive thinking about threats or losses (e.g., “Long after an argument is over with, my thoughts keep going back to what had hap-pened”). Participants indicated their level of agreement with each item on a 5-point Likert-type scale from 1 (strongly disagree) to 5 (strongly agree). Higher averaged scores indicated more rumination. Previous studies have shown good test–retest reliability and convergent validity of this measure (Siegle, Moore, & Thase, 2004; Trapnell & Campbell, 1999). Internal consis-tency for this sample was high, α = .92.

Depressive symptoms. The 20-item Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977) is frequently used to assess current depressive symptoms in clinical and non-clinical populations. Items ask about depressed mood and cognitions, as well as physiological symptoms of depression (e.g., eating, sleeping, and attention) in the last week. Participants responded to all 20 items using a series of four anchored alternatives ranging from 0 (rarely or none of the time) to 3 (all of the time) in terms of severity. Higher summed scores indicate more depression. The CES-D shows good convergent validity with other indices of depression (Radloff, 1991) and effectively reflects individual differences in depressive severity in college samples (Santor, Zuroff, Ramsay, Cervantes, & Palacios, 1995). Internal consistency for this sample was good, α = .87.


Perceived stress. The 10-item Perceived Stress Scale (PSS-10; Cohen & Wil-liamson, 1988) measures the degree to which individuals have felt anxious, overwhelmed, and unable to cope. Sample items include “How often have you felt that you were unable to control the important things in your life?” and “How often have you felt nervous and ‘stressed?” Participants rate the frequency with which they have felt this way in the past month on a 5-point scale from 0 (never) to 4 (very often). Higher summed scores indicate more perceived stress. The measure demonstrates both convergent and divergent validity in college sam-ples (Cohen, Kamarck, & Mermelstein, 1983; Roberti, Harrington, & Storch, 2006). Internal consistency was adequate in this sample, α = .82.

Aggression. The Explicit Aggression Scale (EAS; Barnwell, Borders, & Earley-wine, 2006) measures experiences with aggressive behavior, anger, and hostil-ity. The 17-item measure asks participants to report the number of times (e.g., 0, 1, 2, 3-5, 6-10, 11-19, 20+) they have engaged in different types of aggressive behaviors (e.g., push another person, yell at someone, say mean things) and felt angry or hostile (e.g., eaten up with jealousy, felt really angry) in the past 6 months. The original measure asked participants whether they also engaged in these behaviors after drinking alcohol, but for this study, we did not ask partici-pants these alcohol-related questions. Higher summed indices indicate more recent aggressive behavior and anger/hostility. The aggressive behavior and anger/hostility subscales had adequate internal consistency in this sample, αs = .72 and .75, respectively. Barnwell et al. (2006) found correlations between this measure and dispositional aggression, suggesting convergent validity.

Data Analysis

Continuous variables were first evaluated for deviations from normality. Rumination and perceived stress were normally distributed. Sexual orienta-tion uncertainty, depressive symptoms, aggressive behavior, and anger/hos-tility were all positively skewed. A log transformation effectively normalized sexual orientation uncertainty. Square root transformations were conducted on the other skewed variables (Tabachnick & Fidell, 2001). There were no multi-variate outliers based on Mahalanobis’s distance with p < .001. We then explored the associations between continuous variables and gender, self-identified sexual orientation, method of recruitment (subject pool vs. campus flyers vs. LGBT listserv), and age, to determine whether any of these variables should be included as covariates in our mediation model.

Our primary analyses involved testing path models using the MPlus pro-gram Version 7.0 (Muthén & Muthén, 1998-2012), with the missing-at-random assumption (Little & Rubin, 1987) and maximum likelihood estimation. The

Borders et al. 507

missing-at-random option assumes that the pattern of missing data is either random or can be fully accounted for by already-measured variables (Little & Rubin, 1987). Accordingly, missing data points are included as latent vari-ables, and path estimates are calculated as if all participants had complete data. Overall model fit was assessed using the chi-square statistic, compara-tive fit index (CFI), and root mean square error of approximation (RMSEA). General rules of thumb for concluding adequate model fit include a non- significant chi-square, small RMSEA (e.g., <.05), and CFI close to 1 (Kline, 2010).

We created two path models. To explore our initial hypothesis, we first built a total effects model (see Figure 1) with direct paths from the independent vari-able (sexual orientation uncertainty) to all three dependent variables (depres-sive symptoms, perceived stress, and aggression). Aggression was modeled as a latent variable using the aggressive behavior and anger/hostility subscales as indicators. All other variables were modeled as single observed variables. To examine Hypotheses 2 and 3, we added rumination as a mediator between sex-ual orientation uncertainty and each of the dependent variables (see Figure 2). In both models, the dependent variables were allowed to covary.

These two path models were initially tested with the entire sample. To explore our fourth hypothesis, we next examined whether these models dif-fered for LGB and heterosexual participants. To do this, self-identified sex-ual orientation served as a grouping variable. Because so few participants identified as bisexual, queer, or pansexual, these participants were combined with individuals who identified as lesbian or gay, to comprise the sexual minority group. Therefore, for the purpose of statistical analyses, we used a dichotomous sexual orientation variable of heterosexual or LGB. We first ran our total effects and mediation models separately for each group, to deter-mine whether the models were a good fit for each sample group. If they were, we then ran multi-group models with the estimated path coefficients and residuals either (a) constrained to be the same or (b) allowed to vary across heterosexual and LGB groups. We compared model fit using chi-square dif-ference tests. In these tests, if the difference in chi-square between the con-strained and unconstrained models is significant for the difference in degrees of freedom, then the path coefficients for the LGB and heterosexual groups are meaningfully different from each other.

Mediation was examined by calculating indirect effects, which are defined as the product of the path coefficients for (a) the independent variable to the mediator, and (b) the mediator to the dependent variable after controlling for the independent variable (Preacher & Hayes, 2008). An indirect effect that is significantly different from zero suggests that the mediator is accounting for a significant proportion of the variance between the independent and


dependent variables. We examined indirect effects of sexual orientation uncertainty via rumination on three outcomes indicating psychological dis-tress: (a) depressive symptoms, (b) perceived stress, and (c) aggression. The significance of indirect effects was examined using bootstrapping methodol-ogy (Preacher & Hayes, 2008). This procedure creates an empirical sampling distribution of 5,000 bootstrap samples, from which indirect effects and their 95% confidence intervals are estimated. Recent simulation studies suggest that the bias-corrected bootstrap produces the most accurate confidence inter-vals (Cheung & Lau, 2008; MacKinnon, Lockwood, & Williams, 2004). We calculated the bootstrap estimates and bias-corrected confidence intervals for each indirect effect. Any indirect effect whose confidence interval does not include zero indicates a significant effect of mediation.

Results

Descriptive Statistics

Table 1 presents descriptive statistics for all study variables, both for the entire sample and separately by self-identified sexual orientation. Only

Depressive Symptoms

Perceived Stress

Aggression


.67 (.76).23 (.31)

.22 (.43)

.06 (.27).46 (.74)

.36 (.63)

Figure 1. Path model with sexual orientation uncertainty predicting dependent variables, separately by sexual orientation group.Note. Coefficients outside of parentheses are for the heterosexual group; coefficients inside parentheses are for the lesbian, gay, and bisexual group. Significant coefficients (p < .05) are in bold.

Borders et al. 509

depressive symptoms differed by sexual orientation, with LGB participants reporting significantly more symptoms than heterosexual participants, F(1, 194) = 11.43, p < .01, ηp

2 = .06. Depressive symptoms also varied by method

of recruitment, F(2, 193) = 6.35, p < .01, ηp2

= .06. Participants recruited from the LGBT listserv reported more depressive symptoms (M = 17.09, SD = 11.82) than participants recruited from the psychology subject pool (M = 11.41, SD = 5.50) or campus flyers (M = 10.80, SD = 6.61). The differ-ence in depressive symptoms between LGB and heterosexual participants was not significant when we controlled for method of recruitment, making it difficult to determine if sexual orientation alone, something about the listserv method of recruitment, or both explain the observed differences in depressive symptoms. There were no other significant differences by study recruitment or gender differences on any variables.

Correlational analyses (see Table 2) indicated that across the entire sam-ple, higher levels of sexual orientation uncertainty were significantly associ-ated with greater rumination, depressive symptoms, and perceived stress. However, sexual orientation uncertainty was not significantly correlated with aggressive behavior or anger/hostility. As predicted, greater rumination was

Depressive Symptoms

Perceived Stress

Aggression


.44 (.59)

.15 (.35).50 (.52)

.44 (.64)

.16 (.11)

.15 (.24)

-.01 (.05)

.57 (.65)

.29 (.63)

.19 (.43)

Rumination

Figure 2. Mediational model with rumination mediating the associations between sexual orientation uncertainty and dependent variables, separately by sexual orientation group.Note. Coefficients outside of parentheses are for the heterosexual group; coefficients inside parentheses are for the lesbian, gay, and bisexual group. Significant coefficients (p < .05) are in bold.

510

Tab

le 1

. D

escr

iptiv

e St

atis

tics

of S

tudy

Var

iabl

es.

Tot

al s

ampl

e (N

= 2

07)

Het

eros

exua

l (n

= 1

55)

LGB

(n =

52)

M

(SD

)Sk

ewne

ss b

efor

e (a

fter

) tr

ansf

orm

atio

nM

(SD

; ran

ge)

M (

SD; r

ange

)

Sexu

al o

rien

tatio

n un

cert

aint

y.0

1 (.7

8)1.

86 (

.48)

−.0

2 (.6

9; −

.7-3

.3)

.09

(.99;

−.7

-3)

Rum

inat

ion

3.51

(.7

9)−

.11

(—)

3.55

(.7

6; 1

.7-5

)3.

40 (

.87;

1.3

-5)

Dep

ress

ive

sym

ptom

sa12

.60

(7.7

8)1.

59 (

.83)

11.2

8 (5

.74,

3-3

6)16

.23

(11.

00; 1

-47)

Perc

eive

d st

ress

17.4

5 (6

.19)

.24

(—)

17.1

9 (5

.78;

6-3

3)18

.21

(7.2

7; 2

-33)

Agg

ress

ive

beha

vior

20.9

7 (2

1.22

)1.

80 (

.49)

21.9

5 (2

2.30

; 0-1

22)

18.0

6 (1

7.48

; 0-8

3)H

ostil

ity19

.00

(18.

64)

1.25

(.3

5)19

.25

(18.

84; 0

-80)

18.2

3 (1

8.22

; 0-9

1)

Not

e. S

exua

l ori

enta

tion

unce

rtai

nty

is r

epor

ted

as a

sta

ndar

dize

d va

riab

le. F

or e

ase

of in

terp

reta

tion,

we

repo

rt r

aw m

eans

, sta

ndar

d de

viat

ions

, and

ra

nges

. The

tra

nsfo

rmed

var

iabl

es w

ere

used

to

run

all s

tatis

tical

tes

ts. L

GB

= le

sbia

n, g

ay, a

nd b

isex

ual.

a t te

st fo

und

sign

ifica

nt d

iffer

ence

s by

sex

ual o

rien

tatio

n gr

oup,

p <

.05.

Borders et al. 511

significantly associated with higher depressive symptoms and perceived stress, as well as more aggressive behavior and anger/hostility. Age (in years) was positively correlated with depressive symptoms and perceived stress.

Total Effects Analyses

A model with direct paths from sexual orientation uncertainty to the three dependent variables was fitted first. The model fit for the entire sample was excellent (see Table 3). Both aggressive behavior (λ = .72, p < .001) and anger/hostility (λ = .98, p < .001) showed high factor loadings on the aggres-sion latent variable. Sexual orientation significantly predicted depressive symptoms (β = .25, p < .001) and perceived stress (β = .29, p < .001) but not aggression (β = .12, p = .09). As expected, the three dependent variables were significantly intercorrelated (all βs > .40, ps < .001).

We next tested whether these results differed in LGB versus heterosexual participants. Fit statistics for all models are shown in Table 3. The separate models for LGB and heterosexual participants fit the data well. We than ran multi-group models. The multi-group model with all coefficients and residu-als constrained across the two groups was a poor fit to the data. By contrast, the unconstrained multi-group model was a significantly better fit, Δχ2(16) = 62.32, p < .0001. Therefore, the coefficients for LGB and heterosexual groups cannot be assumed to be the same. Path coefficients separately by group are reported in Figure 1. For heterosexual participants, sexual orientation uncer-tainty significantly predicted depressive symptoms and perceived stress but not aggression. For LGB participants, sexual orientation uncertainty signifi-cantly predicted depressive symptoms, perceived stress, and aggression.

Table 2. Correlations Among Study Variables for the Entire Sample.

1 2 3 4 5 6 7

1. Sexual orientation uncertainty — .17* .25** .25** .10 .11 .022. Rumination — .49** .54** .34** .47** −.053. Depressive symptoms — .71** .32** .41** .20*4. Perceived stress — .30** .51** .18*5. Aggressive behavior — .70** .016. Anger/hostility — .027. Age —

*p < .05. **p < .01.


Mediational Analyses

We then added rumination as a mediator to the model. For the entire sample, this model was an excellent fit to the data (see Table 3). As expected, sexual orientation uncertainty significantly predicted rumination (β = .21, p < .01). In turn, rumination significantly predicted depressive symptoms (β = .45, p < .001), perceived stress (β = .50, p < .001), and aggression (β = .48, p < .001). Finally, sexual orientation uncertainty maintained a significant direct effect on depressive symptoms (β = .15, p < .05) and perceived stress (β = .18, p < .01), but not on aggression (β = .02, ns). Estimated indirect effects and their confidence intervals indicated that rumination significantly mediated the paths between sexual orientation uncertainty and all three dependent vari-ables (see Table 4). To test for potential bias due to age and method of recruit-ment, we assessed the impact of these variables by adding them to the mediation model as covariates; however, doing so did not alter the results (not shown), suggesting that age and recruitment model did not bias the observed results.

We again ran multi-group analyses to test whether these results differed in LGB versus heterosexual participants. Fit statistics are shown in Table 3. The separate models for LGB and heterosexual participants fit the data well. The multi-group model with all coefficients and residuals constrained to be

Table 3. Fit Statistics for All Models Tested.

Model tested χ2(df) p RMSEA CFI

Total effects model Entire sample 1.01 (2) .60 .00 1.00 Heterosexual only 2.02 (2) .36 .01 .99 LGB only 2.16 (2) .34 .04 .99 Constrained multi-group 68.92 (22) <.0001 1.40 .87 Unconstrained multi-group 6.60 (6) .36 .03 .99Mediational model Entire sample 1.05 (3) .79 .00 1.00 Heterosexual only 3.08 (3) .38 .00 1.00 LGB only 2.90 (3) .41 .00 1.00 Constrained multi-group 79.74 (30) <.0001 1.27 .89 Unconstrained multi-group 8.83 (8) .35 .03 .99

Note. In the constrained multi-group model, all coefficients and residuals were constrained to be equal across the two groups (LGB and heterosexual). In the unconstrained multi-group model, coefficients and residuals were free to vary. LGB = lesbian, gay, and bisexual; RMSEA = root mean square error of approximation; CFI = comparative fit index.

Borders et al. 513

equal across the two groups was again a poor fit. The unconstrained multi-group model was a significantly better fit to the data, Δχ2(22) = 70.91, p < .0001. Thus, path coefficients again differed meaningfully by sexual orien-tation group (see Figure 2). We also tested a model that controlled for method of recruitment and age, but this did not alter the results (not shown). Table 4 presents indirect effects and confidence intervals separately for each group.

For LGB participants, sexual orientation uncertainty significantly pre-dicted rumination, and rumination significantly predicted all three dependent variables. With rumination in the model, sexual orientation uncertainty pre-dicted perceived stress but not aggression or depressive symptoms. Finally, all the indirect effects were significantly different from zero, suggesting sig-nificant effects of mediation.

In contrast, for heterosexual participants, sexual orientation uncertainty did not significantly predict rumination. Rumination still predicted all depen-dent variables, and sexual orientation uncertainty predicted depressive symp-toms and perceived stress but not aggression. However, none of the indirect effects were significantly different from zero, indicating non-significant effects of mediation.

Discussion

In this study, we explored whether rumination mediated the associations between sexual orientation uncertainty and measures of psychological dis-tress in university students. Unlike many previous studies, we conceptualized and measured sexual orientation uncertainty as a separate construct from sexual identity. This allowed us to test whether the effects of sexual orienta-tion uncertainty on rumination and psychological distress differed by sexual identity (heterosexual or LGB). Several interesting findings emerged.

Table 4. Indirect Effects and Confidence Intervals for the Entire Sample and Separately by Sexual Orientation Group.

Dependent variablesTotal sample

indirect effect (CI)Heterosexual

indirect effect (CI)LGB indirect effect (CI)

Depressive symptoms

.10 [.03, .16] .06 [−.01, .13] .21 [.04, .37]

Perceived stress .11 [.04, .18] .07 [−.01, .15] .18 [.04, .33]Aggression .10 [.03, .17] .06 [−.01, .14] .22 [.04, .40]

Note. Bias-corrected 95% confidence intervals that do not contain 0 indicate a significant indirect effect. CI = confidence interval; LGB = lesbian, gay, and bisexual.


First, higher sexual orientation uncertainty was associated with more depressive symptoms and perceived stress for both LGB and heterosexual students. These results are in accord with previous studies showing that uncertain children and adolescents experience more depressive symptoms (Espelage et al., 2008; Poteat et al., 2009; Williams et al., 2005). Our findings indicate that this effect also occurs in emerging adults, a population for whom identity exploration and depression are often linked (e.g., Luyckx et al., 2008). Moreover, this was the first study to examine and find associations between sexual orientation uncertainty and perceived stress. Taken together, these results suggest that sexual orientation uncertainty constitutes a source of psychological distress in emerging adults. At an age when their peers are exploring intimacy in romantic relationships and attempting to answer the question: “Given the kind of person I am, what kind of person do I wish to have as a partner through life?” (Arnett, 2000, p. 473), individuals who are uncertain about their sexual orientation may feel that they have an additional hurdle to overcome. Emerging adulthood is also characterized by changes in worldviews, particularly for individuals in higher education (Arnett, 2000). If their previously held worldviews include heteronormative beliefs, emerging adults who are questioning their sexual orientation may feel that their world-views are threatened and may struggle with internalized homophobia or expectations of rejection. For these and other reasons, sexual orientation uncertainty may exacerbate already high levels of identity distress in emerg-ing adults (Berman et al., 2004).

Interestingly, sexual orientation uncertainty predicted aggression in LGB but not heterosexual participants. Our aggression latent variable included recent instances of both physical and verbal aggression, as well as anger and hostility. One previous study found higher externalizing symptoms (a combi-nation of delinquency and aggression) in both uncertain and LGB adoles-cents, compared with heterosexuals (Williams et al., 2005). In contrast, LGB-identified individuals as a group did not report greater anger/hostility or aggression than heterosexuals in our sample. Why, then, might sexual orien-tation uncertainty be associated with these outcomes for LGB but not hetero-sexual emerging adults? One explanation may be that LGB emerging adults who are uncertain about their sexual orientation perceive or fear more dis-crimination, which in turn contributes to greater anger, hostility, and aggres-sive behavior. LGB-identified young adults on college campuses experience high levels of verbal harassment and threats of physical violence, and some-times experience actual physical and/or sexual attacks (e.g., D’Augelli, 1992; Herek, 1993). A recent meta-analysis found that questioning individuals report even more verbal harassment than do lesbians and gay men (Katz-Wise & Hyde, 2012). Thus, LGB-identified young adults who are uncertain

Borders et al. 515

about their sexual orientation may have already experienced various forms of victimization and/or may have legitimate concerns about the probability of experiencing discrimination and microaggressions in the future. Moreover, research with various minority groups suggests that anger and aggression are common responses to perceived discrimination (e.g., Levitt et al., 2009; Mackie, Devos, & Smith, 2000). Future research might examine perceived and feared discrimination in LGB emerging adults and its potential to explain the association between sexual orientation uncertainty and psychological dis-tress. Sexual orientation uncertainty in sexual minority emerging adults may also be related to other types of externalizing symptoms (e.g., substance use) that this population is at higher risk for than heterosexuals (Marshal et al., 2008). To the extent that sexual orientation uncertainty helps in explaining such behaviors, it may contribute to understanding health disparities by sex-ual orientation.

As hypothesized, we found that increased rumination significantly medi-ated the associations between sexual orientation uncertainty and depression, perceived stress, and aggression. Multi-group analyses suggested that these results were driven by the effect of sexual orientation uncertainty on LGB participants. In fact, sexual orientation uncertainty was not significantly asso-ciated with rumination for heterosexuals. Thus, increased sexual orientation uncertainty may be related to rumination uniquely among emerging adults who identify as LGB. Rumination in general is a maladaptive coping response to perceived stressors and threats to personal well-being (Martin & Tesser, 1996). Stressors may lead to rumination more for minority group members because they already experience greater acute and chronic stress and have fewer coping resources (Meyer, Schwartz, & Frost, 2008), so they may be more likely to turn to maladaptive coping strategies. Although not observed in our study, other research suggests that sexual minority adolescents rumi-nate more than their sexual majority peers (Hatzenbuehler, McLaughin, & Nolen-Hoeksema, 2008). Moreover, rumination increases following stigma-related stressors in various minority populations (Hatzenbuehler et al., 2009). For example, in a study of discrimination related to race/ethnicity, perceived discrimination was associated with more rumination for (non-LGB) ethnic minority emerging adults but not for non-Latino White participants (Borders & Liang, 2011). Therefore, rumination may be a coping method that is more commonly used by minority emerging adults who are struggling with minority-related stressors.

The study has several limitations. First, we recruited our sample in three different ways, and participants recruited through the LGBT listserv differed from the other participants in demographic characteristics, sexual orientation uncertainty, and levels of psychological distress. This may lead to faulty


inference if, for example, sample source rather than sexual identity was responsible for the observed differences in uncertainty and psychological dis-tress. To address potential bias, we assessed the impact of recruitment method in the path models and found that sampling differences did not explain the observed associations.

Second, because our data were cross-sectional, we cannot know whether participants’ rumination in fact resulted from their sexual orientation uncer-tainty. Determining the temporal associations between our variables requires a longitudinal design. We also measured general rumination tendencies rather than rumination about any particular topic. Thus, our suggestion that LGB individuals with high levels of sexual orientation uncertainty ruminate about issues related to their uncertainty or other minority stressors cannot be tested in this study. Future research is needed to assess ruminative thinking about specific stressors like sexual orientation uncertainty. More generally, we did not assess what factors account for the association between sexual orientation uncertainty and rumination in LGB individuals. A conceptual model that tests other causes of rumination in sexual minority emerging adults should be developed so that additional hypotheses can be put to empirical test.

In addition, the measure of sexual orientation uncertainty we used con-tained only three items, perhaps jeopardizing full coverage of the construct. Moreover, the measure does not assess the reasons why individuals feel uncertain and what it means to them. This is the only existing measure to our knowledge that assesses uncertainty in individuals who identify as LGB or heterosexual. The measure has good psychometric properties in other research (Morgan et al., 2010), and the internal consistency in our sample was more than adequate. Future work in this area should focus on developing a more nuanced continuous measure of sexual orientation uncertainty.

Despite these limitations, this study contributes important new informa-tion about the association between sexual orientation uncertainty and psy-chological distress in LGB emerging adults. We suggest that rumination constitutes an important coping response that warrants continued attention in the sexual minority literature (Hatzenbuehler, 2009). Of course, other mechanisms may also contribute to psychological distress in this population. Future research should examine sexual orientation uncertainty together with minority stressors such as internalized homophobia, social concerns, and/or in-group marginalization to assess how other processes add to the variance explaining the association between sexual orientation uncertainty and psy-chological distress in LGB emerging adults. It would also be interesting to examine how ethnic differences influence the effects of sexual orientation uncertainty in sexual minorities, a question that the current sample could not address.

Borders et al. 517

Our results suggest that categorizing individuals who are uncertain or questioning as a separate sexual orientation group fails to capture the sexual orientation uncertainty that both LGB and heterosexual individuals may experience. Future research should continue to explore different meanings and outcomes of sexual orientation uncertainty in LGB versus heterosexual emerging adults. Moreover, investigating differences between the various sexual minority categories that we combined for our analyses could answer important questions. For instance, does uncertainty have different meanings and outcomes in individuals who identify as bisexual, queer, and/or pansexual compared with lesbian or gay? Similarly, how are individuals who choose to self-identify as questioning or who decline to label themselves different from individuals who not only chose another sexual minority label but also report sexual orientation uncertainty? There is also evidence that sexual orientation identities fluctuate over time for some people (e.g., Diamond, 2008) and that the traditional three categories of sexual orientation identity (gay/lesbian, bisexual, heterosexual) should be expanded to include “mostly heterosexual” and “mostly gay/lesbian” categories (Vrangalova & Savin-Williams, 2012). Future research should explore how sexual orientation uncertainty functions in individuals who demonstrate fluidity of sexual identities and who inhabit the “in-between” spaces of the sexual orientation continuum.

Our results are preliminary but may also indicate future directions for interventions with LGB emerging adults. We first want to note, however, that focusing on person-level coping strategies should not be equated with blam-ing LGB individuals for their own suffering in the face of perceived threats or discrimination. Counselors working with LGB young adults should first assess whether their clients are experiencing any perceived immediate threats to their well-being and, if so, should work with their clients as well as other significant adults to ensure a safe and protective environment. Moreover, sexual orientation uncertainty is not inherently maladaptive or a necessary target for intervention. Nevertheless, if LGB-identified young adults are repeatedly brooding about sexual orientation uncertainty and this rumination is contributing to psychological distress, interventions targeting ruminative coping may be indicated. Rumination-focused cognitive behavioral therapy aims to decrease the abstract, evaluative thinking that characterizes maladap-tive rumination by encouraging patients to disclose their emotions to others, develop increased compassion, and engage in concrete thinking and activities (Watkins et al., 2007). This treatment has effectively decreased symptoms of depression (Watkins et al., 2007). Another promising intervention involves training in mindfulness, which is defined as bringing one’s full attention to the present moment with an attitude of non-judgmental acceptance (Baer, 2003). This form of paying attention contrasts with the uncontrollable


brooding about the past and future that characterizes rumination. Mindful individuals are more willing to tolerate negative experiences and report greater self-acceptance (Thompson & Waltz, 2008), which may decrease their perceived need for rumination. People who participate in mindfulness courses in fact show not only decreased rumination (Ramel, Goldin, Carmona, & McQuaid, 2004), but also less depression (Chambers, Lo, & Allen, 2008) and aggression (Singh et al., 2007). Future studies should explore the benefits of using these or other therapeutic strategies to decrease ruminative coping, increase adaptive coping, and reduce psychological distress in LGB emerg-ing adults who are struggling with sexual orientation uncertainty.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publi-cation of this article.

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Author Biographies

Ashley Borders, PhD, is an Assistant Professor in the Department of Psychology at The College of New Jersey. Her research interests include the causes and conse-quences of rumination, particularly in minority and veteran populations.

Luis A. Guillén is a graduate student in social work at Rutgers University. His inter-ests include understanding the experiences of and working with minority and under-served groups.

Ilan H. Meyer, PhD, is Senior Scholar for Public Policy at the Williams Institute for Sexual Orientation Law and Public Policy at UCLA’s School of Law. His research interests include stress and illness in minority populations, in particular the relation-ship of minority status, minority identity, prejudice and discrimination, and mental health outcomes in sexual minorities.

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