{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:30:06Z","timestamp":1787923806984,"version":"build-2784847793"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lesbian and bisexual cisgender women in Chinese higher education institutions (HEIs) face compounded psychological distress at the intersection of gender- and sexuality-based stigma. Despite growing evidence of mental health disparities among LGBTQ populations in China, the mechanisms through which structural marginalization is internalized in educational settings remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify how structural stigma is translated into internalized psychological harm among lesbian and bisexual cisgender women in Chinese HEIs, through specific, theoretically specified mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a critical realist, reflexive thematic analysis design, I conducted semi-structured interviews with eight self-identified lesbian, bisexual, or same-sex attracted cisgender women at universities in four province-level regions of China. Analysis followed Braun and Clarke's (2006) six-phase approach, guided by Meyer's (2003) minority stress model, Hatzenbuehler's (2009) psychological mediation framework, and Crenshaw's (1989) intersectionality theory. Researcher positionality was integrated analytically throughout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five themes were identified: (1) awareness of structural inequality as anticipatory anxiety and cognitive vigilance; (2) institutional resource deprivation undermining academic self-efficacy; (3) enacted and internalized stigma and their psychological consequences, including shame, identity concealment, and self-reported depressive symptoms; (4) intersectional invisibility compounding distress; and (5) attenuated outcomes where community and institutional support are present. Three mediation pathways were consistently operative: social-cognitive, emotional regulatory, and interpersonal (Hatzenbuehler, 2009). No diagnostic instrument was administered; all psychological states reported are self-described and interpreted from interview accounts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Distal stigma, internalized homophobia, culture-specific marriage pressure, and regional pathologization interact in complex ways to shape distress, disrupted identity development, and academic disengagement. I examine the limits of applying Western minority stress frameworks in a collectivist context and propose responses grounded in trauma-informed care, LGBTQ-affirmative services, enumerated non-discrimination policy, and educator anti-stigma training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The psychological distress of this underserved population is structurally produced, psychologically mediated, and institutionally addressable. Affirmative mental health infrastructure, enumerated anti-discrimination policy, and LGBTQ-inclusive educator training can meaningfully reduce minority stress and its consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1893495","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:50:50Z","timestamp":1787921450000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological distress, stigma, and intersectional marginalization in lesbian and bisexual cisgender women in Chinese higher education: a thematic analysis guided by minority stress theory"],"prefix":"10.3389","volume":"14","author":[{"given":"Yan","family":"Liu","sequence":"first","affiliation":[{"name":"School of Humanities and Education, Xi'an Eurasia University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/1471-244X-8-70","article-title":"A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people","volume":"8","author":"King","year":"2008","journal-title":"BMC Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol Bull"},{"key":"ref3","volume-title":"Lesbian, Gay, and Bisexual People's Family Experiences and Mental Health in China: A Mixed Methods Approach","author":"Hu","year":"2024"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1186\/s12889-020-08834-y","article-title":"Mapping out a spectrum of the Chinese public's discrimination toward the LGBT community: results from a national survey","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1186\/s12888-023-05202-z","article-title":"Minority stress, social support and mental health among lesbian, gay, and bisexual college students in China: a moderated mediation analysis","volume":"23","author":"Li","year":"2023","journal-title":"BMC Psychiatry"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"309","DOI":"10.3102\/0013189X12457023","article-title":"Bullying explains only part of LGBTQ\u2013heterosexual risk disparities","volume":"41","author":"Robinson","year":"2012","journal-title":"Educ Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1027\/0227-5910\/a000167","article-title":"Gay-related rejection and self-destructive behaviors among sexual minority youth","volume":"34","author":"Toomey","year":"2013","journal-title":"Crisis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.17161\/1808.23874","article-title":"Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics","volume":"1","author":"Crenshaw","year":"1989","journal-title":"Univ Chic Leg Forum"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1007\/s11199-008-9424-4","article-title":"Intersectional invisibility: the distinctive advantages and disadvantages of multiple subordinate-group identities","volume":"59","author":"Purdie-Vaughns","year":"2008","journal-title":"Sex Roles"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1037\/a0016441","article-title":"How does sexual minority stigma \u201cget under the skin\u201d? 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