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Physical Health Risk Among Gay Men Who Conceal Their Homosexual Identity

CITATION:  Cole, S.W., Kemeny, M.E., Taylor, S.E., Visscher, B.R.  (1996) Elevated Physical Health Risk Among Gay Men Who Conceal Their Homosexual Identity.  Health Psychology Vol. 15, No. 4, pp243-251.  

ABSTRACT:  This study examined the incidence of infectious and neoplastic diseases among 222 HIV seronegative gay men who participated in the Natural History of AIDS Psychosocial Study. Those who concealed the expression of their homosexual identity experienced a significantly higher incidence of cancer (odds ratio = 3.18) and several infectious diseases (pneumonia, bronchitis, sinusitis, and tuberculosis; odds ratio = 2.91) over a 5-year follow-up period. These effects could not be attributed to differences in age, ethnicity, socioeconomic status, repressive coping style, health-relevant behavioral patterns (e.g., drug use, exercise), anxiety, depression, or reporting biases (e.g., negative affectivity, social desirability). Results are interpreted in the context of previous data linking concealed homosexual identity to other physical health outcomes (e.g., HIV progression and psychosomatic symptomatology) and theories linking psychological inhibition to physical illness.  

References

Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49, 15-24.

Bendig, A. W. (1956). The development of a short form of the Manifest Anxiety Scale. Journal of Consulting Psychology, 20, 384.

Blair, S. N., Kohl, H. W., Paffenbarger, R. S., Clark, D. G., Cooper, K. H., & Gibbons, L. W. (1989). Physical fitness and all-cause mortality: A prospective study of healthy men and women. Journal of the American Medical Association, 262, 2395-2401.

Booth, R. J., Petrie, K. J., Pennebaker, J. W., Davison, K. P., & Thomas, M. G. (1994, September). Disclosure of trauma and the immune response to hepatitis B vaccination. Abstract presented at the
meeting of the Psychoneuroimmunology Research Society, Key Biscayne, FL.

Breslow, L., & Enstrom, J. E. (1980). Persistence of health habits and their relationship to mortality. Preventive Medicine, 9, 469-483.

Cole, S. W., Kemeny, M. E., Taylor, S. E., & Visscher, B. R. (1996). Social identity and physical health: Accelerated HIV progression in rejection-sensitive gay men, Manuscript submitted for publication.

Cole, S. W., Kemeny, M. E., Taylor, S. E., Visscher, B. R., & Fahey, J. L. (in press). Accelerated course of human immunodeficiency virus infection in gay men who conceal their homosexual identity. Psychosomatic Medicine.

Cox, D. R., & Snell, E. J. (1989). Analysis of binary data (2nd ed.). London: Chapman & Hall.

Esterling, B. A., Antoni, M. H., Kumar, M., & Schneiderman, N. (1990). Emotional repression, stress disclosure responses, and Epstein-Barr viral capsid antigen tilers. Psychosomatic Medicine, 52,
397-410.

Fowles, D. C. (1980). The three arousal model: Implications of Gray's two-factor learning theory for heart rate, electrodermal activity, and psychopathology. Psychophysiology, 17, 87-104.

Gray, J. A. (1982). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford, England: Oxford University Press.

Gross, J. (1989). Emotional expression in cancer onset and progression. Social Science and Medicine, 28, 1239-1248.

Gross, J. J., & Levenson, R. W. (1993). Emotional suppression: Physiology, self-report, and expressive behavior. Journal of Personality and Social Psychology, 64, 970-986.

Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.

Jobe, J. B., Tourangeau, R., Smith, A. F. (1993). Contributions of survey research to the understanding of memory. Applied Cognitive Psychology, 7, 567-584.

Kagan, J. (1994). Galen'sprophecy: Temperament in human nature. New York: Basic Books.

Kagan, J., Reznick, J. S., & Snidman, N. (1988, April 8). Biological bases of childhood shyness. Science, 240, 167-171.

Kagan, J., Snidman, N., Julia-Sellers, M., & Johnson, M. O. (1991). Temperament and allergic symptoms. Psychosomatic Medicine, 53, 332-340.

Kaslow, R. A., Ostrow, D. G., Detels, R., Phair, J. P., Polk, B. F., & Rinaldo, C. R. (1987). The Multicenter AIDS Cohort Study: Rationale, organization, and selected characteristics of the participants. American Journal of Epidemiology, 126, 310-318.

Kemeny, M. E., Weiner, H., Taylor, S. E., Schneider, S., Visscher, B., & Fahey, J. L. (1994). Repeated bereavement, depressed mood, and immune parameters in HIV seropositive and seronegative homosexual men. Health Psychology, 13, 14-24.

Kiecolt-Glaser, J. K., Cacioppo, J. T., Malarkey, W. B., & Glaser, R. (1992). Acute psychological stressors and short-term immune changes: What, why, for whom, and to what extent? Psychosomatic Medicine, 54, 680-685.

King, L. A., & Emmons, R. A. (1990). Conflict over emotional expression: Psychological and physical correlates. Journal of Personality and Social Psychology, 58, 864-877.

Lyte, M. (1993). The role of microbial endocrinology in infectious disease. Journal of Endocrinology, 137, 343-345.

Manuck, S. B., Cohen, S., Rabin, B. S., Muldoon, M. F., & Bachen, E. A. (1991). Individual differences in cellular immune response to stress. Psychological Science, 2, 111-115.

Martin, J. L., & Dean, L. (1990). Developing a community sample of gay men for an epidemiologic study of AIDS. American Behavioral Scientist, 33, 546-561.

Nishanian, P., Taylor, J. M. G., Korns, E., Detels, R., Saah, R., & Fahey, J. L. (1987). Significance of quantitative enzyme-linked immunosorbent assay (ELISA) results in the evaluation of three ELISAs and western blot tests for the detection of antibodies to human immunodeficiency virus in a high-risk population. Journal of Clinical Microbiology, 25, 395-400.

Ottaway, C. A., & Husband, A. J. (1992). Central nervous system influences on lymphocyte migration. Brain, Behavior, and Immunity, 6, 97-116.

Pennebaker, J. W. (1988). Confession, inhibition, and disease. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 22, pp. 211-242). Orlando, FL: Academic Press.

Pennebaker, J. W. (1993). Overcoming inhibition: Rethinking the roles of personality, cognition, and social behavior. In H. C. Traue & J. W. Pennebaker (Eds.), Emotion, inhibition and disease (pp. 100-115). Kirkland, WA: Hogrefe & Huber. 

Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274-281.

Pennebaker, J. W., & Chew, C. H. (1985). Behavioral inhibition and electrodermal activity during deception. Journal of Personality and Social Psychology, 49, 1427-1433.

Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of trauma and immune function: Health implications forpsychotherapy. Journal of Consulting and Clinical Psychology, 56, 239-245.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 386-401.

Rogentine, G. N., Van Kammen, D. P., Fox, B. H., Docherty, J. P., Rosenblatt, J. E., Boyd, S. C, & Bunney, W. E. (1979). Psychological factors in the prognosis of malignant melanoma: A prospective study. Psychosomatic Medicine, 41, 647-655.

Sapolsky, R. M. (1994). Why zebras don't get ulcers: A guide to stress, stress-related diseases, and coping. New York: Freeman.

Solomon, G. F., & Moos, R. H. (1964). Emotions, immunity, and disease. Archives of General Psychiatry, 11, 657-674.

Sommers-Flanagan, J., & Greenberg, R. P. (1989). Psychosocial variables and hypertension: A new look at an old controversy. Journal of Nervous and Mental Disease, 177, 15-24.

Strahan, R., & Gerbasi, K. C. (1972). Short, homogeneous versions of the Marlowe-Crowne Social Desirability Scale. Journal of Clinical Psychology, 28, 191-193.

Suomi, S. J. (1991). Uptight and laid-back monkeys: Individual differences in the response to social challenges. In S. Branch, W. Hall, & E. Dooling (Eds.), Plasticity of development (pp. 27-55). Cambridge, MA: MIT Press.

Taylor, S. E., Kemeny, M. E., Aspinwall, L. G., Schneider, S. G., Rodriguez, R., & Herbert, M. (1992). Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS). Journal of Personality and Social Psychology, 63, 460-473.

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070.

Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234-254.

Wegner, D. M., Shortt, J. W., Blake, A. W., & Page, M. S. (1990). The suppression of exciting thoughts. Journal of Personality and Social Psychology, 58, 409-18.

Weinberg, G. (1972). Society and the healthy homosexual. New York: St. Martin's Press.

Weinberg, M. S., & Williams, C. J. (1974). Male homosexuals: Their problems and adaptations. New York: Penguin Books.

Weinberger, D. A., Schwartz, G. E., & Davidson, R. E. (1979). Low-anxious, high-anxious, and repressive coping styles: Psychometric patterns and behavioral and physiological responses to stress. Journal of Abnormal Psychology, 88, 369-380.