How intersectional identity and discrimination contribute to depressive symptoms and hair cortisol concentrations among low-income, racially and sexual diverse adults

Significant gaps remain in our understanding of how minority stress patterns health outcomes for adults at the intersection of ethnicity/ race and sexual orientation. In particular, little is known about how cumulative cortisol (measured via hair cortisol concentration as an indicator of chronic stress; HCC) and depressive symptoms are related to holding an intersectional minoritized identity (e.g., sexual minority people of color; SM-POC) and experiencing intersectional discrimination (e.g., heterosexism and racism). The current study examined the relationship between intersectional identity or discrimination and HCC or depressive symptoms. Participants were (N = 69) low-income, predominantly sexual minority and people of color in the Greater Los Angeles area. Participants completed self-report measures and provided a hair sample for cortisol assay. Intersectional identity was not associated with greater HCC or depressive symptoms. However, differences in HCC emerged based on discrimination type (F (2, 66) = 3.74, p = .03, η²= .10). Participants who reported intersectional heterosexism and racism had greater HCC concentrations (M = 30.71, SD = 29.71) than did participants who reported only a single type of discrimination (i.e., racism only or heterosexism only; M = 15.35, SD = 2.60, p = .03, 95 % CI = [2.01, 28.71]), or than participants who reported neither types (M = 12.40, SD = 16.11, p = .01, 95 % CI [4.85, 31.76]). There were no differences in depressive symptoms by discrimination type. These results provide initial empirical support to largely theoretical arguments about how to investigate mechanisms underlying disparities to understand why and how minority stress is patterned. Findings showing associations between intersectional discrimination and HCC, but not depressive symptoms, provide potential support for theories about examining allostatic load markers to identify stress-related etiological mechanisms linked to health disparities among minoritized populations.