Rejection Sensitivity and the Intent to Seek Medical Help Among Gender Minority Individuals

Background: As members of a marginalized and socially devalued group, gender minority (GM) individuals regularly experience rejection in healthcare experiences. These rejecting experiences lead to barriers to healthcare access and health disparities. Consequently, GM individuals’ may develop anxious and avoidant attitudes toward their healthcare needs. When considering healthcare, an individual’s inherent attitude informs their intent to seek medical help (ISMH), defined as the attitude that influences one’s decision to seek medical help. When an individual has a hyper-sensitive reaction to perceived rejection, this is termed rejection sensitivity (RS). Purpose: The purpose of the study was to determine if the independent variable, RS, produced an effect on the dependent variable, ISMH, in GM individuals. Additionally, the study aimed to examine the possible confounding effects of demographic and health-related variables on the effect of RS on ISMH. Finally, the study aimed to describe demographic and health-related variables in the study sample. Methods: This study conceptualized the sensitized attitudes and intentions that emerge from rejection using an adopted version of Levy, Ayduk, and Downey’s (2001) RS Model. A correlation, cross-sectional design was used. Participants (n = 100) were recruited online and in-person by a convenience nonprobability sampling technique. Inclusion criteria was a) age 18 and older, b) having a gender identity that is not traditionally or consistently associated with the male or female gender assigned to the individual at birth. Surveys were administered from June 2019- August 2019 via internet based Qualtrics®. RS was measured using a modified version of the Gay Rejection Sensitivity Questionnaire. Demographic and health-related variables including social determinants of health (SDOH) were also collected and examined for central tendency and confounding effects. The ISMH was measured using the ISMH: Action-Intention Subscale. The variables were analyzed using multiple linear regression with Statistical Package Social Sciences (SPSS) software version 26. Results: Pearson’s correlation was used to assess the relationship between ISMH and RS. It was found that there was not a statistically significant correlative relationship between RS and ISMH. The multivariate linear regression enter and hierarchical modeling process was used to assess the confounding effects of chosen demographic and health-related variables including age, gender identity, chronic anxiety, and a cluster of SDOH (having insurance, education, and income) on the relationship of RS to ISMH. While SDOH clusters, chronic anxiety, and gender identity were found to be statistically significant, the model failed to demonstrate that RS predicts ISMH when controlling for demographic and health related variables. Discussion: When compared with normative data, this study’s sample demonstrated higher levels of RS and lower ISMH, overall. It was identified that non-binary GM individuals reported greater health concern than binary GM individuals, especially with regards to mental health. In this study sample, levels of chronic anxiety and depression were higher for those identifying as non-binary GM. Several SDOH indicators in the sample were shown to have less ISMH including not having a regular healthcare provider (HCP), not having insurance, having chronic anxiety, being low income, being of Caucasian race/ethnicity, age under 26 years old, having non-binary gender identity, and having a non-monosexual orientation

A historical and contemporary literature review of rejection sensitivity in marginalized populations

As healthcare research continues to uncover health disparities in marginalized populations, it is critical to work toward understanding the origin of these disparities. Rejection sensitivity (RS) is a phenomenon that may illuminate reasons that disparities continue to exist. The purpose of this paper is to review the literature on RS in marginalized populations, explore outcomes of RS as they relate to interpersonal relationships, valued life goals, and health, and identify gaps in the literature for proposing future research. Titles and abstracts were reviewed yielding 50 articles. Those 50 articles were further reduced to include select articles that focused on marginalized populations, contributed to the diversity of literature, or provided historical context for the development of the concept of rejection sensitivity after 1995. Articles were chosen to highlight the state of the science and subsequent gaps specifically associated with aspects important to healthcare. The final process of elimination resulted in 20 articles for review. Four themes emerged in the literature. The first two themes related to the experience of RS and marginalized groups, including race-based RS and gender and sexual minority-based RS. The second two themes related to the outcomes and consequences of RS, including effects on interpersonal relationships and effects on health. Many areas for future research are identified throughout this literature review that can contribute to future understanding of why health disparities occur in marginalized populations