The additive model posits that women with multiple marginalized identities have distinct experiences of discrimination for each minority identity and that these specific experiences are added together to negatively affect mental health (DeBlaere et al., 2014). The intersectionality framework, on the other hand, posits that women with multiple marginalized identities have completely unique experiences of stigma and discrimination based on the intersection of their identities (Bowleg, 2012; DeBlaere et al., 2014). These experiences still create worse mental health outcomes, but the identities intersect to create a unique form of discrimination that encompasses all aspects of a person’s identity. One of the core ideas of the intersectionality framework focuses on how multiple social identities in an individual connect with structural factors, like racism and sexism, to create disparities in mental health outcomes (Bowleg, 2012). While there is a lot of research and theory regarding the intersectionality framework, there is a lack of public health research that takes into account intersectionality in their studies and results (Bowleg, 2012). Both the additive model and intersectionality framework need to be researched more regarding sexual minority women and adverse mental health outcomes. The majority of research on sexual minority individuals is already based on men, and there is even less research on the intersection of race, gender, and sexuality in women.
Another major gap in the research on sexual minority women and mental health and anxiety disorders comes from a lack of research on mental health interventions that take into account intersectionality (Huang et al., 2020). Intersectionality theory looks at the interaction of minority identities, like race, gender, and sexuality, and the outcomes of these interactions (Huang et al., 2020). When looking at mental health interventions from a minority stress framework, it is important to also take into account intersectionality because an individual’s mental health outcomes may worsen depending on their multiple marginalized identities. Also, mental health interventions are most effective when they deal with the whole picture at once, rather than bits and pieces of the problem. Therefore, it is important to have interventions that look at the whole person and all of their marginalized identities, rather than working from the standpoint of a person’s single marginalized identity (Huang et al., 2020). Another reason why more research is needed on mental health interventions with the inclusion of the intersectionality framework is because it allows for more culturally competent practices. By taking into account intersectionality when working with a client, a mental health provider will be able to provide an intervention that is tailored to the client’s culture and is more effective at meeting all of the client’s unique needs (Huang et al., 2020).
A final tenet of intersectionality that should be researched more in the future is the intersection of race/ethnicity, sexual identity, and socioeconomic status. The intersection of multiple identities can create different outcomes for different people based on the power appointed to each identity (Shangani et al., 2020). For example, in Shangani et al.’s study (2020), African American sexual minority individuals reported experiencing more anticipated stigma than white sexual minority individuals. This is not very surprising considering the systemic racism and racial discrimination in the United States. However, when socioeconomic status was considered, African American sexual minority individuals with a high socioeconomic status experienced more stigma while white sexual minority individuals with a high socioeconomic status experienced less stigma (Shangani et al., 2020). The information from this study provides further evidence for intersectionality theory and that individuals with multiple marginalized identities all have very unique and specific experiences. This is why more future research is needed that takes intersectionality into account when creating mental health interventions for sexual minority women.