The mediating role of internalized stigma in the relationship between just world beliefs and mental health among men who have sex with men in Chile

INTRODUCTION

At the global level, men who have sex with men (MSM) experience significantly higher rates of mental health issues, such as anxiety, depression, suicidal behaviors, and alcohol dependence.(1,2) These mental health issues are about 1,5 times more prevalent among sexual minorities than among their heterosexual counterparts.(3,4) These problems have been reported to be strongly related to the stigma and discrimination experienced by these groups.(5,6) According to some studies, the stress resulting from perceptions of stigma among MSM could explain the fact that this group exhibits mental health problems at higher levels.(7,8)

One factor that could positively influence mental health among members of this group pertains to people’s beliefs regarding the social system. These beliefs help people understand and evaluate the world around them and thus influence their behavior in the context of a collective reality that involves social, political and cultural aspects.(9) In particular, just world beliefs indicate that people need to believe in a world in which everyone receives what they deserve.(10,11) These beliefs could influence people’s experiences and perceptions of well-being. Research has indicated that the emergence of more positive attitudes toward one’s social environment could improve one’s mental health and satisfaction with life.(12,13,14,15,16)

One mechanism that could explain the positive relationship between just world beliefs and mental health lies in the ability of these beliefs to reduce perceptions of stigma. However, research on this mechanism among sexual minority groups in particular remains scarce.(17)

Internalized stigma and mental health

Stigma is a negative characteristic or status attributed to a person, and its meaning and social implications can differ depending on the context.(18) This experience of being stigmatized can restrict individuals' chances to enhance their health and well-being, while also reinforcing inequality between those who are stigmatized and those who are not.(19,20) One of the most relevant forms of stigma among MSM is internalized stigma, which is defined in terms of people’s personal acceptance of the prejudices and stereotypes applied to them.(19) In the literature on MSM, this concept has been referred to as internalized homophobia or internalized homonegativity. These terms refer to a process of self-worth deterioration caused by internalizing society's negative attitudes toward homosexuality.(21,22,23) Different studies have reported that this form of stigma is more prevalent among MSM.(24,25,26,27,28)

In this context, the minority stress model identifies internalized stigma as a significant factor contributing to mental health issues within this population.(7) Empirical evidence has supported this hypothesis by consistently revealing negative relationships between internalized stigma and anxiety-depressive symptomatology,(28,29,30,31,32) suicidal behaviors,(33) psychological well-being (26) and mental health.(34,35)

Just world beliefs and mental health

Just world beliefs indicate that people feel the need to believe that they live in an environment in which everyone receives what they deserve and deserve what they receive, thus allowing all individuals to perceive the world as a stable and orderly place.(11) These beliefs act as a psychological defense mechanism, thereby helping people cope with difficult and stressful situations. This mechanism, which is known as the palliative effect, mitigates the negative emotional impacts of adverse events such as injustice or personal suffering.(10,36)

Research has reported that just world beliefs can be beneficial with regard to people’s health and well-being, improve their self-esteem,(15,37) encourage lower levels of depression,(38,39) mitigate anxiety (40) and reduce psychological distress.(13)

It has been proposed that just world beliefs are structured into two distinct dimensions: general beliefs and personal beliefs.(10,41) General beliefs are the perception that society is fair as a whole, while personal beliefs involve the idea that individuals receive outcomes that match what they deserve. These two dimensions play different roles in the process of shaping people’s health and well-being.(42) Previous studies have demonstrated that personal just world beliefs play a more relevant role than general beliefs regarding one’s health.(16,37,43) Studies have consistently reported that personal just world beliefs have sustained positive effects on health and well-being, whereas general just world beliefs have weak or no effects.(14,44,45,46) These differences probably reflect the fact that personal just world beliefs refer directly to people’s perceptions of justice toward themselves, which could impact their emotional and mental well-being, whereas people’s perceptions of justice in the world in general may not influence the interpretations of their individual experiences of injustice quite so immediately.(10,36)

One mechanism that could explain the positive relationship between just world beliefs and mental health lies in the ability of these beliefs to decrease people’s perceptions of stigma. Research has suggested that people who exhibit strong just world beliefs may experience less stigma,(17) which can be explained by the facts that they may perceive themselves as facing less discrimination (47) and that they might consider negative results to be less unfair.(48) This claim is based on the theoretical assumption that just world beliefs have a mitigating effect on the degree to which people perceive themselves as victims of stigma.(47)

Previous research that has explored the relationship between just world beliefs and stigma in particular has been limited, being restricted mainly to the studies already mentioned.(17,47,48) These studies have reported the existence of a negative association between these two variables; however, no clear direction has been established with regard to this relationship. Furthermore, the mediating effect of stigma on the relationship between just world beliefs and subjective well-being has been previously tested. This investigation analyzed two mediation models in this context. The first, in which stigma served as a mediator, did not indicate confirm a significant indirect effect. The second model confirmed a significant effect of just world beliefs mediating the relationship between stigma and subjective well-being, however, the author highlighted several limitations that could affect the generalizability of the results, such as the small sample size of this research, the cross-sectional design of the study, and the fact that just world beliefs were analyzed without differentiating between the two dimensions of such beliefs, i.e., general and personal.(17)

Despite the limitations of studies that have addressed just world beliefs, internalized stigma and mental health, research on similar ideologies, such as the beliefs in system justification,(49) have offered relevant evidence in this regard. While just world beliefs and beliefs in system justification represent distinct ideologies, they both offer perspectives about the ways in which people support and perpetuate social and political systems. These beliefs help support and justify the status quo in society; they thus reflect a tendency to maintain the social structure. This perspective can thus explain how people internalize and accept traditional social norms and dynamics, thus promoting the stability and continuity of the existing social order.(10,11,41,49,50)

In addition to conceptual similarity, research has suggested that, similar to just world beliefs, system justification beliefs are associated to improved well-being by decreasing perceptions of stigma and discrimination. One explanation for this phenomenon is based on the idea that such a belief in the justice of the system offers individuals a way of looking at the world that can mitigate their experiences of stigma and discrimination.(51) This mechanism bears certain similarities to those proposed as explanations of the relationship between just world beliefs and perceptions of discrimination.(47,48)

Recent longitudinal evidence has explored the direction of the relationship between system justification beliefs and perceptions of discrimination. A study that investigated ethnic minorities in New Zealand, based on eight waves of a representative national survey revealed that within this minority group, beliefs in system justification were negatively and significantly associated with the perceptions of discrimination. No significant results were found with respect to the inverse relationship. These findings suggest that people’s beliefs in system justification precede and reduce their perceptions of discrimination.(52)

In addition, there is some evidence supporting the claim that stigma plays a mediating role in the relationship between people’s beliefs in system justification and their well-being. One study that investigated a gay and lesbian population revealed that participants’ beliefs in system justification had a significant indirect effect on their psychological distress by reducing their perceptions of stigma.(53) Additionally, a study of MSM revealed that the minimization of perceptions of discrimination toward sexual minorities could explains the positive relationship between people’s beliefs in system justification and their subjective well-being.(54)

Study overview

Given that MSM are frequently exposed to stigma and discrimination, which negatively impact their mental health, the objective of this study was to evaluate the mediating role of internalized stigma in the relationship between just world beliefs and mental health. It was hypothesized that (H1) just world beliefs reduce mental health problems among MSM, and that effect is stronger with regard to personal just world beliefs, and (H2) this effect is mediated by the ability of just world beliefs to reduce people’s perceptions of internalized stigma (figure 1).

Source: Own elaboration.

METHODOLOGY

Participants and procedures

This study used a cross-sectional and correlational design, where participants were MSM who were 18 years old or older. The sample size was calculated via a Monte Carlo power analysis,(55) and it took into account correlations and estimates from previous studies.(53,54) The resulting sample size was 180 participants. The recruitment strategy used for this research was the snowball technique, which involves conveying a broad call through various social networks (Facebook, Instagram and X). The questionnaire was distributed with the assistance of the KoboToolbox platform between December 2023 and March 2024.

Participation in the study was voluntary. To access the online questionnaire, participants were required to click a link that directed them to an informed consent form, which had to be completed before beginning the survey. The questionnaire was anonymous and no personally identifiable information was collected. This study complied with ethical standards for research involving human participants (56) and was approved by the Ethics Committee of the School of Nursing at Andrés Bello University (Approval Nº L4/CECENF/04-2023).

Measures

The variables considered in this study were just world beliefs, internalized stigma and mental health. In addition, various sociodemographic variables collected from the participants were evaluated.

Sociodemographic variables: age, level of education (secondary or higher) and self-reported socioeconomic level were included as variables in this study. Self-reported socioeconomic status was measured on a scale ranging from 1 to 6, in which context 1 indicated a very low socioeconomic level and 6 indicated a very high socioeconomic level. Previous studies have reported that these variables are significant predictors of mental health and perceptions of stigma among this group.(57,58)

Just world beliefs: a 13 item scale for general and personal just world beliefs was used in this research;(10,41) this scale has been adapted to the Latin American context.(59) The general just world subscale contains 6 items, while the personal just world subscale contains 7 items. The participants rated each item on a scale ranging from 1= strongly disagree to 6= strongly agree; higher scores indicated stronger general and personal just world beliefs. In this study, the total scale exhibited good reliability (α= ,88). However, given the differentiated role described for the general and personal dimensions of the just world beliefs in health and well-being, a confirmatory factor analysis was conducted, which confirmed the presence of both dimensions in this sample (χ² (df= 64) = 132,856, p < ,001; RMSEA= 0,07, p= ,01; CFI= ,933; TLI= ,919). The reliability for the general and personal just world beliefs dimensions was adequate (α = ,79 and α = ,89, respectively).

Internalized stigma: a scale targeting people’s reactions to homosexuality was used in this research;(23) this scale has previously been used in Chile.(60) This measure consists of 26 items, each of which is scored on a scale ranging from 1= totally disagree to 5= totally agree; higher scores indicate stronger perceptions of internalized stigma. In this study, the scale exhibited good reliability (α= ,84).

Mental health: the anxiety and depression dimension of the OQ-45,2 symptom questionnaire was used (61) in its standardized Chilean version.(62) This dimension encompasses 25 items. The participants scored each item on a scale ranging from 1= never to 5= always; higher scores indicated higher levels of anxiety and depression. In this study, the scale exhibited good reliability (α= ,92).

Data analysis

Descriptive analyses were conducted via frequency tables for discrete variables and via measures of central tendency for continuous variables. Pearson's correlations were used to explore the relationships among the variables included in this study, and Cronbach's α was employed to assess the reliability of the scales used in this research.

For the main analyses, a simple mediation model was used to estimate the effects via the bootstrapping method, and 95% confidence intervals were calculated for each effect. The findings indicated that mediation was present if the 95% confidence interval did not include 0. The analyses were conducted via the PROCESS macro for SPSS, version 29, and Mplus, version 8,0, software.(63,64)

RESULTS

Sociodemographic variables

The average age of the Chilean MSM who participated in this study was 32 years, ranging from 18 to 49 years. A total of 98% of these participants had reached higher education. Regarding health insurance, 41.1% reported being affiliated with the public health system, while 56.7% reported having private health insurance; 1.1% reported other types of insurance and 1.1% did not know or did not respond. Concerning the participants’ subjective socioeconomic level, they reported an average socioeconomic level of 4 (SD= ,71) on a scale ranging from 1 to 6 (table 1).

Note. N= 180. Participants had a mean age of 32 years (SD= 6) and a mean subjective socioeconomicᵃ level of 4 (SD= ,71).

ᵃ Measured on a scale from 1 to 6, where 1 indicates the lowest economic status and 6 the highest economic status.

Descriptive and correlation analysis of the variables

Table 2 presents a descriptive analysis of the variables investigated in this research: just world beliefs (mean= 46,41, SD= 9,75), including their general dimension (mean= 19,05, SD= 5,06) and their personal dimension (mean= 27,36, SD= 6,03), internalized stigma (mean= 64,07, SD= 13,61) and mental health (mean= 58,97, SD= 14,78).

In the correlation analysis, a moderate and positive relationship was observed between the personal and general dimensions of just world beliefs (r= ,497, p= <,001). A negative correlation was also observed between just world beliefs and the presence of symptoms of depression and anxiety (r= -,388, p= <,001). This correlation was significant with respect to both general just world beliefs (r= -,218, p= ,003) and personal just world beliefs (r= -,429, p= <,001); however, the strength of the association between the personal dimension and mental health was greater. In contrast, internalized stigma was positively correlated with mental health problems (r= ,319, p= <,001), thus indicating that higher levels of internalized stigma are associated with the presence of more mental health problems. Regarding the relationship between just world beliefs and internalized stigma, a significant relationship was observed only between the personal dimension of just world beliefs and perceptions of stigma (r= -,252, p= <,001).

Note. N=180. Men who have sex with men participants.

*p<,05; **p<,01; ***p<,001.

Mediation models

To test the hypotheses proposed in this research, three simple mediation analyses, which are presented in figure 2, were conducted.

The analyses of the model that focused on the relationship between just world beliefs (in terms of the total score of general and personal just world beliefs) and mental health via the mediating effect of internalized stigma (figure 2, panel a) revealed that just world beliefs had a significant negative total effect on mental health β= -,30, p= <,001). No significant relationship between just world beliefs and internalized stigma was observed (β= -,15, p= ,05). Internalized stigma was significantly associated with mental health (β= ,26, p= <,001). In this model, internalized stigma did not significantly mediate the relationship between just world beliefs and mental health (β= -,04, 95% CI [-0,09, 0,001]).

In the model that focused on the relationship between the general dimension of just world beliefs and mental health via the mediating effect of internalized stigma (figure 2, panel b), a significant negative total effect of the general dimension of just world beliefs on mental health was observed (β= -,16, p= ,03). However, no significant relationship was observed between general just world beliefs and internalized stigma (β= ,01, p= ,92). Furthermore, no significant mediating effect of this variable on the relationship between the general dimension of just world beliefs and mental health was observed (β= ,002, CI 95% [-0,05, 0,005]).

In the mediation model that included the personal dimension of just world beliefs (figure 2, panel c), a significant negative total effect was observed between personal just world beliefs and mental health (β= -,36, p= <,001). A negative association was also observed between personal just world beliefs and internalized stigma (β= -,26, p= <,001). Therefore, as personal just world beliefs increase, perceptions of internalized stigma decrease. Unlike the previous models, personal just world beliefs were observed to have a significant indirect effect on mental health via internalized stigma (β= -,06, 95% CI [-0,11, -0,02]), thus suggesting that internalized stigma mediates the relationship between personal just world beliefs and mental health. A total of 17% of the total effect of personal just world beliefs on mental health thus depends on the ability of such beliefs to reduce perceptions of internalized stigma among MSM.

Note. X= independent variable, Y= dependent variable, M= mediator variable. Standardized regression coefficients: a= effect of X on M, b= effect of M on Y, c’= direct effect of X on Y. Confidence interval included in parentheses. Model adjusted for age, socioeconomic status, and educational level.

*p<,05; **p<,01; ***p<,001.

Although the previous models indicated that just world beliefs and its dimensions have positive effects on mental health, these effects were evaluated separately. On the basis of a simultaneous analysis of both dimensions of just world beliefs, it has been reported that opposite effects could emerge with respect to the relationships between these dimensions and well-being.(65) On the basis of these findings, a multiple mediation model was developed to examine the interactions among the two dimensions of just world beliefs, internalized stigma, and mental health (figure 3).

The multiple mediation model revealed that the general dimension of just world beliefs had a significant positive effect on internalized stigma (β= ,185, p= ,03). No direct relationship between the general dimension and mental health was observed (β= -,013, p= ,86). Furthermore, internalized stigma was not demonstrated to have a significant mediating effect on the relationship between general just world beliefs and mental health (β indirect= ,042, p= ,06).

As in the previous model (figure 2, panel c), the personal dimension of just world beliefs was observed to have significant negative effects on internalized stigma (β= -,359, p= <,001) and mental health (β= -,293, p= <,001). Furthermore, internalized stigma was observed to have a significant indirect effect on the relationship between personal just world beliefs and mental health (β indirect= -,083, p= ,006).

These findings indicate that general and personal just world beliefs could have opposing effects on internalized stigma and mental health. Specifically, the general dimension of just world beliefs seems to increase the levels of internalized stigma among MSM without directly influencing their mental health, whereas the personal dimension reduces their internalized stigma and improves their mental health both directly and indirectly.

Note. Model adjusted for age, socioeconomic status, and educational level.

*p<,05; **p<,01; ***p<,001.

DISCUSSION

The present study provides empirical evidence regarding the mediating role played by internalized stigma in the relationship between just world beliefs and mental health among MSM in Chile. The bivariate analyses revealed a significant and positive correlation with a moderate magnitude between the general and personal dimensions of just world beliefs. This finding supports a two-dimensional model of these beliefs, suggesting that while the two dimensions are distinct, they are moderately correlated with each other.(10,41) In addition, a negative correlation was observed between just world beliefs and symptoms of depression and anxiety; this finding is consistent with the results of previous studies that have suggested that these beliefs may have a protective effect on mental health by reducing depression and anxiety.(38,39,40) However, this association was stronger with personal just world beliefs than with respect to general just world beliefs. This finding is in line with previous studies that have highlighted the fact that the personal dimension plays a more relevant role in the process of shaping people’s life satisfaction,(16) self-esteem(37,43) and subjective well-being.(43) Therefore, the results confirm our hypothesis (H1), which posited that just world beliefs would reduce mental health problems among MSM; in particular, the strongest negative association was observed in the personal dimension of just world beliefs.

We propose that internalized stigma could play an important role in this context by operating as a mechanism through which just world beliefs influence mental health among MSM. This effect was observed exclusively in the model that included the personal dimension of just world beliefs (figure 2, panel c). In line with the results of a previous review, the personal dimension was demonstrated to be more relevant than the general dimension with regard to well-being (42) since the effects associated with the general dimension were notably lower.(14,16) This finding could be explained by the fact that more ingrained personal beliefs elicit greater confidence in the justice of events that happen to an individual than do general beliefs.(10,41)

Research on the mechanisms that mediate the relationship between just world beliefs and well-being in terms of health among MSM remains limited, and such research has largely focused on people with human immunodeficiency virus (HIV). That research has not reported any significant indirect effects pertaining to the relationship between just world beliefs and subjective well-being via the mediation of stigma.(17) This result could be explained by the fact that previous studies on this topic have used a combined measure of the personal and general dimensions of just world beliefs, rather than distinguishing between these dimensions as suggested by the two-dimensional model.(10,41) In contrast with that evidence, our results confirm H2, which focused on the mediating role of internalized stigma in the relationship between just world beliefs and mental health and posited that this effect is significant with regard to the personal dimension (but not the general dimension) of just world beliefs.

Although the mediation analyses that were conducted to investigate each dimension of just world beliefs separately revealed that the personal dimension could improve people's mental health, a joint analysis of both dimensions revealed opposing results. The multiple mediation analysis in which the effects of the two dimensions of just world beliefs on mental health were evaluated simultaneously revealed that the personal dimension could be beneficial in this context, whereas the general dimension could increase people’s symptoms of depression and anxiety. In addition, this analysis revealed that internalized stigma is a mechanism through which the personal dimension can affect people’s mental health. A study reported that both dimensions are related to certain social goals in different ways.(65) In this study, personal just world beliefs were revealed to be positively associated with goals that promote social adaptation and well-being (i.e., intimacy and care) and negatively associated with goals pertaining to dominance, which could hinder social relationships (i.e., leadership and dominance). In contrast, general just world beliefs were positively related to dominance goals and negatively related to goals that promote adaptation. These findings confirm the two-dimensional model, thus suggesting the existence of an inverse relationship between the two dimensions in terms of their influence on subjective well-being and other social aspects.

This research contributes to the theoretical literature on the mechanisms through which just world beliefs can promote individual well-being. One such mechanism is assimilation.(66) This mechanism suggests that when people hold just world beliefs firmly despite facing situations of injustice, such as those involving stigma, they tend to reevaluate these experiences with the aim of achieving a certain degree of cognitive harmony. One possible result of such assimilation is the minimization of perceived harm.(42) In this sense, it is likely that when people who exhibit strong just world beliefs encounter situations that involve stigmatization, they minimize the relevance or seriousness of these events. In addition, they could interpret these experiences as infrequent or less threatening to their well-being, thus contributing to their perceptions of well-being.(67) This mechanism may be similar to the situation that has been described with regard to other ideologies that support the status quo, such as the justification of the system.(68) Previous research has reported that people who justify the system tend to minimize events of stigma and discrimination, thereby promoting their own well-being.(54) Despite the relevance of this study with respect to the aforementioned mechanisms, research on this topic remains lacking, thus highlighting the need for additional research to explore these phenomena in further detail.

Limitations

To our knowledge, this study is the first to analyze the relationships among just world beliefs, internalized stigma, and mental health by reference to a sample of MSM in Chile. Notably, this sample was composed predominantly of people who exhibited a medium–high socioeconomic level and a good level of education, which could limit the generalization of the results of this research to the general population of MSM, especially to those who exhibit higher levels of social and economic vulnerability. The findings of previous research have suggested that, in populations that face higher levels of adversity, general just world beliefs could be psychologically more adaptive than personal just world beliefs.(69) Our study employed a cross-sectional design, thus preventing us from drawing causal or temporal inferences among the variables. Despite these limitations, this study strengthens the two-dimensional model of just world beliefs by confirming the distinction between the two dimensions of such beliefs, thus enhancing the theoretical solidity of the results of this research. Moreover, this study broadens our knowledge of this topic in a local context by providing novel evidence concerning a population that has hitherto received insufficient investigation.

Future studies

Since various factors, such as social position, can influence just world beliefs and well-being,(70) future studies should include samples that exhibit a wider variety of social characteristics with the goal of evaluating whether these results can be replicated in more vulnerable populations than the population analyzed in this study. We recommend that future researchers should conduct longitudinal research to analyze the causality of the relationships among just world beliefs, internalized stigma and mental health as well as to identify the impacts of these beliefs in both the short and long term. Studies on this topic have been limited; however, the evidence suggests that these outcomes could vary over time.(67,71)

Finally, the findings of this study highlight the importance of considering ideological beliefs, such as just world beliefs, as essential components of well-being in terms of health. This aspect is particularly relevant in contexts where there may be some incongruence between certain life events and these beliefs, which could negatively impact individuals' well-being. An example of this phenomenon is seen in situations of stigmatization: when individuals perceive themselves as victims of stigma, they may experience a conflict with their just world beliefs, potentially affecting their mental and physical health. Although no studies have specifically explored the effects of such cognitive dissonance in this particular context, previous research that has been conducted in adverse situations—for example, in cases of catastrophic diseases such as cancer—has suggested that declining just world beliefs can have a significant negative effect. In such situations, restoring or strengthening these beliefs could be critical with regard to improving resilience, mitigating stress, and promoting greater emotional well-being.(72) These antecedents could suggest a possible area of intervention in situations such as those indicated.

CONCLUSIONS

Just world beliefs play a fundamental role in the process of mitigating mental health problems among MSM, and this effect is especially pronounced with respect to personal beliefs. Furthermore, the various dimensions of just world beliefs appear to have opposing effects on people's health, thus highlighting the need to consider these dimensions separately in future studies. These findings emphasize the relevance of continuing to explore how just world beliefs influence people’s mental health, especially in contexts in which internalized stigma affects people's well-being.

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