Psychological distress, stigma, and intersectional marginalization in lesbian and bisexual cisgender women in Chinese higher education: a thematic analysis guided by minority stress theory.

BACKGROUND: Lesbian and bisexual cisgender women in Chinese higher education institutions (HEIs) face compounded psychological distress at the intersection of gender- and sexuality-based stigma. Despite growing evidence of mental health disparities among LGBTQ populations in China, the mechanisms through which structural marginalization is internalized in educational settings remain poorly understood. OBJECTIVE: To identify how structural stigma is translated into internalized psychological harm among lesbian and bisexual cisgender women in Chinese HEIs, through specific, theoretically specified mechanisms. METHODS: Using a critical realist, reflexive thematic analysis design, I conducted semi-structured interviews with eight self-identified lesbian, bisexual, or same-sex attracted cisgender women at universities in four province-level regions of China. Analysis followed Braun and Clarke's (2006) six-phase approach, guided by Meyer's (2003) minority stress model, Hatzenbuehler's (2009) psychological mediation framework, and Crenshaw's (1989) intersectionality theory. Researcher positionality was integrated analytically throughout. RESULTS: Five themes were identified: (1) awareness of structural inequality as anticipatory anxiety and cognitive vigilance; (2) institutional resource deprivation undermining academic self-efficacy; (3) enacted and internalized stigma and their psychological consequences, including shame, identity concealment, and self-reported depressive symptoms; (4) intersectional invisibility compounding distress; and (5) attenuated outcomes where community and institutional support are present. Three mediation pathways were consistently operative: social-cognitive, emotional regulatory, and interpersonal (Hatzenbuehler, 2009). No diagnostic instrument was administered; all psychological states reported are self-described and interpreted from interview accounts. DISCUSSION: Distal stigma, internalized homophobia, culture-specific marriage pressure, and regional pathologization interact in complex ways to shape distress, disrupted identity development, and academic disengagement. I examine the limits of applying Western minority stress frameworks in a collectivist context and propose responses grounded in trauma-informed care, LGBTQ-affirmative services, enumerated non-discrimination policy, and educator anti-stigma training. CONCLUSION: The psychological distress of this underserved population is structurally produced, psychologically mediated, and institutionally addressable. Affirmative mental health infrastructure, enumerated anti-discrimination policy, and LGBTQ-inclusive educator training can meaningfully reduce minority stress and its consequences.