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C 2004) Archives of Sexual Behavior, Vol. 33, No. 2, April 2004, pp. 149–157 (°

Coming Out Experiences and Psychological Distress of Chinese Homosexual Men in Hong Kong Chi-yan Wong, M.S.Sc.,1 and Catherine So-kum Tang, Ph.D.1,2 Received July 9, 2002; revision received December 4, 2002; accepted March 5, 2003

This study adopted a cognitive–behavioral conceptual framework based on the Theory of Reasoned Action (TRA) in understanding coming out experiences and psychological distress of 187 Chinese gay men. Results showed that participants’ coming out experiences were characterized by same-sex sexual fantasy at teenage years, followed by awareness of homosexual tendency, same-sex sexual contact, and then self-identification and disclosure of homosexual orientation in young adulthood. Regarding targets of disclosure, participants tended to disclose their sexual orientation to their gay friends first, followed by heterosexual friends, siblings, parents, and coworkers. This study also supported the extension of the TRA conceptual framework to Chinese societies. Results showed that a low level of psychological distress in Chinese gay men was linked to their coming out experiences, which were in turn related to TRA components of involvement and identification with gay communities and positive attitudes toward coming out. Limitations and implications were also discussed. KEY WORDS: homosexuality; distress; Chinese; Hong Kong.

INTRODUCTION

Coming Out Experiences

The term “coming out” refers to the process of accepting oneself as gay, lesbian, or bisexual and to integrate this sexual orientation into different spheres of one’s life (Cass, 1996; D’Augelli & Patterson, 1995; SavinWilliams, 1990). This process thus encompasses two dimensions: self-identification of homosexual orientation and disclosure of this sexual orientation to others (Cass, 1984; Troiden, 1989). At present, far more is known about homosexuality and the coming out process in Western than in Chinese societies. This study adopted a cognitive– behavioral conceptual framework based on the Theory of Reasoned Action (TRA; Ajzen & Madden, 1986) to facilitate the understanding of coming out experiences and psychological distress of Chinese gay men in Hong Kong.

Previous research has conceptualized the coming out process as the unfolding of sequential milestones (Cass, 1984; Fassinger & Miller, 1996; Floyd & Stein, 2002; Troiden, 1989). In spite of variations in personal experiences, studies on U.S. gay samples have shown that the coming out process generally begins with one’s awareness of same-sex attractions at about 9–11 years of age, followed by first same-sex sexual contact around 13– 15 years, first self-labeling of homosexuality between 14 and 16 years, and first disclosure of homosexual orientation between 16 and 18 years (D’Augelli, 2002; D’Augelli & Hershberger, 1993; Herdt & Boxer, 1993; Rosario, Meyer-Bahlurg, et al., 1996; Savin-Williams & Diamond, 2000). Gender disparity has also been noted in the sequencing and timing of these milestones. For example, gay men are more likely to experience same-sexual contacts before labeling themselves as having homosexual orientation, whereas lesbians tend to report the reverse sequence (Herdt & Boxer, 1993; Savin-Williams & Diamond, 2000). Lesbians also tend to experience later timing for the coming out process, often late into their adolescence or adulthood (Kitzinger & Wilkinson, 1995).

1 Department

of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong. 2 To whom correspondence should be addressed at Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong; e-mail: [email protected].

149 C 2004 Plenum Publishing Corporation 0004-0002/04/0400-0149/0 °

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150 Studies have explored various factors associated with coming out experiences of gay people. The present investigators attempted to organize these factors according to a cognitive–behavioral conceptual framework based on the TRA (Ajzen & Madden, 1986). The TRA model proposes that behavior can be predicted by behavioral intentions that are, in turn, influenced by subjective norms regarding the target behavior, attitudes/beliefs toward outcomes of the behavior, and perceived behavioral control. When the TRA model is applied to the understanding of coming out experiences, subjective norms refer to attitudes toward homosexuality and being gay. The attitudes/beliefs component includes perceived discrimination or actual discrimination experiences in relation to homosexual identification and disclosure. Identification and involvement with gay communities is conceptualized as perceived behavioral control, as gay communities often provide sources of knowledge about ways of coming out, presenting information about oneself to others to elicit certain reactions, and handling negative reactions others might have. The following sections summarize past studies on the above components of the TRA model. Attitudes Toward Coming Out Earlier research on homosexuality has noted that some gay people tend to hold rejecting attitudes toward other people whose acts or presentation may signify homosexuality, and may refuse to identify themselves as homosexual despite their feelings, thoughts, or acts (Troiden, 1989). More recent studies further suggest that many gay people make the decision to “come out” according to societal attitudes toward people with a homosexual orientation (DiPlacido, 1998; Jackson & Sullivan, 1994). They are less likely to come out if they perceive the public as having negative attitudes toward gay people. Discrimination In Western countries, discrimination against people who are gay, or are thought to be gay, has a long history. Civil rights for gay people have been limited by discrimination in such areas as housing, employment, immigration, child custody, and military services. With widespread societal rejection of gay people, it is thus not surprising that gay people are often targets of ridicule, victimization, and discrimination in a variety of settings (D’Augelli & Grossman, 2001; D’Augelli & Hershberger, 1993; D’Augelli, Pilkington, & Hershberger, 2002; DiPlacido, 1998; Waldo, Hesson-McInnis, & D’Augelli, 1998). Thus, many gay people remain “closeted” to avoid rejection or hostile reaction by others.

Wong and Tang Identification and Involvement With Gay Communities Various studies have documented positive associations between support from gay communities and coming out experiences. Identification and involvement with gay communities is found to be related to homosexual identity, disclosure of homosexual orientation to others, and a sense of comfort with homosexual orientation (Cass, 1996; Herdt & Boxer, 1993; McKirnan, Stokes, Doll, & Burzette, 1995; Savin-Williams, 1995; Troiden, 1989). It may be that social contacts with other gay people help individuals to come to terms with a self-definition of sexual identity as well as provide support to cope with stigma and feelings of alienation from the heterosexual world. Coming Out Experiences and Psychological Adjustment Studies have shown that gay people tend to experience psychological distress in relation to their homosexual orientation (D’Augelli, 2002; D’Augelli et al., 2002; D’Augelli & Hershberger, 1993; DiPlacido, 1998; Lock & Hans, 1999; Rosario, Rotheram-Borus, & Reid, 1996). Sources of distress include confusion arising out of their repeated reexamination of their sexual orientation, discrimination and social isolation with their deviation from normative sex-role behaviors and sexuality, struggles about whether or not to reveal their lifestyles, and uncertainty about the extent they can be affectionate to their partner in public. Other studies have also suggested that homosexual identification at a very young age may be associated with adjustment problems such as emotional distress, substance use, school failure, and peer rejection (D’Augelli, 2002; Floyd & Stein, 2002: Pilkington & D’Augelli, 1995; Rosario, Rotheram-Borus, et al., 1996). In other words, psychological distress of gay people mainly comes from discrimination, a sense of differentness, and a lack of social support. Although gay people may experience various stressors in relation to their sexual orientation, studies have found that gay people tend to report a reduction in psychological distress and a more coherent self-concept after coming out (Cass, 1996; Hammersmith & Weinberg, 1973; Rosario, Hunter, Maguen, Gwadz, & Smith, 2001; Savin-Williams, 1990). Furthermore, researchers have argued that gay people’s psychological functioning may change in different stages of the coming out process. Some studies find that psychological distress is most apparent at the early phase of homosexuality identity formation, and a more positive and coherent sense of self tends to emerge at the later stage of the coming out process (Cass, 1984; Malyon, 1981).

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Coming Out Experiences and Distress in Chinese Homosexual Men Homosexuality in Chinese Societies There has been a paucity of studies on homosexuality in Chinese societies due to various historical and cultural reasons. Some of these reasons may be particularly salient in the context of Hong Kong. First, homosexuality by itself constitutes a challenge to the yin-yang harmony of heterosexual relationship, family integrity, and social order as prescribed by the traditional Confucian sexual philosophy (Tang, Lai, & Chung, 1997). According to Confucian principles, sex is viewed mainly for procreation. Any sexual activities occurring outside the marital relationship do not fulfil procreational purposes and are thus disapproved. Second, homosexual behavior was an offence punishable by life imprisonment in Hong Kong prior to 1991. Third, homosexuality was included as a psychiatric diagnostic category in the second edition of the Diagnostic and Statistic Manual of Mental Disorders (American Psychiatric Association, 1968), which was commonly adopted by local mental health practitioners. Recently, there have been gradual changes in the lives of gay people in Hong Kong. In the legal discourse, the ordinance on the decriminalization of homosexuality was enacted in 1991. Homosexuality is no longer regarded as a form of mental disorder; thus, the need to treat and change gay people has become less pressing. An increasing proliferation of local gay self-help groups has also been noted. Surveys on general characteristics of gay people in both Hong Kong and the People’s Republic of China are also available (Queer Sisters & Hong Kong Women Christian Council, 1998; Ruan & Bullough, 1992). However, there is still no available information in relation to coming out experiences of Chinese gay men and women. Aims of this Study This study adopted a cognitive–behavioral TRA model in understanding coming out experiences and psychological distress of Chinese gay men. Previous research has documented gender differences in the context, timing, spacing, and sequencing of sexual identity milestones. Compared to adolescent females, adolescent males tend to have an earlier onset of all milestones except disclosure (Savin-Williams & Diamond, 2000). This study thus focused on Chinese gay men only. In particular, the purposes of the present study were threefold: (1) to explore the age at various milestones of the coming out process; (2) to determine correlates of coming out experiences according to the TRA model; and (3) to examine associations between coming out experiences and psychological distress. On the basis of past literature, it was hypothesized that components of the TRA model, such as positive attitudes toward

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coming out, few perceived/actual discrimination experiences, and identification and involvement with gay communities, would be related to coming out experiences. It was also hypothesized that coming out experiences would be negatively related to psychological distress. METHOD Participants As it was practically infeasible to recruit a random sample of homosexual men, this study thus comprised a convenience sample of Chinese gay men referred by support groups for gay people in Hong Kong. Only ethnic Chinese men who reported to have a homosexual orientation and were between 17 and 35 years of age at the time of the survey were included in the study. This age range was set with reference to the age of coming out documented in previous studies (Cass, 1984; Troiden, 1993). A total of 200 participants meeting the inclusion criteria were contacted and 197 returned their completed questionnaire. Four cases were discarded for missing too much data and another six cases were discarded because they indicated uncertainty about their sexual orientation. Thus, the present sample comprised of 187 participants. Participants had a mean age of 28.2 years (SD = 5.3). Slightly more than half of the participants had completed university education (54%) and nearly 80% had monthly income between US$1,300 and US$3,800. About 40% of the participants held blue-collar, sales, or clerical jobs; 19% were managers; 18% worked in healthcare or social welfare sectors; 9% were unemployed; remaining participants did not specify their occupation. About half of the respondents (46%) were living with their family members and the remaining either lived with friends/relatives (31%) or alone (23%). Compared to heterosexual men of comparable age in Hong Kong, the present sample of gay men had higher educational attainment and tended to concentrate in healthcare and social welfare occupations. Measures Milestones of Coming Out Participants were asked to recall their ages at the five milestones of the coming out process (Savin-Williams & Diamond, 2000). These milestones include first same-sex sexual fantasy, first awareness of homosexual tendency, first same-sex sexual activity, first self-identification as gay men, and first disclosure of sexual orientation to another person.

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152 Attitudes Toward Coming Out Modified after the behavioral attitudes scale as developed by Fishbein et al. (1993), participants were asked to rate their attitudes toward the coming out process on six semantic differential scales. Examples of these scales are: “easy-difficult” and “comfortable-embarrassed.” Each scale is scored on a 5-point Likert scale, with higher scores indicating more positive attitudes toward coming out. For this study, the internal reliability coefficient of the scale was .82. Discrimination Experiences Participants were asked to report on their perceived and actual experiences of being discriminated against on the basis of their homosexual orientation on a 9-item subscale of the Male Homosexual Questionnaire (Weinberg & Williams, 1974). Examples of these items include, “Do you think the general public dislike gay people?” and “Have you ever encountered problems when people suspect that you are gay?” Participants were asked to rate these items on a 5-point scale, with 1 as strongly disagree and 5 as strongly agree. High scores on these items indicate greater perceived and actual discrimination experiences in relation to homosexual orientation. For this study, the internal reliability coefficients were .83 for perceived discrimination and .71 for actual discrimination subscales. Identification With Gay Communities The 8-item Identification and Involvement With the Gay Community Scale (IGCS; McKirnan et al., 1995) was initially developed to measure the association between support from gay communities and HIV/AIDS risk behaviors among bisexual men. For this study, the items were modified to reflect participants’ involvement and identification with gay communities. Examples of these items are “Participating in activities organized by gay support groups” and “Having a sense of belongingness to gay communities.” Participants were asked to indicate whether or not they agreed with the items on a 5-point scale, with 1 as strongly disagree and 5 as strongly agree. For this study, the internal reliability coefficient of this scale was .78. Coming Out Experiences Participants’ coming out experiences were assessed by a 17-item subscale based on the Male Homosexual Questionnaire (Weinberg & Williams, 1974). This subscale contains items measuring self-identification of ho-

Wong and Tang mosexuality as well as the level and targets of disclosure, namely family members, relatives, friends, and coworkers. Higher scores indicate higher level of homosexual identification and greater disclosure of this sexual orientation to others. For the present study, the internal reliability coefficient of this scale was .92. Psychological Distress The 28-item General Health Questionnaire (GHQ; Goldberg & Hiller, 1979) was used to measure participants’ psychological distress. This scale has been validated with Chinese samples (Shek, 1989) and assesses participants’ somatic symptoms, depression, anxiety, and social dysfunction with a 4-point scale. Higher scores of this scale indicate an increasing level of distress. For the present study, the internal reliability coefficient of this scale was .91. Procedure Participants were asked to complete the questionnaire in a quiet room provided by support group centers. Written consent was obtained from the participants. Participants were also informed that their responses to the questionnaire were strictly confidential and they could withdraw their participation at any time. They were asked to put the completed questionnaire in a sealed envelope before returning it to the collection box at the support group centers. The questionnaire took about 30 min to complete and no monetary reward was given to participants. RESULTS Milestones of the Coming Out Process For this study, all participants had disclosed their sexual orientation to either friends or family members. With regard to targets of disclosure of homosexual orientation, 77.4% of the participants disclosed their sexual orientation to their gay friends, another 52% to their heterosexual friends, and only 20% to their coworkers. Within the family context, fewer participants disclosed their sexual orientation to parents than to siblings (32.4 vs. 40.6%; χ 2 = 8.33, p < .01). Percentages of participants disclosing their sexual orientation to their social circles were similar between fathers and mothers, between brothers and sisters, and between male and female friends (all ps > .05). Table I summarizes mean ages of various coming out milestones. Mean ages were 13.5 years (SD = 4.2, ranged

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Table I. Summaries of Studies Documenting Timing of Sexual Orientation Identity Milestones of Gay Men

Sample size Age range of the sample Mean age of the sample Mean age of first awareness of homosexual tendency Mean age of first same-sex sexual behaviors Mean age of self-identification of homosexual orientation Mean age of first disclosure of homosexuality

Wong and Tang (2004)

D’Augelli and Hershberger (1993)

Rosario et al. (1996)

Dube and Savin-Williams (1999)

Savin-Williams and Diamond (2000)

D’Augelli (2002)

187 17–35 28.2 (5.3) 16.4 (4.3)

142 15–21 18.9 (1.6) 9.8 (3.7)

80 14–21 18.3 (1.7) 10.8 (3.7)

24 16–26 21.1 (2.7) 9.2 (3.7)

86 17–25 21.6 (2.2) 7.7 (3.0)

336 14–21 19.1 (1.5) 9.9 (3.6)

18.7 (4.2)

14.9 (3.8)

13.3 (3.8)

17.7 (2.9)

14.1 (4.7)

14.3 (—)

20.2 (4.5)

14.8 (3.1)

14.6 (2.9)

15.8 (2.6)

16.4 (2.9)

14.9 (2.9)

21.2 (5.3)

16.7 (2.4)

—

17.7 (2.0)

17.9 (2.4)

16.7 (2.1)

Note. Numbers in parenthesis represent standard deviation.

from 10 to 22) for first same-sex sexual fantasy, 16.4 years (SD = 4.3, ranged from 10 to 2) for first awareness of homosexual tendency, 18.7 years (SD = 4.2, ranged from 13 to 30) for first same-sex sexual behaviors, 20.2 years (SD = 4.5, ranged from 16 to 27) for first self-identification of homosexual orientation, and 21.2 years (SD = 5.3, ranged from 15 to 30) for first disclosure of homosexuality to others. The mean interval between first same-sex sexual fantasy and first self-awareness of homosexual tendency was 3.7 years (SD = 3.8), and between first self-awareness and first same-sex sexual behaviors was 3.5 (SD = 4.2). The time between first same-sex sexual behaviors, first self-identification, and first disclosure of homosexuality overlapped with an average of 1–2 years. A Guttman scalogram analysis (Green, 1956) was also performed to test the sequential model of coming out milestones. Results showed that the sequencing of various stages of the coming out process generally fitted into a Guttman sequence, with the coefficient of reproducibility (CR) being .91. About 60% of the participants followed the

sequence of the coming out process as found in previous studies.

Correlates of Coming Out Experiences Pearson correlation analyses were performed to examine associations among coming out experiences, age of coming out milestones, and TRA components of attitudes toward coming out, perceived discrimination, actual discrimination experiences, and identification and involvement with gay communities. Ages of coming out milestones, i.e., age of first same-sex sexual fantasy, age of first awareness of homosexual tendency, and age of first samesex sexual behaviors, were unrelated to coming out experiences (all ps > .05). Correlation results of coming out experiences and TRA components are presented in Table II. In general, coming out experiences were correlated with TRA components in the expected directions (sr ranged from −.49 to .68, all ps < .001), with the exception of

Table II. Intercorrelations Among Predictor Variables, Coming Out Experiences, and Psychological Distress

Variables 1. Attitudes toward coming out 2. Perceived discrimination 3. Discrimination experience 4. Identification with gay communities 5. Coming out experiences 6. Psychological distress Mean SD Range Internal reliability coefficient ∗p

< .005. ∗∗ p < .001.

1

2

3

4

5

6

— −45∗ −.08 .61∗∗ .65∗∗ −.17∗ 3.34 0.72 1–5 .82

— 26∗ −.52∗∗ −.49∗∗ .06 2.65 0.62 1–3 .83

— −.30∗∗ −.11 .09 1.51 0.56 1–3 .71

— .69∗∗ −.10 3.20 0.67 1–5 .78

— −.23∗∗ 2.64 0.41 1–3 .92

— 0.44 0.29 0–2 .92

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Table III. Results of Hierarchical Regression Analysis for Coming Out Experiences Predictors

R2 R21

F1

β

t

Block 1: Demographic variables .04 .04 1.58 Age .13 2.07∗ Education .01 0.20 Occupation .01 0.18 Monthly salary . 05 0.73 Block 2: Theory of Reasoned .59 .55 99.35∗∗ Action (TRA) components Identification and involvement .46 6.44∗∗ with gay community Attitudes toward come out .37 5.18∗∗ Perceived discrimination −.13 −1.95 Discrimination experiences .08 1.43 ∗p

Table IV. Results of Hierarchical Regression Analysis for Psychological Distress

< .05. ∗∗ p < .01.

Predictors

Block 1: Demographic variables .05 .05 1.85 Age Education Occupation Monthly salary Block 2: Theory of Reasoned .08 .04 1.42 Action (TRA) components Identification and involvement with gay community Attitudes toward coming out Perceived discrimination Discrimination experiences Block 3: Coming out variable Coming out experiences .13 .04 7.01∗ ∗p

actual discrimination experiences. As hypothesized, coming out experiences were related to favorable attitudes toward coming out, greater identification with gay communities, and fewer perceptions about being discriminated against. A hierarchical multiple regression analysis was performed to identify the best predictors for coming out experiences. Demographic variables including age, education, occupation, and monthly salary were entered as Block 1. TRA components were entered in a stepwise procedure as Block 2. Detailed results of the regression analysis are presented in Table III. The two blocks of predictor variables together accounted for 59% of the variance in coming out experiences. Block 1 as a whole was not significant in the prediction of coming out experiences (R 2 = .04, p > .05), despite age showing a significant beta value (β = .13, p < .05). Variables in Block 2 were significant, accounting for an additional 55% of variance in coming out experiences, even after controlling for effects of demographic variables (R 2 1 = .55, p < .001). With a stepwise regression procedure, participants’ coming out experiences were best predicted by identification with gay communities and positive attitudes toward coming out (β = .46, .37, p < .001).

R 2 R 2 1 F1

β

t

.18 1.93 −.06 −0.63 −.08 0.90 −.11 −1.07 −.07 −0.52 .07 0.57 −.16 −1.56 .03 0.33 −.33 −2.65∗

< .01.

tress. Results are also presented in Table II. A hierarchical multiple regression analysis was then performed to determine the best predictors for psychological distress. Demographic variables including age, education, occupation, and monthly salary were entered as Block 1. Components of the TRA model were entered as Block 2, and coming out experiences were entered as Block 3 of the regression analysis. Results are presented in Table IV. Results of the hierarchical regression analysis showed that the three blocks of predictor variables together accounted for 13% of the variance in psychological distress. Demographic variables in Block 1 and TRA components in Block 2 were not significant in the prediction of psychological distress (R 2 = .05, p > .05). Examination of the individual beta values of TRA components confirmed that no one component regressed significantly on psychological distress ( p > .05). Coming out experiences of Block 3 demonstrated significant predictive power. This variable accounted for an additional 4% of variance in psychological distress, even after controlling for effects of demographic variables and TRA components (R 2 1 = .04, β = −.33, p < .01). DISCUSSION

Coming Out Experiences and Psychological Distress Coming Out Experiences The mean score of the scale measuring psychological distress was within the nonclinical range, suggesting that the present sample, on average, did not present clinically significant psychological symptoms. Pearson correlation analyses were then performed to examine associations among age of coming out milestones, TRA components, coming out experiences, and psychological dis-

The present results showed that the sequence of the coming out process for Chinese gay men was generally in line with previous research on Western samples (D’Augelli, 2002; D’Augelli & Hershberger, 1993; Floyd & Stein, 2002; Herdt & Boxer, 1993; Rosario, MeyerBahlurg, et al., 1996; Savin-Williams & Diamond, 2000).

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Coming Out Experiences and Distress in Chinese Homosexual Men For Chinese gay men, the coming out process generally began with same-sex sexual fantasy, followed by selfawareness of homosexual tendency, same-sex sexual behaviors, and then commitment in homosexual orientation and disclosure of this sexual orientation to others. The time gaps between Chinese gay men’s first same-sex behaviors, self-identification, and disclosure also tended to overlap. Table I also summarizes studies on the timing of various sexual identity milestones of Western gay men. In general, Chinese gay men experienced the coming out milestones about 5 years later than their Western counterparts. This study found that Chinese gay men typically started the coming out process at around 13 years old and completed at about 21 years old. In Western gay samples, the coming out process generally unfolded earlier at about 7 years old and finished at about 18 years old. These age differences in coming out milestones were also evident between the present sample and Asian American gay men (Dube & Savin-Williams, 1999). Furthermore, age differences between Chinese and Western samples have also been noted in the timing of puberty maturation (Lam, Shi, Ho, Stewart, & Fan, 2002) as well as in sexual behaviors among adolescents (Lam et al., 2002) and college students (Tang et al., 1997). These differences may be related to the fact that sexuality remains a taboo topic in most Chinese societies, and sexual exploration and expression is socially sanctioned or discouraged in young age and before marriage. These cultural norms may limit adolescents’ opportunities to explore their sexuality; and even if they do, they may be reluctant to disclose their sexual behaviors to others. In Western societies, there is greater visibility of gay people, and this may also promote early trajectories for sexual orientation identity development (Floyd & Stein, 2002; Herdt & Boxer, 1993). This study also showed that Chinese gay men were more likely to disclose their homosexual orientation to gay friends than to friends of heterosexual orientation, and to siblings than to parents. Several reasons may account for these findings. The five “cardinal relationships” wu lun of Chinese culture prescribe clearly roles, responsibilities, bonding, and support of different social relationships. According to these guidelines, parents are authority figures whom children are expected to obey and respect. The parent–child relationship is more distant than the sibling relationship or friendships. As a result, it is not surprising that Chinese gay men were more willing to disclose their sexual orientation to friends and siblings than to their parents. Another plausible reason for a low level of disclosure to parents is the cultural emphasis on family continuity. In Chinese societies, male descendants are very important to the continuity of a family. For the parents,

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knowledge of their son being gay means not only the loss of a “real son,” but the discontinuity of the family line as well. This brings shame to the family and grief to parents, thus making Chinese gay men very hesitant in disclosing their sexual orientation to their parents. Current studies in Western societies suggest that factors related to disclosure to parents are the need for stress reduction from deception and secrecy about their sexual orientation as well as the desire to improve relationships with their parents (Boxer, Cook, & Herdt, 1991; D’Augelli et al., 2002). It should be noted that these factors may not be applicable to Chinese gay men, as disclosure of homosexual orientation to their parents may be an additional source of stress and may further worsen their relationship with them. This study also examined whether or not the proposed cognitive–behavioral TRA conceptual framework was applicable in understanding coming out experiences of Chinese gay men in Hong Kong. The present results supported the extension of this conceptual framework to Chinese societies. In line with the TRA model and previous studies (DiPlacido, 1998; Jackson & Sullivan, 1994; McKirnan et al., 1995; Waldo et al., 1998), identification and involvement with gay communities and positive attitudes toward coming out were found to associate with coming out experiences. The proposed component of perceived discrimination was also linearly related to coming out experiences, but its importance was greatly reduced when shared variances of identification with gay communities and attitudes toward coming out were also considered. Actual discrimination experiences were found to be unrelated to coming out experiences. It may be that as participants had already come out, they thus disregarded past discrimination experiences and focused instead on subjective evaluation of future experiences as a means of preserving healthy self-concepts.

Psychological Distress Contrary to public misconceptions that gay people tended to have psychological problems (D’Augelli, 2002; D’Augelli & Hershberger, 1993; Landolt & Dutton, 1997), the present results demonstrated that psychological functioning of the present sample of Chinese gay men was generally in the nonclinical range. However, it should be noted that as participants in this study had already come out, caution should be taken when generalizing the present results to other Chinese gay samples who may be at various stages of the coming out process and exhibit varying level of psychological functioning. This study also attempted to apply the TRA conceptual framework in understanding the association between

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156 coming out experiences and psychological distress of Chinese gay men. Results showed that a low level of psychological distress was linked to coming out experiences, which were in turn related to TRA components of involvement and identification with gay communities and positive attitudes toward coming out. The present findings were thus consistent with previous studies on Western gay samples (Cass, 1996; Hammersmith & Weinberg, 1973; Leserman, DiSantostefano, Perkins, & Evans, 1994; Rosario et al., 2001; Savin-Williams, 1990), which have indicated that coming out experiences are associated with a reduction in psychological distress. In fact, researchers have generally agreed that homosexual orientation forms a part of people’s overall identity, and a coherent sense of self is related to psychological health (Cass, 1984, 1996; Floyd & Stein, 2002; Herdt & Boxer, 1993). Gay people develop an integrated view of themselves, that is, an identity, by struggling through a period of confusion where reflection and reexamination of values and beliefs in relation to homosexuality have taken place. Disclosure of this homosexual orientation also brings closer social contacts with other gay people who may help to propel toward greater openness and self-acceptance. This will result in the formation of a consolidated sexual orientation identity in which a personal sense of self is synthesized with public roles. Furthermore, increased involvement and identification with gay communities may also provide support to cope with stigma and feelings of alienation. Thus, coming out experiences are related to better psychological health. Limitations and Implications This study had a number of limitations that might restrict the generalizability of its results. This study was based on a nonrandom sample of Chinese gay men recruited through gay self-help groups in Hong Kong. It remained unclear to what extent the present results could be generalized to the general gay population. Caution should also be taken when extending the present findings to gay samples residing in other Chinese societies, such as the People’s Republic of China, Taiwan, and Singapore, as these regions might have varying public attitudes and laws in relation to homosexuality. Moreover, this study relied solely on participants’ self-reports that might be subject to self-selection, social desirability, and recall bias. Finally, the cross-sectional nature of this study provided information on associations among various components of the TRA model, coming out experiences, and psychological distress only. Thus, no conclusive statements regarding causal effects could be made. Despite the above limitations, the present findings have significant service implications. First, psychological

Wong and Tang distress was negatively related to coming out experiences, which in turn were influenced by identification and involvement with gay communities and positive attitudes toward coming out. Thus, efforts should be made to identify positive role models who have successfully come out, to encourage gay people to make contacts and establish support networks, and to cultivate positive attitudes toward coming out. Moreover, as perceived discrimination was also found to associate with coming out, public education programs should aim to dispel myths and stereotypes as well as to reduce discrimination in relation to homosexuality. Lastly, educational programs that target family members and close friends of gay men are needed as their acceptance and support are of great importance to Chinese gay men’s decision to come out. REFERENCES Ajzen, I., & Madden, T. J. (1986). Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22, 453–474. American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: Author. Boxer, A. M., Cook, J. A., & Herdt, G. (1991). Double jeopardy: Identity transitions and parent–child relations among gay and lesbian youth. In K. Pillemer & K. McCartney (Eds.), parent–child relations throughout life (pp. 59–62). Hillsdale, NJ: Erlbaum. Cass, V. (1984). Homosexual identity formation: Testing a theoretical model. Journal of Sex Research, 20, 143–167. Cass, V. (1996). Sexual orientation identity formation: A western phenomenon. In R. P. Cabaj & T. S. Sten (Eds.), Textbook of homosexuality and mental health (pp. 227–251). Washington, DC: American Psychiatric Press. D’Augelli, A. R. (2002). Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry, 7, 433–456. D’Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence, 16, 1008– 1027. D’Augelli, A. R., & Hershberger, S. L. (1993). Lesbian, gay, and bisexual youth in community settings: Personal challenges and mental health problems. American Journal of Community Psychology, 21, 421– 448. D’Augelli, A. R., & Patterson, C. J. (Eds.). (1995). Lesbian, gay, and bisexual identities over the lifespan: Psychological perspectives. New York: Oxford University Press. D’Augelli, A. R., Pilkington, N. W., & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17, 148–167. DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals (pp. 138–159). Newbury Park, CA: Sage. Dube, E. M., & Savin-Williams, R. C. (1999). Sexual identity development among ethnic sexual-minority male youths. Developmental Psychology, 35, 1389–1398. Fassinger, R. E., & Miller, B. A. (1996). Validation of an inclusive model of sexual minority identity formation on a sample of gay men. Journal of Homosexuality, 32, 53–78.

P1: FLT Archives of Sexual Behavior

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Style file version July 26, 1999

Coming Out Experiences and Distress in Chinese Homosexual Men Fishbein, M., Chan, D. K., O’Reilly, K., Schnell, D., Wood, R., Beeker, C., et al. (1993). Factors influencing gay men’s attitudes, subjective norms, and intentions with respect to performing sexual behaviors. Journal of Applied Social Psychology, 23, 417–438. Floyd, F., & Stein, T. (2002). Sexual orientation identity formation among gay, lesbian, and bisexual youths: Multiple pattern of milestone experiences. Journal of Research on Adolescence, 12, 167–191. Goldberg, D. P., & Hiller, V. F. (1979). A scaled version of the General Health Questionnaire. Psychological Medicine, 24, 18–26. Green, B. F. (1956). A method of scalogram analysis using summary statistics. Psychometrika, 21, 79–88. Hammersmith, S. K., & Weinberg, M. S. (1973). Homosexual identity: Commitment, adjustment, and significant others. Sociometry, 36, 56–79. Herdt, G., & Boxer, A. M. (1993). Children of horizons: How gay and lesbian teens are leading a new way out of the closet. Boston: Beacon Press. Jackson, D., & Sullivan, R. (1994). Developmental implications of homophobia for lesbian and gay adolescents: Issues in policy and practice. In T. DeCrescenzeo (Ed.), Helping gay and lesbian youth: New policies, new programs, new practice (pp. 93–110). Binghamton, NY: Harrington Park Press. Kitzinger, C., & Wilkinson, S. (1995). Transitions from heterosexuality to lesbianism: The discursive production of lesbian identities. Developmental Psychology, 31, 95–104. Lam, T. H., Shi, H. J., Ho, L. M., Stewart, S. M., & Fan, S. (2002). Timing of pubertal maturation and heterosexual behavior among Hong Kong Chinese adolescents. Archives of Sexual Behavior, 31, 359–366. Landolt, M., & Dutton, D. (1997). Power and personality: An analysis of gay male intimate abuse. Sex Roles, 37, 335–359. Leserman, J., DiSantostefano, R., Perkins, D. O., & Evans, D. L. (1994). Gay identification and psychological health in HIV-positive and HIV-negative gay men. Journal of Applied Social Psychology, 24, 2193–2208. Lock, J., & Hans, S. (1999). Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 297–304. Maylon, A. K. (1981). The homosexual adolescent: Developmental issues and social bias. Child Welfare, 60, 321–330. McKirnan, D. J., Stokes, J. P., Doll, L. S., & Burzette, R. G. (1995). Bisexually active men: Social characteristics and sexual behavior. Journal of Sex Research, 32, 64–75. Pilkington, N. W., & D’Augelli, A. R. (1995). Victimization of lesbian, gay, and bisexual youth in community settings. Journal of Community Psychology, 23, 34–56.

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Queer Sisters & Hong Kong Women Christian Council. (1998). Human rights report on sexual rights, 1998. Hong Kong: Author. Rosario, M., Hunter, J., Maguen, S., Gwadz, M., & Smith, R. (2001). The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: Stipulation and exploration of a model. American Journal of Community Psychology, 29, 133–160. Rosario, M., Meyer-Bahlurg, H., Hunter, J., Exner, T., Gwadz, M., & Keller, A. (1996). The psychosexual development of urban lesbian, gay, and bisexual youths. Journal of Sex Research, 33, 113– 126. Rosario, M., Rotheram-Borus, M. J., & Reid, H. (1996). Gay-related stress and its correlates among gay and bisexual male adolescents of predominantly Black and Hispanic background. Journal of Community Psychology, 24, 136–159. Ruan, F. F., & Bullough, V. L. (1992). Lesbianism in China. Archives of Sexual Behavior, 21, 217–226. Savin-Williams, R. C. (1990). Gay and lesbian youth: Expressions of identity. New York: Hemisphere. Savin-Williams, R. C. (1995). Lesbian, gay male, and bisexual adolescents. In A. R. D’Augelli & C. J. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan: Psychological perspectives (pp. 165–189). New York: Oxford University Press. Savin-Williams, R. C., & Diamond, L. M. (2000). Sexual identity trajectories among sexual-minority youths: Gender comparisons. Archives of Sexual Behavior, 29, 607–627. Shek, D. (1989). Validity of the Chinese version of the General Health Questionnaire. Journal of Chinese Psychology, 45, 890– 897. Tang, C. S., Lai, F. D., & Chung, T. (1997). Assessment of sexual functioning for Chinese college students. Archives of Sexual Behavior, 26, 79–90. Troiden, R. R. (1989). The formation of homosexual identities. Journal of Homosexuality, 17, 43–73. Troiden, R. R. (1993). The formation of homosexual identities. In L. D. Garnets & D. G. Kimmel (Eds.), Psychological perspectives on lesbian and gay male experiences (pp. 191–217). New York: Columbia University Press. Waldo, C. R., Hesson-McInnis, M. S., & D’Augelli, A. R. (1998). Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: A structural model comparing rural university and urban samples. American Journal of Community Psychology, 26, 307–334. Weinberg, M. S., & Williams, C. J. (1974). Male homosexuals: Their problems and adaptations. New York: Oxford University Press.