The Closet Within: A Systematic Review of Internalized Sexual Stigma in Sexual Minority Men

Background: Internalized sexual stigma (ISS) has been associated with poorer mental health among sexual minority men, yet few reviews have synthesized the literature. This review aimed to identify the variables linked with ISS as a predictor, mediator, or outcome. Methods: This systematic review followed PRISMA guidelines. ProQuest, Google Scholar, PubMed, Scopus, and PsycINFO were searched using predefined keywords. Risk of bias was assessed with the AXIS tool and the Newcastle-Ottawa Scale, and certainty of evidence with GRADE. Results: Thirty-five studies were included: 19 examined ISS as a predictor, seven as a mediator, and nine as an outcome. Twenty-four studies focused exclusively on gay, bisexual, or queer men, and 11 reported pooled mixed sexual-minority samples. ISS was associated with poorer mental health (depression, suicidal ideation, psychological distress), riskier sexual health behaviour (reduced HIV testing, condomless sex, higher STI incidence), and compromised relationship and social functioning. Identity resilience, secure attachment, and social support emerged as protective factors. Culturally specific pathways included filial piety and marriage pressure in Chinese-heritage populations and structural criminalization in sub-Saharan Africa. Certainty of evidence was very low, largely because of cross-sectional, non-probability sampling. Conclusions: The findings are broadly consistent with minority stress theory, although cross-sectional evidence cannot establish temporal or causal processes. They may inform policies, interventions, and support services for sexual minority men.