Safety First: The Health Implications of Social Belonging Among Utah Women

For over three decades, health psychologists have documented disproportionately high mental and physical health problems among individuals who are socially marginalized due to their race/ethnicity, sexual identity, gender identity, or socioeconomic status. The prevailing explanation for these health disparities has been “minority stress,” defined as the cumulative chronic stress provoked by everyday instances of discrimination, unfair treatment, and shame. This explanation predicts that the poorest health outcomes should be observed in those with the greatest minority stressors, yet studies suggest that this model might be oversimplified. Although marginalized individuals with high exposure to mistreatment do have compromised mental/physical health, so do those with low exposure. Because links between stigma and health do not depend solely on the frequency and magnitude of overt stigma-related stressors, we need to better understand how stigma harms the health of individuals in Utah and beyond.  

Social safety may be the missing piece. Social safety refers to reliable social connection, social belongingness, social inclusion, social recognition, and social protection, which are essential human needs at all life stages. Most of us give and receive hundreds of subtle cues and reminders of social connectedness as we go about our everyday lives, such as smiling at strangers, responding to requests for help, and showing interest in other people’s lives and families. These routine indicators of human concern and connection allow us to move through our social worlds without fear, reminding us that we belong to an interconnected and protective social fabric.  

Study Background 

Existing measures of minority stress and stigma focus exclusively on the potential negative effects of social marginalization, such as harassment, victimization, and unfair/denigrating treatment. Yet, according to the social safety framework, without careful assessment of positive experiences of inclusion and belonging, our understanding of the impact of marginalization will be incomplete. To address this gap, the author and her research team designed a novel self-report measure that asks individuals to report on social safety. 

Overall, this research provides an unprecedented assessment of Utah women’s experiences of social safety, marginalization, and health. The following research questions were explored:  

1. How often do Utah women experience social safety within different social domains?  
2. How does social marginalization affect Utah women’s social safety?
3. Do Utah women who experience low social safety have unique risks for complex trauma and mental/physical health problems, independent of other health risk factors such as community violence and childhood adversity?

Social Safety 

Across all participants, 34.9% had at least three social domains in which they experienced high safety, 58.0% had one or two safe domains, and 7.1% had no safe domains. The domains included household, family, close friends, identity group, colleagues, social media, and public settings. Women who occupied one or more marginalized categories reported significantly lower social safety across all domains than women without any forms of marginalization. 

Predicting Social Safety 

Notably, a woman’s marginalization status predicted her social safety independently of her social isolation and her exposure to ostracization, disrespect, childhood adversity, and community violence. This indicates that occupying a marginalized social category can interfere with women’s social safety independently of their direct experiences of exclusion, shame, and violence. Furthermore, the effects of disrespect and ostracization on social safety remained highly significant even after controlling for women’s overall exposure to neighborhood violence, childhood adversity, and social isolation. These findings provide powerful confirmation that social safety is specifically related to experiences of exclusion, rather than experiences of hardship and violence exposure more generally. 

Impact of Social Safety on Health 

• Physical & Mental Health: Individuals with lower social safety reported significantly greater physical health problems, greater depressive symptoms, and greater anxiety symptoms. 
• Complex Trauma & Chronic Unsafety: When individuals are chronically exposed to social relationships that place them at risk for shame, fear, harm, or coercion (i.e., chronic unsafety), they sometimes develop trauma symptoms such as nightmares, unwanted thoughts, emotional numbing, feelings of dread, and hypervigilance, all of which have been found to erode mental and physical well-being over time. Scholars use the term “complex trauma” to describe this phenomenon, and to differentiate it from post-traumatic stress reactions that develop in response to single, acute events (e.g., assaults, accidents, natural disasters). 

Impact of Social Safety on Suicidality 

Perhaps the most striking findings of the study concerned suicidal ideation and behavior. In all, 31.0% of participants reported prior suicidal ideation, and 13.5% reported a previous suicide attempt. Predicting the odds of each outcome (ever having had suicidal ideation and ever having attempted suicide) from social safety, age, ethnicity, income, sexual/gender identity, exposure to violence, and exposure to adversity, results showed that social safety was significantly related to both suicidal ideation and behavior independent of other factors. 

Conclusions and Recommendations 

Many scholars argue that health disparities in marginalized groups stem from the fact that such groups have less access to health-protective resources, such as financial resources and access to preventive health care. Yet, the findings of this study indicate that reliable social safety is another fundamental health resource that plays a critical role in psychological and physical well-being. 

The findings of this research confirm that we cannot promote well-being among Utah women simply by reducing their exposure to stress and hardship: we must also amplify their experiences of connection, validation, and affirmation at all stages of life and across all social contexts. 

Perhaps the most important recommendation arising from this report is that we need to devote as much attention to amplifying social safety as we have devoted to reducing discrimination and maltreatment. But how can we do this? These research findings suggest that a critical component is helping individuals experience certainty and reliability in their social connections. People need to know that those around them will approve, protect, and care about them, more than to suspect that they might. 

As Utah policymakers and community leaders continue seeking ways to enhance Utah women’s economic opportunities, health status, and social standing, we must treat social safety with equal importance. Accordingly, health promotion efforts should adopt a “safety first” approach that begins by identifying whether individuals have sufficient and reliable access to affirmative and protective social relationships that provide them with consistent validation, affirmation, protection, and belonging. In the same way that “housing first” approaches to social services emphasize the primary importance of having a safe place to live, “safety first” approaches to psychological well-being must emphasize the primary importance of having social ties that make people feel that they matter to those around them. Ensuring that all Utahns have opportunities for meaningful connection with protective social ties may be one of the most powerful steps that we can take to promote thriving among all Utahns. 

To learn more about the health implications of social belonging among Utah women, read the full brief.