Depression and anxiety in patients with and without same-sex attraction: differences in clinical expression, lifestyle factors, and vulnerability indicators.

Henny M W Bos,Robert A Schoevers,Theo G M Sandfort,Lynn Boschloo

doi:10.1002/brb3.363

Abstract

BackgroundThe aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even though it is now well documented that depression and anxiety are more prevalent among persons with same-sex attraction.MethodData, derived from the Netherlands Study of Depression and Anxiety (NESDA), allowed us to compare patients with a same-sex (n = 122) and an exclusively opposite-sex (n = 1658) attraction. Persons with same-sex attraction included persons who were attracted to both sexes. Data were collected by means of the Composite International Diagnostic Interview and paper-and pencil questionnaires.ResultsSeven percent of the patients reported any same-sex orientation. Clinical expression of depression and anxiety did not differ in relation to sexual attraction. Regarding substance use, same-sex attracted women reported more drug use than heterosexual women (drug use: 16.2% vs. 6.6%, P = 0.003). Regarding stressful childhood experiences, men with any same-sex attraction reported more sexual abuse during childhood than men with a heterosexual orientation (20.4% vs. 8.5%, P = 0.005).ConclusionsFor women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology.

Highlights

Several studies with large probability samples have shown that persons with a same-sex sexual orientation have a greater risk of developing psychopathology than heterosexual people, and the health disparities revealed to be larger for bisexual than for gay and lesbian people (Cochran and Mays 2000; Sandfort et al 2001; Bostwick et al 2010; Gevonden et al 2014; Elliott et al 2015)
It should be noted that in the present study, carried out in the Netherlands, 6.9% (n = 122; 54 men and 68 women) of the patients with a past-year depressive and/or anxiety disorder reported to experience same-sex attraction. This percentage is higher than that found in the Netherlands Mental Health Survey and Incidence Studies (NEMESIS) which is a longitudinal study focusing on the incidence, prevalence, course, and consequences of mental health problems in the general population between 18– 64 years old in the Netherlands
For the vulnerability factors we found that experiences with sexual abuse during childhood was the only childhood trauma factor on which we found a significant difference between male patients with same-sex attraction compared to heterosexual attraction

Summary

Introduction

Several studies with large probability samples have shown that persons with a same-sex sexual orientation have a greater risk of developing psychopathology than heterosexual people, and the health disparities revealed to be larger for bisexual than for gay and lesbian people (Cochran and Mays 2000; Sandfort et al 2001; Bostwick et al 2010; Gevonden et al 2014; Elliott et al 2015) These findings have been found independently of whether sexual orientation was assessed as behavior, identity, or attraction. These sexual orientation-related mental health disparities have been found on a lifetime basis and when assessed for shorter time periods, such as the past year (King et al 2008) These studies with large probability samples showed that unhealthy lifestyle factors such as substance use (Cochran et al 2004) and vulnerability factors such as stressful childhood experiences (Schneeberger et al 2014) are more prevalent in sexual minorities. Conclusions: For women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology

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