Abstract
Evidence suggests that sexual minorities (e.g., those identifying as lesbian, gay, or bisexual) experience increased rates of depression compared to heterosexual individuals. Minority stress theory suggests that this disparity is due to stigma experienced by sexual minorities. Stigma processes are proposed to contribute to reduced coping/support resources and increased vulnerability processes for mental health problems. This review provided a systematic examination of research assessing the evidence for mediating factors that help explain such disparities. A literature search was conducted using the databases PubMed, PsycINFO, and Web of Science. The review included 40 identified studies that examined mediators of sexual minority status and depressive outcomes using a between-group design (i.e., heterosexual versus sexual minority participants). Studies of adolescents and adult samples were both included. The most common findings were consistent with the suggestion that stressors such as victimization, harassment, abuse, and increased stress, as well as lower social and family support, may contribute to differing depression rates in sexual minority compared to heterosexual individuals. Differences in psychological processes such as self-esteem and rumination may also play a role but have had insufficient research attention so far. However, caution is needed because many papers had important methodological shortcomings such as the use of cross-sectional designs, inferior statistical analyses for mediation, or measures that had not been properly validated. Although firm conclusions cannot be drawn, the current evidence base highlights many factors potentially suitable for further exploration in high-quality longitudinal research or randomized studies intervening with the potential mediators.
Highlights
Sexual Minorities and DepressionSystematic reviews have reported that compared to heterosexual people, sexual minority individuals have elevated rates of mental health problems and are as much as four times more likely to attempt suicide (King et al, 2008; Plöderl & Tremblay, 2015)
In a female adult sample, sexual and physical abuse and parental neglect prior to age 18 were found to mediate the association between sexual minority status and depressive symptoms only when comparing heterosexual to bisexual women; no depression differences were found between heterosexual and lesbian women
A study found some evidence of mediation for parental support but only when comparing bisexual to heterosexual women, as other groups were not found to differ in depression rates
Summary
Systematic reviews have reported that compared to heterosexual people, sexual minority individuals (e.g., those identifying as lesbian, gay, or bisexual) have elevated rates of mental health problems and are as much as four times more likely to attempt suicide (King et al, 2008; Plöderl & Tremblay, 2015). A strong link has been consistently demonstrated. Robust research evidence about the mechanisms through which such disparities come about would be both theoretically and clinically valuable. The identification of intermediate factors that contribute to elevated rates of depression in this population would be instrumental for designing and refining effective prevention programs that would help protect at-risk LGB individuals and developing targeted therapeutic approaches for sexual minority people who experience depression
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