Sexual Minority Mental Health Research Articles

Multilevel Sexual Minority Stigma-Based Experiences and Mental Health Among U.S. Sexual Minority Adults: A Socio-Ecological Longitudinal Moderated Mediation Analysis

Abstract Background The current study aimed to longitudinally examine whether intrapersonal stigma (i.e., internalized stigma; identity concealment) mediates the associations between interpersonal stigma (i.e., adulthood and childhood victimization; everyday discrimination; perceived external stigma) and mental health outcomes among sexual minority adults, and as a function of two moderators: structural climate and generation. Methods Data from 600 sexual minorities across three generations (i.e., ages 18-25, 34-42, 48-55) who completed all three waves of the 2016-2019 Generations Study were merged with census division data on legal climate (2016 Human Rights Campaign State Equality Index). A series of three-wave time-lagged simplex moderated mediation models were estimated for each independent and dependent variable combination through two parallel mediators, with both moderators included on each independent-mediator variable pathway. Results Greater identity concealment partially explained the effects of perceived external stigma on greater psychological distress and suicidal ideation, but most strongly among older generations. Other mediation was not supported. Reversed sensitivity analyses revealed how identity concealment’s positive effect on suicidal ideation may be suppressed through lower adulthood victimization and, only among younger generations in higher stigma climates, how it’s positive effects on psychological distress and suicidal ideation may be suppressed through lower everyday discrimination. Conclusions Identity concealment may represent a salient mechanism through which sexual minorities navigate structural climates and the harmful effects of interpersonal stigma on distress and suicidal ideation. While the longitudinal findings provide some support for the cross-level effects of sexual minority stigma on mental health outcomes, further advanced time-lagged examinations are warranted.

Sexual and/or gender minority mental health disparities in adolescence: effects of adverse peer and family experiences

ABSTRACT Research exploring developmental explanations for sexual and/or gender minority (i.e. SGM) mental health disparities often rely on adults’ retrospectively reported childhood adversity, leaving gaps in understanding how childhood adversity affects SGM mental health disparities during critical developmental periods and/or in contemporary youth. We tested the association between 459 12- to 17-year-old Canadian adolescents’ SGM status and mental health (i.e. life satisfaction, internalizing symptoms) and whether this was explained by indirect effects of peer and family adversity. Additionally, we examined developmental differences between early and middle adolescence. SGM status significantly predicted worse mental health. In an adjusted model, indirect effects through peer and family adversity were significant; the previously detected total effect of SGM status on life satisfaction disappeared and the effect on internalizing symptoms lessened. No significant developmental differences were detected. This suggests that mental health disparities are present in contemporary SGM youth and concurrent adverse experiences may underlie these disparities.

Protective and Risk Factors for Suicidal Ideation and Behavior Among Sexual Minority Women in the United States: A Cross-Sectional Study.

Purpose: The purpose of this study was to understand the factors associated with suicidal ideation and behavior and serious suicidal ideation and behavior among sexual minority women (SMW), including resilience, discrimination, mental health, and sociodemographic characteristics. Methods: Web-based surveys were conducted with SMW from across the United States during January-February, 2022 using psychometric valid tools. Bivariate, hierarchical regression, and logistic regression analyses were used to analyze the data. Results: Of 497 participants, 70% were identified as bisexual and 30% as lesbian. The mean scores for anxiety, depression, and stress were significantly higher among bisexual women compared to their lesbian counterparts (p < 0.05). The proportion of serious suicidal ideation and behavior was higher among bisexual women compared to lesbian women (53.9% vs. 41.2%, p = 0.012). Conversely, the mean scores of resilience were lower among bisexual women compared to lesbian women (139.7 ± 33.4 vs. 147.5 ± 33.6, p = 0.024). Lesbian women had nearly 57.4% lower odds of having serious suicidal ideation and behavior as compared to bisexual women (adjusted odds ratio = 0.426; p = 0.023). Experiencing anxiety, depression, victimization distress, and family discrimination distress were positively associated with serious suicidal ideation and behavior, whereas personal resilience and family cohesion were negatively associated with serious suicidal ideation and behavior. Conclusions: Tackling structural inequities such as racism and homophobia remains vital to improving the mental health of SMW. Interventions to strengthen social and familial supports may be particularly impactful, especially at the family level.

Investigating suicide related behaviours across sexual orientation and neighbourhood deprivation levels: A cohort study using linked health administrative data.

There have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on suicide-related behaviours (SRB). Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study aims to investigate the association between sexual minority status and clinical SRB, and examine whether the effect of neighbourhood deprivation differs across sexual orientation. A population-representative survey sample (169,090 respondents weighted to represent 8,778,120 individuals; overall participation rate 75%) was linked to administrative health data in Ontario, Canada to measure SRB-related events (emergency department visits, hospitalizations, and deaths) from 2007 to 2017. Neighbourhood-level deprivation was measured using the Ontario Marginalisation index measure of material deprivation at the dissemination area level. Discrete-time survival analysis models, stratified by sex, tested the effects of neighbourhood deprivation and sexual minority status, while controlling for individual-level covariates. Sexual minority men had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority women had 2.14 times higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: men in the most deprived neighbourhoods (Q5) had 2.01 times higher odds (95% CI 1.38 to 2.92) of SRB compared to those in the least deprived (Q1), while women had 1.75 times higher odds (95% CI 1.28 to 2.40). No significant interactions were observed between sexual minority status and neighbourhood deprivation levels. In both men and women, sexual minority status and neighbourhood deprivation are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have the highest chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.

Hypervigilance: An Understudied Mediator of the Longitudinal Relationship Between Stigma and Internalizing Psychopathology Among Sexual-Minority Young Adults

Hypervigilance is often theoretically invoked as a psychological mechanism linking stigma to internalizing psychopathology among sexual minorities. Empirically, however, hypervigilance is rarely explicitly assessed but is instead commonly conflated with putatively related constructs, including sexual-orientation-related rejection sensitivity and rumination, hindering conceptual and mechanistic understandings of this process. We therefore embedded a hypervigilance measure in a longitudinal, population-based study of 811 Swedish sexual-minority young adults (ages 17–34). Hypervigilance—but neither sexual-orientation-related rejection sensitivity nor rumination, with which it was only weakly correlated ( rs = .23–.24)—uniquely mediated prospective associations between perceived discrimination and internalizing symptoms 2 years later, explaining up to 40% of these effects. Sexual-orientation-related rejection sensitivity and rumination prospectively predicted hypervigilance on these paths. Findings suggest that hypervigilance represents a distinct construct and transdiagnostic mechanism through which stigma-related experiences and processes undermine sexual-minority mental health. We discuss implications for enhancing psychological interventions for sexual minorities by addressing hypervigilance.

Social Anxiety Across Sexual and Gender Identity Subpopulations

Recent research indicates that gay/lesbian identified sexual minority individuals report lower social anxiety than their counterparts who identify as bisexual or indicate an emerging identity label (e.g., queer, pansexual, or asexual). The current study advances the knowledge base by comparing levels of social anxiety across both sexualandgender identity subpopulations in a sexual minority sample residing in the Republic of Ireland. Six hundred two sexual minority adults participated in an online survey in which they completed measures of sociodemographic variables (including sexual and gender identity) and social anxiety. Across gender identity subpopulations, transgender/non-binary individuals were more likely to report elevated social anxiety symptoms than both cisgender men and cisgender women; further, cisgender women were more likely to report elevated social anxiety symptoms than cisgender men. Within each of these gender identity groups, there was no significant difference in odds of elevated social anxiety symptoms across sexual identity subgroups (gay/lesbian, bisexual, and emerging identity) when adjusted for sociodemographic variables. Results highlight the necessity to represent the mental health experiences of diverse sexual minority subpopulations, especially in population-based studies of sexual minority mental health. Additionally, future studies should aim to explore the potentially distinctive and complex social stressors encountered by the diverse groups within the sexual and gender minority population.

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review.

Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa. We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities. We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms. Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence. Research designs of the 98 articles we reviewed included quantitative (n=73), qualitative (n=20), and mixed methods (n=5). Most studies were conducted in Lebanon (n=33), Pakistan (n=32), and Iran (n=23) and focused mainly on gender minority individuals (n=46) and men who have sex with men (n=32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study. Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.

Sexual Minority Identity and Mental Health Among Individuals on the Asexuality Spectrum in China: A Longitudinal Study.

This study examined the association between sexual minority identity and mental health among Chinese asexual individuals. Data were collected in two waves at 12-months intervals, and 156 participants (27 male and 129 female) completed measures of the Asexuality Identification Scale (AIS) and Depression Anxiety Stress Scales at Times 1 and 2. The adjusted version of the Lesbian, Gay, and Bisexual Identity Scale was assessed at Time 1. Participants self-reported as asexual/gray-sexual and pansexual/demi-sexual, and those having an AIS ≥ 40 were classified as being on the asexuality spectrum. Compared with a control sample of lesbian and gay individuals (521 gay and 216 lesbian individuals), asexual individuals reported poorer mental health. Self-reported non-asexual individuals on the asexuality spectrum had a negative minority identity and poorer mental health than self-reported asexual individuals. Participants who changed their asexual orientation scored higher on internalized asexuality-phobia and identity uncertainty than participants maintaining an asexual orientation. At Time 1, acceptance concern, difficult process, and identity uncertainty were associated with poorer mental health. A difficult process was longitudinally associated with poorer mental health. The findings indicate that minority stress was partially related to asexual people's mental health and, for this reason, more asexuality-specific factors should be explored.

A heavy burden: Associations between sexual minority status, mental health, and BMI in women.

Sexual minority women (SMW) are at increased risk of elevated body mass index (BMI) compared to heterosexual women, increasing their vulnerability to chronic diseases. Nonmonosexual SMW appear to be at additional risk for elevated BMI, likely due to unique sexual minority stressors. A total of 437 SMW and heterosexual women completed a cross-sectional, online survey including self-report measures of sexual orientation dimensions, weight, psychological distress, and eating behaviors. We investigated relations among these variables to better understand disparities in self-reported BMI based on sexual orientation and sexual orientation discordance (SOD). SMW self-reported more psychological distress, more binge eating, and higher BMIs than their heterosexual peers, with nonmonosexual groups of SMW often reporting the highest values. SOD was positively associated with psychological distress. SMW-particularly nonmonosexual SMW-are at increased risk for psychological distress, binge eating, and elevated BMI relative to heterosexual peers. Future research should further elucidate mechanisms for these disparities.

Social Determinants of Sexual and Gender Minority Mental Health

Social Determinants of Sexual and Gender Minority Mental Health

Anticipated Sexual Minority Stress and Mental Health after the 2016 Presidential Election: Examining a Psychological Mediation Framework

ABSTRACT Sexual minorities are at an increased risk for psychopathology, compared to heterosexual counterparts, in part due to stressors unique to their sexual minority identity. The greater socio-political climate may exacerbate sexual minority stress, and the context of the 2016 United States presidential election infringed upon the rights and well-being of LGBQ individuals. In our sample of sexual minorities (n = 253), we examined the association between anticipated stigma in response to the 2016 presidential election and symptoms of anxiety and depression, and the potential mediating role of self-compassion, hopelessness and social support. Greater anticipated stigma was associated with less self-compassion, less perceived social support, and greater hopelessness, and, in turn, greater symptoms of anxiety and depression. Anticipated stigma may erode feelings of environmental support and may be internalized as negative views of the self and future. From a public health perspective, policy-makers should be aware that the discussion and/or enactment of policies which discriminate against LGBQ persons may negatively impact mental health. Clinically, bolstering self-compassion and interpersonal functioning, and targeting hopelessness, through strategies such as Acceptance and Commitment Therapy and Compassion-Focused Therapy, may buffer the impact of minority stress among sexual minorities.

Family Rejection during COVID-19: Effects on Sexual and Gender Minority Stress and Mental Health among LGBTQ University Students

This study examines the relationship between family rejection and moderate to severe psychological distress during COVID-19 among LGBTQ university students. Data were obtained from a national cross-sectional electronic survey of LGBTQ university students (N = 565) collected in the summer of 2020. Hierarchical logistic regression models were used to examine the predictive association between increased family rejection and moderate to severe psychological distress. Respondents who reported increased rejection were more than twice as likely to report moderate to severe psychological distress, with social isolation and LGBTQ identity concealment being significant covariate predictors in the model. These results demonstrate the importance of public health, medical, mental health, and higher education stakeholders understanding the significance of LGBTQ-identity related family rejection when addressing the mental health and well-being of LGBTQ young people.

Problematic Smartphone Use and Its Associations with Sexual Minority Stressors, Gender Nonconformity, and Mental Health Problems among Young Adult Lesbian, Gay, and Bisexual Individuals in Taiwan.

Smartphones are a necessity for many people; however, problematic smartphone use (PSU) may negatively influence people’s mental health. Using multivariate linear regression analysis, the study examined the associations of sexual minority stressors [namely perceived sexual stigma from family members, sexual orientation microaggressions (SOMs), and internalized sexual stigma] and gender nonconformity with PSU severity as well as the associations of PSU with depression and anxiety in young adult lesbian, gay, and bisexual (LGB) individuals. This cross-sectional survey study recruited 1000 young adult LGB individuals (500 men and 500 women). PSU severity was assessed using the Smartphone Addiction Inventory. The experiences of perceived sexual stigma from family members, SOMs, and internalized sexual stigma and the levels of gender nonconformity, depression, and anxiety were assessed. The results indicated that perceived sexual stigma from family members, SOMs, internalized sexual stigma in the dimensions of social discomfort and identity and gender nonconformity were significantly associated with PSU severity in LGB individuals. Moreover, PSU was significantly associated with depression and anxiety in LGB individuals. The findings highlight the significance of developing strategies for the prevention and early detection of PSU and sexual minority stress in LGB individuals.

Complicating Narratives of Sexual Minority Mental Health: An Intersectional Analysis of Frequent Mental Distress at the Intersection of Sexual Orientation, Gender Identity, and Race/Ethnicity

Purpose: Research indicates that sexual minority populations experience mental health inequities. However, few studies have examined mental health outcomes in sexual minority populations while including intersecting dimensions of social identity. This study had two objectives: (1) to quantify the prevalence of frequent mental distress among U.S. adults across intersecting social identity categories and (2) to evaluate the contribution of intersectional interactions to observed inequities. Methods: Using data from the Behavioral Risk Factor Surveillance System 2014-2019 (N = 1,024,261), we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA). Participants were nested in 45 intersectional groups defined by combining 3 sexual orientation (gay/lesbian, bisexual, and heterosexual), 5 gender identity (transgender women, transgender men, gender nonconforming, cisgender women, and cisgender men), and 3 racial/ethnic (non-Hispanic Black, Hispanic/Latinx, and non-Hispanic White) categories. We estimated the predicted probability of frequent mental distress for each stratum. We then calculated the variance partition coefficient (VPC) and proportional change in variance (PCV). Results: We found that multiply marginalized groups tended to have the highest prevalence of frequent mental distress. Groups with racial/ethnic minority individuals were equally represented among low- and high-prevalence groups. The VPC indicated that slightly over 10% of observed variance in prevalence was attributable to group-level differences, while the PCV revealed that a small but meaningful amount of observed heterogeneity in prevalence was due to intersectional interactions between the dimensions of social identity. Conclusion: I-MAIHDA is a promising method for examining the patterning of sexual orientation-based mental health inequities at the population level.

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Images Sean P. Murphy (bio) [End Page 142] Click for larger view View full resolution IMAGE: DIALECTICAL MATERIALISM, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 143] Click for larger view View full resolution FORMALISM, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 3] Click for larger view View full resolution NEW HISTORICISM, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 89] Click for larger view View full resolution DECONSTRUCTION, 2022 Acrylic paint on wood 8 x 8 x 1 inches [End Page 141] Sean P. Murphy Sean P. Murphy, PhD, MSN, PMHNPBC, is a Clinical Assistant Professor teaching in the University of Illinois Chicago's Psychiatric-Mental Health Nurse Practitioner doctoral program. He practices at university health and counseling centers, specializing in sexual and gender minority mental health, emerging adult populations, and trauma. Murphy holds a PhD in Literature, Cultural Theory, and Social Practice and was a tenured professor of English and Humanities prior to entering nursing. He uses visual art as a space to digest and metabolize emotions associated with clinical practice as well as to explore connections between the humanities, literary and critical theories, and science. Email: sean@murphynp.com Copyright © 2023 Cornell University

23.2 LGBTQ FAMILIES AND THE U.S. SUPREME COURT

This session aims to review the literature on how the Supreme Court of the United States (SCOTUS) decisions have impacted the mental health of LGBTQ families and the upcoming cases that may impact LGBTQ families, and to provide practical clinical recommendations on how to support families with the impact of these decisions. The peer-reviewed literature on the impact of recent SCOTUS decisions on LGBTQ mental health will be reviewed and discussed. Transcripts from oral arguments from recent cases were reviewed (Fulton v The City of Philadelphia, Obergefell v Hodges, Employment Division v Smith, Bostock v Clayton County), along with published commentary by constitutional scholars. In 2015, SCOTUS established marriage equality with its decision in Obergefell v Hodges. Marriage equality for sexual minority people has resulted in decreased mental healthcare visits and lower suicide attempt rates. These outcomes are thought to be secondary to broad cultural impacts on society’s views of homosexuality. Conversely, policies that limit LGBTQ civil rights, including those that permit the denial of services to LGBTQ people, have been linked to adverse mental health outcomes. SCOTUS recently heard oral arguments in Fulton v The City of Philadelphia, a case examining an organization’s right to refuse adoption screening services to LGBTQ people on the basis of religious beliefs. A case permitting such denial of services, based on extant literature, would be expected to result in worsening mental health outcomes for LGBTQ people. Past court precedent relevant to the case, including Employment Division v Smith, will be discussed. Recent changes in the court’s composition and their implications for this case and potential future cases will be discussed. The mental health impact of these cases will be discussed through the minority stress framework, and practical recommendations for supporting LGBTQ families in this regard will be reviewed. Public policies and related SCOTUS decisions have profound public health impacts in the realm of sexual minority mental health. These decisions have important implications for LGBTQ families, and clinicians should be aware of these implications and strategies to mitigate adverse impacts on mental health.

Development and Validation of Two Abbreviated Intraminority Gay Community Stress Scales.

Social stressors stemming from within the gay community might render gay and bisexual men vulnerable to mental health problems. The 20-item intraminority Gay Community Stress Scale (GCSS) is a reliable measure of gay community stress, but the scale's length limits its widespread use in sexual minority mental health research. Using three independent samples of gay and bisexual men, the present research developed two abbreviated versions of the GCSS using nonparametric item response modeling and validated them. Results indicated that eight items provided maximal information about the gay community stress construct; these items were selected to form the eight-item GCSS. The eight-item GCSS reproduced the factor structure of the parent scale, and gay community stress scores obtained from it correlated with other identity-specific social stress constructs and mental health symptoms. Associations between gay community stress and mental health symptoms remained significant even after controlling for related identity-specific stressors, general life stress, and relevant demographics. A four-item version was also developed and assessed, showing good structural, convergent, criterion, and incremental validity and adequate reliability. The eight- and four-item versions of the GCSS offer efficient measures of gay community stress, an increasingly recognized source of stress for gay and bisexual men.

Book Review: The Oxford handbook of sexual and gender minority mental health

Book Review: The Oxford handbook of sexual and gender minority mental health

The Role of Implementation Science in Reducing Sexual and Gender Minority Mental Health Disparities.

Owing to multiple and multilevel ecological factors, sexual and gender minority (SGM) populations exhibit persistent mental health disparities. SGM populations are also at increased risk for never being reached by evidence-based mental health care in real-world settings, which is essential for reducing these disparities. To be maximally effective in reducing these disparities, we must strive to bring our research findings into routine clinical care quickly. Implementation science can help SGM health researchers achieve this goal. This perspective outlines how researchers can use implementation science theories and methods to reduce SGM mental health disparities more efficiently and more durably.

Preteen Behaviors and Sexual Orientation of High School Students Who Report Depressive Symptoms, United States, 2015-2017.

Unhealthy preteen behaviors are associated with adolescent depression. However, little is known about preteen factors among sexual minority young people, a group at increased risk for teen depression and suicide. We completed weighted multivariate logistic regression analyses on data from the national 2015 and 2017 Youth Risk Behavior Survey of 30 389 high school students in the United States. Preteen sex, cigarette smoking, and alcohol and marijuana use were significantly more prevalent among lesbian, gay, or bisexual (LGB) and questioning students who reported depressive symptoms than among their heterosexual peers (adjusted prevalence ratio [APR] range, 1.33-2.34; all significant at P < .05). The only exception was that marijuana use among questioning students was not significantly different from use among heterosexual peers (APR = 1.34; P = .11). Assessment of preteen sex and substance use-especially among LGB and questioning young people, who are more prone to depressive symptoms and more likely to initiate risky preteen behaviors than their heterosexual counterparts-will facilitate a life course approach to sexual minority mental health that should begin by early adolescence.