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Social Psychiatry and Psychiatric Epidemiology

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01-06-2019 | Original Paper

Are sociodemographic, lifestyle, and psychosocial characteristics associated with sexual orientation group differences in mental health disparities? Results from a national population-based study

Authors: Evan A. Krueger, Dawn M. Upchurch

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 6/2019

Abstract

Purpose

Sexual minority mental health disparities are well documented. However, distinct sexual minority subgroups are often collapsed into a single “lesbian, gay, or bisexual” (LGB) analytic group. While limited research has shown sexual minority subgroup differences in mental health, little is known about the factors underlying these differences. This study examines whether sociodemographic, lifestyle, and psychosocial characteristics are associated with sexual orientation subgroup differences in mental health.

Methods

Using the National Epidemiologic Survey on Alcohol and Related Conditions, Wave III, differences in various mental health measures, and sociodemographic, lifestyle, and psychosocial characteristics were assessed across three sexual minority subgroups [lesbians/gay men, bisexuals, and heterosexuals reporting same-sex attractions or behaviors (“heterosexual-identified sexual minorities, HSM”)] and heterosexuals reporting only opposite-sex attractions and behaviors (“heterosexuals”). Sequential linear regressions evaluated the degrees to which different factors attenuated mental health (SF-12) disparities between heterosexuals and sexual minority subgroups. Analyses were sex-stratified.

Results

Several sociodemographic, lifestyle, and psychosocial characteristic differences existed between sexual orientation groups. Further, all sexual minority subgroups had lower SF-12 scores than heterosexuals, except lesbian women. Sociodemographic factors attenuated the disparity for bisexual men. Sociodemographic, lifestyle, plus psychosocial factors attenuated the disparity for HSM men. However, sociodemographic, lifestyle, and psychosocial factors partially, but did not fully, attenuate the disparity for gay men, bisexual women, or HSM women.

Conclusions

Different factors are associated with mental health disparities for sexual minority subgroups. To maximize health intervention efforts, additional research is needed to uncover the specific mechanisms contributing to health disparities across diverse sexual minority populations.

Institute of Medicine (2011) The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Institute of Medicine, Washington, D.C.

Ward BW, Dahlhamer JM, Galinsky AM, Joestl SS Among (2014) Sexual Orientation and Health. National Health Interview Survey, 2013, U.S. Adults

Almeida J, Johnson RM, Corliss HL et al (2009) Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. J Youth Adolesc 38:1001–1014. https://doi.org/10.1007/s10964-009-9397-9 CrossRefPubMedPubMedCentral

Marshal MP, Dietz LJ, Friedman MS et al (2011) Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Heal 49:115–123. https://doi.org/10.1016/j.jadohealth.2011.02.005 CrossRef

Russell ST, Fish JN (2016) Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annu Rev Clin Psychol 12:465–487. https://doi.org/10.1146/annurev-clinpsy-021815-093153 CrossRefPubMedPubMedCentral

Bostwick WB, Boyd CJ, Hughes TL, McCabe SE (2010) Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health 100:468–475. https://doi.org/10.2105/AJPH.2008.152942 CrossRefPubMedPubMedCentral

Cochran SD, Sullivan JG, Mays VM (2003) Prevalence of mental disorders, psychological distress, and mental services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol 71:53–61CrossRefPubMedPubMedCentral

King M, Semlyen J, Tai SS et al (2008) A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. https://doi.org/10.1186/1471-244X-8-70 CrossRefPubMedPubMedCentral

Cochran SD, Mays VM (2000) Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. Am J Public Health 90:573–578CrossRefPubMedPubMedCentral

10.

Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129:674–697. https://doi.org/10.1037/0033-2909.129.5.674 CrossRefPubMedPubMedCentral

11.

Hatzenbuehler ML, Pachankis JE (2016) Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin N Am 63:985–997. https://doi.org/10.1016/j.pcl.2016.07.003 CrossRef

12.

Bogart LM, Revenson TA, Whitfield KE, France CR (2014) Introduction to the special section on lesbian, gay, bisexual, and transgender (LGBT) health disparities: where we are and where we’re going. Ann Behav Med 47:1–4. https://doi.org/10.1007/s12160-013-9574-7 CrossRefPubMed

13.

Warburton DER, Nicol CW, Bredin SSD (2006) Health benefits of physical activity: the evidence. Can Med Assoc J 174:801–809CrossRef

14.

Mander T (2012) Better life better health—lifestyle and diet for a healthy future. Menopause Int 18:123–124. https://doi.org/10.1258/mi.2012.012041 CrossRefPubMed

15.

Penedo FJ, Dahn JR (2005) Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry 18:189–193CrossRefPubMed

16.

Saha SP, Bhalla DK, Whayne TF, Gairola C (2007) Cigarette smoke and adverse health effects: an overview of research trends and future needs. Int J Angiol 16:77–83CrossRefPubMedPubMedCentral

17.

Glantz SA, Johnson KC (2014) The surgeon general’s report on smoking and health 50 years later: breast cancer and the cost of increasing caution. Cancer Epidemiol Biomark Prev 23:37–47. https://doi.org/10.1158/1055-9965.EPI-13-1081 CrossRef

18.

Chaiton MO, Cohen JE, Loughlin JO, Rehm J (2009) A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health 9:356. https://doi.org/10.1186/1471-2458-9-356 CrossRefPubMedPubMedCentral

19.

Hatzenbuehler ML, Jun HJ, Corliss HL, Austin SB (2014) Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Ann Behav Med 47:48–56. https://doi.org/10.1007/s12160-013-9548-9 CrossRefPubMedPubMedCentral

20.

Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 80–94

21.

Phelan JC, Link BG, Tehranifar P (2010) Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 51(Suppl):S28–S40. https://doi.org/10.1177/0022146510383498 CrossRefPubMed

22.

Dressler WW, Oths KS, Gravlee CC (2005) Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthropol 34:231–252. https://doi.org/10.1146/annurev.anthro.34.081804.120505 CrossRef

23.

Read JG, Gorman BK (2010) Gender and health inequality. Annu Rev Sociol 36:371–386. https://doi.org/10.1146/annurev.soc.012809.102535 CrossRef

24.

Rieker PP, Bird CE (2005) Rethinking gender differences in health: why we need to integrate social and biological perspectives. J Gerontol 60B:40–47CrossRef

25.

Turner RJ, Avison WR (2003) Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender. J Health Soc Behav 44:488–505CrossRefPubMed

26.

George L, Lynch S (2003) Race differences in depressive symptoms: a dynamic perspective on stress exposure and vulnerability. J Health Soc Behav 44:353–369CrossRefPubMed

27.

Krieger N (2003) Genders, sexes, and health: what are the connections—and why does it matter? Int J Epidemiol 32:652–657. https://doi.org/10.1093/ije/dyg156 CrossRefPubMed

28.

Connell R (2012) Gender, health and theory: conceptualizing the issue, in local and world perspective. Soc Sci Med 74:1675–1683. https://doi.org/10.1016/j.socscimed.2011.06.006 CrossRefPubMed

29.

George LK, Ellison CG, Larson DB (2002) Explaining the relationships between religious involvement and health. Psychol Inq 13:190–200CrossRef

30.

Levin JS (1994) Religion and health: is there an association, is it valid, and is it causal? Soc Sci Med 38:1475–1482CrossRefPubMed

31.

Koenig HG, Larson DB (2001) Religion and mental health: evidence for an association. Int Rev Psychiatry 13:67–78. https://doi.org/10.1080/09540260120037290 CrossRef

32.

Balsam KF, Beauchaine TP, Mickey RM, Rothblum ED (2005) Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family. J Abnorm Psychol 114:471–476. https://doi.org/10.1037/0021-843X.114.3.471 CrossRefPubMed

33.

Koh A, Ross L (2006) Mental health issues: a comparison of lesbian, bisexual and heterosexual women. J Homosex 51:33–57CrossRefPubMed

34.

Saewyc EM, Skay CL, Hynds P et al (2008) Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk? J LGBT Health Res 3:25–36. https://doi.org/10.1300/J463v03n02 CrossRef

35.

Krueger EA, Meyer IH, Upchurch DM (2018) Sexual orientation group differences in perceived stress and depressive symptoms among young adults in the United States. LGBT Health 5:242–249. https://doi.org/10.1089/lgbt.2017.0228 CrossRefPubMedPubMedCentral

36.

Gattis MN, Sacco P, Cunningham-Williams RM (2012) Substance use and mental health disorders among heterosexual identified men and women who have same-sex partners or same-sex attraction: results from the national epidemiological survey on alcohol and related conditions. Arch Sex Behav 41:1185–1197. https://doi.org/10.1007/s10508-012-9910-1 CrossRefPubMedPubMedCentral

37.

Hoy A, London AS (2018) The experience and meaning of same-sex sexuality among heterosexually identified men and women: an analytic review. Sociol Compass. https://doi.org/10.1111/soc4.12596 CrossRef

38.

Talley AE, Aranda F, Hughes TL et al (2015) Longitudinal associations among discordant sexual orientation dimensions and hazardous drinking in a cohort of sexual minority women. J Health Soc Behav 56:225–245. https://doi.org/10.1177/0022146515582099 CrossRefPubMedPubMedCentral

39.

McCabe SE, Matthews AK, Lee JGL et al (2018) Tobacco use and sexual orientation in a national cross-sectional study: age, race/ethnicity, and sexual identity–attraction differences. Am J Prev Med 54:736–745. https://doi.org/10.1016/j.amepre.2018.03.009 CrossRefPubMedPubMedCentral

40.

Carrillo H, Hoffman A (2017) ‘Straight with a pinch of bi’: the construction of heterosexuality as an elastic category among adult US men. Sexualities 21:90–108. https://doi.org/10.1177/1363460716678561 CrossRef

41.

Ward J (2012) Born this way: congenital heterosexuals and the making of heteroflexibility. In: Hines S, Taylor Y (eds) Sexualities: past reflections, future directions. Palgrave Macmillan, London, pp 91–108CrossRef

42.

Silva TJ, Whaley RB (2017) Bud-sex, dude-sex, and heteroflexible men: the relationship between straight identification and social attitudes in a nationally representative sample of men with same-sex attractions or sexual practices. Sociol Perspect 61:426 – 443. https://doi.org/10.1177/0731121417745024 CrossRef

43.

van Anders SM (2015) Beyond sexual orientation: integrating gender/sex and diverse sexualities via sexual configurations theory. Arch Sex Behav 44:1177–1213. https://doi.org/10.1007/s10508-015-0490-8 CrossRefPubMed

44.

Wolff M, Wells B, Ventura-DiPersia C et al (2017) measuring sexual orientation: a review and critique of U.S. data collection efforts and implications for health policy. J Sex Res 54:507–531CrossRefPubMed

45.

Grant BF, Chu A, Sigman R et al (2014) Source and accuracy statement: national epidemiologic survey on alcohol and related conditions-III (NESARC-III). National Institute on Alcohol Abuse and Alcoholism, Rockville, MD

46.

Ware JE, Kosinski M, Keller S (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRefPubMed

47.

Data Notes: National epidemiologic survey on alcohol and related conditions-III (NESARC-III). National Institute on Alcohol Abuse and Alcoholism, Rockville, MD

48.

(2018) Physical activity guidelines: adults. In: Off. Dis. Prev. Heal. Promot. https://health.gov/paguidelines/guidelines/adults.aspx. Accessed 5 July 2017

49.

Cohen S, Mermelstein R, Kamarck T, Hoberman H (1985) Measuring the functional components of social support. In: Social support: theory, research and applications. Springer Dordrecht, pp 73–94CrossRef

50.

Dr. Cohen’s Scales: interpersonal support evaluation list (ISEL). http://www.psy.cmu.edu/~scohen/scales.html

51.

Badgett L, Goldberg NE (2009) Best practices for asking questions about sexual orientation on surveys. The Williams Institute, Los Angeles, CA

52.

Lindley LL, Walsemann KM, Carter JW (2012) The association of sexual orientation measures with young adults’ health-related outcomes. Am J Public Health 102:1177–1185. https://doi.org/10.2105/AJPH.2011.300262 CrossRefPubMedPubMedCentral

53.

Korchmaros JD, Powell C, Stevens S (2013) Chasing sexual orientation: a comparison of commonly used single-indicator measures of sexual orientation. J Homosex 60:596–614. https://doi.org/10.1080/00918369.2013.760324 CrossRefPubMed

54.

Frost DM, Meyer IH, Schwartz S (2016) Social support networks among diverse sexual minority populations. Am J Orthopsychiatry 86:91–102. https://doi.org/10.1037/ort0000117 CrossRefPubMedPubMedCentral

55.

Jackson JS, Knight KM, Rafferty JA (2010) Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health 100:933–939. https://doi.org/10.2105/AJPH.2008.143446 CrossRefPubMedPubMedCentral

56.

Morgan EM (2012) Contemporary Issues in sexual orientation and identity development in emerging adulthood. Emerg Adulthood 1:52–66. https://doi.org/10.1177/2167696812469187 CrossRef

57.

Galupo MP, Davis KS, Grynkiewicz AL, Mitchell RC (2014) Conceptualization of sexual orientation identity among sexual minorities: patterns across sexual and gender identity. J Bisex 14:433–456. https://doi.org/10.1080/15299716.2014.933466 CrossRef

58.

Hatzenbuehler ML, Phelan JC, Link BG (2013) Stigma as a fundamental cause of population health inequalities. Am J Public Health 103:813–821. https://doi.org/10.2105/AJPH.2012.301069 CrossRefPubMedPubMedCentral

Title: Are sociodemographic, lifestyle, and psychosocial characteristics associated with sexual orientation group differences in mental health disparities? Results from a national population-based study
Authors: Evan A. Krueger
Dawn M. Upchurch
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 6/2019
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-018-1649-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Are sociodemographic, lifestyle, and psychosocial characteristics associated with sexual orientation group differences in mental health disparities? Results from a national population-based study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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