Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T03:24:37.208Z Has data issue: false hasContentIssue false
  • English
  • Français

The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples

Published online by Cambridge University Press:  17 February 2021

Alexandra Pitman Open the ORCID record for Alexandra Pitman [Opens in a new window] ,
Louise Marston Open the ORCID record for Louise Marston [Opens in a new window] ,
Gemma Lewis Open the ORCID record for Gemma Lewis [Opens in a new window] ,
Joanna Semlyen Open the ORCID record for Joanna Semlyen [Opens in a new window] ,
Sally McManus Open the ORCID record for Sally McManus [Opens in a new window]  and
Michael King
Alexandra Pitman*
Affiliation:
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
Louise Marston
Affiliation:
UCL Research Department of Primary Care and Population Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
Gemma Lewis
Affiliation:
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
Joanna Semlyen
Affiliation:
Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
Sally McManus
Affiliation:
NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK School of Health Sciences, City University, Northampton Square, London, EC1V 0HB, UK
Michael King
Affiliation:
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
*
Author for correspondence: Alexandra Pitman, E-mail: a.pitman@ucl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Evidence on inequalities in mental health in lesbian, gay, and bisexual people arises primarily from non-random samples.

Aims

To use a probability sample to study change in mental health inequalities between two survey points, 7 years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification.

Methods

We analysed data from 10 443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), hazardous alcohol use, and illicit drug use. Multivariable models were adjusted for age, gender, and economic factors, adding interaction terms for survey year, age, gender, childhood sexual abuse, and religious identification. We explored bullying and discrimination as mediators.

Results

Inequalities in risks of CMD or substance misuse were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people [adjusted odds ratio (AOR) = 2.86; 95% CI 1.83–4.46], and to report alcohol misuse and illicit drug use. When adjusted for bullying, odds of CMD remained elevated only for bisexual people (AOR = 3.21; 95% CI 1.64–6.30), whilst odds of alcohol and drug misuse were unchanged. When adjusted for discrimination, odds of CMD and alcohol misuse remained elevated only for bisexual people (AOR = 2.91; 95% CI 1.80–4.72; and AOR = 1.63; 95% CI 1.03–2.57 respectively), whilst odds of illicit drug use remained unchanged. There were no interactions with age, gender, childhood sexual abuse, or religious identification.

Conclusions

Mental health inequalities in non-heterosexuals have not narrowed, despite increasing societal acceptance. Bullying and discrimination may help explain the elevated rate of CMD in lesbian women and gay men but not in bisexual people.

Keywords

DiscriminationinequalitiesLGBmental healthminority stresssexual minorities
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3402 - 3411
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amos, R., Manalastas, E. J., White, R., Bos, H., & Patalay, P. (2019). Mental health, social adversity, and health-related outcomes in sexual minority adolescents: A contemporary national cohort study. The Lancet Child & Adolescent Health, 4(1), 36–45.CrossRefGoogle ScholarPubMed
Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5), 688–696.CrossRefGoogle ScholarPubMed
Baboor, T., Higgins-Biddle, J., Saunders, J., & Monteiro, M. (2001). AUDIT: The alcohol use disorders identification test – guidelines for Use in primary care. Geneva: WHO.Google Scholar
Balsam, K., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology 73, 477–487.CrossRefGoogle ScholarPubMed
Bebbington, P. E., Jonas, S., Brugha, T., Meltzer, H., Jenkins, R., Cooper, C., … McManus, S. (2011). Child sexual abuse reported by an English national sample: Characteristics and demography. Social Psychiatry and Psychiatric Epidemiology 46, 255–262.CrossRefGoogle ScholarPubMed
Berner, M. M., Kriston, L., Bentele, M., & Harter, M. (2007). The alcohol use disorders identification test for detecting at-risk drinking: A systematic review and meta-analysis. Journal of Studies on Alcohol and Drugs 68, 461–473.CrossRefGoogle ScholarPubMed
Blosnich, J. R., Farmer, G. W., Lee, J. G. L., Silenzio, V. M. B., & Bowen, D. J. (2014). Health inequalities among sexual minority adults: Evidence from ten U.S. States, 2010. American Journal of Preventive Medicine 46, 337–349.CrossRefGoogle ScholarPubMed
Bouris, A., Guilamo-Ramos, V., Pickard, A., Shiu, C., Loosier, P. S., Dittus, P., … Michael, W. J. (2010). A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. The Journal of Primary Prevention 31, 273–309.CrossRefGoogle ScholarPubMed
Bristowe, K., Hodson, M., Wee, B., Almack, K., Johnson, K., Daveson, B. A., … Harding, R. (2018). Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSC are national qualitative interview study. Palliative Medicine, 32(1), 23–35.CrossRefGoogle Scholar
Brooks, H., Llewellyn, C. D., Nadarzynski, T., Pelloso, F. C., De Souza Guilherme, F., Pollard, A., & Jones, C. J. (2018). Sexual orientation disclosure in health care: A systematic review. British Journal of General Practice 68, e187.CrossRefGoogle ScholarPubMed
Brugha, T. S., & Cragg, D. (1990). The list of threatening experiences: The reliability and validity of a brief life events questionnaire. Acta Psychiatrica Scandinavica 82, 77–81.CrossRefGoogle ScholarPubMed
Capistrant, B. D., & Nakash, O. (2019). Suicide risk for sexual minorities in middle and older age: Evidence from the national survey on drug use and health. The American Journal of Geriatric Psychiatry 27, 559–563.CrossRefGoogle ScholarPubMed
Carr, S. (2014). Social care for marginalised communities: Balancing self-organisation, micro-provision and mainstream support. Policy Paper 18, 12.Google Scholar
Chakraborty, A., McManus, S., Brugha, T. S., Bebbington, P., & King, M. (2011). Mental health of the non-heterosexual population of England. British Journal of Psychiatry, 198(2), 143–148.CrossRefGoogle ScholarPubMed
Diamond, L. M. (2015). Sexual fluidity. In Whelehan, P. & Bolin, A. (Eds.), The international encyclopedia of human sexuality (p. 1198). Hoboken, New Jersey, NY: Wiley.Google Scholar
Dunlop, B. J., Hartley, S., Oladokun, O., & Taylor, P. J. (2020). Bisexuality and Non-suicidal self-injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk. Journal of Affective Disorders 276, 1159–1172.CrossRefGoogle Scholar
El-Khoury, F., Heron, M., Van der Waerden, J., Leon, C., du Roscoat, E., Velter, A., … Sitbon, A. (2020). Verbal victimisation, depressive symptoms, and suicide risk among sexual minority adults in France: Results from the nationally-representative 2017 health barometer survey. Social Psychiatry and Psychiatric Epidemiology 55, 1073–1080.CrossRefGoogle ScholarPubMed
Elliott, M. N., Kanouse, D. E., Burkhart, Q., Abel, G. A., Lyratzopoulos, G., Beckett, M. K., … Roland, M. (2015). Sexual minorities in England have poorer health and worse health care experiences: A national survey. Journal of General Internal Medicine, 30(1), 9–16.CrossRefGoogle ScholarPubMed
Erlangsen, A., Drefahl, S., Haas, A., Bjorkenstam, C., Nordentoft, M., & Andersson, G. (2020). Suicide among persons who entered same-sex and opposite-sex marriage in Denmark and Sweden, 1989–2016: A binational, register-based cohort study. Journal of Epidemiology and Community Health, 74, 78–83.CrossRefGoogle ScholarPubMed
Ewing, V., Stukas, A. A., & Sheehan, E. P. (2003). Student prejudice against gay male and lesbian lecturers. The Journal of Social Psychology 143, 569–579.CrossRefGoogle ScholarPubMed
Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and health. Current Sexual Health Reports, 9(1), 42–49.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Horwood, L. J., Ridder, E. M., & Beautrais, A. L. (2005). Sexual orientation and mental health in a birth cohort of young adults. Psychological Medicine, 35(7), 971–981.CrossRefGoogle Scholar
Fredriksen-Goldsen, K. I., Emlet, C. A., Kim, H., Muraco, A., Erosheva, E. A., Goldsen, J., … Hoy-Ellis, C. P. (2013). The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors. The Gerontologist, 53(4), 664–675.CrossRefGoogle ScholarPubMed
Gallagher, M., Prinstein, M. J., Simon, V., & Spirito, A. (2014). Social anxiety symptoms and suicidal ideation in a clinical sample of early adolescents: Examining loneliness and social support as longitudinal mediators. Journal of Abnormal Child Psychology 42, 871–883.CrossRefGoogle Scholar
Government Equalities Office (2018). National LGBT Survey: Research Report. Report number: GEO – RR001.Google Scholar
Gower, A. L., Forster, M., Gloppen, K., Johnson, A. Z., Eisenberg, M. E., Connett, J. E., & Borowsky, I. W. (2018). School practices to foster LGBT-supportive climate: Associations with adolescent bullying involvement. Prevention Science 19, 813–821.CrossRefGoogle ScholarPubMed
Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin 135, 707–730.CrossRefGoogle ScholarPubMed
Hatzenbuehler, M. L. (2017). The influence of state laws on the mental health of sexual minority youth. JAMA Pediatrics 171, 322–324.CrossRefGoogle ScholarPubMed
Hatzenbuehler, M. L., O'Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2011). Effect of same-sex marriage laws on health care Use and expenditures in sexual minority men: A quasi-natural experiment. American Journal of Public Health 102, 285–291.CrossRefGoogle Scholar
Hayes, J., Chakraborty, A. T., McManus, S., Bebbington, P., Brugha, T., Nicholson, S., & King, M. (2012). Prevalence of same-sex behavior and orientation in England: Results from a national survey. Archives of Sexual Behavior 41, 631–639.CrossRefGoogle ScholarPubMed
House of Commons: Women and Equalities Committee. (2019). Health and Social Care and LGBT Communities: First Report of Session 2019.Google Scholar
Hudson-Sharp, N., & Metcalf, H. (2016). Inequality among lesbian, gay bisexual and transgender groups in the UK: a review of evidence. National Institute of Economic and Social Research.Google Scholar
Irish, M., Solmi, F., Mars, B., King, M., Lewis, G., Pearson, R. M., … Lewis, G. (2019). Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: A population-based cohort study. The Lancet Child & Adolescent Health 3, 91–98.CrossRefGoogle Scholar
King, M., Semlyen, J., Tai, S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8, 70.CrossRefGoogle ScholarPubMed
Lewis, G., Pelosi, A. J., Araya, R., & Dunn, G. (1992). Measuring psychiatric disorder in the community: A standardized assessment for use by lay interviewers. Psychological Medicine, 22(2), 465–486.CrossRefGoogle ScholarPubMed
Lucassen, M., Stasiak, K., Samra, R., Frampton, C., & Merry, S. N. (2017). Sexual minority youth and depressive symptoms or depressive disorder: A systematic review and meta-analysis of population-based studies. Australian & New Zealand Journal of Psychiatry 51, 774–787.CrossRefGoogle ScholarPubMed
MacCarthy, S., Saunders, C. L., & Elliott, M. N. (2020). Increased reporting of sexual minority orientation from 2009 to 2017 in England and implications for measuring sexual minority health disparities. LGBT Health 7, 393–400.CrossRefGoogle ScholarPubMed
Maycock, P., Bryan, A., Carr, N., & Kitching, K. (2009). Supporting LGBT lives: a study of the mental health and well-being of lesbian, gay, bisexual and transgender people. Gay and Lesbian Equality Network (GLEN) and BeLonG to Youth Service.Google Scholar
Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health 91, 1869–1876.CrossRefGoogle ScholarPubMed
McManus, S., Bebbington, P., Jenkins, R., Brown, L., Collinson, D., & Brugha, T. (2020). Data resource profile: Adult psychiatric morbidity survey (APMS). International Journal of Epidemiology, 49(2), 361–362.CrossRefGoogle ScholarPubMed
McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. NHS Digital: Leeds.Google Scholar
McManus, S., Gunnell, D., Cooper, C., Bebbington, P. E., Howard, L. M., Brugha, T., … Appleby, L. (2019). Prevalence of non-suicidal self-harm and service contact in England, 2000–14: Repeated cross-sectional surveys of the general population. The Lancet Psychiatry 6, 573–581.CrossRefGoogle ScholarPubMed
McManus, S., Meltzer, H., Brugha, T., Bebbington, P., & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007. Results of a household survey. pp. 1–141. The Health and Social Care Information Centre; National Centre for Social Research; A survey carried out for The NHS Information Centre for health and social care by the National Centre for Social Research: Leeds.Google Scholar
McManus, S., Turley, C., & Lubian, K. (2019c). Suicide and self-harm in Britain: researching risk and resilience. In (ed. NatCen Research Report), NatCen Social Research: London.Google Scholar
Meader, N., & Chan, M. (2017). Sexual orientation and suicidal behaviour in young people. British Journal of Psychiatry, 211(2), 63–64.CrossRefGoogle ScholarPubMed
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior. 36, 38–56.CrossRefGoogle ScholarPubMed
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin 129, 674–697.CrossRefGoogle ScholarPubMed
Ministry of Housing Communities and Local Government. (2014). Index of Multiple Deprivation 2004. https://data.gov.uk/dataset/59599787-bd50-4500-a409-fc586260dbbd/index-of-multiple-deprivation-2004.Google Scholar
Miranda-Mendizabal, A., Castellvi, P., Pares-Badell, O., Almenara, J., Alonso, I., Blasco, M. J., … Alonso, J. (2017). Sexual orientation and suicidal behaviour in adolescents and young adults: Systematic review and meta-analysis. British Journal of Psychiatry, 211(2), 77–87.CrossRefGoogle Scholar
NatCen (2019). Relationships and gender identity. In British Social Attitudes 36, NatCen: London.Google Scholar
Office for National Statistics (ONS) (2014). Sexual identity guidance and project. https://www.ons.gov.uk/methodology/classificationsandstandards/sexualidentityguidanceandprojectdocumentation.Google Scholar
Office for National Statistics (ONS) (2020). Sexual orientation, UK: 2018.Google Scholar
Oginni, O. A., Robinson, E. J., Jones, A., Rahman, Q., & Rimes, K. A. (2019). Mediators of increased self-harm and suicidal ideation in sexual minority youth: A longitudinal study. Psychological Medicine, 49(15), 2524–2532.CrossRefGoogle ScholarPubMed
Orel, N. A. (2014). Investigating the needs and concerns of lesbian, gay, bisexual, and transgender older adults: The use of qualitative and quantitative methodology. Journal of Homosexuality 61, 53–78.CrossRefGoogle ScholarPubMed
Parameshwaran, V., Cockbain, B. C., Hillyard, M., & Price, J. (2017). Is the lack of specific lesbian, Gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice Among UK medical students. Journal of Homosexuality 64, 367–381.CrossRefGoogle ScholarPubMed
Patalay, P., & Gage, S. H. (2019). Changes in millennial adolescent mental health and health-related behaviours over 10 years: A population cohort comparison study. International Journal of Epidemiology 48, 1650–1664.CrossRefGoogle Scholar
Ploderl, M., & Tremblay, P. (2015). Mental health of sexual minorities. A systematic review. International Review of Psychiatry 27, 367–385.CrossRefGoogle ScholarPubMed
Pride in Diversity (2016). http://www.pid-awei.com.au/content/uploads/2016/08/AWEI_SurveyReport_20161.pdf.Google Scholar
Proujansky, R. A., & Pachankis, J. E. (2014). Toward formulating evidence-based principles of LGB-affirmative psychotherapy. Pragmatic Case Studies in Psychotherapy: PCSP 10, 117–131.CrossRefGoogle ScholarPubMed
Raifman, J., Moscoe, E., Austin, S. B., Hatzenbuehler, M. L., & Galea, S. (2018). Association of state laws permitting denial of services to same-sex couples with mental distress in sexual minority adults: A difference-in-difference-in-differences analysis. JAMA Psychiatry 75, 671–677.CrossRefGoogle ScholarPubMed
Remafedi, G., Resnick, M., Blum, R., & Harris, L. (1992). Demography of sexual orientation in adolescents. Pediatrics 89, 714.CrossRefGoogle ScholarPubMed
Robinson, J. P., Espelage, D. L., & Rivers, I. (2013). Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics 131, 423.CrossRefGoogle ScholarPubMed
Ross, L. E., Salway, T., Tarasoff, L. A., MacKay, J. M., Hawkins, B. W., & Fehr, C. P. (2018). Prevalence of depression and anxiety among bisexual people compared to Gay, lesbian, and heterosexual individuals: A systematic review and meta-analysis. The Journal of Sex Research 55, 435–456.CrossRefGoogle ScholarPubMed
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, Gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465–487.CrossRefGoogle ScholarPubMed
Semlyen, J., King, M., Varney, J., & Hagger-Johnson, G. (2016). Sexual orientation and symptoms of common mental disorder or low wellbeing: Combined meta-analysis of 12 UK population health surveys. BMC Psychiatry 16, 67.CrossRefGoogle ScholarPubMed
Shahab, L., Brown, J., Hagger-Johnson, G., Michie, S., Semlyen, J., West, R., & Meads, C. (2017). Sexual orientation identity and tobacco and hazardous alcohol use: Findings from a cross-sectional English population survey. BMJ Open 7, e015058.CrossRefGoogle ScholarPubMed
Spittlehouse, J. K., Boden, J. M., & Horwood, L. J. (2020). Sexual orientation and mental health over the life course in a birth cohort. Psychological Medicine, 50(8), 1348–1355.CrossRefGoogle ScholarPubMed
Stonewall (2017a). https://www.stonewall.org.uk/lgbt-britain-hate-crime-and-discrimination.Google Scholar
Stonewall (2017b). School Report: The experiences of lesbian, gay, bi and trans pupils in Britain's schools.Google Scholar
Ward, R., Pugh, S., & Price, E. (2010). Don't look back? Improving health and social care service delivery for older LGB users. Equality and Human Rights Commission.Google Scholar
Westefeld, J. S., Maples, M. R., Buford, B., & Taylor, S. (2001). Gay, lesbian, and bisexual college students: The relationship between sexual orientation and depression, loneliness, and suicide. Journal of College Student Psychotherapy 15, 71–82.CrossRefGoogle Scholar
Supplementary material: File

Pitman et al. supplementary material

Tables S1-S5

Download Pitman et al. supplementary material(File)
File 24.3 KB