Mental Health Disparities Mediating Increased Risky Sexual Behavior in Sexual Minorities: A Twin Approach

Abstract

Increased risky sexual behavior in sexual minorities relative to heterosexual individuals may be partly explained by mental health disparities, and both factors may be further jointly influenced by common genetic and environmental factors. However, these relationships have not been previously investigated. The objectives of the present study were to investigate mental health disparities as a mediator of the relationship between sexual orientation and risky sexual behavior, controlling for genetic and environmental effects in this relationship and testing for sex differences. Participants included 5814 twins from a Finnish twin cohort. Specified latent factors included sexual orientation, mental health indicators, and risky sexual behavior. Twin models were fitted to the factor structure of the data whereby a Cholesky decomposition on the factors was compared to a mediation submodel using OpenMx. Sex differences were tested in the final model. Phenotypically, mental health disparities partially mediated the relationship between sexual orientation and increased risky sexual behavior, with comparable effects in males and females. However, while this indirect route from sexual orientation to risky sexual behavior mainly contained transmitted genetic effects in males, there was a significant proportion of transmitted shared environmental effects in females. This is the first study to demonstrate that the mediation relationships between sexual orientation, mental health disparities, and risky sexual behavior are not confounded by genetic and environmental factors. The significant sex differences need to be recognized in future research and intervention design to improve sexual health in sexual minorities.

Do psychosocial factors mediate sexual minorities’ risky sexual behaviour? A twin study.

“…Consistent with previous literature, nonheterosexuality was associated with increased risky sexual behavior indicated by lifetime sexual partners in the present study (Bränström & Pachankis, 2018;Charlton et al, 2011), psychosocial adversity (depressive and anxiety symptoms, early life adversities, and intimate partner violence) and substance use (King et al, 2008;Roberts et al, 2012;Rollè et al, 2018). Using a reduced factor structure, we replicated the finding from a previous study (Oginni et al, 2020) whereby mental health indicators partly mediated increased risky sexual behavior among sexual minority men and women. Our findings demonstrated that two mediation paths, through a separate substance use factor and in combination with increased psychosocial adversity, explained a larger proportion of the higher lifetime sexual partners among sexual minorities, especially women.…”

“…To our knowledge, only one population-based study has investigated this possibility. Using a twin sample, mental health disparities were shown to mediate ten percent of the higher risky sexual behavior among sexual minorities (Oginni et al, 2020). By incorporating the genetic information from the sample (i.e., comparing similarities in identical and nonidentical twins), it was further shown that in contrast to previous findings indicating genetic correlations between sexual orientation, psychosocial factors, and risky sexual behavior including higher lifetime sexual partners (Ganna et al, 2019;Zietsch et al, 2010Zietsch et al, , 2012, this mediation relationship was not confounded by correlated (or overlapping) etiological genetic and individual-specific environmental influences.…”

“…Similarly, individual-specific environmental correlations may be interpreted as reflecting simultaneous effects of nonfamilial factors on sexual orientation and adverse health outcomes. However, Oginni et al (2020) demonstrated that these etiological (genetic and environmental) correlations are best understood as being transmitted through the mediation paths rather than reflecting true pleiotropy. This finding indicates the potential that the observed mediation relationships can be elaborated, targeted for further intervention, and psychosocial disparities completely eliminated.…”

“…However, despite recognized associations between psychosocial adversities and risky sexual behavior (Stall et al, 2003; Tsai & Burns, 2015), Oginni et al (2020) did not include social adversity variables in their analytic model. Furthermore, they did not investigate the possibility that substance use represents a distinct factor as suggested by previous research (Halkitis et al, 2013).…”

“I Do Not Like Being Me”: the Impact of Self-hate on Increased Risky Sexual Behavior in Sexual Minority People

“…Despite the efforts to identify these factors that can explain elevated RSB rates in sexual minority people, few studies have investigated the disparities in correlates and predictors of RSB of sexual minority people compared to heterosexual people. Indeed, Oginni et al (2020) showed that mental health disparities mediated the impact of sexual orientation on RSB, and both externalizing disorders (e.g., alcohol and substance use) and internalizing disorders (e.g., depressive symptoms and anxiety) were higher in non-heterosexual individuals (King et al, 2008;Plöderl & Tremblay, 2015).…”