Sexual orientation openness and depression symptoms: A population-based study.

Abstract

Background: Compared to heterosexual individuals, sexual minorities (e.g., those identifying as gay, lesbian, or bisexual) are at higher risk of several mental health problems, including suicidality, substance abuse, depression, and anxiety. Research has attributed much of these elevated risks to unique and chronic stress experiences, so-called minority stress, relating to the stigma and prejudice that many sexual minorities face. Less is known about how sexual minority stigma may function as a multilevel socio-ecological system that includes stigma-related risk factors at various levels, such as the structural (e.g., negative population attitudes and discriminatory laws and policies), interpersonal (e.g., victimization and harassment), and individual level (e.g., internalization of negative societal attitudes and concealment of sexual identity), to drive poor mental health among sexual minorities. Such a socio-ecological system of sexual minority stigma may feature unique characteristics and components, including 1) a chronosystem in which stigma-related factors may vary and exert effects across time, space, and the life course, 2) cross-level effects in which stigma-related factors at one level may give rise to stigma at another level, and 3) mechanisms that explain how stigma-related factors may compromise sexual minorities' mental health. Purpose and aims:The purpose of this Doctor of Philosophy (Ph.D.) thesis was to contribute to the advancement of sexual minorities' mental health equity by furthering the scientific knowledge on the mechanisms underlying sexual orientation-based disparities in mental health. The Ph.D. thesis aimed to do so by 1) advancing theoretical thinking through combing the existing frameworks of minority stress and psychological mediation with socioecological theory, 2) examining mental health disparities by sexual orientation, and 3) testing different elements of a proposed socio-ecology of sexual minority stigma framework.Methods: Cross-sectional individual-level data were used from surveys sent out to sexual minorities living in Sweden, across Europe, and/or with migration backgrounds. The first two of the presented studies used probability-based sampling techniques to identify representative population-based samples, while the other two studies used convenience samples of sexual minorities who lived in, or have moved from, various countries, diverse in structural climates. Data for the latter two studies were combined with objective indicators of structural forms of stigma present in these countries. In all studies, mediation and/or moderation analyses were employed to examine the explanatory or buffering, respectively, mechanisms underlying the associations between stigma-related factors and sexual minority mental health or wellbeing.

Sexual orientation concealment and mental health: A conceptual and meta-analytic review.

“…Only two published studies of sexual orientation concealment and mental health problems have used probability-based sampling, in which all residents of the geographic area of study have equal likelihood of being selected into the sample. The results of these studies-that concealment is associated with fewer mental health problems, at least among some sexual minorities (Pachankis, Cochran, & Mays, 2015;van der Star, Pachankis, & Bränström, 2019)-perhaps contradict the assumption drawn across the more common nonrepresentative sampling approaches-that concealment predicts greater mental health problems (e.g., Jackson & Mohr, 2016). Yet studies relying on nonprobability samples overrepresent the experience of sexual minorities who are relatively out and who are otherwise unrepresentative of the general sexual minority population (e.g., consistently younger; Hottes, Bogaert, Rhodes, Brennan, & Gesink, 2016;Kuyper, Fernee, & Keuzenkamp, 2016).…”

“…Highlighting the importance of probability-based sampling for sexual orientation concealment-related research questions in particular, the two published studies utilizing such sampling find that a sizable proportion (around 10%) of sexual minorities, in both California (Pachankis et al, 2015) and Sweden (van der Star et al, 2019), report completely concealing their sexual orientation from all others. One of these studies found that sexual minority men who have never told another person of their sexual minority status experienced significantly lower odds of major depression than out sexual minority men (Pachankis et al, 2015), whereas the other found that sexual orientation concealment protects against depression for sexual minorities with high social support (van der Star et al, 2019). Population-based studies would likely find that sexual minority individuals living in less-supportive environments are even more likely to conceal their sexual orientation from all others, with potentially distinct pathways to and buffers against mental health problems compared with those living in California and Sweden (Pachankis & Bränström, 2018).…”

How many sexual minorities are hidden? Projecting the size of the global closet with implications for policy and public health

“…[30] Also, the proportion of closeted sexual minorities found in low-stigma countries in the EU-LGBT Survey roughly parallels the proportion of this population found in the only two known population-based surveys of the closet, also conducted in low-stigma contexts (i.e., California and Sweden). [31, 32] Another source of estimation imprecision stems from range restriction in our initial predictor. While highly variable, the range of structural stigma across European countries does not cover the upper limit of structural stigma globally; thus, the validity of our extrapolation outside of the range of European structural stigma is uncertain.…”

The roles of discrimination and social support in the associations between outness and mental health outcomes among sexual minorities.

“…Multiple studies have examined the relationship between outness and depression. Some studies have found that greater outness is associated with lower depressive symptoms (Earle, 2000; Jackson & Mohr, 2016; Kosciw et al, 2012, 2015; Legate et al, 2012; Lehavot & Simoni, 2011; Pachankis, Cochran, et al, 2015; Schrimshaw et al, 2013), whereas other studies have found that greater outness is related to greater depressive symptoms (Pachankis, Cochran, et al, 2015; Pachankis et al, 2020; Riggle et al, 2017; van der Star et al, 2019). Together, these findings suggest that outness may influence mental health through multiple different mechanisms, and that the relationships between outness and mental health may depend on contextual factors.…”