The Mental Health of Lesbian, Gay, and Bisexual Adults Compared With Heterosexual Adults: Results of Two Nationally Representative English Household Probability Samples
Evidence on inequalities in mental health in lesbian, gay, and bisexual adults arises primarily from non-random samples.
To use a probability sample to study change in mental health inequalities between two survey points, seven years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification.
This study analyzed data from 10,443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), heavy 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. The study explored bullying and discrimination as mediators.
Inequalities in risks of CMD or substance use problems were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people, and to report alcohol use problems and illicit drug use.
When adjusted for bullying, odds of CMD remained elevated only for bisexual people, whilst odds of alcohol and other drug use problems were unchanged.
When adjusted for discrimination, odds of CMD and alcohol use problems remained elevated only for bisexual people, whilst odds of illicit drug use remained unchanged.
There were no interactions with age, gender, childhood sexual abuse, or religious identification.
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.
Research in context
The study found that,
- The prevalence of depression and anxiety disorders among bisexual people was 40%, and for lesbian and gay people it was 28%, which was significantly higher than that for heterosexuals at 16%.
- Similarly, illicit drug use was highest among bisexual people, at 37%, while for lesbian and gay people it was 25% and heterosexuals, at 10.5%.
- Alcohol use problems were highest in lesbian and gay people, at 37%, compared with bisexual people at 31%, and heterosexuals, at 24%.
Given the findings of the study, the researchers are calling for Government action to ensure equity in health and social care services. They highlight the need for improved awareness among health professionals regarding the mental health needs of sexual minority groups.
The authors are calling for policies that improve societal understanding, starting with encouraging schools to intervene earlier to encourage tolerant attitudes towards sexual minorities across the whole school community.
What this study highlights is the significant and ongoing disparity in mental health between LGB people and heterosexual people, as evidenced by higher levels of mental health problems and alcohol and [other] drug [problems],” said Dr. Alexandra Pitman, lead author of the study from UCL Psychiatry, as per Eureka Alert.Dr. Alexandra Pitman, study lead author, UCL Psychiatry
The authors recommend following action:
- Ensure that health and social care professionals are better trained to identify and care for the wellbeing and mental health needs of sexual minority groups,
- Secondary schools must implement policies and practices that create supportive environments for sexual minority students, including providing (and actively promoting) access to a member of staff who is a designated minorities contact person, who students can talk to in confidence about experiences of discrimination, bullying, or mental health difficulties, and
- Improving action to implement anti-discrimination strategies and policies in health care institutions.