Health and socio-economic inequalities by sexual orientation among older women in the United Kingdom: findings from the UK Household Longitudinal Study

Patalay

2023

Preprint

Background: Sexual orientation has been measured in a wide variety of ways which reflect both theoretical and practical considerations. However, choice of sexual orientation measure and recoding strategy can impact sample size, as well as demographic and health profiles, in analyses of sexual minority populations. We aimed to examine how choice of sexual orientation dimension and recoding strategy decisions impact estimates in the sexual minority population in two population-based studies in the UK.   Methods: We used data collected at age 17 (2018) in the UK Millennium Cohort Study and at wave six (2012-13) and eight (2017-18) of the English Longitudinal Study of Ageing. Descriptive statistics were used to examine the impact of choice of sexual orientation dimension (i.e. identity, attraction and experience) and data recoding strategy on achieved sample size and composition by selected demographic and health measures within and between datasets.    Results: Dimension choice and recoding decisions resulted in variation in sample size. For example, more respondents reported some same-sex sexual attraction than reported a non-heterosexual identity (MCS: 20.77% vs 8.97%, ELSA: 4.77% vs 1.04%). Demographic distributions varied, but not substantially by dimension choice or recoding strategy. Overall, in both datasets sexual minority respondents were more likely to be White and in the highest quintiles for income and education than heterosexual respondents. Health status did not vary substantially by dimension choice or recoding strategy, however sexual minority respondents reported worse health than their heterosexual peers. Conclusions: This study explores a range of practical and theoretical considerations when analysing sexual minority respondents using survey data. We highlight the impact recoding strategy decisions may have on sample size and demographic and health distributions in this understudied population. We also demonstrate the benefits of including multiple dimensions for capturing mechanisms of interest, elucidating ambiguous responses and exploring sexual diversity.

Section: Demographic Distributionssupporting

confidence: 89%

Mainly Heterosexual, Bisexual, or Other?: the measurement of sexual minority status and its impact on analytic sample, demographic distribution and health outcomes

Patalay

2023

Preprint

“…New purposeful data collection was deemed appropriate as although a number of large representative studies (eg, the UK Household Longitudinal Study) are currently collecting data on COVID-19 experiences, they typically contain small numbers of LGBTQ+ people, 8 12 often do not collect information on TGGD identities, and contain heteronormative measures that can be exclusionary to LGBTQ+ respondents. An online convenience sample was deemed appropriate due to the absence of robust data on LGBTQ+ people from large surveys that could help determine the characteristics of a representative sample of LGBTQ+ people, as well as the risks inherent with any form of physical data collection during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Discrimination as a predictor of poor mental health among LGBTQ+ people during the COVID-19 pandemic: cross-sectional analysis of the online Queerantine study

Bécares

2021

BMJ Open

Self Cite

ObjectivesTo assess the mental health and experiences of discrimination among lesbian, gay, bisexual, transgender, queer (LGBTQ) people at the start of the COVID-19 pandemic.DesignData come from a cross-sectional online survey targeted at LGBTQ+ people, which collected data on mental health, experiences of discrimination and a number of other pandemic-related experiences. To examine the association between sexual orientation and gender and mental health and experiences of discrimination, we conducted regression analyses that adjusted for a range of sociodemographic variables.SettingA web-based survey was used to collect data between the end of April and mid July 2020.ParticipantsAn analytical sample of 310 LGBTQ+ respondents aged 18 and above.Main outcome measuresWe assessed mental health with the 4-item Perceived Stress Scale and with the 10-item Center for Epidemiological Studies Depression scale (CES-D-10). We asked respondents about discriminatory experiences because of their LGBTQ+ identity during the coronavirus pandemic.ResultsPerceived stress scores among our LGBTQ+ sample were high (mean: 7.67; SD: 3.22). Based on a score of 10 or more on the CES-D-10, the majority of participants had high levels of depressive symptoms (72%). Around one-in-six respondents reported some form of discrimination since the start of the pandemic because they were LGBTQ+ (16.7%). The average score for perceived stress increased by 1.44 points (95% CI 0.517 to 2.354) for respondents who had experienced discrimination versus those who had not. Similarly, the odds of exhibiting significant depressive symptomology increased threefold among those who had experienced discrimination compared with those who had not (OR: 3.251; 95% CI 1.168 to 9.052).ConclusionsThe LGBTQ+ community exhibited high levels of depression, stress and experienced discrimination during the coronavirus pandemic. High levels of poor mental health were partially explained by experiences of discrimination, which had a large, consistent and pernicious impact on mental health.

“…New purposeful data collection was deemed appropriate as although a number of large representative studies (e.g. the UK Household Longitudinal Study) are currently collecting data on COVID-19 experiences, they typically contain small numbers of LGBTQ+ people [40 41], often do not collect information on TGGD identities, and contain heteronormative measures that can be exclusionary to LGBTQ+ respondents. An online convenience sample was deemed appropriate due to the absence of robust data on LGBTQ+ people from large surveys that could help to determine the characteristics of a representative sample of LGBTQ+ people.…”

Section: Limitationsmentioning

confidence: 99%

“…However, where evidence does exist, this overwhelmingly suggests that higher levels of pre-existing health conditions compared to cisgender and heterosexual populations, may place the LGBTQ+ community at additional risk of adverse prognosis. This includes long-term chronic illness, and higher rates of smoking and asthma among LGBTQ+ people [2-8]; higher rates of obesity, and alcohol consumption among lesbian, bisexual, and queer women [7 9 10]; and increased likelihood of being immunocompromised (e.g. HIV+ with a low CD4 cell count or with untreated HIV) among gay men and transgender people [11].…”

Section: Introductionmentioning

confidence: 99%

The mental health and experiences of discrimination of LGBTQ+ people during the COVID-19 pandemic: Initial findings from the Queerantine Study

Bécares

2020

Preprint

Self Cite

Objective: To assess mental health status and experiences of discrimination among a sample of Lesbian, Gay, Bisexual, Transgender, Queer people (LGBTQ+, the + including those who don't identify with any such label) during the COVID-19 pandemic. Design: Cross-sectional web-based survey. Setting: Responses were collected during the COVID-19 pandemic between April 27th and July 13th. Participants: 398 LGBTQ+ respondents forming an analytical sample of 310 in the main models. Methods: We used a combined measure of gender identity or expression and sexual orientation as the main explanatory variable. We assessed mental health with the 4-item Perceived Stress Scale (PSS-4), and with the 10-item Center for Epidemiological Studies Depression scale (CES-D-10). We measured experiences of discrimination with a battery of questions that asked respondents whether they had experienced a set of discriminatory experiences because of their LGBTQ+ identity during the coronavirus pandemic. Experiences of discrimination was considered a mediating factor and examined both as an outcome as well as an explanatory variable. Models were adjusted for a range of demographic and socioeconomic variables. Results: The prevalence of depression and stress were both high, with the majority of the sample exhibiting significant depressive symptomology (69%). Around one-in-six respondents reported some form of discrimination since the start of the pandemic because they were LGBTQ+ (16.7%). In regression models, the average score for perceived stress increased by 1.44 (95% Confidence Interval (CI): 0.517-2.354) for those who had experienced an instance of homophobic or transphobic harassment, compared to respondents who had not. Similarly, the odds of exhibiting significant depressive symptomology (CES-D-10 scores of 10 or more) increased three-fold among those who had experienced harassment based on their gender or sexuality compared to those who had not (OR: 3.251; 95% CI: 1.168-9.052). These marked associations remained after adjustment for a number of socioeconomic and demographic covariates. Cis-female respondents who identify as gay or lesbian had the lowest scores for perceived social or depressive symptoms; conversely transgender and gender diverse individuals had the highest scores. Conclusions: We found high levels of stress and depressive symptoms, particularly among younger and transgender and gender diverse respondents. These associations were partially explained by experiences of discrimination which had a large, consistent and pernicious impact on stress and mental health.