Mental health among UK inner city non-heterosexuals: the role of risk factors, protective factors and place

Abstract

Aims. Sexual minorities experience excess psychological ill health globally yet UK data exploring reasons for poor mental health among sexual minorities is lacking. This study compares the prevalence of a measure of well-being, symptoms of common mental disorder (CMD), lifetime suicidal ideation, harmful alcohol and drug use among inner city nonheterosexual and heterosexual individuals. It is the first UK study which aims to quantify how much major, everyday and anticipated discrimination; lifetime and childhood trauma; and, coping strategies for dealing with unfair treatment, predict excess mental ill health among non-heterosexuals. Further, inner city and national outcomes are compared.Methods. Self-report survey data came from the South East London Community Health (SELCoH) study (N=1052) and the Adult Psychiatric Morbidity Survey (APMS) (N=7403).Results. Adjustments for greater exposure to measured experiences of discrimination and lifetime and childhood trauma had a small to moderate impact on effect sizes for adverse health outcomes though in fully adjusted models, non-heterosexual orientation remained strongly associated with CMD, lifetime suicidal ideation, harmful alcohol use and drug use.There was limited support for the hypothesis that measured coping strategies might mediate some of these associations. The inner city sample had poorer mental health overall compared to the national sample and the discrepancy was larger for non-heterosexuals than heterosexuals.Conclusions. Childhood and adult adversity substantially influence but do not account for sexual orientation-related mental health disparities. Longitudinal work taking a life course approach with more specific measures of discrimination and coping is required to further understand these associations. Sexual minorities should be considered as a priority in the design and delivery of health and social services.

The long-term mental health risk associated with non-heterosexual orientation

“…In comparison with those of a heterosexual orientation, participants of a non-heterosexual orientation were more likely to be male, younger, reported earlier age of first sexual encounters, to have experienced some sexual trauma, to have poor physical health, and to be smokers, with worse physical health and health behaviours. These findings are in line with the current literature base (Friedman et al , 2011; Green & Feinstein, 2012; Woodhead et al 2016). Importantly, many of these mental health risk factors are, to some extent, modifiable.…”

“…We recognise a number of limitations, which need to be considered. Whilst the proportion with a non-heterosexual orientation in PATH is consistent with other population estimates (Cochran & Mays, 2000; Mays & Cochran, 2001; Sandfort et al 2001; Swannell et al 2016; Woodhead et al 2016) this proportion is still very low. However, model estimates for each sexual orientation group consistent in unadjusted and adjusted models suggesting that estimation is robust to the unbalanced group numbers.…”

“…Many community-based studies do not differentiate between homosexual and bisexual orientations (Cochran & Mays, 2000; Sandfort et al 2001, 2006; Cochran et al 2003; Chakraborty et al 2011; Fredriksen-Goldsen et al 2013; Woodhead et al 2016). Whilst Jorm et al (2002) identified those with a homosexual orientation at slightly elevated risk for mental ill health and poorer wellbeing outcomes than heterosexual respondents, it was those with a bisexual orientation who were at considerably greater risk of poorer mental health outcomes.…”

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review

“…The review yielded 42 studies relating to LGBT+ mental health. Of these included papers, 10 were qualitative papers [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ], 22 were quantitative papers [ 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ], 6 were review papers [ 97 , 98 , 99 , 100 , 101 , 102 ], and 4 were mixed-methods papers [ 103 , 104 , 105 , 106 ]. Broadly, these papers were thematically divided across three areas.…”

“…Firstly, six papers focused on professional opinions and treatment outcomes of LGBT+ mental health [ 70 , 77 , 82 , 87 , 98 , 99 ]. Secondly, 22 papers were concerned with the incidence of mental health problems, and the risk factors associated with the elevated rates of mental health problems within LGBT+ populations [ 75 , 76 , 78 , 79 , 80 , 81 , 83 , 84 , 85 , 86 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 100 , 101 , 102 , 106 ]. Thirdly, 14 papers were concerned with LGBT+ people’s experiences of having mental health problems and treatment, and explaining the factors contributing to their poor mental health [ 65 , 66 , 67 , 68 , 69 , 71 , 72 , 73 , 74 , 88 , 89 , 103 , 104 , 105 ].…”