Minority Stress and Psychosocial Influences on Cognitive Performance in Sexual Minority Older Adults

Abstract

Background and Objectives Sexual minorities experience health inequalities, but little is known about differences in neurocognitive health between heterosexual and sexual minority older adults and potential risk factors. To investigate minority stress, depression, and marital status as risk factors for worse cognitive performance in sexual minority older adults. Research Design and Methods 336 sexual minority and 5,561 heterosexual participants aged 50+, non-institutionalized and free from neurodegenerative diseases from Wave 6 of the English Longitudinal Study of Ageing were included. Cognitive performance (i.e., temporal orientation, episodic memory, and fluid intelligence) of sexual minority and heterosexual older adults was compared using general linear models including age, sex and education as covariates. The differential impact of minority stress, depressive symptoms and marital status on cognition in the two groups was also tested. Analyses were weighted for sampling probability and differential non-response. Results Sexual minority participants were more likely to report minority stress and to be single but had better episodic memory than heterosexual participants. Depression and being single were associated with worse cognitive performance in both groups. However, minority stress was negatively associated (b = -2.116, p = 0.016) with fluid intelligence in the sexual minority group only. Discussion and Implications Better memory in sexual minority participants and a negative effect of risk factors on cognition are in line with previous studies. However, this study provides the first evidence of a potential negative impact of minority stress on cognitive performance in sexual minorities. Further investigations are needed to assess minority stress more in detail and clarify its potential mechanisms of action on cognition in sexual minorities.

Neurocognitive health in LGBTQIA+ older adults: current state of research and recommendations

“…Moreover, these databases might be affected by different types of bias, such as SOGI-related non-response (Jesdale, 2021 ), healthy volunteer (Lindsted et al, 1996 ), and survival biases (Cochran et al, 2016 ), that may affect findings and their interpretations. These may have skewed sample compositions (e.g., mostly White, highly educated, healthier participants with greater social resources) explaining both inconsistent findings on dementia risk (i.e., either higher than or equivalent to non-SGM people) and better episodic memory performance of SGM people (Stinchcombe and Hammond, 2021 ; Manca et al, 2022 ; Manca and Venneri, 2023 ).…”

“…on both cognitive performance and brain metrics (e.g., volumes and functional connectivity) should be compared between SGM and non-SGM samples to clarify group-specific effects that could explain disparities. In fact, previous investigations found that depression was associated with worse cognitive performance equally in heterosexual and non-heterosexual older adults (Manca and Venneri, 2023) and that psychological distress did not explain higher rates of SCD in SGM people (Fredriksen-Goldsen et al, 2023). Future studies should also address the role of protective and resilience factors, either general (e.g., cognitive reserve (Stern et al, 2020)) or specific for SGM older adults (e.g., social support (Yang et al, 2024) and identity affirmation (Fredriksen-Goldsen et al, 2017)).…”

“…A high degree of methodological heterogeneity characterizes the definition of SGM groups. While most studies used self-identified sexual orientation (Seelman, 2019 ; Brown and Patterson, 2020 ; Nelson and Andel, 2020 ; Flatt et al, 2021 ; Hsieh et al, 2021 ; Saunders et al, 2021 ; Stinchcombe and Hammond, 2021 , 2023 ; Fredriksen-Goldsen et al, 2022 ; Brown et al, 2023 ; Hopper et al, 2023 ; Stinchcombe et al, 2023 ; Yang et al, 2024 ), some focused on either sexual attraction (Manca and Venneri, 2023 ) or same-sex relationships (Perales-Puchalt et al, 2019 ; Manca and Venneri, 2020 ; Liu et al, 2021 ; Manca et al, 2022 ; Correro et al, 2023 ; Hanes and Clouston, 2023 ) due to lack of detailed SOGI data. Gender minorities have been identified by using either self-reported identity (Brady et al, 2023 ; Cicero et al, 2023 ; Saunders et al, 2023 ) or by selecting people with gender identity disorders who accessed gender-affirming care (Guo et al, 2022 ; Hughto et al, 2023 ; Jasuja et al, 2023 ).…”

“…While most studies have attempted to quantify cognitive health differences between SGM and non-SGM people, little research has focused on hypothesis-driven factors driving potential disparities. Correro and Nielson ( 2020 ) suggested that minority stress (Meyer, 2003 ) could be a crucial risk factor for cognitive decline, yet only one recent study investigated and found a negative impact of minority stress on fluid intelligence (but not on episodic memory and temporal orientation abilities) of non-heterosexual older adults (Manca and Venneri, 2023 ). This is primarily due to the lack of data on risk/protective factors relevant to SGM populations in cohort studies and databases not designed for such purpose.…”

“…When ethnicity data were collected, people of color have been systematically underrepresented in most of the studies published so far and often make up <15% of the sample. Such small sample sizes prevented clinically meaningful analyses (Perales-Puchalt et al, 2019 ; Manca and Venneri, 2023 ) and led researchers to choose race/ethnicity as a covariate to control for, rather than investigating interaction/mediation effects with SOGI characteristics (Hsieh et al, 2021 ; Liu et al, 2021 ; Correro et al, 2023 ).…”