Modeling Minority Stress Effects on Homelessness and Health Disparities among Young Men Who Have Sex with Men

Abstract

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one's home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one's home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.

Risk and Protective Factors for Substance Use Among Sexual and Gender Minority Youth: a Scoping Review

“…In contrast, school enrollment was associated with less drug use among Black SMY [68]. Compared to Whites, racial/ethnic minority adolescent SMY also reported disproportionately high rates of stigma [92], physical threats/victimization, and feeling unsafe at school [28]. Each of these was associated with greater risk of substance use [78, 58, 24, 36, 39].…”

Mental and Physical Health among Homeless Sexual and Gender Minorities in a Major Urban US City

“…11,12,14 It is possible that the paths to homelessness for an older population of sexual and gender minorities are more similar to those for older heterosexual and cisgender individuals, or that if they differ, these differences were not captured in our measures of reasons for becoming homeless.…”

“…For instance, estimates have suggested that sexual and gender minorities comprise between 22.4 and 40 % of homeless youth. 9,10 Reasons for this increased risk of homelessness can include family conflict, 11 disapproval of sexual orientation, 12,13 or stressful experiences such as childhood sexual abuse. 14 The reason that sexual minority individuals become homeless may in turn be related to their experiences later on, for example, young sexual minority men who were kicked out of their homes were more likely to have daily marijuana use or to have experienced recent homelessness.…”

“…14 The reason that sexual minority individuals become homeless may in turn be related to their experiences later on, for example, young sexual minority men who were kicked out of their homes were more likely to have daily marijuana use or to have experienced recent homelessness. 12 Previous studies on homeless sexual and gender minorities have focused primarily on the sexual minority population, and among that population primarily on homeless youth with only a few including gender minorities, because surveys collecting information about gender identity have been limited. Studies examining reasons for becoming homeless among the general adult population have found typical reasons for homelessness include disruptive experiences in childhood as well as mental health and substance use.…”

Mental health disorders among homeless, substance‐dependent men who have sex with men

“…MSM demonstrate high prevalence and severity of mental health disorders and substance use disorders relative to their heterosexual male counterparts [10,11], and samples of homeless MSM demonstrate greater prevalence of substance use and mental health disorders relative to their unstably housed heterosexual counterparts [12-14]. …”