Psychiatric Disorders Mediates the Association between Sexual Orientation Discrimination and Substance Use Disorders among Sexual Minority Adults

Abstract

Although sexual orientation discrimination (SO-discrimination) is associated with an increased risk of psychiatric and substance use disorders (SUD) among sexual minority (SM) adults, these relationships are not well understood, particularly in the context of SUD severity. To address this gap, we assessed the direct and indirect effect of SO-discrimination and sexual identity on psychiatric disorders and SUD severity in the context of stress and resilience among SM adults. We used data from 3,494 adults reporting nonheterosexual identity, attraction, or behavior collected as part of a nationally representative cross-sectional sample of adults in the United States. Structural equation modeling assessed potential pathways between SO-discrimination, psychiatric disorders, and SUD severity. Past-year psychiatric disorders and SUD severity were significantly correlated in the multivariate model. Concordant homosexual orientation was associated with reduced risk of psychiatric disorders, but not with past-year SUD severity. SO-discrimination was significantly associated with increased risk of psychiatric disorders, but was not a significant predictor of SUD severity. Notably, SO-discrimination was not directly associated with SUD severity, but was found to have a significant indirect effect on SUD severity through psychiatric disorders. SO-discrimination was directly associated with increased risk of psychiatric disorders, and psychiatric disorders mediated the pathway between SO-discrimination and SUD severity. Since psychiatric disorders and SUD are often cooccurring, these data indicate integrated assessment strategies and dual interventions for SM populations.

Use of the Heterosexist Harassment, Rejection, and Discrimination Scale With Different Sexual Orientation, Gender, and Racial/Ethnic Groups: An Examination of Measurement Invariance

“…Furthermore, in a U.S. probability sample of sexual minorities, 72 to 81% had been verbally insulted or abused, 46 to 61% had been threatened with violence, and 37 to 51% had been hit, beaten, physically attacked, or sexually assaulted (Meyer et al, 2021). In line with the minority stress model, research has consistently demonstrated that sexual orientation-related discrimination is a robust risk factor for adverse mental and physical health outcomes (e.g., depression, anxiety, non-suicidal self-injury, substance use disorders, poor physical health, HIV infection; Flentje et al, 2020; Jeffries et al, 2021; Kahle et al, 2021; Lee et al, 2016; Liu et al, 2019; Meyer & Frost, 2013). Based on these findings, discrimination represents a major public health concern with significant consequences for the health of sexual minorities.…”