Quality of Life and Mental Health of Chinese Sexual and Gender Minority Women and Cisgender Heterosexual Women: Cross-sectional Survey and Mediation Analysis

Abstract

Background Health-related research on sexual minority populations in China is lacking, and research on sexual and gender minority women (SGMW, including transgender women and persons of other gender identities assigned female at birth of all sexual orientations, and cisgender women with nonheterosexual orientations) is even less. Currently, there are limited surveys related to mental health in Chinese SGMW, but there are no studies on their quality of life (QOL), no studies comparing the QOL of SGMW with that of cisgender heterosexual women (CHW), and no studies on the relationship between sexual identity and the QOL as well as associated mental health variables. Objective This study aims to evaluate the QOL and mental health in a diverse sample of Chinese women and make comparisons between SGMW and CHW and then investigate the relationship between sexual identity and the QOL through the role of mental health. Methods A cross-sectional online survey was conducted from July to September 2021. All participants completed a structured questionnaire containing the World Health Organization Quality of Life–abbreviated short version (WHOQOL-BREF), the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Rosenberg Self-Esteem Scale (RSES). Results In total, 509 women aged 18-56 years were recruited, including 250 (49.1%) CHW and 259 (50.9%) SGMW. Independent t tests showed that the SGMW reported significantly lower levels of QOL, higher levels of depression and anxiety symptoms, and lower self-esteem than the CHW. Pearson correlations showed that every domain and the overall QOL were positively associated with mental health variables, with moderate-to-strong correlations (r range 0.42-0.75, P<.001). Multiple linear regressions found that participants belonging to the SGMW group, current smokers, and women with no steady partner were associated with a worse overall QOL. The mediation analysis found that depression, anxiety, and self-esteem significantly completely mediated the relationship between sexual identity and physical, social, and environment domains of the QOL, while the relationship between sexual identity and the overall QOL and psychological QOL was partially mediated by depression and self-esteem. Conclusions The SGMW had poorer levels of QOL and a worse mental health status than the CHW. The study findings affirm the importance of assessing mental health and highlight the need to design targeted health improvement programs for the SGMW population, who may be at higher risk of a poor QOL and mental health.

Understanding suicidal ideation disparity between sexual minority and heterosexual Chinese young men: a multiple mediation model of social support sources, self-esteem, and depressive symptoms

“…The results indicated a significant difference in marital status (c 2 = 273.67, p < 0.001) between heterosexual and sexual minority groups. Similar to the previous study, sexual minority participants showed less marriage intention than heterosexual participants in the current study (35). The differences in other demographics were not significant between groups (ps > 0.05).…”

“…Unlike previous western studies unveiling the mediation effect of the total score of social support or only the score of family support, our results showed that family support and friends' support are prominent protective factors in Chinese sexual minority young men (32,33). Individuals with lower family support and friends' support may face more challenges and become more vulnerable to depressive symptoms and suicidal ideation (35,45,46). An explanation that can account for these results may be that in Asian culture, sexual minority youth were more likely to rely more on family and friends' support rather than support from others.…”

“…The psychological mediation framework also conceptualized selfesteem as a related cognitive risk factor in developing psychological distress, including suicidality (17). Recent evidence suggests that selfesteem is another critical psychosocial variable indirectly affecting the well-being and psychopathology of the sexual minority population (16,29,34,35). Indeed, low self-esteem is likely to be caused by not receiving enough social support, which in turn confers the risk of psychological problems.…”