Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders

Abstract

Objective: To assess the relationships between adverse childhood experiences (ACEs) and comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use and mental health disorders across 5 sexual orientation subgroups: lesbian/ gay, bisexual, unsure, discordant heterosexual (ie, heterosexualidentified with same-sex attraction or behavior), and concordant heterosexual. Methods: Data were from the 2012−2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional, nationally representative survey of non-institutionalized US adults. Data were collected in households via structured diagnostic faceto-face interviews; the overall response rate was 60.1%. The sample included 36,309 US adults aged 18 years and older. Results: Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders.Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders. Multivariable regression analyses indicated a curvilinear relationship between ACEs and comorbid substance use and mental health disorders, and sexual minorities consistently had a higher ACE mean than concordant heterosexual respondents. The majority of sexual minorities with high levels of ACEs had comorbid substance use and mental health disorders. Conclusions: Sexual minorities are exposed to more ACEs than their heterosexual counterparts in the US. We found evidence that US sexual minorities are at higher risk of comorbid substance use and mental health disorders. These findings reinforce the importance of identifying exposure to ACEs and developing trauma-informed interventions to treat comorbidities in those exposed to multiple ACEs, especially sexual minorities.

The Association between Hazardous Drinking Indicators and Drinking Problem Concerns among Sexual Minority Women

“…34,35 More research including bisexual women and women with other sexual minority identities is needed to better understand how treatment experiences might vary by sexual identity. 50 Past-five-year drinking problem concerns did not significantly differ by other demographic characteristics, including race/ethnicity. This contrasts with previous research findings that SMW of color have substantially greater likelihood of reporting substance use problems 43,51 than heterosexual women of color and white lesbian women.…”

First-time exploration of adverse childhood experiences among adults in Delaware using BRFSS data: A cross-sectional study

“…16 Adults who responded yes to the question, “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?” were included as veterans. Studies also show a higher prevalence of ACEs amongst sexual minorities compared to their heterosexual counterparts [ 16 ]. Delawareans who self-identified as lesbian, gay, bisexual, or transgender were together defined as the “sexual minority” category.…”

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

“…33,34 The NESARC-III includes reliable and validated measures that align with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM -5) criteria for SUD and mental health 35 and the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5), a fully structured diagnostic interview. 36 All NESARC-III procedures received institutional review board (IRB) approval before data collection, and the present secondary analysis using de-identified data was determined exempt by the IRB at the first author's institute.…”

“…changed job, victim of theft). 42,43 Test-retest reliability of the scale was excellent (Intercorrelation coefficient (ICC) = 0.9); 36 Cronbach's alphas was equal to .70 within the analytic sample.…”

“…13,33,34 Compounding the impact of SOdiscrimination are additional distal stressors experienced by SM, including family rejection, adverse childhood experiences, and social isolation. 35,36 Studies have found that cumulative effects of abuse and victimization in childhood and adolescence have a stigmatizing effect that may increase risk for later mental health disorders and SUD. 26,[37][38][39] However, less is understood about the combined effect of SM-related stressors and the specific relationships between SO-discrimination, mental health, and SUD severity.…”