Skip to main content Accessibility help

Mental health among UK inner city non-heterosexuals: the role of risk factors, protective factors and place

  • C. Woodhead (a1), B. Gazard (a1), M. Hotopf (a1), Q. Rahman (a1), K. A. Rimes (a1) and S. L. Hatch (a1)...
  • Please note a correction has been issued for this article.



Sexual minorities experience excess psychological ill health globally, yet the UK data exploring reasons for poor mental health among sexual minorities is lacking. This study compares the prevalence of a measure of well-being, symptoms of common mental disorder (CMD), lifetime suicidal ideation, harmful alcohol and drug use among inner city non-heterosexual and heterosexual individuals. It is the first UK study which aims to quantify how much major, everyday and anticipated discrimination; lifetime and childhood trauma; and coping strategies for dealing with unfair treatment, predict excess mental ill health among non-heterosexuals. Further, inner city and national outcomes are compared.


Self-report survey data came from the South East London Community Health study (N = 1052) and the Adult Psychiatric Morbidity Survey (N = 7403).


Adjustments for greater exposure to measured experiences of discrimination and lifetime and childhood trauma had a small to moderate impact on effect sizes for adverse health outcomes though in fully adjusted models, non-heterosexual orientation remained strongly associated with CMD, lifetime suicidal ideation, harmful alcohol and drug use. There was limited support for the hypothesis that measured coping strategies might mediate some of these associations. The inner city sample had poorer mental health overall compared with the national sample and the discrepancy was larger for non-heterosexuals than heterosexuals.


Childhood and adult adversity substantially influence but do not account for sexual orientation-related mental health disparities. Longitudinal work taking a life course approach with more specific measures of discrimination and coping is required to further understand these associations. Sexual minorities should be considered as a priority in the design and delivery of health and social services.


Corresponding author

* Address for correspondence: Dr Charlotte Woodhead, Department of Applied Health Research, 1-19 Torrington Place, London, WC1E 7HB. (Email:


Hide All
American Psychological Association (APA) (2013). Diagnosticand Statistical Manual of Mental Disorders, 5th edn. APA: Washington, DC.
Austin, SB, Jun, HJ, Jackson, B, Spiegelman, D, Rich-Edwards, J, Corliss, HL, Wright, RJ (2008). Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses’ Health Study II. Journal of Women's Health 17, 597606.
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (2001). The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care, 2. World Health Organisation: Geneva.
Balsam, KF, Rothblum, ED, Beauchaine, TP (2005). Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology 73, 477487.
Berkman, LF, Glass, T, Brissette, I, Seeman, TE (2000). From social integration to health: Durkheim in the new millennium. Social Science and Medicine 51, 843857.
Bostwick, WB, Meyer, I, Aranda, F, Russell, S, Hughes, T, Birkett, M, Mustanski, B (2014). Mental health and suicidality among racially/ethnically diverse sexual minority youths. American Journal of Public Health 104, 11291136.
Burns, MN, Ryan, DT, Garofalo, R, Newcomb, ME, Mustanski, B (2015). Mental health disorders in young urban sexual minority men. Journal of Adolescent Health 56, 5258.
Buttram, ME, Kurtz, SP (2013). Risk and protective factors associated with gay neighborhood residence. American Journal of Men's Health 7, 110118.
Chakraborty, A, McManus, S, Brugha, TS, Bebbington, P, King, M (2011). Mental health of the non-heterosexual population of England. British Journal of Psychiatry 198, 143148.
Cochran, SD, Mays, VM, Sullivan, JG (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology 71, 5361.
Friedman, MS, Marshal, MP, Guadamuz, TE, Wei, C, Wong, CF, Saewyc, EM, Stall, R (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health 101, 14811494.
Frissa, S, Hatch, S, Gazard, B, Fear, N, Hotopf, M (2013). Trauma and current symptoms of PTSD in a South East London community. Social Psychiatry and Psychiatric Epidemiology 48, 11991209.
Glick, SN, Golden, MR (2010). Persistence of racial differences in attitudes toward homosexuality in the United States. Journal of Acquired Immune Deficiency Syndrome 55, 516523.
Greater London Authority (GLA) (2011). Assessment of GLA Impact on Lesbian, Gay And Bisexual Equality. Retrieved 15 June 2014 from
Green, KE, Feinstein, BA (2012). Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychology of Addictive Behaviors 26, 265278.
Guasp, A (2012). The School Report: the Experiences of Gay Young People in Britain's Schools in 2012. Stonewall: UK.
Guasp, A, Gammon, A, Ellison, G (2013). Homophobic Hate Crime: the Gay British Crime Survey 2013. Stonewall: UK.
Hatch, S, Frissa, S, Verdecchia, M, Stewart, R, Fear, N, Reichenberg, A, Morgan, C, Kankulu, B, Clark, J, Gazard, B, Medcalf, R, the SELCoH study team, Hotopf, M (2011). Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: the South East London Community Health (SELCoH) study. BMC Public Health 11, 861.
Hatch, SL, Woodhead, C, Frissa, S, Fear, NT, Verdecchia, M, Stewart, R, Reichenberg, A, Morgan, C, Bebbington, P, McManus, S, Brugha, T, Kankulu, B, Clark, JL, Gazard, B, Medcalf, R, Hotopf, M, the SELCoH study team (2012). Importance of thinking locally for mental health: data from cross-sectional surveys representing South East London and England. PLoS ONE 7, e48012. doi: 10.1371/journal.pone.0048012.
Hatzenbuehler, ML (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin 135, 707730.
Hatzenbuehler, ML (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics 127, 896903.
Hatzenbuehler, ML, McLaughlin, KA, Nolen-Hoeksema, S (2008). Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child Psychology and Psychiatry 49, 12701278.
Hatzenbuehler, ML, Keyes, KM, McLaughlin, KA (2011). The protective effects of social/contextual factors on psychiatric morbidity in LGB populations. International Journal of Epidemiology 40, 10711080.
Herek, GM, McLemore, KA (2013). Sexual prejudice. Annual Review of Psychology 64, 309333.
Kessler, RC, Mickelson, KD, Williams, DR (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior 40, 208230.
King, M, McKeown, E, Warner, J, Ramsay, A, Johnson, K, Cort, C, Wright, L, Blizard, R, Davidson, O (2003). Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study. British Journal of Psychiatry 183, 552558.
King, M, Semlyen, J, Tai, S, Killaspy, H, Osborn, D, Popelyuk, D, Nazareth, I (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8, 70.
LaVeist, TA, Thorpe, RJ, Pierre, G, Mance, GA, Williams, DR (2014). The relationships among vigilant coping style, race, and depression. Journal of Social Issues 70, 241255.
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465486.
Lewis, NM (2014). Rupture, resilience, and risk: relationships between mental health and migration among gay-identified men in North America. Health and Place 27, 212219.
Marshal, MP, Dietz, LJ, Friedman, MS, Stall, R, Smith, HA, McGinley, J, Thoma, BC, Murray, PJ, D'Augelli, AR, Brent, DA (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. Journal of Adolescent Health 49, 115123.
McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. The Health & Social Care Information Centre, Social Care Statistics: UK.
McNeilly, MD, Anderson, NB, Armstead, CA, Clark, R, Corbett, M, Robinson, EL, Pieper, CF, Lepisto, EM (1996). The perceived racism scale: a multidimensional assessment of the experience of white racism among African Americans. Ethnicity and Disease 6, 154166.
Meyer, IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin 129, 674697.
Nadal, KL, Wong, Y, Issa, M-A, Meterko, V, Leon, J, Wideman, M (2011). Sexual orientation microaggressions: processes and coping mechanisms for lesbian, gay, and bisexual Individuals. Journal of LGBT Issues in Counseling 5, 2146.
Newcomb, ME, Mustanski, B (2010). Internalized homophobia and internalizing mental health problems: a meta-analytic review. Clinical Psychology Review 30, 10191029.
Nodin, N, Peel, E, Tyler, A, Rivers, I (2015). The RaRE research reportt: LGB&T mental health-risk and resilience explored. PACE Health. Retrieved 15 June 2015 from
Office for National Statistics (ONS) (2013). Key Findings from the Integrated Household Survey: January 2012 to December 2012. Retrieved 15 June 2014 from
Office for National Statistics (ONS) (2014). Integrated Household Survey, January to December 2013: Experimental Statistics. Retrieved 15 June 2015 from
Paolucci, EO, Genius, ML, Violato, C (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology 135, 1736.
Rao, JN, Scott, AJ (1984). On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Annals of Statistics, 4660.
Robinson, JP, Espelage, DL, Rivers, I (2013). Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics 131, 423430.
Rosario, M, Schrimshaw, EW, Hunter, J (2004). Ethnic/racial differences in the coming-out process of gay, lesbian, and bisexual youths: a comparison of sexual identity development over time. Cultural Diversity and Ethnic Minority Psychology 10, 215228.
Saewyc, EM, Skay, CL, Hynds, P, Pettingell, S, Bearinger, LH, Resnick, MD, Reis, E (2007). Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk? Journal of LGBT Health Research 3, 2536.
Savin-Williams, RC (2006). Who's gay? Does it matter? Current Directions in Psychological Science 15, 4044.
StataCorp (2009). Stata Statistical Software: Release 11. StataCorp LP: College Station, TX.
Tennant, R, Hiller, L, Fishwick, R, Platt, S, Joseph, S, Weich, S, Parkinson, J, Secker, J, Stewart-Brown, S (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of LifeOutcomes 5, 63.
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M, INDIGO Study Group (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408415.
Turner, RJ, Lloyd, DA (1995). Lifetime traumas and mental health: the significance of cumulative adversity. Journal of Health and Social Behaviour 36, 360376.
Williams, DR, Yan, Yu, Jackson, JS, Anderson, NB (1997). Racial differences in physical and mental health: socio-economic status, stress and discrimination. Health Psychology 2, 335351.
Williamson, IR (2000). Internalized homophobia and health issues affecting lesbians and gay men. Health Education Research 15, 97107.
Winter, A (2012). LGBT Communities – a Summary for Joint Strategic Needs Assessment. Lesbian & Gay Foundation: UK.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A correction has been issued for this article: