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The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples

Published online by Cambridge University Press:  17 February 2021

Alexandra Pitman Open the ORCID record for Alexandra Pitman [Opens in a new window] ,
Louise Marston Open the ORCID record for Louise Marston [Opens in a new window] ,
Gemma Lewis Open the ORCID record for Gemma Lewis [Opens in a new window] ,
Joanna Semlyen Open the ORCID record for Joanna Semlyen [Opens in a new window] ,
Sally McManus Open the ORCID record for Sally McManus [Opens in a new window]  and
Michael King
Alexandra Pitman*
Affiliation:
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
Louise Marston
Affiliation:
UCL Research Department of Primary Care and Population Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
Gemma Lewis
Affiliation:
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
Joanna Semlyen
Affiliation:
Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
Sally McManus
Affiliation:
NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK School of Health Sciences, City University, Northampton Square, London, EC1V 0HB, UK
Michael King
Affiliation:
UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
*
Author for correspondence: Alexandra Pitman, E-mail: a.pitman@ucl.ac.uk
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Abstract

Background

Evidence on inequalities in mental health in lesbian, gay, and bisexual people arises primarily from non-random samples.

Aims

To use a probability sample to study change in mental health inequalities between two survey points, 7 years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification.

Methods

We analysed data from 10 443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), hazardous alcohol use, and illicit drug use. Multivariable models were adjusted for age, gender, and economic factors, adding interaction terms for survey year, age, gender, childhood sexual abuse, and religious identification. We explored bullying and discrimination as mediators.

Results

Inequalities in risks of CMD or substance misuse were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people [adjusted odds ratio (AOR) = 2.86; 95% CI 1.83–4.46], and to report alcohol misuse and illicit drug use. When adjusted for bullying, odds of CMD remained elevated only for bisexual people (AOR = 3.21; 95% CI 1.64–6.30), whilst odds of alcohol and drug misuse were unchanged. When adjusted for discrimination, odds of CMD and alcohol misuse remained elevated only for bisexual people (AOR = 2.91; 95% CI 1.80–4.72; and AOR = 1.63; 95% CI 1.03–2.57 respectively), whilst odds of illicit drug use remained unchanged. There were no interactions with age, gender, childhood sexual abuse, or religious identification.

Conclusions

Mental health inequalities in non-heterosexuals have not narrowed, despite increasing societal acceptance. Bullying and discrimination may help explain the elevated rate of CMD in lesbian women and gay men but not in bisexual people.

Keywords

DiscriminationinequalitiesLGBmental healthminority stresssexual minorities
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3402 - 3411
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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