Social Determinants of Psychiatric Morbidity in Lesbian, Gay, and Bisexual Populations

Objectives: Research on the mental health of lesbian, gay, and bisexual (LGB) populations has focused almost exclusively on individual-level factors. Consequently, research is needed to evaluate whether the social environment confers risk for, and/or protection against, psychiatric disorders.

Methods: Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653; 577 LGB individuals), a nationally representative study of noninstitutionalized U.S. adults. Two measures of the social environment were used, indexing risk and protection, respectively: (1) state-level hate crimes perpetrated against LGBs (data from the F.B.I); and (2) state-level concentrations of same-sex couples (data from U.S. Census), a measure of social capital. Outcome measures were past 12-month DSM-IV-defined psychiatric disorders.

Results: Living in states with higher rates of hate crimes due to sexual orientation predicted a stronger association between LGB status and social phobia (F=13.91, P<0.01), compared to living in states with lower rates of hate crimes. In contrast, among LGB respondents, those in states with greater concentrations of same-sex couples had lower prevalence of major depression (OR=0.57, 95% CI: 0.33-0.99) and generalized anxiety disorder (OR=0.30, 95% CI: 0.10-0.88), compared to those in states with lower concentrations of same-sex couples. Results remained robust after controlling for multiple sociodemographic variables, experiences of individual discrimination, and state-level income inequality.

Conclusions: Social factors can increase risk for psychiatric morbidity in LGB populations, but greater social capital may confer protection against mental health problems. Measures of the social environment should be incorporated in future research on the mental health of LGB populations.