Social support as an antidote to sexual-minority distress? A study of US middle-aged sexual minorities

Background: Minority stress theory argues that mental health disparities exist by sexual orientation in part because sexual minorities have insufficient access to coping resources. Few studies have investigated how coping resources reduce mental distress among sexual minorities at the population level. Objectives: This study examines the role of social support in promoting the mental health of middle-aged sexual minorities in the US. Methods: The analyses use data from three waves (2003-2008) of the National Health and Nutrition Examination Survey (NHANES). The analytical sample consists of 3,650 individuals aged 40-59, of which 3% reported themselves as being lesbian/gay/bisexual. Zero-inflated negative binomial regression models are used to investigate the relationship between sexual orientation, social support (perceived emotional support and number of close friends), and mental health status (number of days feeling mentally ill in the past 30 days). The analyses are adjusted for sampling design, socio-demographic characteristics, and physical health. Results: Both perceived emotional support and number of close friends significantly decreased the mental health disparity by sexual orientation (p<0.01; p<0.05). Based on the prediction of the regression models, gay/bisexual men without any emotional support were found to feel mentally ill, on average, for 9.6 days during the past 30 days, which is 6 days more than their heterosexual counterparts were found to be. In contrast, among those having sufficient emotional support, the number of days feeling mentally ill declined to 1.9 days for gay/bisexual men, becoming lower than that of heterosexual men (2.2 days). The number of close friends showed similar beneficial effects. The same patterns were also observed among lesbian/bisexual and heterosexual women. Conclusion: Social support benefits sexual minorities' mental well-being more than that of heterosexuals. Strengthening social support for sexual minorities may be key in narrowing mental health disparities by sexual orientation.