Sexual Identity Concordance and Mental Health

Background: People who identify as lesbian, gay, or bisexual (LGB) are at higher risk for experiencing psychological distress compared to heterosexual individuals. However, sexual orientation consists of sexual identity, romantic or sexual attraction, and sexual behavior, which do not always align. Due to the stigmatized nature of holding a non-heterosexual identity, people with same-sex attractions or behaviors may fail to take on an LGB identity. Little work has measured concordance between identity, attraction, and behavior (concordance defined as matching identity and attraction/behavior), and examined its relationship to mental health.

Methods: Data are drawn from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (n=12,068).   Weighted OLS linear regressions, suitably transformed, were performed to examine the effects of identity-attraction (heterosexual identity, same-sex attraction) and identity-behavior (heterosexual identity, same-sex behavior) discordance on key mental health outcomes, including perceived stress, depression, and mastery. Results were stratified by self-reported gender.

Results: Compared to concordant respondents, identity-attraction discordant women and identity-behavior discordant men and women reported significantly higher perceived stress and depression, and significantly lower mastery (all p-values <0.05).

Conclusions: Sexual identity discordance may play an important role in shaping stress and mental health outcomes among sexual minorities. LGB-identified individuals experience elevated mental health hardship. Our results suggest that these disparities persist, and are amplified among identity discordant sexual minorities. Identity development occurs throughout the life course, and the disparities observed here may be partly explained by the stressors inherent to reconciling an LGB identity with same-sex attractions or behaviors.