Sexual Orientation and Psychological Disorder

(JAMES THOMPSON) For decades, homosexuality has been known to be associated with psychological disorder. In the past, the interpretation was that social ostracism caused stress, and that in turn led to psychological distress. If that was true, the massive changes in the acceptability of homosexuality should have reduced the pressures of social rejection, and led to an improvement in psychological well-being. So, how are results turning out now?

A review studied epidemiological studies to look at the mental health of the non-heterosexuals.

Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys
Joanna Semlyen, Michael King, Justin Varney & Gareth Hagger-Johnson
BMC Psychiatry volume 16, Article number: 67 (2016)

Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys – PMC (nih.gov)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806482/

Around 1–2 % of the United Kingdom’s adult population identify as lesbian, gay or bisexual (LGB) and 5 % as non-heterosexual, although because sexual orientation comprises identity, behaviour and attraction, the chosen definition used can lead to variability in these estimates. We know that sexual minority populations experience poorer physical heath and engage in riskier health behaviours such as smoking and hazardous drinking. These inequalities may emerge in adolescence and early adulthood, then persist throughout the life-course.

Symptoms of poor mental health (e.g. anxiety, depression) and low wellbeing (e.g. not having ‘positive mental health’) are common in the adult population but there is established evidence that adults who identify as lesbian, gay or bisexual are at higher risk of experiencing these symptoms than adults who identify as heterosexual. A systematic review of the prevalence of mental disorder, substance abuse, suicidality and self-harm in LGB people showed that these populations experience a greater incidence of depression, anxiety, suicidality and substance misuse than heterosexuals. Meta-analysis following this review found that LGB people were around twice as likely to have attempted suicide in their lifetime and have around 1.5 times higher prevalence of depression and anxiety disorders in the preceding 12 months. Associations between minority sexual orientation and poorer mental health have persisted over time with recent studies showing the same effects as older studies. Such disparities are thought to emerge early in adolescence and persist into adulthood.
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Of the 94,818 participants in the analytic sample (those with available data on sexual orientation identity, mental health and covariates), 97.2 % as heterosexual, 1.1 % identified as lesbian/gay, 0.9 % as bisexual and 0.8 % as ‘other’ (Table 1). People meeting the threshold of common mental disorder or low wellbeing were significantly different across all study variables (using bivariate t-test or chi-square tests): they were younger, comprised more females, and had lower levels of educational attainment, more current smokers, more longstanding illness/disability and fewer married/co-habiting participants than those below the threshold (Table 2). Significantly higher proportions of those who identified as lesbian/gay, bisexual and ‘other’ were found among those who met the mental disorder threshold.
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Our results are consistent with evidence internationally that non-heterosexual adults are at increased risk of mental health symptoms compared to heterosexuals, but provide important new insights by suggesting that younger and older non-heterosexual adults are particularly vulnerable (compared to those at mid-life).

To my mind the “minimally adjusted” figures are most reliable, since the “additionally adjusted” list of factors includes ones that might be a consequence of sexual orientation.

Bisexual men 2.66
Gay men 2.25
Bisexual women 2.23
Other women 1.69
Other men 1.52
Lesbian women 1.38

Non hetero Men (total) 2.14
Non hetero Women (total) 1.76

Leaving aside the sex of the person, the relative odds are worst for Bisexuals 2.37, Lesbian/Gay 1.82, Other 1.59. This is a significant and real increase in the risk of psychological distress. Why is this the case?

The authors suggest that stigmatisation, in various forms and operating from adolescence is the most likely cause. They do not raise any other hypotheses.

One possible interpretation is that bisexuals are the most confused about their identity, which suggests that a sense of clear identity about sexual orientation is partly protective in mental health terms, although non-heterosexuals are more distressed. It was sometimes asserted that bisexuals had “the best of both worlds” in that they had the double the number of prospective sexual partners, but even if that is the case, the result is that this is a very disturbed group.

More generally, it could be that, even given social acceptance, something about the non-heterosexual mode has an intrinsically unsettling effect. A psychological interpretation is that one source of meaning, the strengthening of a personal commitment to children and the resultant future perspective/slow life history is denied to many non-heterosexuals. (This could be tested by comparing them with childless heterosexuals).

Another hypothesis is that whatever the primary cause which leads to non-procreative sexuality, it is also a cause of mental distress, either by some direct route, or as a strong consequence. In this interpretation, even open support of non-hetero orientation by the public is of little help, because the set of choices, orientations and behaviours is inherently damaging to well-being. How might that happen? Does it lead directly or indirectly to a more vivid emotional sensibility, so that emotions become a part of identity?

Usually, women are more emotionally vulnerable than men, and twice as likely to be emotionally upset. This is not the pattern here. Both are more disturbed than normal, but non-hetero men are more feminine in their vulnerability, with high levels of distress; and non-hetero women, while still being distressed, are relatively more masculine, and a bit more resilient than the men. It seems that there has been an inversion of the usual sexual differences in psychological vulnerability.

Another interpretation is that being non-hetero is inherently unsettling. How could one test this? There has been a massive change in the public status of homosexuals, which ought to have had a very big effect. Results as shown in the above paper should be very unlikely if the main cause of distress is lack of public acceptance. The fact that the pattern is international also makes it seem that social acceptance is not the key variable, since this still varies in different countries.

The cause of non-hetero preferences is not determined. The usual interpretation is that these preferences would not of themselves cause distress. However, perhaps the cause of the preferences also brings about vulnerabilities, as a result of increased emotionality.

As for all studies, there are some caveats. Everyone self-reported their problems, but there was, understandably, no test of actual behaviours. Perhaps non-heterosexuals pay much more attention to minor troubles and over-report them. The suicide data would make this unlikely. They would appear to be more distressed and at risk. A minority of respondents did not state their sexual orientation. Hard to see why that would necessarily lead to lower risk figures, unless most of the refusers were also absolutely stable non-heterosexuals.

In sum, to have a sexual orientation other than heterosexuality seems to come together with psychological vulnerability.