Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence

Abstract

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

Figures

Figure 1

Minority stress processes in lesbian, gay, and bisexual populations.

Figure 2

Combined Mantel–Haenszel weighted odds ratios and 95% confidence intervals for lifetime and 1-year prevalence of mental disorders in lesbian, gay, and bisexual versus heterosexual populations. Each calculated combined Mantel–Haenszel weighted odds ratio is displayed between the upper and lower bounds of its respective 95% confidence interval. Odds ratios were recalculated from aggregated data using the Statcalc procedure of the statistical software Epi Info (Centers for Disease Control and Prevention, 2001). This procedure does not adjust for demographics characteristics or any other control variables (e.g., sampling weights) that may be necessary to arrive at unbiased population estimates. These statistics are provided to allow synthesis of the risk for lesbian, gay, and bisexual versus heterosexual respondents in the studies, but they cannot be used as accurate estimates of adjusted population odds ratios.

Figure 3

Combined Mantel–Haenszel weighted odds ratios and 95% confidence intervals for lifetime prevalence of mental disorders in studies of lesbian, gay, and bisexual versus heterosexual populations that used random and nonrandom samples. Each calculated combined Mantel–Haenszel weighted odds ratio is displayed between the upper and lower bounds of its respective 95% confidence interval. Odds ratios were recalculated from aggregated data using the Statcalc procedure of the statistical software Epi Info (Centers for Disease Control and Prevention, 2001). This procedure does not adjust for demographics characteristics or any other control variables (e.g., sampling weights) that may be necessary to arrive at unbiased population estimates. These statistics are provided to allow synthesis of the risk for lesbian, gay, and bisexual versus heterosexual respondents in the studies, but they cannot be used as accurate estimates of adjusted population odds ratios.