Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys

Jan Ole H. Gmelin, Ymkje Anna De Vries, Laura Baams, Sergio Aguilar-Gaxiola, Jordi Alonso, Guilherme Borges, Brendan Bunting, Graça Cardoso, Silvia Florescu, Oye Gureje, Elie G. Karam, Norito Kawakami, Sing Lee, Zeina Mneimneh, Fernando Navarro-Mateu, José Posada-Villa, Charlene Rapsey, Tim Slade, Juan Carlos Stagnaro, Yolanda TorresRonald C. Kessler, Peter de Jonge, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Somnath Chatterji, Alfredo H. Cia, Louisa Degenhardt, Koen Demyttenaere, Silvia Florescu, Giovanni de Girolamo, Oye Gureje, Josep Maria Haro, Meredith Harris, Hristo Hinkov, Chi yi Hu, Peter de Jonge, Aimee Nasser Karam, Elie G. Karam, Norito Kawakami, Ronald C. Kessler

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Purpose: Lesbian,gay, and bisexual (LGB) individuals, and LB women specifically, have anincreased risk for psychiatric morbidity, theorized to result from stigma-baseddiscrimination. To date, no study has investigated the mental healthdisparities between LGB and heterosexual AQ1individuals in a largecross-national population-based comparison. The current study addresses thisgap by examining differences between LGB and heterosexual participants in 13cross-national surveys, and by exploring whether these disparities wereassociated with country-level LGBT acceptance. Since lower social support hasbeen suggested as a mediator of sexual orientation-based differences inpsychiatric morbidity, our secondary aim was to examine whether mental healthdisparities were partially explained by general social support from family andfriends. Methods: Twelve-monthprevalence of DSM-IV anxiety, mood, eating, disruptive behavior, and substancedisorders was assessed with the WHO Composite International DiagnosticInterview in a general population sample across 13 countries as part of theWorld Mental Health Surveys. Participants were 46,889 adults (19,887 males; 807LGB-identified). Results: Maleand female LGB participants were more likely to report any 12-month disorder (OR2.2, p < 0.001 and OR 2.7, p < 0.001, respectively) and most individualdisorders than heterosexual participants. We found no evidence for anassociation between country-level LGBT acceptance and rates of psychiatricmorbidity between LGB and heterosexualAQ2 participants. However, among LBwomen, the increased risk for mental disorders was partially explained by lowergeneral openness with family, although most of the increased risk remainedunexplained. Conclusion: These results provide cross-national evidence for an association between sexual minority status and psychiatric morbidity, and highlight that for women, but not men, this association was partially mediated by perceived openness with family. Future research into individual-level and cross-national sexual minority stressors is needed.

Original languageEnglish
JournalSocial Psychiatry and Psychiatric Epidemiology
Publication statusE-pub ahead of print - 19 Jul 2022


  • Cross-national
  • Epidemiology
  • Health status disparities
  • Mental disorders
  • Sexual orientation


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