Sexual orientation, social support, and mental health resilience in a U.S. national sample of adults

Abstract

Sexual minority mental health disparities can be attributed, in large part, to chronic exposure to stress. There is growing interest in understanding the factors associated with psychological resilience, or the ability to positively cope with life’s stressors. Using nationally representative data (2012-2013; N = 14,470), this study compared differences in resilience status (operationalized empirically using SF-12 mental health score among respondents reporting 2+ past-year stressful life events; respondents were categorized as “flourishing,” “average,” or “languishing”) by sexual orientation and assessed whether social support mediated sexual minority disparities in resilience. Comparisons were made across four sexual orientation groups: heterosexuals and three sexual minority subgroups (lesbians/gay men, bisexual, heterosexual-identified sexual minorities [HSM]). Generally, heterosexual respondents were more likely to be flourishing, less likely to be languishing, and reported more social support, compared to sexual minority respondents. In multivariable analysis, bisexual women, HSM women, and gay men had lower odds of resilience than heterosexual women and men, respectively. In mediation models, lower social support was associated with reduced resilience for all sexual minority subgroups except lesbian/gay women. This study demonstrated that sexual orientation is an important determinant of resilience, and further, that social support contributes to sexual minority peoples’ abilities to flourish when faced with stress.

Keywords:

• mental health
• resilience
• sexual orientation
• social support
• stress

Acknowledgements

This manuscript was prepared using a limited access dataset obtained from the National Institute on Alcohol Abuse and Alcoholism and does not reflect the opinions or views of NIAAA or the U.S. Government. No additional financial disclosures were reported by the authors of this paper. On behalf of all authors, the corresponding author states that there is no conflict of interest. No additional financial disclosures were reported by the authors of this paper. On behalf of both authors, the corresponding author states that there is no conflict of interest.

Notes

1 Stressful life events and SF-12 mental health status have been examined previously by sexual orientation, using the full NESARC-III sample,¹⁷ and so are not reported in this study.

2 To serve as an unambiguous referent group, heterosexual respondents were required to report no same-sex behaviors in their lifetimes. Conversely, the recency of same-sex behaviors were taken into account for sexual minority respondents; HSM were classified as those currently identifying as heterosexual yet reporting recent (past-year) same-sex behavior and/or attraction.

3 There were significant indirect effects through social support on resilience for both bisexual and HSM men, yet non-significant total effects. As such, the proportion of the total effects explained by the indirect effects were not reported for these groups.