Understanding co-occurring depression symptoms and alcohol use symptoms among cisgender sexual minority women

Abstract

Sexual minority women (SMW; e.g., lesbian, bisexual) experience depression and alcohol use disorder at approximately twice the rates of heterosexual women. Though discrimination is a common explanation for these disparities, little is known about the mechanisms through which discrimination contributes to these disparities. Past research has found that the strategies that individuals use to regulate their emotions in response to discrimination may influence their depression symptoms and alcohol use symptoms. The current study proposes and validates a model to test whether alcohol use, suppression of emotion expression, and social support explain the relationships between discrimination and depression/alcohol use symptoms of cisgender SMW. A national sample of 1,782 cisgender SMW completed an online survey in 2017 through The PRIDE Study. Structural equation modeling was used to test model hypotheses. Discrimination was associated with lower levels of social support, but discrimination was not associated with higher levels of alcohol use or suppression. Social support, alcohol use, suppression, and discrimination were all significantly associated with depression symptoms. This study makes an important contribution to the literature by evaluating mechanisms that may potentially drive depression and alcohol use symptoms among cisgender SMW, focusing on mechanisms that can be intervened upon using existing evidence-based practices.

Keywords:

• Sexual minority women
• depression
• alcohol use disorder
• discrimination

Acknowledgements

The PRIDE Study is a community-engaged research project that serves and is made possible by LGBTQ + community involvement at multiple points in the research process, including the dissemination of findings. We acknowledge the courage and dedication of The PRIDE Study participants for sharing their stories; the careful attention of PRIDEnet Participant Advisory Committee (PAC) members for reviewing and improving every study application; and the enthusiastic engagement of PRIDEnet Ambassadors and Community Partners for bringing thoughtful perspectives as well as promoting enrollment and disseminating findings. For more information, please visit https://pridestudy.org/pridenet.

Disclosure statement

Dr. Juno Obedin-Maliver has consulted for Sage Therapeutics (5/2017), Ibis Reproductive Health (a non-for-profit research group; 3/2017-5/2018, 2020 - present), Folx, Inc (2020 – present), and Hims Inc. (2019 - present). Dr. Lunn has consulted for Hims Inc. (2019 - present) and Folx, Inc. (2020). None of these roles present a conflict of interest with this work as described here. The other authors have no conflicts of interest to report.

Notes

1 All AUDIT items have response options ranging from 0 to 4. For items 4 – 8, responses options are Never (0 points), Less than monthly (1 point), Monthly (2 points), Weekly (3 points), and Daily or almost daily (4 points). For items 9 and 10, response options are No (0 points), Yes, but not in the last year (2 points), and Yes, during the last year (4 points).

Additional information

Funding

This work was supported by Award Number T32AA007240, Graduate Research Training in Alcohol Problems: Alcohol-Related Disparities, from the National Institute on Alcohol Abuse and Alcoholism. Dr. Annesa Flentje’s work on this project was partially supported by K23DA039800 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily present the official view of the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, or the National Institutes of Health. Research reported in this article was partially funded through a Patient-Centered Outcomes Research Institute [www.pcori.org; PPRN-1501- 26848] to Dr. Mitchell R. Lunn. The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of Patient- Centered Outcomes Research Institute, its Board of Governors or Methodology Committee, or the National Institutes of Health.