For years, one of the most common explanations for higher rates of mental-health problems among gay, lesbian and bisexual people has been minority stress: the idea that stigma, discrimination and other pressures associated with belonging to a sexual minority contribute substantially to poorer psychological outcomes.
A new systematic meta-analysis published in Psychological Medicine challenges how much of that disparity can be attributed specifically to those experiences.
The researchers examined studies containing family and genetic comparison data, including research involving twins and siblings. Their central question was straightforward: If discrimination associated with sexual orientation is primarily responsible for the mental-health gap, what happens to that gap when researchers compare heterosexual and non-heterosexual people while accounting for characteristics shared within families?
The results complicated the conventional explanation.
“Most of the mental health disparities between non-heterosexual and heterosexual persons were eliminated after controlling for family-genetic factors,” the researchers wrote.
That finding does not establish that discrimination has no effect on mental health, nor does it show that family dysfunction is necessarily the cause. Rather, the researchers argue that shared familial and genetic factors may confound estimates that have previously been attributed to minority stress.
The distinction is important.
Sexual Minority Stress Theory, or SMST, proposes that sexual minorities experience additional stressors arising from stigma and discrimination and that these help explain their elevated rates of psychological problems. The authors tested that explanation by examining whether heterosexual genetic relatives raised alongside non-heterosexual people also demonstrated poorer mental health.
“Compared with heterosexual persons, non-heterosexual persons have worse mental health,” the paper states. “Sexual Minority Stress Theory (SMST) explains the disparity as resulting from stigma and discrimination.”
The researchers then used a multilevel meta-analysis to determine how much the observed disparity changed as genetic relatedness was taken into account.
Their conclusion was that familial and genetic factors accounted for a substantial portion of the association.
Jay Richards, vice president of Social and Domestic Policy at The Heritage Foundation, argued that the findings expose weaknesses in minority-stress explanations.
“The minority stress theory was always implausible,” Richards told The Washington Stand. “It makes little sense to argue that there’s more prejudice against ‘sexual minorities’ now than there was, say, 50 years ago.”
But the study itself reaches a more specific conclusion than that political argument. It addresses whether family-genetic confounding can explain part of the association between sexual orientation and mental health; it does not establish that contemporary discrimination has disappeared or cannot negatively affect individuals who experience it.
One factor receiving particular attention in the research was neuroticism, a personality trait associated with greater susceptibility to negative emotions.
“Signs of a neurotic temperament often emerge quite early, well before puberty when sexual orientation becomes apparent for most persons,” the researchers wrote.
They also noted evidence of genetic correlations connecting non-heterosexual orientation with major depressive disorder and neuroticism.
That raises a potentially significant methodological problem. If inherited or early-emerging traits are associated with both sexual orientation and vulnerability to mental-health problems, researchers could mistakenly attribute some of the resulting mental-health disparity to discrimination.
In statistical terms, correlation with minority stress would not necessarily demonstrate that minority stress caused the entire disparity.
The paper’s authors argue that this possibility has received insufficient attention.
The debate also intersects with a much broader cultural argument over sexuality, marriage and discrimination.
Katy Faust, founder of the children’s-rights organization Them Before Us, has argued that disagreement with LGBT political causes is frequently treated as evidence of personal hostility toward gay people. In a previous conversation with theologian Albert Mohler, Faust described noticing a major cultural change after former President Barack Obama announced his support for same-sex marriage in 2012.
“The notion that support for traditional natural marriage was grounded upon bigotry, phobia, and animus towards gay people. That’s a problem,” Faust said.
Faust, whose mother has been in a same-sex relationship for decades, argued that personal affection and disagreement over marriage are not mutually exclusive.
That cultural dispute, however, should be separated from the narrower scientific question investigated in the new meta-analysis.
People can experience genuine discrimination. Such experiences can be psychologically damaging. At the same time, demonstrating that discrimination occurs is different from demonstrating that it accounts for the observed population-level mental-health disparity between heterosexual and non-heterosexual people.
The new research argues that the latter claim requires considerably more caution because family and genetic factors appear to account for much of the statistical difference.
Professor Michael Bailey of Northwestern University’s Department of Psychology, one of the study’s authors, summarized the implication succinctly.
“We need to look elsewhere, other than minority stress, if we want to improve their mental health.”
