Academic journal article
By Sandfort, Theo G. M.; Melendez, Rita M.; Diaz, Rafael M.
The Journal of Sex Research , Vol. 44, No. 2
Recent studies using large-scale population-based samples have shown convincingly that compared with heterosexual persons, homosexual men and women are at higher risk for mental health problems (Cochran & Mays, 2000; Cochran, Sullivan, & Mays, 2003; Fergusson, Horwood, & Beautrais, 1999; King et al., 2003; Sandfort, Bakker, Schellevis, & Vanwesembeeck, 2006; Sandfort, de Graaf, Bijl, & Schnabel, 2001; Skegg, Nada-Raja, Dickson, Paul, & Williams, 2003). For example, Cochran and colleagues (2003) found in a U.S. nationally representative survey a higher prevalence of depression, panic attacks, and psychological distress in gay and bisexual men compared to heterosexual men. In the same study, a higher prevalence of generalized anxiety disorder was found in lesbian and bisexual women compared with heterosexual women.
These population-based studies, originally not designed to study mental health in relation to sexual orientation, are unable to provide evidence about the causes of the observed differences. The increased rates of mental health problems in homosexual persons are usually understood as a consequence of the stigma attached to homosexuality. This stigma can result in a range of stressful experiences, which have been labeled "minority stress." Meyer (2003) conceptualizes minority stress as involving a distal-proximal dimension, with stress resulting from objective, external events and conditions, the expectations of such events and the vigilance this expectation requires, the internalization of negative social attitudes, and the concealment of one's sexual orientation. Support for the minority stress-hypothesis is found in studies that have demonstrated that gay men and lesbian women encounter varying levels of stigma, prejudice, and discrimination, and that levels of stress were indeed related to their mental health (Bradford, Ryan, & Rothblum, 1994; Brooks, 1981; Frable, Wortman, & Joseph, 1997; Meyer, 1995; Meyer & Dean, 1998; Ross, 1990; Waldo, Hesson-McInnis, & D'Augelli, 1998). For example, Herek and colleagues (1999), found that gay and bisexual men and women who had experienced victimization because of their sexual orientation (respectively 20% and 25%), manifested significantly more symptoms of depression, anger, anxiety, and posttraumatic stress.
Although studies have shown that gay and lesbian persons are confronted with different levels of minority stress, it is not clear why some of them are more affected than others. This is notable, because homosexuality, unlike race or physical handicaps, is usually understood as a concealable stigma (Herek & Capitanio, 1996), which implies that gay and lesbian persons can avoid being stigmatized by not disclosing their sexual orientation. It may be, however, that for some the stigma of homosexuality is less concealable than for others. This may especially be true for homosexual people who are gender-atypical or gender-nonconforming (Bailey, 1999; Brooks, 2000; Wyss, 2004), a condition that is more prevalent in homosexual than heterosexual persons, especially during childhood (Bailey & Zucker, 1995). Gender nonconformity is the expression of characteristics that are socially and culturally associated with the opposite gender (Bailey & Zucker, 1995). Given the strict norms guarding gender conformity, gender-atypical homosexual persons are more likely targets for discrimination or other negative experiences than homosexual persons who do not openly deviate from gender norms.
Stigma surrounding breaking gender norms may be present during the early stages of one's development, increasing the likelihood of developing more problems in psychosocial well-being in adulthood (Zucker, 1994). Adult mental health may also be affected by current gender nonconformity. It is an open question as to what extent homosexuality-related discrimination is due to someone's homosexuality or gender nonconformity (cf. …