LGB health disparities indirectly linked to childhood maltreatment

Lesbian, gay, and bisexual (“sexually diverse”) people continue to suffer disparities in health outcomes compared to heterosexual people in the US. According to this recently published article in LGBT Health, research findings are inconsistent when it comes to identifying the underlying causes of these disparities. Authors Alley et al. noted that the stress of social stigma and discrimination is widely considered to be a cause, but few large studies look at the influence of childhood stress exposure. Therefore, Alley et al. analyzed data that included responses to the Adverse Childhood Experiences questionnaire, gathered from a  large national sample of sexually diverse adults, to understand the processes by which “different types of adversity, experienced at different stages of life, contribute to sexual minority health disparities.” The sample they drew upon came from Generations: A Study of the Life and Health of LGB People in a Changing Society, United States, 2016-2019 (ICPSR 37166). It surveyed sexually diverse adults between the ages of 18 and 60, in three waves conducted between 2016 and 2019. It was the first long-term, five-year study to examine the health and well-being across three generations of lesbians, gay men, and bisexuals (LGB), who came of age during different historical contexts. One aim of the study was to enable research on how differences in stress experience affects mental health and well-being, including depressive and anxiety symptoms, substance and alcohol use, and suicide ideation and behavior, and how younger LGBs utilize LGB-oriented social and health services, relative to older cohorts. Data Sharing for Demographic Research distributes both public-use and restricted-use files for each of the three Generations waves, as well as merged public and restricted files.

For their analytic sample, Alley et al. used data from 1,398 respondents from the first wave of the Generations study. (There were 1,520 participants in the first wave, but Alley et al. excluded gender diverse respondents.) The authors’ statistical modeling included measures of childhood sexual abuse and nonsexual abuse; adult victimization; race; and subjective and objective health problems. Their analysis found that both childhood abuse and adult harassment or victimization had an impact on the health of sexually diverse adults. However, these effects were only observed as diagnosable diseases in adults over the age of 50. They also showed that the link between childhood abuse and adult health was partly due to the fact that those who experienced abuse as children were more likely to face harassment and victimization as adults. This indirect impact of childhood abuse has implications for intervention. Identifying individuals “who are at risk of being victimized again could be an important strategy for helping sexually diverse adults who have experienced childhood adversity,” ultimately improving their health outcomes.