Trans-diagnostic Psychopathology Factors and Sexual Minority Mental Health: Evidence of Disparities and Associations with Minority Stressors

Abstract

Research on mental health disparities between sexual minority individuals and heterosexuals has traditionally taken a disorder-by-disorder approach. Recently developed trans-diagnostic approaches provide a new method to frame such investigations; however, trans-diagnostic factors have yet to be applied to sexual minority mental health disparities research. The current study applied this methodology to investigate mental health disparities between lesbian, gay, bisexual, and heterosexual individuals in a large national probability sample (N = 34,653). Twelve-month diagnoses of 13 common mood, anxiety, substance use, and personality disorders were modeled, and multi-group analysis indicated a sexual orientation-invariant trans-diagnostic latent structure. Significant disparities at the latent trans-diagnostic factor level were observed; these factor-level disparities are manifested as observed mental disorder disparities. Gender differences typically seen in trans-diagnostic research were not present between sexual minority women and men. Trans-diagnostic internalizing and externalizing factors were then used as outcomes in a minority stress framework and were positively predicted by lifetime history of sexual orientation-related minority stressors (i.e., discrimination and victimization). Implications for using trans-diagnostic approaches to frame intervention efforts, supplement disorder-by-disorder disparities methodologies, and synthesize piecemeal disparities literatures are discussed.

Keywords: discrimination; disparities; internalizing-externalizing; sexual minorities; trans-diagnostic.

Figure 1

The internalizing-externalizing latent structure of common mental disorders in sexual minority individuals. Note. Values are standardized estimates from model using all sexual minority individuals. MDD: major depressive disorder. Dysth: dysthymic disorder. GAD: generalized anxiety disorder. Panic: panic disorder. Social: social phobia. Spec: specific phobia. PTSD: posttraumatic stress disorder. BPD: borderline personality disorder. ASPD: antisocial personality disorder. Nic: nicotine dependence. Alc: alcohol dependence. Marij: marijuana dependence. Drug: other drug dependence. All diagnoses are 12-month. Arrows without numbers indicate unique variances, including error.