The relationship between sexual orientation and depression in a national population sample

Abstract

Aims and objectives: The aim of this study was to examine the relationship between sexual orientation and depression in a nationally representative population to determine if sexual minorities report higher levels of depression than the remainder of the population.

Background: Depression is a highly prevalent and disabling chronic disorder worldwide. Prior research utilizing national population samples have reported that members of sexual minorities are at higher risk for depression when compared to heterosexual people. More recent studies have revealed differences in depression risk based on sexual orientation, sexual activity and sex. There have been significant shifts in societal attitudes towards sexual minorities in recent decades. Continuing research into predictors for reporting depression amongst sexual minorities is needed.

Methods: National Health and Nutrition Examination Survey cycles 2005-2012 were used to identify sexual minority status based on declared sexual orientation and presence of same-sex sexual activity. Complex samples logistic and multivariate regression models were used to predict depression adjusted for sexual orientation, sexual activity, age, sex, marital status, education, income, race/ethnicity, employment and health status.

Results: Sexual orientation was not a significant independent predictor of depressive symptoms overall. Gay men reported lower levels of depressive symptoms than heterosexual men. In the sex stratified analyses, men who reported having sex with men were five times more likely to report depressive symptomatology compared to men who reported opposite sex partners (2005-2008 adjusted odds ratios: 5·00; 95% confidence interval: 1·44-17·38; 2009-2012 adjusted odds ratios: 5·10; 95% confidence interval: 1·33-19·54) after controlling for sexual orientation.

Conclusions: Results of our analyses indicate that homosexually experienced heterosexual men appear to be at highest risk for depression. Furthermore, reported physical health status was a significant independent predictor of depression in all models, suggesting a strong link between physical and mental health.

Relevance to clinical practice: Health care providers should inquire about sexual orientation and sexual behaviour as part of a routine health history and be familiar with the unique health needs of sexual minorities to tailor clinical practice and foster safe, inclusive, health care environments.

Keywords: depression; depressive symptomatology; health risks; mental health; sexuality.