The impact of social connectedness on mental health in LGBTQ + identifying individuals during the COVID-19 pandemic in Germany

Abstract

Background: Recent studies report that LGBTQ + people have experienced high levels of mental health problems during COVID-19-related social distancing. Given the well-established association between social isolation and mental health, the main aim of the current study was to investigate differences in mental health and (perceived) social isolation and social support in LGBTQ + individuals compared to heterosexual, cisgender people and to explore whether the hypothesized higher mental health burden in LGBTQ + individuals is (partly) mediated by (perceived) social isolation or social support.

Methods: N = 531 participants indicating belonging to the LGBTQ + community and N = 1826 not identifying as LGBTQ + participated in a cross-sectional online survey during the initial COVID-19-related lockdown in Germany. Standardized questionnaires were used to assess depression, anxiety, suicidality, loneliness and social support. Further, perceived social isolation and face-to-face communication during the lockdown were assessed.

Results: LGBTQ + people had higher levels of depression, anxiety and suicidal thought, were lonelier and experienced less social support than non-LGBTQ + identifying individuals. Mediation analysis showed that the higher levels of mental health burden in LGBTQ + people were (partly) mediated by reduced social connectedness. Further face-to-face contact positively affected mental health by reducing feelings of loneliness.

Conclusion: Given the high impact of loneliness on mental health, governmental actions should be taken to promote social connectedness particularly among LGBTQ + identifying individuals to ensure that the COVID-19 pandemic does not exacerbate the health inequalities that already exist between LGBTQ+-identifying and heterosexual, cisgender people.

Keywords: Anxiety; Depression; LGBTQ+; gender identity; Loneliness; Sexual orientation; COVID-19; mental health; Social isolation; Suicidality.

Fig. 1

Mediation models on the impact of LGBTQ + on mental health through measures of social connectedness during the lockdown. *Unstandardized beta coefficients are presented for a’ and b’. For the direct effect (c’), the unstandardized coefficients after the mediators were added to the model are presented. The relationship between LGBTQ + identity and depression, anxiety, and suicidal thoughts was partly mediated through M1 (depression = 0.84, 95%-CI[0.60, 1.09]; anxiety = 0.71, 95%-CI[0.51, 0.92]; suicidal thoughts = 0.29 95%-CI[0.20, 0.39), M2 (depression = 0.20, 95%-CI[0.07, 0.34]; anxiety: = 0.21, 95%-CI[0.07, 0.36]; suicidal thoughts = 0.07, 95%-CI[0.02, 0.13]) and M3(depression = 0.34, 95%-CI[0.22, 0.47]; anxiety =. 16, 95%-CI[0.07, 0.27], suicidal thoughts = 0.11, 95%-CI[0.04, 0.18]). ** p < .01, ***p < .001

Fig. 2

Mediation models on the impact of face-to-face contact on mental health through social connectedness during the lockdown. *Unstandardized beta coefficients are presented for a’ and b’. For the direct effect (c’), the unstandardized coefficients after the mediators were added to the model are presented. LGBTQ + identity was included as moderator indicating no significant interaction between face-to-face contact and LGBTQ + on depression (-0.21, 95%-CI[-1.07, 0.66]), anxiety (0.12, 95%-CI[-68, 0.92]) and suicidality (0.15, 95%-CI[-0.38, 0.69]).The relationship between face-to-face contact and the mental health measures was mediated by M1 (depression = .-75, 95%-CI[-0.97, − 0.55]; anxiety = − 0.63, 95%-CI[-0.81, − 0.46]; suicidality = − 0.26, 95%-CI[-0.35, − 0.18]), M2 (depression = − 0.26, 95%-CI[-0.39, − 0.15]; anxiety = − 0.28, 95%-CI[-0.41, − 0.16]; suicidality = − 0.09, 95%-CI[-0.15, − 0.05]) and M3 (depression = − 0.33, 95%-CI[-0.46, − 0.22]; anxiety = − 0.16, 95%-CI[-0.26, − 0.07]; suicidality = − 0.11, 95%-CI[-0.18, − 0.05]). ** p < .01, ***p < .001