The Mental Health of Lesbian, Gay, Bisexual, and Transgender Older Adults: Do Sexual Orientation and Gender Identity Play Differential Roles?

Thesis (Ph.D.)--University of Washington, 2015Lesbian, gay, bisexual, and transgender older adults evidence significant physical and mental health disparities as a result of their marginalized status, yet little is known regarding pathways that link risks associated with sexual orientation and gender identity to poor health outcomes. The minority stress model has been increasingly used by researchers examining health disparities among sexual and gender minorities. Chapter 1 reviews research over the past decade that has used the minority stress model as a framework to examine lesbian, gay, and bisexual mental health disparities. The chapter identifies strengths and limitations of the model, and suggests areas where the minority stress model can be revised, extended, and more fully applied to better understand the causes, correlates, and consequences of health disparities among lesbian, gay, and bisexual older adults. Utilizing structural equation modeling of secondary analysis of data from the National Health, Aging, & Sexuality Study: Caring & Aging with Pride over Time (N = 2,560), Chapter 2 specifically tests a part of the minority stress model by examining the relationships between the internal minority stress processes of concealment-disclosure of sexual orientation and internalized heterosexism, and chronic health conditions, and depression among lesbian, gay and bisexual older adults (n = 2,372). Results indicate complex indirect and direct relationships among these variables, which has important policy and practice implications. Although the minority stress model specifies that marginalized groups experience both general and minority stress, general stress is rarely accounted for in studies of minority stress. Also utilizing structural equation modeling of secondary analysis of data from the aforementioned study, Chapter 3 examines the relative contributions of general and internal minority stress processes to depression among a subsample of transgender older adults (n = 174). Findings suggest that both general and minority stress play a significant role in depression among transgender older adults. These results point to important research and policy implications that must be addressed to better understand the alarmingly high rates of depression among transgender older adults