Resilience and Health Outcomes of Sexual Minority Middle-Aged and Older Adults

While research on lesbian, gay, and bisexual (hereafter referred to as sexual minority) middle-aged and older adults has increased over the past decade, there is still a critical need for more research on the health and resilience in this growing subpopulation. Research has provided evidence that sexual minority adults have an increased risk of negative health outcomes when compared to heterosexual adults. Research has also demonstrated possible resilience in sexual minority middle-aged and older adults; however, few studies have measured resilience in middle-aged and older adults. Gaining a better understanding of resilience in sexual minority adults may help identify modifiable factors that can be targeted to potentially improve the health of sexual minority older adults as well as to prevent or delay negative health outcomes in younger sexual minority individuals. It may also help identify sexual minority individuals who are more at risk of negative health outcomes.The overarching goal of the three studies in this dissertation was to examine the relationship between resilience and health disparities and whether the relationship is different for sexual minority middle-aged and older adults compared to their heterosexual counterparts. Study 1 used data from MIDUS 2 and MIDUS Refresher to identify personality profiles, including a resilient personality profile, and examined differences in health risk/promoting behaviors among the personality profiles in a sample of sexual minority (n=159) and propensity matched heterosexual (n=318) middle-aged and older adults. The results found that participants with a Resilient personality were not less likely to engage in health risk behaviors but were significantly more likely to report engaging in more moderate physical activity than the other personality groups, regardless of sexual orientation. The results indicated that having a resilient personality was not more beneficial for the sexual minority group than it was for the heterosexual group. Study 2 used data from MIDUS 1, MIDUS 2, and MIDUS 3 to examine the moderating effect of emotion-focused and problem-focused coping on the association between perceived daily discrimination and health outcomes over approximately 20 years in a sample of sexual minority (n=162) and propensity matched heterosexual (n=324) middle-aged and older adults. Results found that, for sexual minority participants, reporting higher perceived discrimination was associated with a greater number of chronic conditions at baseline, but was also associated with a significant decrease in the number of chronic conditions over time. For the heterosexual participants, both high and low perceived daily discrimination was associated with an increase in the number of chronic conditions over time. For both sexual minority and heterosexual participants, mental health decreased over time, regardless of perceived daily discrimination. The results of this study also found significant moderating effects of problem-focused and emotion-focused coping on the number of chronic conditions and self-rated mental health over time. Study 3 used data from MIDUS 2 and MIDUS Refresher to examine the integrative effect of three conceptual dimensions of resilience (optimism, perceived control, and social support) on physical and mental health outcomes in a sample of sexual minority (n=164) and propensity matched heterosexual (n=238) middle-aged and older adults. The results found different results by sexual orientation. For sexual minority participants, perceived control had a significant negative association with the number of chronic conditions; optimism had a significant negative association with depressed affect plus anhedonia. For heterosexual participants, perceived control had a significant negative relationship with both the number of chronic conditions and depressed affect plus anhedonia. The results also found different results by sexual minority subgroup. These results suggest that factors of resilience may differ by sexual orientation. Overall, this dissertation provides insight into the association between resilience and the health of sexual minority middle-aged and older adults as well as differences compared to their heterosexual counterparts. The results of this dissertation provide evidence that potential adversity faced by sexual minority adults does not always result in negative health outcomes. Future research should further examine the strengths of sexual minority individuals as well as the health promoting pathways used to build resilience and age successfully