Sexual orientation and health : general and minority stress factors explaining health differences between lesbian, gay, bisexual and heterosexual individuals

Previous studies show that lesbian, gay and bisexual (LGB) individuals report more health problems than heterosexual individuals. However, several important gaps remain in the knowledge regarding the explanations for these health differences. In general, there is a lack of differentiation between subgroups in the LGB population, a lack of specific attention for older LGB individuals and LGB youth who grow up in relatively tolerant countries, and a lack of combined between-and-within-groups study designs that examine factors associated with health differences. These gaps are addressed in the current dissertation. Although some gender and sexual orientation differences were found in the associations between risk factors and health problems, the presented studies that addressed potential gender and sexual orientation differences in the association between minority stress factors and mental health, sexual health, substance use, and social wellbeing provide no reason to suspect that the usefulness of the minority stress model differs substantially for sexual minority women and men or for lesbian/gay and bisexual individuals. In addition, the minority stress model seems to be a useful model for explaining health problems of both LGB youth and ageing LGB individuals. Research combining between-and-within-groups study designs was shown to be a useful way of examining health differences between LGB and heterosexual individuals. Firstly, using a between-and-within-groups design enabled showing that feelings of loneliness as well as sexual health problems of LGB individuals can be explained by general risk factors as well as by LGB-specific factors. To be most effective, interventions aiming to decrease sexual health problems among LGB adults or loneliness among elderly LGB individuals should therefore target both types of factors. Secondly, the use of a between-and-within-groups study design clearly showed the hypothesized, additive health compromising effects of minority stress factors. These findings provide important and novel support for one of the main assumptions of the minority stress model, that minority stress is a form of additive stress that is experienced by minority groups in addition to the stressors that are also experienced by members of the social majority, and that it is this additional stress takes its toll on LGB individuals and affects their health over and above general health risk factors