Sexual minority stress: Is it finally down to homophobia?

Carolyn Moynihan
July 22, 2019
Reproduced with Permission

People who depart from the sexual norm in New Zealand have poorer mental health than heterosexual people, new research shows. Those who are bisexual are the most at risk of depression and suicidal thoughts, and more women than men identify as bisexual.

There is contradictory evidence, though, about how large the non-heterosexual population is, and the causes of lower wellbeing among sexual minorities are debatable. Activists and experts are quick to claim that homophobia is responsible for "minority stress", but negative childhood experiences are also common among homosexual and bisexual men and women.

Two different reports, however, confirm that the psychological problems are real and significant.

Statistics NZ's latest General Social Survey (GSS), which asked a question about sexual identity for the first time, found that bisexual people were the least happy on average. On a 10-point scale, only six out of 10 bisexuals rated their life satisfaction at 7 or above, compared with eight of 10 adults in the whole sample. (The survey includes people aged 15 and over.)

Asked specifically how they would rate their mental wellbeing, about one-fifth of adults said theirs was poor, compared with a third of bisexual people.

A new study from the University of Otago found that across three sexual minority groups, people were twice as likely to experience poorer mental health than heterosexual people. Bisexuals again came off badly, being twice as likely to report depression and five times as likely to report suicidal thoughts. The gay/lesbian group were nearly three times as likely to report anxiety symptoms, and four times as likely to report suicidal thoughts.

Drug abuse was only significant when it came to cannabis use among bisexuals (2.4 times more likely than among heterosexuals) especially men.

How big is this problem?

These findings will feed into the government's wellbeing focus and affect spending and other policies. That will, or should depend on two things: the actual scale of the problem and the causes of distress.

Regarding scale, the two sources discussed here give quite different ideas of the number of people suffering in this way.

Among the 8000 people (less minors?) surveyed in the 2018-2019 GSS, non-heterosexual people accounted for only 3.5 percent: bisexual (1.9%), gay/lesbian (1.1%) and others (0.5%). Everyone else identified as heterosexual. This, in response to the question: "Which of the following options best describes how you think of yourself? Heterosexual or straight; Gay or lesbian; Bisexual; Other; Don't know; Choose not to answer."

In contrast, the Otago study found that sexual minorities accounted for 18 percent of its subjects, suggesting that nearly one in five Kiwis are not (quite) straight. It was, to be sure, a different sort of exercise than the snapshot provided by the GSS.

Otago study: longitudinal, with four kinds of sexuality

Janet Spittlehouse and colleagues based their study on 1040 adults (511 males, 529 females) from the Christchurch Health and Development Study (CCHD) – a cohort of 1265 children born in 1977. At ages 18, 21, 25, 30 and 35 they were asked a series of questions about sexual behaviour, identity, attraction and "sexual fantasies". It appears to be the first study with this combination of features.

At the first interview (age 18) subjects were asked if they had ever had a same-sex relationship. At the second (21) they were also asked whether they identified as heterosexual, homosexual or bisexual. From age 25, the questions became more detailed. Subjects were asked if they had ever had a same-sex sexual experience. To ascertain sexual identity and attraction they were asked to describe their feelings about each category by choosing from a five-point scale ("which of the following best describes…"). They were also asked: "When you think or daydream about sex, do you think about: 'males only'; 'females only'; or 'both males and females'."

Depending on their responses, they were assigned to one of four groups: heterosexual (82%), mostly heterosexual (12.6%), bisexual (3.5%) and gay/lesbian (1.9%). Since the proportions of bisexuals and gay/lesbian individuals is similar to those of the GSS, the new group "mostly heterosexual" seems to represent people who might otherwise be counted as simply heterosexual.

Sexual 'fluidity'

In their journal article the Otago researchers point out that this group represents people whose responses varied over time, particularly in relation to the later questions about identity, attraction and fantasies. However, even the "heterosexual" group includes some people who reported either same-sex experience (2.9%) or same-sex fantasies (nearly 5%).

These findings confirmed a "fluidity" in sexuality that, according to their introduction, the researchers expected and were looking for. As Dr Spittlehouse said in a radio interview, "I think what these four groups show is that sexuality lies on a spectrum."

Of the 131 people assigned to the mostly heterosexual group, 71 had a same-sex experience, 19 had a same-sex relationship, 10 identified themselves (at some stage) as bisexual or gay/lesbian, 5 had experienced both-sex or same-sex attraction, and 66 said they had had both-sex or same-sex fantasies.

Presumably there is overlapping between some of these items (the supplementary data may clarify this), but is also possible that some people got into this category on the strength of their (occasional or passing) fantasies alone.

Women and sexual fluidity

In any case, the most notable feature of the group is that 76 percent of them were female. This was another result that did not surprise the Otago team, who refer to a couple of previous studies suggesting that women have more "fluid" sexuality than men. Women also outnumbered men in the bisexual category and, atypically, in the gay/lesbian category.

(The New Zealand social survey turned up a similar result for bisexuals – nearly 70 percent were women; but 60 percent of the gay/lesbian group were men.)

What is behind this female fluidity? Dr Spittlehouse and colleagues give us a couple clues. In the whole study group, two experiences were significant predictors of fluidity: exposure to more severe sexual abuse, and over-controlling mothers. Sexual abuse has become an epidemic since the 1970s and its effects are often lasting.

The researchers note that other New Zealand studies have shown that young women engage in more same-sex behaviour. One can think of many reasons for this, especially among those who have grown up in the era of LGB tolerance and affirmation. Adolescents are very suggestible, and much of the kissing and canoodling among young women that passes for same-sex attraction could be simply a matter of fashion.

Disappointment in marriage and with men in general also comes to mind. Dr Elisabeth Wells, author a 2010 Otago study, found that 40 percent of lesbians had been married and had children, compared with 13 percent for homosexual men.

What is driving women to flirt with or to adopt bisexual or homosexual identities is a question worth exploring further.

Homophobia and 'minority stress'

Experiencing a change of sexual attraction, the new Otago study found, is not on the whole related to mental health problems; but belonging to any sexual minority definitely is, so what could be the cause/s?

Other research, including Dr Wells' study, has linked homosexual and bisexual identities with negative childhood experiences. Dr Spittlehouse and colleagues therefore controlled for 14 variables relating to family background and childhood experiences in data available from the CCHD study. These included changes of parents, sexual abuse and violence between parents, childhood anxiety and other psychological disorders.

Three variables – sex (being male or, especially, female), childhood sexual abuse, and "neuroticism at age 14" – were correlated with all three major mental health issues (depression, anxiety and suicidal thoughts), but these and other variables accounted for relatively little of the wellbeing deficit. After taking them into account, the net result was the high risk-ratios noted earlier.

Dr Spittlehouse and colleagues speculate that the higher incidence of reported mental health problems in all sexual minority groups may be due to "minority stress", or internalised homophobia. Although society has grown more tolerant of those with same-sex tendencies – and more so with the legalising of same-sex marriage in New Zealand in 2012, which came after the Otago researchers had gathered their data – it is still, they suggest, not affirming enough.

Confirmation bias?

It is hard to escape the impression of confirmation bias in this study, both as to the spread of homosexual tendencies across the board ("sexuality lies on a spectrum") and the suggested attribution of mental health problems to social stigma (homophobia). It would need to be replicated before any policy decisions are based on it.

A Columbia University study from a few years ago provides a cautionary tale. Researchers there found that individuals who lived in communities with high levels of anti-gay prejudice had a shorter life expectancy -- 12 years on average -- compared with their peers in the least prejudiced communities. However, their findings, published in 2014 and widely reported to great consternation, could not be replicated and the paper has since been retracted.

That active homosexuals are more likely to shorten their own lives, of course, must not be mentioned, let alone the possibility that homosexuality itself is a disorder crying out for therapy rather than affirmation and celebration.

As for sexuality that lies on a spectrum, perhaps the progressive homosexualisation of sex has more to do with the sexual revolution and the pervasiveness of pornography than with fantasies and attractions that spring unbidden from some innate fluidity in sexual orientation.

To the extent that the study captures real trends in sexuality and mental health, however, it should lead to rigorous questioning of official and professional encouragement of sexual "diversity", and how good it really is for the individual.