Gay and bisexual men suffer significant psychological harm when living in countries where legal protections and social attitudes combine to create structural stigma against them, according to new research led by the Yale School of Public Health.
Published in the Journal of Abnormal Psychology, the study is believed to be the first to evaluate the effects of country-level structural stigma on the mental health of this population by examining geographic mobility patterns.
For the study, the researchers evaluated data from a 2017-2018 online survey of more than 123,000 gay and bisexual men in Europe and then assigned a score to all countries based on their level of structural stigma. They measured this stigma based on the presence of country-level anti-LGBTQ laws, policies, and community attitudes.
Their analysis suggests that the degree of structural stigma in gay and bisexual men's home countries is strongly related to their risk of both depression and suicidality, or their likelihood to have suicidal thoughts or make attempts on their own lives. For those who move after living in a lower-stigma country for several years, however, this association wanes.
The study also examined various reasons that structural stigma might harm mental health. The researchers found that gay and bisexual men living in countries where there is higher structural stigma or who had moved from such countries were more likely to conceal their sexual identity, isolate themselves, and internalize negativity toward themselves and other gay and bisexual men - with negative mental health consequences.
"By taking advantage of the fact that many of the men in this study had moved between countries, we were able to take a novel approach to answering the question of whether and how structural conditions surrounding gay and bisexual men might be relevant to their mental health," said John Pachankis, the Susan Dwight Bliss Associate Professor of Public Health at Yale and the study's lead author. "We found that stigma against gay and bisexual men is a public health threat that needs to be addressed."
In a country like Russia, which has several anti-LGBTQ laws and policies, the data show that more than 30% of surveyed residents reported suffering from depression. In Belgium, meanwhile, where the researchers found among the lowest levels of structural stigma, the chances of depression were around half as much as in Russia. Prior studies have found that men living in less stigmatizing countries are less likely to hide their sexuality or seek asylum.
The study also revealed that moving in the opposite direction - from a lower-stigma country to a higher-stigma country (from Belgium to Russia, for example) - had no significant effect on mental health. This may be because areas with more protective structural environments allow gay and bisexual men to build resilience against stigma exposure later in life.
More studies are needed to fully understand the ways that stigma can impact gay and bisexual men's mental health. Still, the researchers explained, the findings provide evidence that can better inform laws and policies as well as mental health care for this population.
Study co-authors include Mark L. Hatzenbuehler of Harvard University; Richard Bränström from the Karolinska Institutet; Peter Weatherburn and Axel J. Schmidt from the Sigma Research group at London School of Hygiene & Tropical Medicine; Rigmor C. Berg from the University of Tromso and Norwegian Institute of Public Health; Kai Jonas from Maastricht University; Michal Pitoňák from the National Institute of Mental Health Klecany; Sladjana Baros from the Institute of Public Health of Serbia; and Milan Jovanovic Batut from the European Centre for Diseases Prevention and Control.
