Minority stress, chronic physical health conditions, and depression among older lesbian, gay, and bisexual adults

This study investigates the complex pathways through which minority stress—specifically the concealment of sexual orientation and internalized heterosexism—contributes to depression among older lesbian, gay, and bisexual (LGB) adults. It also examines how these stressors interact with chronic physical health conditions to exacerbate mental health disparities in this aging population.

The authors conducted a secondary analysis of the National Health, Aging, & Sexuality Study (NHAS), a large, community-based survey of 2,349 LGB adults aged 50 and older in the United States. Using structural equation modeling (SEM), the researchers tested a theoretical model that maps the direct and indirect relationships between sexual orientation disclosure, internalized heterosexism, the number of chronic physical health conditions, and depressive symptoms, while controlling for sociodemographic factors like income and education.

The results support the minority stress theory, demonstrating that the stress of concealing one's sexual orientation is indirectly associated with depression and chronic physical health conditions, primarily through the mediator of internalized heterosexism. Internalized heterosexism acts as a significant predictor of both physical health decline and depression. Furthermore, the study found that chronic physical health conditions have a direct, independent relationship with depression, suggesting a synergistic effect where minority stress and physical illness compound to increase mental health risks for older LGB adults.

As the population of older LGB adults grows, understanding the unique social and psychological drivers of their health outcomes is critical. This research highlights that depression in this group is not merely a byproduct of aging but is deeply tied to the cumulative, "embodied" effects of societal heterosexism. The findings suggest that interventions should move beyond individual therapy to address the structural and community-level barriers that force individuals to conceal their identities, which in turn fuels the cycle of internalized stigma and poor health.