“Our study found that gay and bisexual men had a lower risk of depression and suicidality when they moved from higher-stigma countries to lower-stigma countries, especially when they had lived in the new country for five years or longer,” said lead study author John Pachankis, PhD, an associate professor of public health and director of the LGBTQ Mental Health Initiative at the Yale School of Public Health.
The study used data from a 2017-18 online survey of more than 123,000 participants living in countries in Europe and Asia. Most of the participants were gay or bisexual men, while approximately 6% were men who had sex with men who identified as heterosexual or another identity. The survey asked participants questions designed to assess their mental health as well as other factors, such as the extent to which they felt compelled to conceal their sexual orientation, internalized negative attitudes they held toward homosexuality and how socially isolated they felt.
The researchers analyzed data from participants who moved between countries with differing levels of structural stigma as measured by an indicator compiled from 15 laws and policies relating to LGBTQ rights, as well as social attitudes. More than 11,000 participants who moved from higher- to lower-stigma countries were included in the analysis.
The results also suggest some reasons why exposure to high structural stigma may affect mental health of gay and bisexual men, according to Pachankis.
Although the study didn’t examine the effects of specific laws and policies, one of the most common forms of structural stigma in the higher-stigma countries was a lack of legal recognition of relationships, such as same-sex marriage. Men who moved from higher- to lower-stigma countries were more likely to move to live openly as LGBTQ and to seek asylum than men who moved from lower- to higher-stigma countries.
For the smaller number of gay and bisexual men who moved from lower- to higher-stigma countries, there wasn’t an increased risk for suicidality and depression, possibly because growing up in a more tolerant society had some lasting mental health benefits.
The study didn’t include participants living in the United States, but previous research in the United States has found significantly poorer mental health among LGBTQ people who live in states where hate crime and employment non-discrimination laws lack protections based on sexual orientation.
Mental health professionals working in high-stigma environments across the world should consider addressing the internalized homonegativity and social isolation of LGBTQ clients, while advocating for changes to laws, policies and societal stigma directed against LGBTQ people, Pachankis said.
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