A systematic review examining risk factors for depression in sexual and gender minority subgroups: Lesbian, Gay and Bisexual sub-group analysis.
Summary
Depression rates among lesbian, gay and bisexual (LGB) people are higher than in cisgender
heterosexuals. Despite the need for targeted research that can be translated into specific
interventions, these discrete sexual minorities are often grouped together. By not
distinguishing, subgroup differences regarding the risk factors contributing to depression
are obscured, and resources are not optimally focused to subgroup distinctions. This
systematic review challenges this tradition by separating out data on lesbian, gay and
bisexual men and women in relation to risk factors for depression. An extensive search
across PubMed, Scopus, and PsycINFO was conducted by two reviewers. Findings from 39
papers suggest that LGB populations share several minority stress related risk factors and
that the most researched risk factors, and the risk factors with the strongest association for
depression, fall consistently within the minority stress framework (Meyer, 2003). For
lesbians, an absence of self-esteem was most associated with depression. For gay men
internalised homophobia and for bisexual women bi-negativity was most associated with
depression. While coming-out/disclosure of sexual identity was most associated with
depression for bisexual men. The data does contain a number of inconsistencies, with over
half of the 39 included studies including gay men (69.2%) and the least including bisexual
men (25.64%). Data lacked reporting on race/ethnicity across contexts and most studies
received mid/low-quality ratings, based on The Newcastle - Ottawa Quality Assessment
Scale evaluation from two reviewers, due to a reliance on convenience sampling strategies
and a lack of controls. Overall, this review provides a breakdown of risk factors for
depression in LGB sub-populations and further urges researchers to follow this approach in
the future to uncover both research bias and the unique ways in which minority stress, and
other risk factors, may affect the mental health needs of sexual minority subgroups.