A systematic review examining risk factors for depression in sexual and gender minority subgroups: Lesbian, Gay and Bisexual sub-group analysis.

Abstract

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.