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Mental health of the non-heterosexual population of England

  • Apu Chakraborty (a1), Sally McManus (a2), Terry S. Brugha (a3), Paul Bebbington (a4) and Michael King (a4)...
Abstract
Background

There has been little research into the prevalence of mental health problems in lesbian, gay and bisexual (LGB) people in the UK with most work conducted in the USA.

Aims

To relate the prevalence of mental disorder, self-harm and suicide attempts to sexual orientation in England, and to test whether psychiatric problems were associated with discrimination on grounds of sexuality.

Method

The Adult Psychiatric Morbidity Survey 2007 (n = 7403) was representative of the population living in private UK households. Standardised questions provided demographic information. Neurotic symptoms, common mental disorders, probable psychosis, suicidality, alcohol and drug dependence and service utilisation were assessed. In addition, detailed information was obtained about aspects of sexual identity and perceived discrimination on these grounds.

Results

Self-reported identification as non-heterosexual (determined by both orientation and sexual partnership, separately) was associated with unhappiness, neurotic disorders overall, depressive episodes, generalised anxiety disorder, obsessive–compulsive disorder, phobic disorder, probable psychosis, suicidal thoughts and acts, self-harm and alcohol and drug dependence. Mental health-related general practitioner consultations and community care service use over the previous year were also elevated. In the non-heterosexual group, discrimination on the grounds of sexual orientation predicted certain neurotic disorder outcomes, even after adjustment for potentially confounding demographic variables.

Conclusions

This study corroborates international findings that people of non-heterosexual orientation report elevated levels of mental health problems and service usage, and it lends further support to the suggestion that perceived discrimination may act as a social stressor in the genesis of mental health problems in this population.

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Copyright
Corresponding author
Apu Chakraborty, Department of Mental Health Sciences, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Email: rejuatc@ucl.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Mental health of the non-heterosexual population of England

  • Apu Chakraborty (a1), Sally McManus (a2), Terry S. Brugha (a3), Paul Bebbington (a4) and Michael King (a4)...
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eLetters

Mental health of the non-heterosexual population

MOHINDER KAPOOR, Specialty Registrar (ST5) Old Age Psychiatry
16 February 2011

Chakraborty et al1 describe an interesting paper looking at the mental health of the non-heterosexual population of England. As we all know that there is only limited information available in relation to mental health problems in representative populations of lesbian, gay and bisexual (LGB) people in Europe. Therefore credit should be given to the authors in conducting this study, which is the first one of its kind in England, that examined the mental health and well being of LGB people in general population.

Authors used cross-sectional study design as part of their methodology. Cross-sectional studies (also known as Cross-sectional analysis) form a class of research methods that involve observation of allof a population, or a representative subset, at a defined time.2 Cross-sectional study is a type of descriptive study, in which risk and outcome are assessed simultaneously among individuals in a well-defined population. The risk factors may be subject to alteration subsequent (or even consequent) to the development of outcome. Therefore, the data can beused to describe characteristics of individuals with the outcome and to formulate hypotheses, but not to test them.3 Thus, cross-sectional studiesare useful for raising the question of the presence or absence of an association rather than for testing a hypothesis.

The point I want to raise is that the authors of this study appear over ambitious in achieving the aims of the study based on the design of the study. Given the nature of design of the study it is possible to determine the prevalence of psychiatric and service-use outcomes by sexualorientation status in the general population. We can conclude from this study that people of non-heterosexual orientation report elevated levels of mental health problems and service usage. However, one cannot test whether psychiatric problems are associated with discrimination on groundsof sexuality as stated by the authors, based on the arguments discussed above. It is quite remarkable that the authors mention this limitation of cross-sectional surveys under the limitations section. However, they seem to have over looked this limitation of cross-sectional studies while setting the aims of their study.

In order to study the true impact of discrimination on grounds of sexuality in the genesis of mental health problems future research based on analytic study design is needed. In analytic study designs (case-control, cohort) the investigator would be able to determine whether or not the risk of mental health problems is different for heterosexual and non-heterosexual individuals reporting discrimination on the basis of sexual orientation. It is the use of an appropriate comparison group that will allow the testing of hypothesis (impact of discrimination on grounds of sexuality in the genesis of mental health problems) in an analytic study design.3

Declaration of interest: None

References:

1.Chakraborty et al. Mental health of the non-heterosexual population of England. Br J Psychiatry 2011; 198: 143-148.

2.http://en.wikipedia.org/wiki/Cross-sectional_study

3.Hennekens CH, Burning JE et al. Epidemiology in Medicine. Little, Brown and Company Boston/Toronto, 1987.
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Conflict of interest: None Declared

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Eating Disorders and Sexuality

William R Jones, ST5 in Psychiatry
09 February 2011

In their excellent article, Chakraborty et al [1] conclude that non-heterosexual individuals are at higher risk of mental health problems and service usage. As eating disorders were not included in the mental health outcomes of the study, we felt that further discussion was needed regarding the complex relationship between eating disorders and sexuality,and particularly sexual orientation.

Feldman and Meyer [2] demonstrated a higher prevalence for eating disorders among gay and bisexual men than their heterosexual counterparts,with more than 15% of gay or bisexual men suffering from an eating disorder. Conversely, Carlat et al [3] found 27% of a male eating disordersample were homosexual or bisexual, 41% heterosexual, and 32% 'asexual'. Other studies have found less significant results with indications that ofthe subjects seen, only 4% were homosexual and 8% were bisexual.

A number of explanations have been offered to explain the associationof eating disorders with male sexuality. It has been suggested that gay men may be under more pressure to conform to an impossible beauty ideal, with consequent body image dissatisfaction and related eating disorder behaviours. Chakraborty et al's [1] findings also raise the possibility ofdisordered eating arising from co-morbidities such as affective disorder, and this has been under-explored. However, Morgan and Arcelus [4] found widespread body dissatisfaction among younger men regardless of sexual orientation, with both gay and straight men exposed to the toxic soup of media influences.

Past research into eating disorders and sexual orientation has been limited by oversimplification of the latter, being far more complex than simple categorisation. However, in our opinion, commentary on mental health of non-heterosexual populations is incomplete without reference to eating disorders and related body image disturbance.

References

1. Chakraborty A, McManus S, Brugha TS, Bebbington P, King M. Mental health of the non-heterosexual population of England. British Journal of Psychiatry 2011; 198: 143–8.

2. Feldman MB, Meyer IH. Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders 2007; 40: 218–26.

3. Carlat DJ, Camargo CA, Herzog DB. Eating disorders in males: a report on 135 patients. American Journal of Psychiatry 1997; 154: 1127–32.

4. Morgan JF, Arcelus J. Body image in gay and straight men: a qualitative study. European Eating Disorders Review 2009; 17: 435–43.
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Conflict of interest: None Declared

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