The Impact of Sexual Stigma and Gender Non-Conformity Stigma On Mental Health Outcomes: Implications for Social Work Practice and Research

Background

The deleterious impacts of sexual stigma on mental health outcomes among sexual minorities in North America and Europe has been widely documented. Yet there remains a scarcity of information regarding stigma and health outcomes among lesbian, gay and bisexual (LGB) populations in developing countries. There has also been an over-emphasis within social work practice and research on rigid categories of sexual orientation and sexual stigma, rendering gender non-conformity stigma largely unexamined although it may intersect with, and exacerbate, sexual stigma. Perceived stigma refers to awareness of negative societal attitudes, fear of discrimination and feelings of shame. Enacted stigma encompasses overt acts of discrimination, such as violence and exclusion. Quantitative research with men who have sex with men (MSM) in India has predominately focused on individual level risk behaviour rather than stigma or mental health. The purpose of this study was to examine the impact of sexual stigma and gender-non conformity stigma on depression and life satisfaction among MSM in South India.

Methods

This collaborative investigation was designed in partnership between the University of Toronto and community based organizations in South India. Community consultations, key informant interviews and pilot testing were utilized to develop a cross-sectional survey to examine sexual and gender non-conformity stigma, depression and life satisfaction. The survey was developed in English, translated into Tamil, and back-translated into English. Using purposive and convenience sampling, peer research assistants administered the survey in Tamil to MSM in urban and semi-urban locations in Tamil Nadu between October 2009 and January 2010. Bivariate correlations and multiple linear regression (MLR) analyses were conducted using SPSS 17 to measure associations between independent (sexual stigma, gender non-conformity stigma) and dependent (life satisfaction, depression) variables.

Results

Participants (n=200, mean age=30.9) reported experiences of sexual stigma (perceived: 89%; enacted: 92%) and gender non-conformity stigma (perceived: 86.5%; enacted: 75.5%). Half of participants (n=100; 50.0%) reported experiencing physical violence because of same sex behaviour. The majority of participants had moderate/severe depression scores (n=116, 58%). Sexual stigma and gender non-conformity scales had high reliability (Cronbach's alpha >0.80). Gender non-conformity stigma and sexual stigma were significantly correlated with higher rates of depression and lower life satisfaction. In MLR analyses, gender non-conformity and sexual stigma predicted higher levels of depression, R2=0.15, F(1, 198)=36.64, p<0.001, and lower levels of life satisfaction, R2=0.11, F(1, 198)=24.78, p<0.001.

Conclusions

Results highlight the associations between sexual stigma and gender non-conformity stigma— discriminatory social processes—and inequitable health outcomes (e.g. increased depression), contributing evidence to the role of human rights in health. Findings have implications for social work practice and research. Understanding the impact of sexual and gender-non conformity stigma on mental health can inform social work practice through highlighting the importance of multi-level interventions, including individual (e.g. mental health assessments) and structural (e.g. challenging sexual and gender non-conformity stigma) initiatives. Future social work research should focus on conceptualization and measurement that examines the intersection of sexual and gender non-conformity stigma to enhance understanding of the mechanisms of stigma and discrimination that influence the lives of sexual minorities.