Alcohol Dependence, Co-Occurring Depression, and Drinking-Related Consequences Among Sexual Minorities and Heterosexuals

BACKGROUND AND PURPOSE:

Alcohol dependence is a profound social problem with many behavioral health consequences (e.g., fighting, unprotected sex, or suicidality), which can be exacerbated by co-occurring mental health conditions, such as depression. Past research has found sexual minorities (e.g., gay, lesbian, bisexual) experience higher rates of alcohol dependence and depression than their heterosexual counterparts. Less is known about the differences between sexual minorities and heterosexuals in rates of types of depression (e.g., major depression vs. persistent depression), co-occurring alcohol dependence and depression, and consequences of alcohol dependence. To fill this gap, this presentation utilizes data from a nationally representative survey to answer the following questions: (a) Do sexual minorities experience higher rates of major depression, persistent depression, and co-occurring depression and alcohol dependence than heterosexuals? (b) Do sexual minorities with co-occurring depression and alcohol dependence experience more alcohol-related consequences than heterosexuals with co-occurring depression and alcohol dependence?

METHODS:

A nationally representative sample of 5,128 adults (n=155 sexual minorities) were surveyed between 2009 and 2010 through the National Alcohol Survey. Sexual orientation, major depression, persistent depression, and alcohol dependence were self-reported and dichotomized for analysis. A composite variable was created for number of alcohol-related consequences (e.g., fighting or arrest while drinking). Logistic regression was utilized to determine odds of depression, alcohol dependence, and co-occurrence across sexual orientation, controlling for other mental health and demographic variables. Poisson regression was utilized to determine the associations of sexual orientation and depression with the average number of alcohol-related consequences.

RESULTS:

Rates were 39% (n=61) vs. 28% (n=1,357) for major depression, 24% (n=37) vs. 22% (1,079) for persistent depression, 10% (n=15) vs. 3% (n=126) for alcohol dependence, and 6% (n=9) vs. 2% (n=75) for co-occurring depression and alcohol dependence for sexual minorities and heterosexuals, respectively. Sexual minorities experienced higher adjusted odds of persistent (AOR: 1.64, p<.01) but not major depression, after controlling for gender and alcohol dependence. Sexual minorities experienced higher adjusted odds of alcohol dependence (AOR: 2.29, p<.01) after controlling for gender and depression. Sexual minority and heterosexual individuals with co-occurring depression had, on average, more alcohol-related consequences than did individuals without co-occurring depression (IRR:1.28, p<.01), but no significant differences in number of alcohol-related consequences were found by sexual orientation.

CONCLUSIONS AND IMPLICATIONS:

This analysis finds that sexual minorities are more likely to experience persistent depression, but not major depression, after controlling for alcohol dependence and gender, and that sexual minorities have higher rates of co-occurring depression and alcohol dependence than do heterosexuals. These findings have implications for social work practice, including the importance of targeted mental health interventions for sexual minorities addressing persistent depression and co-occurring conditions. A limitation of this study is that the small number of sexual minority respondents limited statistical power and precluded analyses from controlling for potentially important confounders, such as race and victimization. Data using larger samples of sexual minority respondents, longitudinal methods, and more robust measures of minority stress risk factors for alcohol dependence and co-occurring depression are necessary to better understand sexual orientation-related disparities.