Social Support As a Mechanism Driving the Association between Stigma and Alcohol Use Disorders/Depression Among Sexual Minority Women

BACKGROUND/PURPOSE:

Sexual minority (e.g., lesbian, bisexual) women (SMW) experience alcohol use disorder (AUD) and depression at approximately twice the rates of heterosexual women. Though stigma serves as a common explanation for these disparities, less is known about the mechanisms through which stigma may contribute to these disparities. Past research has found the strategies that individuals use to regulate their emotions in response to experiences of stigma may influence their mental health outcomes. Among general samples, seeking social support (i.e., talking to someone about the experience) following a stigma-related stressor has been linked to reduced risk for AUD and depression symptoms. To determine whether social support serves as a mechanism through which stigma may influence AUD and depression symptoms among SMW, this study examines if (a) number of stigma-related stressors predicts level of social support and number of AUD and depression symptoms among SMW; (b) social support predicts AUD and depression symptoms among SMW; (c) social support mediates the relationship between stigma and AUD and depression symptoms among SMW.

METHODS: A national sample of 2,423 SMW participated in an online survey in 2017 through the PRIDE Study. Respondents self-reported demographic information, number of experiences of stigma, levels of social support, and number of AUD and depression symptoms. To address the first and second aims, bivariate regressions were run to determine if stigma predicted social support, AUD, and depression and if social support predicted AUD and depression. To address the third aim, bootstrapping estimates were utilized in mediation regression analyses and Sobel-Goodman mediation tests were performed to determine if social support mediated the relationships between stigma and AUD and depression symptoms.

RESULTS:

Stigma-related stressors significantly predicted level of social support (β=-.1183, t(2,181)=-3.02, p<.0001), AUD symptoms (β=.2622, t(1,858)=4.19, p<.0001), and depression symptoms (β=.6600, t(2,147)=8.13, p<.0001). Social support significantly predicted AUD symptoms (β=-.0318, t(1,817)=-0.92, p<.05) and depression symptoms (β=-.7041, t(2,054)=-17.11, p<.0001). In a model that explained a significant portion of the variance in depression (R² =.1480, F(2,2052)=179.34, p<.0001), social support partially mediated the relationship between stigma and depression (β=.0865, z(2,052)=3.00, p<.05), explaining 13% of the relationship between stigma and depression. Social support did not significantly mediate the relationship between stigma and AUD.

CONCLUSIONS/IMPLICATIONS:

Stigma-related stressors are associated with AUD and depression symptoms among SMW. Stigma-related experiences may cause SMW to deplete their social support systems, potentially increasing risk for depression; this mechanism does not appear to drive AUD symptoms. This finding suggests that cultivating social support networks that are responsive to experiences of stigma may be an important component of depression treatments for SMW. Though the cross-sectional design of this study limits the potential for causal inference, this study makes an important contribution to the literature by utilizing a largescale, national sample of SMW to evaluate a potential mechanism driving both AUD and depression symptoms among this vulnerable population. Future research should use longitudinal methods to improve potential for causal inference. Future research should also identify mechanisms common to AUD and depression to facilitate the development of interventions for co-occurring alcohol and depressive disorders.