Perceived Attitudes Towards LGB Issues and Mental Health Among Taiwanese LGB Adults: The Mediating Role of Self-Acceptance

Background and Purpose: Despite conspicuous progress towards equal rights for sexual minorities, sexual orientation disparities in mental health remain a global issue owing to persistent social stigma and institutional exclusion. While social determinant literature and the theoretical notion of structural stigma have associated adverse mental health outcome among marginalized communities with stigmatizing forces at social and institutional levels, less is known about the consequence of LGB individuals’ perception of attitudes towards homosexuality and same-sex marriage expressed by different sources (i.e., society as a whole, heterosexual friends, and family members). In addition, both Psychological Meditation Framework and Negotiated Identity Model contend that sexual minority people’s self-acceptance serves as a mediator that explains how a stigmatizing environment impinges on individual mental health. Combing these theoretical accounts, this study intended to answer two questions 1) how the unfavourable attitudes from different sources impact LGB people’s mental health; and 2) whether self-acceptance plays a mediating role.

Methods: In January 2017, 1,527 Taiwanese LGB adults were recruited to complete an online-based survey via Facebook. The survey consists of the 5-item Brief Symptom Rating Scale (BSRS-5) to assess respondents’ mental health and several single-item questions to rate their self-acceptance and their perceptions of other people’s attitude towards homosexuality and same-sex marriage. We conducted path analyses to examine directs and indirect effects of the various sources of perceived attitudes towards same-sex sexuality and partnership and to investigate the mediating role of self-acceptance.

Result: The sample has slightly more male respondents (n=812, 53.2%) than female respondents (n=715, 46.8%) with majority of them self-identified as homosexual (n=1,128, 73.9%), followed by bisexual (n=399, 26.1%). The age range of the sample is 20-62, with a mean age of 29.47 (SD= 6.89). The results indicated significant correlations between perceived attitudes towards homosexuality and same-sex marriage (r = 0.22 ~ 0.89, p < 0.001). The model fits the data well (RMSEA = 0.054, CFI = 0.99, TLI = 0.97) and shows that besides a direct effect of self-acceptance (B = -1.40, p < 0.001) on symptoms, self-acceptance partially mediates the association between symptoms and the perceived societal disapproval of homosexuality (B = 0.06, p < 0.05, CI = 0.15-0.01) as well as fully mediates the effects of perceived disapproval of homosexuality from heterosexual friends (B = -0.09, p < 0.01, CI, -0.03, -0.16). In addition, self-acceptance also fully mediates the effects of perceived approval of same-sex marriage from friends (B = -0.06, p < 0.01, CI, -.0.01, -0.12) and families (B = -0.06, p < 0.01, CI, -0.01, -0.14).

Conclusions and Implications: This study extends the literature on structural stigma by highlighting the consequences of perceived social attitudes and the mediating role of self-acceptance. Results provide crucial implications for promoting mental health of sexual minorities especially in the wake of public discussion and policy debate about diversity and marriage equality. Anti-stigma interventions should be rendered at a systematic level when opinions of objection are vocalized. LGB affirmative principles should be integrated into services in order to strengthen sexual minority’s self-acceptance.