Heterosexist Microaggressions and Depression Among Gay, Bisexual, and Two-Spirit Men Who Have Sex with Men: An Ontario Study

Background: Minority stressors, such as discrimination, can increase gay, bisexual, and two-spirited men’s (GB2M) risk for mental health problems. Microaggressions are an everyday form of discrimination characterized by verbal and non-verbal expressions that convey hostile, derogatory, or negative messages toward people from marginalized groups. They can occur in interpersonal exchanges and the larger social environment. Previous research suggests microaggressions can contribute to negative outcomes. GB2M face regular exposure to microaggressions, which can adversely affect their health outcomes. To date, the role of microaggressions among this population has not been explored, though they are at high risk for poor mental health. The objective of this study was to examine the relationship between heterosexist microaggressions and major depression in a sample of GB2M in Ontario.

Methods: Participants were recruited via social media, dating websites, and mobile-apps and completed an online questionnaire. To measure microaggressions, we adapted the LGBQ Microaggressions on Campus Scale for use with GB2M (20 items; 5-point response-set; score range 0-100; a=.93; e.g., “I was told I should act ‘less, gay, bisexual, or queer’”), with higher scores indicating greater/more frequent experiences of microaggressions. The Patient Health Questionnaire (PHQ-9; score range 0-27) assessed depressive symptoms. Logistic regression modelling was used to examine the relationship between microaggressions and depression. To explore the incremental effects of different levels of exposure to microaggressions, we examined the relationship between each microaggression quartile. Using the median and interquartile range of the score distribution in our sample, we categorized microaggression scale scores into quartiles: Quartile 1 (0-29); Quartile 2 (30-43); Quartile 3 (44-59); Quartile 4 (60-100).

Results: The study sample included 846 GB2M. Median age was 30 years (IQR: 25-42 years). Most were HIV-negative/unknown HIV status (88%), single/never married (62%), White (61%), and completed post-secondary level education (87%). Seventy-one percent were employed and 57% had an annual income less than $40,000. Microaggression scores ranged from 0 to 100 (median: 43; interquartile range: 29-60). Nearly one-third (30.2%) met the criteria for major depression (PHQ-9 score ≥10) and prevalence of major depression increased with greater burden of microaggressions from 17% in the lowest quartile (Q1) to 48% in the highest quartile (Q4). Compared to GB2M in Q1, odds of major depression were 1.5 times (95% CI: 1.03-2.18), 1.8 times (95% CI: 1.29-2.63), and 2.8 times (95% CI: 2.04-3.91) higher in GB2M in Q2, Q3, Q4, respectively. After adjusting for demographic variables and HIV status, odds of major depression remained significantly higher (p<0.05) in GB2M in Q3 (aOR =1.39, 95% CI: 1.06-1.81) and Q4 (aOR=1.76, 95% CI: 1.37-2.26) of the microaggression scores.

Conclusions: Our findings provide evidence supporting a link between heterosexist microaggressions and increased burden of depression among GB2M, including when controlling for HIV status and other variables. The results suggest that trauma-informed clinical approaches that address the experiences of microaggressions may be helpful in improving mental health outcomes of GB2M. Likewise, structural interventions, such as awareness campaigns that aim to reduce the prevalence of microaggressions may ultimately contribute to positive outcomes for GB2M.