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.