Direct and Indirect Pathways Linking Socioeconomic Status and Race/Ethnicity to Wellbeing Among Gay and Bisexual Men

Background: Research on the well-being of gay, bisexual, and other men who have sex with men has examined socioeconomic status (SES) as one of many factors associated with a wide range of physical and behavioral health outcomes. While prior studies have shown that SES is an important factor affecting health, few studies have investigated the direct and indirect role of socioeconomic factors in gay and bisexual men’s health outcomes. Even fewer are studies that have investigated SES as a potential mediator between race/ethnicity and health outcomes among gay and bisexual men. This study examined the direct and indirect pathways that link SES to psychological and social well-being in gay and bisexual men. We also investigated whether SES is a pathway that may explain the association of race/ethnicity with health outcomes.

Methods: We analyzed data from a sample of gay and bisexual men (n = 198) who participated in Project STRIDE. Project STRIDE was a longitudinal study on intersectional identities and social stressors that affect minority populations. All participants were recruited in New York City. SES was a latent variable comprising six indicators: net worth, employment status, education level, household income, financial strain, and residential stress. Social well-being referred to participants’ perception of their social environment, whereas psychological well-being measured participants’ level of self-acceptance, autonomy, relations with others, purpose in life, environmental mastery and personal growth. Psychosocial pathways included internalized homophobia, chronic and routine unfair treatment in everyday life, collective self-esteem, and connectedness to gay community. We used structural equation modeling to test measurement and structural relationships. SES was measured at baseline. All other variables were measured one year later.

Results: Eighty six percent of study sample identified as gay; 34% and 32% were Black/African American and Latino/Hispanic men, respectively. Both measurement (χ² = 12.50, p = .19; RMSEA = 0.04; CFI = 0.97) and structural models had good fit (χ² = 117.76, p = .001; RMSEA = 0.05; CFI = 0.90). Being a racial/ethnic minority, being born in the United States, and larger household size were associated with low SES. SES was directly associated with collective self-esteem, chronic and routine unfair treatment in everyday life, and internalized homophobia. SES was also directly associated with psychological well-being and indirectly associated with psychological and social well-being. Racial/ethnic minority was indirectly associated with collective self-esteem, internalized homophobia, chronic and routine unfair treatment in everyday life, and psychological and social well-being via SES.

Implications: Study results suggest that SES is an important predictor of gay and bisexual men’s overall well-being. Low SES is both a direct and indirect factor affecting psychosocial outcomes and well-being. SES also appears to be a pathway linking racial/ethnic minority status to poor psychosocial and well-being outcomes. Economic and financial programs to assist gay and bisexual men might be a valuable tool to improve their overall well-being. These programs may be particularly salient to gay and bisexual men of color who are more likely to be unemployed, be financially strained, and earn less income than gay and bisexual white men.