Family Socioeconomic Status Buffers Serial Consequences of Adverse Childhood Experiences on Mental Illness Among Sexual Minority Population: A Conditional Process Modeling

Background and Purpose: As informed by the minority stress and intersectionality literature, adverse childhood experiences (ACE) may intersect with sexual minority populations to deteriorate their perceived discrimination (PD), self-stigma (SS), and subsequent mental illness conditions (MI). Conservation of resources theory also supports such a serial pathway, while it further proposes a positive facet of resource gain, which buffers and protects the cumulative pathways of resource loss and stress proliferation. Researchers have discussed some protective factors, such as psychological resilience and social support. However, an important domain, i.e., family SES, gets much less attention. Despite recognition for decades that SES is a powerful predictor of health and mental health, researchers have mainly controlled for SES without explicitly studying the construct. It is necessary and valuable for this study to explore how family SES protects the cumulative pathways among sexual minority populations.

Methods: This study utilized the data from a national online survey of lesbians, gay men, and bisexuals in the United States in 2016–2017. 1462 participants aged 18–60 (Mean = 36.55, SD = 14.67) provided full information relevant to the key variables. A moderated serial mediation model including covariates of participants’ sex at birth, gender identity, sexual identity, race, education, urbanicity, and age was examined using the conditional process analysis method.

Results: ACE was positively associated with PD (β = .254, SE = .024, p < .001) and MI (β = .075, SE = .023, p < .01), but negatively associated with SS (β = -.004, SE = .028, p >.05). PD was positively associated with SS (β = .157, SE = .030, p < .001) and MI (β = .298, SE = .025, p < .001). SS was positively associated with MI (β = .059, SE = .022, p < .01). SES significantly moderated the path from ACE to PD (β = -.083, SE = .022, p < .001) and the path from ACE to MI (β = -.049, SE = .022, p < .05). PD significantly mediated the relationship between ACE and MI while SS not. The serial mediation model was significant only at the mean and 1+SD levels of SES.

Conclusions and Implications: The study suggests that family SES could be a protective factor to buffer the cumulative shocks from ACE to PD, SS, and then MI among sexual minority populations. This study could be the first to comprehensively explore how SES plays a role in sexual minority mental health processes. It contributes to the applicability of ACE and SES literature to sexual minority populations. It also addresses the “myths of gay affluence” in the sexual minority literature by explicitly examining family SES. This study can provide practical implications for financial and health promotion and intervention targeted at sexual minority populations. Future research can unfold mental health processes among sexual minority groups at lower SES, particularly those in poverty, thus addressing the intersectionality and social inequality issues.