Moderating Roles of Race/Ethnicity and Sexual/Gender Minority Status on the Asthma–Mental Health Relationship

Background and Purpose

Current literature shows that asthma and mental health disparities impact individuals identifying as either racial/ethnic or sexual/gender minorities. Despite this, there is currently limited research on the connection between asthma and mental illness in persons that are both racial/ethnic minority (REM) and sexual/gender minority (SGM). The present study aims to examine if REM and SGM moderate the asthma – mental health connection.

Methods

Utilizing the years 2018 through 2022 of the Behavioral Risk Factor Surveillance System (BRFSS), participants were included if they answered the Sexual Orientation and Gender Identity module and the asthma call-back survey (N=28,862). Asthma severity was categorized as remission and mild or moderate and severe. The mental health measure used the number of poor mental health days (≥14 days indicating frequent mental distress). Control variables included age, sex, education, smoking status, BMI, education, income, and insurance. Logistic regression was used to assess relationships between mental health and asthma severity amongst SGM and REM people.

Results

Identification as Black (0.79 [0.68, 0.91]) had a statistically significant lower odds ratio for asthma severity versus identification as white but identification as Latino (0.94 [0.83, 1.06]) was not statistically significant. Severe mental distress (1.92 [1.77, 2.07]) and identification as SOGI (1.18 [1.04, 1.34]) also presented as increased risk of moderate to severe asthma. Triple interactions between REM, SGM, and severe mental distress were not statistically significant. Severe mental distress had two separate statistically significant interactions with SOGI and identification as Black. When interacting with severe mental distress, identification as SOGI (0.793 [0.65, 0.97]) and Black (1.31 [1.01, 1.70]) moderated the relationship. Follow-up statistical analyses were conducted to examine both statistically significant double interactions further. The interaction between SGM and severe mental distress (1.47 [1.20, 1.79]), was weaker when compared to the cis-heterosexual population (1.96 [1.82, 2.12]). Finally, each race category was examined separately in the context of severe mental distress with persons identifying as white (1.80 [1.70, 1.92]) having the lowest odds ratio, persons identifying as Latino (2.04 [1.71, 2.44]) having the second highest, and persons identifying as Black (2.36 [1.905, 2.93]) as having the highest odds ratio. Correlations were assessed among covariates for multicollinearity, and no correlates >.7 or greater were found.

Conclusions and Implications

Identification as SGM may be a protective factor against the influence of severe mental distress on asthma severity. The present study supports prior literature, which has shown persons identifying as Black as having a higher risk regarding the mental health – asthma connection. The partial protective factor persons in the SGM community experience contradicts earlier SGM research but does not conflict with theory as Meyer (2003; 2015) asserts that SGM individuals and communities are capable of engaging in adaptive coping strategies that not only mitigate the harmful impacts of stress but also promote well-being (Meyer, 2015). More research is needed, specifically with tools designed to examine depression and anxiety, to examine the relationships between multiple minority stressors further.