The Moderating Effects of Adverse Childhood Experiences and Age on Loneliness and Depression: Examining Disparities for Sexual and Gender Minorities

Background: Sexual and gender minorities experience a disproportionate burden of mental health conditions including depression, anxiety, and substance abuse disorders due, in part, to social factors. Recent population-level analyses have found that sexual and gender minorities, particularly those who identify as bisexual and transgender, experience significantly higher rates of social isolation and depression than those who identify as cisgender and straight/heterosexual. Separate studies identified excess burden in adverse childhood experiences (ACEs) among sexual and gender minorities compared to those who identify as cisgender and straight/heterosexual. This study assesses the relationship among ACEs, loneliness, and depression. We hypothesize that greater number of ACEs will significantly moderate higher probabilities of loneliness and depression among sexual and gender minorities compared to those who identify as cisgender and straight/heterosexual.

Methods: The Behavioral Risk Factor Surveillance System is a yearly cross-sectional survey carried out by the Centers for Disease Control and Prevention (CDC). It evaluates health risk behaviors, chronic diseases, and mental health among other measures of health and wellbeing and is the longest running national survey that includes variables on sexual orientation and gender in the U.S. In 2023, the optional social determinants and health equity module used in the present study gathered responses from 39 states, Puerto Rico, and the District of Columbia.

Descriptive statistics in addition to Rao-Scott chi-squared tests were used to meaningfully compare those with and without a history of depression and those who felt and did not feel lonely. We assessed the odds of feeling lonely and having a history of depression using weighted, multivariable logistic regressions and moderating effects of ACEs using interaction terms.

Results: Over 44% of the full sample felt lonely, and over 20% reported a history of depression. The prevalence of loneliness and depression was highest in those aged 18-34 (36.9% and 35.8% respectively) compared to those aged 55+ (32.4% and 32.7%; P<0.0001). Individuals identifying as transgender nonbinary had the highest odds of feeling lonely compared to cisgender straight/heterosexual males (OR = 3.25, 95% CI: 2.17–4.87). Those who did not graduate from high school had significantly increased odds of loneliness (OR = 1.54, 95% CI: 1.42–1.68). Unemployed individuals had notably higher odds of feeling lonely compared to employed individuals (OR = 1.86, 95% CI: 1.73–1.99). Transgender nonbinary individuals had exceptionally high odds of being told they had depression compared to cisgender straight males (OR = 17.72, 95% CI: 12.29–25.55). Single individuals had increased odds of being diagnosed with depression compared to married individuals (OR = 1.31, 95% CI: 1.23–1.41). Interaction effects between age and number of ACEs significantly predicted higher probabilities of loneliness and depression among younger, sexual and gender minorities with greater numbers of ACEs compared to cisgender, straight/heterosexual and older individuals with fewer ACEs (P<0.0001).

Discussion: Sexual and gender minorities, younger people, and individuals with lower education levels had significantly higher odds of reporting loneliness and depression. Future efforts should examine interventions to increase social connection while treating depression and other mental health issues for these populations.