Enjeux: santé mentale

Conclusion: This review highlights key mental health-related issues that need to be taken into account in the creation and provision of appropriate, responsive and inclu- sive supports and services. Impact: What were the main findings? Some older people who identify as LGBTQ + have experienced stigma, discrimination, and minority stress. However, many have developed coping strategies and resilience while others have developed mental health issues. It is necessary to have in place appropriate interventions and supports to effectively meet the needs of this population. Where and on whom will the research have impact? The review has significant im- plications for health and nursing policy and inform developments in nursing practice and nurse education.

Background: Living alone is a risk factor for depressive symptoms among older adults, although it is unclear if it is a risk factor for older gay men. A sense of belonging to the gay community is protective and might compensate for living alone. This research investigated whether a sense of belonging with gay friends weakened the relationship between living alone and depressive symptoms among older gay men. Methods: A community sample of 160 Australian gay men aged 65{–}92 years completed the Center for Epidemiologic Studies Depression Scale and two visual analogue scales assessing a sense of belonging with gay friends. Results: Results supported the moderation model, with increasing levels of belonging with gay friends weakening the relationship between living alone and depressive symptoms. Conclusion: Results imply that enhancing a sense of belonging with gay friends among older gay men who live alone is likely to be a protective factor in relation to depressive symptoms.

During the past 50 years, there have been marked improvement in the social and legal envi- ronment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956{–}1963), visibility (born 1974{–}1981), and equality (born 1990{–}1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors{—}both distal stressors, such as violence and discrimination, and proximal stress- ors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities.

We evaluate the association between emotional and instrumen- tal support and perceived health and depression symptoms in a sample of 182 gay/bisexual men age $\ge$ 55. Perceived health was positively correlated with number of sources of emotional sup- port and depression was negatively associated with instrumental support and health care providers{’} knowledge of patients{’} sexual orientation. Depression mediates the connection between providers{’} knowledge of patients{’} sexual orientation and perceived health. Number of sources of emotional support varied negatively with age and ethnic minority status, and positively with living with a part- ner. Instrumental support seemed to be dependent on living with a partner.

Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care

Country-level structural stigma, defined as prejudiced population attitudes and discriminatory legislation and policies, has been suggested to compromise the wellbeing of sexual minority adults. This study explores whether and how structural stigma might be associated with sexual minorities{’} school-based and adulthood experiences of victimization and adulthood life satisfaction. Using a sample of 55,263 sexual minority individuals (22% female; 53% 18{–}29 years old; 85% lesbian/gay, 15% bisexual) living across 28 European countries and a country-level index of structural stigma, results show that sexual minorities, especially men, reported school bullying in both higher- and lower-stigma countries. Higher rates of school bullying were found among sexual minorities living in higher-stigma countries when open about their identity at school. Past exposure to school bullying was associated with lower adulthood life satisfaction, an association partially explained by an increased risk of adulthood victimization. These findings suggest that sexual minorities living in higher-stigma countries might benefit from not being open about their sexual identity at school, despite previously established mental health costs of identity concealment, because of the reduced risk of school bullying and adverse adulthood experiences. These results provide one of the first indications that structural stigma is associated with sexual minority adults{’} wellbeing through both contemporaneous and historical experiences of victimization.

Social Science {&} Medicine, 147 (2015) 200-208. doi:10.1016/j.socscimed.2015.10.066