title: The protective effects of social/contextual factors on psychiatric morbidity in LGB populations.
abstract: BACKGROUND
  Lesbian, gay and bisexual (LGB) populations evidence higher rates of psychiatric disorders than heterosexuals, but most LGB individuals do not have mental-health problems. The present study examined risk modifiers at the social/contextual level that may protect LGB individuals from the development of psychiatric disorders.
  
  
  METHODS
  Data are drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653), a nationally representative study of non-institutionalized US adults. Risk variables included social isolation and economic adversity. High state-level concentration of same-sex couples, obtained from the US Census, was examined as a protective factor.
  
  
  RESULTS
  The past-year prevalence of major depression and generalized anxiety disorder was lower among LGB respondents living in states with higher concentrations of same-sex couples, compared with LGB respondents in states with lower concentrations. Additionally, the increased risk for mood and anxiety disorders among LGB individuals exposed to economic adversity and social isolation was evident only in states with low concentrations of same-sex couples. These interactions between the risk and protective factors were not found among heterosexuals, suggesting specificity of the effects to LGB individuals. Results were not attenuated after controlling for socio-demographic factors, state-level income inequality, state-level policies targeting LGBs and state-level attitudes towards LGB-relevant issues.
  
  
  CONCLUSIONS
  These results provide evidence for the protective effect of social/contextual influences on the prevalence of psychiatric disorders in LGB individuals. Measures of the social environment should be incorporated into future research on the mental health of LGB populations.
authors.affiliation: Center for Study of Social Inequalities and Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. mlh2101@columbia.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
authors.forename: Katie A
authors.initials: KA
authors.lastname: McLaughlin
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D001727:Bisexuality / Q000523:psychology* / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D018452:Homosexuality, Female / Q000523:psychology* / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D012044:Regression Analysis; D012307:Risk Factors; D012934:Social Isolation; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology