title: Life stress as a mediator and community belonging as a moderator of mood and anxiety disorders and co-occurring disorders with heavy drinking of gay, lesbian, bisexual, and heterosexual Canadians.
abstract: To examine the extent to which sexual identity disparities in mental health outcomes (anxiety disorder, mood disorder, anxiety-mood disorder, and co-occurring anxiety or mood disorder and heavy drinking) are mediated by life stress or moderated by a sense of community belonging.
  
  
  
  This study pooled data from a large, national, multi-year sample of Canadians aged 18-59 years, who self-identified as lesbian, gay, bisexual, or heterosexual (N = 222,548). A series of stratified binary mediation models were fitted. Significance of the indirect effect was determined by using bootstrapping to obtain standard errors and confidence intervals.
  
  
  
  Sexual minority (versus heterosexual) respondents were significantly more likely to describe their lives as stressful, their sense of community belonging as weak, and had significantly greater odds of the negative mental health outcomes. Perceived life stress partially mediated the effects of sexual identity on the mental health outcomes. The differences between the mediated effects for the gay/lesbian and bisexual subgroups were statistically significant (all p < 0.05). When stratified by sense of community belonging, life stress mediated the relationship with mood disorders for the gay/lesbian group, where a strong sense of community belonging was associated with greater odds of mood disorders for gay/lesbian versus heterosexual respondents.
  
  
  
  These mediation and moderated mediation models provide further evidence for a social patterning of the mental health disparities experienced by sexual minorities in Canada.
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. bpakula@alumni.ubc.ca.
authors.forename: Basia
authors.initials: B
authors.lastname: Pakula
authors.affiliation: Department of Sociology, University of British Columbia, 6303 Northwest Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Carpiano
authors.affiliation: Faculty of Education, University of British Columbia, 651-1958 Main Mall, Vancouver, BC, V6T 1Z2, Canada.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ratner
authors.affiliation: School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Shoveller
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology*; D002170:Canada; D005260:Female; D020010:Heterosexuality / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology*; D012929:Psychological Distance; D012111:Residence Characteristics; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Community belonging; Gay, lesbian, and bisexual health; Mental health; Sexual minority populations; Stress