title: Discrimination, Mental Health, and Substance Use Disorders Among Sexual Minority Populations.
abstract: Sexual minority (lesbian, gay, bisexual) populations have a higher prevalence of mental health and substance use disorders compared to their heterosexual counterparts. Such disparities have been attributed, in part, to minority stressors, including distal stressors such as discrimination. However, few studies have examined associations between discrimination, mental health, and substance use disorders by gender among sexual minority populations.
  
  
  
  We analyzed data from 577 adult men and women who self-identified as lesbian, gay, or bisexual and participated in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Six questions assessed discrimination due to sexual orientation. Weighted multivariable logistic regression examined associations between experiences of sexual orientation discrimination and both mental health and substance use disorders. Analyses were conducted separately for sexual minority men and women, adjusting for sociodemographic covariates.
  
  
  
  Sexual minority men who ever experienced discrimination (57.4%) reported higher odds of any lifetime drug use disorder and cannabis use disorder compared to sexual minority men who never experienced discrimination. Sexual minority women who ever experienced discrimination (42.9%) reported higher odds of any lifetime mood disorder and any lifetime anxiety disorder compared to sexual minority women who never experienced discrimination.
  
  
  
  The findings suggest that discrimination is differentially associated with internalizing (mental health) and externalizing (substance use) disorders for sexual minority men and women. These findings indicate a need to consider how homophobia and heteronormative discrimination may contribute to distinct health outcomes for lesbian and bisexual women compared with gay and bisexual men.
authors.affiliation: 1 Brown University School of Public Health , Providence, Rhode Island.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: 2 Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University , Providence, Rhode Island.
authors.forename: Kristi E
authors.initials: KE
authors.lastname: Gamarel
authors.affiliation: 3 National Institute on Alcohol Abuse and Alcoholism , Rockville, Maryland.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.affiliation: 4 Fay W. Boozman College of Public Health, University of Arkansas , Little Rock, Arkansas.
authors.forename: Nickolas D
authors.initials: ND
authors.lastname: Zaller
authors.affiliation: 1 Brown University School of Public Health , Providence, Rhode Island.
authors.forename: Don
authors.initials: D
authors.lastname: Operario
mesh_terms: D000328:Adult; D004192:Discrimination, Psychological; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012737:Sex Factors; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D019529:Sexuality / Q000523:psychology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States
keywords: discrimination; gender; mental health; sexual minorities; substance use.