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Sexual orientation disparities in mental health: the moderating role of educational attainment

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Mental health disparities between sexual minorities and heterosexuals remain inadequately understood, especially across levels of educational attainment. The purpose of the present study was to test whether education modifies the association between sexual orientation and mental disorder.

Methods

We compared the odds of past 12-month and lifetime psychiatric disorder prevalence (any Axis-I, any mood, any anxiety, any substance use, and comorbidity) between lesbian, gay, and bisexual (LGB) and heterosexual individuals by educational attainment (those with and without a bachelor’s degree), adjusting for covariates, and tested for interaction between sexual orientation and educational attainment. Data are drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of non-institutionalized US adults (N = 34,653; 577 LGB).

Results

Sexual orientation disparities in mental health are smaller among those with a college education. Specifically, the disparity in those with versus those without a bachelor’s degree was attenuated by 100 % for any current mood disorder, 82 % for any current Axis-I disorder, 76 % for any current anxiety disorder, and 67 % for both any current substance use disorder and any current comorbidity. Further, the interaction between sexual orientation and education was statistically significant for any current Axis-I disorder, any current mood disorder, and any current anxiety disorder. Our findings for lifetime outcomes were similar.

Conclusions

The attenuated mental health disparity at higher education levels underscores the particular risk for disorder among LGBs with less education. Future studies should consider selection versus causal factors to explain the attenuated disparity we found at higher education levels.

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Acknowledgments

This work was supported by a fellowship from the National Institute of Mental Health (grant number T32 MH013043 to D.M.B.), the National Institute on Drug Abuse (grant number K01 DA032558 to M.L.H.), and  the National Institute on Alcohol Abuse and Alcoholism (K01 AA021511 to K.M.K.), all of the National Institutes of Health. The funders had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    David M. Barnes, Ava D. Hamilton & Katherine M. Keyes

  2. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    Mark L. Hatzenbuehler

  3. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Katherine M. Keyes

Authors
  1. David M. Barnes
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  2. Mark L. Hatzenbuehler
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  3. Ava D. Hamilton
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  4. Katherine M. Keyes
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Corresponding author

Correspondence to David M. Barnes.

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All authors contributed equally to the article.

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Barnes, D.M., Hatzenbuehler, M.L., Hamilton, A.D. et al. Sexual orientation disparities in mental health: the moderating role of educational attainment. Soc Psychiatry Psychiatr Epidemiol 49, 1447–1454 (2014). https://doi.org/10.1007/s00127-014-0849-5

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  • DOI: https://doi.org/10.1007/s00127-014-0849-5

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