Social Psychiatry and Psychiatric Epidemiology

, Volume 51, Issue 8, pp 1181–1192 | Cite as

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

  • Basia Pakula
  • Richard M. Carpiano
  • Pamela A. Ratner
  • Jean A. Shoveller
Original Paper



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.


Sexual minority populations Gay, lesbian, and bisexual health Stress Community belonging Mental health 



BP is the recipient of a CIHR Doctoral Research Award (Frederick Banting and Charles Best Canada Graduate Scholarship), a CIHR Institute of Gender and Health, Skills Development Award, and a Killam Doctoral Scholarship. RC held a Canadian Institutes of Health Research, New Investigator Award.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Basia Pakula
    • 1
  • Richard M. Carpiano
    • 2
  • Pamela A. Ratner
    • 3
  • Jean A. Shoveller
    • 1
  1. 1.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  2. 2.Department of SociologyUniversity of British ColumbiaVancouverCanada
  3. 3.Faculty of EducationUniversity of British ColumbiaVancouverCanada

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