Archives of Sexual Behavior

, Volume 43, Issue 8, pp 1571–1578 | Cite as

Minority Stress in Lesbian, Gay, and Bisexual Young Adults in Australia: Associations with Psychological Distress, Suicidality, and Substance Use

  • Toby LeaEmail author
  • John de Wit
  • Robert Reynolds
Original Paper


Lesbian, gay, bisexual, and other same-sex attracted young people have been shown to be at a higher risk of mental health problems, including depression, anxiety, suicidality, and substance abuse, compared to their heterosexual peers. Homophobic prejudice and stigma are often thought to underlie these disparities. In this study, the relationship between such experiences of social derogation and mental health and substance use in same-sex attracted young people was examined using Meyer’s minority stress theory. An online survey recruited 254 young women and 318 young men who identified as same-sex attracted, were aged 18–25 years, and lived in Sydney, Australia. Multivariate logistic regression analyses showed that internalized homophobia, perceived stigma, and experienced homophobic physical abuse were associated with higher levels of psychological distress and self-reported suicidal thoughts in the previous month. Furthermore, perceived stigma and homophobic physical abuse were associated with reporting a lifetime suicide attempt. The association between minority stress and substance use was inconsistent. While, as expected, higher levels of perceived stigma were associated with club drug dependence, there was an inverse association between internalized homophobia and club drug use, and between perceived stigma and hazardous alcohol use. The findings of this study provide support for the minority stress theory proposition that chronic social stress due to sexual orientation is associated with poorer mental health. The high rates of mental health and substance use problems in the current study suggest that same-sex attracted young people should continue to be a priority population for mental health and substance use intervention and prevention.


Sexual orientation Minority stress Mental health Alcohol Drugs Substance use 


  1. Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2009). Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38, 1001–1014.PubMedCentralCrossRefPubMedGoogle Scholar
  2. Attorney General’s Department. (2011). Same-sex reforms: Overview of the Australian Government’s same-sex law reforms. Retrieved from
  3. Australian Bureau of Statistics. (2007). National survey of mental health and wellbeing: Summary of results (ABS Cat No. 4326.0). Canberra: ABS.Google Scholar
  4. Australian Institute of Health and Welfare. (2011). Young Australians: Their health and wellbeing 2011 (Cat. No. PHE 140). Canberra: AIHW.Google Scholar
  5. Baiocco, R., D’Alessio, M., & Laghi, F. (2010). Binge drinking among gay, and lesbian youths: The role of internalized sexual stigma, self-disclosure, and individuals’ sense of connectedness to the gay community. Addictive Behaviors, 35, 896–899.CrossRefPubMedGoogle Scholar
  6. Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence, 38, 989–1000.CrossRefPubMedGoogle Scholar
  7. Bontempo, D. E., & D’Augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364–374.CrossRefPubMedGoogle Scholar
  8. Brubaker, M. D., Garrett, M. T., & Dew, B. J. (2009). Examining the relationship between internalized heterosexism and substance abuse among lesbian, gay, and bisexual individuals: A critical review. Journal of LGBT Issues in Counseling, 3, 62–89.CrossRefGoogle Scholar
  9. Bruno, R., Matthews, A. J., Topp, L., Degenhardt, L., Gomez, R., & Dunn, M. (2009). Can the severity of dependence scale be usefully applied to ‘ecstasy’? Neuropsychobiology, 60, 148–158.CrossRefGoogle Scholar
  10. Burton, C. M., Marshal, M. P., Chisolm, D. J., Sucato, G. S., & Friedman, M. S. (2013). Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: A longitudinal analysis. Journal of Youth and Adolescence, 42, 394–402.PubMedCentralCrossRefPubMedGoogle Scholar
  11. Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795.CrossRefPubMedGoogle Scholar
  12. D’Augelli, A. R., Pilkington, N. W., & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17, 148–167.CrossRefGoogle Scholar
  13. Dawson, D. A., Grant, B. F., & Stinson, F. S. (2005). The AUDIT-C: Screening for alcohol use disorders and risk drinking in the presence of other psychiatric disorders. Comprehensive Psychiatry, 46, 405–416.CrossRefPubMedGoogle Scholar
  14. Degenhardt, L., Darke, S., & Dillon, P. (2002). GHB use among Australians: Characteristics, use patterns and associated harm. Drug and Alcohol Dependence, 67, 89–94.CrossRefPubMedGoogle Scholar
  15. Drasin, H., Beals, K. P., Elliott, M. N., Lever, J., Klein, D. J., & Schuster, M. A. (2008). Age cohort differences in the developmental milestones of gay men. Journal of Homosexuality, 54, 381–399.CrossRefPubMedGoogle Scholar
  16. Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School Psychology Review, 37, 202–216.Google Scholar
  17. Fergusson, D. M., Horwood, L. J., Ridder, E. M., & Beautrais, A. L. (2005). Sexual orientation and mental health in a birth cohort of young adults. Psychological Medicine, 35, 971–981.CrossRefPubMedGoogle Scholar
  18. Floyd, F. J., & Bakeman, R. (2006). Coming-out across the life course: Implications of age and historical context. Archives of Sexual Behavior, 35, 287–296.CrossRefPubMedGoogle Scholar
  19. Galaxy Research. (2010). Same-sex marriage study. Commissioned by Australian Marriage Equality and Parents and Friends of Lesbians and Gays. Sydney: Galaxy Research.Google Scholar
  20. Gossop, M., Griffiths, P., Powis, B., & Strang, J. (1992). Severity of dependence and route of administration of heroin, cocaine and amphetamines. British Journal of Addiction, 87, 1527–1536.CrossRefPubMedGoogle Scholar
  21. Greenwood, G. L., White, E. W., Page-Shafer, K., Bein, E., Osmond, D. H., Paul, J., et al. (2001). Correlates of heavy substance use among young gay and bisexual men: The San Francisco young men’s health study. Drug and Alcohol Dependence, 61, 105–112.CrossRefPubMedGoogle Scholar
  22. Grierson, J., & Smith, A. M. A. (2005). In from the outer: Generational differences in coming out and gay identity formation. Journal of Homosexuality, 50, 53–70.CrossRefPubMedGoogle Scholar
  23. Grov, C., Kelly, B. C., & Parsons, J. T. (2009). Polydrug use among club-going young adults recruited through time-space sampling. Substance Use and Misuse, 44, 848–864.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Erickson, S. J. (2008). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychology, 27, 455–462.CrossRefPubMedGoogle Scholar
  26. Heffernan, K. (1998). The nature and predictors of substance use among lesbians. Addictive Behaviors, 23, 517–528.CrossRefPubMedGoogle Scholar
  27. Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Pscyhology, 56, 32–43.CrossRefGoogle Scholar
  28. Hillier, L., Jones, T., Monagle, M., Overtron, N., Gahan, L., Blackman, J., et al. (2010). Writing themselves in 3: The third national study on the sexual health and wellbeing of same sex attracted and gender questioning young people. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University.Google Scholar
  29. Hughes, T., Szalacha, L. A., & McNair, R. (2010). Substance abuse and mental health disparities: Comparisons across sexual identity groups in a national sample of young Australian women. Social Science and Medicine, 71, 824–831.CrossRefPubMedGoogle Scholar
  30. Johnston, A. K., Pirkis, J. E., & Burgess, P. M. (2009). Suicidal thoughts and behaviours among Australian adults: Findings from the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 43, 635–643.CrossRefPubMedGoogle Scholar
  31. Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 180, 423–427.CrossRefPubMedGoogle Scholar
  32. Kaye, S., & Darke, S. (2002). Determining a diagnostic cut-off on the Severity of dependence scale (SDS) for cocaine dependence. Addiction, 97, 727–731.CrossRefPubMedGoogle Scholar
  33. Keleher, A., & Smith, E. R. A. N. (2012). Growing support for gay and lesbian equality since 1990. Journal of Homosexuality, 59, 1307–1326.CrossRefPubMedGoogle Scholar
  34. Kelleher, C. (2009). Minority stress and health: Implications for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people. Counselling Psychology Quarterly, 22, 373–379.CrossRefGoogle Scholar
  35. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976.CrossRefPubMedGoogle Scholar
  36. Kuyper, L., & Fokkema, T. (2011). Minority stress and mental health among Dutch LGBs: Examination of differences between sex and sexual orientation. Journal of Counseling Pscyhology, 58, 222–233.CrossRefGoogle Scholar
  37. Lea, T., Reynolds, R., & de Wit, J. (2013). Alcohol and club drug use among same-sex attracted young people: Associations with frequenting the lesbian and gay scene and other bars and nightclubs. Substance Use and Misuse, 48, 129–136.CrossRefPubMedGoogle Scholar
  38. Lehavot, K., & Simoni, J. M. (2011). The impact of minority stress on mental health and substance use among sexual minority women. Journal of Consulting and Clinical Psychology, 79, 159–170.PubMedCentralCrossRefPubMedGoogle Scholar
  39. Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., et al. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49, 115–123.PubMedCentralCrossRefPubMedGoogle Scholar
  40. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556.PubMedCentralCrossRefPubMedGoogle Scholar
  41. McCormack, M. (2012). The declining significance of homophobia: How teenage boys are redefining masculinity and heterosexuality. Oxford: Oxford University Press.CrossRefGoogle Scholar
  42. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefPubMedGoogle Scholar
  43. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.PubMedCentralCrossRefPubMedGoogle Scholar
  44. Meyer, I. H., Frost, D. M., Narvaez, R., & Dietrich, J. H. (2006). Project stride: Methodology and technical notes. Unpublished report.Google Scholar
  45. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30, 1019–1029.CrossRefPubMedGoogle Scholar
  46. Nicholas, J., & Howard, J. (1998). Better dead than gay? Depression, suicide ideation and attempt among a sample of gay and straight-identified males aged 18 to 24. Youth Studies Australia, 17, 28–33.Google Scholar
  47. Plöderl, M., Wagenmakers, E. J., Tremblay, P., Ramsay, R., Kralovec, K., Fartacek, C., et al. (2013). Suicide risk and sexual orientation: A critical review. Archives of Sexual Behavior, 42, 715–727.CrossRefPubMedGoogle Scholar
  48. Reynolds, R. (2008). Unremarkably gay: Post-gay life in Sydney. Identities: Journal for Politics, Gender and Culture, 6, 201–234.CrossRefGoogle Scholar
  49. Savin-Williams, R. C. (1994). Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: Associations with school problems, running away, substance abuse, prostitution, and suicide. Journal of Consulting and Clinical Psychology, 62, 261–269.CrossRefPubMedGoogle Scholar
  50. Savin-Williams, R. C., & Ream, G. L. (2003). Suicide attempts among sexual-minority male youth. Journal of Clinical Child and Adolescent Psychology, 32, 509–522.CrossRefPubMedGoogle Scholar
  51. Seidman, S., Meeks, C., & Traschen, F. (1999). Beyond the closet? The changing social meaning of homosexuality in the United States. Sexualities, 2, 9–34.CrossRefGoogle Scholar
  52. Smith, A. M. A., Rissel, C. E., Richters, J., Grulich, A. E., & de Visser, R. O. (2003). Sex in Australia: Sexual identity, sexual attraction and sexual experience among a representative sample of adults. Australian and New Zealand Journal of Public Health, 27, 138–145.CrossRefPubMedGoogle Scholar
  53. Topp, L., & Mattick, R. P. (1997). Choosing a cut-off on the severity of dependence scale (SDS) for amphetamine dependence. Addiction, 92, 839–845.CrossRefPubMedGoogle Scholar
  54. van Bergen, D. D., Bos, H. M. W., van Lisdonk, J., Keuzenkamp, S., & Sandfort, T. G. M. (2012). Victimization and suicidality among Dutch lesbian, gay, and bisexual youths. American Journal of Public Health, 103, 1–3.Google Scholar
  55. van den Berghe, W., Dewaele, A., Cox, N., & Vincke, J. (2010). Minority-specific determinants of mental well-being among lesbian, gay, and bisexual youth. Journal of Applied Social Psychology, 40, 153–166.CrossRefGoogle Scholar
  56. Willoughby, B. L. B., Doty, N. D., & Malik, N. M. (2010). Victimization, family rejection, and outcomes of gay, lesbian, and bisexual young people: The role of negative GLB identity. Journal of GLBT Family Studies, 6, 403–424.CrossRefGoogle Scholar
  57. Wright, E. R., & Perry, B. L. (2006). Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth. Journal of Homosexuality, 51, 81–110.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
  2. 2.Faculty of ArtsMacquarie UniversitySydneyAustralia

Personalised recommendations