LGB individuals living in anti-gay communities die early
In the first study to look at the consequences of anti-gay prejudice for mortality, researchers at Columbia University’s Mailman School of Public Health found that lesbian, gay, and bisexual (LGB) individuals who lived in communities with high levels of anti-gay prejudice have a shorter life expectancy of 12 years on average compared with their peers in the least prejudiced communities. “The results of this study suggest a broadening of the consequences of prejudice to include premature death,” noted the study’s lead author, Mark Hatzenbuehler, PhD, assistant professor of Sociomedical Sciences. The study is online in the journal Social Science & Medicine.
“Our findings indicate that sexual minorities living in communities with higher levels of prejudice die sooner than sexual minorities living in low-prejudice communities, and that these effects are independent of established risk factors for mortality, including household income, education, gender, ethnicity, and age, as well as the average income and education level of residents in the communities where the respondents lived,” said Dr. Hatzenbuehler. “In fact, our results for prejudice were comparable to life expectancy differences that have been observed between individuals with and without a high school education.”
In order to examine the relationship between prejudice and mortality, the researchers constructed a measure capturing the average level of anti-gay prejudice in the communities where LGB individuals lived, beginning in 1988, using data on prejudicial attitudes from the General Social Survey, one of the primary sources of social indicator data in the social sciences. This information on sexual orientation and community-level prejudice was then linked longitudinally to mortality data via the National Death Index, through 2008. Thus, the authors were able to examine whether mortality risk differed for LGB individuals who lived in communities that were characterized by high versus low levels of prejudice. By the end of the study, 92% of LGB respondents living in low-prejudice communities were still alive; in contrast, only 78% of the LGB respondents living in high-prejudice communities were still alive.
The authors also found that suicide, homicide/violence, and cardiovascular diseases were all substantially elevated among sexual minorities in high-prejudice communities. LGB respondents living in high-prejudice communities died of suicide on average at age 37.5, compared to age 55.7 for those living in low-prejudice communities, a striking 18-year difference. Homicide and violence-related deaths are one of the most direct links between hostile community attitudes and death, and results indicated that homicide rates were over three times more likely to occur in high-prejudice communities than in low-prejudice communities.
- Suicidal Behavior among LGBT Youth Many studies have found that LGB youth attempt suicide more freq uently than straight peers. Garafalo et al. (1999) found that LGB high school students and students unsure of their sexual orientation were 3.4 times more likely to have attempted suicide in the last year than their straight peers. Eisenberg and Resnick (2006) found LGB high school students were more than twice as likely as their straight peers to have attempted suicide.
- Safren and Heimberg found that among youth who had attempted suicide, almost twice as many LGB you as their straight peers said that they had really hoped to die.
- Little research has been done about transgender individuals, but in one study of adults and young adults 30.1 percent of transgender individuals surveyed reported having ever attempted suicide (Kenagy, 2005). For US adults overall, 4.6 percent of adults and young adults report having ever attempted (Kessler et al ., 1999)
- Numerous studies confirm that LGB youth have higher rates of suicidal ideation than their straight peers; for example, the Massachusetts Youth Risk Behavior Survey found that youth who self - identified as LGB or reported any same - sex sexual contact were more than three times more likely to report having seriously considered suicide in the last year (Massachusetts Department of Education, 2006)
- Because no reliable data exists, we do not know whether LGBT youth die by suicide more frequently than their straight peers. Sexual orientation and gender identity data are not included on death certificates so aggregated national death data do not include this information. In addition, many LGBT youth do not disclose this information to family members and friends; as a result, sexual orientation and gender identity often do not show up in psychological autopsy interviews
Of the deaths in high-prejudice communities, 25% were due to cardiovascular disease, compared to 18.6% of deaths in the low-prejudice communities. “Psychosocial stressors are strongly linked to cardiovascular risk, and this kind of stress may represent an indirect pathway through which prejudice contributes to mortality. Discrimination, prejudice, and social marginalization create several unique demands on stigmatized individuals that are stress-inducing,” said Dr. Hatzenbuehler.
A significant strength of the study was the ability to document the associations between prejudice and mortality at the community level. Also of note, Dr. Hatzenbuehler points out, the community-level measure of prejudice does not rely on sexual minorities’ perceptions of how stigmatizing their communities are, but rather was based on the prejudicial attitudes of all respondents living in that community. “Therefore, this approach overcomes many of the limitations of individual-level measures of stigma and prejudice, which have characterized most stigma and health research to date.”
Mental Health of LGB Individuals Varies With Their Support
The level of support that people perceive in their surroundings when they come out as lesbian, gay, or bisexual (LGB) is closely related to their mental health and overall well-being, and this may mean that coming out to some people (but not others) is less psychologically damaging than has been believed, a new study suggests.
People who reveal their sexual orientation to friends, family, or coworkers whom they consider tolerant and supportive tend to be less depressed, angry, and insecure in those social contexts than their peers who come out in less accepting or outright hostile environments, according to the study, which was published in the June 20 issue of Social Psychological and Personality Science.
“It makes sense theoretically,” says Stephen Russell, PhD, a professor of family studies and human development at the University of Arizona, in Tucson, who was not involved in the study but has researched health risks among gay and lesbian adolescents. “People come out in places where they feel supported and they do better in terms of more self-esteem and less depression. That’s encouraging.”
The study findings aren’t entirely surprising, but they do add a new wrinkle to the research on the health implications of coming out.
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About Columbia University’s Mailman School of Public Health
Founded in 1922, Columbia University’s Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master’s and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity.
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Stephanie Berger
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Columbia University’s Mailman School of Public Health