Life Satisfaction Across Adulthood in Bisexual Men and Women: Findings from the Midlife in the United States (MIDUS) Study

Quality of Life among LGBTQ Older Adults in the United States: A Systematic Review

BACKGROUND

Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples.

AIM

To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020.

METHOD

Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations.

RESULTS

The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

CONCLUSIONS

Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.

Associations of Psychological Distress and Alcohol Use Patterns Among Older Adults of Sexual Minority Status and Heterosexual Peers

BACKGROUND

There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use.

OBJECTIVE

The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns.

METHODS

This study was a secondary analysis of data from the 2017-2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption.

RESULTS

Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use.

CONCLUSION

Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse.

Sexual Orientation and Gender Identity-Related State-Level Policies and Perceived Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the United States

ObjectivesWe examined the associations between state-level policies and the health of lesbian, gay, bisexual, and transgender (LGBT) older adults. Methods: Using data from the 2018-2020 Behavioral Risk Factor Surveillance System surveys, we assessed physical and mental health by the tally of points for enacted LGBT-related policies (Low= <0-49.9% of possible points, High= 50-100% of possible points) in 10,032 sexual minority (i.e., lesbian, gay, and bisexual) and 1,072 transgender (non-sexual minority) adults aged 50 and older from 41 states. Results: Sexual minority adults in low tally states had greater odds of reporting fair or poor general health and 14 or more days of poor physical health in the past 30 days. Transgender participants in low tally states also had greater odds of reporting fair or poor general health. Discussion: Lesbian, gay, bisexual, and transgender adults have significantly greater risk of poor health if they live in a state with fewer LGBT anti-discriminatory policies enacted.

Distribution and Prevalence of Health in a National Probability Sample of Three Cohorts of Sexual Minority Adults in the United States

Purpose: This study examined the health profile of a national probability sample of three cohorts of sexual minority people, and the ways that indicators of health vary among sexual minority people across age cohorts and other defining sociodemographic characteristics, including sexual identity, gender identity, and race/ethnicity. Methods: The Generations Study, the first national probability sample of three age cohorts of sexual minority people (n = 1507) in the United States collected in 2016-2017, was used to examine general health profiles across several broad domains: alcohol and drug abuse; general health, physical health, and health disability; mental health and psychological distress; and positive well-being, including general happiness, social well-being, and life satisfaction. Results: There were no cohort differences in substance abuse or positive well-being. The younger cohort was physically healthier, but had worse psychological health than both the middle and older cohorts. Conclusions: Cohort differences in physical health were consistent with patterns of aging, whereas for mental health, there were distinct cohort differences among sexual minority people. Given that compromised mental health in the early life course creates trajectories of vulnerability, these results point to the need for mental health prevention and intervention for younger cohorts of sexual minority people.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

Daily Stressor Exposure and Daily Well-Being Among Sexual Minority and Heterosexual Adults in the United States: Results from the National Study of Daily Experiences (NSDE)

BACKGROUND

Daily stress plays a significant role in mental and physical health. Negative mood (e.g., hopelessness) and physical symptoms (e.g., headaches) are responses often associated with daily stressors. It is theorized that some people or populations are more vulnerable or reactive to daily stressors. We propose sexual orientation as one factor that is associated with daily stress exposure and reactivity.

PURPOSE

To understand whether sexual minorities (SMs) differ from heterosexuals in their exposure and reactivity to general, non-sexual minority-specific stressors (e.g., arguments/disagreements, job concerns).

METHODS

We used daily diary data (n = 3,323 heterosexuals [52% identified as female and 85% identified as White]; n = 98 SMs [50% identified as female and 93% identified as White]) from the National Study of Daily Experiences (NSDE). Participants completed eight consecutive evening daily diary interviews (n days = 24,773; mean days completed = 7.24) and reported daily stress exposure and daily well-being. We used multilevel modeling as an approach to examine whether sexual orientation interacted with daily stressors to predict daily negative affect and physical health.

RESULTS

SMs tended to experience more daily stressors compared to heterosexuals; specifically, SMs reported at least one stressor on nearly half (48%) of the study days they completed, and heterosexuals reported at least one stressor on about two-fifths (41%) of the study days they completed. SMs also tended to experience more negative mood when they experienced a daily stressor compared to heterosexuals when they experienced a daily stressor.

CONCLUSION

We emphasize the importance of SMs' exposure and reactivity to general daily stressors and the implications of our results for the day-to-day lives and health of SMs.

Femininity Concerns and Feelings About Menstruation Cessation Among Lesbian, Bisexual, and Heterosexual Women: Implications for Menopause

Background: Women differ in how they psychologically respond to the end of menstruation and onset of menopause; however, little empirical evidence exists for understanding how sexual orientation and gendered dynamics contribute to menstrual experiences in middle-to-late adulthood. We investigated if women's attitudes toward the cessation of menstruation vary by their sexual orientation. Methods: Using data from the Midlife in the United States Study (MIDUS, N = 3471), we examined the relationship between women's sexual orientation and attitudes toward menstruation cessation. We also assessed their femininity concerns, such as their worries about attractiveness and fertility in the context of aging. Results: Sexual minority (SM) women, compared with their heterosexual counterparts, expressed less regret of their menstrual periods ending. SM women also expressed lower concerns about femininity compared with heterosexual women, and concerns about femininity mediated the relationship between sexual orientation and regret. That is, SM women felt less regret about menstrual periods ending than heterosexual women, and this finding was partially explained through SM women's lower concerns about femininity (attractiveness and fertility). Conclusions: Our results contribute to a growing body of research on the psychological strengths of sexual minorities by highlighting SM women's potential strengths in an aging context. We propose implications for understanding aging stigma and women's health, and we discuss how menopause may be differently experienced by women based on sexual orientation.

Intensity of Leisure-Time Physical Activity and Dimensions of Mental Well-Being: A Reciprocal Approach Using Parallel Latent Growth Curve Modeling

BACKGROUND

The examination of the longitudinal effect of leisure-time physical activity (LTPA) on mental well-being is important, but previous studies have typically been limited by their use of a cross-sectional approach. This study empirically examined how LTPA intensity was associated with changes in distinct functions of mental well-being (eg, emotional, psychological, social) over time, and vice versa.

METHODS

Parallel latent growth curve modeling in combination with propensity score matching analysis was conducted. Data were derived from a sample of adults from the Midlife in the United States (MIDUS) study.

RESULTS

The results showed that the initial level of moderate LTPA at the baseline was associated with growth in psychological and social functioning over time, and vice versa. However, vigorous LTPA at the baseline was related only to growth in emotional functioning over time.

CONCLUSION

The longitudinal association between LTPA and mental well-being had different matching mechanisms for LTPA intensities and their relation to distinct functioning for mental well-being. The findings contribute to an enhanced understanding of LTPA's longitudinal effect on mental well-being.

Internalized homophobia and depression levels in LGBT individuals

PURPOSE

This study was conducted to evaluate internalized homophobia and depression levels in LGBT individuals.

DESIGN AND METHODS

This descriptive study, conducted between June and October 2018, included 110 LGBT individuals.

FINDINGS

The mean Beck Depression Inventory total score of LGBT individuals was 3.14 ± 4.84. The mean total score of the Internalized Homophobia Scale was 15.5 ± 8.09. It was determined that there was a positive but weak relationship between the mean scores of internalized homophobia of the LGBT individuals and the mean score of depression, and internalized homophobia made a statistically significant contribution to depression.

PRACTICE IMPLICATIONS

It is considered that the presence of internalized homophobia should be taken into consideration in the prevention of depression in LGBT individuals or in investigating of existing depressive factors in LGBT individuals.

Charting adult development through (historically changing) daily stress processes

This article views adult development through the lens of daily life experiences and recent historical changes in these experiences. In particular, it examines whether theories that postulate general linear increases in well-being throughout adulthood still hold during times of less prosperity and more uncertainty. Descriptive analyses of the National Study of Daily Experiences chart show how stress in the daily lives of Americans may have changed from the 1990s (N = 1,499) to the 2010s (N = 782). Results revealed that adults in the 2010s reported experiencing stressors on 2% more days than in the 1990s, which translates to an additional week of stressors across a year. Participants in the 2010s also reported that stressors were more severe and posed more risks to future plans and finances and that they experienced more distress. These historical changes were particularly pronounced among middle-aged adults (e.g., proportion of stressor days increased by 19%, and perceived risks to finances and to future plans rose by 61% and 52%, respectively). As a consequence, age-related linear increases in well-being observed from young adulthood to midlife in the 1990s were no longer observed in the 2010s. If further studies continue to replicate our findings, traditional theories of adult well-being that were developed and empirically tested during times of relative economic prosperity may need to be reevaluated in light of the changes in middle adulthood currently observed in this historic period. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interest, Personality, and Sexual Traits That Distinguish Heterosexual, Bisexual, and Homosexual Individuals: Are There Two Dimensions That Underlie Variations in Sexual Orientation?

A diverse U.S. sample comprising 1437 men and 1474 women was assessed on sexual orientation, masculinity-femininity of occupational preferences (MF-Occ), self-ascribed masculinity-femininity (Self-MF), Big Five personality traits, sex drive, and sociosexuality (positive attitudes toward uncommitted sex). Discriminant analyses explored which traits best distinguished self-identified heterosexual, bisexual, and homosexual individuals within each sex. These analyses correctly classified the sexual orientation of 55% of men and 60% of women, which was substantially better than a chance rate (33%) of assigning participants to one of three groups. For men, MF-Occ and Self-MF distinguished heterosexual, bisexual, and gay men, with heterosexual men most gender typical, gay men most gender atypical, and bisexual men intermediate. Independently, higher sex drive, sociosexuality, and neuroticism and lower conscientiousness distinguished bisexual men from other groups. For women, gender-related interests and Self-MF distinguished lesbians from other groups, with lesbians most gender atypical. Independently, higher sociosexuality, sex drive, and Self-MF distinguished non-heterosexual from heterosexual women. These findings suggest that variations in self-reported sexual orientation may be conceptualized in terms of two broad underlying individual difference dimensions, which differ somewhat for men and women: one linked to gender typicality versus gender atypicality and the other linked to sex drive, sociosexuality, and various personality traits.

The health and well-being of LGBTQ serving and ex-serving personnel: a narrative review

The relaxation of discriminatory policies against lesbian, gay, bisexual, transgender, and queer (LGBTQ) service personnel has led to increased diversity among military populations. Given this increase, it is important to assess sexual and gender minority groups' health and well-being in the context of military service. This narrative review assessed these outcomes in LGBTQ military personnel. The electronic databases OVID Medline, PsycInfo, and Embase were searched for papers published between January 2000 and July 2018. Thirty papers were included. In line with life course model, studies aligned with four themes: (1) mental health and well-being; (2) stigma and healthcare utilization; (3) sexual trauma; and (4) physical health. These themes highlighted that LGBTQ military personnel and veterans have poorer mental health and well-being; report more stigma and barriers to mental healthcare, which reduces uptake of accessed healthcare services; experience more sexual trauma; and have poorer physical health than heterosexual military personnel and veterans. However, there are substantial gaps in the current evidence for this population. Future research should aim to address limitations of the literature, and to ensure that data on LGBTQ personnel and veterans is collected as standard.