Perceived Community Belonging as a Moderator of the Association Between Sexual Orientation and Health and Well-Being

PURPOSE

This study examines the moderating role of perceived community belonging in the association between sexual orientation and various health and well-being outcomes.

DESIGN

A national cross-sectional survey.

SETTING

Confidential microdata from the 2021 Canadian Community Health Survey.

SUBJECTS

Individuals aged 15 and older, with a sample size ranging from 43,000 to 44,100.

MEASURES

Sexual orientation, health and well-being outcomes, and sense of community belonging were all self-reported. Outcomes included self-rated general and mental health, depressive symptoms, and life satisfaction.

ANALYSIS

A series of multiple linear regression models.

RESULTS

Compared to heterosexual individuals, bisexual individuals reported poorer self-rated general health (b = .402, P < .001 for men; b = .454, P < .001 for women) and mental health (b = .520, P < .001 for men; b = .643, P < .001 for women), higher depressive symptoms (b = 2.140, P < .001 for men; b = 2.685, P < .001 for women), and lower life satisfaction (b = .383, P < .05 for men; b = .842, P < .001 for women). Few disparities were observed among gay men and lesbians. Contrary to some recent findings, no disparities were observed among individuals uncertain about their sexual orientation or those who chose not to disclose it, even without controlling for covariates. A stronger sense of community belonging mitigated the disadvantages associated with self-rated general health (b = -.276, P < .01) and depressive symptoms (b = -.983, P < .01) for gay men, and life satisfaction (b = -.621, P < .01) for lesbians.

CONCLUSION

This study is among the first to highlight the stress-buffering role of community belonging in the association between sexual orientation and health and well-being outcomes.

Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging

The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.

The impact of COVID-19 on the mental health of older sexual minority Canadians in the CLSA

PURPOSE

Limited research has examined the mental health impacts of the COVID-19 pandemic on sexual minority (i.e., lesbian, gay, bisexual; LGB) older adults using a longitudinal approach. This study aimed to compare the mental health trajectories (i.e., reported symptoms of depression and loneliness) of LGB and heterosexual participants across four time points.

METHODS

Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), an ongoing study on the experiences of adults between 45 to 85 at Baseline. Data included for analysis were collected at Baseline (2011-2015), Follow-up 1 (2015-2018), and two time points during the COVID-19 pandemic (April-December 2020). We used General Estimating Equations (GEE) to model changes in depression symptoms (CESD-10; n = 47,728) and loneliness (UCLA 3-item loneliness scale; n = 41,698), adjusting for covariates (i.e., age, sex, race/ethnicity, education, and income).

RESULTS

Results indicated that LGB participants reported more symptoms of depression (B = .595, p < .001) and loneliness (B = .313, p < .001) in comparison to heterosexual peers across the four time points. Mean depression and loneliness scores increased regardless of sexual orientation.

CONCLUSION

This study highlighted the detrimental effects of the pandemic on the mental health of older adults regardless of sexual orientation. It also showed that LGB older adults experienced more loneliness and depression symptoms than heterosexual older adults both before and during the pandemic. Understanding diverse identities, needs, and disparities in mental health is critical to promoting equitable aging experiences for everyone.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

How Older White Gay Men and Lesbians Leverage Advantages to Navigate Healthcare

A lifetime of disadvantages shapes how lesbians and gay men navigate healthcare as they age and their fears about end-of-life care. This paper investigates how a localized group of older white, college educated, and economically privileged gay men and lesbians conceptualize their approach to healthcare. Analyzing 23 in-depth interviews with gay men and lesbians over the age of 60 I consider how they utilize their advantages when aging and facing declining health. I pay particular attention to how discriminatory social and legal contexts shaped elders' current situations and ability to be "out" and engage with healthcare professionals. I utilize the theory of cumulative advantages and disadvantages as another way to understand literature on health inequalities and LGBTQ health work, finding that despite systemic inequalities some gay men and lesbian elders use their resources to find gay-friendly primary care physicians, age at home, and build social supports for caregiving as their health declines.

Life Events and Loneliness Among Older Women of Diverse Sexual Identities: Application of the Stress Process Model

Loneliness among older adults has been a topic of interest in recent years. We analyse four waves of data from the Australian Longitudinal Study on Women's Health. We estimate growth models to examine differences in loneliness trajectories from age 50 for women who identify as exclusively heterosexual, plurisexual (bisexual, mainly heterosexual, mainly lesbian) and exclusively lesbian. We find no significant differences in levels of loneliness across sexual identity groups at age 50. We find that while loneliness trajectories of exclusively heterosexual women trend down, levels of loneliness increase with age among plurisexual women. Adverse health events and relationship problems increase loneliness to a greater extent among plurisexual women compared to exclusively heterosexual and exclusively lesbian women. Our results suggest older lesbian women may have accumulated social or personal resources or developed coping mechanisms over the courses of their lives, while plurisexual women remain a vulnerable group.

Sexual Identity and Birth Cohort Differences in Social Support and Its Link with Well-Being among Sexual Minority Individuals

This study examined sexual identity and birth cohort differences in social support and its association with well-being, using a longitudinal national probability sample of 706 cisgender and non-binary sexual minority individuals from the USA. The data allowed for extensive descriptions of perceived social support and support networks across subgroups. Findings demonstrated that sexual identity and birth cohort differences in overall sizes of support networks and levels of perceived social support were small. Furthermore, fixed effects analyses indicated that changes in the size of respondents' social support networks were not related to well-being, with a one-person change being associated with a .04 SD change in well-being or less, depending on the indicator of well-being being tested. Moreover, changes in perceived social support were only limitedly related to changes in respondents' well-being, a 1-point change in the scale of perceived social support being associated with a .11 SD change in life-satisfaction. Associations were smaller for overall well-being or psychological distress, the other two indicators of well-being used. Together, these findings could imply that cross-sectional research has overestimated the relevance of social support for the well-being of sexual minority individuals, but also that general social support is insufficiently tailored to the support needs of the sexual minority population.

Centering sexual and gender diversity within Compassionate Communities: insights from a community network of LGBTQ2S+ older adults

Background and Rationale:

The Compassionate Communities movement emphasizes the importance of illness, disability, dying, caregiving, and grief across the lifespan and highlights the communal responsibility of caring for one another. There is a need to recognize and incorporate the needs of diverse communities within this movement and research on dying, caregiving and grief. An important axis of this diversity is related to individuals’ sexual orientation and gender identity.

Methods:

As part of the early phases of Healthy End of Life Project Ottawa, a Compassionate Communities, community-based, participatory action research project, we held focus groups with older members of lesbian, gay, bisexual, transgender, queer, and two-spirit communities. Nine older lesbian, gay, bisexual, transgender, queer, and two-spirit people participated in the focus groups (mean age = 72 years). Data were analysed using an inductive, reflexive thematic approach.

Results:

Through an iterative analysis process, we identified themes related to lifecourse experiences of trauma, the need for safety within care contexts, the importance of relationships and connection, as well as participants’ ability to ask for and receive help. A core tenet of Compassionate Communities involves responding to the needs of diverse communities with respect to aging, end-of-life, and grief. Our findings emphasize the importance of incorporating the voices of diverse sexual and gender identities and promoting health equity within Compassionate Community initiatives.

Correlates of memory and executive function in mid-aged and older adults in the CLSA: A minority stress approach

OBJECTIVES

Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years.

METHODS

Data were drawn from the baseline of the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing).

RESULTS

Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking and fruit/ vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function.

DISCUSSION

These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.