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UBC Theses and Dissertations

One of the most interesting things about the collection is the mandate that it follows. Out on the Shelves has also taken the initiative of managing collections for the other groups in the AMS Resource Centre, including: Murray said that they are hoping to collaborate with SLAIS in the future through professional experience projects, which could be recognized as courses and would help librarians-in-training work firsthand on coordination, collaboration and cataloguing.

However, these are all next steps for a library still trying to establish itself within the space. Differences in the proportions of respondents living in the various regions of Canada stratified by sexual identity were also observed. Across the five study outcomes, higher prevalence rates were observed among sexual minority vs. In the to period, anxiety disorders were reported by 5.

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Mood disorders were reported by 7. Heavy drinking was reported by A total of 2. The frequency distributions of the study outcomes, stratified by sexual identity of the CCHS respondents, are included in Appendix E. All confounders were significantly associated with anxiety, mood, anxiety-mood disorders, and heavy drinking. Compared with men, women were more likely to report mood, anxiety, and anxiety-mood disorders, and less likely to report heavy drinking.

Heavy drinking was most prevalent among respondents in the younger age groups. All study outcomes were 66 more likely to be reported by single, widowed, or divorced respondents. In general, respondents with relatively more educational attainment or household income were less likely to report anxiety, mood, anxiety-mood, and co-occurring disorders. Respondents in the higher household income categories were more likely to report heavy drinking. The same patterns of bivariable associations were observed in the unpooled, biennial CCHS cycles data not shown.

Overall, the rates of the study outcomes for heterosexual respondents from Ontario most closely resembled those for the rest of Canada while respondents in Quebec and the Atlantic provinces reporting the lowest and the highest rates of mental health disorders, respectively. LGB respondents in the Atlantic provinces consistently reported the highest rates of the study outcomes compared with LGB respondents of other regions in Canada.

As many as While some of the differences in the regional prevalence rates were not statistically significant, as indicated by the overlapping confidence intervals, they nonetheless indicate that the mental health burden experienced by LGB individuals has substantial regional variation. Bisexual respondents had 4. Bisexual respondents had 5. In the stratified analyses, odds ratios for gay and heterosexual male respondents were not significantly different, but lesbian women had 1.

Relative to heterosexuals, bisexual respondents had 1. Although the odds of heavy drinking among bisexual and heterosexual men did not differ significantly, bisexual women had 1. Also, the interaction was statistically significant. The survey cycle—time effect was included in all of the adjusted models and tested for significance.

The coefficient for the — cycle vs.

Relative to heterosexuals, those with missing data were more likely to be male, older, and single; to have lower educational attainment; to live in British Columbia; and to self-identify as a racialized minority. Respondents with missing information had higher rates of anxiety 8. Rates of heavy drinking This same pattern was observed for the respondents with missing data in sensitivity analyses that used adjusted logistic regression models see Appendix F.

The substantially greater odds of these outcomes among LGB people, even after controlling for multiple confounders, point to the disproportionate mental health burden experienced by this population in Canada.

The results also point to the important moderating role of sex, with higher adjusted odds of anxiety and anxiety—mood disorders among gay male respondents and higher adjusted odds of heavy drinking among lesbian and bisexual women. There is some evidence that, at least for alcohol use, the factors associated with negative outcomes may be different for women e.

Accordingly, the findings add to the existing national studies of LGB populations39,41—43, and enlarge the evidence base regarding health disparities related to sexual identity. In addition, this investigation corroborates other studies indicating that bisexuality confers the greatest odds of adverse health outcomes, including mood and anxiety disorders,42,81 by providing new population-level evidence of the disparities experienced by bisexual Canadians. The results implicate the consequences of minority stressors experienced by LGB people.

Pervasive stereotypes about and negative attitudes toward bisexuality e. Several observations specific to the analyses reported in this chapter deserve noting here. First, because of the stigma some attach to LGB status, collecting information about sexual identity may be sensitive to the mode of data gathering used.

This discrepancy may lead to underestimates of the true associations between sexual identity and the study outcomes because respondents who self-identified might, on average, be healthier and experience less stress than those who did not self-identify or disclose i. The findings may therefore not be generalizable to all LGB people in Canada, including those who identify with specific 79 dimensions of same-sex sexuality e.

This suggests that the model with heavy drinking may have omitted relevant variables, resulting in unobserved confounding, or that the logistic model is not an appropriate representation of the relationship between the predictors and heavy drinking. Consequently, due to these limitations, the results, although informative, may represent imprecise estimates of existing disparities. Nonetheless, the primary strength of this study is the use of pooled epidemiological survey data, which allowed us to examine disparities across specific sexual identities and to calculate relatively precise prevalence rates and reasonable confidence intervals while adjusting for multiple confounders.

At a population level, the results point to the importance of concomitantly addressing treatment responding to current rates of 80 mental disorders and heavy drinking and prevention addressing factors known to affect mental health and heavy drinking among LGB communities. With respect to treatment, there is some evidence that LGB people report less healthcare utilization and may experience barriers to accessing care.

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The sex-stratified findings highlight the utility of analyses that assess the potential multiple effects of sexual identity at its intersection with other advantaged and disadvantaged social positions. It is important to remember that, despite being more likely than their heterosexual peers to report mental health disorders, the majority of LGB people do not experience mental health problems. Therefore, research on how LGB people not only experience adversity, but overcome it and demonstrate significant resilience,, could offer value in understanding and addressing mental health and substance misuse disparities related to sexual identity.

Having documented the mental health disparities experienced by LGB individuals in Canada, in Chapter 5, I consider and test the mediating effects of life stress and the moderating effects of community belonging to begin to explain the observed prevalence rates across sexual identities. As previously described, this greater risk is most compellingly attributed to the inter-connected theories of social or minority stress and other consequences of social disadvantage,11,55,,, which posit that socially disadvantaged groups are exposed to more stressors, such as discrimination, and have access to fewer coping resources, such as social support.

Minority stress theory postulates that minorities are disadvantaged not only by greater exposure to stress, but also by greater barriers to resources, such as supportive social networks. In this section I reiterate and examine further the specific research gaps that this work aims to address. Although minority stress theory has elucidated the role of social stress related to prejudice and discrimination in explaining mental health disparities, several knowledge gaps exist.

First, existing research has tended to treat sexual minority populations as one group, generally ignoring distinctions that exist within sexual minority subgroups e. This limits our understanding of interventions that could target stressors at both the individual and structural levels. Regarding community belonging, one between-group analysis testing additive, moderation, and mediation models of the interrelations among sexual orientation, sense of belonging to the general community, and depression, did not find support for the additive and moderation models—only mediation: This model is consistent with conceptualizations of stress in the general population, wherein perceived stress may be a consequence of environmental stress, and may be moderated by factors such as social support.

A Moderated Mediation Model for the Effect of Sexual Identity on Mental Health The conceptual framework guiding this study is theoretically grounded in transactional definitions of stress, wherein stress is conceptualized as a series of successive transactions between an individual and the environment, such as external challenges and perceptions of those challenges, coping resources and perceptions of those coping resources, and their dynamic interplay over time.

Specifically, the study tested the following hypotheses: H1 Life stress partially mediates the relationships between sexual identity and the mental health outcomes, such that a reduction in the magnitude of the direct effects is expected after accounting for the indirect effect of life stress; H2 The mediating effect of life stress on the relationships between sexual identity and the mental health outcomes is reduced in magnitude for respondents with a strong versus a weak sense of community belonging; and H3 The magnitude of the mediating and moderating effects significantly differ for bisexual respondents compared with the other sexual identities, such that the greatest reductions in effects are expected for bisexual respondents who report a relatively strong sense of community belonging.

The study addresses the noted gaps in the literature by a proposing a conceptual framework that considers both the mediating effects of life stress and the moderating effects of community belonging in explaining any observed disparities and b utilising mediating and moderating measures, applicable to all sexual identity groups, which capture the mechanisms of the hypothesized processes. Four binary outcome variables were examined: I did not include heavy drinking as an outcome in this study because I was primarily interested in applying the proposed model to explain disparities, and the odds of heavy drinking as described in the previous chapter were either not statistically significant men or relatively small women , and the binary logistic model did not achieve good fit for the data.

The perceived life stress variable was treated as a mediating variable in the study while sense of belonging to a community, a moderator. Potential confounders were identified from the review of the literature, and included: The study hypotheses were tested using methods for mediation analysis with categorical data. For hypothesis 2, the test of moderated mediation, the mediation models detailed above were calculated separately across the strata of the moderating community belonging variable see 88 paths a1,2 and b1,2 in Figure 1.

The statistical significance of the differences between the mediated effects across levels of the moderator was tested by taking the difference in the sample estimates of ab across groups and dividing by the pooled variance of the estimates, as described elsewhere, such that: However, a comparison of logistic regression models examining the total effects path c with and without bootstrapping showed negligible differences in the results data not shown. The significance of the indirect effects was determined by using bootstrapping to obtain standard errors and confidence intervals, as recommended in previous research.

In Table 8 below, I display the distribution of the primary variables of interest in this study, life stress and sense of community belonging, in the study sample. As can be seen, the sexual minority respondents were significantly more likely than were heterosexual respondents to describe their lives as stressful and their sense of community belonging as weak. Unstratified models also controlled for community belonging. As hypothesized, after controlling for the confounders, life stress partially mediated the associations between sexual identity and the mental health outcomes.

Based on the tests of equal mediated effects, the mediating effect of life stress was not significantly different in any of the other models stratified by community belonging. In the non-moderated mediation models i. Although the bisexual respondents with a weak sense of community belonging had greater odds of reporting the study outcomes, compared with the bisexual respondents with a strong sense of community belonging, the differences between the mediated effects across the strata of community belonging were not statistically significant.

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Jointly, these results partially support the hypotheses 95 regarding the magnitude of the mediating and moderating effects for bisexual people: The amount of variance explained in the mediation models was relatively modest pseudo-R2 between. Analysing Canadian nationally representative data, the findings provide evidence that life stress mediates the relationships between sexual identity and the mental health outcomes after controlling for common covariates H1 , provide partial evidence of moderated mediation by the degree of perceived community belonging H2 , and reveal greater magnitudes of these hypothesized effects for bisexual people H3.

As hypothesized, a partial mediation effect was observed, with significantly greater odds of mental health outcomes reported by sexual minority compared with heterosexual respondents, and the greatest odds observed for the bisexual respondents. The odds ratios observed in the mediation and moderated mediation models, which accounted for multiple covariates, suggest that the mental health disparities experienced by sexual minorities are socially patterned, rather than determined solely by individual-level factors.

For example, a sense of belonging to a local community may not confer the coping functions that LGBT-specific affiliations offer. The latter may provide stigmatized persons with social environments in which they are not stigmatized and may provide support and opposing messages for the negative evaluations of the stigmatized minority group proffered by the larger, general or local community.

Further research is needed to assess the buffering role of community belonging to the LGB-specific vs. It is unclear as to whether people become more connected with community-based social supports as a result of their mental health challenges and subsequent diagnoses, or if community belonging and the associated supports implied might lead to being diagnosed.

Chronic stressors are stronger predictors of the onset and course of an illness than are acute life events; ideally, the assessment of stressful experiences should be multi-dimensional and provide coverage of all relevant domains. The potentially moderating effects of belonging to an LGBT community e.

Despite these limitations, through the use of large pooled survey data, I was 99 able to examine several hypothesized general mediating and moderating mechanisms, addressing several existing knowledge gaps.

Vancouver’s first “gay library” finds a new home with Pride UBC

In fact, some have argued that LGB people demonstrate considerable resilience by their relative well-being, and that it is important to study the source s of resilience in this at-risk population. These findings have implications for policy and practice because they suggest that while addressing the known individual-level determinants of mental health, applicable to all sexual identities, may ameliorate the observed effects for LGB people, interventions that target sexual minority-specific factors e.

Future research is needed to better examine the unique experiences of multiple minority stressors or buffers, and how these may be intersectional in their effects such as experiences of discrimination arising from multiple stigmatized identities. Specifically, I proceed to assess the heterogeneity in the prevalence of mental health outcomes by sexual identity at intersections with other social positions sex, age, income, education, and racialized minority status to better understand the factors that may serve to exacerbate or buffer the adverse mental health outcomes of LGB population subgroups.

Specifically, a bisexual identity as compared with other sexual identities has been noted to have the greatest odds of adverse mental health outcomes.

As posited by intersectionality theorists,62,64,, the effects of stigmatization based on sexual identity may also be reinforced or exacerbated across multiple axes e.

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