Syndemic Factors Mediate the Relationship between Sexual Stigma and Depression among Sexual Minority Women and Gender Minorities.

INTRODUCTION: Stigma and discrimination contribute to elevated depression risks among sexual minority women (SMW) and gender minority (GM) people who identify as lesbian, bisexual, or queer. Syndemics theory posits that adverse psychosocial outcomes cluster to negatively impact health and mental health outcomes among sexual minorities. We tested whether a syndemic condition composed of low social support, low self-rated health, low self-esteem, and economic insecurity mediated the relationship between sexual stigma and depressive symptoms among SMW/GM.

METHODS: We implemented a cross-sectional, Internet-based survey with SMW and GM in Toronto, Canada. We conducted structural equation modeling using maximum likelihood estimation to test a conceptual model of pathways between sexual stigma, syndemic factors, and depressive symptoms.

RESULTS: A total of 391 SMW/GM with a mean age of 30.9 (SD = 7.62) were included in the analysis. The model fit for a latent syndemics construct consisting of psychosocial variables (low social support, low self-rated health, low self-esteem, economic insecurity) was very good (χ2  = 6.022, df = 2, p = .049; comparative fit index = 0.973, Tucker-Lewis index = 0.918, root-mean square error of approximation = 0.072). In the simultaneous model, sexual stigma had a significant direct effect on depression. When the syndemic variable was added as a mediator, the direct path from sexual stigma to depression was no longer significant, suggesting mediation. The model fit the data well: χ2 = 33.50, df = 12, p = .001; comparative fit index = 0.951, Tucker-Lewis index = 0.915, root-mean square error of approximation = 0.068.

CONCLUSIONS: Our results highlight the salience of considering both sexual stigma and syndemic factors to explain mental health disparities experienced by SMW and GM. Addressing sexual stigma in the context of co-occurring psychosocial factors and economic insecurity will be key to achieving optimal health for SMW and GM.