Structural stigma and sexual minority men’s depression and suicidality: A multi-level examination of mechanisms and mobility across 48 countries

Abstract Background Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association Methods The current study uses data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health and psychosocial mediators. We linked these data to an objective indicator of structural stigma related to sexual orientation in respondents’ countries of origin (N = 178) and receiving (N = 48) countries Results Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators. Conclusions This study provides evidence that structural stigma is associated with the mental health of sexual minority men, both through proximal experiences and as a function of length of exposure to structurally diverse contexts, at least for those who move higher-to-lower structural stigma contexts. Findings suggest the importance of routinely assessing life-course structural influences on mental health and deploying interventions to address those influences.


Background:
Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association Methods: The current study uses data from the 2017/18 European Menwho-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health and psychosocial mediators. We linked these data to an objective indicator of structural stigma related to sexual orientation in respondents' countries of origin (N = 178) and receiving (N = 48) countries Results: Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators.

Conclusions:
This study provides evidence that structural stigma is associated with the mental health of sexual minority men, both through proximal experiences and as a function of length of exposure to structurally diverse contexts, at least for those who move higher-to-lower structural stigma contexts. Findings suggest the importance of routinely assessing life-course structural influences on mental health and deploying interventions to address those influences.

Background:
Structural stigma toward sexual minority individuals varies widely across countries and is associated with psychosocial health outcomes. Yet, the association of changes in countrylevel structural stigma over time, as has recently characterized many European countries, with such outcomes is largely unknown. The current study examined the association between change in structural stigma from 2012 to 2019 across European Union countries and change in life satisfaction among sexual minority individuals during the same period. Secondary analyses examined whether changes in structural stigma differentially benefitted some subgroups of sexual minority individuals more than others.

Results:
Adjusted multilevel models showed that life satisfaction had improved among sexual minority individuals in all countries between 2012 and 2019 (b = 0.32, 95% CI: 0.29, 0.35), but the improvement was stronger among those living in higher stigma countries compared to those living in lower stigma countries. Changes also varied by relationship status; the strongest improvement in life satisfaction as a function of improvement in structural stigma was found among sexual minority individuals in a relationship.

Conclusions:
Although life satisfaction has increased during the past decade among sexual minority individuals living in Europe, significant variation in this change exists across countries as a function of country-level structural stigma and individual sociodemographic characteristics. The findings support the relevance of structural stigma for sexual minority individuals' life satisfaction and call for further research to understand the differential impact of structural stigma across sexual minority subgroups.
iii82 European Journal of Public Health, Volume 32 Supplement 3, 2022