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Stigma and Health-Related Quality of Life in Sexual Minorities

  • S. Bryn Austin
    Correspondence
    Address correspondence to: S. Bryn Austin, ScD, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, 333 Longwood Ave., Room #634, Boston MA 02115
    Affiliations
    Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts

    Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

    Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • Allegra R. Gordon
    Affiliations
    Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
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  • Najat J. Ziyadeh
    Affiliations
    Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
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  • Brittany M. Charlton
    Affiliations
    Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • Sabra L. Katz-Wise
    Affiliations
    Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts

    Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • Mihail Samnaliev
    Affiliations
    Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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      Introduction

      Stigma against sexual minorities is well documented, but its long-term consequences for health-related quality of life (HRQL) are unknown. This study examined stigma-related predictors of sexual orientation disparities in HRQL and their contribution to young adult HRQL disparities.

      Methods

      In 2013, participants (N=7,304, aged 18–31 years) reported sexual orientation (completely heterosexual [CH], mostly heterosexual, bisexual, and lesbian/gay). The EQ5D-5L, preference weighted for the U.S. population, was used to assess HRQL (range, –0.109 [worse than dead] to 1 [full health]). In prior waves conducted during adolescence, participants reported past-year bullying victimization (range, 1 [never] to 5 [several times/week]) and subjective social status (SSS) in their school (range, 1 [top] to 10 [bottom]). Analyses conducted in 2016 used longitudinal, multivariable linear and logistic regression to assess the contribution of bullying victimization and SSS in adolescence to sexual orientation disparities in HRQL in young adulthood, controlling for confounders and stratified by gender.

      Results

      Compared with CHs, both female and male sexual minorities reported more bullying victimization and lower SSS in adolescence and lower HRQL in young adulthood (HRQL score among women: mostly heterosexual, 0.878; bisexual, 0.839; lesbian, 0.848; CH, 0.913; HRQL score among men: mostly heterosexual, 0.877; bisexual, 0.882; gay, 0.890; CH, 0.925; all p-values <0.05). When bullying and SSS were added into multivariable models, orientation group effect estimates were attenuated substantially, suggesting bullying and lower SSS in adolescence partly explained HRQL disparities in young adulthood.

      Conclusions

      Stigma-related experiences in adolescence may have lasting adverse effects on sexual minority health in adulthood.
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