The Relationship of Sexual Orientation and Depresion

182 Pages·2016·2.48 MB·English

The Relationship of Sexual Orientation and Depression
by
Roger L. Scott

A thesis submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy

Faculty of Nursing
University of Alberta

© Roger L. Scott, 2016
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Abstract
Depression a disabling chronic illness that crosses borders, cultures, and elements of
society. It is well known that there are a number of risk factors for depression including
younger age, racial minority status, female sex, presence of substance abuse disorders,
chronic illness, and lower socio-economic status. Sexual minorities have been identified
as being another group at higher risk for depression, but there have been methodological
issues with much of the existing research on sexual orientation and depression. In this
work, methodological issues such as grouping different mental illnesses, failing to
differentiate by sex, and failing to differentiate by sexual orientation have been overcome
to describe the relationship between sexual orientation and depression. Three population
representative samples were analyzed using regression techniques to examine the
relationship of depression and sexual orientation. The results were combined with
existing literature in a meta-analysis. The findings were that overall lesbians, gay men,
and bisexuals do not have higher prevalence of depression than heterosexuals. There
were three important findings: 1) heterosexual identified men who have same-sex activity
have highest risk for depression, 2) gay men may have lower risk for depression than
heterosexual men, and 3) gay men in the Canadian Armed Forces differ from civilian
counterparts with higher prevalence of depression. This work adds to the existing
literature on mental health in sexual minority populations. Further research is needed to
examine other mental health disorders and to identify differences in risks based on more
complex measures of sexual orientation.
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Preface
This thesis is an original work by Roger L. Scott. The University of Alberta Health
Research Ethics Board was consulted prior to commencing the research comprising this
thesis and it was determined that no further ethics approval was required for the
secondary analysis of the datasets.
Chapter 3 of this thesis has been accepted for publication as: Scott, R.L., Lasiuk, G.,
& Norris, C.M. (2016). The relationship between sexual orientation and depression in a
national population sample. Journal of Clinical Nursing. Advance online publication.
doi:10.1111/jocn.13286. I was responsible for the study design, data analysis and
manuscript composition. G. Lasiuk was a supervisory author and was involved in the
concept formation and manuscript composition. C.M. Norris was a supervisory author
and was involved in the concept formation, review of data analysis, and manuscript
composition.
Chapter 4 of this thesis has been accepted for publication as Scott, R.L., Lasiuk, G., &
Norris, C.M. (2016). Sexual orientation and depression in Canada. Canadian Journal of
Public Health. I was responsible for the study design, data analysis and manuscript
composition. G. Lasiuk was a supervisory author and was involved in the concept
formation and manuscript composition. C.M Norris was a supervisory author and was
involved in the concept formation and manuscript composition.
Chapter 5 of this thesis has been accepted for publication as Scott, R.L., Lasiuk, G., &
Norris, C.M. (2016). Depression in Lesbian, Gay, and Bisexual Members of the Canadian
Armed Forces. LGBT Health, Advance online publication. doi:10.1089/lgbt.2016.0050. I
was responsible for the study design, data analysis and manuscript composition. G.
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Lasiuk was a supervisory author and was involved in the concept formation and
manuscript composition. C.M. Norris was a supervisory author and was involved in the
concept formation and manuscript composition.
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Dedication
To my mentor and friend, the Late Commodore Christine Newburn-Cook, CD, PhD.
You provided me encouragement and support through my first graduate degree and were
there for me during the first steps of my doctorate. Without your inspiration and backing,
I would not have undertaken to complete a PhD. I miss your leadership, friendship,
humour, and occasional “kick in the pants.” Fair winds and following seas.
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Acknowledgements
I wish to thank Dr. Colleen Norris and Dr. Gerri Lasiuk who so willingly took over as
my co-supervisors after the death of Dr. Newburn-Cook. Your support, encouragement,
understanding and guidance through what turned out to be a turbulent period in both my
academic and personal life enabled me to carry on working toward my goal. Thank you.
Thank you to the members of my committee for your time and participation in my
work and for the critiques that made it better.
Thank you to Richard and my friends who listened to me, supported me, and
encouraged me through this process. In particular to thank you to Abe who came into my
life unexpectedly, but when needed most. Who too often was waiting for me to finish my
work on this endeavour, but still cheered me on me through the times when I didn’t think
I would ever finish. Whose love and ability to see things in me that I have trouble seeing
in myself has changed me for the better.
And finally, I thank my parents for always telling me I was “the smart one” and who
always believed I could do this.
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Table of Contents
Glossary ..........................................................................................................................
Chapter 1. Introduction ................................................................................................. 1
Depression................................................................................................................. 1
Sexual Orientation .................................................................................................... 4
Mental Health and Lesbian, Gay and Bisexual People ............................................. 5
Social Change ........................................................................................................... 8
The Role of Stress ..................................................................................................... 9
Theoretical Base...................................................................................................... 10
Purpose of the Study ............................................................................................... 11
References ................................................................................................................... 13
Chapter 2. Literature Review ...................................................................................... 21
Introduction ................................................................................................................. 21
Review Method ........................................................................................................... 21
Results ......................................................................................................................... 22
Depression and Sexual Orientation ......................................................................... 22
Sex........................................................................................................................... 23
Sexual Orientation .................................................................................................. 29
Other Sub-Group Differences ................................................................................. 32
Discussion ................................................................................................................... 34
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Conclusion .................................................................................................................. 36
References ................................................................................................................... 37
Chapter 3. The Relationship Between Sexual Orientation and Depression in a
National Population Sample ............................................................................................. 52
Introduction ................................................................................................................. 55
Background ................................................................................................................. 55
Methods....................................................................................................................... 57
Aim ......................................................................................................................... 57
Data Sources ........................................................................................................... 57
Variables ................................................................................................................. 58
Statistical Methods .................................................................................................. 59
Results ......................................................................................................................... 60
Discussion ................................................................................................................... 64
Conclusion .................................................................................................................. 69
Relevance to clinical practice ................................................................................. 70
References ................................................................................................................... 72
Chapter 4. Sexual Orientation and Depression in Canada .......................................... 83
Introduction ................................................................................................................. 84
Methods....................................................................................................................... 85
Design ..................................................................................................................... 85
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Sample..................................................................................................................... 85
Variables ................................................................................................................. 86
Results ......................................................................................................................... 88
Discussion ................................................................................................................... 92
References ................................................................................................................... 97
Chapter 5. Depression in Lesbian, Gay and Bisexual Members of the Canadian
Armed Forces .................................................................................................................. 105
Chapter 6. Sexual Orientation and Depression: A meta-analysis ............................. 127
Method ...................................................................................................................... 127
Data ....................................................................................................................... 128
Study Selection. .................................................................................................... 128
Analysis................................................................................................................. 129
Results ....................................................................................................................... 129
Sexual Orientation Identity ................................................................................... 129
Sexual Orientation Behaviour ............................................................................... 130
Discussion ................................................................................................................. 131
Strengths and Limitations. .................................................................................... 132
References ................................................................................................................. 134
Chapter 7. Summary, Conclusions and Recommendations ...................................... 141
Summary of Findings ................................................................................................ 141
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Reporting Sexual Orientation ............................................................................... 141
The Effect of Sex .................................................................................................. 143
Minority Stress ...................................................................................................... 144
Important Risk Factors .......................................................................................... 146
Strengths and Limitations ......................................................................................... 146
Implications for Further Research ............................................................................ 148
Implications for Clinical Practice ............................................................................. 149
References ................................................................................................................. 150
Bibliography ............................................................................................................. 152