Generalized Anxiety Disorder Symptoms are Higher Among Same- and Both-Sex Attracted Individuals in a Large, International Sample

Introduction This study examines the severity of generalized anxiety disorder (GAD) symptoms among sexual minorities in a large international sample and analyzes the relationship between GAD symptoms and two nation-level policies discriminating against sexual minorities: marriage inequality and criminalization of same-sex sex acts. Members of sexual minorities show higher rates of GAD. Structural stigma may contribute to poor mental health outcomes among sexual minorities. Methods We collected GAD symptoms in a sample of 5,929 participants from countries with differing policies restricting the rights of sexual minorities between May 2018 and October 2018. We then used mixed effects regression to examine the effects of sexual orientation and structural stigma (marriage inequality and criminalization of same-sex sex acts) on GAD symptoms. Results Participants reporting same-sex and both-sex attraction showed more anxiety symptoms than participants reporting opposite-sex attraction. There was no significant interaction effect between marriage inequality or criminalization of same-sex sex acts and sexual orientation on GAD symptoms. Discussion The higher measured anxiety among sexual minority participants is consistent with previous research; however, the absence of an interaction effect between sexual orientation and discriminatory policies was contrary to our predictions. We hypothesize that this could be due to differential concealment of sexual orientation due to structural stigma or the effects of stigma and discrimination outside of policy. Policy Implications These findings suggest that changing discriminatory policies may not be sufficient to improve mental health outcomes among sexual minorities; instead, it may be necessary to address sources of stigma beyond direct legal policies.