Sexual Orientation Openness and Depression Symptoms: A Population-Based Study

Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for depression than heterosexual individuals. Lack of openness about one's sexual orientation is a suggested source of these disparities, but it has been linked to both positive and negative mental health. Few population-based studies have explored the association between openness and depression, and potential mediators and moderators of this association, including social support and sexual orientation-based victimization. Swedish respondents to the 2014 wave of the European Health Interview Survey were used to identify a population-based sample of self-reported sexual minorities. All individuals reporting a nonheterosexual identity (and a matched sample of heterosexuals) were invited to participate in a follow-back study in 2016 (n = 320). A total of 191 (59.7%) individuals completed the survey, of whom 80 reported a gay, lesbian, bisexual, or other nonheterosexual identity. This first nationally representative survey of sexual orientation openness showed that only about one third of the sample reported being completely open. We found no evidence of a direct association between openness and depression or a mediating effect of social support or victimization on this association. However, social support moderated this relationship, such that greater openness was linked to higher depression among sexual minorities reporting low levels of social support. Our study suggests that sexual orientation openness is not directly related to lower risk of depression among sexual minorities, but is instead dependent on access to social support. Sexual minorities might need social support for navigating the stress of open self-identification.