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Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53-61.

Cochran, S.D., Sullivan, J.G., & Mays, V.M. (2003)

Whether gay, lesbian and bisexually identified people are more at risk for mental health problems has long been controversial. Evelyn Hooker produced research that was designed to answer the question: Does homosexual preference of necessity a sign of or lead to mental disturbance? This question merely requires the researcher find one or a few exemplars that are not mentally ill and the question is answered negatively. Here is a quote from Hooker (1993) that details her reaction to her findings:

“First, can you imagine what it was like when I examined the results of the three judges of the adjustment ratings from the projective techniques? I knew the men for whom the ratings were made, and I was certain as a clinician that they were relatively free of psychopathology. But what would these superb clinicians find? You know now that the two groups, homosexuals and heterosexuals, did not differ in adjustment of psychopathology. When I saw that, I wept with joy. I knew that the psychiatrists would not accept it then. But sometime!” (Hooker, 1993).

A related question derives from an increasing concern that lesbians and gay men as a group may be at elevated risk for some psychological disorders. Two possible explanations could exist for any such elevation. One, greater prevalence of mental disorders could occur because of some co-morbid feature of homosexuality that predisposes such persons for mental illness. The factor could be genetically and/or environmentally mediated.

A second possibility is that the increased prevalence is because of the harmful effects of social stigma. Researchers have shown that some forms of mental disorders, particularly affective, anxiety, and substance use disorders, are correlated with higher levels of social stress. Certainly, homosexuality is widely stigmatized despite greater acceptance in American culture. An interesting research question that I have not seen explored is whether former homosexuals also have a higher rate of mental disorder. Clearly, these individuals also suffer from social stigma and it would be interesting to see if the change of sexual identity also produces a change in mental health status.

The authors of this study used data from a nationally representative survey of 2,917 midlife adults to examine possible sexual orientation-related differences in morbidity, distress, and mental health services use. “Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use” (from the abstract).

Approximately 58% of lesbian, gay, and bisexual individuals studied did not evidence any of the five disorders assessed. Major depression and panic was especially pronounced for gay men and lesbians reported greater problems with generalized anxiety disorders. Given that most individuals did not report disorders it cannot be assumed that being homosexual automatically leads to mental health problems. However, there clearly is a greater probability of such problems co-occurring with a nonheterosexual orientation. More research will be needed to more clearly elucidate the factors that create this increased risk.


Hooker, E. (1993). Reflections of a 40-year exploration: A scientific view on homosexuality. American Psychologist, 48, 450-453.


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