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Effects of Geography on Mental Health Disparities on Sexual Minorities in New York City

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Abstract

Gay and lesbian individuals have higher rates of psychological distress than do heterosexual individuals. The minority stress hypothesis attributes this disparity to adversity-related stress experienced by sexual minorities. In support of this idea, research in the U.S. has generally found that mental health disparities between sexual minorities and others are narrower in places where tolerance is relatively high. However, few studies have examined disparities between sexual minorities and others in neighborhoods where sexual minorities are most highly concentrated. Likewise, little research attention has been given to disparities for people who move to more tolerant places from less tolerant states and countries. Using data from the New York City Community Health Survey, we found some evidence that disparities between sexual minorities and others were lower in areas with higher concentrations of sexual minorities. However, disparities did not vary by the tolerance level of the state of birth among those born in the U.S. and were actually lower among those born in the least tolerant nations. These results complicate the idea that there is a dose–response relationship between tolerance and psychological distress among sexual minorities.

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Notes

  1. Among participants under 50 in the NYC Health and Nutrition Examination Survey, we found that ten times as many survey participants with same-gender sex partners reported having used club drugs like methamphetamine in the last 12 months as compared with others. Meanwhile, no participant over 50 in the survey reported using any club drugs in the last year.

  2. Multilevel regression and post-stratification proceeded according to the procedure outlined by Kastellec, Lax, & Phillips (2010). First, we obtained data from the ANES, which included a question in which participants indicated how warmly they felt toward homosexual individuals as well as county identifiers. This information was available for surveys in 1984, 1988, 1992, 1994, 1996, and 1998. We also obtained rates of evangelical Protestant and Mormon adherence by county culled from the 2000 Religious Congregations and Membership Study and presidential election results by county. Using all of these data, we ran regressions predicting attitudes about homosexual individuals. This model estimated random effects of age, race, education, interactions among those variables, a fixed effect for the county rate of evangelical and Mormon adherence and a fixed effect for the proportion of voters who voted for Al Gore in the 2000 presidential election. These effects were combined with demographic information from the 2000 census (5% sample) to generate estimates of tolerance for each county.

  3. Results were about the same regardless of whether sexual orientation was measured only with respect to identity or only with respect to behavior. Perhaps this is to be expected given that the measures overlap substantially. Ninety-seven percent of self-identified heterosexuals reported only different-gender partners over the prior year. Ninety-four percent of self-identified homosexual participants reported having only same-sex partners in that time period. That said, only 39% of self-identified bisexuals reported partners of both genders over the previous year; another 46% of them reported only opposite-sex partners.

  4. A map of NYC divided into UHF areas is available at https://www1.nyc.gov/assets/doh/downloads/pdf/survey/uhf_map_100604.pdf.

  5. Ideally, we would include information on whether subjects were born in NYC and more specifically whether they were born in the neighborhoods where they now reside, but this information was not available in the NYC CHS.

  6. CHS data on location of residence were not fine-grained enough to distinguish between residents of Chelsea and residents of the West Village.

  7. We estimated the concentration of sexual minorities in each UHF area by computing the percentage of participants identifying as homosexual or bisexual. This measure correlated at about 0.91 with the percentage of households containing same-sex couples in each area in the 2006–2011 American Community Surveys, suggesting that the NYC CHS measure is a valid indicator of the extent to which sexual minorities are concentrated in the area.

  8. Also, in results not shown, we found that disparities in mental health did not narrow after the passage of same-sex marriage legislation in 2011.

  9. We estimated analogous models to the ones shown here, switching out the K6-dependent variable with answers to a question about whether participants had received mental health counseling in the past 30 days. This alternative dependent variable is problematic as a measure of psychological distress since it confounds distress with willingness to seek assistance. Nonetheless, it may be useful as a check on the main analysis presented in the body of the paper. The difference between homosexual and heterosexual participants in reporting mental health treatment was substantial, (30 vs 11%), but did not vary by area of the city, or by tolerance levels in the state or nation of birth among immigrants to NYC.

  10. Our analyses of the effect of sexual minority status could obscure differences between homosexual and bisexual individuals, although in models not shown here we found little evidence this was the case.

  11. In a multinomial logistic regression not shown, the effect of homosexual X 50+ years old on the probability or moderate psychological distress was equivalent to a Cohen’s d of −0.10, and about half as large as the effect of homosexuality alone. The effect of bisexual X 50+ years old on the probability of moderate psychological distress was approximately equivalent to a Cohen’s d of −0.34, and about half as large as the effect of bisexuality alone.

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Authors and Affiliations

  1. Department of Sociology, William Paterson University, 300 Pompton Road, Wayne, NJ, 07470, USA

    Jacob Felson

  2. John Jay College of Criminal Justice and the Graduate Center, City University of New York, New York, NY, USA

    Amy Adamczyk

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  1. Jacob Felson
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Correspondence to Jacob Felson.

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Felson, J., Adamczyk, A. Effects of Geography on Mental Health Disparities on Sexual Minorities in New York City. Arch Sex Behav 47, 1095–1107 (2018). https://doi.org/10.1007/s10508-017-1013-6

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  • DOI: https://doi.org/10.1007/s10508-017-1013-6

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