Skip to main content
SpringerLink
Log in

Is Being Out About Sexual Orientation Uniformly Healthy? The Moderating Role of Socioeconomic Status in a Prospective Study of Gay and Bisexual Men

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Stress associated with concealing sexual orientation is a possible mechanism for health disparities among lesbian, gay, bisexual (LGB) individuals. However, disclosing one’s sexual orientation might not be uniformly healthy across social contexts.

Purpose

The present study tested whether being out is less healthy for gay and bisexual men of lower socioeconomic status (SES) relative to higher SES men.

Methods

Using longitudinal data on gay and bisexual men (N = 564, ages 18–72), we examined whether the association between outness and physical health differs by SES.

Results

SES significantly moderated associations between outness and physician visits, nonprescription medication use, and physical symptoms. Outness predicted physical health benefits for higher SES men but health problems for lower SES men.

Conclusions

The common assumption that disclosing one’s sexual orientation is uniformly healthy may be less accurate (or inaccurate) for lower status groups. Future research should explore SES as context for minority stress and LGB health disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995; 36: 38-56.

    Article  CAS  PubMed  Google Scholar 

  2. Lick DJ, Durso LE, Johnson KL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci. 2013; 8: 521-549.

    Article  Google Scholar 

  3. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press; 2011.

    Google Scholar 

  4. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003; 129: 674-697.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Floyd FJ, Bakeman R. Coming-out across the life course: Implications of age and historical context. Arch Sex Behav. 2006; 35: 287-296.

    Article  PubMed  Google Scholar 

  6. Cox N, Dewaele A, Houtte M, Vincke J. Stress-related growth, coming out, and internalized homonegativity in lesbian, gay, and bisexual youth: An examination of stress-related growth within the minority stress model. J Homosex. 2011; 58: 117-137.

    Article  PubMed  Google Scholar 

  7. Calzo JP, Antonucci TC, Mays VM, Cochran SD. Retrospective recall of sexual orientation identity development among gay, lesbian, and bisexual adults. Dev Psychol. 2011; 47: 1658-1673.

    Article  PubMed Central  PubMed  Google Scholar 

  8. D’Augelli AR. Identity development and sexual orientation: Toward a model of lesbian, gay, and bisexual development. In: Trickett EJ, Watts RJ, Birman D, eds. Human diversity: Perspectives on people in context. San Francisco, CA: Jossey-Bass; 1994: 312-333.

    Google Scholar 

  9. Pachankis JE. The psychological implications of concealing a stigma: A cognitive–affective–behavioral model. Psychol Bull. 2007; 133: 328-345.

    Article  PubMed  Google Scholar 

  10. Pennebaker JW, Chung CK. Expressive writing, emotional upheavals, and health. In: Friedman H, ed. Oxford handbook of health psychology. New York, NY: Oxford University Press; 2011.

    Google Scholar 

  11. Mohr JJ, Fassinger RE. Sexual orientation identity and romantic relationship quality in same-sex couples. Personal Soc Psychol Bull. 2006; 32: 1085-1099.

    Article  Google Scholar 

  12. Morris JF, Waldo CR, Rothblum ED. A model of predictors and outcomes of outness among lesbian and bisexual women. Am J Orthopsychiatry. 2001; 71: 61-71.

    Article  CAS  PubMed  Google Scholar 

  13. Juster RP, Smith NG, Ouellet E, Shireen S, Lupien SJ. Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosom Med. 2013; 75: 103-116.

    Article  PubMed  Google Scholar 

  14. Beals KP, Peplau LA, Gable SL. Stigma management and well-being: The role of perceived social support, emotional processing, and suppression. Personal Soc Psychol Bull. 2009; 35: 867-879.

    Article  Google Scholar 

  15. Rothman EF, Sullivan M, Keyes S, Boehmer U. Parents’ supportive reactions to sexual orientation disclosure associated with better heatlh: Results from a population-based survey of LGB adults in Massachusetts. J Homosex. 2012; 59: 186-200.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Scrimshaw EW, Siegel K, Downing MJ Jr, Parsons JT. Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. J Consult Clin Psychol. 2013; 81: 141-153.

    Article  Google Scholar 

  17. Frost DM, Parsons JT, Nanin JE. Stigma, concealment, and symptoms of depression as explanations for sexually transmitted infections among gay men. J Health Psychol. 2007; 12: 636-640.

    Article  PubMed  Google Scholar 

  18. Cole SW, Kemeny ME, Taylor SE, Visscher BR, Fahey JL. Accelerated course of human immunodeficiency virus infection in gay men who conceal their homosexual identity. Psychosom Med. 1996; 58: 219-231.

    CAS  PubMed  Google Scholar 

  19. Ullrich PM, Lutgendorf SK, Stapleton JT. Concealment of homosexual identity, social support, and CD4 cell count among HIV-seropositive gay men. J Psychosom Res. 2003; 54: 205-212.

    Article  PubMed  Google Scholar 

  20. Cole SW, Kemeny ME, Taylor SE, Visscher BR. Elevated physical health risk among gay men who conceal their homosexual identity. Health Psychol. 1996; 15: 243-251.

    Article  CAS  PubMed  Google Scholar 

  21. Friedman MS, Marshal MP, Stall R, Cheong J, Wright ER. Gay-related development, early abuse, and adult health outcomes among gay males. AIDS Behav. 2008; 12: 891-902.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Kosciw JG, Greytak EA, Diaz EM, Bartkiewicz MJ. The 2009 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian, and Straight Education Network; 2010.

    Google Scholar 

  23. D’Augelli AR, Hershberger SL, Pilkington NW. Lesbian, gay, and bisexual youth and their families: Disclosure of sexual orientation and its consequences. Am J Orthopsychiatry. 1998; 68: 361-371.

    Article  PubMed  Google Scholar 

  24. Igartua KJ, Gill K, Montoro R. Internalized homophobia: A factor in depression, anxiety, and suicide in the gay and lesbian population. Can J Community Mental Health. 2003; 22: 15-30.

    Google Scholar 

  25. Legate N, Ryan RM, Weinstein N. Is coming out always a “good thing”? Exploring the relations of autonomy, support, outness, and wellness for lesbian, gay, and bisexual individuals. Soc Psychol Personal Sci. 2012; 3: 145-152.

    Article  Google Scholar 

  26. Rosario M, Schrimshaw EW, Hunter J. Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychol Addict Behav. 2009; 23: 175-184.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Ragins BR, Singh R, Cornwell JM. Making the invisible visible: Fear and disclosure of sexual orientation at work. J Appl Psychol. 2007; 92: 1103-1118.

    Article  PubMed  Google Scholar 

  28. Huebner DM, Davis MC. Gay and bisexual men who disclose their sexual orientations in the workplace have higher workday levels of salivary cortisol and negative affect. Ann Behav Med. 2005; 30: 260-267.

    Article  PubMed  Google Scholar 

  29. Matthews KA, Gallo LC. Psychological perspectives on pathways linking socioeconomic status and physical health. Annu Rev Psychol. 2011; 62: 501-530.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Adler NE, Boyce T, Chesney MA, et al. Socioeconomic status and health: The challenge of the gradient. Am Psychol. 1994; 49: 15-24.

    Article  CAS  PubMed  Google Scholar 

  31. Matthews KA. Are sociodemographic variables markers for psychological determinants of health? Health Psychol. 1989; 8: 641-648.

    Article  CAS  PubMed  Google Scholar 

  32. Adler NE. Health disparities through a psychological lens. Am Psychol. 2009; 64: 663-673.

    Article  PubMed  Google Scholar 

  33. Barrett DC, Pollack LM. Whose gay community? Social class, sexual self-expression, and gay community involvement. Sociol Q. 2005; 46: 437-456.

    Article  Google Scholar 

  34. Cleary PD, Jette AM. The validity of self-reported physician utilization measures. Med Care. 1984; 22: 796-803.

    Article  CAS  PubMed  Google Scholar 

  35. Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002; 64: 258-266.

    PubMed  Google Scholar 

  36. Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff. 2002; 21: 245-253.

    Article  Google Scholar 

  37. Chappell NL. Measuring functional ability and chronic health conditions among the elderly: A research note on the adequacy of three instruments. J Health Soc Behav. 1981; 22: 90-102.

    Article  CAS  PubMed  Google Scholar 

  38. Huebner DM, Nemeroff CJ, Davis MC. Do hostility and neuroticism confound associations between perceived discrimination and depressive symptoms? J Soc Clin Psychol. 2005; 24: 723-740.

    Article  Google Scholar 

  39. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983; 24: 385-396.

    Article  CAS  PubMed  Google Scholar 

  40. Landrine H, Klonoff EA. The Schedule of Racist Events: A measure of racist discrimination and a study of its negative physical and mental health consequences. J Black Psychol. 1996; 22: 144-168.

    Article  Google Scholar 

  41. Klonoff EA, Landrine H. The Schedule of Sexist Events: A measure of lifetime and recent sexist discrimination in women’s lives. Psychol Women Q. 1995; 19: 439-472.

    Article  Google Scholar 

  42. NORM: Multiple Imputation of Incomplete Multivariate Data Under A Normal Model [computer program]. Version 2.021999.

  43. Graham JW. Missing data analysis: Making it work in the real world. Annu Rev Psychol. 2009; 60: 549-576.

    Article  PubMed  Google Scholar 

  44. Aiken LS, West SG. Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage; 1991.

    Google Scholar 

  45. Kloss JD. An exposure-based examination of the effects of written emotional disclosure. Br J Health Psychol. 2002; 7: 31-46.

    Article  PubMed  Google Scholar 

  46. Schilte AF, Portegijs PJM, Blankenstein AH, et al. Randomized controlled trial of disclosure of emotionally important events in somatisation in primary care. Br Med J. 2001; 323: 86-89.

    Article  CAS  Google Scholar 

  47. Stroebe M, Stroebe W, Schut H, Zech E, Bout J. Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. J Consult Clin Psychol. 2002; 70: 169-178.

    Article  PubMed  Google Scholar 

  48. Cole SW. Social threat, personal identity, and physical health in closeted gay men. In: Omoto A, Kurtzman HS, eds. Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people. Washington, DC: American Psychological Association; 2006: 245-267.

    Chapter  Google Scholar 

  49. Huebner DM, Davis MC. Perceived antigay discrimination and physical health outcomes. Health Psychol. 2007; 26: 627-634.

    Article  PubMed  Google Scholar 

  50. Avendano M, Kawachi I, Van LF, et al. Socioeconomic status and stroke incidence in the US elderly: The role of risk factors in the EPESE study. Stroke. 2006; 37: 1368-1373.

    Article  PubMed  Google Scholar 

  51. Matthews KA, Raikkonen K, Gallo L, Kuller LH. Association between socioeconomic status and metabolic syndrome in women: Testing the reserve capacity model. Health Psychol. 2008; 27: 576-583.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Prescott E, Godtfredsen N, Osler M, Schnohr P, Barefoot J. Social gradient in the metabolic syndrome not explained by psychosocial and behavioural factors: Evidence from the Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil. 2007; 14: 405-412.

    Article  PubMed  Google Scholar 

  53. Shinn LK, O’Brien M. Parent–child conversational styles in middle childhood: Gender and social class differences. Sex Roles. 2008; 59: 61-67.

    Article  Google Scholar 

  54. Walch SE, Orlosky PM, Sinkkanen KA, Stevens HR. Demographic and social factors associated with homophobia and fear of AIDS in a community sample. J Homosex. 2010; 57: 310-324.

    Article  PubMed  Google Scholar 

  55. Gallo LC, Matthews KA. Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychol Bull. 2003; 129: 10-51.

    Article  PubMed  Google Scholar 

  56. Adler NE, Snibbe AC. The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Curr Dir Psychol Sci. 2003; 12: 119-123.

    Article  Google Scholar 

  57. Holahan CJ, Moos RH. Personal and contextual determinants of coping strategies. J Pers Soc Psychol. 1987; 52: 946-955.

    Article  CAS  PubMed  Google Scholar 

  58. Billings AG, Moos RH. The role of coping resources and social resources in attenuating the stress of life events. J Behav Med. 1981; 4: 139-157.

    Article  CAS  PubMed  Google Scholar 

  59. Ritter KY, Terndrup AI. Handbook of affirmative psychotherapy with lesbians and gay men. New York, NY: The Guilford Press; 2002.

    Google Scholar 

  60. American Psychological Association. Answers to your questions: For a better understanding of sexual orientation and homosexuality. Washington, DC: American Psychological Association; 2008.

  61. Rasmussen ML. The problem of coming out. Theory Pract. 2004; 43: 144-150.

    Article  Google Scholar 

  62. Human Rights Campaign Foundation. Resource guide to coming out. Washington, DC: Human Rights Campaign Foundation; 2001.

Download references

Acknowledgments

This research was supported by a grant from the Centers for Disease Control and Prevention to the Arizona Department of Health Services through Cooperative Agreement #99004. We very much appreciate the contributions of Carol Nemeroff and Rae Jean Proescholdbell.

Conflict of Interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Utah, Salt Lake City, UT, USA

    Larissa A. McGarrity M.S. & David M. Huebner Ph.D.

Authors
  1. Larissa A. McGarrity M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David M. Huebner Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Larissa A. McGarrity M.S..

About this article

Cite this article

McGarrity, L.A., Huebner, D.M. Is Being Out About Sexual Orientation Uniformly Healthy? The Moderating Role of Socioeconomic Status in a Prospective Study of Gay and Bisexual Men. ann. behav. med. 47, 28–38 (2014). https://doi.org/10.1007/s12160-013-9575-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-013-9575-6

Keywords

Search

Navigation