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Emotional support is essential to health outcomes, especially for marginalized communities. The coronavirus disease 2019 pandemic increased the prevalence of mental health issues and thus increased the need for emotional support, particularly for sexual minoritized people. The authors applied minority stress theory and the stress process framework by drawing on a population-based data source of 3,642 respondents, the National Couples’ Health and Time Study, which oversampled sexual minoritized people during the pandemic. The authors examine three sources of emotional support (friends, family, and partners) and their association with three mental health outcomes (depression, anxiety, and loneliness) separately for cisgender men and cisgender women. The authors find that emotional support plays a larger role in the association between sexual identity and mental health for cisgender men than cisgender women. Regardless of gender, bisexual individuals have consistently higher levels of depression, anxiety, and loneliness across all models, and this difference is not attenuated by emotional support.
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https://doi.org/10.1177/23780231241247999
Socius: Sociological Research for
a Dynamic World
Volume 10: 1 –16
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Emotional support is essential to mental health outcomes
especially for members of the lesbian, gay, bisexual, trans-
gender, and/or queer (LGBTQ+) community (Doty et al.
2010). Prior to the pandemic, sexual minoritized persons
more often experienced mental health issues than people
who identified as heterosexual (Almeida et al. 2009;
Borgogna et al. 2019; Plöderl and Tremblay 2015; Ross et al.
2018; Stacey, Reczek, and Spiker 2022). During the corona-
virus disease 2019 (COVID-19) pandemic, stress levels
(Park et al. 2020; Prowse et al. 2021; Taylor et al. 2020a,
2020b) and the prevalence of mental health issues (Ettman
et al. 2020; Hawes et al. 2021) for general population sam-
ples substantially increased. Moreover, individuals with
LGBTQ+ identities experienced more COVID-19-related
stress than heterosexual individuals (Goldbach, Knutson,
and Cole Milton 2021; Manning and Kamp Dush 2021;
Moore et al. 2021; Salerno et al. 2023). A key strategy to
manage stress is via emotional support. For the LGBTQ+
population, it is important to account for sources of emo-
tional support because individuals with sexual minoritized
identities report higher levels of emotional support from
friends and lower levels of family support (Gustafson et al.
2023; Hsieh and Wong 2020). We examine whether emo-
tional support was especially important for individuals that
do not identify as heterosexual during the pandemic, and we
examine support from family, friends, and partners.
Women also suffered more mental health issues during
the pandemic than men (Almeida et al. 2020; Thibaut and
van Wijngaarden-Cremers 2020), similar to prepandemic,
when women reported higher levels of depression and anxi-
ety (Afifi 2007; Nolen-Hoeksema 2001; Riecher-Rössler
2017). At the same time, women receive more social support
than men (Antonucci and Akiyama 1987; Rueger, Malecki,
and Demaray 2008, 2010) and that additional support may be
Original Article
1247999SRDXXX10.1177/23780231241247999Socius: Sociological Research for a Dynamic WorldGustafson et al.
research-article2024
1Bowling Green State University, Bowling Green, OH, USA
2University of Minnesota, Minneapolis, MN, USA
Corresponding Author:
Kristen E. Gustafson, Bowling Green State University, Department of
Sociology and Center for Family and Demographic Research, Williams
Hall, Bowling Green, OH 43403, USA
Email: kgustaf@bgsu.edu
Emotional Support and Mental Health
during the COVID-19 Pandemic: A Focus
on Gender and Sexual Identities
Kristen E. Gustafson1, Wendy D. Manning1,
and Claire M. Kamp Dush2
Abstract
Emotional support is essential to health outcomes, especially for marginalized communities. The coronavirus disease
2019 pandemic increased the prevalence of mental health issues and thus increased the need for emotional support,
particularly for sexual minoritized people. The authors applied minority stress theory and the stress process framework
by drawing on a population-based data source of 3,642 respondents, the National Couples’ Health and Time Study,
which oversampled sexual minoritized people during the pandemic. The authors examine three sources of emotional
support (friends, family, and partners) and their association with three mental health outcomes (depression, anxiety,
and loneliness) separately for cisgender men and cisgender women. The authors find that emotional support plays a
larger role in the association between sexual identity and mental health for cisgender men than cisgender women.
Regardless of gender, bisexual individuals have consistently higher levels of depression, anxiety, and loneliness across
all models, and this difference is not attenuated by emotional support.
Keywords
emotional support, depression, anxiety, loneliness, COVID-19, sexual minority, LGBTQ+
2 Socius: Sociological Research for a Dynamic World
critical during stressful events. Given gender disparities in
well-being, studies of well-being during the pandemic
require attention to gender-specific analyses of sexual
identity.
We apply a minority stress framework to examine the
well-being of men and women by their sexual identity. We
draw on one of the only population-based data collections
initiated during the pandemic, the National Couples’ Health
and Time Study (NCHAT) with oversamples of individuals
with sexual minoritized identities. These data offer a unique
opportunity to explore emotional support of sexual minori-
tized people at a time when one’s mental and physical health
was particularly crucial to their overall well-being. We test
separate models for cisgender women and men because of
the well-documented gender disparities in levels of mental
health well-being and social support (Barnett et al. 2021;
McLean et al. 2022). We focus on three sources of emotional
support (family, friend, and partner) and we hypothesize that
these sources of support may be particularly important for
sexual minoritized people as they navigate elevated discrimi-
nation and stress in their lives. These findings will provide
new insights into the links between emotional support and
well-being for a marginalized but growing population during
the recent public health crisis.
Background
The stress process model (Pearlin 1999; Pearlin et al. 1981)
suggests that there is a process by which people respond to
difficult life circumstances such as chronic strains or adverse
experiences. Wheaton et al. (2013) defined stress as “a dis-
crete and observable event representing change and thus
requiring some social and/or psychological adjustment on
the part of the individual” (p. 303). Stress can manifest in
terms of mental, emotional, or physical toll, and it causes
change and requires adaptation (Meyer 1995, 2003). The
stress process model proposes that there are three compo-
nents of stress, including stressors, buffers, and outcomes.
Stressors can affect individuals, leading to a variety of out-
comes, while buffers serve to mitigate these effects. Stress
has been linked to both mental health outcomes such as
depression, anxiety, and suicidality (Meyer 1995, 2003;
Mongelli et al. 2019; Wight et al. 2012) and physical health
outcomes such as cancer, flu, hypertension, and physical
health items from the SF-36 subscale of the RAND Health
Survey, including dizziness, aches and pains, headaches,
nausea, and others (Frost, Lehavot, and Meyer 2015; Raposa
et al. 2014).
The stress process model suggests that at least some of the
variation in mental health outcomes can be attributed to dif-
ferences in individual coping resources (Pearlin 1999).
Emotional support is a key coping resource that buffers the
effects of stressors on adverse mental health outcomes
(Kornblith et al. 2001; Szkody et al. 2021), especially for
sexual minoritized people (Clarke 2012; Dakin, Williams,
and MacNamara 2020). Emotional support consists of love,
caring, trust, listening, discussing personal issues and wor-
ries, and other affective behaviors (Frost, Meyer, and
Schwartz 2016; House 1987). In this article, we argue that
the incorporation of emotional support from partners, friends,
and family members will partially mitigate the disparities in
mental health issues between sexual minoritized and hetero-
sexual people.
For sexual minoritized people, their stigmatized identity
can be a major source of stress (Cyrus 2017; Kelleher 2009),
with their unique experiences with stigma and aggressions
acting as stressors (Balsam et al. 2011; Munro, Travers, and
Woodford 2019). The minority stress theory (MST), as
developed by Brooks (1981) and Meyer (1995, 2003) is the
most prominent approach used to assess the well-being of
sexual minoritized individuals. MST posits that stigma-
related stress associated with sexual minoritized status drives
increased risk for poor mental and physical health outcomes
among LGBT individuals. MST operates under the assump-
tions that minority stress is (1) unique, (2) chronic, and (3)
socially based (Meyer 1995, 2003). Meyer (2003:676)
argued that stressors faced by minoritized people are additive
to stressors faced by all people, are related to underlying
social and cultural structures, and stem from social pro-
cesses, institutions, and structures. There are four principal
components of minority stress: (1) general external pressures
(i.e., “don’t say gay” bills and policies) and specific instances
of stress (i.e., violence), (2) expected stigma, (3) conceal-
ment of one’s sexual orientation or identity, and (4) internal-
ized homophobia (Peleg and Hartman 2019). Each of these
components contribute to poorer mental health outcomes
among people who identify as sexual minorities (Hoy-Ellis
2023; Ramirez and Paz Galupo 2019). In this study, we
examine the role of emotional support in mitigating the
harmful effects of minority stress and how emotional support
may operate differently according to gender.
Emotional Support
A large body of research has demonstrated the importance of
social support for sustaining mental and physical health in
marginalized communities (Donev 2005; Heaney and Israel
2008). Social support is a valuable resource and serves to
help ameliorate the negative impacts of stress (Kamp Dush
et al. 2022). For both men and women, higher social support
is associated with better self-rated health and higher life sat-
isfaction (Matud, García, and Fortes 2019). We focus on
emotional support, though prior research may refer to such
as social support. When discussing the research of others, we
will use the authors’ own terminology.
However, there are gender differences in the need for and
receipt of emotional support. Women report higher stress
levels and slightly more negative life events but also have a
larger support network, receive more social support, are
more socially connected, and enjoy higher quality social
Gustafson et al. 3
support than men (Dalgard et al. 2006; Henning-Smith et al.
2018; Kneavel 2021). Men have been shown to have consis-
tently smaller support networks, regardless of partnership
status (Dykstra and Fokkema 2007) and are less likely to say
that they can open up to family or friends (Henning-Smith
et al. 2018), which may exacerbate the importance of social
support for men. Stronge, Overall, and Sibley (2019) noted a
stronger association between men’s relationship status and
well-being (self-esteem and life satisfaction), partially due to
men’s stronger connection between relationship status and
perceived social support. That is, relationship status is a key
predictor of men’s perceived social support. Among gender
minoritized people, including transgender individuals, high
levels of support from family and friends was associated
with strikingly lower levels of depression and anxiety
(Puckett et al. 2019).
Support from family members has an important and posi-
tive influence on mental health (Bouris et al. 2010; Newcomb,
Heinz, and Mustanski 2012; Padilla, Crisp, and Rew 2010;
Roberts and Christens 2021). Sexual minoritized individuals
have more strained family relationships and lower levels of
support from parents and family members (Gustafson et al.
2023; McConnell, Birkett, and Mustanski 2016; Needham
and Austin 2010; Watson et al. 2019). Thus, other sources of
emotional support may be key for LGBTQ+ persons.
Friend support is a central resource and associated with
lower levels of mental health problems (Bruce, Harper, and
Bauermeister 2015; Gillespie et al. 2015; Tebbe and Moradi
2016). Given the lower levels of family support given to
individuals with sexual minoritized identities, friend support
may be especially salient. Although friend support was posi-
tively associated with life satisfaction for all sexual orienta-
tions, the strongest associations were among lesbian women,
bisexual men, and bisexual women (Gillespie et al. 2015).
This may be due to the tendency for sexual minoritized indi-
viduals to be more reliant on their “chosen families” (defined
as their non-blood-related friends who come to fill the roles
normally filled by family members) as their primary source
of social support (Blair and Pukall 2015, 267). Although cho-
sen families come in different forms within different sub-
groups of society, the rejection by or the lack of support from
family members plays a crucial role in the formation of cho-
sen families for LGBs (Dewaele et al. 2011).
A proximal source of support, partner or spouse support,
contributes to better mental health (Choi and Ha 2011;
Davey-Rothwell 2017; Stapleton et al. 2012) across sexual
identities (Kamp Dush et al. 2022). Among older LGBT
adults, caregivers assisting friends had lower levels of social
support than those assisting partners and thus resulted in
higher levels of depressive symptomology for caregivers
(Shiu, Muraco, and Fredriksen-Goldsen 2016). Partner sup-
port is also linked to relationship satisfaction (Cramer 2004;
Lal and Bartle-Haring 2011), which can contribute to lower
levels of depression (Leach and Butterworth 2020; Misri
et al. 2000), anxiety (Borstelmann et al. 2020; Leach and
Butterworth 2020) and loneliness (Eshbaugh 2010; Lee and
Goldstein 2016).
Mental Health
Mental health is crucial to one’s overall well-being. As with
emotional support, there are significant gender differences in
mental health. Women have much higher rates of major
depressive disorder and anxiety disorder (Alexander 2007;
Zender and Olshansky 2009). The prevalence of mental
health disorders differs across sexual and gender identities,
as the patterns of risk are different for men and women and
for specific sexual minoritized groups (Bostwick et al. 2010).
Although there is research linking sexual and gender minori-
tized identities and racial/ethnic minoritized identities to
greater psychological distress and mental health outcomes
(Sutter and Perrin 2016; Williams et al. 2007), we focus this
work on the intersection of gender and sexual identity.
Women have higher levels of depressive symptoms than
men (Botticello 2009; Brown 2000; Kamp Dush et al. 2022;
Mirowsky and Ross 1995), and it is well established that
sexual minoritized people have greater risk for depression
than their heterosexual counterparts (Borgogna et al. 2019;
Hatzenbuehler, McLaughlin, and Xuan 2012; Lucassen et al.
2017; Marshal et al. 2011; Safren and Heimberg 1999).
Traditionally sexual minoritized individuals are grouped
together, but there are distinct differences between individu-
als with different sexual minoritized identities, particularly
among bisexual individuals. Individuals identifying as bisex-
ual most frequently have mental health problems, including
depression, anxiety, self-harm, and suicidality compared
with gay, lesbian, and heterosexual individuals (Jorm et al.
2002). Among young adults, Li, Pollitt, and Russell (2016)
noted individuals identifying as bisexual and “mostly hetero-
sexual” had significantly higher concurrent depression than
heterosexual individuals. In Sweden, all sexual minoritized
groups had increased risk for depression compared with het-
erosexual individuals, with bisexual individuals and gay men
having the highest likelihood of depression (Björkenstam
et al. 2017). Bisexual women are less likely to receive posi-
tive responses to their sexual identity, and bisexual men
experience more psychological distress than gay men (King
et al. 2003). In a meta-analysis by Ross et al. (2018), hetero-
sexual individuals had the lowest rates of depression and
anxiety, and bisexual individuals had higher or equivalent
rates compared with gay or lesbian individuals. Furthermore,
individuals in the emerging sexual and gender minoritized
categories (pansexual, demisexual, asexual, queer, question-
ing, and transgender or gender nonconforming) report sig-
nificantly higher rates of depression and anxiety compared
with cisgender, heterosexual individuals, as well as gay and
lesbian individuals (Borgogna et al. 2019).
There are also sexual and gender identity differences in
anxiety (Kamp Dush et al. 2022). Sexual minoritized indi-
viduals have higher anxiety (Borgogna et al. 2019; Pakula
4 Socius: Sociological Research for a Dynamic World
et al. 2016; Ross et al. 2018) than their heterosexual counter-
parts. For both men and women, bisexual identity and behav-
ior were strongly and persistently associated with heightened
risk for mood and anxiety disorders (Bostwick et al. 2010).
Bisexual individuals are more likely to report anxiety disor-
ders, mood disorders, and anxiety-mood disorders (Pakula
et al. 2016). Women have higher prevalence and severity of
social anxiety disorder than men (Asher and Aderka 2018)
and have a higher likelihood of affective and anxiety disor-
ders when holding other characteristics and stress exposure
constant (Aneshensel, Rutter, and Lachenbruch 1991).
Among adolescents, girls had significantly higher preva-
lence in all mood and anxiety disorders than boys (Kessler
et al. 2012).
Loneliness has been identified as a key indicator of health
with researchers demonstrating the detrimental effects of
social isolation (Umberson, Lin, and Cha 2022). Loneliness
varies by sexual and gender identity (Kamp Dush et al.
2022), and those with a sexual minoritized identity have
higher levels of loneliness than their heterosexual counter-
parts. However, there are mixed results when it comes to
gender and loneliness. Some studies show that men report
more loneliness than women across cultures (in a study span-
ning 237 countries, islands, and territories) and age (Barreto
et al. 2021) and have higher levels of social and emotional
loneliness regardless of partnership status (Dykstra and
Fokkema 2007). However, a study conducted during the
COVID-19 pandemic revealed women to have greater odds
of loneliness than men among all age groups (Wickens et al.
2021). Rokach (2018) suggested that women may express,
but not necessarily experience, more loneliness than men.
The Present Study
The objective of this study is to apply the stress process
framework (Pearlin 1999) and MST (Brooks 1981; Meyer
1995, 2003) to assess the associations between emotional
support from family, partners, and friends and three mental
health indicators (loneliness, depression, and anxiety) by
sexual identity separately for cisgender men and women. In
both theories, emotional support is a crucial element driving
the mental and physical well-being of sexual minoritized
people. We expect that the negative mental health outcomes
experienced by diverse sexual identities will be partially
mediated with the inclusion of emotional support for part-
nered cisgender men and women.
A contribution of this study is the ability to include an
indicator of minority stress, aggressions, in the model. The
models will include indicators that are related to levels of
mental health outcomes in prior studies, specifically those
focusing on sexual and gender diverse populations (Kamp
Dush et al. 2022). The traditional sociodemographic indica-
tors include gender identity (Kendler, Myers, and Prescott
2005), racial/ethnic identity (Wong Santos, and Tobin 2022),
age (Bruine De Bruin, Parker, and Strough 2020), education
(DeBerard, Spielmans, and Julka 2004), marital status
(Marcussen 2005), and parenthood status (Samandari,
Speizer, and O’Connell 2010). Furthermore, to contextualize
this work in the pandemic, this study includes an indicator of
COVID-19 stress to capture the unique experience of the
pandemic and potentially a measure of demand for emotional
support as well as month of survey to account for variability
in experiences during different periods of the pandemic.
Data and Methods
NCHAT is a nationally representative sample of 20- to
60-year-old partnered individuals who are married or cohab-
iting in the United States. Data were collected using an online
survey from September 2020 to April 2021. These data are
especially suited for this project because of the breadth of
questions, timing of the data collection, and the large, popu-
lation-based sample of sexual and gender minoritized
respondents. To date no data collections, other than NCHAT,
were conducted during the pandemic and have large overs-
amples of sexual minoritized people to address these research
questions and are nationally representative. Furthermore, the
NCHAT data provide a new opportunity to examine emo-
tional support differences among sexual minoritized people
as well as a unique time-specific item, COVID-19 stress.
Understanding the correlates of emotional support among
sexual minoritized individuals is important for future
research on the role of emotional support and well-being
amid a global pandemic or a major event such as a climate
change shock. The NCHAT data are publicly available for
download from the Inter-University Consortium for Political
and Social Research at https://www.icpsr.umich.edu/web/
DSDR/studies/38417.
The initial sample included 3,642 respondents with valid
responses to age and gender. The sample was limited to those
who provided responses to the dependent variables (depres-
sive symptoms, anxiety, and loneliness; n = 3,640) and then
restricted to those who responded to the support indicators
(partner support, family support, friend support; n = 3,630).
The sample was further limited to respondents with valid
responses to the independent variables, education (n = 3,625),
and parenthood status (n = 3,618). The final analytical sam-
ple size was 3,618. When running the models separately by
gender, the samples were 1,723 cisgender women and 1,768
cisgender men. Given that there were only 127 noncisgender
individuals, we did not run a third set of models for gender
minoritized respondents. However, supplemental models
described below show the association between noncisgender
identities and mental health.
Measures
Depression. Depression was measured by asking respon-
dents, “Below is a list of ways you might have felt or
behaved. How often have you felt this way in the past
Gustafson et al. 5
7 days?” Responses ranged from 1 = “rarely or none of the
time (less than 1 day)” to 4 = “most or all of the time (5–
7 days).” We calculated the average score for respondents’
answers to the following 10 statements: “I was bothered by
things that don’t usually bother me”, “I had trouble keeping
my mind on what I was doing”, “I felt lonely”, “My sleep
was restless”, “I felt depressed”, “I felt like everything I did
was an effort”, “I felt hopeful for the future”, “I felt fearful”,
“I was happy”, and “I could not get going” (α = .87). The
items “I felt hopeful for the future” and “I was happy” were
reverse-coded in the analyses.
Anxiety. Anxiety was measured by asking the question “In
the past 7 days, how often have you been bothered by the fol-
lowing problems?” and obtaining the average score for
respondents’ answers to the following seven options: “Feel-
ing nervous, anxious, or on edge”; “Not being able to stop or
control your worrying”; “Worrying too much about different
things”; “Trouble relaxing”; “Being so restless that it is hard
to sit still”; “Becoming easily annoyed or irritable”; and
“Feeling afraid as if something awful might happen.”
Responses ranged from 1 = “not at all” to 4 = “nearly every
day” (α = .92).
Loneliness. Loneliness was measured on the basis of the short
version of the UCLA Loneliness Scale (Hughes et al. 2004).
Respondents were asked, “In the past 7 days, how often have
you been bothered by the following problems?” We obtained
the average score for the respondents’ answers to the follow-
ing items: “How often did you feel that you lacked compan-
ionship?” “How often did you feel left out?” and “How often
did you feel isolated from others?” Responses ranged from
1 = “never” to 5 = “very often.”
Sexual Identity. The question used to identify sexual identity
was “What do you consider yourself to be? Select all that
apply,” with 11 responses: “heterosexual or straight,” “gay or
lesbian,” “bisexual,” “same-gender loving,” “queer,” “pan-
sexual,” “omnisexual,” “asexual,” “don’t know,” “question-
ing,” and “something else,” with an option to specify. We
coded respondents into four mutually exclusive categories:
“exclusively heterosexual,” “exclusively gay/lesbian,”
“bisexual plus pansexual, omnisexual, and queer,” and
“another/multiple sexual identities.” Those in the “bisexual
plus pansexual, omnisexual, and queer” category are those
who selected only bisexual as a sexual identity as well as
those who chose both bisexual and any combination of the
latter three identities. Those selecting exclusively pansexual,
omnisexual, and/or queer were categorized in the “another/
multiple” category.
Gender Identity. Gender identity was measured by responses
to the question “Which of the following best describes your
gender?” Responses were “man,” “woman,” “trans man,”
“trans woman,” and “do not identify as any of the above.”
We coded gender into three mutually exclusive categories:
“cisgender man,” “cisgender woman,” and “transgender or
another gender identity.”
Emotional Support. Emotional support was measured with
three questions (Procidano and Heller 1983): “How much do
you rely on each of the following people for emotional sup-
port . . . I rely on my spouse/partner for emotional support, I
rely on my family for emotional support, I rely on my friends
for emotional support.” Responses ranged from 1 = “not at
all” to 5 = “a great deal.”
Aggressions. Aggressions were measured by scaling respon-
dents’ answers to the following nine statements: “You were
treated with less respect than other people”; “You received
poorer service than other people at restaurants or stores”;
“People acted as if they were afraid of you”; “People acted as
if they thought you were dishonest”; “People acted as if they
were better than you”; “You were called names or insulted”;
“You were threatened or harassed”; “You were hit, beaten,
physically attacked, or assaulted”; and “You were robbed, or
your property was stolen, vandalized, or purposely dam-
aged.” Respondents were asked, “In your day-to-day life
over the past months how often did any of the following
things happen to you?” Responses ranged from 1 = “never”
to 5 = “very often” (α = .86). These measures were modeled
after measures used by Williams et al. (1997) and the Gen-
erations Study Baseline Questionnaire and Measure Sources
(Meyer et al. 2016).
COVID-19 Stress. COVID-19 stress was measured by scaling
respondents’ answers to the question “How stressed are you
about the following?” and scaling their responses to the items
“Getting coronavirus”; “My spouse or partner getting coro-
navirus”; “My parents, siblings, or other family members
getting coronavirus”; and “Giving someone the coronavirus”
(α = .87). Responses ranged from 1 = “not at all stressed” to
5 = “very stressed.”
Covariates. The models included indicators measuring race/
ethnicity (non-Hispanic White, non-Hispanic Black, non-
Hispanic Asian, Hispanic/Latinx, non-Hispanic multirace,
and another), age as a continuous variable, education level
(high school or less, some college, college degree), marital
status (married, cohabiting), and parenthood status (have
children, don’t have children).
Analytic Strategy
We estimated a series of ordinary least squares models to
regress emotional support from partners, friends, and family
onto mental health indicators for sexual minoritized and het-
erosexual people. We ran initial models to test significant
gender differences in mental health outcomes net of support
indicators and sociodemographic covariates (tables not
6 Socius: Sociological Research for a Dynamic World
shown). We then estimated models separately by gender
because of established differentials in mental health and
emotional support, using each mental health indicator as a
separate dependent variable (depressive symptoms, anxiety,
and loneliness) and sexual identity and emotional support as
key independent variables. A baseline model included sexual
identity and month of interview, a second model included the
indicators of emotional support, and the third model included
the sociodemographic covariates. We conducted formal
mediation analyses using a sequential mediation model
(Baron and Kenny 1986; Hayes and Preacher 2014). To test
significance of the indirect effects, 95 percent bias-corrected
bootstrapped confidence intervals were generated using
2,000 samples, and results indicating significance are pre-
sented in the text. The analyses were weighted in accordance
with weights established by Gallup. Further details about the
study and weighting can be found in Kamp Dush et al.
(2023).
Results
Overall, mean levels of depression, anxiety, and loneliness
were higher for partnered cisgender women than partnered
cisgender men, as shown in Table 1. Initial multivariable
models were estimated that did not separate respondents on
the basis of gender identity (results not shown). Partnered
cisgender women and respondents identifying as transgender
or another gender identity had significantly higher levels of
depression, anxiety, and loneliness than partnered cisgender
men (results not shown). Furthermore, partnered cisgender
women had significantly higher levels of depression and
anxiety than transgender and those reporting another gender
identity, but not loneliness (results not shown). The small
sample size of noncisgender respondents prevented separate
analyses. Given these findings and prior work on mental
health and gender, subsequent analyses were run separately
for cisgender women and men.
Cisgender Men
Table 1 includes the distribution of the sample separately for
partnered cisgender men and women. There were 1,768 cis-
gender men in the sample. The weighted mean levels for the
dependent variables were as follows: depression, 1.68
(range = 1–4); anxiety, 1.51 (range = 1–4), and loneliness,
1.87 (range = 1–5). Of the cisgender men, 97.82 percent
(n = 1,039) identified as exclusively heterosexual, 1.23 per-
cent (n = 487) as exclusively gay, 0.33 percent (n = 117) as
bisexual (plus pansexual, omnisexual, and queer), and
0.61 percent (n = 125) with another or multiple sexual identi-
ties. The weighted mean levels for the support variables were
as follows: family support, 3.17 (range = 1–5); friend sup-
port, 2.71 (range = 1–5); and partner support, 4.01 (range = 1–
5). Regarding race, 55.02 percent (n = 1,005) of the cisgender
men in this sample identified as non-Hispanic White,
6.99 percent (n = 149) as non-Hispanic Black, 7.92 percent
(n = 126) as non-Hispanic Asian, 19.97 percent (n = 278) as
Hispanic, 3.68 percent (n = 98) as non-Hispanic multiracial,
and 6.41 percent (n = 112) as another racial/ethnic identity.
The mean age of cisgender men was 43.59 years. Just under
half (41.98 percent [n = 1,044]) of the cisgender men in this
sample had a college degree or higher, with 31.38 percent
(n = 340) reporting less than or equal to a high school degree
and 26.64 percent (n = 384) reporting some college educa-
tion. The majority (80.68 percent [n = 487]) of cisgender men
in this sample were married, the remaining 19.31 percent
(n = 1,281) were cohabiting. Fewer than one third (30.14 per-
cent [n = 446]) of the cisgender men in the sample had chil-
dren, and the remaining 69.86 percent (n = 1,322) did not.
Last, the weighted mean levels for the other covariates for
cisgender men were as follows: aggressions, 13.36
(range = 0–41) and COVID-19 stress, 9.72 (range = 3–20).
Table 2 includes the multivariable regression results for
partnered cisgender men. The first three columns focus on
depressive symptoms, the next three anxiety and the final set
loneliness. The first model shows that gay and bisexual cis-
gender men had significantly elevated levels of all three
mental health outcomes (depression, anxiety, and loneliness)
than exclusively heterosexual cisgender men. Cisgender men
reporting another or multiple sexual identities also had sig-
nificantly higher levels of depression than cisgender hetero-
sexual men.
The second model, which added the measures of emo-
tional support, shows that only bisexual cisgender men had
significantly higher levels of depression, while gay and
bisexual men had significantly higher levels of anxiety and
loneliness compared with cisgender heterosexual men.
Family support was directly associated with lower levels of
depression, anxiety and loneliness. Partner support was only
associated with lower levels of loneliness and friend support
was tied to lower levels of anxiety. Mediation analyses indi-
cated that sexual minoritized identities (relative to hetero-
sexual men) were indirectly associated with depression and
anxiety through family support (gay men depression 95 per-
cent confidence interval [CI] = 0.013 to 0.042 and anxiety
95 percent CI = 0.014 to 0.051; bisexual men depression
95 percent CI = 0.012 to 0.046 and anxiety 95 percent
CI = 0.013 to 0.053; another/multiple sexual identities
depression 95 percent CI = 0.014 to 0.051 and anxiety 95 per-
cent CI = 0.015 to 0.059). Depression and loneliness for part-
nered gay men were indirectly influenced through partner
support (depression 95 percent CI = −0.017 to −0.001; loneli-
ness 95 percent CI = −0.065 to −0.004). Additionally, the
association of men with another/multiple identities and anxi-
ety operated indirectly through friend support (95 percent
CI = 0.000 to 0.036). Thus, emotional support was a key indi-
rect pathway to mental health for each group of sexually
minoritized men.
In the full model including all the covariates, no sexual
identity was significantly different from heterosexual
Gustafson et al. 7
cisgender men in levels of depression and loneliness. Gay
and bisexual cisgender men had significantly higher levels of
anxiety than cisgender heterosexual men in the full model.
For cisgender men, family and partner support were signifi-
cantly associated with all three mental health outcomes, but
not friend support. Similar to the prior models for partnered
cisgender men of all sexual minoritized identities, family
support was indirectly associated with depression and anxi-
ety (gay men depression 95 percent CI = 0.015–0.042 and
anxiety 95 percent CI = 0.016–0.050; bisexual men depres-
sion 95 percent CI = 0.012–0.043 and anxiety 95 percent
CI = 0.012–0.048; another/multiple sexual identities depres-
sion 95 percent CI = 0.015–0.050 and anxiety 95 percent
CI = 0.017–0.058) with all covariates in the models. Partner
and friend support were no longer significant mediators in
the full model.
In the full model, there were other covariates associated
with the mental health outcomes. Regarding the sociodemo-
graphic indicators, non-Hispanic Black cisgender men had
lower levels of depression, anxiety, and loneliness when
accounting for emotional support indicators. Age was nega-
tively associated with depression and anxiety but was not
statistically significantly associated with loneliness. Of par-
ticular relevance to sexual minority men, experience of
aggressions and COVID-19 stress were significantly posi-
tively associated with all three mental health indicators.
Given the time frame of the study in supplemental models
we found that COVID-19 stress operated similarly for all
except cisgender bisexual men. The association between
COVID-19 stress and depression was significantly stronger
for cisgender bisexual men than cisgender heterosexual men.
Cisgender Women
The next set of results are limited to partnered cisgender
women, and there were 1,723 in the sample. The weighted
mean levels for the dependent variables were as follows:
depression, 1.83 (range = 1–4); anxiety, 1.75 (range = 1–4);
Table 1. Descriptive Table of the Full, Cisgender Men, and Cisgender Women Samples.
Full Sample (n = 3,618) Cisgender Men (n = 1,768) Cisgender Women (n = 1,723)
Variable Unweighted nWeighted % or Mean Unweighted nWeighted % or Mean Unweighted nWeighted % or Mean
Depression (range = 1–4) 1.76 1.68 1.83
Anxiety (range = 1–4) 1.64 1.51 1.75
Loneliness (range = 1–5) 1.99 1.87 2.11
Sexual identity
Exclusively heterosexual 2,004 96.55% 1,039 97.82% 962 95.88%
Exclusively gay/lesbian 730 1.01% 487 1.23% 234 .79%
Bisexual + pan, omni, queer 475 1.17% 117 .33% 315 1.81%
Another/multiple sexual
identities
409 1.27% 125 .61% 212 1.52%
Family support (range = 1–5) 3.35 3.17 3.52
Friend support (range = 1–5) 2.98 2.71 3.25
Partner support (range =1–5) 4.07 4.01 4.14
Race
NH White 2,139 56.01% 1,005 55.02% 1,037 56.86%
NH Black 307 7.34% 149 6.99% 153 7.67%
NH Asian 201 6.62% 126 7.92% 73 5.40%
Hispanic 574 21.77% 278 19.97% 287 23.61%
NH multirace 199 3.40% 98 3.68% 93 3.12%
Another racial/ethnic identity 198 4.86% 112 6.41% 80 3.34%
Age (range = 20–60) 43.12 43.59 42.71
Education
High school or less 639 31.23% 340 31.38% 287 31.13%
Some college 702 22.13% 384 26.64% 283 17.71%
College degree 2,284 46.65% 1,044 41.98% 1,153 51.16%
Marital status
Married 2,663 80.69% 487 80.69% 1,307 80.92%
Cohabiting 955 19.31% 1,281 19.31% 416 19.08%
Parenthood status
Don’t have children 2,680 69.25% 1,322 69.86% 1,244 68.53%
Have children 940 30.75% 446 30.14% 479 31.47%
Aggressions (range = 0–41) 13.15 13.36 12.93
COVID-19 stress (range = 3–20) 10.52 9.72 11.27
Source: National Couples’ Health and Time Study.
Note: COVID-19 = coronavirus disease 2019; NH = non-Hispanic.
8 Socius: Sociological Research for a Dynamic World
and loneliness, 2.11 (range = 1–5). Of the cisgender women,
when weighted, 95.88 percent (n = 962) identified as exclu-
sively heterosexual, 0.79 percent (n = 234) as exclusively gay
or lesbian, 1.81 percent (n = 315) as bisexual (plus pansexual,
omnisexual, and queer), and 1.52 percent (n = 212) with
another or multiple sexual identities. The weighted mean
levels for the support variables were as follows: family sup-
port, 3.52 (range = 1–5); friend support, 3.25 (range = 1–5);
and partner support, 4.14 (range = 1–5). Regarding race,
56.86 percent (n = 1,037) of the cisgender women in this sam-
ple identified as non-Hispanic White, 7.67 percent (n = 153)
as non-Hispanic Black, 5.40 percent (n = 73) as non-Hispanic
Asian, 23.61 percent (n = 287) as Hispanic, 3.12 percent
(n = 93) as non-Hispanic multiracial, and 3.34 percent (n = 80)
as another racial/ethnic identity. The mean age of cisgender
women was 42.71 years. More than half (51.16 percent
[n = 1,153]) of cisgender women in this sample had a college
degree or higher, with 31.13 percent (n = 287) having less
than or equal to a high school degree and 17.71 percent
(n = 283) having some college education. The majority
(80.92 percent [n = 1,037]) of cisgender women in this sam-
ple were married, the remaining 19.08 percent (n = 416) were
cohabiting. Fewer than one third (31.47 percent [n = 479]) of
the cisgender women in the sample had children, and the
remaining 68.53 percent (n = 1,244) did not. Last, the
weighted mean levels for the other covariates for cisgender
women were as follows: aggressions, 12.93 (range = 0–41)
and COVID-19 stress, 11.27 (range = 3–20).
Table 3 presents the multivariable regression results for
partnered cisgender women. Among cisgender women, gay/
lesbian and heterosexual women shared similar levels of
depression, anxiety, and loneliness. Cisgender women who
identified as bisexual or “another” or multiple sexual identi-
ties reported significantly higher depression, anxiety, and
loneliness levels than their heterosexual counterparts in the
initial model.
The emotional support indicators did not explain the sex-
ual identity disparities in mental health outcomes. For part-
nered cisgender women, family and partner support were
significantly negatively associated with depression and anxi-
ety, but only friend and partner support were associated with
loneliness. Mediation analyses indicated that relative to het-
erosexual cisgender women, sexual minoritized identities
were indirectly associated with depression, anxiety, and
loneliness through family support (lesbian women depres-
sion 95 percent CI = 0.018 to 0.055, anxiety 95 percent
CI = 0.016 to 0.061, and loneliness 95 percent CI = 0.014 to
0.064; bisexual women depression 95 percent CI = 0.017 to
Table 2. Ordinary Least Squares Models Regressing Support Types and Mental Health for Cisgender Men (n = 1,768).
Depression Anxiety Loneliness
Variable Baseline
Baseline +
Support Full Baseline
Baseline +
Support Full Baseline
Baseline +
Support Full
Sexual identity (reference: heterosexual)
Exclusively gay/lesbian .122* .096 .061 .183*** .161** .131* .199** .161* .086
Bisexual + pan, omni, queer .262** .229* .157 .293** .267** .210* .400*** .346** .217
Another .187* .144 .022 .196 .167 .016 .288 .195 .058
Family support −.055** −.050** −.060** −.057** −.034 −.033
Friend support .024 .024 .016 .020 .053 .050
Partner support −.046* −.045* .006 .055 −.216*** −.203***
Race (reference: NH White)
NH Black −.191*** −.235*** −.225*
NH Asian .013 .025 −.007
Hispanic −.046 −.008 −.071
NH multirace .117 .058 .114
Another racial/ethnic identity .008 −.047 −.013
Age −.005** −.006** −.002
Education (reference: HS or less)
Some college −.013 −.082 .057
College degree −.018 −.060 .188*
Married −.069 −.016 −.139
Have children (reference: don’t
have children)
−.003 −.005 −.042
Aggressions .038*** .042*** .058***
COVID-19 stress .029*** .038*** .027***
Source: National Couples’ Health and Time Study.
Note: COVID-19 = coronavirus disease 2019; HS = high school; NH = non-Hispanic.
*p .05. **p .01. ***p .001.
Gustafson et al. 9
0.054, anxiety 95 percent CI = 0.015 to 0.059, and loneliness
95 percent CI = 0.013 to 0.062; another/multiple sexual iden-
tities depression 95 percent CI = 0.019 to 0.060, anxiety
95 percent CI = 0.018 to 0.066, and loneliness 95 percent
CI = 0.014 to 0.068). Additionally for cisgender women, the
association between sexual minoritized identities and depres-
sion and loneliness were indirectly influenced via partner
support, but anxiety was not (lesbian women depression
95 percent CI = −0.048 to −0.014 and loneliness 95 percent
CI = −0.124 to −0.050; bisexual women depression 95 per-
cent CI = −0.041 to −0.010 and loneliness 95 percent
CI = −0.124 to −0.050; another/multiple sexual identities
depression 95 percent CI = −0.038 to −0.008 and anxiety
95 percent CI = −0.105 to −0.025). Last, all mental health
outcomes for women who identified as bisexual and another
or multiple sexual identities were indirectly influenced by
friend support (bisexual women depression 95 percent
CI = −0.018 to −0.001, anxiety 95 percent CI = −0.023 to
−0.001, and loneliness 95 percent CI = −0.028 to −0.003;
another/multiple sexual identities depression 95 percent
CI = −0.016 to −0.000, anxiety 95 percent CI = −0.020 to
−0.000, and loneliness 95 percent CI = −0.027 to −0.002).
After the addition of the sociodemographic indicators, the
disparity in anxiety and loneliness between cisgender women
reporting another or multiple sexual identities and cisgender
women with heterosexual identities was explained, but the
disparity in depressive symptoms remained. In our formal
mediation analysis, all three mental health outcomes for part-
nered cisgender women of all sexual minoritized identities
were indirectly associated with family support (lesbian
women depression 95 percent CI = 0.015 to 0.048, anxiety
95 percent CI = 0.009 to 0.051, and loneliness 95 percent
CI = 0.004 to 0.053; bisexual women depression 95 percent
CI = 0.009 to 0.037, anxiety 95 percent CI = 0.007 to 0.041,
and loneliness 95 percent CI = 0.003 to 0.040; another/multi-
ple sexual identities depression 95 percent CI = 0.012 to
0.046, anxiety 95 percent CI = 0.009 to 0.045, and loneliness
95 percent CI = 0.003 to 0.049). Additionally, women of all
sexual minoritized identities were indirectly associated with
depression and loneliness through partner support (lesbian
women depression 95 percent CI = −0.046 to −0.012 and
loneliness 95 percent CI = −0.120 to −0.043; bisexual women
depression 95 percent CI = −0.030 to −0.003 and loneliness
95 percent CI = −0.077 to −0.004; another/multiple sexual
Table 3. Ordinary Least Squares Models Regressing Support Types and Mental Health for Cisgender Women (n = 1,723).
Depression Anxiety Loneliness
Variable Baseline
Baseline +
Support Full Baseline
Baseline +
Support Full Baseline
Baseline +
Support Full
Sexual identity (reference: heterosexual)
Exclusively gay/lesbian .042 .026 −.029 .095 .043 .009 −.004 .029 −.010
Bisexual + pan, omni, queer .535*** .502*** .349*** .562*** .513*** .343*** .683*** .668*** .500***
Another .397*** .346*** .198** .330*** .264** .090 .308** .263* .080
Family support −.060** −.037* −.098*** −.070** −.019 .015
Friend support −.027 −.025 −.024 −.019 −.063* −.068*
Partner support −.098*** −.097*** −.010 −.016 −.268*** −.271***
Race (reference NH White)
NH Black −.230*** −.380*** −.261*
NH Asian −.013 −.267* −.126
Hispanic −.111 −.112 −.145
NH multirace −.123 −.205 .052
Another racial/ethnic
identity
−.105 −.116 −.266*
Age −.006** −.009** −.011**
Education (reference: HS
or less)
Some college .090 .047 .058
College degree .005 −.017 .134
Married .018 .030 .107
Have children (reference:
don’t have children)
−.060 −.097 −.072
Aggressions .038*** .052*** .057***
COVID-19 stress .040*** .047*** .042***
Source: National Couples’ Health and Time Study.
Note: COVID-19 = coronavirus disease 2019; HS = high school; NH = non-Hispanic.
*p .05. **p .01. ***p .001.
10 Socius: Sociological Research for a Dynamic World
identities depression 95 percent CI = −0.027 to −0.001 and
loneliness 95 percent CI = −0.074 to −0.001). Last, the asso-
ciation between bisexuality and loneliness operated indi-
rectly through friend support (95 percent CI = −0.022 to
−0.000) and friend support was not indirectly related to men-
tal health for other minoritized sexual identities.
The final model showed how the other covariates were
associated with mental health outcomes for partnered
women. The disparities between bisexual and heterosexual
cisgender women remained significant and positive in every
model for each of the mental health outcomes. Regarding the
sociodemographic covariates, non-Hispanic Black cisgender
women had lower levels of depression, anxiety, and loneli-
ness compared with non-Hispanic White cisgender women.
Non-Hispanic Asian cisgender women had lower levels of
anxiety, and cisgender women with another racial/ethnic
identity had lower levels of loneliness than non-Hispanic
White cisgender women. Age was negatively associated with
all three mental health outcomes for cisgender women. We
found that experience with aggressions and COVID-19 stress
were positively associated with all three mental health out-
comes. Additional analyses indicated that COVID-19 stress
operated similarly for each sexual identity.
Discussion
Consistent with prior work there were distinct gender differ-
ences in mental health and emotional support. Stratifying the
sample between partnered cisgender men and cisgender
women allowed us to examine how emotional support shaped
associations between mental health outcomes and sexual
identity. Our findings parallel prior work that showed women
reported higher levels of negative mental health outcomes
but received more emotional support than men. However,
among both men and women emotional support was associ-
ated with improved mental health. Family support was most
consistently significantly associated with lower levels of
depression, anxiety, and loneliness. Friend support was only
related to lower levels of loneliness among women. Partner
support was directly associated with lower levels of depres-
sion and loneliness for partnered cisgender men and women,
but not anxiety.
A contribution of our work is a focus on individuals with
a range of sexual identities. MST suggests that individuals
with marginalized identities face unique stressors as a result
of their stigmatized identity. The initial models stratified by
gender provided support for MST as those with sexual
minoritized identities generally had higher levels of depres-
sion, anxiety and loneliness. The stress process framework
posits that increased stress may lead to adverse outcomes,
and these outcomes may be mitigated by buffers or coping
resources. We found for gay, cisgender men, and men with
another or multiple identities that emotional support,
specifically family and partner support, served as a buffer to
two mental health outcomes: depression and loneliness. In
contrast, these framework’s suppositions did not hold for
partnered cisgender women identifying as bisexual (plus
pansexual, omnisexual, and queer) as their lower mental
health persisted across models, thus resulting in partial sup-
port for the stress process framework. Partnered lesbian
women reported levels of depression, anxiety and loneliness
on par with heterosexual women. Among both cisgender
women and men, experiences with aggressions and COVID-
19 stress were associated with negative mental health out-
comes. This suggests that the individuals who struggled with
COVID-19 stress the most during the pandemic and those
who experienced aggressions did not fare well.
It is notable that both bisexual men and bisexual women
had lower levels of mental health than heterosexual individu-
als, and these associations were not attenuated with the inclu-
sion of emotional support or the sociodemographic, minority
stress or COVID-19 stress measures. Individuals with bisex-
ual identities are a significant population, as they represent
about half of individuals identifying as sexual minoritized
people, and the bisexual identity is especially more common
among younger individuals (Julian, Manning, and Westrick-
Payne 2024). We found that for bisexual women there were
indirect pathways to at least one indicator of mental health
via family, partner, and friend support, but for bisexual men
the only indirect pathway was via family support to depres-
sion and anxiety. Thus, this showcases the unique ways that
bisexual identities operated for men and women and calls for
further attention to the specific and potentially unique
sources of stress and emotional support among the bisexual
population.
We found several key indirect pathways through which
minoritized sexual identities were associated with mental
health. Although in the final model there were no direct asso-
ciations between sexual identity and depression as well as
anxiety for men, there were indirect associations through
family support. These findings suggest that family support is
an important factor to consider in analysis of sexual minori-
tized men’s mental health. Among partnered cisgender les-
bian women there were no direct associations with mental
health, but there were indirect pathways through family and
partner emotional support. Bisexual women both directly
and indirectly (via friend, family, and partner support) expe-
rienced lower levels of loneliness. Women who identified as
another sexual identity indirectly experienced lower levels of
mental health through family support and lower levels of
depression and loneliness through partner support. Thus, the
pathways between emotional support and sexual identity are
important to consider among men and women but do appear
more complex for women.
Although this study makes an important contribution to
literature on sexual identity, emotional support, and mental
Gustafson et al. 11
health, it is not without limitations. One limitation of this
study is that it was cross-sectional, which hindered our abil-
ity to observe pre-pandemic effects of emotional support and
mental health outcomes by gender. Furthermore, the lack of
longitudinal data meant our analyses were restricted to asso-
ciations among the indicators. Second, only measures of
emotional support were included in this study, so the analy-
ses did not account for other forms of support such as instru-
mental and informational support. The measures of support
also were not specific to individuals with minoritized sexual
identities. Additionally, in this study we examined friends,
family, and spouses or partners as sources of support and not
sources of micro- and macro-aggressions. Third, NCHAT
included only partnered individuals so we cannot observe
emotional support and mental health linkages among unpart-
nered sexual minority people. Single individuals may have
greater demands for emotional support and are an important
population to study. Fourth, although this study was focused
primarily on internalized mental health, we acknowledge
research by Rosenfield and Mouzon (2013) indicating that
men and women manifest issues differently, with men being
more likely to externalize their mental health challenges.
Fifth, we did not consider overlapping minoritized identities
related to race/ethnicity or social class. Future research
should carefully assess how these intersecting identities are
related to emotional support and mental health. Last, this
study was limited to individuals identifying as cisgender,
excluding transgender and gender-nonconforming individu-
als. Furthermore, attention to this population is warranted as
they may face even greater threats to their mental health.
This study contributes to our understanding of how emo-
tional support may shape mental health outcomes. Although
men receive lower levels of emotional support, it appeared to
play a larger direct role in the association between sexual
identity and mental health outcomes for cisgender men than
cisgender women. Strikingly, people who identified as bisex-
ual had the lowest mental health outcomes and emotional
support did not appear to directly attenuate these disparities.
This suggests a need for further investigation for individuals
identifying as bisexual and their levels of and access to emo-
tional support. We found many indirect pathways through
which sexual identity operated, suggesting that future
research should consider the more nuanced ways that sexual
identity and mental health are linked. These findings present
a more complex portrait of sexual identity and mental health
that needs to be further developed in minority stress frame-
work. MST could be expanded to incorporate the complexi-
ties of intersecting gender and sexual identities. Furthermore,
our work confirms minority stress perspectives arguing that
emotional support is a key mechanism through which sexual
identities relate to mental health, but an important next step
is to extend the theoretical focus to variation according to
specific sexual and gender identities, sources of support, and
mental health outcomes. Net of the emotional support
indicators and other covariates, aggressions and COVID-19
stress were crucial factors when examining mental health
outcomes by sexual and gender identity. Future research
should take these into account, as well as include individuals
who do not identify as cisgender for a more diverse under-
standing of mental health and gender identity. As growing
shares of the population possess more complex gender and
sexual identities, these questions will be increasingly impor-
tant. Emotional support is vital for mental health, and not all
individuals have equal access to support from their families,
partners, and friends.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
NCHAT is funded by the Eunice Kennedy Shriver National Institute
of Child Health and Human Development of the National Institutes
of Health (grant 1R01HD094081-01A1). This project benefited
from support provided by P2C infrastructure grants from the Eunice
Kennedy Shriver Eunice Kennedy Shriver National Institute of
Child Health and Human Development to the Minnesota Population
Center (grant P2CHD041023), the Center for Family and
Demographic Research (grant P2CHD050959), and The Ohio State
University Institute for Population Research (grant P2CHD058484).
ORCID iDs
Kristen E. Gustafson https://orcid.org/0000-0003-0336-235X
Wendy D. Manning https://orcid.org/0000-0002-8063-7380
References
Afifi, Mustafa. 2007. “Gender Differences in Mental Health.”
Singapore Medical Journal 48:385–91.
Alexander, Jeanne Leventhal. 2007. “Quest for Timely Detection
and Treatment of Women with Depression.” Journal of
Managed Care Pharmacy 13(9 Suppl. A):3–11.
Almeida, Joanna, Renee M. Johnson, Heather L. Corliss, Beth E.
Molnar, and Deborah Azrael. 2009. “Emotional Distress among
LGBT Youth: The Influence of Perceived Discrimination Based
on Sexual Orientation.” Journal of Youth and Adolescence
38(7):1001–14.
Almeida, Marcela, Angela D. Shrestha, Danijela Stojanac, and
Laura J. Miller. 2020. “The Impact of the COVID-19 Pandemic
on Women’s Mental Health.” Archives of Women’s Mental
Health 23(6):741–48.
Aneshensel, Carol S., Carolyn M. Rutter, and Peter A. Lachenbruch.
1991. “Social Structure, Stress, and Mental Health: Competing
Conceptual and Analytic Models.” American Sociological
Review 56(2):166–78.
Antonucci, Toni C., and Hiroko Akiyama. 1987. “An Examination
of Sex Differences in Social Support among Older Men and
Women.” Sex Roles 17(11):737–49.
Asher, Maya, and Idan M. Aderka. 2018. “Gender Differences
in Social Anxiety Disorder.” Journal of Clinical Psychology
74(10):1730–41.
12 Socius: Sociological Research for a Dynamic World
Balsam, Kimberly F., Yamile Molina, Blair Beadnell, Jane
Simoni, and Karina Walters. 2011. “Measuring Multiple
Minority Stress: The LGBT People of Color Microaggressions
Scale.” Cultural Diversity and Ethnic Minority Psychology
17(2):163–74.
Barnett, Michael D., Idalia V. Maciel, Dylan M. Johnson, and Ilona
Ciepluch. 2021. “Social Anxiety and Perceived Social Support:
Gender Differences and the Mediating Role of Communication
Styles.” Psychological Reports 124(1):70–87.
Baron, Reuben M., and David A. Kenny. 1986. “The Moderator-
Mediator Variable Distinction in Social Psychological Research:
Conceptual, Strategic, and Statistical Considerations.” Journal
of Personality and Social Psychology 51(6):1173–82.
Barreto, Manuela, Christina Victor, Claudia Hammond, Alice Eccles,
Matt T. Richins, and Pamela Qualter. 2021. “Loneliness around
the World: Age, Gender, and Cultural Differences in Loneliness.”
Personality and Individual Differences 169:110066.
Björkenstam, Charlotte, Emma Björkenstam, Gunnar Andersson,
Susan Cochran, and Kyriaki Kosidou. 2017. “Anxiety and
Depression among Sexual Minority Women and Men in
Sweden: Is the Risk Equally Spread within the Sexual Minority
Population?” Journal of Sexual Medicine 14(3):396–403.
Blair, Karen L., and Caroline F. Pukall. 2015. “Family Matters, but
Sometimes Chosen Family Matters More: Perceived Social
Network Influence in the Dating Decisions of Same- and
Mixed-Sex Couples.” Canadian Journal of Human Sexuality
24(3):257–70.
Borgogna, Nicholas C., Ryon C. McDermott, Stephen L. Aita, and
Matthew M. Kridel. 2019. “Anxiety and Depression across
Gender and Sexual Minorities: Implications for Transgender,
Gender Nonconforming, Pansexual, Demisexual, Asexual,
Queer, and Questioning Individuals.” Psychology of Sexual
Orientation and Gender Diversity 6(1):54–63.
Borstelmann, Nancy A., Shoshana Rosenberg, Shari Gelber, Yue
Zheng, Meghan Meyer, Kathryn J. Ruddy, and Lidia Schapira,
et al. 2020. “Partners of Young Breast Cancer Survivors: A
Cross-Sectional Evaluation of Psychosocial Concerns, Coping,
and Mental Health.” Journal of Psychosocial Oncology
38(6):670–86.
Bostwick, Wendy B., Carol J. Boyd, Tonda L. Hughes, and Sean
Esteban McCabe. 2010. “Dimensions of Sexual Orientation
and the Prevalence of Mood and Anxiety Disorders in
the United States.” American Journal of Public Health
100(3):468–75.
Botticello, Amanda L. 2009. “A Multilevel Analysis of Gender
Differences in Psychological Distress over Time.” Journal of
Research on Adolescence 19(2):217–47.
Bouris, Alida, Vincent Guilamo-Ramos, Angela Pickard, Chengshi
Shiu, Penny S. Loosier, Patricia Dittus, and Kari Gloppen,
et al. 2010. “A Systematic Review of Parental Influences on the
Health and Well-Being of Lesbian, Gay, and Bisexual Youth:
Time for a New Public Health Research and Practice Agenda.”
Journal of Primary Prevention 31(5):273–309.
Brooks, Virginia R. 1981. Minority Stress and Lesbian Women.
Lexington, MA: Lexington Books.
Brown, Susan L. 2000. “The Effect of Union Type on Psychological
Well-Being: Depression among Cohabitors versus Marrieds.”
Journal of Health and Social Behavior 41(3):241–55.
Bruce, Douglas, Gary W. Harper, and Jose A. Bauermeister.
2015. “Minority Stress, Positive Identity Development,
and Depressive Symptoms: Implications for Resilience
among Sexual Minority Male Youth.” Psychology of Sexual
Orientation and Gender Diversity 2(3):287–96.
Bruine De Bruin, Wändi, Andrew M. Parker, and JoNell Strough.
2020. “Age Differences in Reported Social Networks and
Well-Being.” Psychology and Aging 35(2):159–68.
Choi, Namkee G., and Jung-Hwa Ha. 2011. “Relationship
between Spouse/Partner Support and Depressive Symptoms
in Older Adults: Gender Difference.” Aging & Mental Health
15(3):307–17.
Clarke, Thomas James. 2012. “The Influence of Social Connections
and Social Support on Academic Achievement among LGBT
and Straight Students.” PhD dissertation, University of
Arizona, Tucson.
Cramer, Duncan. 2004. “Emotional Support, Conflict, Depression,
and Relationship Satisfaction in a Romantic Partner.” Journal
of Psychology 138(6):532–42.
Cyrus, Kali. 2017. “Multiple Minorities as Multiply Marginalized:
Applying the Minority Stress Theory to LGBTQ People of
Color.” Journal of Gay & Lesbian Mental Health 21(3):194–
202.
Dakin, Emily K., Kelly A. Williams, and Maureen A. MacNamara.
2020. “Social Support and Social Networks among LGBT
Older Adults in Rural Southern Appalachia.” Journal of
Gerontological Social Work 63(8):768–89.
Dalgard, Odd Steffen, Christopher Dowrick, Ville Lehtinen, Jose
Luis Vazquez-Barquero, Patricia Casey, Greg Wilkinson, and
Jose Luis Ayuso-Mateos, et al. 2006. “Negative Life Events,
Social Support and Gender Difference in Depression.” Social
Psychiatry and Psychiatric Epidemiology 41(6):444–51.
Davey-Rothwell, Melissa A., Jennifer Stewart, Alison Vadnais,
Sharif A. Braxton, and Carl A. Latkin. 2017. “The Role of
Partner Support among Women with Depressive Symptoms.”
Community Mental Health Journal 53(4):415–19.
DeBerard, M. Scott, Glen I. Spielmans, and Deana L. Julka. 2004.
“Predictors of Academic Achievement and Retention among
College Freshmen: A Longitudinal Study.” College Student
Journal 38(1):66–81.
Dewaele, Alexis, Nele Cox, Wim Van den Berghe, and John
Vincke. 2011. “Families of Choice? Exploring the Supportive
Networks of Lesbians, Gay Men, and Bisexuals.” Journal of
Applied Social Psychology 41(2):312–31.
Donev, Doncho. 2005. “Social Networks and Social Support as
Determinants of Health.” Pp. 531–48 in Health Determinants
in the Scope of New Public Health, edited by L. Georgieva and
G. Burazeri. Lage, Germany: Hans Jacobs.
Doty, Nathan Daniel, Brian L. B. Willoughby, Kristin M. Lindahl,
and Neena M. Malik. 2010. “Sexuality Related Social Support
among Lesbian, Gay, and Bisexual Youth.” Journal of Youth
and Adolescence 39(10):1134–47.
Dykstra, Pearl, and Tineke Fokkema. 2007. “Social and Emotional
Loneliness among Divorced and Married Men and Women:
Comparing the Deficit and Cognitive Perspectives.” Basic and
Applied Social Psychology 29(1):1–12.
Eshbaugh, Elaine M. 2010. “Friend and Family Support as
Moderators of the Effects of Low Romantic Partner Support
Gustafson et al. 13
on Loneliness among College Women.” Individual Differences
Research 8(1):8–16.
Ettman, Catherine K., Salma M. Abdalla, Gregory H. Cohen,
Laura Sampson, Patrick M. Vivier, and Sandro Galea. 2020.
“Prevalence of Depression Symptoms in US Adults before
and during the COVID-19 Pandemic.” JAMA Network Open
3(9):e2019686.
Frost, David M., Keren Lehavot, and Ilan H. Meyer. 2015.
“Minority Stress and Physical Health among Sexual Minority
Individuals.” Journal of Behavioral Medicine 38(1):1–8.
Frost, David M., Ilan H. Meyer, and Sharon Schwartz. 2016.
“Social Support Networks among Diverse Sexual Minority
Populations.” American Journal of Orthopsychiatry 86(1):91–
102.
Gillespie, Brian Joseph, David Frederick, Lexi Harari, and
Christian Grov. 2015. “Homophily, Close Friendship, and Life
Satisfaction among Gay, Lesbian, Heterosexual, and Bisexual
Men and Women.” PLoS One 10(6):e0128900.
Goldbach, Chloe, Douglas Knutson, and David Cole Milton.
2021. “LGBTQ+ People and COVID-19: The Importance
of Resilience during a Pandemic.” Psychology of Sexual
Orientation and Gender Diversity 8(2):123–32.
Gustafson, Kristen E., Wendy D. Manning, and Claire M. Kamp
Dush. 2023. “Emotional Support among Partnered Sexual
Minority and Heterosexual Individuals during the COVID-19
Pandemic.” Social Science Research 114:102910.
Hatzenbuehler, Mark L., Katie A. McLaughlin, and Ziming Xuan.
2012. “Social Networks and Risk for Depressive Symptoms in
a National Sample of Sexual Minority Youth.” Social Science
& Medicine 75(7):1184–91.
Hawes, Mariah T., Aline K. Szenczy, Daniel N. Klein, Greg
Hajcak, and Brady D. Nelson. 2022. “Increases in Depression
and Anxiety Symptoms in Adolescents and Young Adults
during the COVID-19 Pandemic.” Psychological Medicine
52(14):3222–30.
Hayes, Andrew F., and Kristopher J. Preacher. 2014. “Statistical
Mediation Analysis with a Multicategorical Independent
Variable.” British Journal of Mathematical and Statistical
Psychology 67(3):451–70.
Heaney, Catherine A., and Barbara A. Israel. 2008. “Social
Networks and Social Support.” Pp. 189–210 in Health Behavior
and Health Education: Theory, Research, and Practice, edited
by K. Glanz, B. K. Rimer, and K. Viswanath. San Francisco,
CA: Jossey-Bass.
Henning-Smith, Carrie, Alexandra Ecklund, Ira Moscovice, and
Katy Kozhimannil. 2018. “Gender Differences in Social
Isolation and Social Support among Rural Residents.”
University of Minnesota Rural Health Research Center Policy
Brief. Retrieved April 17, 2024. https://rhrc.umn.edu/wp-con-
tent/files_mf/1532458325UMNpolicybriefsocialisolationgend
erdifferences.pdf.
House, James S. 1987. “Social Support and Social Structure.”
Sociological Forum 2(1):135–46.
Hoy-Ellis, Charles P. 2023. “Minority Stress and Mental Health:
A Review of the Literature.” Journal of Homosexuality
70(5):806–30.
Hsieh, Ning, and Jaclyn S. Wong. 2020. “Social Networks in Later
Life: Similarities and Differences between Sexual-Minority
and Heterosexual Older Adults.” Socius.
Hughes, Mary Elizabeth, Linda J. Waite, Louise C. Hawkley,
and John T. Cacioppo. 2004. “A Short Scale for Measuring
Loneliness in Large Surveys: Results From Two Population-
Based Studies.” Research on Aging 26(6):655–72.
Jorm, Anthony F., Ailsa E. Korten, Bryan Rodgers, Patricia A.
Jacomb, and Helen Christensen. 2002. “Sexual Orientation and
Mental Health: Results from a Community Survey of Young
and Middle-Aged Adults.” British Journal of Psychiatry
180(5):423–27.
Julian, Christopher A., Wendy D. Manning, and Krista K.
Westrick-Payne. 2024. “Responses to Sexual and Gender
Identity Measures in Population-Level Data by Birth Cohort:
A Research Note.” Demography 61(1):15–30.
Kamp Dush, Claire M., Wendy D. Manning, Miranda N. Berrigan,
and Rachel R. Hardeman. 2022. “Stress and Mental Health: A
Focus on COVID-19 and Racial Trauma Stress.” RSF: The Russell
Sage Foundation Journal of the Social Sciences 8(8):104–34.
Kamp Dush, Claire M., Wendy D. Manning, Miranda N. Berrigan,
Jenny Marlar, Alexandra VanBergen, Angelina Theodorou,
and Dato Tsabutashvili, et al. 2023. “National Couples’ Health
and Time Study: Sample, Design, and Weighting.” Population
Research and Policy Review 42(4):62.
Kelleher, Cathy. 2009. “Minority Stress and Health: Implications
for Lesbian, Gay, Bisexual, Transgender, and Questioning
(LGBTQ) Young People.” Counselling Psychology Quarterly
22(4):373–79.
Kendler, Kenneth S., John Myers, and Carol A. Prescott. 2005.
“Sex Differences in the Relationship between Social Support
and Risk for Major Depression: A Longitudinal Study of
Opposite-Sex Twin Pairs.” American Journal of Psychiatry
162(2):250–56.
Kessler, Ronald C., Shelli Avenevoli, E. Jane Costello, Katholiki
Georgiades, Jennifer Greif Green, Michael J. Gruber, and
Jian-ping He, et al. 2012. “Prevalence, Persistence, and
Sociodemographic Correlates of DSM-IV Disorders in
the National Comorbidity Survey Replication Adolescent
Supplement.” Archives of General Psychiatry 69(4):372–80.
King, Michael, Eamonn Mckeown, James Warner, Angus Ramsay,
Katherine Johnson, Clive Cort, and Lucie Wright, et al.
2003. “Mental Health and Quality of Life of Gay Men and
Lesbians in England and Wales.” British Journal of Psychiatry
183(6):552–58.
Kneavel, Meredith. 2021. “Relationship between Gender, Stress,
and Quality of Social Support.” Psychological Reports
124(4):1481–1501.
Kornblith, Alice B., James E. II Herndon, Enid Zuckerman,
Catherine M. Viscoli, Ralph I. Horwitz, M. Robert Cooper, and
Lyndsay Harris, et al. 2001. “Social Support as a Buffer to the
Psychological Impact of Stressful Life Events in Women with
Breast Cancer.” Cancer 91(2):443–54.
Lal, Arpita, and Suzanne Bartle-Haring. 2011. “Relationship
among Differentiation of Self, Relationship Satisfaction,
Partner Support, and Depression in Patients with Chronic Lung
Disease and Their Partners.” Journal of Marital and Family
Therapy 37(2):169–81.
Leach, Liana, and P. Butterworth. 2020. “Depression and Anxiety
in Early Adulthood: Consequences for Finding a Partner,
and Relationship Support and Conflict.” Epidemiology and
Psychiatric Sciences 29(e141): 1–9.
Lee, Chih-Yuan Steven, and Sara E. Goldstein. 2016. “Loneliness,
Stress, and Social Support in Young Adulthood: Does the
Source of Support Matter?” Journal of Youth and Adolescence
45(3):568–80.
14 Socius: Sociological Research for a Dynamic World
Li, Gu, Amanda M. Pollitt, and Stephen T. Russell. 2016.
“Depression and Sexual Orientation during Young Adulthood:
Diversity among Sexual Minority Subgroups and the Role
of Gender Nonconformity.” Archives of Sexual Behavior
45(3):697–711.
Lucassen, Mathijs F. G., Karolina Stasiak, Rajvinder Samra,
Christopher M. A. Frampton, and Sally N. Merry. 2017.
“Sexual Minority Youth and Depressive Symptoms or
Depressive Disorder: A Systematic Review and Meta-analysis
of Population-Based Studies.” Australian & New Zealand
Journal of Psychiatry 51(8):774–87.
Manning, Wendy D., and Claire M. Kamp Dush. 2022.
“COVID-19 Stress and Sexual Identities.” Socius.
doi:10.1177/23780231221105376.
Marcussen, Kristen. 2005. “Explaining Differences in Mental
Health between Married and Cohabiting Individuals.” Social
Psychology Quarterly 68(3):239–57.
Marshal, Michael P., Laura J. Dietz, Mark S. Friedman, Ron Stall,
Helen A. Smith, James McGinley, and Brian C. Thoma, et al.
2011. “Suicidality and Depression Disparities between Sexual
Minority and Heterosexual Youth: A Meta-analytic Review.”
Journal of Adolescent Health 49(2):115–23.
Matud, M. Pilar, M. Concepción García, and Demelza Fortes. 2019.
“Relevance of Gender and Social Support in Self-Rated Health
and Life Satisfaction in Elderly Spanish People.” International
Journal of Environmental Research and Public Health
16(15):2725.
McConnell, Elizabeth A., Michelle Birkett, and Brian Mustanski.
2016. “Families Matter: Social Support and Mental Health
Trajectories among Lesbian, Gay, Bisexual, and Transgender
Youth.” Journal of Adolescent Health 59(6):674–80.
McLean, Caitlin L., Gage M. Chu, Melissa M. Karnaze, Cinnamon
S. Bloss, and Ariel J. Lang. 2022. “Social Support Coping
Styles and Psychological Distress during the COVID-19
Pandemic: The Moderating Role of Sex.” Journal of Affective
Disorders 308:106–10.
Meyer, Ilan H. 1995. “Minority Stress and Mental Health in Gay
Men.” Journal of Health and Social Behavior 36(1):38–56.
Meyer, Ilan H. 2003. “Prejudice, Social Stress, and Mental Health in
Lesbian, Gay, and Bisexual Populations: Conceptual Issues and
Research Evidence.” Psychological Bulletin 129(5):674–97.
Meyer, Ilan H., David M. Frost, Phillip L. Hammack, Marguerita
A. Lightfoot, Stephen T. Russell, and Bianca D. M. Wilson.
2016. “Generations Study Baseline Questionnaire and Measure
Sources.”
Mirowsky, John, and Catherine E. Ross. 1995. “Sex Differences
in Distress: Real or Artifact?” American Sociological Review
60(3):449–68.
Misri, Shaila, Xanthoula Kostaras, Don Fox, and Demetra Kostaras.
2000. “The Impact of Partner Support in the Treatment of
Postpartum Depression.” Canadian Journal of Psychiatry
45(6):554–58.
Mongelli, Francesca, Daniela Perrone, Jessica Balducci, Andrea
Sacchetti, Silvia Ferrari, Giorgio Mattei, and Gian M.
Galeazzi. 2019. “Minority Stress and Mental Health among
LGBT Populations: An Update on the Evidence.” Minerva
Psichiatrica 60(1).
Moore, Scott Emory, Kelly L. Wierenga, Dana M. Prince, Braveheart
Gillani, and Laura Janine Mintz. 2021. “Disproportionate
Impact of the COVID-19 Pandemic on Perceived Social
Support, Mental Health and Somatic Symptoms in Sexual
and Gender Minority Populations.” Journal of Homosexuality
68(4):577–91.
Munro, Lauren, Robb Travers, and Michael R. Woodford.
2019. “Overlooked and Invisible: Everyday Experiences
of Microaggressions for LGBTQ Adolescents.” Journal of
Homosexuality 66(10):1439–71.
Needham, Belinda L., and Erika L. Austin. 2010. “Sexual
Orientation, Parental Support, and Health during the Transition
to Young Adulthood.” Journal of Youth and Adolescence
39(10):1189–98.
Newcomb, Michael E., Adrienne J. Heinz, and Brian Mustanski.
2015. “Examining Risk and Protective Factors for Alcohol
Use in Lesbian, Gay, Bisexual, and Transgender Youth: A
Longitudinal Multilevel Analysis.” Journal of Studies on
Alcohol and Drugs 73(5):783–93.
Nolen-Hoeksema, Susan. 2001. “Gender Differences in
Depression.” Current Directions in Psychological Science
10(5):173–76.
Padilla, Y. C., C. Crisp, and D. L. Rew. 2010. “Parental Acceptance
and Illegal Drug Use among Gay, Lesbian, and Bisexual
Adolescents: Results from a National Survey.” Social Work
55(3):265–75.
Pakula, Basia, Jean Shoveller, Pamela A. Ratner, and Richard
Carpiano. 2016. “Prevalence and Co-occurrence of Heavy
Drinking and Anxiety and Mood Disorders among Gay,
Lesbian, Bisexual, and Heterosexual Canadians.” American
Journal of Public Health 106(6):1042–48.
Park, Crystal L., Beth S. Russell, Michael Fendrich, Lucy
Finkelstein-Fox, Morica Hutchison, and Jessica Becker. 2020.
“Americans’ COVID-19 Stress, Coping, and Adherence to
CDC Guidelines.” Journal of General Internal Medicine
35(8):2296–2303.
Pearlin, Leonard I. 1999. “The Stress Process Revisited.” Pp. 395–
415 in Handbook of the Sociology of Mental Health, edited by
Aneshensel, C. S., and J. C. Phelan. Boston: Springer.
Pearlin, Leonard I., Elizabeth G. Menaghan, Morton A. Lieberman,
and Joseph T. Mullan. 1981. “The Stress Process.” Journal of
Health and Social Behavior 22(4):337–56.
Peleg, Alona, and Tova Hartman. 2019. “Minority Stress in an
Improved Social Environment: Lesbian Mothers and the
Burden of Proof.” Journal of GLBT Family Studies 15(5):442–
60.
Plöderl, Martin, and Pierre Tremblay. 2015. “Mental Health of
Sexual Minorities. A Systematic Review.” International
Review of Psychiatry 27:1–19.
Procidano, Mary E., and Kenneth Heller. 1983. “Measures of
Perceived Social Support from Friends and from Family:
Three Validation Studies.” American Journal of Community
Psychology 11(1):1–24.
Prowse, Rebecca, Frances Sherratt, Alfonso Abizaid, Robert L.
Gabrys, Kim G. C. Hellemans, Zachary R. Patterson, and
Robyn J. McQuaid. 2021. “Coping with the COVID-19
Pandemic: Examining Gender Differences in Stress and Mental
Health among University Students.” Frontiers in Psychiatry
12:650759.
Puckett, Jae A., Emmie Matsuno, Christina Dyar, Brian Mustanski,
and Michael E. Newcomb. 2019. “Mental Health and Resilience
Gustafson et al. 15
in Transgender Individuals: What Type of Support Makes a
Difference?” Journal of Family Psychology 33(8):954–64.
Ramirez, Johanna L., and M. Paz Galupo. 2019. “Multiple Minority
Stress: The Role of Proximal and Distal Stress on Mental Health
Outcomes among Lesbian, Gay, and Bisexual People of Color.”
Journal of Gay & Lesbian Mental Health 23(2):145–67.
Raposa, Elizabeth B., Constance L. Hammen, Frances O’Callaghan,
Patricia A. Brennan, and Jake M. Najman. 2013. “Early
Adversity and Health Outcomes in Young Adulthood: The
Role of Ongoing Stress.” Health Psychology 33(5):410–18.
Riecher-Rössler, Anita. 2017. “Sex and Gender Differences in
Mental Disorders.” Lancet Psychiatry 4(1):8–9.
Roberts, Leah Marion, and Brian D. Christens. 2021. “Pathways to
Well-Being among LGBT Adults: Sociopolitical Involvement,
Family Support, Outness, and Community Connectedness
with Race/Ethnicity as a Moderator.” American Journal of
Community Psychology 67(3–4):405–18.
Rokach, Ami. 2018. “The Effect of Gender and Culture on
Loneliness: A Mini Review.” Emerging Science Journal
2(2):59–64.
Rosenfield, Sarah, and Dawne Mouzon. 2013. “Gender and Mental
Health.” Pp. 277–96 in Handbook of the Sociology of Mental
Health, edited by C. S. Aneshensel, J. C. Phelan, and A.
Bierman. Dordrecht, the Netherlands: Springer.
Ross, Lori E., Travis Salway, Lesley A. Tarasoff, Jenna M. MacKay,
Blake W. Hawkins, and Charles P. Fehr. 2018. “Prevalence of
Depression and Anxiety among Bisexual People Compared
to Gay, Lesbian, and Heterosexual Individuals: A Systematic
Review and Meta-analysis.” Journal of Sex Research 55(4–
5):435–56.
Rueger, Sandra Yu, Christine Kerres Malecki, and Michelle
Kilpatrick Demaray. 2008. “Gender Differences in the
Relationship between Perceived Social Support and Student
Adjustment during Early Adolescence.” School Psychology
Quarterly 23(4):496–514.
Rueger, Sandra Yu, Christine Kerres Malecki, and Michelle
Kilpatrick Demaray. 2010. “Relationship between Multiple
Sources of Perceived Social Support and Psychological and
Academic Adjustment in Early Adolescence: Comparisons
across Gender.” Journal of Youth and Adolescence
39(1):47–61.
Safren, Steven A., and Richard G. Heimberg. 1999. “Depression,
Hopelessness, Suicidality, and Related Factors in Sexual
Minority and Heterosexual Adolescents.” Journal of Consulting
and Clinical Psychology 67(6):859–66.
Salerno, John P., Long Doan, Liana C. Sayer, Kelsey J.
Drotning, R. Gordon Rinderknecht, and Jessica N. Fish.
2023. “Changes in Mental Health and Well-Being Are
Associated with Living Arrangements with Parents dur-
ing COVID-19 among Sexual Minority Young Persons in
the U.S.” Psychology of Sexual Orientation and Gender
Diversity 10(1):150–56.
Samandari, Ghazaleh, Ilene S. Speizer, and Kathryn O’Connell.
2010. “The Role of Social Support and Parity in Contraceptive
Use in Cambodia.” International Perspectives on Sexual and
Reproductive Health 36(3):122–31.
Shiu, Chengshi, Anna Muraco, and Karen Fredriksen-Goldsen.
2016. “Invisible Care: Friend and Partner Care among Older
Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults.”
Journal of the Society for Social Work and Research 7(3):527–
46. doi:10.1086/687325.
Stacey, Lawrence, Rin Reczek, and R. Spiker. 2022. “Toward a
Holistic Demographic Profile of Sexual and Gender Minority
Well-Being.” Demography 59(4):1403–30.
Stapleton, Lynlee R. Tanner, Christine Dunkel Schetter, Erika
Westling, Christine Rini, Laura M. Glynn, Calvin J. Hobel,
and Curt A. Sandman. 2012. “Perceived Partner Support in
Pregnancy Predicts Lower Maternal and Infant Distress.”
Journal of Family Psychology 26(3):453–63.
Stronge, Samantha, Nickola C. Overall, and Chris G. Sibley. 2019.
“Gender Differences in the Associations between Relationship
Status, Social Support, and Wellbeing.” Journal of Family
Psychology 33(7):819–29.
Sutter, Megan, and Paul B. Perrin. 2016. “Discrimination, Mental
Health, and Suicidal Ideation among LGBTQ People of Color.”
Journal of Counseling Psychology 63(1):98–105.
Szkody, Erica, Melanie Stearns, Lydia Stanhope, and Cliff
McKinney. 2021. “Stress-Buffering Role of Social Support
during COVID-19.” Family Process 60(3):1002–15.
Taylor, Steven, Caeleigh A. Landry, Michelle M. Paluszek, Thomas
A. Fergus, Dean McKay, and Gordon J. G. Asmundson.
2020a. “COVID Stress Syndrome: Concept, Structure, and
Correlates.” Depression and Anxiety 37(8):706–14.
Taylor, Steven, Caeleigh A. Landry, Michelle M. Paluszek, Thomas
A. Fergus, Dean McKay, and Gordon J. G. Asmundson. 2020b.
“Development and Initial Validation of the COVID Stress
Scales.” Journal of Anxiety Disorders 72:102232.
Tebbe, Elliot A., and Bonnie Moradi. 2016. “Suicide Risk in Trans
Populations: An Application of Minority Stress Theory.”
Journal of Counseling Psychology 63(5):520–33.
Thibaut, Florence, and Patricia J. M. van Wijngaarden-Cremers.
2020. “Women’s Mental Health in the Time of COVID-19
Pandemic.” Frontiers in Global Women’s Health 1:588372.
Umberson, Debra, Zhiyong Lin, and Hyungmin Cha. 2022. “Gender
and Social Isolation across the Life Course.” Journal of Health
and Social Behavior 63(3):319–35.
Watson, Ryan J., Hilary A. Rose, Marion Doull, Jones Adjei, and
Elizabeth Saewyc. 2019. “Worsening Perceptions of Family
Connectedness and Parent Support for Lesbian, Gay, and
Bisexual Adolescents.” Journal of Child and Family Studies
28(11):3121–31.
Wheaton, Blair, Marisa Young, Shirin Montazer, and Katie Stuart-
Lahman. 2013. “Social Stress in the Twenty-First Century.”
Pp. 299–323 in Handbook of the Sociology of Mental Health,
edited by C. S. Aneshensel, J. C. Phelan, and A. Bierman.
Dordrecht, the Netherlands: Springer.
Wickens, Christine M., André J. McDonald, Tara Elton-
Marshall, Samantha Wells, Yeshambel T. Nigatu, Damian
Jankowicz, and Hayley A. Hamilton. 2021. “Loneliness in
the COVID-19 Pandemic: Associations with Age, Gender
and Their Interaction.” Journal of Psychiatric Research
136:103–108.
Wight, Richard G., Allen J. LeBlanc, Brian de Vries, and Roger
Detels. 2012. “Stress and Mental Health among Midlife and
Older Gay-Identified Men.” American Journal of Public
Health 102(3):503–10.
Williams, David R., Hector M. González, Harold Neighbors,
Randolph Nesse, Jamie M. Abelson, Julie Sweetman, and
James S. Jackson. 2007. “Prevalence and Distribution of Major
Depressive Disorder in African Americans, Caribbean Blacks,
and Non-Hispanic Whites: Results from the National Survey of
American Life.” Archives of General Psychiatry 64(3):305–15.
16 Socius: Sociological Research for a Dynamic World
Williams, David R., Yan Yu, James S. Jackson, and Norman
B. Anderson. 1997. “Racial Differences in Physical
and Mental Health: Socio-Economic Status, Stress and
Discrimination.” Journal of Health Psychology 2(3):335–51.
doi: 10.1177/135910539700200305.
Wong, Michele J., Carlos Santos, and Courtney S. Thomas Tobin.
2023. “Racial/Ethnic Differences in Social Support and Health
among Asian American and Non-Hispanic White Midlife
Women: Results from the Study of Women’s Health across the
Nation (SWAN).” Ethnicity & Health 28(2):182–99.
Zender, Robynn, and Ellen Olshansky. 2009. “Women’s Mental
Health: Depression and Anxiety.” Nursing Clinics of North
America 44(3):355–64.
Author Biographies
Kristen E. Gustafson is a PhD candidate in sociology at Bowling
Green State University studying family and social psychology, with
a particular focus on sexual and gender minority people.
Wendy D. Manning is the Dr. Howard E. Aldrich and Penny Daum
Aldrich Distinguished Professor of Sociology and codirector of the
National Center for Family and Marriage Research at Bowling
Green State University. She is a family demographer focusing on
trends in family formation, dissolution, and well-being for individu-
als identifying as sexual minority people as well as same-gender
and different-gender couples. Her research examines social rela-
tionships and the health and well-being of children, parents, and
adults in the United States. She has contributed to major data col-
lections, including the seven-wave Toledo Adolescent Relationships
Study and the two-wave NCHAT.
Claire M. Kamp Dush is a professor of sociology and the codirec-
tor of the Development Core at the Minnesota Population Center at
the University of Minnesota Twin Cities. She is a family demogra-
pher who studies intimate relationships and their intersection with
human development, with a particular focus on mental health. She
is the lead investigator or co–lead investigator of two large data col-
lection focused on intimate relationships and health: the two-wave
NCHAT and the Work and Family Life Study.
ResearchGate has not been able to resolve any citations for this publication.
Article
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In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychosocial predictors of present distress, significant differences between the 2 samples disappeared. For past suicidality scores, the effects of sexual orientation were reduced, but still significant, when accounting for the other predictor variables. These results suggest that environmental factors associated with sexual orientation, which can be targeted and changed through prevention and intervention efforts, play a major role in predicting distress in this population.
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The National Couples’ Health and Time Study (NCHAT) is the first fully powered, population-representative study of couples in America containing large samples of sexual, gender, and racial and ethnic diverse individuals. Drawn from the Gallup Panel and the Gallup Recontact Sample, when weighted, the data are population representative of individuals in the United States who (1) are married or cohabiting, (2) are between 20 and 60, (3) speak English or Spanish, and (4) have internet access. The data were collected between September 2020 and April 2021 in the midst of a global pandemic as well as racial and political upheaval. NCHAT includes surveys of 3,642 main respondents and 1,515 partners along with time diaries. We describe the sampling process, challenges weighting a diverse population-representative samples, and sociodemographic characteristics of the NCHAT study. These data will provide opportunities for new research on the health and well-being of American families.
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The coronavirus disease 2019 pandemic has disrupted lives and resulted in high levels of stress. Although the evidence at the societal level is clear, there have been no population-based studies of pandemic-based stress focusing on individuals who identify as sexual minorities. Drawing on representative data collected during the pandemic, National Couples’ Health and Time Study, the authors find that partnered (cohabiting or married) individuals who identified as sexual minorities experienced higher levels of stress than individuals who identified as heterosexual. However, variation exists observed among sexual minority adults. Although economic resources, discrimination, social and community support, and health conditions are tied to reported stress levels, they do not explain differentials according to sexual identity. These results provide evidence that sexual minority adults faced greater stress during the pandemic and the importance of recognizing that sexual minorities are not a monolithic group with varying stress responses to the pandemic.
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In the United States, COVID-19 unfolded alongside profound racial trauma. Drawing on a population representative sample of 20-60 year-olds who were married or cohabiting, the National Couples' Health and Time Study (N =3,642), we examine two specific sources of stress: COVID-19 and racial trauma. We leverage the fully powered samples of respondents with racial/ethnic and sexual minority identities and find that COVID-19 and racial trauma stress were higher among individuals who were not White or heterosexual most likely due to racism, xenophobia, and cis-heterosexism at the individual and structural levels. Both COVID-19 and racial trauma stress were associated with poorer mental health outcomes even after accounting for a rich set of potential mechanistic indicators, including discrimination and social climate. We argue that the inclusion of assessments of stress are critical for understanding health and well-being among individuals impacted by systemic and interpersonal discrimination.
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Objective: Although prior research suggests Asian Americans experience physical health advantages relative to other racial/ethnic groups, increasing evidence points to health inequalities within Asian American subgroups. Disparities are especially pronounced among middle-aged Asian American women, who remain an understudied population, despite studies showing that midlife corresponds with distinct social stressors and changes in the availability of protective resources, such as social support. Thus, the purpose of the study was to examine racial/ethnic differences in social support and self-rated health (SRH) among middle-aged women. Design: With data from the Study of Women's Health Across the Nation (SWAN; N = 1258), we used modified Poisson regression models to estimate incidence rate ratios (IRR), examining how social support shaped the risk of fair-to-poor SRH by race/ethnicity. We tested interactions between perceived stress, social support and race/ethnicity to determine whether the stress-buffering role of social support varies by group. Results: Results demonstrate racial/ethnic differences in SRH. Higher levels of social support were linked to higher fair-to-poor SRH among Chinese American women (IRR = 1.24; 95% CI [1.02, 1.52]); while greater social support conferred lower risk among White women. Interaction analyses revealed additional nuances in the stress-buffering effects of social support among Chinese American women, such that the health benefits of social support depended on levels of perceived stress (IRR = 0.75; 95% CI [0.57, 1.00]). Conclusions: These findings highlight important distinctions in the ways that psychosocial factors shape health across racial/ethnic groups. In particular, this study helps advance our understanding of important subgroup differences in the stress-buffering role of social support for Asian American midlife women. Interventions should focus on identifying sources of social strain among Asian American women that can increase the risk for poor health and identify alternative sources of support that mitigate stressors to improve health.