Fundação para a Ciência e Tecnologia - FCTN/

Costa, Pedro

Jesus, Joana Correia

Leal, Isabel

Ribeiro-Gonçalves, José Alberto

English

Repositório do ISPA

José Alberto Ribeiro-Gonçalves*, Joana Correia Jesusª, Pedro Costa*, & Isabel Leal**William James Center for Research, ISPA – Instituto UniversitárioªSecretaria Regional da Educação, Ciência e Tecnologiajgoncalves@ispa.ptMental Health and Sexual Stigma on LGB Senior: A Systematic Scoping Review(BD: SFRH/BD/143214/2019)IntroductionCurrently, and for the first time in history, most people can expect to live beyondthe age of 60 years (WHO, 2015).According to data from the United Nations, in 2050 one in six people in the worldwill be senior (UN, 2019).Preoccupation about health of these seniors – Mental and physicalTo understand the specific needs of this population, it is essential to examine thepsychosocial context in which they have developed throughout their life cycleSexual minority seniors (LGB) in particular seem to have lower levels of mentalhealth when compared to heterosexual seniors (Stonewall, 2011), and one of themain causes attributed to this health disparity is the continued exposure to severalsources of sexual stigma, generating minority stress (Meyer, 2003).Self-stigma             Felt stigma             Enacted StigmaIntroductionThe present systematic scoping review aimed at:- Understanding how and which factors of sexual stigma influence the mental health of sexual minority seniors;- Summarize the empirical research in this field of sexual minority aging;This population are at higher risk for the development of mental issues such asdepression, anxiety and substance abuse (Hawthorne et al., 2018).Previous Reviews:Cruikshank's classic review (1991)Fredriksen-Goldsen and Muraco (2010)Murray et al.’s (2012)McParland & Camic (2016)…MethodSearch StrategiesA comprehensive search of the relevant literature was undertaken using theelectronic databases EBSCO Host (Psyinfo and Psyarticles), PubMed, Web ofScience, Scopus and Scielo. In addition, ResearchGate, Google Scholar andreference lists and publications of identified authors were also inspected.The search broad-based key-terms was as follows:[Aging or old* or elder* or gerontol* (TI/ABS)] AND [sexual minorit* orhomosexual* or bisexual* or sexual identity or sexual orientation or non-heterosexual or lesbian or gay (TI/ABS)] AND [stigma or homophobia or self-stigma or felt stigma or homonegativity or heterosexism (TI/ABS)].Inclusion/Exclusion CriteriaFour main inclusion criteria: (1) exclusively senior people aged 60 or over, (2)sexual minorities - LGB, (3) addressing sexual stigma and (4) its relationship withmental health.A further criterion was that papers had been published in peer-reviewed scientificjournals between January 2000 and October 2020, in English, Portuguese orSpanish.All systematic searches followed PRISMA guidelinesMethodCodingA coding scheme wasdeveloped in order tosystematize theinformation obtainedfrom the selectedstudies. Based on theliterature, and usingHerek’s (2009)conceptualization ofsexual stigma, tworesearchersindependentlyextracted and codedthe results of allstudies included inthe review.ResultsApproximately 70% of studies were published after 2009, and the overwhelmingmajority were carried out in the United States (35%) and Australia (35%).Combining the 17 studies included in this review, the total number of participantswas 3,672 LGB seniors, 69% gay men and 29% lesbian womenNearly 53% of the studies used a quantitative approach, 41% a qualitativeapproach, and 6% a mixed-methods approach.Regarding theoretical models, although most articles did not identify a theoreticalperspective to guide the research (47%), the main theoretical perspectives usedwere the Minority Stress Theory (MSM; 29.4%),Five themes were identified: (1) Sexual stigma(s) and mental health indicators; (2)Self-stigma and mental health; (3) felt-stigma and mental health; (4) enactedstigma and mental health, and (5) Sexual stigma(s), access to health care, andmental health.Results(1) Sexual stigma(s) and mental health indicatorsDifferent types of sexual stigma have a different influence on mental health of LGBseniorsAmong the three types of sexual stigma, self-stigma was lesser examined (64%) thanenacted stigma (70%), but more so addressed than felt stigma (58%).Several studies reported moderate levels of psychological distress, depression, andmoderate levels of drug use/abuse, and low levels of alcohol consumptionSexual stigma variables were often moderately related to these mental health indicators(2) Self-stigma and mental health;Studies reported high levels (average scores between 60% and 76% of the total valueof the scales) of self-stigma among LGB seniorsModerate correlations with mental health variables such as psychological distress(about .50)Concealment of sexual orientation and internal identity conflicts as two of main factorsthat promoted self-stigmaResults(3) Felt-stigma and mental health;Rejection was associated with feelings of loneliness and anxietyInvisibility also strongly contributed to felt stigma, which negatively impact thequality of life of LGB seniorsEvents of discrimination can contribute to facilitating and heightening fears offuture stigmatization; this hypervigilance mechanism is characteristic of felt stigma(4) Enacted stigma and mental healthEnacted stigma had a significant positive relationship with physical impairment anddepression (b around .39 and 1.09 respectively), a significant negative relationshipwith quality of life (b around -.16), and a high prevalence of substance use and/orabusePhysically assaulted reported more negative changes in their mental health(5) Sexual stigma(s), access to health care, and mental healthSelf-stigma and enacted stigma - among the most significant predictors ofdisclosure of sexual orientation to health and age-care service providers (ORbetween .34 and .46).LGB seniors also reported fear of victimization, avoiding seek health care, which inturn increasing the risk of mental health difficultiesDiscussionThe review shows that the three types of sexual stigma have a direct relationship with the levels of mental health in LGB seniorsAll three sexual stigmas were associated with moderate to high impact onanxious and depressive symptoms – Particularly, for LGB seniors, in addition tothe chronicity of the minority stress, it can also have a cumulative effectthroughout the life cycle, insofar as continued exposure can generate cumulativemental and physical health risk; this exposure can lead to a diminished capacityto face aggression and microaggression, thus leaving LGB seniors even morevulnerable to mental health difficultiesWe found that hypervigilance was one of the main intermediary factors betweensexual stigma and mental health variables, particularly in anxiety -hypervigilance can generate psychophysiological reactions characteristic ofanxiety such as muscle tension, constant fear, excessive worry, rumination and afeeling of loss of control or that something negative is about to happen,reinforcing the relationship between sexual stigma and anxiety symptomsDiscussionInvisibility and social rejection were other major intermediary factors betweensexual stigma and mental health in LGB seniors - invisibility enhances the fear ofLGB seniors to expose themselves, reinforcing the cycle of withdrawal andretraction and seem to be strongly associated to more restlessness and mentalhealth issues, creating the expectation of LGB seniors to be alone, stigmatized,disadvantaged, and isolated with a feeling of silencing, disempowering, andrejection.A recent review by Brunson et al. (2019) indicates that rejection sensitivitymediated the degree of emotional dysregulation and proximal stress in LGBseniors, enhancing the internalization of symptoms.Concealment of sexual orientation and internal conflicts appeared as two of theintermediate factors between sexual stigma, particularly self-stigma, and mentalhealth…and all types of sexual stigmas negatively influenced mental and physicalhealth care of LGB seniorsDiscussionSuggestions for future studies and gaps in the literature:- Research on populations with specific orientations/identities who may suffermore stigma, including bisexual, transgender, intersex, and non-binary people.- Oldest LGB senior populations, aged 80 and over,- Studies regarding the cumulative impact of sexual stigma over the lifecycle onmental health of LGB seniors- Comparative studies that focus on health indicators and their variation accordingto sexual orientation, comparing mainly LGB and heterosexual seniors.- Research that focuses on positive variables in LGB seniors, mainly studies thataddress the determinants of well-being, resilience and successful aging in LGBseniors.- Research to validate the applicability and effectiveness of interventions from thegeneral population to the LGB senior population.References- Dalia. 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Mental health and sexual stigma on LGB senior:  A systematic scoping review

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Mental health and sexual stigma on LGB senior: A systematic scoping review

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