Stronger together: Community participation, structural stigma, and depressive symptoms of sexual and gender minority individuals living across 28 European countries

Abstract Background Although previous studies demonstrated that structural stigma (i.e., discriminatory state laws, public policies, and attitudes) predicts adverse mental health outcomes among sexual and gender minority (SGM) populations, less is known how protective factors interact with structural stigma. Thus, we aimed to examine the associations between structural stigma, community participation, and depressive symptoms in a large sample of SGM adults. Methods Discriminatory laws, policies, and attitudes affecting SGM people were assessed to measure each country's structural stigma levels (i.e., sexual and gender). Data from the 2019 EU-LGBTI-II-Survey assessing community participation levels and depressive symptoms of sexual minority men (n = 62.825), women (n = 38.912), and gender minority adults (n = 15.801) in 28 European countries were analyzed by using multilevel models. Results The results demonstrated that structural stigma was positively, and community participation was negatively associated with depressive symptoms of sexual minority men (β = .147, p < .001; β = -.020, p < .05), women (β = .149, p < .01; β = −.040, p < .01), and gender minority adults (β = .085, p < .05; β = -.088, p < .001), respectively. Unlike sexual minority women and gender minority adults, for sexual minority men, a statistically significant interaction was found (β = .018, p < .05) such that participating to the community predicted lower depressive symptoms only in lower-stigma countries. Conclusions The results highlight the need for changes in discriminatory laws, social policies, and negative attitudes that impact depressive symptoms of SGM individuals. Although community participation protects individuals from depression, these findings suggest that sexual minority men in higher-stigma countries benefit less from community participation. Thus, interventions aiming to increase SGM individuals’ community participation should consider structural factors and gender differences.


Background:
The mental health gap between sexual minorities and heterosexuals remains a pressing issue for policy makers and scholars.In past years, numerous studies from the US found support for the vast impact structural stigma on a state level can have on the lives of LGB individuals.However, most research has been conducted within a US context and research capturing structural stigma on a country level remains scarce.
In the current study we aim to close this gap by examining whether country-level structural stigma can explain loneliness and social capital among sexual minorities across the world and testing whether these relationships are different for LGB individuals from different age groups.

Methods:
The current study analysed a sample of over 7000 LGB people from across 113 European and non-European countries to examine the influence of country-level structural stigma on individual level loneliness and social capital.

Results:
Multilevel models showed that the greater structural stigma present in a country, the lower social capital was experienced by LGB respondents (b = -0.05,95% CI: -0.07, -0.02, p < 0.001).This relationship was unaffected by respondent age.Further, multilevel models showed the following for loneliness as an outcome: The greater structural stigma present in a country, the more loneliness was experienced by LGB individuals (b = .01,95% CI: .01,.21,p = .048).Furthermore, this relationship was moderated by respondent age (b = -.03,95% CI: -.06, -.01, p = .01),in the sense that younger LGB people showed significantly higher levels of loneliness than older LGB people in countries with greater, but not lesser, levels of structural stigma.These effects remained robust to adjustment for demographics as well as adding country-level covariates.

Conclusions:
The findings of this study demonstrate the impact structural stigma on a country level can have on LGB individuals' loneliness and social capital, differing for older and younger individuals.

Background:
Although previous studies demonstrated that structural stigma (i.e., discriminatory state laws, public policies, and attitudes) predicts adverse mental health outcomes among sexual and gender minority (SGM) populations, less is known how protective factors interact with structural stigma.Thus, we aimed to examine the associations between structural stigma, community participation, and depressive symptoms in a large sample of SGM adults.Methods: Discriminatory laws, policies, and attitudes affecting SGM people were assessed to measure each country's structural stigma levels (i.e., sexual and gender).Data from the 2019 EU-LGBTI-II-Survey assessing community participation levels and depressive symptoms of sexual minority men (n = 62.825), 15th European Public Health Conference 2022 women (n = 38.912),and gender minority adults (n = 15.801) in 28 European countries were analyzed by using multilevel models.

Results:
The results demonstrated that structural stigma was positively, and community participation was negatively associated with depressive symptoms of sexual minority men (b = .147,p < .001;b = -.020,p < .05),women (b = .149,p < .01;b = À.040, p < .01),and gender minority adults (b = .085,p < .05;b = -.088,p < .001),respectively.Unlike sexual minority women and gender minority adults, for sexual minority men, a statistically significant interaction was found (b = .018,p < .05)such that participating to the community predicted lower depressive symptoms only in lower-stigma countries.

Conclusions:
The results highlight the need for changes in discriminatory laws, social policies, and negative attitudes that impact depressive symptoms of SGM individuals.Although community participation protects individuals from depression, these findings suggest that sexual minority men in higher-stigma countries benefit less from community participation.Thus, interventions aiming to increase SGM individuals' community participation should consider structural factors and gender differences.

Background:
Sexual minority men are at greater risk of depression and suicidality than heterosexuals.Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma).However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association Methods: The current study uses data from the 2017/18 European Menwho-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health and psychosocial mediators.We linked these data to an objective indicator of structural stigma related to sexual orientation in respondents' countries of origin (N = 178) and receiving (N = 48) countries Results: Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators.

Conclusions:
This study provides evidence that structural stigma is associated with the mental health of sexual minority men, both through proximal experiences and as a function of length of exposure to structurally diverse contexts, at least for those who move higher-to-lower structural stigma contexts.Findings suggest the importance of routinely assessing life-course structural influences on mental health and deploying interventions to address those influences.
Institute of Psychology, ELTE Eo ¨tvo ¨s Lora ´nd University, Budapest, Hungary Contact: berk.unsal@ppk.elte.hu Changes also varied by relationship status; the strongest improvement in life satisfaction as a function of improvement in structural stigma was found among sexual minority individuals in a relationship.Conclusions:Although life satisfaction has increased during the past decade among sexual minority individuals living in Europe, significant variation in this change exists across countries as a function of country-level structural stigma and individual sociodemographic characteristics.The findings support the relevance of structural stigma for sexual minority individuals' life satisfaction and call for further research to understand the differential impact of structural stigma across sexual minority subgroups.