Structural stigma and mental health among lesbian, gay, and bisexual adults: Policy protection and cultural acceptance

Emerging studies link the mental health of lesbian, gay, and bisexual (LGB) adults to structural stigma, focusing on state policies. Limited work considered cultural norms and the time changing nature of culture and policy. In this study, we draw from the structural stigma theory and hypothesize that both policy protection and cultural acceptance will independently promote LGB mental health and explore their interactive roles. Composing a novel state-year longitudinal dataset on policy and culture related to sexual minority people, we link it to a sample of cisgender LGB adults from the large-scale, representative Behavioral Risk Factor Surveillance System (2016–2023). Our multilevel regression models predicted depressive diagnosis and frequent mental distress from varied stigma measures, controlling for state-level and individual-level factors. The results revealed that LGB adults especially bisexual women faced elevated mental health challenges. Models generally showed structural stigma measures in the policy and culture domains were not independent, significant predictors of LGB mental health. Moreover, there was generally no significant and sizable interactions between policy and culture. One exception came from lesbian women, where policy protection was negatively associated with worse mental health, reducing frequent mental distress by around 6 percentage points across policy score ranges. We conclude by discussing the varied findings and encouraging future studies to incorporate the time-changing nature of policy and culture when linking structural stigma to LGB mental health.