Sexual minorities more likely to experience posttraumatic stress disorder

A new study from researchers at the Harvard School of Public Health (HSPH) and Children's Hospital Boston has found that gay men, lesbians, bisexuals, and heterosexuals who have ever had a same-sex sex partner are one-and-a-half to two times as likely to experience violent events, especially in childhood, than the general population and have double the risk of experiencing posttraumatic stress disorder (PTSD) as a consequence of these events. It is the first study to directly link higher rates of PTSD in those four groups (classified as sexual minorities) to greater violence exposure.

The research appears online and in an upcoming print issue of the American Journal of Public Health.

Traumatic events like active combat, child maltreatment, interpersonal violence, or unexpected death of a loved one can lead to PTSD, a mental illness which is characterized by distressing memories of the traumatic event, avoidance of objects, places, or people associated with the event, emotional numbing and an increased sense of vigilance. PTSD in turn can lead to drug and alcohol abuse, depression, and difficulties with relationships and employment if it goes untreated. The lifetime risk of PTSD in the general population is about 4% for men and 10% for women. Among sexual minority adults, the risk of PTSD is doubled - over 9% for men and 20% for women.

One of the most important lessons from this study, said lead author Andrea Roberts, a postdoctoral fellow in epidemiology at HSPH, is that "medical professionals need to be aware that a high percentage of patients with minority sexual orientation may have been victims of interpersonal violence and may benefit from follow-up care to cope with the aftermath of violent victimization."

"Our study documents that profound sexual orientation disparities exist in exposure to violence and other traumatic events beginning in childhood," said senior author Karestan Koenen, associate professor of society, human development and health at HSPH. "Something about our society puts individuals with minority sexual orientations at high risk for victimization. This is a major public health problem that needs to be addressed."

This study used data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults. Respondents in the study were asked not only about how they classify their sexual orientation, but also about their sexual behavior and feelings of sexual attraction. This enabled the researchers to analyze in more detail to discover that heterosexuals with same-sex attractions but no same-sex sex partners were not at elevated risk of violence or PTSD. This is possibly because heterosexual individuals who do not act on their homosexual attractions may not face as much stigma, the authors suggest.

Exposure to multiple traumatic events at a young age may be contributing to the increased rates of PTSD among sexual minorities: 45% of sexual minority women and 28% of sexual minority men experienced violence or abuse in childhood, whereas 21% of women and 20% of men in the general population experience violence or abuse in childhood. The researchers suggest five mechanisms for the increased risk of victimization and PTSD among sexual minorities:

• Hate crimes--almost one-third of sexual minority adults in the U.S. report being victims of a hate crime
• Gender non-conforming behavior in childhood, which increases risk of being bullied and victimized
• Social isolation and discrimination due to sexual minority orientation
• Elevated risk-taking behavior stemming from social isolation and perceived stigma
• Limited access to mental health care

The authors urge that health care providers and families be aware that sexual minorities face a greater risk of violence and PTSD and may have a history of trauma that should be addressed before it becomes mentally debilitating.

This study was supported by the Harvard Training Program in Psychiatric Genetics and Translational Research, the U.S. Maternal and Child Health Bureau, Health Resources and Services Administration, and the National Institutes of Health.

"Pervasive Trauma Exposure Among US Sexual Orientation Minority Adults and Risk of Posttraumatic Stress Disorder," Andrea L. Roberts, S. Bryn Austin, Heather L. Corliss, Ashley K. Vandermorris, Karestan C. Koenen, American Journal of Public Health, online April 15, 2010.