Sexual Orientation And Depression
Despite the existence of effective treatments for depression, the most common and well-studied of which include psychotherapy and antidepressant medications (Weissman et al., 1979, Hollon et al., 2005, Bauer et al., 2007), the majority of the estimated 350 million individuals experiencing depression worldwide (http://www.who.int/mediacentre/factsheets/fs369/en/) are untreated or undertreated. An estimated 50% of those suffering from depression in the United States, and 75% worldwide, are undertreated (Kessler et al., 2003). Even if treatments are available, depressed individuals, on average, defer seeking treatment for up to 10 years (Mark et al., 2007). Reasons for this alarming rate of undertreatment range from logistic (e.g., lack of trained providers, or lack of means) to the reluctance to pursue care when opportunities are present, possibly due to the stigma associated with mental illness and its treatment (Barney et al., 2006).
Sexual minority individuals (that is, those who do not explicitly endorse a heterosexual orientation) are at an increased risk for mental health difficulties, including major depressive episodes and suicidality (Chakraborty et al., 2011, Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2011, McNair et al., 2005). The higher rates of mental health disorders among sexual minority individuals can be explained by minority stress theory (Meyer, 1995, Meyer, 2003) which posits that sexual minority individuals experience higher rates of social prejudice, discrimination, and internalized stigma related to their sexual orientation and that these factors, in turn, are related to poorer mental health outcomes. Accordingly, sexual minority individuals seek mental health treatment at greater rates than heterosexual counterparts both in adolescence (Lucassen et al., 2011, Williams and Chapman, 2011) and adulthood (Cochran et al., 2003, Grella et al., 2009), even if the specific mental health issue is not formally defined (Grella et al., 2009).
Given the pervasive stigma faced by sexual minorities (Herek, 2009), which is perhaps compounded by the stigma of having mental health concerns, it is likely that sexual minority individuals with depression have mental health needs that remain unmet. Indeed, research among selected sexual minority communities has shown that fears of stigma and bias interfere with help-seeking among sexual minority individuals (e.g., veterans of the military, Simpson et al., 2013; rural communities, Willging et al., 2006). Stigma appears to present barriers to treatment across the lifespan. Among adolescents, sexual minority youth experience higher levels of anxiety, depression, and suicidality and a greater unmet mental health need (Williams and Chapman, 2011). Among older sexual minority populations, only 33% of those who utilized Veteran Administration Healthcare services reported open communication of their sexual orientation, with 25% indicating that they avoided treatment due to anticipated stigma (Simpson et al., 2013).