Explaining health inequalities based on sexual orientation across the life course: a prospective longitudinal study of risk and protective factors in a representative population-based study

Research shows that sexual minority (e.g., lesbian, gay, bisexual, and other non-heterosexual) individuals represent a high-risk population for poor mental health, some physical health concerns, and other indicators of poor life-satisfaction.

Increasing evidence locates the source of this disparity in sexual minority individuals’ disproportionate exposure to stigma and associated stress compared to heterosexuals.

But there is insufficient knowledge about which risk and protective factors are important for the development of these differences and how these factors vary across the life course.In this study, we propose to create a representative population-based dataset using a random sample of the population in Sweden (16-years and older).

Participants will be assessed using annual web surveys for three years.

Comprehensive data will be collected concerning: (a) health outcomes (mental and physical health, health-risk behaviors), (b) social stressors (e.g. victimization, discrimination, social exclusion), (c) psychological stressors (e.g. expectation of rejection, loneliness), as well as (d) stress-ameliorating factors (e.g. social support, sense of belongingness).

The study will answer questions about which factors explain health disparities based on sexual orientation and if these factors vary among individuals in different periods in their lives and in different subgroups of sexual minorities.The proposed longitudinal data structure using a population-based sample across age groups is rare in the world and offers unique opportunities to overcome several of the limitations of previous studies in the field, which have tended to rely on cross-sectional designs, often using non-representative samples and heavily focusing on youth.

The research team has extensive experience studying stigma, minority stress and differences in health based on sexual orientation. Results can identify modifiable intervention targets to reduce health inequities based on sexual orientation.