Haarmann, Lena 
ORCID: 0000-0002-1427-151X
(2024).
Physical Health in Lesbian-, Gay-, and Bisexual-Identified Adults – Status Quo and Underlying Mechanisms Focusing on Minority Stress, Psychological Factors and Mental Health.
PhD thesis, Universität zu Köln.
![[img]](https://kups.ub.uni-koeln.de/style/images/fileicons/application_pdf.png) |
PDF
Dissertation_Lena_Haarmann_191224.pdf - Accepted Version Download (4MB) |
Abstract
Background and Objectives: Regarding mental health, many studies and systematic reviews have consistently indicated mental health disparities to the detriment of sexual minority individuals compared to heterosexual individuals. With regard to the status quo of physical health, however, empirical evidence lags behind, and systematic reviews are still sparse (for women) to non-existent (for men). Therefore, the first objective of this thesis was to answer Research Question I: What is the status quo of physical health among sexual minority individuals? Specifically, does the prevalence of physical health conditions differ between lesbian- and bisexual-identified women compared to heterosexual-identified women, and gay- and bisexual-identified men compared to heterosexual-identified men? When examining causes for both mental and physical health disparities, ‘minority stress’ is often discussed. In a theoretical framework, Lick et al. (2013) proposed that minority stress influences health outcomes, mediated by psychological stress responses and other factors. Since some of the pathways postulated by Lick et al. (2013) have not yet been tested, the second objective was to provide empirical evidence to answer Research Question II: Is there a negative total effect of intersectional minority stress on the physical health of lesbian-, gay-, and bisexual-identified individuals? Is the effect mediated by mediated by psychopathological stress responses, resilience, and health literacy? Methods: Research Question I was addressed in Studies I and II within the framework of a comprehensive systematic review and meta-analyses on physical health conditions in lesbian- and bisexual-identified women compared to heterosexual-identified women (Study I), and in gay- and bisexual-identified men compared to heterosexual-identified men (Study II). A systematic literature search was conducted across six databases for epidemiologic studies, published between 2000 and 2021, on physical health conditions that fit into the classification of the Global Burden of Disease project (Institute for Health Metrics and Evaluation, 2020). Meta-analyses on odds ratios were performed. In total, 44 studies were included in the women’s review, and 32 studies were included in the men’s review. Research Question II was addressed in Study III, a cross-sectional online-survey in a final sample of 521 German lesbian-, gay-, and bisexual-identified adults aged (≥18 years). For mediation analysis, Structural Equation Modelling (SEM) in AMOS V.29 was applied. Results: Regarding Research Question I, the main results were: (i) For both women and men, the most notable differences in prevalence by sexual identity were observed in chronic respiratory conditions, particularly asthma, with a higher prevalence in sexual minority individuals. (ii) Beyond chronic respiratory conditions, a higher prevalence in sexual minority individuals was found regarding a number of further health conditions, e.g., headache disorders and back pain. (iii) A lower prevalence was found regarding pregnancy-related conditions and cancer in sexual minority women. No lower prevalence was found in sexual minority men. (iv) Furthermore, two trends could be observed: regarding some of the stress-related conditions, 1) bisexual-identified individuals tended to be more affected than lesbian- and gay-identified individuals, and 2) women tended to be more affected than men. Regarding Research Question II, the main results were: (v) There was a negative total effect of intersectional minority stress on the physical health of lesbian-, gay-, and bisexual-identified individuals. (vi) This total effect of intersectional minority stress on physical health was primarily mediated by psychopathological stress responses, which were mitigated by resilience. Health literacy did not contribute to the mediation. Conclusion: We found evidence of physical health disparities to the detriment of both lesbian- and bisexual-identified women, as well as gay- and bisexual-identified men, compared to heterosexual-identified individuals. Furthermore, we gained insights into mechanisms that contribute to these health disparities: intersectional minority stress was found to have a negative total effect on physical health, mediated mainly by psychopathological stress responses that were buffered by resilience. Future studies should validate these findings using longitudinal designs. It should also be of future research interest to develop and evaluate interventions to reduce minority stress and strengthen resilience in sexual minority individuals. From a practical perspective, healthcare professionals should develop greater awareness of physical conditions with existing disparities, as well as the potential impact of minority stress on physical health.
| Item Type: | Thesis (PhD thesis) | ||||||||
| Translated title: |
|
||||||||
| Creators: |
|
||||||||
| URN: | urn:nbn:de:hbz:38-749276 | ||||||||
| Date: | 2024 | ||||||||
| Language: | English | ||||||||
| Faculty: | Faculty of Human Sciences | ||||||||
| Divisions: | Faculty of Human Sciences > Department Psychologie | ||||||||
| Subjects: | Psychology Social sciences Medical sciences Medicine |
||||||||
| Uncontrolled Keywords: |
|
||||||||
| Date of oral exam: | 18 December 2024 | ||||||||
| Referee: |
|
||||||||
| Refereed: | Yes | ||||||||
| URI: | http://kups.ub.uni-koeln.de/id/eprint/74927 |
Downloads
Downloads per month over past year
Export
Actions (login required)
 |
View Item |