Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T10:02:11.398Z Has data issue: false hasContentIssue false
  • English
  • Français

Sexual minority status and psychotic symptoms: findings from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS)

Published online by Cambridge University Press:  28 May 2013

M. J. Gevonden ,
J. P. Selten ,
I. Myin-Germeys ,
R. de Graaf ,
M. ten Have ,
S. van Dorsselaer ,
J. van Os  and
W. Veling
M. J. Gevonden*
Affiliation:
Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands Rivierduinen Psychiatric Institute, Leiden, The Netherlands Academic Medical Centre, Department of Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
J. P. Selten
Affiliation:
Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands Rivierduinen Psychiatric Institute, Leiden, The Netherlands
I. Myin-Germeys
Affiliation:
Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands
R. de Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
M. ten Have
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
S. van Dorsselaer
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
J. van Os
Affiliation:
Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
W. Veling
Affiliation:
Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands Parnassia Psychiatric Institute, The Hague, The Netherlands
*
* Address for correspondence: M. J. Gevonden, PO Box 22660 (F2–233), 1100 DD Amsterdam; The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Ethnic minority position is associated with increased risk for psychotic outcomes, which may be mediated by experiences of social exclusion, defeat and discrimination. Sexual minorities are subject to similar stressors. The aim of this study is to examine whether sexual minorities are at increased risk for psychotic symptoms and to explore mediating pathways.

Method

A cross-sectional survey was performed assessing cumulative incidence of psychotic symptoms with the Composite International Diagnostic Interview in two separate random general population samples (NEMESIS-1 and NEMESIS-2). Participants were sexually active and aged 18–64 years (n = 5927, n = 5308). Being lesbian, gay or bisexual (LGB) was defined as having sexual relations with at least one same-sex partner during the past year. Lifetime experience of any psychotic symptom was analysed using logistic regression, adjusted for gender, educational level, urbanicity, foreign-born parents, living without a partner, cannabis use and other drug use.

Results

The rate of any psychotic symptom was elevated in the LGB population as compared with the heterosexual population both in NEMESIS-1 [odds ratio (OR) 2.56, 95% confidence interval (CI) 1.71–3.84] and NEMESIS-2 (OR 2.30, 95% CI 1.42–3.71). Childhood trauma, bullying and experience of discrimination partly mediated the association.

Conclusions

The finding that LGB orientation is associated with psychotic symptoms adds to the growing body of literature linking minority status with psychosis and other mental health problems, and suggests that exposure to minority stress represents an important mechanism.

Keywords

Discriminationepidemiologyhomosexualityminority stresspsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 421 - 433
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aldrich, R (2004). Homosexuality and the city: an historical overview. Urban Studies 41, 1719–1737.CrossRefGoogle Scholar
Annes, A, Redlin, M (2012). Coming out and coming back: rural gay migration and the city. Journal of Rural Studies 28, 56–68.CrossRefGoogle Scholar
Bak, M, Delespaul, P, Hanssen, M, De Graaf, R, Vollebergh, W, Van Os, J (2003). How are ‘false’ positive psychotic symptoms? Schizophrenia Research 62, 187–189.CrossRefGoogle ScholarPubMed
Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bijl, RV, Van Zessen, G, Ravelli, A, De Rijk, C, Langendoen, Y (1998). The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design. Social Psychiatry and Psychiatric Epidemiology 33, 581–586.CrossRefGoogle ScholarPubMed
Bolton, S-L, Sareen, J (2011). Sexual orientation and its relation to mental disorders and suicide attempts: findings from a nationally representative sample. Canadian Journal of Psychiatry 56, 35–43.CrossRefGoogle ScholarPubMed
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 12–24.CrossRefGoogle ScholarPubMed
Chakraborty, A, McManus, S, Brugha, TS, Bebbington, P, King, M (2011). Mental health of the non-heterosexual population of England. British Journal of Psychiatry 198, 143–148.CrossRefGoogle ScholarPubMed
Cottler, LB, Robins, LN, Grant, BF, Blaine, J, Towle, LH, Wittchen, HU, Sartorius, N (1991). The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA Field Trial. British Journal of Psychiatry 159, 653–658.CrossRefGoogle ScholarPubMed
Das-Munshi, J, Becares, L, Dewey, ME, Stansfeld, SA, Prince, MJ (2010). Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England. British Medical Journal 341, c5367.CrossRefGoogle ScholarPubMed
D'Augelli, AR (2002). Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry 7, 433–456.CrossRefGoogle Scholar
De Graaf, R, Sandfort, TGM, Ten Have, M (2006). Suicidality and sexual orientation: differences between men and women in a general population-based sample from The Netherlands. Archives of Sexual Behavior 35, 253–262.CrossRefGoogle Scholar
De Graaf, R, Ten Have, M, Van Dorsselaer, S (2010). The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. International Journal of Methods in Psychiatric Research 19, 125–141.CrossRefGoogle ScholarPubMed
De Graaf, R, Ten Have, M, Van Gool, C, Van Dorsselaer, S (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology 47, 203–213.CrossRefGoogle ScholarPubMed
Ender, P (2008). Stata FAQ: how to perform Sobel–Goodman mediation tests in Stata? (http://www.ats.ucla.edu/stat/stata/faq/sgmediation.htm). Accessed 1 March 2012.Google Scholar
Hanssen, M, Peeters, F, Krabbendam, L, Radstake, S, Verdoux, H, Van Os, J (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149–154.CrossRefGoogle ScholarPubMed
Hatzenbuehler, ML, Keyes, KM, McLaughlin, KA (2011). The protective effects of social/contextual factors on psychiatric morbidity in LGB populations. International Journal of Epidemiology 40, 1071–1080.CrossRefGoogle ScholarPubMed
Hatzenbuehler, ML, McLaughlin, KA, Keyes, KM, Hasin, DS (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. American Journal of Public Health 100, 452–459.CrossRefGoogle ScholarPubMed
Janssen, I, Hanssen, M, Bak, M, Bijl, RV, De Graaf, R, Vollebergh, W, McKenzie, K, Van Os, J (2003). Discrimination and delusional ideation. British Journal of Psychiatry 182, 71–76.CrossRefGoogle ScholarPubMed
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, Graaf, R, Van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 38–45.CrossRefGoogle ScholarPubMed
Juster, R-P, Smith, NG, Ouellet, É, Sindi, S, Lupien, SJ (2013). Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosomatic Medicine 75, 103–116.CrossRefGoogle ScholarPubMed
Kaymaz, N, Drukker, M, Lieb, R, Wittchen, HU, Werbeloff, N, Weiser, M, Lataster, T, Van Os, J (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine. Published online 20 01 2012 . doi:10.1017/S0033291711002911.CrossRefGoogle Scholar
Kendler, KS, Gallagher, TJ, Abelson, JM, Kessler, RC (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample: The National Comorbidity Survey. Archives of General Psychiatry 53, 1022–1031.CrossRefGoogle Scholar
Kessler, RC, Mickelson, KD, Williams, DR (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior 40, 208–230.CrossRefGoogle ScholarPubMed
Keuzenkamp, S (2011). Acceptatie van homoseksualiteit in Nederland. Internationale vergelijking, ontwikkelingen en actuele situatie (Acceptance of homosexuality in the Netherlands. International comparison, developments and current situation). Sociaal en Cultureel Planbureau: The Hague.Google Scholar
King, M, Semlyen, J, Tai, SS, Killaspy, H, Osborn, D, Popelyuk, D, Nazareth, I (2008). A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC Psychiatry 8, 70.CrossRefGoogle ScholarPubMed
Kuyper, L, Fokkema, T (2011). Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation. Journal of Counseling Psychology 58, 222–233.CrossRefGoogle ScholarPubMed
Landolt, M, Bartholomew, K, Saffrey, C, Oram, D, Perlman, D (2004). Gender nonconformity, childhood rejection, and adult attachment: a study of gay men. Archives of Sexual Behavior 33, 117–128.CrossRefGoogle ScholarPubMed
Lataster, T, van Os, J, Drukker, M, Henquet, C, Feron, F, Gunther, N, Myin-Germeys, I (2006). Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences. Social Psychiatry and Psychiatric Epidemiology 41, 423–428.CrossRefGoogle ScholarPubMed
Marshal, MP, Friedman, MS, Stall, R, King, KM, Miles, J, Gold, MA, Bukstein, OG, Morse, JQ (2008). Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction 103, 546–556.CrossRefGoogle ScholarPubMed
McCabe, SE, Bostwick, WB, Hughes, TL, West, BT, Boyd, CJ (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health 100, 1946–1952.CrossRefGoogle ScholarPubMed
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.CrossRefGoogle ScholarPubMed
Meyer, IH (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior 36, 38–56.CrossRefGoogle ScholarPubMed
Meyer, IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin 129, 674–697.CrossRefGoogle ScholarPubMed
Miller, P, Lawrie, SM, Hodges, A, Clafferty, R, Cosway, R, Johnstone, EC (2001). Genetic liability, illicit drug use, life stress and psychotic symptoms: preliminary findings from the Edinburgh study of people at high risk for schizophrenia. Social Psychiatry and Psychiatric Epidemiology 36, 338–342.CrossRefGoogle ScholarPubMed
Moore, TH, Zammit, S, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319–328.CrossRefGoogle ScholarPubMed
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655–664.CrossRefGoogle Scholar
Paradies, Y (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology 35, 888–901.CrossRefGoogle ScholarPubMed
Perlis, RH, Uher, R, Ostacher, M, Goldberg, JF, Trivedi, MH, Rush, AJ, Fava, M (2011). Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. Archives of General Psychiatry 68, 351–360.CrossRefGoogle ScholarPubMed
Preacher, KJ, Hayes, AF (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers 36, 717–731.CrossRefGoogle ScholarPubMed
Rieger, G, Linsenmeier, JAW, Gygax, L, Bailey, JM (2008). Sexual orientation and childhood gender nonconformity: evidence from home videos. Developmental Psychology 44, 46–58.CrossRefGoogle ScholarPubMed
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA, et al. (1988). The Composite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Sandfort, TGM, De Graaf, R, Bijl, RV (2003). Same-sex sexuality and quality of life: findings from the Netherlands Mental Health Survey and Incidence Study. Archives of Sexual Behavior 32, 15–22.CrossRefGoogle ScholarPubMed
Sandfort, TGM, De Graaf, R, Bijl, RV, Schnabel, P (2001). Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry 58, 85–91.CrossRefGoogle ScholarPubMed
Savin-Williams, R, Ream, G (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior 36, 385–394.CrossRefGoogle ScholarPubMed
Selten, JP, Cantor-Graae, E (2005). Social defeat: risk factor for schizophrenia? British Journal of Psychiatry 187, 101–102.CrossRefGoogle ScholarPubMed
Van Nierop, M, van Os, J, Gunther, N, Myin-Germeys, I, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, van Winkel, R (2012). Phenotypically continuous with clinical psychosis, discontinuous in need for care: evidence for an extended psychosis phenotype. Schizophrenia Bulletin 38, 231–238.CrossRefGoogle ScholarPubMed
Van Os, J, Hanssen, M, Bijl, RV, Ravelli, A (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 11–20.CrossRefGoogle ScholarPubMed
Van Os, J, Hanssen, M, Bijl, RV, Vollebergh, W (2001). Prevalence of psychotic disorder and community level of psychotic symptoms: an urban–rural comparison. Archives of General Psychiatry 58, 663–668.CrossRefGoogle ScholarPubMed
Van Os, J, Kenis, G, Rutten, BPF (2010). The environment and schizophrenia. Nature 468, 203–212.CrossRefGoogle ScholarPubMed
Van Os, J, Verdoux, H, Maurice-Tison, S, Gay, B, Liraud, F, Salamon, R, Bourgeois, M (1999). Self-reported psychosis-like symptoms and the continuum of psychosis. Social Psychiatry and Psychiatric Epidemiology 34, 459–463.CrossRefGoogle ScholarPubMed
Veling, W, Susser, E, Van Os, J, Mackenbach, JP, Selten, J-P, Hoek, HW (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 66–73.CrossRefGoogle ScholarPubMed
Verdoux, H, Van Os, J, Maurice-Tison, S, Gay, B, Salamon, R, Bourgeois, M (1998). Is early adulthood a critical developmental stage for psychosis proneness? A survey of delusional ideation in normal subjects. Schizophrenia Research 29, 247–254.CrossRefGoogle ScholarPubMed
Wittchen, HU (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 57–84.CrossRefGoogle ScholarPubMed
Wittchen, HU, Robins, LN, Cottler, LB, Sartorius, N, Burke, JD, Regier, D (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. British Journal of Psychiatry 159, 645–653, 658.CrossRefGoogle ScholarPubMed
Woodberry, KA, Giuliano, AJ, Seidman, LJ (2008). Premorbid IQ in schizophrenia: a meta-analytic review. American Journal of Psychiatry 165, 579–587.CrossRefGoogle ScholarPubMed
World Health Organization (1990). Composite International Diagnostic Interview (CIDI), version 1.0. WHO: Geneva.Google Scholar
Zietsch, BP, Verweij, KJH, Heath, AC, Madden, PAF, Martin, NG, Nelson, EC, Lynskey, MT (2012). Do shared etiological factors contribute to the relationship between sexual orientation and depression? Psychological Medicine 42, 521–532.CrossRefGoogle Scholar